- Email: [email protected]
PLASTIC SURGICAL DRESSINGS
1030
pressure-cooker out of old tin cans. suspected of being a at of cause fatigue great altitudes, where every drop part of moisture must be obtained by melting snow-a process laborious and expensive in fuel and therefore in manpower. Somehow or other the 1953 expedition managed to ensure an intake of 5-7 pints per man, compared with the single pint consumed by the Swiss in 1952. Since much of the fluid loss is by way of the lungs rather than the skin, loss of salt was a less serious problem and improvise
their
own
A low fluid intake has often been
easier to solve. We shall look forward to a more detailed discussion of the oxygen problem. That oxygen, given a suitable apparatus for its carriage, would be of inestimable benefit has never been doubted by serious physiologists. Whether it is necessary is another and more difficult matter. It has never been proved that man cannot reach the summit of Everest without it, and the arguments that he cannot which have lately been put forward (and rather mysteriously accepted without question) have been very specious. Five men have reached 28,000 feet without oxygen apparatus, and it is doubtful whether any of them were turned back by oxygen deficiency alone. That a ceiling exists is certain ; but we are not yet sure that it lies below 29,000 feet. This is one of the few puzzles which the 1953 expedition has left unsolved. PLASTIC SURGICAL DRESSINGS IDEALLT a dressing should be protective against bacteria and abrasion, flexible but tough, transparent, and permeable to water vapour. Furthermore it should be innocuous to tissue, it should not interfere with chemotherapeutic agents, and it should not be too costly. Flexible collodion forms a plastic, adhesive, and cheap dressing ; but on evaporation of the solvent it contracts, and furthermore it hermetically seals the wound. The various adhesive elastic dressings are either impermeable to moisture or irritating to skin, and they are opaque ; while adhesive cellulose tape does not allow evaporation of sweat, although it has been used for some purposesfor example, strapping umbilical hernia in infants.l Farquhar and Lewis2 suggested transparent ’Polythene ’ sheeting strapped over a window in a gauze swab as a dressing for transfusion wounds, so that the incision could be watched for sepsis without exposing it. More recently a partially hydrolysed casein gel has been used in the treatment of burns.3 The dressing forms an insoluble protective film of coagulum which is pliable and also semipermeable, permitting evaporation of water ; but it is not transparent. Polyvinyl plastic4 is being tested as a dressing which may be sprayed on burns from an aerosol can or pump. On evaporation of the solvent, it forms a tough, flexible, adhesive, and transparent film which is permeable to water vapour but not to bacteria. Experimental trials have been encouraging, but trials in man have not yet been reported. A plastic surgical dressing (’Bonoplast’) described at the conference of Scandinavian surgeons in June has aroused much interest. This substance is an acrylic resin dissolved in a mixture of acetic esters, and when spread thinly on the dry skin with a polythene applicator it forms in a matter of minutes a tough, transparent film which is permeable to moisture. The film is not injurious to tissue, and experimentally superficial wounds have healed more cleanly than in a control series where conventional gauze dressings were used. The solution is self-sterilising, and the resultant film impervious to bacteria ; surgeons have used it for preparing the operation field, making the incision through the dry film and then painting over the operative wound after sutures and clips are in position. The film eventually 1. Prince, G. E. J. Pediat. 1951, 39, 481. 2. Farquhar, J. W., Lewis, I. C. Lancet, 1948, ii, 244. 3. J. Amer. med. Ass. 1953, 152, 611. 4. Chou, D. S. J., Went, W. E. U.S. Forces med. J. 1952 3, 1241
flakes at the margins and can be stripped from the skin, removal being aided by spirit or benzene. Disadvantages are few. One is that the film will not adhere to a wet surface. The solvent is inflammable, but the dried film is not and may be cut with the diathermy knife. The solvent gives rise to temporary stinging in unansesthetised tissue, and there is a tendency for bleeding to be locally prolonged ; but this may be minimised by good hsemostasis and suturing. The dressing has much to commend it for certain fields-for example, herniotomies in infants -where the wound requires protection from local soiling. Because the dressing is pliable it may be used in the region of joints, and it has also proved satisfactory in facial work. It seems not to antagonise the antibiotics at the point of contact, and it has been suggested that an antibiotic might be incorporated in it. Finally, in these days of rising costs, it is of particular interest that Swedish hospitals carrying out trials have found a 6% saving in the cost of surgical dressings-not to speak of the very considerable economy in the nursing-staff’s time. The preparation of an aerosol means additional expense, but the simple applicator gives perfectly satisfactory results. Further trials are taking place both in Sweden and in the United Kingdom. ALCOHOLISM IN FRANCE ACCORDING to a W.H.O. report,’ France in 1945 had 1420 alcoholics with complications per 100,000 adults (a prevalence exceeded only in Switzerland with 1590, and Chile with 1497), while the total number of French alcoholics, with and without complications, per 100,000 adults was 2850, which was exceeded only in the U.S.A. with 3952. Rouvillois and Derobert2 find that in the present century there have been five well-defined phases: 1900 to 1914.-Alcoholism was rife, and the evils of absinthe contributed to its steady rise without any legislative restraint. 1914 to 1918.-Owing to the war, anti-liquor laws were passed. The manufacture and sale of absinthe was prohibited in 1915, the number of licensed premises was reduced in 1916, and drunkenness was suppressed in 1917-which resulted in a decrease in alcoholism to a level lower than had hitherto obtained. 1919 to 1939.-Legislation favouring the production of alcoholic drink was introduced as a result of pressure from the vested interests of the liquor trade ;the war-time laws were revoked and various new laws were introduced, such as that of 1922 allowing the manufacture of alcoholic drinks with an aniseed base, replacing the former absinthe ; various laws permitting the re-opening of licensed premises closed during the war and the opening of new ones ; and a law in 1931 giving exchequer aid to the advertisement of alcoholic drinks. During this phase alcoholism increased again, and by the outbreak of the second world war had reached a higher level than ever before. 1939 to 1945.-Alcoholism increased by leaps and bounds during the period of mobilisation, the phoney war, and the German invasion, but diminished during the years of occupa. tion, with its hardships and scarcities and represssive Vichy legislation. At the time of the Liberation, alcoholism could almost be said to be non-existent in France. 1945 to 1952.-The experience of the two wars had made no impression on the legislature which, under pressure from the liquor trade, repealed the restrictive anti-liquor laws of the Vichy regime and passed laws favouring expansion of the trade. Thus a law passed in January, 1950, permitted the advertisement of liquor ; another in March, 1951, allowed the opening of licensed premises on aerodromes ; and other laws in the same year re-established the unrestricted manufac. ture and sale of alcoholic aperitifs, and the rebuilding of licensed premises. "
"
Rouvillois and Derobert base estimates of alcoholism three sets of figures : deaths from cirrhosis of the liver, deaths from delirium tremens, and admissions to mental hospitals of patients with alcoholic psychoses. on
1. Tech. Rep. Wld Hlth Org. 1951, 2. Rouvillois, H., Dérobert, L. 137, 362.
no.
42, p. 20.
Bull. Acad.
Méd., Paris, 1953,
pressure-cooker out of old tin cans. suspected of being a at of cause fatigue great altitudes, where every drop part of moisture must be obtained by melting snow-a process laborious and expensive in fuel and therefore in manpower. Somehow or other the 1953 expedition managed to ensure an intake of 5-7 pints per man, compared with the single pint consumed by the Swiss in 1952. Since much of the fluid loss is by way of the lungs rather than the skin, loss of salt was a less serious problem and improvise
their
own
A low fluid intake has often been
easier to solve. We shall look forward to a more detailed discussion of the oxygen problem. That oxygen, given a suitable apparatus for its carriage, would be of inestimable benefit has never been doubted by serious physiologists. Whether it is necessary is another and more difficult matter. It has never been proved that man cannot reach the summit of Everest without it, and the arguments that he cannot which have lately been put forward (and rather mysteriously accepted without question) have been very specious. Five men have reached 28,000 feet without oxygen apparatus, and it is doubtful whether any of them were turned back by oxygen deficiency alone. That a ceiling exists is certain ; but we are not yet sure that it lies below 29,000 feet. This is one of the few puzzles which the 1953 expedition has left unsolved. PLASTIC SURGICAL DRESSINGS IDEALLT a dressing should be protective against bacteria and abrasion, flexible but tough, transparent, and permeable to water vapour. Furthermore it should be innocuous to tissue, it should not interfere with chemotherapeutic agents, and it should not be too costly. Flexible collodion forms a plastic, adhesive, and cheap dressing ; but on evaporation of the solvent it contracts, and furthermore it hermetically seals the wound. The various adhesive elastic dressings are either impermeable to moisture or irritating to skin, and they are opaque ; while adhesive cellulose tape does not allow evaporation of sweat, although it has been used for some purposesfor example, strapping umbilical hernia in infants.l Farquhar and Lewis2 suggested transparent ’Polythene ’ sheeting strapped over a window in a gauze swab as a dressing for transfusion wounds, so that the incision could be watched for sepsis without exposing it. More recently a partially hydrolysed casein gel has been used in the treatment of burns.3 The dressing forms an insoluble protective film of coagulum which is pliable and also semipermeable, permitting evaporation of water ; but it is not transparent. Polyvinyl plastic4 is being tested as a dressing which may be sprayed on burns from an aerosol can or pump. On evaporation of the solvent, it forms a tough, flexible, adhesive, and transparent film which is permeable to water vapour but not to bacteria. Experimental trials have been encouraging, but trials in man have not yet been reported. A plastic surgical dressing (’Bonoplast’) described at the conference of Scandinavian surgeons in June has aroused much interest. This substance is an acrylic resin dissolved in a mixture of acetic esters, and when spread thinly on the dry skin with a polythene applicator it forms in a matter of minutes a tough, transparent film which is permeable to moisture. The film is not injurious to tissue, and experimentally superficial wounds have healed more cleanly than in a control series where conventional gauze dressings were used. The solution is self-sterilising, and the resultant film impervious to bacteria ; surgeons have used it for preparing the operation field, making the incision through the dry film and then painting over the operative wound after sutures and clips are in position. The film eventually 1. Prince, G. E. J. Pediat. 1951, 39, 481. 2. Farquhar, J. W., Lewis, I. C. Lancet, 1948, ii, 244. 3. J. Amer. med. Ass. 1953, 152, 611. 4. Chou, D. S. J., Went, W. E. U.S. Forces med. J. 1952 3, 1241
flakes at the margins and can be stripped from the skin, removal being aided by spirit or benzene. Disadvantages are few. One is that the film will not adhere to a wet surface. The solvent is inflammable, but the dried film is not and may be cut with the diathermy knife. The solvent gives rise to temporary stinging in unansesthetised tissue, and there is a tendency for bleeding to be locally prolonged ; but this may be minimised by good hsemostasis and suturing. The dressing has much to commend it for certain fields-for example, herniotomies in infants -where the wound requires protection from local soiling. Because the dressing is pliable it may be used in the region of joints, and it has also proved satisfactory in facial work. It seems not to antagonise the antibiotics at the point of contact, and it has been suggested that an antibiotic might be incorporated in it. Finally, in these days of rising costs, it is of particular interest that Swedish hospitals carrying out trials have found a 6% saving in the cost of surgical dressings-not to speak of the very considerable economy in the nursing-staff’s time. The preparation of an aerosol means additional expense, but the simple applicator gives perfectly satisfactory results. Further trials are taking place both in Sweden and in the United Kingdom. ALCOHOLISM IN FRANCE ACCORDING to a W.H.O. report,’ France in 1945 had 1420 alcoholics with complications per 100,000 adults (a prevalence exceeded only in Switzerland with 1590, and Chile with 1497), while the total number of French alcoholics, with and without complications, per 100,000 adults was 2850, which was exceeded only in the U.S.A. with 3952. Rouvillois and Derobert2 find that in the present century there have been five well-defined phases: 1900 to 1914.-Alcoholism was rife, and the evils of absinthe contributed to its steady rise without any legislative restraint. 1914 to 1918.-Owing to the war, anti-liquor laws were passed. The manufacture and sale of absinthe was prohibited in 1915, the number of licensed premises was reduced in 1916, and drunkenness was suppressed in 1917-which resulted in a decrease in alcoholism to a level lower than had hitherto obtained. 1919 to 1939.-Legislation favouring the production of alcoholic drink was introduced as a result of pressure from the vested interests of the liquor trade ;the war-time laws were revoked and various new laws were introduced, such as that of 1922 allowing the manufacture of alcoholic drinks with an aniseed base, replacing the former absinthe ; various laws permitting the re-opening of licensed premises closed during the war and the opening of new ones ; and a law in 1931 giving exchequer aid to the advertisement of alcoholic drinks. During this phase alcoholism increased again, and by the outbreak of the second world war had reached a higher level than ever before. 1939 to 1945.-Alcoholism increased by leaps and bounds during the period of mobilisation, the phoney war, and the German invasion, but diminished during the years of occupa. tion, with its hardships and scarcities and represssive Vichy legislation. At the time of the Liberation, alcoholism could almost be said to be non-existent in France. 1945 to 1952.-The experience of the two wars had made no impression on the legislature which, under pressure from the liquor trade, repealed the restrictive anti-liquor laws of the Vichy regime and passed laws favouring expansion of the trade. Thus a law passed in January, 1950, permitted the advertisement of liquor ; another in March, 1951, allowed the opening of licensed premises on aerodromes ; and other laws in the same year re-established the unrestricted manufac. ture and sale of alcoholic aperitifs, and the rebuilding of licensed premises. "
"
Rouvillois and Derobert base estimates of alcoholism three sets of figures : deaths from cirrhosis of the liver, deaths from delirium tremens, and admissions to mental hospitals of patients with alcoholic psychoses. on
1. Tech. Rep. Wld Hlth Org. 1951, 2. Rouvillois, H., Dérobert, L. 137, 362.
no.
42, p. 20.
Bull. Acad.
Méd., Paris, 1953,