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IMPROVEMENT OF THE NATIONAL DIET
808
dingy unpainted patients in the
Here
wards. same
we saw
male and
female
Letters to the Editor
wards, nearly all showing the
bloated leonine facies and many the more unpleasant IMPROVEMENT OF THE NATIONAL DIET effects of ulceration. One old lady with a severe ectropion and hardly a finger remaining had been an inmate for SiR,-It seems from their report, which you published 35 years. Many patients were hidden under enormouson May 8, that the nutrition committee of the Central piles of bedding, probably too self-conscious to show Council for Health Education were not concerned with the effects of the diet on the health of teeth and gums. themselves. After these wards, of which we saw four or five, each containing 12-16 patients, we visited one of It is, presumably, well known that dental caries at least the houses in the grounds for ambulatory cases, where we is the direct result of civilised diet; experience and were introduced to five little girls, all showing ravages of experiment have shown that sufficient intake of protective factors, including fluorine, can cause- only a the disease. They greeted us in Japanese fashion on limited reduction in its incidence ; nor can antibiotics their knees, bowing their foreheads almost to the tatami matting, and as we left a chorus of rather pathetic or better tooth brushing be expected to cause a substantial improvement. Conservative dental treatment " goodbyes followed us. will long be economically impossible for the bulk of the After paddling our shoes in an antiseptic solution, washing our hands in another, and gargling in a third, population, and nefore condemning them to extractions and artificial teeth it is surely worth considering what we sped back to Tokyo thinking that the man who evolves a successful treatment for leprosy will deserve dietary reform may be practicable and effective. the thanks of mankind. Apart from predisposing causes, such as inherited * * * factors and vitamin and mineral deficiencies, the cause of dental caries is the stagnation and fermentation The New Look was very evident in Paris-all grades about the teeth of carbohydrates, especially sugars. of it, from the most severe and straight-laced corseting Such stagnation is due to the eating of softened and downwards (or should one say upwards?). Like alopecia, refined carbohydrates. It can be prevented by a greater can be into and it divided patchy, partial, diffuse, total, intake of roughage "-especially raw fruit and vegeuniversal. Sitting at the Cafe de la Paix, observing the tables-and by hard and fibrous foods generally. The varieties down the of these several boulevard, parade of hard and unrefined foods keeps the teeth questions pose themselves, as the French say. What, mastication clean, not only by the scouring effect of ,the fibrous for instance, has happened to the " shifting erogenous matter but by stimulating a copious flow of saliva and zones " ?Whitherhave they shifted ?For shifted they causing movements of the tongue and cheeks. Adequate have, in no mean way. Almost overnight thebend of function also reduces potential stagnation areas by the elbow is shrouded again, the shoulders have closed up of the teeth and by promoting full development shop, the knees are plunged into the inner darkness. attrition the growing jaws and the eruption of the teeth into What compensation has been offered to the psyche in of a regular arch. Finally, it stimulates resistance of the this flight to the newly prepared positions ? Perhaps a to infection and atrophy. tantalising glimpse of the ankle may once again throw periodontal tissues Although all this is well known to those who have our primitive emotions into a flutter ; and surely the studied the aetiology of dental disease, and is the basis bustle is significant. of what dental health education has been attempted, to a be the have issued Americans Not outdone, yet it is contrary to a great part of ordinary dietetic counter-blast-for males, and called the Bold Look. and nutritional teaching. Compact foods-i.e., those From the pictures in my last copy of Esquire it’s the real with a small content of roughage-are commonly peacock’s feathers. * considered " nutritious," and the rapid assimilability * * of sugar is commended while its rapid fermentation in A patient came to me on May 2 with a gunshot wound the mouth is ignored. Perhaps this is because the bioof the chest which had penetrated the alimentary canal, chemist, in trying to make dietetics an exact science. so that when he drank the liquid came out through the confines his attention, and sometimes his definition wound of entry. I No exit wound was discovered. of food, to that part of it which is absorbed into the ordered small feeds of mixed oatmeal and barleymeal at Besides ignoring the hygienic effects of such body. short intervals, water to drink, and rest and quiet. In food " as is not absorbed, this narrow definition less than.a week the patient discharged himself fully excludes an important independent function of foodrecovered. Apart from the initial stage of shock, followed its function as a source of pleasure. Such expressions as by a dazed sort of depression, the chief symptom was the common taste " and ’’ habits sanctioned diarrhoea, and somebody is going to have a hard job bymoulding of custom " show our ignorance of the generations clearing it all away. What ? Oh, it was a homing-pigeon origins of food habits and of the fundamental causes of shot by some lout with a gun. their change. Apart from the trend towards variety, * * * "
"
"
"
.
It has been said that you will get the best opinion in differential diagnosis by sending a patient up to Examination Hall. On this principle it seemed to me a good opportunity to submit a recent X-ray film of my chest to a number of would-be consulting physicians. The experience was humbling and to some extent nerve-
shattering. Pooling the opinions, I learnt that I had a cavity at the right apex, mitral stenosis, hypertension, aneurysm of every part of the thoracic aorta, probably syphilitic aortitis, bronchial carcinoma, a mediastinal tumour, bronchiectasis, miliary tuberculosis, extreme emphysema, coarctation of the aorta, and pathological fracture of a rib. A,s the shadows lengthened I speculated on my future course of action, divided between a jaunty devil-may-care blustering decision to make the most of what might be left to me, and the more sober resolution to put my affairs in order. The sands were fast running out when the last candidate (God bless him) announced that he couldn’t see much the matter in the film. *
*
*
Passing B.M.A. House last week, I
saw outside it a BLACK. SPOT-LOOK BOTH WAYS. Inquiry shows that this was erected by the St. Pancras borough council, not by Mr. Bevan.
notice :
THIS
IS
A
*
"... So
*
they’re still arguing
*
up hill and down dain.’.’
which the report mentions, there are two other consistent trends-one towards more softening and refinement of food by cooking and machinery, and the other towards increased sugar consumption. Both trends are closely paralleled by the increase in dental disease. In view of them it is unwise to take it for granted that a rational balance will be approached when foods are more freehavailable. However much fruit becomes obtainable, cereals will, for as long as we can foresee, be the staff of life, and excessive pure sugar will tend to be consumed with them. The taste for sweetness, as opposed to the actual level of sugar consumption, is not a habit but an elementary fact of physiology which education cannot eradicate. Health education will be difficult enough when it opposes an instinctive drive, but it must fail if it ignores this factor and recognises merely ignorance, custom, and poverty as the forces opposed to it. Vested interests are also powerful obstructive agents. Another factor, which is frequently neglected, is dental disease ; though this is a result of bad food habits it is also a cause of their further degradation. Most of the population suffers from some impairment of masticatory efficiency, and the combined effects of inefficient dentures in the parents and untreated caries in the child often reinforce, at the most impiessionable age, the child’s preference for soft foods. Biochemists, doctors, and dentists themselves have been confused by a mass of contradictory and merely
809
negative statements about the aetiology of dental disease ; but much of this confusion springs from the assumption, tacit or explicit, that the defects of modern diet which are ultimately responsible are beyond remedy. Surely the Central Council for Health Education will not accept this
assumption ?
- - - - ’
R. B. D. STOCKER.
London, N.W.6.
SiR,-Your annotation of May 8, based partially on the memorandum of the Central Council for Health Education, raises many important points. As you rightly say, the Chancellor of the Exchequer has made it clear that the pattern of our diet will hardly be changed for some time to come. - Our prospects are even more seriously threatened by the fact that the introduction of Western living standards and hygienic conditions into certain European and Middle-Eastern and FarEastern countries has been followed by an unexpected and prodigious increase of the world’s consuming popul.ation. Thus the gap between wor1fl production and requirements of food-apart from soil erosion-is steadily growing. The selection of food from available sources and the avoidance of monotony is of great importance, but do we know enough about the many and varied factors involved ? An analysis of the apparently wretched diets of the poorest of the Mexican people revealed a surprising adequacy, or even abundance, of the necessary nutrients in types of food completely unknown in the United States.l. Meat and dairy products were no part of their diet, which mainly consisted of certain plants growing wild in the Mexican plateau, a special bread, and some inexpensive dried fish. A survey of the nutritional status of 1000 very poor Mexican school-children (the families of these children averaged 5-7 members and the family income about 20 cents a day) revealed the remarkable fact that their nutritional status was superior to that of 760 middle-class school-children in Michigan. The biochemical, biomicroscopical, and haematological studies were carried out by the same team of Boston workers in both cases. Other group surveys in Mexico showed also a negligible incidence of detectable malnutrition or deficiencies. This work came as a great surprise to all interested in nutrition and demonstrated that in choosing a well-balanced diet for any people, not only should there be sufficient calories and essential nutrients but the diet should conform with their dietary custom and with the availability of food. In view of these facts the education of the public in food habits appears to be of the greatest importance in the coming ’
years.
Your annotation discusses the great debt the doctor to the biochemist but points out that certain aspects of nutritional research have so far been rather neglected because they are difficult to pursue. Most controlled experiments have been carried out on laboratory animals and the results are not easily transferable to man. Many of us will warmly approve your remark that the medical man has a right to express his views on basic nutritional research; I would go a step further and suggest that the doctor should take an active part in nutritional research. A whole-day conference on the results of recent owes
investigations of nutritional status in Great Britain One was held by the Nutrition Society on March 13. speaker regretted " that none of the speakers had provided any substantial information on the present nutritional status of the country, but had focused their attention mainly on the discussion of methods."2 The fact is that modern nutritional research has become
complicated that only those familiar with results of recent investigations and with their application are able to express considered views. Some of the main exponents of nutritional science in the U.S.A. are clinicians (e.g., McLester, Sydenstricker, Jolliffe, Spies, and Wilder), and most American hospitals have not only a physician in charge of nutrition but also well-organised nutritional clinics. Similar nutritional clinics should be established in the teaching and all the larger general hospitals. The responsibilities of dietitians and catering officers should be shared by the physician so
1. Harris, R. S. 2. Brit. med. J.
J. Amer. dietet. Ass. p. 654.
April 3,
1946, 22, 974.
in
charge of the nutritional clinic. He Would be’able to maintain a constant interest in nutritional problems at the hospital and instruct not only the students and nurses but also the public through the outpatient department. He would deal with patients with deficiency symptoms, which are not uncommon and are often overlooked. It would be his duty to inform other members of the medical staff about new developments in nutritional research. He would have the knowledge with which to convince the administrative authorities of the need to provide first-class food to patients and He would also have a unique opportunity to nurses. organise and to carry out nutritional research on hospital patients, nurses, and students, which has been, as you say, unduly neglected. London, W.I.
Z. A. LEITNER.
INFECTED BURNS OF THE CHEST
SiR,-In the treatment of burns of the limbs the
irrigation envelope has many advantages. In view of these advantages a comparable method has been devised for treating the infected burn of the chest or back.
In many trades the shirt is the article of clothing which catches fire and the burns are of the chest and axillse, the limbs and face escaping. With an infected burn the problem of dressings is very real. Daily cleanings and dressings with creams or lotions are both painful and time-consuming, and gauze applied to a burn either sticks if the discharge is serous, or becomes separated from the wound by pus if the discharge is purulent. There is often a mixture of the two, and’ dressings are offensive and painful to change, requiring anaesthesia. A makeshift " irrigation envelope " does away with these disadvantages. The burns are thoroughly cleaned under anaesthesia ; and large squares of folded gauze are soaked in warm eusol and applied to the wounds. Two catheters, containing two additional holes, are placed with their ends medial to the nipples and their open ends protruding 2 in. above the ,
clavicles. A wad of wool is placed over the end of each catheter and sterile dry gauze is next placed over the chest, wet gauze and wool included. A wad of cotton-wool is placed in each axilla and sufficient gauze is used on the chest to form a thick absorbent cushion without preventing drainage. Sterile jaconet is next placed on the dressings to cover them completely. This is fixed to the waist-an unburned area in cases where the shirt has ignited-by elastic adhesive bandage. A further sheet of jaconet is placed on the back with overlap at the sides sufficient to allow pinning. The neck is fixed with pins and a jaconet vest is thus formed. The patient returns to the ward and is propped up slightly in bed. Eusol is injected 6-hourly by day with an ear syringe down the catheters.- After injecting about 40 ml. a pause is allowed before injecting a further amount. The patient feels the solution, which is absorbed by the cotton-wool overlying the catheters’ terminal hole. A further injection is made until the patient feels other areas of his chest being washed. The eusol washes between the burn and the gauze and is absorbed by the gauze from within out. Excess tracks off the chest into the axillse to be absorbed by the cotton-wool there. The discharge of pus is kept away from the burn by the washings, and is to be found evenly impregnating the gauze ; owing to the jaconet it does not stain the visible dressings. The most severely burned areas, the pectorals and axillae, are constantly moist with eusol owing to the placing of the wool. The elastic adhesive bandage round the waist is sufficient to prevent leakage of the small amount of eusol which is not absorbed immediately by the gauze. There is no leakage from the sides if a sufficient gauze cushion and jaconet overlap has been provided. This dressing can remain for a week in cases of severely infected chest burns. Morale remains high as the patient and his fellows can smell only eueol and cannot see the burn, as in the case of the irrigation envelope. When a change of dressing is required the gauze can be removed without any pain or bleeding from granulating areas.
I haveused this method for infected burns with eusol and hypochlorite combined with chemotherapy, and have found it entirely satisfactory. N. J. BLOCKEY. Aden Protectorate Levies Hospital. --
-
--
dingy unpainted patients in the
Here
wards. same
we saw
male and
female
Letters to the Editor
wards, nearly all showing the
bloated leonine facies and many the more unpleasant IMPROVEMENT OF THE NATIONAL DIET effects of ulceration. One old lady with a severe ectropion and hardly a finger remaining had been an inmate for SiR,-It seems from their report, which you published 35 years. Many patients were hidden under enormouson May 8, that the nutrition committee of the Central piles of bedding, probably too self-conscious to show Council for Health Education were not concerned with the effects of the diet on the health of teeth and gums. themselves. After these wards, of which we saw four or five, each containing 12-16 patients, we visited one of It is, presumably, well known that dental caries at least the houses in the grounds for ambulatory cases, where we is the direct result of civilised diet; experience and were introduced to five little girls, all showing ravages of experiment have shown that sufficient intake of protective factors, including fluorine, can cause- only a the disease. They greeted us in Japanese fashion on limited reduction in its incidence ; nor can antibiotics their knees, bowing their foreheads almost to the tatami matting, and as we left a chorus of rather pathetic or better tooth brushing be expected to cause a substantial improvement. Conservative dental treatment " goodbyes followed us. will long be economically impossible for the bulk of the After paddling our shoes in an antiseptic solution, washing our hands in another, and gargling in a third, population, and nefore condemning them to extractions and artificial teeth it is surely worth considering what we sped back to Tokyo thinking that the man who evolves a successful treatment for leprosy will deserve dietary reform may be practicable and effective. the thanks of mankind. Apart from predisposing causes, such as inherited * * * factors and vitamin and mineral deficiencies, the cause of dental caries is the stagnation and fermentation The New Look was very evident in Paris-all grades about the teeth of carbohydrates, especially sugars. of it, from the most severe and straight-laced corseting Such stagnation is due to the eating of softened and downwards (or should one say upwards?). Like alopecia, refined carbohydrates. It can be prevented by a greater can be into and it divided patchy, partial, diffuse, total, intake of roughage "-especially raw fruit and vegeuniversal. Sitting at the Cafe de la Paix, observing the tables-and by hard and fibrous foods generally. The varieties down the of these several boulevard, parade of hard and unrefined foods keeps the teeth questions pose themselves, as the French say. What, mastication clean, not only by the scouring effect of ,the fibrous for instance, has happened to the " shifting erogenous matter but by stimulating a copious flow of saliva and zones " ?Whitherhave they shifted ?For shifted they causing movements of the tongue and cheeks. Adequate have, in no mean way. Almost overnight thebend of function also reduces potential stagnation areas by the elbow is shrouded again, the shoulders have closed up of the teeth and by promoting full development shop, the knees are plunged into the inner darkness. attrition the growing jaws and the eruption of the teeth into What compensation has been offered to the psyche in of a regular arch. Finally, it stimulates resistance of the this flight to the newly prepared positions ? Perhaps a to infection and atrophy. tantalising glimpse of the ankle may once again throw periodontal tissues Although all this is well known to those who have our primitive emotions into a flutter ; and surely the studied the aetiology of dental disease, and is the basis bustle is significant. of what dental health education has been attempted, to a be the have issued Americans Not outdone, yet it is contrary to a great part of ordinary dietetic counter-blast-for males, and called the Bold Look. and nutritional teaching. Compact foods-i.e., those From the pictures in my last copy of Esquire it’s the real with a small content of roughage-are commonly peacock’s feathers. * considered " nutritious," and the rapid assimilability * * of sugar is commended while its rapid fermentation in A patient came to me on May 2 with a gunshot wound the mouth is ignored. Perhaps this is because the bioof the chest which had penetrated the alimentary canal, chemist, in trying to make dietetics an exact science. so that when he drank the liquid came out through the confines his attention, and sometimes his definition wound of entry. I No exit wound was discovered. of food, to that part of it which is absorbed into the ordered small feeds of mixed oatmeal and barleymeal at Besides ignoring the hygienic effects of such body. short intervals, water to drink, and rest and quiet. In food " as is not absorbed, this narrow definition less than.a week the patient discharged himself fully excludes an important independent function of foodrecovered. Apart from the initial stage of shock, followed its function as a source of pleasure. Such expressions as by a dazed sort of depression, the chief symptom was the common taste " and ’’ habits sanctioned diarrhoea, and somebody is going to have a hard job bymoulding of custom " show our ignorance of the generations clearing it all away. What ? Oh, it was a homing-pigeon origins of food habits and of the fundamental causes of shot by some lout with a gun. their change. Apart from the trend towards variety, * * * "
"
"
"
.
It has been said that you will get the best opinion in differential diagnosis by sending a patient up to Examination Hall. On this principle it seemed to me a good opportunity to submit a recent X-ray film of my chest to a number of would-be consulting physicians. The experience was humbling and to some extent nerve-
shattering. Pooling the opinions, I learnt that I had a cavity at the right apex, mitral stenosis, hypertension, aneurysm of every part of the thoracic aorta, probably syphilitic aortitis, bronchial carcinoma, a mediastinal tumour, bronchiectasis, miliary tuberculosis, extreme emphysema, coarctation of the aorta, and pathological fracture of a rib. A,s the shadows lengthened I speculated on my future course of action, divided between a jaunty devil-may-care blustering decision to make the most of what might be left to me, and the more sober resolution to put my affairs in order. The sands were fast running out when the last candidate (God bless him) announced that he couldn’t see much the matter in the film. *
*
*
Passing B.M.A. House last week, I
saw outside it a BLACK. SPOT-LOOK BOTH WAYS. Inquiry shows that this was erected by the St. Pancras borough council, not by Mr. Bevan.
notice :
THIS
IS
A
*
"... So
*
they’re still arguing
*
up hill and down dain.’.’
which the report mentions, there are two other consistent trends-one towards more softening and refinement of food by cooking and machinery, and the other towards increased sugar consumption. Both trends are closely paralleled by the increase in dental disease. In view of them it is unwise to take it for granted that a rational balance will be approached when foods are more freehavailable. However much fruit becomes obtainable, cereals will, for as long as we can foresee, be the staff of life, and excessive pure sugar will tend to be consumed with them. The taste for sweetness, as opposed to the actual level of sugar consumption, is not a habit but an elementary fact of physiology which education cannot eradicate. Health education will be difficult enough when it opposes an instinctive drive, but it must fail if it ignores this factor and recognises merely ignorance, custom, and poverty as the forces opposed to it. Vested interests are also powerful obstructive agents. Another factor, which is frequently neglected, is dental disease ; though this is a result of bad food habits it is also a cause of their further degradation. Most of the population suffers from some impairment of masticatory efficiency, and the combined effects of inefficient dentures in the parents and untreated caries in the child often reinforce, at the most impiessionable age, the child’s preference for soft foods. Biochemists, doctors, and dentists themselves have been confused by a mass of contradictory and merely
809
negative statements about the aetiology of dental disease ; but much of this confusion springs from the assumption, tacit or explicit, that the defects of modern diet which are ultimately responsible are beyond remedy. Surely the Central Council for Health Education will not accept this
assumption ?
- - - - ’
R. B. D. STOCKER.
London, N.W.6.
SiR,-Your annotation of May 8, based partially on the memorandum of the Central Council for Health Education, raises many important points. As you rightly say, the Chancellor of the Exchequer has made it clear that the pattern of our diet will hardly be changed for some time to come. - Our prospects are even more seriously threatened by the fact that the introduction of Western living standards and hygienic conditions into certain European and Middle-Eastern and FarEastern countries has been followed by an unexpected and prodigious increase of the world’s consuming popul.ation. Thus the gap between wor1fl production and requirements of food-apart from soil erosion-is steadily growing. The selection of food from available sources and the avoidance of monotony is of great importance, but do we know enough about the many and varied factors involved ? An analysis of the apparently wretched diets of the poorest of the Mexican people revealed a surprising adequacy, or even abundance, of the necessary nutrients in types of food completely unknown in the United States.l. Meat and dairy products were no part of their diet, which mainly consisted of certain plants growing wild in the Mexican plateau, a special bread, and some inexpensive dried fish. A survey of the nutritional status of 1000 very poor Mexican school-children (the families of these children averaged 5-7 members and the family income about 20 cents a day) revealed the remarkable fact that their nutritional status was superior to that of 760 middle-class school-children in Michigan. The biochemical, biomicroscopical, and haematological studies were carried out by the same team of Boston workers in both cases. Other group surveys in Mexico showed also a negligible incidence of detectable malnutrition or deficiencies. This work came as a great surprise to all interested in nutrition and demonstrated that in choosing a well-balanced diet for any people, not only should there be sufficient calories and essential nutrients but the diet should conform with their dietary custom and with the availability of food. In view of these facts the education of the public in food habits appears to be of the greatest importance in the coming ’
years.
Your annotation discusses the great debt the doctor to the biochemist but points out that certain aspects of nutritional research have so far been rather neglected because they are difficult to pursue. Most controlled experiments have been carried out on laboratory animals and the results are not easily transferable to man. Many of us will warmly approve your remark that the medical man has a right to express his views on basic nutritional research; I would go a step further and suggest that the doctor should take an active part in nutritional research. A whole-day conference on the results of recent owes
investigations of nutritional status in Great Britain One was held by the Nutrition Society on March 13. speaker regretted " that none of the speakers had provided any substantial information on the present nutritional status of the country, but had focused their attention mainly on the discussion of methods."2 The fact is that modern nutritional research has become
complicated that only those familiar with results of recent investigations and with their application are able to express considered views. Some of the main exponents of nutritional science in the U.S.A. are clinicians (e.g., McLester, Sydenstricker, Jolliffe, Spies, and Wilder), and most American hospitals have not only a physician in charge of nutrition but also well-organised nutritional clinics. Similar nutritional clinics should be established in the teaching and all the larger general hospitals. The responsibilities of dietitians and catering officers should be shared by the physician so
1. Harris, R. S. 2. Brit. med. J.
J. Amer. dietet. Ass. p. 654.
April 3,
1946, 22, 974.
in
charge of the nutritional clinic. He Would be’able to maintain a constant interest in nutritional problems at the hospital and instruct not only the students and nurses but also the public through the outpatient department. He would deal with patients with deficiency symptoms, which are not uncommon and are often overlooked. It would be his duty to inform other members of the medical staff about new developments in nutritional research. He would have the knowledge with which to convince the administrative authorities of the need to provide first-class food to patients and He would also have a unique opportunity to nurses. organise and to carry out nutritional research on hospital patients, nurses, and students, which has been, as you say, unduly neglected. London, W.I.
Z. A. LEITNER.
INFECTED BURNS OF THE CHEST
SiR,-In the treatment of burns of the limbs the
irrigation envelope has many advantages. In view of these advantages a comparable method has been devised for treating the infected burn of the chest or back.
In many trades the shirt is the article of clothing which catches fire and the burns are of the chest and axillse, the limbs and face escaping. With an infected burn the problem of dressings is very real. Daily cleanings and dressings with creams or lotions are both painful and time-consuming, and gauze applied to a burn either sticks if the discharge is serous, or becomes separated from the wound by pus if the discharge is purulent. There is often a mixture of the two, and’ dressings are offensive and painful to change, requiring anaesthesia. A makeshift " irrigation envelope " does away with these disadvantages. The burns are thoroughly cleaned under anaesthesia ; and large squares of folded gauze are soaked in warm eusol and applied to the wounds. Two catheters, containing two additional holes, are placed with their ends medial to the nipples and their open ends protruding 2 in. above the ,
clavicles. A wad of wool is placed over the end of each catheter and sterile dry gauze is next placed over the chest, wet gauze and wool included. A wad of cotton-wool is placed in each axilla and sufficient gauze is used on the chest to form a thick absorbent cushion without preventing drainage. Sterile jaconet is next placed on the dressings to cover them completely. This is fixed to the waist-an unburned area in cases where the shirt has ignited-by elastic adhesive bandage. A further sheet of jaconet is placed on the back with overlap at the sides sufficient to allow pinning. The neck is fixed with pins and a jaconet vest is thus formed. The patient returns to the ward and is propped up slightly in bed. Eusol is injected 6-hourly by day with an ear syringe down the catheters.- After injecting about 40 ml. a pause is allowed before injecting a further amount. The patient feels the solution, which is absorbed by the cotton-wool overlying the catheters’ terminal hole. A further injection is made until the patient feels other areas of his chest being washed. The eusol washes between the burn and the gauze and is absorbed by the gauze from within out. Excess tracks off the chest into the axillse to be absorbed by the cotton-wool there. The discharge of pus is kept away from the burn by the washings, and is to be found evenly impregnating the gauze ; owing to the jaconet it does not stain the visible dressings. The most severely burned areas, the pectorals and axillae, are constantly moist with eusol owing to the placing of the wool. The elastic adhesive bandage round the waist is sufficient to prevent leakage of the small amount of eusol which is not absorbed immediately by the gauze. There is no leakage from the sides if a sufficient gauze cushion and jaconet overlap has been provided. This dressing can remain for a week in cases of severely infected chest burns. Morale remains high as the patient and his fellows can smell only eueol and cannot see the burn, as in the case of the irrigation envelope. When a change of dressing is required the gauze can be removed without any pain or bleeding from granulating areas.
I haveused this method for infected burns with eusol and hypochlorite combined with chemotherapy, and have found it entirely satisfactory. N. J. BLOCKEY. Aden Protectorate Levies Hospital. --
-
--