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BURNS AND SCALDS
809
The particular advantage of this method of treatment is its extreme simplicity, which eliminates all the discomforts and inconveniences of starvation and purging necessary when mepacrine or male-fern are used, and enables the patient to be treated in his home with little or no
interruption
Dichlorophen Messrs. May &
of his
was
activities.
ordinary
supplied by
Dr.
Robert
Forgan,
of
Baker Ltd.
Liverpool School of Tropical Medicine.
D. R. SEATON.
BURNS AND SCALDS
SIR,—The dermatologist, whose opinion is sometimes
sought by
a
surgical colleague,
will read with interest
and benefit your leader last week. Most
dermatologists, however,
would
disagree strongly
with this recommendation to the family doctor : " Before the development of blisters an anti-histamine ointment It is the experience of may minimise the reaction."
dermatologists that the anti-histamine rapidly displacing topical sulphonamides
ointments and peniof treatment-induced
many are
cillin as the commonest cause contact dermatitis. In those cases of burns which can be treated at home, or by a casualty department, a 1% greasy hydrocortisone ointment combined with neomycin is a pain-relieving and safe application. If used early it may prevent blister formation and should guard against secondary infection. It has proved to be a most useful first-aid application in a casualty department where dermatological advice was requested on this problem. PATRICK HALL-SMITH. Hove, Sussex. TREATMENT OF TETANUS
SIR,—Professor Lassen and his colleagues are to be commended for their interesting paper (April 28). It is only within recent years that cases of severe tetanus have survived long enough to exhibit bone-marrow depression, which has been reported in a number of recent papers. There are three factors that are most likely to be responsible : the tetanus toxin ; muscle relaxants ; and sedatives, including nitrous oxide. In their paper, Lassen et al. present us with some interesting, although inconclusive, evidence that nitrous oxide may be the causal
agent. This
problem can be elucidated attempting to separate these three reason, I wish to mention
infective
further factors.
only by
For this of a man, aged 49, with to be reported in full).
a case
polyneuritis (shortly
This patient received intermittent positive-pressure respiration for seventeen days until his own respiratory efforts were adequate. Throughout this period narcosis was maintained with nitrous oxide in concentrations varying from 50% to 75%, with oxygen. At no stage did his peripheral-blood counts exhibit any signs of bone-marrow depression.
I am sure that other workers may have similar cases where neither a toxin nor muscle relaxants need be considered. Such cases should be reported so that the dangers of nitrous oxide can be evaluated. Meanwhile, I feel that neither the muscle relaxants nor the tetanus toxin itself can be completely absolved as a cause of the bone-marrow depression reported in some recent cases of tetanus. Department of Anæsthesia, Royal Melbourne Hospital, Victoria, Australia.
PATRICIA WILSON.
Personal Papers TWENTY-THREE YEARS AFTER IN his essay on child guidance in Old Age,l Professor Mackintosh mentioned that in his early 40s he wrote himself a warning letter not to be opened until his 65th birthday. When that day came, he duly unsealed the envelope ; and this is what he found : 6th March, 1933. dear MACKINTOSH, I hesitate to call you by your Christian name, because I do not know you well enough. All the same, I think you may profit by a few words of friendly advice. Certain undesirable tendencies in your character and outlook are already apparent ; and I have little doubt that they will become more marked as you grow older. In the first place, you will become more talkative. Do try to curb this fault, because it is the early sign of unwillingness to learn from younger people. It will lead you to a final inability to learn anything. Try to be a good listener as you grow older : it is well worth your pains. But you must really listen-not just turn your head and make gestures which have become
My
automatic. do not get suspicious of people and their and avoid especially prying into the affairs of young folk, even on the plea (for self-justification) that you can help them. If they ask for help in time of trial, give it in full measure, but don’t imagine that the so-called wisdom acquired by you from experience will help them, unless they feel the need. They have to live their own lives. They have their souls to keep. Thirdly, do not try to attract sympathy to yourself. Do not pose as the dear old man, in the hope of hearing affectionate murmurs that you are young in spirit. For God’s sake be a real person, with a valuation that does not need artificial boosting. There are three qualities that you can develop as you grow older : they are courtesy, tolerance, and integrity, which together make an understanding spirit. By integrity I simply mean that wholeness of spirit that does not scour a narrow chamber. By tolerance I do not mean an easy-going acceptance of everything that is " done." I mean a mind that is still open : a capacity to understand the point of view of others, and especially of the younger ones ; a willingness to argue without acrimony, and yet with fire and spirit. By courtesy I mean the ability to put yourself in the place of other people. It is a rare and beautiful virtue, and it needs to be cherished
Secondly,
motives ;
continually. The main practical thing to remember, however, is that you are now sixty-five and on the point of retirement. For heaven’s sake retire and do not persuade yourself that you are a special case. If you have kept mind and body active, a world of new interests lies before you. If not, then you have no business to cling to office, or indeed to any voluntary or other service to which Do not rationalise by Clear out. you are attached. saying that you " want to see this thing through." That is just another barnacle argument ; what you really want to do is to cling. As we grow older, self-criticism tends to become blunted. I know of no better test than the one proposed by George Meredith : " You may estimate your capacity for comic perception by being able to detect the ridicule of them you love, without loving them less ; and more by being able to see yourself somewhat ridiculous in dear eyes, and accepting the correction their image of you proposes."
Now remember ... Yours
Mr. N. P. NEWTON, of Smith &
writes :
Nephew Ltd.,
With reference to the last paragraph of the letter last week from Mr. D. F. Thomas, it is not the intention of my company to withdraw from the market ’ Gypsona ’ or ’ Glassona.’ GypsonaExtra ’ polymer-reinforced plaster-of-paris bandages are complementary to our other splinting materials and not
necessarily
a
replacement.
-
faithfully,
[Sgd] JAMES M. MACKINTOSH.
RESIN-REINFORCED PLASTER CASTS
So he
replied briefly
,
to his earlier self : 20th February, 1956.
My dear MACKINTOSH, Many thanks for your letter of twenty-three years ago. I opened it, as you directed, on my sixty-fifth birthday. 1.
Lancet, 1947, i, 659.
The particular advantage of this method of treatment is its extreme simplicity, which eliminates all the discomforts and inconveniences of starvation and purging necessary when mepacrine or male-fern are used, and enables the patient to be treated in his home with little or no
interruption
Dichlorophen Messrs. May &
of his
was
activities.
ordinary
supplied by
Dr.
Robert
Forgan,
of
Baker Ltd.
Liverpool School of Tropical Medicine.
D. R. SEATON.
BURNS AND SCALDS
SIR,—The dermatologist, whose opinion is sometimes
sought by
a
surgical colleague,
will read with interest
and benefit your leader last week. Most
dermatologists, however,
would
disagree strongly
with this recommendation to the family doctor : " Before the development of blisters an anti-histamine ointment It is the experience of may minimise the reaction."
dermatologists that the anti-histamine rapidly displacing topical sulphonamides
ointments and peniof treatment-induced
many are
cillin as the commonest cause contact dermatitis. In those cases of burns which can be treated at home, or by a casualty department, a 1% greasy hydrocortisone ointment combined with neomycin is a pain-relieving and safe application. If used early it may prevent blister formation and should guard against secondary infection. It has proved to be a most useful first-aid application in a casualty department where dermatological advice was requested on this problem. PATRICK HALL-SMITH. Hove, Sussex. TREATMENT OF TETANUS
SIR,—Professor Lassen and his colleagues are to be commended for their interesting paper (April 28). It is only within recent years that cases of severe tetanus have survived long enough to exhibit bone-marrow depression, which has been reported in a number of recent papers. There are three factors that are most likely to be responsible : the tetanus toxin ; muscle relaxants ; and sedatives, including nitrous oxide. In their paper, Lassen et al. present us with some interesting, although inconclusive, evidence that nitrous oxide may be the causal
agent. This
problem can be elucidated attempting to separate these three reason, I wish to mention
infective
further factors.
only by
For this of a man, aged 49, with to be reported in full).
a case
polyneuritis (shortly
This patient received intermittent positive-pressure respiration for seventeen days until his own respiratory efforts were adequate. Throughout this period narcosis was maintained with nitrous oxide in concentrations varying from 50% to 75%, with oxygen. At no stage did his peripheral-blood counts exhibit any signs of bone-marrow depression.
I am sure that other workers may have similar cases where neither a toxin nor muscle relaxants need be considered. Such cases should be reported so that the dangers of nitrous oxide can be evaluated. Meanwhile, I feel that neither the muscle relaxants nor the tetanus toxin itself can be completely absolved as a cause of the bone-marrow depression reported in some recent cases of tetanus. Department of Anæsthesia, Royal Melbourne Hospital, Victoria, Australia.
PATRICIA WILSON.
Personal Papers TWENTY-THREE YEARS AFTER IN his essay on child guidance in Old Age,l Professor Mackintosh mentioned that in his early 40s he wrote himself a warning letter not to be opened until his 65th birthday. When that day came, he duly unsealed the envelope ; and this is what he found : 6th March, 1933. dear MACKINTOSH, I hesitate to call you by your Christian name, because I do not know you well enough. All the same, I think you may profit by a few words of friendly advice. Certain undesirable tendencies in your character and outlook are already apparent ; and I have little doubt that they will become more marked as you grow older. In the first place, you will become more talkative. Do try to curb this fault, because it is the early sign of unwillingness to learn from younger people. It will lead you to a final inability to learn anything. Try to be a good listener as you grow older : it is well worth your pains. But you must really listen-not just turn your head and make gestures which have become
My
automatic. do not get suspicious of people and their and avoid especially prying into the affairs of young folk, even on the plea (for self-justification) that you can help them. If they ask for help in time of trial, give it in full measure, but don’t imagine that the so-called wisdom acquired by you from experience will help them, unless they feel the need. They have to live their own lives. They have their souls to keep. Thirdly, do not try to attract sympathy to yourself. Do not pose as the dear old man, in the hope of hearing affectionate murmurs that you are young in spirit. For God’s sake be a real person, with a valuation that does not need artificial boosting. There are three qualities that you can develop as you grow older : they are courtesy, tolerance, and integrity, which together make an understanding spirit. By integrity I simply mean that wholeness of spirit that does not scour a narrow chamber. By tolerance I do not mean an easy-going acceptance of everything that is " done." I mean a mind that is still open : a capacity to understand the point of view of others, and especially of the younger ones ; a willingness to argue without acrimony, and yet with fire and spirit. By courtesy I mean the ability to put yourself in the place of other people. It is a rare and beautiful virtue, and it needs to be cherished
Secondly,
motives ;
continually. The main practical thing to remember, however, is that you are now sixty-five and on the point of retirement. For heaven’s sake retire and do not persuade yourself that you are a special case. If you have kept mind and body active, a world of new interests lies before you. If not, then you have no business to cling to office, or indeed to any voluntary or other service to which Do not rationalise by Clear out. you are attached. saying that you " want to see this thing through." That is just another barnacle argument ; what you really want to do is to cling. As we grow older, self-criticism tends to become blunted. I know of no better test than the one proposed by George Meredith : " You may estimate your capacity for comic perception by being able to detect the ridicule of them you love, without loving them less ; and more by being able to see yourself somewhat ridiculous in dear eyes, and accepting the correction their image of you proposes."
Now remember ... Yours
Mr. N. P. NEWTON, of Smith &
writes :
Nephew Ltd.,
With reference to the last paragraph of the letter last week from Mr. D. F. Thomas, it is not the intention of my company to withdraw from the market ’ Gypsona ’ or ’ Glassona.’ GypsonaExtra ’ polymer-reinforced plaster-of-paris bandages are complementary to our other splinting materials and not
necessarily
a
replacement.
-
faithfully,
[Sgd] JAMES M. MACKINTOSH.
RESIN-REINFORCED PLASTER CASTS
So he
replied briefly
,
to his earlier self : 20th February, 1956.
My dear MACKINTOSH, Many thanks for your letter of twenty-three years ago. I opened it, as you directed, on my sixty-fifth birthday. 1.
Lancet, 1947, i, 659.