1
886 record, had passed through the nasal duct into the throat and so into the ear. It was more probable that the otitis was due to the mother, who still had a specific discharge. As the otorrhoea proved to be very obstinate, the possibility of gonococcal infec- tion suggested itself, and on bacteriological examina- tion typical gonococci were found in the ear dis- charge. Treatment with 1 per cent. protargol was instituted and rapid recovery took place. The case illustrates the necessity of making a bacterio- logical examination in all cases of obstinate otorrhcea in infants, especially in those who have previously suffered from ophthalmia; for, where indicated, specific treatment with protargol followed by potassium permanganate leads to cure in a few .days. ____ A PATHOLOGICAL RESEARCH FELLOWSHIP. AT a time when hospital finance is becoming more and more difficult it is pleasing to note that the value of organised clinical research is recog- nised by a few generous souls. St. Bartholomew’s Hospital Medical School has become the recipient of a sum of money sufficient to endow a research into " the Pathology and Treatment of Lymph- adenoma." This is due to the munificence of Mrs. L. B. Rose, of Bedford, who has so arranged that sufficient funds are available for the research to he carried on for a period of ten years if necessary. Working expenses are also provided for, and the sum given is sufficient to support a second researcher if the board of electors to the fellow- ship deem it desirable. The gift should have attraction for workers from all parts of the ,country, for it has been decided by the hospital authorities to throw open the Rose Research Fellowship for competition by any who may ,desire to apply. Lymphadenoma is still a disease of which little is known, either on the pathological or therapeutic side. The available material is scanty, and although it is expected that the research will for the most part be carried on at St. Bartholomew’s Hospital, powers are given to the electors from time to time to permit a part of it being performed elsewhere. It will be seen that the fellowship is generously conceived, and its holder will be a fortunate person. NORMAL LABOUR ON THE CINEMA. Dr. Drummond Robinson has spent time, trouble, and money on the obstetrical films recently shown at the Royal Society of Medicine, but we do not share the apologetic attitude adopted by those members of the society who criticised them in ,detail. The principle of teaching by cinematograph, where practicable, has long been accepted, and it is in the details of its application to any subject that an individual film must stand or fall, especially if it is offered for sale to teaching institutions. In Dr. Robinson’s films the diagrammatic line drawings in sagittal section were similar to those seen in many text-books. Had they been sufficiently numerous ,-to give an impression of continuous movement .when released at a fast pace, they might have been helpful, though drawings of such complicated movements in two dimensions only are always difficult to interpret. The baby moved down in a series of jerks comparable to those made by the minute hands of certain large clocks worked by electricity; no one attitude merged into the next even rapidly enough to cause the disagreeable flicker associated with a slow film. Moreover, doubtless through slight differences in successive drawings of the vertebral column, too much apparent movement of the bony structures took place, including even alternate narrowing and widening of the spinal canal. The use of a stamp for the fixed portions of the vertebral column would have averted this curious illusion and saved time in drawing. Dr. Robinson excused the jerky movements on the score of the enormous expense involved in the drawings, but for experimental and demonstration, if not for selling purposes, it would have proved more effective to concentrate on either vertex or breech and show the same number of drawings spread over one presentation only. The pictures of actual labour on the living subject were also disappointing, though the birth area cer- tainly filled the picture, and the movements of the emerging child were shown as clearly as possible. Since in’ the vertex case no attempt was made to guard the perineum-doubtless so as not to obscure the view of the child’s movements-we may con- clude that the object was the demonstration of the physiology as opposed to the management of labour; such movements, however, as are visible to an observer facing the perineum form too small a part of the whole complicated process to be of any help to a student. As to the possible value of these films in teaching the management of labour, the most important duty of the obstetrician in a normal case is to guard the perineum, and the spectacle of an unaided delivery with a torn peri. neum is of negative educational value. It will not tend to improve the practice of the student, only too prone to regard a tear merely as an opportunity for practice in putting in stitches, if this accident is deliberately allowed to occur in what should be amodelfilm. In any case, the doctrine that a person should be allowed to conduct labour without having watched actual delivery and having received practical instruction in technique at the bedside would surely be indefensible; films of the natural subject could in no way replace such instruc- tion. The omission of the customary warm flannel round the buttocks of the breech baby, and the demonstration of pictures of a case insufficiently prepared, seem to show that the preparation of a really satisfactory obstetric film is very difficult. Dr. Robinson should have discarded all unsatis- factory films and have delayed release until he could show a model one, if he wished to convince his audience that his subject is suitable for cinemato- graph teaching. Such films might be useful in the future for training midwives in this country or in India, especially if less prominence were given to the actual delivery in comparison with the preparations therefor. They should comprise pictures of ante- natal clinics, the taking of measurements, and testing of urines; hygienic under-garments for pregnant women should be shown, and pictures of the fittings of a lying-in hospital. Midwives and students should be seen washing up, putting on sterile gowns and gloves, otheis making and arrang- ing the bed, and movable tables with accessories should be demonstrated; other pictures might show the adaptation of a small cottage to the purpose of a lying-in room. Certain details in Dr. Robinson’s film, such as the cleaning of the baby’s eyes, the jaw and shoulder traction method of extracting a breech baby, and subsequent resuscitation from asphyxia, were excellently shown. Had the pictures been offered only as a demonstration of possibilities, and criticism invited, we should have congratulated all concerned on the enterprise, and trusted that

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886

record, had passed through the nasal duct into thethroat and so into the ear. It was more probablethat the otitis was due to the mother, who still hada specific discharge. As the otorrhoea proved to bevery obstinate, the possibility of gonococcal infec-tion suggested itself, and on bacteriological examina-tion typical gonococci were found in the ear dis-charge. Treatment with 1 per cent. protargol wasinstituted and rapid recovery took place. Thecase illustrates the necessity of making a bacterio-logical examination in all cases of obstinateotorrhcea in infants, especially in those who havepreviously suffered from ophthalmia; for, whereindicated, specific treatment with protargol followedby potassium permanganate leads to cure in a few.days. ____

A PATHOLOGICAL RESEARCH FELLOWSHIP.

AT a time when hospital finance is becomingmore and more difficult it is pleasing to note thatthe value of organised clinical research is recog-nised by a few generous souls. St. Bartholomew’sHospital Medical School has become the recipientof a sum of money sufficient to endow a researchinto " the Pathology and Treatment of Lymph-adenoma." This is due to the munificence of Mrs.L. B. Rose, of Bedford, who has so arranged thatsufficient funds are available for the research tohe carried on for a period of ten years if necessary.Working expenses are also provided for, and thesum given is sufficient to support a secondresearcher if the board of electors to the fellow-ship deem it desirable. The gift should haveattraction for workers from all parts of the,country, for it has been decided by the hospitalauthorities to throw open the Rose Research

Fellowship for competition by any who may,desire to apply. Lymphadenoma is still a diseaseof which little is known, either on the pathologicalor therapeutic side. The available material isscanty, and although it is expected that theresearch will for the most part be carried on atSt. Bartholomew’s Hospital, powers are given tothe electors from time to time to permit a part of itbeing performed elsewhere. It will be seen thatthe fellowship is generously conceived, and itsholder will be a fortunate person.

NORMAL LABOUR ON THE CINEMA.

Dr. Drummond Robinson has spent time, trouble,and money on the obstetrical films recently shownat the Royal Society of Medicine, but we do notshare the apologetic attitude adopted by thosemembers of the society who criticised them in

,detail. The principle of teaching by cinematograph,where practicable, has long been accepted, and itis in the details of its application to any subjectthat an individual film must stand or fall, especiallyif it is offered for sale to teaching institutions. In Dr.Robinson’s films the diagrammatic line drawings insagittal section were similar to those seen in manytext-books. Had they been sufficiently numerous,-to give an impression of continuous movement.when released at a fast pace, they might have beenhelpful, though drawings of such complicatedmovements in two dimensions only are alwaysdifficult to interpret. The baby moved downin a series of jerks comparable to those madeby the minute hands of certain large clocksworked by electricity; no one attitude mergedinto the next even rapidly enough to cause thedisagreeable flicker associated with a slow film.

Moreover, doubtless through slight differences insuccessive drawings of the vertebral column, toomuch apparent movement of the bony structurestook place, including even alternate narrowingand widening of the spinal canal. The use of astamp for the fixed portions of the vertebral columnwould have averted this curious illusion and savedtime in drawing. Dr. Robinson excused the jerkymovements on the score of the enormous expenseinvolved in the drawings, but for experimentaland demonstration, if not for selling purposes, itwould have proved more effective to concentrate oneither vertex or breech and show the same numberof drawings spread over one presentation only.The pictures of actual labour on the living subjectwere also disappointing, though the birth area cer-tainly filled the picture, and the movements of theemerging child were shown as clearly as possible.Since in’ the vertex case no attempt was made toguard the perineum-doubtless so as not to obscurethe view of the child’s movements-we may con-clude that the object was the demonstration ofthe physiology as opposed to the management oflabour; such movements, however, as are visibleto an observer facing the perineum form too smalla part of the whole complicated process to be ofany help to a student. As to the possible value ofthese films in teaching the management of labour,the most important duty of the obstetrician in anormal case is to guard the perineum, and thespectacle of an unaided delivery with a torn peri.neum is of negative educational value. It will nottend to improve the practice of the student, onlytoo prone to regard a tear merely as an opportunityfor practice in putting in stitches, if this accidentis deliberately allowed to occur in what should beamodelfilm. In any case, the doctrine that a personshould be allowed to conduct labour withouthaving watched actual delivery and having receivedpractical instruction in technique at the bedsidewould surely be indefensible; films of the naturalsubject could in no way replace such instruc-tion. The omission of the customary warm flannelround the buttocks of the breech baby, and thedemonstration of pictures of a case insufficientlyprepared, seem to show that the preparation of areally satisfactory obstetric film is very difficult.Dr. Robinson should have discarded all unsatis-factory films and have delayed release until hecould show a model one, if he wished to convincehis audience that his subject is suitable for cinemato-graph teaching. Such films might be useful in thefuture for training midwives in this country or inIndia, especially if less prominence were given to theactual delivery in comparison with the preparationstherefor. They should comprise pictures of ante-natal clinics, the taking of measurements, andtesting of urines; hygienic under-garments for

pregnant women should be shown, and pictures ofthe fittings of a lying-in hospital. Midwives andstudents should be seen washing up, putting onsterile gowns and gloves, otheis making and arrang-ing the bed, and movable tables with accessoriesshould be demonstrated; other pictures might showthe adaptation of a small cottage to the purpose ofa lying-in room. Certain details in Dr. Robinson’sfilm, such as the cleaning of the baby’s eyes, the jawand shoulder traction method of extracting a breechbaby, and subsequent resuscitation from asphyxia,were excellently shown. Had the pictures beenoffered only as a demonstration of possibilities, andcriticism invited, we should have congratulatedall concerned on the enterprise, and trusted that