209

2. Taylor, S., Fothergill, L. Lancet, 1956, i, 1050.

heard during operation. We have improved on this by attachinga tiny microphone to the end of a catheter, which is thenconnected to an amplifier, the ’ Soniscope ’,2 and so to a loud-speaker (’ Cardiophone ’). The controls of the soniscope permithigh-pitched or low-pitched sounds to be excluded at will, andby sliding the catheter up or down the cesophagus, heart andbreath sounds can be heard.The catheter, with its terminal microphone, is best intro-

duced into the oesophagus with the aid of a Macintosh laryngo-scope and a Magill’s forceps when the patient is fully relaxedbefore endotracheal intubation. It may also be used with an

oropharyngeal airway and face mask. Heart sounds are bestheard in the adult at 23-25 cm. from the incisor teeth.The oesophageal microphone allows anxsthetist and surgeon

continuous or intermittent monitoring of heart and breathsounds during operation. It is especially valuable for detectingearly evidence of cardiac irregularities or accumulation ofbronchial secretions. It is also useful in teaching.The ’ Soniscope’ and ’ Cardiophone’ are made by Faraday

P.lftmmrR T .tr1 . 6’i- TairviBx Rn>lr1. T nnrirtn q W 16

T. D. W. DAVIESM.B. Cantab., F.F.A. R.C.S., D.A.Senior Registrar in Anaesthetics

L. FOTHERGILLElectromedical PhysicistSELWYN TAYLORD.M., M.CH., F.R.C.S.

SurgeonKing’s College Hospital,

London, S.E.5

A SIMPLE PUMP FOR INTRAVENOUS INFUSION

JOHN GRACETheatre Technician

PETER PYLEM.B. Lond., D.A.

Registrar

Anæsthetic Department,Salisbury General Hospital,

Salisbury

PARTICULARLY since the introduction of disposable plasticinfusion sets, neither the Higginson syringe nor the mechanicalroller pump has proved consistently satisfactory. The

Higginson syringe has only one non-return valve, which tendsto leak back, and the roller pump requires two hands for

manipulation.The new pump comprises a length of polyethylene tubing

(bore iv/3) with a bulb and valve-control screw from a standardsphygmomanometer at one end. This unit contains both a

simple non-return valve and a modified sleeve valve, whichtogether completely prevent leakage. At the other end of the

1. Doggart, J. H. A.M.A. Arch. Ophthal. 1955, 54, 161.

tubing is a Luer adaptor which fits the air inlet of a disposableinfusion set (see figure).

This apparatus is light and easy to control, and, because thevalves prevent leak back, the pump tubing need not be clippedoff. High pressure can be built up in the bottle, and when thisis empty and the metal needle is exposed, the screw valve maybe operated to release any residual pressure, thus avoiding thedanger of air-embolism.

Medical Societies

MEDICAL OFFICERS OF SCHOOLSASSOCIATION

BOXING was discussed by the Association at. a-meetingin London on Jan. 7.

Dr. MACDONALD CRITCHLEY spoke of the injuries tothe brain that result from head blows. The commonest

type of knock-out is now thought to be due to concussionof the medullary centres in the midbrain. The extremehypotonus, short duration of unconsciousness, and usuallyfull recovery make it a unique response to injury. Evenif not very much harm is done in ninety-nine out of ahundred knock-outs the fact remains that a neurologistholds the central nervous system in some respect. How-ever doubtful the harm may be in some instances, it isbeyond belief that such treatment is good for the brain.There is no question whatever but that harm is likely toresult from repeated injuries. Speaking of serious dam-age to the second most delicate organ at risk-the eye-Dr. Critchley mentioned Doggart’s work especially.Although punch-drunkenness is practically limited to theprofessional boxer, it is a fact that the " groggy state " isseen in amateurs: he referred to nine deaths in theamateur ring in this country since the end of the late war(there were two in December, 1959).

Dr. J. A. WAYCOTT (Charterhouse School) admitted theundoubted benefits of boxing in developing muscularcoordination and courage in adversity. The sport is notas dangerous as some others. But the " absolutely funda-mental " difference, arising from the fact that the injuriesin the ring are deliberate and intentional, distinguishesboxing from every other sport. The chief target for suchinjuries is admittedly the brain. No safeguards currentlyin use can possibly eliminate the fatal blow or detachedretina. Dr. Waycott reminded his audience of the spec-tator’s part. The advocacy of cruel sports is a productnot of reason but of the subconscious mind. That is whyit is so proof against arguments that appeal mainly toreason. Natural displacements and sublimations are

doubtless necessary, but it is vital to prohibit seriouslyobjectionable outlets. On balance the case against box-ing, both medically and morally, is unassailable.

Dr. T. A. A. HUNTER (Marlborough College) agreedthat any sport whose primary purpose was the productionof repeated head injuries must require very strong justi-fication. He wondered whether there was, in fact, evi-dence of such injuries resulting from schoolboy boxing.

Dr. D. E. DUNNILL (Bexhill-on-Sea) condemned pro-fessional boxing but thought that amateur boxing shouldbe retained because it teaches a boy the ability to defendhimself.

210

Dr. R. E. SMITH (sometime medical officer, RugbySchool) thought it quite wrong to compare amateur boxingwith professional. He stressed that many more injurieswere sustained in other games and, anyway, what alterna-tive was there if boxing were to go out ?Mr. G. A. HODGES (director of physical education,

Winchester College) said that after thirty years’ experi-ence he was convinced that boxing could be of greatbenefit educationally. He condemned the bad features ofmuch contemporary boxing and said that careful match-ing of contestants was essential. This often involved

leaving the best boxers out of a team in a match againstanother school and " unfortunately most schools won’taccept this ". He found that between 5 and 10% of boyswanted to box, and the feeble boy who suddenly foundan unsuspected skill was often much helped in his outlook.

Dr. A. W. HENDERSON (St. Edward’s School, Oxford)thought that accidents occurred chiefly when amateurboxing was improperly supervised. This, he felt, was anargument for more efficient supervision and control andnot for the elimination of an admittedly dangerous sport.

The Rev. D. L. GRAHAM (Headmaster of Dean CloseSchool) mentioned his long experience of boxing, whichincluded a period in charge of the sport at Eton. He hadbeen a boxer himself for more than forty years. Althoughboxing undoubtedly gave a boy a certain status there wereother and better ways of acquiring this. Dean Close hasabandoned boxing because of its objectionable features,and replaced it by judo.

Several other speakers referred to judo as the obviousalternative. If properly publicised and taught, it easilycatches the schoolboy imagination. It is superior to box-ing as a means of self-defence, and the rules are framedso as to avoid injury. Any hurt occurring during its prac-tice is accidental and not deliberate, as in boxing. Fenc-

ing and single-sticks were also mentioned as possiblealternatives.The meeting concluded with unanimous assent to the

suggestion that further evidence should be obtained onthe hazards of amateur boxing. Dr. CRITCHLEY said hewould report this to the president of the Royal College ofPhysicians.

Reviews of Books

Progress in Biochemistry Since 1949FELix HAUROWITZ, distinguished service professor, Indiana

University. Basle: S. Karger. London and New York: Inter-science Publishers. 1959. Pp. 357. 60s.

IN a preface Dr. Haurowitz says that one of his reasons forwriting this book was to keep abreast of the state of bio-

chemistry, and this volume is in fact the fifth in his series ofself-imposed refresher courses. He has certainly done hisprospective readers a service by giving them this survey ofprogress in his subject during the past decade. As is inevitablein a book of such wide scope, the chapters are somewhat uneven,but the best are very good and the others worth reading. Theapplication of thermodynamic arguments to biochemical

problems and the general aspects of biological oxidations areparticularly clearly expounded, and, as might be expectedfrom the author’s special interests, the chapters on proteins andtheir derivatives (which take up about a quarter of the book)are very full and fair. Dr. Haurowitz himself adheres to theidea of a template for polypeptide synthesis which includespreformed protein as well as ribonucleic acid. Other chaptersprovide brief accounts of such varied topics as the biochemistryof lipids and carbohydrates (including amino-sugars and theseveral pathways of glucose catabolism), fat synthesis, hor-mones, antibiotics, and immunochemistry.The book can be highly recommended to those who have

fallen behind in their biochemical reading, but it does assumea reasonable familiarity with the fundamentals of the subject.References are plentiful and well chosen, and a glossary of overa hundred abbreviations affords both a sidelight on the

popularity of such figures of speech among the professionalsand enlightenment for amateurs not steeped in biochemicalbadinage.

The Physiology and Treatment of Peptic UlcerEditor: J. GARROTT ALLEN, M.D. Chicago: University of

Chicago Press. London: Cambridge University Press. 1959.

Pp. 236. 56s. 6d.

HERE is an almost limitless subject, to judge from the volumeof work, both observational and experimental, that has beenpouring out over the years. Nevertheless, and it is the achieve-ment of the editor and his eleven noted contributors, condensa-tion has been secured by intelligent sifting. All the contributorshave been under the influence of Dr. Lester Dragstedt at sometime in their career; and this monograph is their testimonial tohim on his retirement. The need to publish the work by theappointed day has imposed a praiseworthy economy, reflected

in both conciseness and clarity, which will be fully appreciatedby all readers. There is an understandable bias towards

physiology associated with the vagus nerve and vagotomy.There is no cavil about the basic hypothesis on which experi-ment and argument are built; on the first page the dogma ofpepsin is squarely stated by Dr. Allen-the ulcer is a sequela ofthe digestive action of pepsin: ergo, acidity is of paramountimportance. And so to a consideration of the phases of gastricsecretion and their mechanisms, and the various experimentalpouches used for their study. A chapter is devoted to thecephalic phase, another to the antral phase, and it is followedby one on its clinical importance. The details of radiologicaldiagnostic technique and interpretation are well set out in achapter by Dr. P. C. Hodges; treatment follows. Gastric ulcer isdealt with in the two final chapters, with an epilogue by themaster himself on " what I would do if I had an ulcer ". Wehope that he has not, but we are grateful for his massive con-tribution to the subject during a very active professional life,and not least for this tribute, a succinct, informative, andreadable monograph, which his work has evoked.

Clinical Chemical Pathology (2nd ed. London: EdwardArnold. 1959. Pp. 160. 14s.).-The new edition of this

popular little book by Prof. C. H. Gray illustrates the rapidityof change in this subject. Test-meals are no longer consideredin detail, but an account is now given of the van den Berghreaction and its connection with non-conjugated and conjugatedbilirubin, the value of the transaminase and other enzymeestimations in determining liver function, and diagnosis ofcardiac infarction. In the urine tests much, some may say toomuch, notice has been taken of the packaged tablet tests.

Chromatography has been introduced but very briefly. Thebook continues to combine brevity with a remarkable complete-ness and clarity and will go on giving valuable service to onestudent generation after another. ,

Complete Cookery Book for Diabetics (2nd ed. Lon-don : H. K. Lewis. For the British Diabetic Association.1959. Pp. 134. 6s.).-The second edition of this popularcookery book for diabetics by Iris Holland Rogers comes threeyears after the first. It contains 33 new recipes, thus increasingfurther the great variety of meals offered in the exchangesystem. More information is given about the use of sorbitol,and it is recommended that its caloric content should beassessed in diets for weight reduction. A useful new table ofequivalent quantities of different sweetening agents is alsoincluded. Another new section deals with the bottling of fruit,and additional valuable advice is given about invalid diets.This book is a bargain at 6s., and should be welcomed by anydiabetics who feel that the scope of their meals is restricted.