1000

and the extraordinary small amount of unheatedserum required for its use, Wyler urges that it shouldbe adopted as a routine. The Kahn micro-method,using only 0-06 c.cm. of serum, compared favourablywith the standard Kahn method, which has nowstood the test of time well. The Rosenthal reactionis simple to carry out, and very specific, showingaccurate agreement with the Wassermann, but it isnot so sensitive as the other flocculation tests. Inhis survey of the results Wyler admits, however, thatwhere but a minute drop of serum is available-sufficient only for one test-it would not be right torely entirely upon a micro-flocculation method, andthe micro-Wassermann remains the method ofchoice. As all four tests described can be done on atotal of 0-15 c.cm. of serum, which is readily obtainablefrom 0-5 c.cm. of blood, it should be simple for anypathologist having to deal with small amounts ofsera to adopt the Wassermann and Kahn reactions heredescribed, and to do a standard flocculation test aswell as a complement-fixation test. The prevalentbelief that it is difficult to obtain half a cubic centi-metre of blood in routine psediatric practice appearsrather surprisingly to be shared by Dr. Wyler. Thisis not the view held by most experienced workers.

SURGICAL INSTRUMENT CRAFT

THREE years ago at the annual dinner of the

Surgical Instrument Manufacturers’ Association, SirThomas Dunhill surveyed the relation betweeninstrument maker and surgeon, from the time whenthe operator was able himself to make the simpletools required for his work. Little by little the twocrafts diverged, some becoming more interested in

making instruments, others in using them. For

himself, he added, while he favoured simple instru-ments, a patient’s life might depend on the availabilityof complicated apparatus. Mr. Patrick Maw (ofS. Maw, Son and Sons) presided on that occasion, andat the annual dinner last week when Mr. H. GuyDrew (of Down Bros.) presided, Mr. W. H. Ogilviespoke of the making of surgical instruments as a craftcomparable to that of the boat-builder. The motorindustry, he said, typified all that he hoped that thesurgical instrument maker would never become;every year the design was more beautiful and thequality of the work worse. The maker of motor-carshad ceased to be a craftsman, but surgical instrumentmaking should and would remain the individualwork of artists in wood, metal, leather, or glass; andthe worker must be not only an artist but somethingof a chemist, mathematician, and even a fashion

expert. Recently Mr. Drew had designed for him asewing machine which might save half an hour of anoperation and a prostate needle which would easilyput stitches into impossible positions. Ten minutesin Mr. Drew’s office would turn one of his own Heath-nooinson arawmgs into a icasicie specmcation. mr.

Drew in reply said something about the enormousprogress in the art of surgery since the war. In a

single week, he remarked, British manufacturersmight be called upon to produce 100 new designs ofsurgical instruments. He spoke of the evils of stan-dardisation in arresting progress, and was happy toannounce the inauguration, in this the eighteenthyear of the Association’s life, of an Institute of BritishSurgical Technicians with two duties : (1) to evolvea code of professional conduct ; (2) to bring into

being an educational scheme with a nationallyrecognised certificate. It was hoped ultimately toobtain similar recognition to that of other groups ofmedical auxiliaries. The manufacturers of surgicalappliances were working even under a greater

disadvantage than surgical instrument makers becauseof the traders who antagonised the public by theiradvertising and business methods. No surgicalappliance maker was admitted to the Associationwithout a certificate of skill, experience, and repute,plus an undertaking that he would not sell or fit

any appliance without the instructions, or the subse-quent approval, of some qualified medical authority.The Association had started a course of training inanatomy and physiology at the Chelsea Polytechnic,at the end of which examinations would be held andcertificates granted. This year the classes had doubledin number and the scheme was already assured of asufficient number of entrants to make it a success.

THE VALUE OF AVERTINTHERE are still anesthetists who doubt the advisa-

bility of any wide use of Avertin. They are mostlyto be found perhaps among those who have hadleast experience of the drug and they will find, littlesupport in a recent paper on the subject by WesleyBourne.1 He gives details of a thousand administra-tions and they clearly show the value of this basalnarcotic when properly employed. Proper employ-ment means in the first place careful discriminationamong patents so that the most suitable and thesafest dosage may be given. No hard-and-fastdetermination of dose by body-weight alone can beconsistently satisfactory. As with other anaesthetics,so with avertin, the patient’s reaction is in accordancewith his nabits, his general physique, and above allwith his mental attitude. These must be studiedand the amounts given must be lessened or increasedin agreement with the anaesthetist’s estimate of thepatient’s reaction. Bourne favours a general level ofdosage higher than that commonly accepted, and ina third of his patients no other anaesthetic was required.It should rarely be necessary to supplement theavertin with any anaesthetic other than nitrousoxide, and avertin by itself causes no nausea. Amongthe thousand patients there was no fatality whichcould be fairly attributed to the drug.

Manchester Royal Infirmary has opened its resi-dent posts to women on equal terms with men.

Dr. Mabel L. Ramsay is standing in opposition toSir Henry Bracken bury for the seat on the GeneralMedical Council, as a direct representative for Englandand Wales. Dr. Ramsay has been engaged in generalpractice for the past 28 years, 26 of these in Plymouth,where she is now specialising in obstetrics and

gynaecology. She has been president of the MedicalWomen’s Federation and represents it on theInsurance Acts Committee, and she is a member ofthe disciplinary procedure committee (N.H.I.) of theMinistry of Health. Dr. Ramsay believes thetime is opportune for the appointment of a womanCouncillor, for of the total number of names on theRegister more than 5000 are women.

Dr. Leonard Kidd is inviting registered medicalpractitioners resident in Ireland to elect him again astheir representative on the General Medical Councilwhen his term of office expires on Dec. 31st. He hassat on the Council since 1906 and has served on theexamination, education, public health, and pharma-copoeia committees. He stands as a provincial generalpractitioner, having always held that the electedmembers were intended by the legislature to be

general practitioners, not connected directly or

indirectly with the teaching and qualifying bodies,each of which nominates its own member. Dr. Kiddis a past president of the Irish Medical Association.

Canad. Med. Assoc. Jour., September, 1934, p. 276.