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A PLASTIC APPROACH TO SURGERY
223 and corresponds with that elapsing before the post-radiation mediastino-cardiac reaction of Blemenfeld and Thomasand Rose and Wolferth.4 It may well obscure a relationship that " " is commoner than either radiotherapists or the neighbours realise. Whittington Hospital, London, N.19.
As with their material, necropsy has revealed no changes in the spinal cord, its coverings, or nerve-roots which could be attributed specifically to the effect of the injected material. However, 4 patients had their spinal cords exposed at the site of injection within two to four weeks of the injection and each showed a marked localised arachnoiditis. Over a distance of about two inches the arachnoid was quite opaque and pink, and adherent to the dura and underlying structures, making exposure of the spinal cord tedious.
So far, no patient subjected to this form of treatment has developed signs suggestive of a progressive adhesive or obliterative arachnoiditis following the injection, but until a sufficient period of observation has been completed it would seem to be prudent to restrict the intrathecal use of carbolic acid dissolved in myodil to the relief of pain of malignant disease. ALLAN S. BROWN.
A PLASTIC APPROACH TO SURGERY
SIR,-It is surprising that Mr. Heanley (Jan. 11) as a plastic surgeon should advocate the making of incisions in the direction of Langer’s lines; for in the face, where the best cosmetic result is particularly desirable, the line of election for a scar bears no relation to Langer’s lines. As Le Gros Clark5 has pointed out: "... with the movements of facial expression, flexure lines appear in the skin at right angles to the pull of the fibres of muscles. In other words, their pattern is determined by the arrangement of the underlying musculature. With advancing age, as the result of the progressive loss of the elasticity of the skin, these creases become established as permanent wrinkles."
momentarily
cutaneous
The illustrations of Kraisse6 have shown convincingly that points the direction of the lines of election and that of Langer’s lines are at complete variance and it would appear that when they do coincide this is quite fortuitous. at many
The continued lip-service paid to Langer’s lines in surgical textbooks would suggest that these facts
most
are not
widely enough appreciated.
Royal Infirmary, Glasgow.
JAMES COUPER BRASH M.C., M.A., M.B. Edin., M.D. Birm., LL.D. St. And., D.Sc. Leeds,
H. E. S. PEARSON.
INTRATHECAL PHENOL FOR INTRACTABLE PAIN SIR,-The report by Dr. Nathan and Dr. Scott in your issue of Jan. 11 corresponds closely with the results obtained during the past year in Edinburgh using a 71/2 % phenol-’Myodil’ solution.
Department of Surgical Neurology, Royal Infirmary, Edinburgh.
Obituary
IAN A. McGREGOR.
CHRISTMAS QUIZ DR. N. HOWARD-JONES writes: "Supplementing Dr. Gurney Smith’s correction (Jan. 4, p. 58) to the excellent Christmas Quiz provided by Dr. Ffrangcon Roberts, I would point out that the St. Bartholomew’s Hospital Reports of (as far as I recollect) the 1870s contain a most amusing article by Robert Bridges on the casualty department of his hospital. The answers to the quiz contain another slip: ’Jesuits’ bark’ was not quinine, but the bark from which quinine and other cinchona alkaloids were subseauentlv isolated." 3. Blemenfeld, H., Thomas, S. F. Radiology, 1945, 44, 335. 4. Rose, E., Wolferth, C. C. J. Amer. med. Ass. 1941, 116, 2648. 5. Le Gros Clark, W. E. The Tissues of the Body; p. 277. Oxford, 1945. 6. Kraisse, C. J., Plast. reconstr. Surg. 1951, 8, 1.
F.R.C.S.E.
Emeritus Professor Brash died at his home in Edinburgh on Jan. 19, at the age of 71. He was one of the great figures and personalities in British anatomy, and his death will cause many practitioners of medicine the world over to feel a deep sense of personal loss. He was born in Helensburgh, and was educated at George Watson’s College and Edinburgh University where he entered on an arts course. The knowledge of literature, philosophy, and Latin that he then gained formed the basis for his own philosophy of life. He recommended others to cultivate, as he himself certainly did, the tranquil mind, the quality of imperturbability and calmness in times of emergency. These indeed formed the theme of his promoter’s address to the new graduates in medicine in Edinburgh in 1940. After graduating M.A., Brash entered on a combined science and medical course in which he distinguished himself in many subjects and extracurricular activities. He was prominent in several student societies and became senior president of the Students’ Representative Council. After graduating M.B. in 1910 he became house-physician in Edinburgh Royal Infirmary to the late Sir Thomas Fraser. In 1911 he joined the anatomy department of Edinburgh University as a demonstrator under the late Prof. D. J. Cunningham-and this connection was always a matter of pride to him. From Edinburgh he moved to the anatomy department at Leeds, but in 1914 he joined the R.A.M.C., and while with it served in France and Belgium, attained the rank of major, and was awarded the M.C. Returning to academic life he was later translated to Birmingham, where he became professor of anatomy and dean of the faculty of medicine. He was responsible for the planning of many of the developments that led to the formation of the new Medical School in Birmingham, and for such responsibility he was eminently well qualified. He succeeded Prof. Arthur Robinson in the chair of anatomy at Edinburgh University in 1931, and for 23 years he laboured ungrudgingly and without stint for his alma mater. His lectures were always most carefully prepared expositions of the subject with which he was dealing, and on occasions he was carried away by his own enthusiasm. He and the late Dr. E. B. Jamieson established a close and firm friendship that matured over the years, and they were co-editors of the 7th and 8th editions of Cunningham’s Text-book of Anatomy and also were co-editors of two editions of Cunningham’s Manual of Practical Anatomy. The last editions of the manual were, however, entirely Brash’s work, and he was also sole editor of the most recent edition of the textbook.
His main scientific interest was the development and of bone, and his Struthers lecture on the subject in 1933 to the Royal College of Surgeons of Edinburgh is now regarded as a classical study. Much of his original work was associated with the growth of the jaws and palate, and he had a particular interest in the xtiology of irregularity and malocclusion of the teeth. The mechanism involved in the movement of the teeth during growth of the jaws always fascinated him and his madder preparations threw great light on the subject. His eminence as an anatomist was recognised by the Anatomical Society when he was elected president for 1945-47 and also by the Universities of St. Andrews and Leeds from which he received honorary degrees. His anatomical skill was brought to the notice of the general public through his researches and meticulous work in connection with the
growth
As with their material, necropsy has revealed no changes in the spinal cord, its coverings, or nerve-roots which could be attributed specifically to the effect of the injected material. However, 4 patients had their spinal cords exposed at the site of injection within two to four weeks of the injection and each showed a marked localised arachnoiditis. Over a distance of about two inches the arachnoid was quite opaque and pink, and adherent to the dura and underlying structures, making exposure of the spinal cord tedious.
So far, no patient subjected to this form of treatment has developed signs suggestive of a progressive adhesive or obliterative arachnoiditis following the injection, but until a sufficient period of observation has been completed it would seem to be prudent to restrict the intrathecal use of carbolic acid dissolved in myodil to the relief of pain of malignant disease. ALLAN S. BROWN.
A PLASTIC APPROACH TO SURGERY
SIR,-It is surprising that Mr. Heanley (Jan. 11) as a plastic surgeon should advocate the making of incisions in the direction of Langer’s lines; for in the face, where the best cosmetic result is particularly desirable, the line of election for a scar bears no relation to Langer’s lines. As Le Gros Clark5 has pointed out: "... with the movements of facial expression, flexure lines appear in the skin at right angles to the pull of the fibres of muscles. In other words, their pattern is determined by the arrangement of the underlying musculature. With advancing age, as the result of the progressive loss of the elasticity of the skin, these creases become established as permanent wrinkles."
momentarily
cutaneous
The illustrations of Kraisse6 have shown convincingly that points the direction of the lines of election and that of Langer’s lines are at complete variance and it would appear that when they do coincide this is quite fortuitous. at many
The continued lip-service paid to Langer’s lines in surgical textbooks would suggest that these facts
most
are not
widely enough appreciated.
Royal Infirmary, Glasgow.
JAMES COUPER BRASH M.C., M.A., M.B. Edin., M.D. Birm., LL.D. St. And., D.Sc. Leeds,
H. E. S. PEARSON.
INTRATHECAL PHENOL FOR INTRACTABLE PAIN SIR,-The report by Dr. Nathan and Dr. Scott in your issue of Jan. 11 corresponds closely with the results obtained during the past year in Edinburgh using a 71/2 % phenol-’Myodil’ solution.
Department of Surgical Neurology, Royal Infirmary, Edinburgh.
Obituary
IAN A. McGREGOR.
CHRISTMAS QUIZ DR. N. HOWARD-JONES writes: "Supplementing Dr. Gurney Smith’s correction (Jan. 4, p. 58) to the excellent Christmas Quiz provided by Dr. Ffrangcon Roberts, I would point out that the St. Bartholomew’s Hospital Reports of (as far as I recollect) the 1870s contain a most amusing article by Robert Bridges on the casualty department of his hospital. The answers to the quiz contain another slip: ’Jesuits’ bark’ was not quinine, but the bark from which quinine and other cinchona alkaloids were subseauentlv isolated." 3. Blemenfeld, H., Thomas, S. F. Radiology, 1945, 44, 335. 4. Rose, E., Wolferth, C. C. J. Amer. med. Ass. 1941, 116, 2648. 5. Le Gros Clark, W. E. The Tissues of the Body; p. 277. Oxford, 1945. 6. Kraisse, C. J., Plast. reconstr. Surg. 1951, 8, 1.
F.R.C.S.E.
Emeritus Professor Brash died at his home in Edinburgh on Jan. 19, at the age of 71. He was one of the great figures and personalities in British anatomy, and his death will cause many practitioners of medicine the world over to feel a deep sense of personal loss. He was born in Helensburgh, and was educated at George Watson’s College and Edinburgh University where he entered on an arts course. The knowledge of literature, philosophy, and Latin that he then gained formed the basis for his own philosophy of life. He recommended others to cultivate, as he himself certainly did, the tranquil mind, the quality of imperturbability and calmness in times of emergency. These indeed formed the theme of his promoter’s address to the new graduates in medicine in Edinburgh in 1940. After graduating M.A., Brash entered on a combined science and medical course in which he distinguished himself in many subjects and extracurricular activities. He was prominent in several student societies and became senior president of the Students’ Representative Council. After graduating M.B. in 1910 he became house-physician in Edinburgh Royal Infirmary to the late Sir Thomas Fraser. In 1911 he joined the anatomy department of Edinburgh University as a demonstrator under the late Prof. D. J. Cunningham-and this connection was always a matter of pride to him. From Edinburgh he moved to the anatomy department at Leeds, but in 1914 he joined the R.A.M.C., and while with it served in France and Belgium, attained the rank of major, and was awarded the M.C. Returning to academic life he was later translated to Birmingham, where he became professor of anatomy and dean of the faculty of medicine. He was responsible for the planning of many of the developments that led to the formation of the new Medical School in Birmingham, and for such responsibility he was eminently well qualified. He succeeded Prof. Arthur Robinson in the chair of anatomy at Edinburgh University in 1931, and for 23 years he laboured ungrudgingly and without stint for his alma mater. His lectures were always most carefully prepared expositions of the subject with which he was dealing, and on occasions he was carried away by his own enthusiasm. He and the late Dr. E. B. Jamieson established a close and firm friendship that matured over the years, and they were co-editors of the 7th and 8th editions of Cunningham’s Text-book of Anatomy and also were co-editors of two editions of Cunningham’s Manual of Practical Anatomy. The last editions of the manual were, however, entirely Brash’s work, and he was also sole editor of the most recent edition of the textbook.
His main scientific interest was the development and of bone, and his Struthers lecture on the subject in 1933 to the Royal College of Surgeons of Edinburgh is now regarded as a classical study. Much of his original work was associated with the growth of the jaws and palate, and he had a particular interest in the xtiology of irregularity and malocclusion of the teeth. The mechanism involved in the movement of the teeth during growth of the jaws always fascinated him and his madder preparations threw great light on the subject. His eminence as an anatomist was recognised by the Anatomical Society when he was elected president for 1945-47 and also by the Universities of St. Andrews and Leeds from which he received honorary degrees. His anatomical skill was brought to the notice of the general public through his researches and meticulous work in connection with the
growth