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THE SHAPE OF THE CHEST
526 lived action, and it was said to be antagonised by pentamethonium. Unfortunately, however, in clinical practice this antagonism cannot be relied on. Nearly a year ago a newcomer to this group, succinylcholine, was introduced. It was reputed to be the safest of all relaxants because of its very short action and rapid disintegration, and the absence of after-effects. Here again early hopes have not been completely fulfilled ; for lately there have been many reports of unexpectedly long-continued effects from this " short-acting " relaxant. The criticism that such untoward effects were largely due to overdosage has not wholly stilled uneasiness about the safety of this drug. The latest synthetic relaxant to be tested, known as Compound 20 or ’ Laudolissin,’ is described in this issue by Dr. Bodman and his colleagues, who report that it acts in a true curare-like manner, is antagonised by neostigmine, lasts a little longer than the natural alkaloid, and apparently has no side-effects. This objective and encouraging report will no doubt stimulate other clinical research-workers to study this drug further. There is perhaps a danger that successful preliminary tests such as these, made by skilled workers, will be taken by anaesthetists in general as evidence that the drug investigated is the best. That this is not necessarily so is suggested by the story of other relaxants. The somewhat disastrous effect of pentamethonium given to " neutralise " hexamethonium, the unexpected and alarming complications from the use of mephenesin, and the sometimes far from short action of succinylcholine, suggest a need for caution and an open mind. THE
SHAPE OF
THE CHEST
COMMUNICATION between humans might be much improved by a collective inward eye. A mental image of a face, a scene, or a patient’s physical signs can be so vivid that we itch to pass it on entire. But since visual memories are as subject as other memories to erasions, distortions, and decorations, it is perhaps as well that we rely, for scientific purposes, on less subjective records. The trouble is that some visual images are curiously awkward to record ; and among these the shape of the chest ranks high. Dr. H. R. E. "Wallis,! who has had trouble with it, points out that a photograph does not readily lend itself to accurate measurement ; and though funnel chests are fairly easily shown by the camera, Harrison’s grooves, to be demonstrated successfully, need a highly skilled photographer. When the subject is a child aged three or four he may also have to and acrobat. be a combination of naturalist, localised deformities of will show course, Radiography, of the ribs or spine, and the inclination and spacing of ribs in emphysema and collapse ; and lateral views show pigeon and funnel chests. Casts of the chest are useful for following the development of abnormal shapes, such as the bulges associated with congenital heart-disease ; but casts are expensive to make and difficult to store, and young children are frightened by the long process of their construction. Even the old-fashioned tape-measure is defeated by this oddly shaped part of the body, this irregular frustum which ceaselessly expands and contracts in several directions." Callipers will measure diameters of the chest, and the of anteroposterior and lateral respiratory amount
psychologist,
Cyrtometers measure curves, and there are several kinds of them. Strips of soft lead are commonly used, which can be moulded round the chest wall and then removed to a sheet of paper, on which the curves can be traced with a pencil. The two sides of the chest may then be easily compared by superimposing the drawings ; and tracings can also be made of the vertical contours of depressions and prominences. Lead. however, is rather stiff, and the physician may find the ribs of a pliable young child fitting themselves to the lead rather than the other way about. Moreover the method is tedious and dirty, and exposes the operator, Dr. Wallis suspects, M a new occupational hazard-chest-physician’s colic. He has therefore devised a multiple-rod cyrtometer, composed with great ingenuity from two ebonite plates, 14 in. long and 3 in. wide, and 13 dozen aluminium rods, 9 in. long and 1/13 in. in diameter, obtained from the manufacturers of a well-known children’s building-set. The lower plate is grooved tram. versely, and the rods lie side by side in the grooves, projecting on either side of the plate. On top of them is a strip of ’ Sorbo’ rubber, and then the upper plate ; and the plates are held together by two nuts and bolts which allow the rods to he made loose or firm. In practice the rods are loosened, and their free ends are pushed gently against the front of the chest just below the nipple line ; they adapt themselves to the shape of the chest wall, forming a line shaped to its contours. The plates are then screwed together, and the outline of the chest wall is traced on paper by running a pencil along the tips of the rods. This little instrument, Dr. Wallis remarks, is easy and quick to use, does not seem to frighten children, and comes in handy when cutting linoleum to fit against moulded corners.
Even an outline of the chest wall, however, does not call up a very lively mental picture of a child’s chest. The posture-recorder, used as an aid to physical training in schools, contrib.utes something more. This consists of a movable lens, a mirror, and a groundscreen contained in a box with a flap which acts as a The child stands against a white screen against the light. background, and an image of him in profile is thrown on the glass screen, as in a reflex camera ; the outline of this image i, traced off on tracing-paper. The method gives a very clear idea of habitual stance, and if the child is shown the tracings they often encourage him to stand better. But small children find it hard to keep still long enough to be drawn, and defective draughtsmanship can influence the result.
glass
Pursuing his ideal of the perfect record, Dr. Wallis has also made use of the optical contour apparatus, designed to facilitate the carving of portrait heads in wood. It consists of two lamps, each containing two’ Photoflood ’ bulbs and a parabolic reflector. The lamps are placed opposite each other a foot or so apart, and the light from each of them passes through a screen of plywood strips, 1/4 in. wide and 1/s2 in. apart. There are 48 strips and 47 spaces ; and when anyone stands between the two lighted lamps he is striped with light and dark bands like a zebra. The stripes, of cour--;e. follow the contours of his body, and demonstrate very strikingly not only its curves and hollows but any asymmetry between the two sides.
Photographs of children illuminated in this way record accurately the shape of the chest and its movement with respiration ; and Dr. Wallis suggests that the apparatus could also be used to record the movements of individual ribs in health and disease.
*’
but since, in children, the expansion is small in reading apt to be large, the measurements are not of great value. The depth of Harrison’s grooves or of a funnel-shaped depression can be measured by a small sliding ruler, attached at right angles to a bar ; the bar is laid across the groove, and the ruler pushed in until it touches the bottom of the crater. This measurement, however, tells nothing about the width or slope of the groove : to record these a cyrtometer is needed.
expansion ; and the
errors
1. Brit. J. Tuberc.
1952, 46, 136.
THE European Congress of Cardiology, which is meeting in London this week, held its first session on Sept. 16 After Sir JOHN PARKINSON, the chairman, had welcomed the delegates, Prof. CHARLES LAUBRY (Paris), the honors’ president, delivered his inaugural address. Prof. GUSTAV NYLIN (Stockholm), the president, also spoke. THE INDEX and title-page to Vol I, 1952, which was completed with THE LANCET of June 28, is now in preparation. A copy will be sent gratis to subscribers on receipt of a postcard addressed to the Manager <:‘ THE LANCET, 7, Adam Street, Adelphi, W.C.2. Subscribers who have not already indicated their desir to receive indexes regularly as published should doa now.
SHAPE OF
THE CHEST
COMMUNICATION between humans might be much improved by a collective inward eye. A mental image of a face, a scene, or a patient’s physical signs can be so vivid that we itch to pass it on entire. But since visual memories are as subject as other memories to erasions, distortions, and decorations, it is perhaps as well that we rely, for scientific purposes, on less subjective records. The trouble is that some visual images are curiously awkward to record ; and among these the shape of the chest ranks high. Dr. H. R. E. "Wallis,! who has had trouble with it, points out that a photograph does not readily lend itself to accurate measurement ; and though funnel chests are fairly easily shown by the camera, Harrison’s grooves, to be demonstrated successfully, need a highly skilled photographer. When the subject is a child aged three or four he may also have to and acrobat. be a combination of naturalist, localised deformities of will show course, Radiography, of the ribs or spine, and the inclination and spacing of ribs in emphysema and collapse ; and lateral views show pigeon and funnel chests. Casts of the chest are useful for following the development of abnormal shapes, such as the bulges associated with congenital heart-disease ; but casts are expensive to make and difficult to store, and young children are frightened by the long process of their construction. Even the old-fashioned tape-measure is defeated by this oddly shaped part of the body, this irregular frustum which ceaselessly expands and contracts in several directions." Callipers will measure diameters of the chest, and the of anteroposterior and lateral respiratory amount
psychologist,
Cyrtometers measure curves, and there are several kinds of them. Strips of soft lead are commonly used, which can be moulded round the chest wall and then removed to a sheet of paper, on which the curves can be traced with a pencil. The two sides of the chest may then be easily compared by superimposing the drawings ; and tracings can also be made of the vertical contours of depressions and prominences. Lead. however, is rather stiff, and the physician may find the ribs of a pliable young child fitting themselves to the lead rather than the other way about. Moreover the method is tedious and dirty, and exposes the operator, Dr. Wallis suspects, M a new occupational hazard-chest-physician’s colic. He has therefore devised a multiple-rod cyrtometer, composed with great ingenuity from two ebonite plates, 14 in. long and 3 in. wide, and 13 dozen aluminium rods, 9 in. long and 1/13 in. in diameter, obtained from the manufacturers of a well-known children’s building-set. The lower plate is grooved tram. versely, and the rods lie side by side in the grooves, projecting on either side of the plate. On top of them is a strip of ’ Sorbo’ rubber, and then the upper plate ; and the plates are held together by two nuts and bolts which allow the rods to he made loose or firm. In practice the rods are loosened, and their free ends are pushed gently against the front of the chest just below the nipple line ; they adapt themselves to the shape of the chest wall, forming a line shaped to its contours. The plates are then screwed together, and the outline of the chest wall is traced on paper by running a pencil along the tips of the rods. This little instrument, Dr. Wallis remarks, is easy and quick to use, does not seem to frighten children, and comes in handy when cutting linoleum to fit against moulded corners.
Even an outline of the chest wall, however, does not call up a very lively mental picture of a child’s chest. The posture-recorder, used as an aid to physical training in schools, contrib.utes something more. This consists of a movable lens, a mirror, and a groundscreen contained in a box with a flap which acts as a The child stands against a white screen against the light. background, and an image of him in profile is thrown on the glass screen, as in a reflex camera ; the outline of this image i, traced off on tracing-paper. The method gives a very clear idea of habitual stance, and if the child is shown the tracings they often encourage him to stand better. But small children find it hard to keep still long enough to be drawn, and defective draughtsmanship can influence the result.
glass
Pursuing his ideal of the perfect record, Dr. Wallis has also made use of the optical contour apparatus, designed to facilitate the carving of portrait heads in wood. It consists of two lamps, each containing two’ Photoflood ’ bulbs and a parabolic reflector. The lamps are placed opposite each other a foot or so apart, and the light from each of them passes through a screen of plywood strips, 1/4 in. wide and 1/s2 in. apart. There are 48 strips and 47 spaces ; and when anyone stands between the two lighted lamps he is striped with light and dark bands like a zebra. The stripes, of cour--;e. follow the contours of his body, and demonstrate very strikingly not only its curves and hollows but any asymmetry between the two sides.
Photographs of children illuminated in this way record accurately the shape of the chest and its movement with respiration ; and Dr. Wallis suggests that the apparatus could also be used to record the movements of individual ribs in health and disease.
*’
but since, in children, the expansion is small in reading apt to be large, the measurements are not of great value. The depth of Harrison’s grooves or of a funnel-shaped depression can be measured by a small sliding ruler, attached at right angles to a bar ; the bar is laid across the groove, and the ruler pushed in until it touches the bottom of the crater. This measurement, however, tells nothing about the width or slope of the groove : to record these a cyrtometer is needed.
expansion ; and the
errors
1. Brit. J. Tuberc.
1952, 46, 136.
THE European Congress of Cardiology, which is meeting in London this week, held its first session on Sept. 16 After Sir JOHN PARKINSON, the chairman, had welcomed the delegates, Prof. CHARLES LAUBRY (Paris), the honors’ president, delivered his inaugural address. Prof. GUSTAV NYLIN (Stockholm), the president, also spoke. THE INDEX and title-page to Vol I, 1952, which was completed with THE LANCET of June 28, is now in preparation. A copy will be sent gratis to subscribers on receipt of a postcard addressed to the Manager <:‘ THE LANCET, 7, Adam Street, Adelphi, W.C.2. Subscribers who have not already indicated their desir to receive indexes regularly as published should doa now.