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NASAL RECONSTRUCTION: THE TUBED PEDICLE FLAP
1132 infectious diseases by the bacterial toxins I induced artificially by intramuscular injections of milk (5-10 c.cm.) or of bacterial proteins such as Omnadin or Stormin (Austrian Serum Works). This immunising stimulus, combined with the osmotic stimulus of the dextrose proved sufficient to abort the attack in about 70 per cent. of the cases of lobar pneumonia, typhoid, erysipelas, and Bang’s fever. Whenever possible we adminster early in pneumonia and before the fifteenth day in typhoid a dose of albumin intramuscularly, and 20 hours later 20 c.cm. of 50 percent. dextrose solution with 0-25 mg. strych. nitr. intravenously. In pneumonia fever and pain disappear by the fourth or fifth day after the beginning of this treatment. In typhoid the swelling of the spleen and the abdominal symptoms yield as a rule within four days, the patient becoming afebrile by the sixth day. I have published temperature curves of such cases (Wien. med. Woch., 1931, lxxxi., 254) and Dr. Reinthaller has recently recorded his observations on 160 cases of pneumonia at the St. Poltner Hospital (Ars Medici, 1934, p. 512). He confirms the quick and sometimes astonishing effect. Pneumonia of the epidemic kind commonly known as influenza (Grippe) reacts less or not at all. Of 90 typhoid cases in my private practice and in hospital I lost only two, one from hyperpyrexia (? after insolation), the other after operation for a wrongly supposed perforation. In the longer cases it was necessary to inject osmon two or three times. Since there is no actual shock this treatment can be carried out at the patient’s home if nursing is available. I am, Sir, yours faithfully, KARL STEJSKAL.
the second
I am,
Harrogate,
Sir, yours faithfully,
May 6th.
JAMES G. MACASKIE.
SUPPLEMENTS TO THE DIET OF CHILDREN
To the Editor
ofTHE LANCET SiR,-The report recently published by Mr. T. W. Simpson and Mr. Eric C. Wood on the value of supplements to the ordinary mixed diet of children, which is annotated in THE LANCET, May 4th, shows
NASAL RECONSTRUCTION: THE TUBED PEDICLE FLAP
To the Editor
of THE LANCET SIR,—In reply to Dr. Aymard, I have nothing to add to what you published in the correspondence columns of THE LANCET in August, 1920, in reply to a similar claim by him ; except to draw his attention to my recent publication re the tubed pedicle in Surgery, Gyncacology and Obstetrics in which priority of publication of this flap is given to Filatoff. With regard to the stirrup flap mentioned by Dr. Aymard, I would refer him to Tripier’s operation published in the Revue de Chirurgie, No. 4, 1890. I am, Sir, yours faithfully, H. D. GILLIES.
MATERNAL MORTALITY
of THE
well advanced, stating that if
were weakened and the labour There was often great difficulty in making and friends believe this. In using forceps I felt I was acting more safely if my patient was fully conscious, for she would easily show when they hurt her, howev6r gently they were applied. After they were in position she got more chloroform, though in very small amounts. I am therefore in accord with Mr. Eardley Holland on all these points. Nature does the work best, and is much to be pre. ferred to instrumental aid with its risk of injuries to the soft parts. In a busy practice one is often tempted to bring the case to an end, but the question should always be what is best for the patient.
Spital der Barmherzigen Briider, Vienna, May 3rd.
To the Editor
was
given prolonged. the patient
--
Harley-street, W., May 3rd.
stage
earlier the pains
LANCET
SIR,—Mr. Eardley Holland’s address to the Royal Sanitary Institute published in your issue of April 27th is most valuable. It is a long time since-in the middle ’seventies-I studied midwifery in Edinburgh under Matthews Duncan who impressed upon uss that " festina lente " was to be our guiding motto when attending an expectant mother. For more than 30 years I had a country practice with an average of one confinement a week, 50 miles away from a hospital, and not within easy reach of a medical friend. For some years there were no nurses-only friendly neighbours too eager to be of help, who never learned to understand why I wished my patient not to bear down in the early stage. In tedious cases I was often urged by relatives to use instruments and bring the delivery to an end. This I always resisted, and I gave no chloroform until
that such mixed diet is deficient at any rate in those factors which make for increased growth. The authors’ other conclusions cannot however be accepted without criticism. In the first place, they use as a criterion the weight increase during the six weeks during which each supplement is being given. Since growth-factors, whatever their chemical nature, continue to exert their influence for varying periods after they are withdrawn from the diet, it is doubtful if the precaution of giving the different diets in rotation for periods as short as six weeks balances this error. A state of nutrition, as Dr. Magee has recently emphasised, is dynamic, not static, and sufficient time must be allowed for each factor to exert its influence after the effects of the previous one have worn off. In the second place, the authors conclude that because a calorie" supplement (vitamin content unstated and unknown) produced better growth than either cod-liver oil or halibllt-liver oil and milk, that " balanced calories " are of greater benefit to the child than " vitamins." Since two of the supplements supplied only vitamins A and D, and the third, containing malt, egg, and lemon juice, presumably contained small quantities of the B complex and C in addition, such a sweeping conclusion scarcely seems justified. Vitamins do not fall into a chemical group, and it is as unreasonable to speak of " vitamins " meaning A and D as, for example, of " minerals " meaning only calcium and phosphorus and disregarding iron. The impression cannot be avoided that different results might have been obtained had the growth factors of the B complex been considered in addition to vitamins A and D. I am, Sir, yours faithfully, Wembley Park, Middlesex, May 7th. M. D. WRIGHT.
clearly
"
PUTNEY HOSPITAL.-Princess Arthur of Connaught visited this hospital last week and opened the new nurses’ home. Extensions at the hospital have cost 30,000, and there is still a debt of £8000. OSWESTRY COTTAGE HOSPITAL.-A
new
cottage
is required at Oswestry, and a scheme has been launched for building it at a cost of £20,000. An effort is being made to raise a 10,000 shilling fund.
hospital
the second
I am,
Harrogate,
Sir, yours faithfully,
May 6th.
JAMES G. MACASKIE.
SUPPLEMENTS TO THE DIET OF CHILDREN
To the Editor
ofTHE LANCET SiR,-The report recently published by Mr. T. W. Simpson and Mr. Eric C. Wood on the value of supplements to the ordinary mixed diet of children, which is annotated in THE LANCET, May 4th, shows
NASAL RECONSTRUCTION: THE TUBED PEDICLE FLAP
To the Editor
of THE LANCET SIR,—In reply to Dr. Aymard, I have nothing to add to what you published in the correspondence columns of THE LANCET in August, 1920, in reply to a similar claim by him ; except to draw his attention to my recent publication re the tubed pedicle in Surgery, Gyncacology and Obstetrics in which priority of publication of this flap is given to Filatoff. With regard to the stirrup flap mentioned by Dr. Aymard, I would refer him to Tripier’s operation published in the Revue de Chirurgie, No. 4, 1890. I am, Sir, yours faithfully, H. D. GILLIES.
MATERNAL MORTALITY
of THE
well advanced, stating that if
were weakened and the labour There was often great difficulty in making and friends believe this. In using forceps I felt I was acting more safely if my patient was fully conscious, for she would easily show when they hurt her, howev6r gently they were applied. After they were in position she got more chloroform, though in very small amounts. I am therefore in accord with Mr. Eardley Holland on all these points. Nature does the work best, and is much to be pre. ferred to instrumental aid with its risk of injuries to the soft parts. In a busy practice one is often tempted to bring the case to an end, but the question should always be what is best for the patient.
Spital der Barmherzigen Briider, Vienna, May 3rd.
To the Editor
was
given prolonged. the patient
--
Harley-street, W., May 3rd.
stage
earlier the pains
LANCET
SIR,—Mr. Eardley Holland’s address to the Royal Sanitary Institute published in your issue of April 27th is most valuable. It is a long time since-in the middle ’seventies-I studied midwifery in Edinburgh under Matthews Duncan who impressed upon uss that " festina lente " was to be our guiding motto when attending an expectant mother. For more than 30 years I had a country practice with an average of one confinement a week, 50 miles away from a hospital, and not within easy reach of a medical friend. For some years there were no nurses-only friendly neighbours too eager to be of help, who never learned to understand why I wished my patient not to bear down in the early stage. In tedious cases I was often urged by relatives to use instruments and bring the delivery to an end. This I always resisted, and I gave no chloroform until
that such mixed diet is deficient at any rate in those factors which make for increased growth. The authors’ other conclusions cannot however be accepted without criticism. In the first place, they use as a criterion the weight increase during the six weeks during which each supplement is being given. Since growth-factors, whatever their chemical nature, continue to exert their influence for varying periods after they are withdrawn from the diet, it is doubtful if the precaution of giving the different diets in rotation for periods as short as six weeks balances this error. A state of nutrition, as Dr. Magee has recently emphasised, is dynamic, not static, and sufficient time must be allowed for each factor to exert its influence after the effects of the previous one have worn off. In the second place, the authors conclude that because a calorie" supplement (vitamin content unstated and unknown) produced better growth than either cod-liver oil or halibllt-liver oil and milk, that " balanced calories " are of greater benefit to the child than " vitamins." Since two of the supplements supplied only vitamins A and D, and the third, containing malt, egg, and lemon juice, presumably contained small quantities of the B complex and C in addition, such a sweeping conclusion scarcely seems justified. Vitamins do not fall into a chemical group, and it is as unreasonable to speak of " vitamins " meaning A and D as, for example, of " minerals " meaning only calcium and phosphorus and disregarding iron. The impression cannot be avoided that different results might have been obtained had the growth factors of the B complex been considered in addition to vitamins A and D. I am, Sir, yours faithfully, Wembley Park, Middlesex, May 7th. M. D. WRIGHT.
clearly
"
PUTNEY HOSPITAL.-Princess Arthur of Connaught visited this hospital last week and opened the new nurses’ home. Extensions at the hospital have cost 30,000, and there is still a debt of £8000. OSWESTRY COTTAGE HOSPITAL.-A
new
cottage
is required at Oswestry, and a scheme has been launched for building it at a cost of £20,000. An effort is being made to raise a 10,000 shilling fund.
hospital