- Email: [email protected]
BRAIDED STAINLESS-STEEL WIRE
141 Services Council on the Reception and Welfare of Hospital There is something seriously In-Patients (para. 12). in a, man soeking to specialise, which a with system wrong who fails, through circumstances over which he has no control, to obtain consultant status, is more or less barred from general practice. In a public concern as large as the National Health Service the various branches of medicine (hospital, general practice, administration, &c.) need to be properly related: hence our suggestion that the whole question should be discussed at high level, to ensure complete
dovetailing. Dr. Forrester’s suggestion that registrars should be interchanged between hospital teaching centres and peripheral hospitals deserves careful consideration. But need we limit this proposal to registrarsIt would help still further if the same process were also applied to house-officers.
We would assure " Filius Terrse " (July 4) that we not content to sit angling on the pier, for we already know there are few fish to be caught. We are pushing out our boat to deeper waters in the hope of finding fish as good in the sea as ever came out ; but we realise that our bait is limited and would welcome suggestions for new bait to catch more mature fish. T. W. HURST C. B. LINFOOT T. K. WOODHOUSE. WOODIIOUSE. Wigan. are
A SIMPLE RESPIRATOR
SIR,—Stimulated by the article by Claus Bang1 we, in the Department of Anaesthetics, have tried to develop a device which would perform a function substantially similar to that of Bang’s device, but which could be made in a short time from components which are easy to get. The device serves, as does Claus Bang’s, so to control the outflow of compressed air from a source (such as a cylinder) that it may be used to inflate an apnoeic patient’s lungs to any desired distension, then allow them to deflate and pause for an adjustable period, before commencing inflation again. The component material is all of the sort which can be found in most hospitals, whether in workshop, laboratories, or operating-rooms, except for two Post Office Type 3000 relays of 400 or 500 ohms. These are widely used in 1. Lancet,
1953, i,
723
ordinary times can be obtained from radio suppliers and "junk shops." It takes about eight hours to assemble a respirator, working single-handed, but by some division of effort this time telephone exchanges
and in
be reduced. The photograph shows our crude first model. It can be, and 1) as been, modified and improved ; but we would like to stress that no precision work is involved and a bread-board " arrangement will work. With our the model of inflation can from be varied present pressure 0-5 cm. water up to 0-25 cm., and the rate of respiration from 30 per minute down to less than 5 per minute. It would be quite easy to alter the dimensions of the manometer if these limits were considered unsuitable. We have not been able to use the device on a patient with respiratory paralysis due to damage to the central nervous system ; but, using special precautions, we have employed it satisfactorily for the artificial respiration of It is ordinarily anæsthetised and curarised patients. unsuitable for this application since it does contain sparks. The device has also inflated rhythmically a rubber bag (see figure) for days on end, and, despite its crude construction, it seems reliable. If an emergency should arise similar to that which occurred in Denmark, it seems possible that this device might be useful. We have therefore prepared illustrated notes on our experience in constructing the respirator which would, we think, enable others to make it or, more probably, make an improved version. A very limited number of these notes is available, and if readers are interested in the device, we will try to send them a copy if they will get in touch with us.
can
"
Department of Anæsthetics, Anaesthetics, Medical School, Newcastle upon Tyne, 1. 1. E.
E. A. PASK. D ASK. A.
BRAIDED STAINLESS-STEEL WIRE
SIR,—In 1952, Hans and I drew attention to the
shortcomings of braided tantalum wire as abdominal incisions, and especially to the incidence of postoperative herniation and
suture for considerable troublesome sinus formation after its use.1 As a result of this communication, an American firm very kindly sent me some braided stainless-steel wire, and I obtained a further supply from a firm in England. After being assured that this material had none of the shortcomings of braided tantalum, I used it to sew up the rectus sheath after a number of abdominal operations. The endresults, however, have been disappointing. Several patients have developed persistent sinuses which needed exploration and removal of the wire and secondary suture. I cannot give the exact figures ; but in one hospital, out of a small total, we have so far had 4 fistule, 3 of which necessitated readmission of the patient to hospital. While I am still loyal to no. 36gauge monofilament stainless-steel wire, which has none of the short comings of the braided variety, I feel it my duty to point out to surgeons the dangers inherent in using braided stainless steel in the rectus sheath. The process of braiding is, in itself, sufficient to convert one of the best sutures we have into one of the worst. Study of the material removed at
the
a
exploratory
operations
that sinus formation is encouraged by fraying of small
suggests 1.
Howkins, J., Hans, S. F. Lancet, 1952, i, 949.
142 strands of the braided wire which then project up into the skin incision and form a track along which cutaneous organisms can travel. The chronic infective reaction thus started persists because of the presence of the non-absorbable steel suture. JOHN HOWKINS. London, W.1.
MÉNIÈRE’S DISEASE Mr. Miles Foxen (July 11) I read your SIR,—Like annotation of June 27 ; but I was not cast into despondency as I have had very encouraging results with most of my cases. I felt that your article, however, did not present an accurate picture of the benefits that can be obtained with modern treatment in a large proportion of cases of Meniere’s disease. I find that about 80% of my cases, if not entirely relieved, are largely improved by fluid and salt restriction and the use of vasodilator drugs. I have a number of miners able to continue their work on this regime ; some of these patients had been off work for months or years. In suitable cases I have found that cervical sympathectomy can produce dramatic relief of symptoms, but it is difficult to assess whether this will be permanent. It is a valuable procedure in unilateral cases with good cochlear function. Labyrinthectomy is a relatively minor procedure and of great value in the intractable unilateral The relief of the tinnitus in itself often alters the case. patient’s whole outlook on life. I feel that your annotation may do some harm if it persuades practitioners that we have no suitable therapy for relieving patients with this common and unpleasant affliction. PHILIP H. BEALES. Doncaster. STOOL FOR BEDPAN
SIR,—Correspondents have emphasised the undesirability of the common w.e. in gynsecological and maternity wards. At St. Mary’s Hospitals, Manchester, a stool for bedpan has been devised and has been in for The
time. accompanying figure shows this simple device, which has proved of great help in the wards. It holds use
some
PORTABLE MEASURING-BOARD FOR INFANTS SIR,—Between the inaccurate method of the tape. measure on the one hand and the cumbersome measuringtable on the other, there seemed to be no satisfactory method of measuring young infants in their own homes with apparatus that was simple, portable, and accurate. The measuring-board described here was designed to meet these requirements. The base consists of a piece of eight-ply wood about 1/2 in. thick and 3 ft. 6 in. long by 1 ft. 6 in. wide (fig. 1). The head end (P) and side supports (Q) are of five-ply wood about 3/8 in. thick ; the former measures 1 ft. 6 in. by 6 in., and the
Fig. I-The measuring-board.
latter extends 1 ft. along the base. Both the head end and side supports are screwed on to the base-board. The angle between the head end and the base-board must be a right-angle. Accuracy is required in marking out the board and the fixing of two 1-metre rules (X). A reference line NM is drawn down the centre of the’board (fig. 2), and continued vertically on the head-board (NL), care being taken that the angle E is a right-angle. In fixing the two 1-metre rules, attention must be paid to the following points : (1) a particular reading on each rule (e.g., 10 cm.) must lie
perpendicularly to a point 10 cm. along the line NM ;9 (2) the distances from the inside edge of each centimetre scale (K) to the reference line must be equal (i.e., CF = FD) ; (3) the two rules must be parallel to each other and the centre line. The rules are screwed into Fig. 2-Details of base. the base. The child is placed supine with the centre of the top of his head against the line LN. His mother keeps his head in contact by gentle, firm pressure, with a hand along each side of the head, care being taken that the tragion-orbitale plane is vertical. The measurer then holds down the child’s knees, to extend the legs and to keep the child along the axis NM. The wedge-shaped block of wood (fig. 1, Y), which has a vertical face, is firmly pressed against the child’s heels ; and the readings on the metric scales, at the point where the front of the block crosses the inner edge of each scale, are recorded. The average of these two is taken as the measure of the infant’s
length.
It is sturdy but the modern type of bedpan snugly. or sterilised, is washed, disinfected, easily portable, and is of a height (15½ in. to top of pan) to encourage easy and complete evacuation of the bowel in the average
adult. ’The stool
was
made for
10, Park Street, Leeds, 1. Ma,nchester.
.
us
by
Chas. F.
Thackray Ltd.,
A. F. C. DAVEY Lately clinical pathologist to St. Mary’s Hospitals.
In practice I take the average of four readings. I have used the board for measuring 100 children in their own homes, finding it easily portable and suitable for placing on any convenient surface, varying from the floor to a kitchen table. I would like to thank Dr. Frank Falkner for his helpful this apparatus, and Mr. P. G. Cull for
suggestions regarding his drawings.
Child Study Centre, Institutes of Education and Child Health,
’University of London. University
H B. HINDLEY. C. B S
dovetailing. Dr. Forrester’s suggestion that registrars should be interchanged between hospital teaching centres and peripheral hospitals deserves careful consideration. But need we limit this proposal to registrarsIt would help still further if the same process were also applied to house-officers.
We would assure " Filius Terrse " (July 4) that we not content to sit angling on the pier, for we already know there are few fish to be caught. We are pushing out our boat to deeper waters in the hope of finding fish as good in the sea as ever came out ; but we realise that our bait is limited and would welcome suggestions for new bait to catch more mature fish. T. W. HURST C. B. LINFOOT T. K. WOODHOUSE. WOODIIOUSE. Wigan. are
A SIMPLE RESPIRATOR
SIR,—Stimulated by the article by Claus Bang1 we, in the Department of Anaesthetics, have tried to develop a device which would perform a function substantially similar to that of Bang’s device, but which could be made in a short time from components which are easy to get. The device serves, as does Claus Bang’s, so to control the outflow of compressed air from a source (such as a cylinder) that it may be used to inflate an apnoeic patient’s lungs to any desired distension, then allow them to deflate and pause for an adjustable period, before commencing inflation again. The component material is all of the sort which can be found in most hospitals, whether in workshop, laboratories, or operating-rooms, except for two Post Office Type 3000 relays of 400 or 500 ohms. These are widely used in 1. Lancet,
1953, i,
723
ordinary times can be obtained from radio suppliers and "junk shops." It takes about eight hours to assemble a respirator, working single-handed, but by some division of effort this time telephone exchanges
and in
be reduced. The photograph shows our crude first model. It can be, and 1) as been, modified and improved ; but we would like to stress that no precision work is involved and a bread-board " arrangement will work. With our the model of inflation can from be varied present pressure 0-5 cm. water up to 0-25 cm., and the rate of respiration from 30 per minute down to less than 5 per minute. It would be quite easy to alter the dimensions of the manometer if these limits were considered unsuitable. We have not been able to use the device on a patient with respiratory paralysis due to damage to the central nervous system ; but, using special precautions, we have employed it satisfactorily for the artificial respiration of It is ordinarily anæsthetised and curarised patients. unsuitable for this application since it does contain sparks. The device has also inflated rhythmically a rubber bag (see figure) for days on end, and, despite its crude construction, it seems reliable. If an emergency should arise similar to that which occurred in Denmark, it seems possible that this device might be useful. We have therefore prepared illustrated notes on our experience in constructing the respirator which would, we think, enable others to make it or, more probably, make an improved version. A very limited number of these notes is available, and if readers are interested in the device, we will try to send them a copy if they will get in touch with us.
can
"
Department of Anæsthetics, Anaesthetics, Medical School, Newcastle upon Tyne, 1. 1. E.
E. A. PASK. D ASK. A.
BRAIDED STAINLESS-STEEL WIRE
SIR,—In 1952, Hans and I drew attention to the
shortcomings of braided tantalum wire as abdominal incisions, and especially to the incidence of postoperative herniation and
suture for considerable troublesome sinus formation after its use.1 As a result of this communication, an American firm very kindly sent me some braided stainless-steel wire, and I obtained a further supply from a firm in England. After being assured that this material had none of the shortcomings of braided tantalum, I used it to sew up the rectus sheath after a number of abdominal operations. The endresults, however, have been disappointing. Several patients have developed persistent sinuses which needed exploration and removal of the wire and secondary suture. I cannot give the exact figures ; but in one hospital, out of a small total, we have so far had 4 fistule, 3 of which necessitated readmission of the patient to hospital. While I am still loyal to no. 36gauge monofilament stainless-steel wire, which has none of the short comings of the braided variety, I feel it my duty to point out to surgeons the dangers inherent in using braided stainless steel in the rectus sheath. The process of braiding is, in itself, sufficient to convert one of the best sutures we have into one of the worst. Study of the material removed at
the
a
exploratory
operations
that sinus formation is encouraged by fraying of small
suggests 1.
Howkins, J., Hans, S. F. Lancet, 1952, i, 949.
142 strands of the braided wire which then project up into the skin incision and form a track along which cutaneous organisms can travel. The chronic infective reaction thus started persists because of the presence of the non-absorbable steel suture. JOHN HOWKINS. London, W.1.
MÉNIÈRE’S DISEASE Mr. Miles Foxen (July 11) I read your SIR,—Like annotation of June 27 ; but I was not cast into despondency as I have had very encouraging results with most of my cases. I felt that your article, however, did not present an accurate picture of the benefits that can be obtained with modern treatment in a large proportion of cases of Meniere’s disease. I find that about 80% of my cases, if not entirely relieved, are largely improved by fluid and salt restriction and the use of vasodilator drugs. I have a number of miners able to continue their work on this regime ; some of these patients had been off work for months or years. In suitable cases I have found that cervical sympathectomy can produce dramatic relief of symptoms, but it is difficult to assess whether this will be permanent. It is a valuable procedure in unilateral cases with good cochlear function. Labyrinthectomy is a relatively minor procedure and of great value in the intractable unilateral The relief of the tinnitus in itself often alters the case. patient’s whole outlook on life. I feel that your annotation may do some harm if it persuades practitioners that we have no suitable therapy for relieving patients with this common and unpleasant affliction. PHILIP H. BEALES. Doncaster. STOOL FOR BEDPAN
SIR,—Correspondents have emphasised the undesirability of the common w.e. in gynsecological and maternity wards. At St. Mary’s Hospitals, Manchester, a stool for bedpan has been devised and has been in for The
time. accompanying figure shows this simple device, which has proved of great help in the wards. It holds use
some
PORTABLE MEASURING-BOARD FOR INFANTS SIR,—Between the inaccurate method of the tape. measure on the one hand and the cumbersome measuringtable on the other, there seemed to be no satisfactory method of measuring young infants in their own homes with apparatus that was simple, portable, and accurate. The measuring-board described here was designed to meet these requirements. The base consists of a piece of eight-ply wood about 1/2 in. thick and 3 ft. 6 in. long by 1 ft. 6 in. wide (fig. 1). The head end (P) and side supports (Q) are of five-ply wood about 3/8 in. thick ; the former measures 1 ft. 6 in. by 6 in., and the
Fig. I-The measuring-board.
latter extends 1 ft. along the base. Both the head end and side supports are screwed on to the base-board. The angle between the head end and the base-board must be a right-angle. Accuracy is required in marking out the board and the fixing of two 1-metre rules (X). A reference line NM is drawn down the centre of the’board (fig. 2), and continued vertically on the head-board (NL), care being taken that the angle E is a right-angle. In fixing the two 1-metre rules, attention must be paid to the following points : (1) a particular reading on each rule (e.g., 10 cm.) must lie
perpendicularly to a point 10 cm. along the line NM ;9 (2) the distances from the inside edge of each centimetre scale (K) to the reference line must be equal (i.e., CF = FD) ; (3) the two rules must be parallel to each other and the centre line. The rules are screwed into Fig. 2-Details of base. the base. The child is placed supine with the centre of the top of his head against the line LN. His mother keeps his head in contact by gentle, firm pressure, with a hand along each side of the head, care being taken that the tragion-orbitale plane is vertical. The measurer then holds down the child’s knees, to extend the legs and to keep the child along the axis NM. The wedge-shaped block of wood (fig. 1, Y), which has a vertical face, is firmly pressed against the child’s heels ; and the readings on the metric scales, at the point where the front of the block crosses the inner edge of each scale, are recorded. The average of these two is taken as the measure of the infant’s
length.
It is sturdy but the modern type of bedpan snugly. or sterilised, is washed, disinfected, easily portable, and is of a height (15½ in. to top of pan) to encourage easy and complete evacuation of the bowel in the average
adult. ’The stool
was
made for
10, Park Street, Leeds, 1. Ma,nchester.
.
us
by
Chas. F.
Thackray Ltd.,
A. F. C. DAVEY Lately clinical pathologist to St. Mary’s Hospitals.
In practice I take the average of four readings. I have used the board for measuring 100 children in their own homes, finding it easily portable and suitable for placing on any convenient surface, varying from the floor to a kitchen table. I would like to thank Dr. Frank Falkner for his helpful this apparatus, and Mr. P. G. Cull for
suggestions regarding his drawings.
Child Study Centre, Institutes of Education and Child Health,
’University of London. University
H B. HINDLEY. C. B S