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THE TREATMENT OF SUPERFICIAL GRANULATING SURFACES
130 excretion of calcium far above normal. It seems reasonable to include as part of the treatment of this disease the administration of calcium in sufficient doses to raise the intake well above the normal optimum of 1 g. daily, and to exceed 2 g. daily when thyrotoxic patients become
pregnant.
to " take." Partial island grafts adhere quite well and extend rapidly. The pads can be of any size or shape with any number of tubes. They can be pre-, pared beforehand so that the dressing is -very rapid.
grafts
Reviews of Books
SUMMARY
There are hypocalcaemia and hypophosphatæmia in active untreated thyrotoxicosis. In the absence of any impairment of the parathyroids, successful subtotal thyroidectomy brings about a rise in the serum calcium and inorganic phosphorus to the normal level. A temporary fall in the serum calcium may take place after subtotal thyroidectomy without clinical manifestations of tetany. This is probably due to trauma to the parathyroids or to a disturbance in their blood-supply from oedema, blood-clot or infection. The heavy calcium loss in thyrotoxicosis suggests that a higher intake than the normal optimum of 1 g. daily should be taken in that condition.
THE TREATMENT OF
SUPERFICIAL GRANULATING SURFACES ARTHUR EDMUNDS, C.B., M.S. Lond., F.R.C.S. CONSULTING SURGEON TO KING’S COLLEGE HOSPITAL ; CUCKFIELD HOSPITAL
SURGEON AT
IN treating injuries, especially burns, one often has to deal with extensive granulating surfaces, which are as a rule infected. Dressings are painful and trying to the patient, especially when they have to be changed frequently. In this condition I have used this modifica. tion of the Carrel-Dakin method with success. Two thin pads of gauze (A-B) are required, about six layers thick, and some small rubber tubing (C), tied up at one end and perforated for a few inches with small holes made by a strap punch-the ordinary Carrel-Dakin tube in fact. These tubes are laid on one of the gauze pads as in fig. 1, so as
Bacillary and Rickettsial Infections Acute and Chronic. By WILLIAM H. HOLMES, professor of medicine, Northwestern University, Chicago. London:
Macmillan and Co. Pp. 676. 258. AFTER twenty-seven years of teaching medicine, Professor Holmes felt a not unusual dissatisfaction with
the conventional textbook of medicine, in which the accumulated facts are set out in a stereotyped and didactic He was convinced that the only satisfying manner. method of teaching is to show how medicine slowly evolved and thus to learn to understand the relationship of medicine to the growth of civilisation. It would thus be seen that there are few medical " discoveries" : our present knowledge represents the cumulative experiences of many generations of priests, physicians, physicists and philosophers, and the painstaking study and observation of many centuries. In pursuance of his object Professor Holmes wrote not another introduction to the history of medicine but a true textbook of medicine, dealing in particular with rickettsial infections and bacterial diseases. The historical method has been followed throughout-plague, tularæmia, brucella infec-
tions, cholera, typhoid, dysentery, diphtheria, botulism, tetanus, gas gangrene, whooping-cough, heemophilus infections and mycobacterial diseases are all considered from their first recognition down to their investigation as recently as 1938. Professor Holmes had a fascinating style and there are few so erudite that they will not learn from this remarkable book. News has just reached this country of his death two months ago ; if he had lived, he might usefully have applied the same technique to the streptococci, gonococci, and pneumococci, the spirochaetes, pathogenic worms, protozoa and viruses.
Early Treatment of War Wounds By WILLIAM ANDERSON, M.B. Aberd., F.R.C.S., surgeon and lecturer in surgery, Aberdeen Royal infinnary ; surgical director, E.M.S. Northern and North-Eastern Districts. London:
Humphrey Milford, Oxford University Press. 96. 5s. THIS little book is mainly an account of experience gained in the last war.’ It is too short to be more than an outline, but it contains many practical hints which should be helpful to surgeons inexperienced in the management of wounds under war conditions. The instructions given are clear and precise without being unduly dogmatic, and the author obviously has a balanced outlook. There are some trivial errors, however, and a few more serious ones. The two most important advances in the treatment of wounds-the use of the sulphonamide Pp.
to divide the surface of the pad into approximately equal Each is fastened in place by two sutures (D). The other pad is then laid over the tubes and the two pads are tacked round the edge, allowing the tubes to project at one corner as in fig. 2. The pad is then sterilised.
parts.
together
In
with
applying these pads,
the wound is first covered "
a layer of " tulle gras or coarse muslin, impregnated with Vaseline, using enough to prevent it from sticking to the wound surface and yet to leave the meshwork of the gauze patent. The pad is then soaked in % chloramine, the excess fluid being lightly expressed and laid on the vaseline gauze. Over this a piece of jaconet or rubber sheetmg is laid. The dressing is completed by a layer of wool especially arranged round the jaconet, and a bandage, through which the tubes project. The gauze is then kept moist and supplied with fresh antiseptic fluid by injecting the solution down the tubes - e.g., 1 oz. every six hours. The quantity and the time will of course vary with the case. This process entails no manipulation of the part and if the solution is warm is usually quite painless, and nothing more need be done for several days. Usually the pads want changing every three days, and it is not harmful to a patient to give gas at that interval, should the dressing be painful. The surgeon may elect to change the gauze pad and leave the vaseline gauze unchanged. Under this dressing the wound granulates readily, and the spread of epithelium from its edges proceeds without hindrance. Skin grafts take well under it, and it is feasible to leave the whole in position to allow the
quite
drugs and the closed-plaster method-are only mentioned briefly. The right technique must be observed if these methods are to be used successfully and safely, and some account of it should be included in any uprtodate book on the treatment of wounds. A third of the book is mainly concerned with military organisation and first aid, and will be chiefly interesting to those who are serving in the Army. An important place is rightly given to delayed primary suture, but it is odd to find Trueta’s name associated with the recommendation for primary suture when he has written that " it is only in very exceptional cases that the wound of a gun-shot fracture can be sutured " (" Treatment of war wounds and fractures," p. 26). The chapters on wounds of the abdomen and chest are excellent, and in spite of the rather scant presentation of recent advances this should prove a useful book. ,
The Index and title-page to Vol. I, 1941, which was completed with the issue of June 28, will be ready shortly. A copy will be sent gratis to subscribers on receipt of
post card addressed to the Manager of THE LANCET, Subscribers who 7, Adam Street, Adelphi, W.C.2. have not already indicated their desire to receive a
indexes
regularly as-published
should do
so
now.
pregnant.
to " take." Partial island grafts adhere quite well and extend rapidly. The pads can be of any size or shape with any number of tubes. They can be pre-, pared beforehand so that the dressing is -very rapid.
grafts
Reviews of Books
SUMMARY
There are hypocalcaemia and hypophosphatæmia in active untreated thyrotoxicosis. In the absence of any impairment of the parathyroids, successful subtotal thyroidectomy brings about a rise in the serum calcium and inorganic phosphorus to the normal level. A temporary fall in the serum calcium may take place after subtotal thyroidectomy without clinical manifestations of tetany. This is probably due to trauma to the parathyroids or to a disturbance in their blood-supply from oedema, blood-clot or infection. The heavy calcium loss in thyrotoxicosis suggests that a higher intake than the normal optimum of 1 g. daily should be taken in that condition.
THE TREATMENT OF
SUPERFICIAL GRANULATING SURFACES ARTHUR EDMUNDS, C.B., M.S. Lond., F.R.C.S. CONSULTING SURGEON TO KING’S COLLEGE HOSPITAL ; CUCKFIELD HOSPITAL
SURGEON AT
IN treating injuries, especially burns, one often has to deal with extensive granulating surfaces, which are as a rule infected. Dressings are painful and trying to the patient, especially when they have to be changed frequently. In this condition I have used this modifica. tion of the Carrel-Dakin method with success. Two thin pads of gauze (A-B) are required, about six layers thick, and some small rubber tubing (C), tied up at one end and perforated for a few inches with small holes made by a strap punch-the ordinary Carrel-Dakin tube in fact. These tubes are laid on one of the gauze pads as in fig. 1, so as
Bacillary and Rickettsial Infections Acute and Chronic. By WILLIAM H. HOLMES, professor of medicine, Northwestern University, Chicago. London:
Macmillan and Co. Pp. 676. 258. AFTER twenty-seven years of teaching medicine, Professor Holmes felt a not unusual dissatisfaction with
the conventional textbook of medicine, in which the accumulated facts are set out in a stereotyped and didactic He was convinced that the only satisfying manner. method of teaching is to show how medicine slowly evolved and thus to learn to understand the relationship of medicine to the growth of civilisation. It would thus be seen that there are few medical " discoveries" : our present knowledge represents the cumulative experiences of many generations of priests, physicians, physicists and philosophers, and the painstaking study and observation of many centuries. In pursuance of his object Professor Holmes wrote not another introduction to the history of medicine but a true textbook of medicine, dealing in particular with rickettsial infections and bacterial diseases. The historical method has been followed throughout-plague, tularæmia, brucella infec-
tions, cholera, typhoid, dysentery, diphtheria, botulism, tetanus, gas gangrene, whooping-cough, heemophilus infections and mycobacterial diseases are all considered from their first recognition down to their investigation as recently as 1938. Professor Holmes had a fascinating style and there are few so erudite that they will not learn from this remarkable book. News has just reached this country of his death two months ago ; if he had lived, he might usefully have applied the same technique to the streptococci, gonococci, and pneumococci, the spirochaetes, pathogenic worms, protozoa and viruses.
Early Treatment of War Wounds By WILLIAM ANDERSON, M.B. Aberd., F.R.C.S., surgeon and lecturer in surgery, Aberdeen Royal infinnary ; surgical director, E.M.S. Northern and North-Eastern Districts. London:
Humphrey Milford, Oxford University Press. 96. 5s. THIS little book is mainly an account of experience gained in the last war.’ It is too short to be more than an outline, but it contains many practical hints which should be helpful to surgeons inexperienced in the management of wounds under war conditions. The instructions given are clear and precise without being unduly dogmatic, and the author obviously has a balanced outlook. There are some trivial errors, however, and a few more serious ones. The two most important advances in the treatment of wounds-the use of the sulphonamide Pp.
to divide the surface of the pad into approximately equal Each is fastened in place by two sutures (D). The other pad is then laid over the tubes and the two pads are tacked round the edge, allowing the tubes to project at one corner as in fig. 2. The pad is then sterilised.
parts.
together
In
with
applying these pads,
the wound is first covered "
a layer of " tulle gras or coarse muslin, impregnated with Vaseline, using enough to prevent it from sticking to the wound surface and yet to leave the meshwork of the gauze patent. The pad is then soaked in % chloramine, the excess fluid being lightly expressed and laid on the vaseline gauze. Over this a piece of jaconet or rubber sheetmg is laid. The dressing is completed by a layer of wool especially arranged round the jaconet, and a bandage, through which the tubes project. The gauze is then kept moist and supplied with fresh antiseptic fluid by injecting the solution down the tubes - e.g., 1 oz. every six hours. The quantity and the time will of course vary with the case. This process entails no manipulation of the part and if the solution is warm is usually quite painless, and nothing more need be done for several days. Usually the pads want changing every three days, and it is not harmful to a patient to give gas at that interval, should the dressing be painful. The surgeon may elect to change the gauze pad and leave the vaseline gauze unchanged. Under this dressing the wound granulates readily, and the spread of epithelium from its edges proceeds without hindrance. Skin grafts take well under it, and it is feasible to leave the whole in position to allow the
quite
drugs and the closed-plaster method-are only mentioned briefly. The right technique must be observed if these methods are to be used successfully and safely, and some account of it should be included in any uprtodate book on the treatment of wounds. A third of the book is mainly concerned with military organisation and first aid, and will be chiefly interesting to those who are serving in the Army. An important place is rightly given to delayed primary suture, but it is odd to find Trueta’s name associated with the recommendation for primary suture when he has written that " it is only in very exceptional cases that the wound of a gun-shot fracture can be sutured " (" Treatment of war wounds and fractures," p. 26). The chapters on wounds of the abdomen and chest are excellent, and in spite of the rather scant presentation of recent advances this should prove a useful book. ,
The Index and title-page to Vol. I, 1941, which was completed with the issue of June 28, will be ready shortly. A copy will be sent gratis to subscribers on receipt of
post card addressed to the Manager of THE LANCET, Subscribers who 7, Adam Street, Adelphi, W.C.2. have not already indicated their desire to receive a
indexes
regularly as-published
should do
so
now.