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IMMEDIATE SKIN-GRAFT FOR MASTECTOMY
257 cular rates may follow the reduction of vagal tone. It would appear that a similar hazard may complicate therapy with procaine amide, since its paralytic effect on the vagus seems to
be
equally definite, rendering previous digitalisation
advisable whenever it is used for auricular flutter.
In the
case described here, previous administration of obscured the effect of procaine amide on the vagus until pressure on the carotid sinus revealed that the pathway was interrupted.
digitalis
I should like to thank Dr. A. L. describe this case. Fulham Hospital,
Wyman for permission
to
G. H. HALL.
London, W.6.
that the flap should be obtained from the anterior surface of the axillary fold. I think this is immaterial provided the original incision is carried well medial to the anterior axillary fold, thereby preventing the scar from crossing the axilla and leading to contractures. I have also found it easier to scrape the piece of skin which is to be taken as a graft in situ when it can be stretched more conveniently. It is then cut and transferred to the centre of the wound and sutured under tension to the edges of the defect. If the graft is inspected after two or three days it will be found to be discoloured and to have turned a dark purple. The superficial epithelium will peel off, but the main thickness of the graft survives and a new epithelial covering soon
develops.
A SHORT WAY WITH TÆNIA SAGINATA
SiR,-Dr. Seaton has described the
of dichlorophen for the quick cure of patients infested with Tee-my saginata.1 This method was introduced in South Africa about five years ago and is the standard treatment in most mine and provincial hospitals in the Witwatersrand and Pretoria areas. Port Elizabeth, R. E. HOLMES. use
South Africa.
Finally the advantages of this method of closure of difficult mastectomy wounds are twofold : (a) it is very simple and it seems that complete success can be expected in most cases ; (b) even if the graft fails it enables one to keep the flaps of the wound much more closely approximated, and the area to be Thierschgrafted eventually is only a fraction of what it would have been. C. BRUN. Salford Royal Hospital.
A NEW CLINICAL ENTITY ? we have had two outbreaks of a disease entity very closely resembling those described in your leader of May 26 under groups two and three. The first outbreak occurred in Tallahassee in the fall of 1954. A total of 463 cases were reported over a two-month period, with an attack-rate of 760.4 per 100,000 population. The disease was highly selective for married white women. This last spring an outbreak with almost identical clinical features occurred in the small community of Punta Gorda. 150 cases occurred over a period of three months, giving an attack-rate of 3750 per 100,000 population. This also was selective for married white women. The clinical findings were severe muscular pain, disturbances of coordination, transient paresis and parsesthesia, and disturbances of mood and mentation, without serious illness or death, but with a notable tendency to relapse and prolonged convalescence. We concluded that these two outbreaks represented the same entity. The cerebrospinal fluid was consistently normal, as were other routine blood and urine tests. Extensive virological and serological studies were consistently negative. We have been calling this syndrome, for want of a better name, Iceland disease or infectious encephalomyelitis ; but we shall be pleased to use the term " benign myalgic encephalomyelitis," if its general acceptance will aid further description of this puzzling disorder. JAMES O. BOND Florida State Board of Health,
Parliament
SiR,-In Florida
Jacksonville.
Epidemiologist.
IMMEDIATE SKIN-GRAFT FOR MASTECTOMY SiR,ŇIread last week’s letter by Mr. Gardiner and Mr. Roy with great interest. By sheer coincidence I
had just concluded a radical mastectomy and inserted a free full-thickness graft, when on opening The Lancet I saw the very method I had just used described in detail. I started using this method some three or four months ago, having been struck by the good results obtained from free full-thickness grafts in cases of advanced Dupuytren’s contracture. I have now done three cases. The first had 100% take ; the second one needed a small Thiersch graft to complete healing ; the third one has just been operated upon as stated above. The technique which has been employed differs only in minor details from that reported by Mr. Gardiner and -Air. Roy. I have left it until the end of the operation before the graft and have taken it from the redundant posterior flap in the axilla. Mr. Gardiner and Mr. Roy stressed
cutting
1.
Seaton, D. R.
Lancet, 1956, i, 808.
QUESTION TIME Hospital Priorities Mr. J. J. ASTOR asked the Minister of Health what representations had been received by the South West Regional Hospital Board over the last eight years from the hospital management committee and medical staff about the inadequate and dangerous conditions in the operating-theatre at the South Devon and East Cornwall Hospital, Greenbank, Plymouth.Mr. R. H. TURTON replied : The board received five representations from the committee ; the earliest was in April, 1950, and the most recent in January, 1955. The committee, however, recommended higher priority for two other capital schemes in their group. Mr. AsTOR: In view of the unfortunate circumstances in this case, will the Minister, in other similar cases, consider intervening when medical opinion is in conflict with that of the hospital management committee ? Can he ensure that the hospital management committee publishes the reasons why it did not give priority for the rebuilding of this operating-theatre ?-Mr. TURTON : It is clear that the committee took the view that the maternity unit was even worse than the operating-theatre. That is why the maternity unit is already being attended to. I have now It was received a proposal for a new operating-theatre. submitted to me on June 19, and I approved the preparation of sketch plans on July 23. The work will go forward in due course.
Detention of Mental Patients Mr. A. BLENKINSOP asked the Minister how many of the neglected persons whose cases have been reviewed were still retained in mental institutions and under what authority.Miss P. HORNSBY-SMITH replied : Of the cases reviewed, 2172 institutions on the are still detained in mental-deficiency authority of orders made by judicial authorities under the provisions of the Mental Deficiency Acts. Mr. BLENKINSOP : Do I understand that in these cases fresh legal powers have been obtained for continued detention, and that the Minister is no longer relying on powers which he considered adequate in the past but which court action has proved not to be adequate ?-Miss HORNSBY-SMITH : No. The order of the judicial authority constitutes proper legal authority for the detention of the patient, unless and until it is set aside by a court of law. It should not be assumed that all the orders made by judicial authorities would necessarily be set aside if challenged. The review is, however, continuing.
St.
George-in-the-East Hospital, Wapping
Mr. W. J. EDWARDS asked the Minister what decision he had now reached on the proposal by the North East Metropolitan Regional Hospital Board to close down the St. Georgein-the-East Hospital, Wapping, E.I.—Mr. TURTON replied : I am today approving the proposal, subject to the proviso that the hospital shall not be closed before Sept. 30, 1956.
be
equally definite, rendering previous digitalisation
advisable whenever it is used for auricular flutter.
In the
case described here, previous administration of obscured the effect of procaine amide on the vagus until pressure on the carotid sinus revealed that the pathway was interrupted.
digitalis
I should like to thank Dr. A. L. describe this case. Fulham Hospital,
Wyman for permission
to
G. H. HALL.
London, W.6.
that the flap should be obtained from the anterior surface of the axillary fold. I think this is immaterial provided the original incision is carried well medial to the anterior axillary fold, thereby preventing the scar from crossing the axilla and leading to contractures. I have also found it easier to scrape the piece of skin which is to be taken as a graft in situ when it can be stretched more conveniently. It is then cut and transferred to the centre of the wound and sutured under tension to the edges of the defect. If the graft is inspected after two or three days it will be found to be discoloured and to have turned a dark purple. The superficial epithelium will peel off, but the main thickness of the graft survives and a new epithelial covering soon
develops.
A SHORT WAY WITH TÆNIA SAGINATA
SiR,-Dr. Seaton has described the
of dichlorophen for the quick cure of patients infested with Tee-my saginata.1 This method was introduced in South Africa about five years ago and is the standard treatment in most mine and provincial hospitals in the Witwatersrand and Pretoria areas. Port Elizabeth, R. E. HOLMES. use
South Africa.
Finally the advantages of this method of closure of difficult mastectomy wounds are twofold : (a) it is very simple and it seems that complete success can be expected in most cases ; (b) even if the graft fails it enables one to keep the flaps of the wound much more closely approximated, and the area to be Thierschgrafted eventually is only a fraction of what it would have been. C. BRUN. Salford Royal Hospital.
A NEW CLINICAL ENTITY ? we have had two outbreaks of a disease entity very closely resembling those described in your leader of May 26 under groups two and three. The first outbreak occurred in Tallahassee in the fall of 1954. A total of 463 cases were reported over a two-month period, with an attack-rate of 760.4 per 100,000 population. The disease was highly selective for married white women. This last spring an outbreak with almost identical clinical features occurred in the small community of Punta Gorda. 150 cases occurred over a period of three months, giving an attack-rate of 3750 per 100,000 population. This also was selective for married white women. The clinical findings were severe muscular pain, disturbances of coordination, transient paresis and parsesthesia, and disturbances of mood and mentation, without serious illness or death, but with a notable tendency to relapse and prolonged convalescence. We concluded that these two outbreaks represented the same entity. The cerebrospinal fluid was consistently normal, as were other routine blood and urine tests. Extensive virological and serological studies were consistently negative. We have been calling this syndrome, for want of a better name, Iceland disease or infectious encephalomyelitis ; but we shall be pleased to use the term " benign myalgic encephalomyelitis," if its general acceptance will aid further description of this puzzling disorder. JAMES O. BOND Florida State Board of Health,
Parliament
SiR,-In Florida
Jacksonville.
Epidemiologist.
IMMEDIATE SKIN-GRAFT FOR MASTECTOMY SiR,ŇIread last week’s letter by Mr. Gardiner and Mr. Roy with great interest. By sheer coincidence I
had just concluded a radical mastectomy and inserted a free full-thickness graft, when on opening The Lancet I saw the very method I had just used described in detail. I started using this method some three or four months ago, having been struck by the good results obtained from free full-thickness grafts in cases of advanced Dupuytren’s contracture. I have now done three cases. The first had 100% take ; the second one needed a small Thiersch graft to complete healing ; the third one has just been operated upon as stated above. The technique which has been employed differs only in minor details from that reported by Mr. Gardiner and -Air. Roy. I have left it until the end of the operation before the graft and have taken it from the redundant posterior flap in the axilla. Mr. Gardiner and Mr. Roy stressed
cutting
1.
Seaton, D. R.
Lancet, 1956, i, 808.
QUESTION TIME Hospital Priorities Mr. J. J. ASTOR asked the Minister of Health what representations had been received by the South West Regional Hospital Board over the last eight years from the hospital management committee and medical staff about the inadequate and dangerous conditions in the operating-theatre at the South Devon and East Cornwall Hospital, Greenbank, Plymouth.Mr. R. H. TURTON replied : The board received five representations from the committee ; the earliest was in April, 1950, and the most recent in January, 1955. The committee, however, recommended higher priority for two other capital schemes in their group. Mr. AsTOR: In view of the unfortunate circumstances in this case, will the Minister, in other similar cases, consider intervening when medical opinion is in conflict with that of the hospital management committee ? Can he ensure that the hospital management committee publishes the reasons why it did not give priority for the rebuilding of this operating-theatre ?-Mr. TURTON : It is clear that the committee took the view that the maternity unit was even worse than the operating-theatre. That is why the maternity unit is already being attended to. I have now It was received a proposal for a new operating-theatre. submitted to me on June 19, and I approved the preparation of sketch plans on July 23. The work will go forward in due course.
Detention of Mental Patients Mr. A. BLENKINSOP asked the Minister how many of the neglected persons whose cases have been reviewed were still retained in mental institutions and under what authority.Miss P. HORNSBY-SMITH replied : Of the cases reviewed, 2172 institutions on the are still detained in mental-deficiency authority of orders made by judicial authorities under the provisions of the Mental Deficiency Acts. Mr. BLENKINSOP : Do I understand that in these cases fresh legal powers have been obtained for continued detention, and that the Minister is no longer relying on powers which he considered adequate in the past but which court action has proved not to be adequate ?-Miss HORNSBY-SMITH : No. The order of the judicial authority constitutes proper legal authority for the detention of the patient, unless and until it is set aside by a court of law. It should not be assumed that all the orders made by judicial authorities would necessarily be set aside if challenged. The review is, however, continuing.
St.
George-in-the-East Hospital, Wapping
Mr. W. J. EDWARDS asked the Minister what decision he had now reached on the proposal by the North East Metropolitan Regional Hospital Board to close down the St. Georgein-the-East Hospital, Wapping, E.I.—Mr. TURTON replied : I am today approving the proposal, subject to the proviso that the hospital shall not be closed before Sept. 30, 1956.