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New Inventions

AN IMPROVED SCREWDRIVER

Orthopædic Unit,Royal Melbourne Hospital,

Melbourne

PETER WILLIAMSM.B. Melb., F.R.C.S., F.R.A.C.S.

ALL the self-holding screwdrivers now in use have thedisadvantage that they need three hands to load them.With the instruments here described, screws can beloaded single-handed and with far greater speed. Theseinstruments have been in constant use by myself andother surgeons over the past four years and have provedextremely satisfactory.The screwdriver is an adaption of the Burns pattern,

in which the sçrew-fixing device at the base of the handlehas been replaced by a quick-action lever recessed intothe handle.

All the usual standard screws, such as Sherman’s or Lane’s

pattern, can be used with this instrument (up to 5/32 in.external diameter of thread with head diameter of 5/ls in.),

for the shaped tubular shaft at the distal end has been madeto suit a wide variation of shapes of screw head.After the screw has been inserted to the required depth and

the screwdriver removed from the screw head, it is possible todrive the screw fully home with the same instrument bymerely closing the lever ; the end of the tubular shaft isconcave externally to accommodate the top of the screwhead. A special feature is an adjusting-screw in the base ofthe handle. This permits the lever to be set to give a firmfixation of the screw head, and once set, it is not necessary toalter it unless a screw with a larger or smaller head is required.All parts of the instruments are made of stainless steel,

except the handle, which is anodised aluminium. Theillustration shows the screwdriver being loaded for use.To avoid the difficulties associated with holding the

screws in forceps to load them into the screwdriver, ithas been found useful to mount them on a solid block ofduralumin drilled to receive six screws of each ,size,ranging from 3/8 in. to 2 in., with the heads protruding.When this " screw bank " is loaded, the whole can beeasily sterilised by boiling.My thanks are due to Mr. A. B. Hallam of Messrs. Thackray,

who was responsible for the technical details involved in theconstruction of these instruments.

AN ADAPTABLE WARD BED

A STANDARD WARD BED ADAPTABLE FOR THE UNCONSCIOUS,’

DISTURBED, OR CHRONIC SICK

THIS bed was developed at Napsbury Hospital forpatients having Sakel’s insulin-coma therapy, and hasbeen in use for over a year. It is an attempt to meet theward situation where permanent " cot-beds " are

undesirable yet additional facilities may help in nursingthe unconscious or restless patient.

Insulin treatment involves the patient in a daily period ofcoma and recovery. There are particular risks in precariousmetabolism, physical restlessness, and a confused (and oftendisturbed) mental state. Besides appropriate nursing, manage-ment entails nasal feeding, intravenous injections, and, at

times, electroconvulsive therapy. The medical team is oftennumerically small, and is simultaneously seeking to providean understanding and careful relationship where purelyrestrictive Dhvsical handling is minimal. These specific

problems are seen in the insulin unit, but they arisein differing contexts throughout general and mentalhospital practice.

Fig. 1 shows the bed for use as a standardward bed and the means of fitting the end-pieces to the frame. Unlocking and removingthe foot-bow and head-piece converts the bedto a trolley, permitting easy access to thepatient, particularly from the head-e.g.,during nasal feeding and electroconvulsivetherapy. The sliding tray under the headprovides a surface for instruments, &c. Itdraws out on either side with stops to preventover-extension. The bed is fitted with a

standard wheeling device at the foot, and withindividually locking wheels at the head.

Fig. 2 shows both padded ends and onepadded side in position. After removal of thearm-rest, fitting the second padded sidecompletes the cot. The padded ends fit andlock in the same way as the foot-bow andhead-piece. The padded sides run in guttersat either side of the end-pieces. The sides andends are interchangeable between beds, makingit possible to use one set of padded ends andsides in conjunction with a number of bed-frames.The cot provides a relatively draught-free

space where the necessity for protectivehandling (which provokes restlessness) isconsiderably reduced. The top of the paddedside is 3 ft. 8 in. above the floor and allows anurse of somewhat under average height togive nursing attention (other than lifting thepatient) without removing the sides. Withadiacent sides removed. two cots can be

fitted together by means of the staples shown, making aprotective pen about 6 ft. square.

Fig. 1.

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Fig. 2.

The arm-rest fits by means of pegs into either side ofthe bed-frame. It is padded level with the mattress. Atthe head end there is provision for fitting an aneroidsphygmomanometer, and at the foot a space for a kidney-dish. The bed can be tilted by means of a standardtilting frame.

I should like to thank the Medical Superintendent and staffat Napsbury Hospital for their help and interest, and acknow-ledge the proficiency of Messrs. S. B. Whitfield in convertingthe prototype to a

"

production model."

The Tavistock Clinic,London, W.1

A. R. WILSONB.M. Oxfd

Formerly Registrar, Napsbury Hospital

Reviews of Books

Practical Forensic MedicineFRANCIS E. CAMPS, M.D., reader in forensic medicine,London Hospital Medical College ; W. BENTLEYPURCHASE, C.B.E., M.c., M.B., barrister-at-law, coroner

for the Royal Household and the county of London.London : Hutchinson’s Medical Publications. 1956.

Pp. 541. 75s.

IN a preface the authors say that they write " to givemedical practitioners ... and others ... a fair idea ofwhat the subject comprises." They have not been ascomprehensive as this suggests, and that may be fortunatesince the subject is, as they remark, already well docu-mented. What the book has done is to make a noveland partly successful assault on the established format.It starts with A for abortion, accidents, and alcoholicintoxication, and proceeds through the alphabet toW for wounds. It then embarks on toxicology, but dis-cards the alphabetical order for a collectanea.

There is much that is practical and useful, and the authors’enthusiasm for their subject is apparent. Because of thisenthusiasm perhaps, some sections are handled brilliantlyand illustrated well, leaving others either inadequately treatedor frankly neglected. Thus, identification receives nearly50 pages of sound and absorbing interest, but perplexingdeaths in infancy-an everyday problem-are given a bare10 and the medicolegal necropsy gets only 2. Barbituratesare generously treated, but there is nothing about the currentmenace of tranquillisers, and the danger of potentiation byalcohol is summarily dismissed. The text is uneven, so that

thoughtful and practical passages are followed by materialless skilfully handled. The English is forthright if not alwayselegant though most readers will know what is meant by the" time taken for a body to be skeletonised,"

.,

any law of local

force," or " she was inflated with oxygen."

Nevertheless, this is a refreshingly new approach,which reflects the authors’ wide knowledge of legalmedicine in a way that the occasional forensic patho-

logist will find most helpful. An index would haveavoided the frustration of searching for the informa-tion that the book undoubtedly contains, but that isthe only really unpractical feature of this attractivework.

Physiologic Principles of SurgeryEditors : L. M. ZIMMERMAN, M.D., professor and chairmanof the department of surgery, Chicago Medical School;R. LEVINE, M.D., chairman, department of medicine, anddirector, department of metabolic and endocrine research,Medical Research Institute, Michael Reese Hospital.Philadelphia and London : W. B. Saunders. 1957. Pp. 988.105s.

ALTHOUGH its main roots remain in anatomy andpathology, modern surgical thought and practice isincreasingly concerned with disturbances of function,as seen both in disease processes and as a result ofsurgical procedures themselves. Consideration of suchproblems must be based on a clear appreciation of thephysiology of the systems involved, and this book isintended as an " authoritative statement of the currentstatus of the various physiologic problems in surgery."In this intention it largely succeeds.

Separate sections, each written by an expert, deal with thevarious basic, general problems, such as hæmorrhage, tissuetransplantation, and pain, and all the more specialisedproblems arising in each and every branch of surgery. Theextent to which purely clinical considerations are emphasisedvaries from section to section, but each is essentially a studyin applied physiology. The book contains a vast amount ofvaluable detailed information not to be found in any other

single volume, and deals fully with the great range of subjectsnow covered by modern surgical research. Each sectioncontains full references to the subject concerned.

Focusing attention on fundamental physiologicalprocesses, this volume is a valuable addition to surgicalliterature. It is of particular interest to postgraduatestudents and those engaged in surgical research work,but practising surgeons should find here much ofinterest and value to them.

Family and Kinship in East LondonA Survey by the Institute of Community Studies. MICHAELYOUNG and PETER WILLMOTT. London : Routledge &

Kegan Paul. 1957. Pp. 232. 25s.

THE first of a series of reports to be issued by theInstitute of Community Studies, this survey deals withthe effect on family life of the new housing-estates whichhave been built in their hundreds since the war. Thefirst part of the book studies the close kinship, the inti-mate family and living conditions in Bethnal’ Green,with Mum always close at hand. The second part discussesthe effects of moving to a new housing-estate, Greenleigh,a few miles away, where the young family is very muchon its own and where the common complaint is that otherresidents are unfriendly and snobbish.The authors conclude that most residents in Bethnal

Green, tied to the district by time and by a lastingattachment to their families, wish to continue to livein the East End. They believe that the authorities shoulddo more than they are at present doing to enable themto continue to do so, rather than insisting that morethousands should migrate beyond the city ; and thatif the authorities regard community spirit as an assetworth preserving, they should build new houses aroundthe social groups to which the people already belong.

Treves’ Surgical Applied Anatomy (13th ed. London:Cassell. 1957. Pp. 591. 30s.).-The first edition of this bookappeared in 1883 ; so it is the oldest textbook of surgical anatomyin English still in current use. It is a tribute to the practicalwisdom and literary skill of the original author and of subse-quent editors that it should also be one of the best. Prof.Lambert Rogers is responsible for the latest edition. It ismore than a safe guide through the finals : with its wealth ofclinical information, it fulfils the wish, expressed in the prefaceto the first edition that " it should make the dry bones live."This edition is unlikely to be the last.