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THE TUBED PEDICLE IN PLASTIC SURGERY.
270 blood is
great that its concentration would, be only very slightly increased by a dose of 15 g. of urea administered by the mouth. From a large experience we are convinced that no danger exists in this direction.-We are, Sir. yours faithfully, H. MACLEAN, A. E. RUSSELL. St. Thomas’s Hospital, S.E., July 26th, 1920. generally
so
The Services.
relatively speaking,
THE TUBED PEDICLE IN PLASTIC SURGERY. To the Editor of THE LANCET.
SIR,-In various medical papers MajorH. D. Gillies lays great importance to the discovery of the tubed pedicle. He claims in the Journal of Surgery, Gynæcology, and Obstetrics, February, 1920, to use his own words, " that he propounded the method in September, 1917." If you, Sir, will refer to your issue of Dec. 15th, 1917, p. 889, you will see that in conjunction with the then Lieutenant G. S. Hett, on Nov. 12th, I performed the second stage of the operation, which consisted in sewing a chest pedicle together. This case is illustrated on p. 891. I distinctly recollect telling Major Gillies why I took this step, and have no recollection of his having done a similar operation previously. I would draw Major Gillies’ attention to the history of the double pedicle flaps to which he attaches so much importance. The first double pedicle flap at Sidcupwas performed upon a man for deficient lower eyelid by ’, myself. I transferred a stirrup flap from above to below .
the eye. Subsequently we found that Tripier had previously done a similar operation. I next made a large double pedicle flap from the throat and slipped it over the chin to make a lower lip in a man named McCrea. Major Gillies next did a converse operation, bringing down the scalp to the chin, and subsequently brought his chest flap up in a case of burn to the face. There are many who recollect this sequence of events, but the records are there for reference. In my work in the press, " Records of Plastic Surgery in Civil Life," I do not intend to enter into any disputes, but hope to depict the influence of war surgery on civil practice, leaving out all war cases and much of the pettiness connected with them. I am quite certain my late colleague will admit my contention in this letter once his attention is drawn to the same. I am,
Late
Sir,
yours faithfully, J. L. AYMARD, Plastic Surgeon, Cambridge Hospital, Aldershot, and Queen’s Hospital, Sidcup.
Globe House, St. George’s-street, Capetown, July 1st, 1920.
MEDICAL EXPERIENCES IN MACEDONIA AND THE CAUCASUS. To the Editor of THE LANCET. glad to find myself in full agreement with Professor L. S. Dudgeon’s conclusions, as stated in his letter appearing in your issue of July 17th, that intramuscular injections of quinine may be regarded without apprehension provided it be recognised that serious troubles may arise unless the dangers, and how to avoid them, are fully understood. It would, indeed, have been surprising had we differed, seeing that the actual cases from which Professor Dudgeon’s conclusions were drawn were for the most part the same that came under my own observation. Nearly all the ill-effects of intramuscular injections observed by Professor Dudgeon and enumerated by him in his article in the Journal of Hygiene were assignable to some error in technique and come under the category of pre-
SIR,-I
ventable
am
complications.
many thousands of injections given in Macedonia, the very small number of cases in which such ill-effects followed is a testimony, as Professor Dudgeon observes, to the recuperative power of the tissues; it also goes far to prove the point for which I was contending, that those who employed this method of treatment were alive to the risks, and with rare exceptions were successful in the precautions they took to prevent complications. I am, Sir, yours faithfully, A. G. PHEAR. Weymouth-street, W., July 19th, 1920.
Considering the
ROYAL ARMY MEDICAL CORPS. Majors to be acting Lieutenant-Colonels : H. T. Wilson, R. N. Hunt. To be
Captains : Temp. Major J. H. Spencer; Capts. W. E. K. Coles (late R.A.M.C.), E. 0. A. Singer (from Spec. Res.). L. Handy and J. W. Malcolm, late R.A.M.C., Spec. Res., to be temporary Captains. Temp. Lieut. J. F. P. Gallagher to be Lieutenant. B. MeB. Richardson to be temporary Honorary Lieutenant. Officers relinquishing their commissions :-Temp. Major A. L. B. Green (retains the rank of Major); Temp. Capt. S. Stockman (granted the rank of Major) ;Temporary Captains retaining the rank A. McK. of Captain : I. M. Grant, J. M. Mitchell, H. R. S. Bell, C. Stanley-Clarke, W. B. U. Patterson, A. P. Adams, P. E. B. D. S. H. A. M. J. D. S. Judson, Barrow, Pitcairn, Masters, Craig; Temp. Hon. Capt. B. M. Richardson (retains the honorary rank of .
Walford,
Captain). Capt. W. N. Greer, R.A.M.C. (S.R.), and Temp. Capt. D. V. O’Malley, R.A.M.C., have been appointed Officers of the Military Division of the Most Excellent Order of the British Empire for valuable services rendered in connexion with military operations in Burma. TERRITORIAL FORCE.
Lieut.-Col. C. I. Ellis to be Deputy Assistant Director of Medical Services, Wessex Division, with the pay and allowances of a Major. Capt. L. T. Challenor to be Deputy Assistant Director of Medical Services, South Midland Division. Lieut.-Col. A. G. Hamilton to command 4th Cheshire Cavalry Field Ambulance. Majors to be Lieutenant-Colonels and to command as stated: A. E. Jerman (4th London Field Ambulance), A. A. W. Merrick (3rd West Lanes. Field Ambulance), T. Kay (2nd Scottish Casualty Clearing Station), E. C. Stack (6th Stafford Cavalry Field Ambulance), F. W. Bailey (lst West Lancs. Field Ambulance), J. G. Martin (2nd West Lancs. Field Ambulance), W. Archibald (2nd Eastern Casualty Clearing Station), C. R. White (3rd Western Casualty Clearing Station). Surg.-Major C. 0. Parsons, from R.G.A., to be Lieutenant-Colonel and to command 2nd Welsh Field Ambulance. Captains to be Lieutenant-Colonels and to command as stated: H. F. W. Boeddicker (lst Southern Casualty Clearing Station), F. Darlow (2nd Northern Casualty Clearing Station), G. L. Thornton (1st Wessex Field Ambulance), F. A. Roper (2nd Southern Casualty Clearing Station), H. F. Everett (lst East Anglian Field Ambulance), T. B. Wolstenholme (2nd Western Casualty Clearing Station). Major L. C. V. Hardwicke to be acting Lieutenant-Colonel whilst
specially employed. Majors T. D. Brown and D. R. Dobie resign their commissions and retain the rank of Major. Capt. P. W. G. Sargent resigns his commission and is granted the rank of Colonel. Capts. F. J. M. Kennedy and D. M. Marr resign their commissions and retain the rank of Captain. Capts. J. Barkley and J. R. Menziesto be Majors. Capt. A. G. Wilson, from 3rd Northern General Hospital, to be
Captain. TERRITORIAL FORCE RESERVE.
Major H. Richardson, from R.A.M.C. (General List), to be Colonel; Capt. C. W. Eames, from General List, to be Lieutenant-Colonel; Capt. C. N. Smith, from General List, to be Major. Capt. K. S. Storrs resigns his commission and retains the rank of Captain. __
ROYAL AIR FORCE. The undermentioned have been granted permanent commissions, subject to physical fitness and to acceptance of conditions of service when promulgated :Wing Commanders : H. V. Wells, C. E. C. Stanford, A. W. Iredell, H. Cooper, A. V. J. Richardson, J. McIntyre, M. W. Flack. Squadron Leaders: H. M. S. Turner, E. C. Clements, W. W. Shorten, W. A. S. Duck, B. A. Playne, R. H. Knowles, H. A. Treadgold, J. MacGregor, H. A. Hewat, H. B. Porteous, T. S. Rippon, F. N. 13. Smartt, H. E. Whittingham, D. Ranken. Flight Lieutenants: A. S. Glynn, A. E. Panter, H. W. Scott, P. M. Keane, T. J. Kelly, R. S. Overton, D’Arcy Power, J. Rothwell, K. Biggs, A. J. 0. Wigmore, J. H. Porter, A. F. Rook, T. C. St. C. Morton, G. S. Marshall, E. W. Craig, R. A. G. Elliott, T. J. Thomas, P. H. Young, R. S. Topham, T. R. S. Thompson, P. C. Livingston, P. J. Flood, J. T. T. Forbes, J. Kyle, C. T. O’Neill. The following promotions are made :Squadron Leaders to be Wing Commanders : H. M. S. Turner, E. C. Clements. Flight Lieutenants to be Squadron Leaders: A. S. Glynn, A. E. Panter, H. W. Scott, P. M. Keane. The undermentioned are granted short service commissions, subject to physical fitness and to acceptance of conditions of service when promulgated :Squadron Leaders (whilst so employed): R. L. Roe, H. Harvey, F. C. Jobsou. Flight Lieutenants: E. P. Punch, E. N. H. Gray, R. E. Bell, C. H. B. Thompson, E. A. Lumley, D. G. Boddie, R. J. Aherne, W. F, Wilson, F. J. P. Saunders, W. A. Malone, F. J. Murphy, H. MeW. Daniel, A. E. Barr-Sim, P. A. Hall, H. B. Troup, R. Mugliston, J. C. Smyth, J. P. Hosford, J. J. O’Mullane, J. P. Wells, T. Montgomery, A. Briscoe, E. G. O’Gorman, T. J. X. Canton, W. F. Shiel, A. Watson, C. H. Young. Flight Lieut. F. J. P. Saunders is seconded ’for duty with the Director of Research.
great that its concentration would, be only very slightly increased by a dose of 15 g. of urea administered by the mouth. From a large experience we are convinced that no danger exists in this direction.-We are, Sir. yours faithfully, H. MACLEAN, A. E. RUSSELL. St. Thomas’s Hospital, S.E., July 26th, 1920. generally
so
The Services.
relatively speaking,
THE TUBED PEDICLE IN PLASTIC SURGERY. To the Editor of THE LANCET.
SIR,-In various medical papers MajorH. D. Gillies lays great importance to the discovery of the tubed pedicle. He claims in the Journal of Surgery, Gynæcology, and Obstetrics, February, 1920, to use his own words, " that he propounded the method in September, 1917." If you, Sir, will refer to your issue of Dec. 15th, 1917, p. 889, you will see that in conjunction with the then Lieutenant G. S. Hett, on Nov. 12th, I performed the second stage of the operation, which consisted in sewing a chest pedicle together. This case is illustrated on p. 891. I distinctly recollect telling Major Gillies why I took this step, and have no recollection of his having done a similar operation previously. I would draw Major Gillies’ attention to the history of the double pedicle flaps to which he attaches so much importance. The first double pedicle flap at Sidcupwas performed upon a man for deficient lower eyelid by ’, myself. I transferred a stirrup flap from above to below .
the eye. Subsequently we found that Tripier had previously done a similar operation. I next made a large double pedicle flap from the throat and slipped it over the chin to make a lower lip in a man named McCrea. Major Gillies next did a converse operation, bringing down the scalp to the chin, and subsequently brought his chest flap up in a case of burn to the face. There are many who recollect this sequence of events, but the records are there for reference. In my work in the press, " Records of Plastic Surgery in Civil Life," I do not intend to enter into any disputes, but hope to depict the influence of war surgery on civil practice, leaving out all war cases and much of the pettiness connected with them. I am quite certain my late colleague will admit my contention in this letter once his attention is drawn to the same. I am,
Late
Sir,
yours faithfully, J. L. AYMARD, Plastic Surgeon, Cambridge Hospital, Aldershot, and Queen’s Hospital, Sidcup.
Globe House, St. George’s-street, Capetown, July 1st, 1920.
MEDICAL EXPERIENCES IN MACEDONIA AND THE CAUCASUS. To the Editor of THE LANCET. glad to find myself in full agreement with Professor L. S. Dudgeon’s conclusions, as stated in his letter appearing in your issue of July 17th, that intramuscular injections of quinine may be regarded without apprehension provided it be recognised that serious troubles may arise unless the dangers, and how to avoid them, are fully understood. It would, indeed, have been surprising had we differed, seeing that the actual cases from which Professor Dudgeon’s conclusions were drawn were for the most part the same that came under my own observation. Nearly all the ill-effects of intramuscular injections observed by Professor Dudgeon and enumerated by him in his article in the Journal of Hygiene were assignable to some error in technique and come under the category of pre-
SIR,-I
ventable
am
complications.
many thousands of injections given in Macedonia, the very small number of cases in which such ill-effects followed is a testimony, as Professor Dudgeon observes, to the recuperative power of the tissues; it also goes far to prove the point for which I was contending, that those who employed this method of treatment were alive to the risks, and with rare exceptions were successful in the precautions they took to prevent complications. I am, Sir, yours faithfully, A. G. PHEAR. Weymouth-street, W., July 19th, 1920.
Considering the
ROYAL ARMY MEDICAL CORPS. Majors to be acting Lieutenant-Colonels : H. T. Wilson, R. N. Hunt. To be
Captains : Temp. Major J. H. Spencer; Capts. W. E. K. Coles (late R.A.M.C.), E. 0. A. Singer (from Spec. Res.). L. Handy and J. W. Malcolm, late R.A.M.C., Spec. Res., to be temporary Captains. Temp. Lieut. J. F. P. Gallagher to be Lieutenant. B. MeB. Richardson to be temporary Honorary Lieutenant. Officers relinquishing their commissions :-Temp. Major A. L. B. Green (retains the rank of Major); Temp. Capt. S. Stockman (granted the rank of Major) ;Temporary Captains retaining the rank A. McK. of Captain : I. M. Grant, J. M. Mitchell, H. R. S. Bell, C. Stanley-Clarke, W. B. U. Patterson, A. P. Adams, P. E. B. D. S. H. A. M. J. D. S. Judson, Barrow, Pitcairn, Masters, Craig; Temp. Hon. Capt. B. M. Richardson (retains the honorary rank of .
Walford,
Captain). Capt. W. N. Greer, R.A.M.C. (S.R.), and Temp. Capt. D. V. O’Malley, R.A.M.C., have been appointed Officers of the Military Division of the Most Excellent Order of the British Empire for valuable services rendered in connexion with military operations in Burma. TERRITORIAL FORCE.
Lieut.-Col. C. I. Ellis to be Deputy Assistant Director of Medical Services, Wessex Division, with the pay and allowances of a Major. Capt. L. T. Challenor to be Deputy Assistant Director of Medical Services, South Midland Division. Lieut.-Col. A. G. Hamilton to command 4th Cheshire Cavalry Field Ambulance. Majors to be Lieutenant-Colonels and to command as stated: A. E. Jerman (4th London Field Ambulance), A. A. W. Merrick (3rd West Lanes. Field Ambulance), T. Kay (2nd Scottish Casualty Clearing Station), E. C. Stack (6th Stafford Cavalry Field Ambulance), F. W. Bailey (lst West Lancs. Field Ambulance), J. G. Martin (2nd West Lancs. Field Ambulance), W. Archibald (2nd Eastern Casualty Clearing Station), C. R. White (3rd Western Casualty Clearing Station). Surg.-Major C. 0. Parsons, from R.G.A., to be Lieutenant-Colonel and to command 2nd Welsh Field Ambulance. Captains to be Lieutenant-Colonels and to command as stated: H. F. W. Boeddicker (lst Southern Casualty Clearing Station), F. Darlow (2nd Northern Casualty Clearing Station), G. L. Thornton (1st Wessex Field Ambulance), F. A. Roper (2nd Southern Casualty Clearing Station), H. F. Everett (lst East Anglian Field Ambulance), T. B. Wolstenholme (2nd Western Casualty Clearing Station). Major L. C. V. Hardwicke to be acting Lieutenant-Colonel whilst
specially employed. Majors T. D. Brown and D. R. Dobie resign their commissions and retain the rank of Major. Capt. P. W. G. Sargent resigns his commission and is granted the rank of Colonel. Capts. F. J. M. Kennedy and D. M. Marr resign their commissions and retain the rank of Captain. Capts. J. Barkley and J. R. Menziesto be Majors. Capt. A. G. Wilson, from 3rd Northern General Hospital, to be
Captain. TERRITORIAL FORCE RESERVE.
Major H. Richardson, from R.A.M.C. (General List), to be Colonel; Capt. C. W. Eames, from General List, to be Lieutenant-Colonel; Capt. C. N. Smith, from General List, to be Major. Capt. K. S. Storrs resigns his commission and retains the rank of Captain. __
ROYAL AIR FORCE. The undermentioned have been granted permanent commissions, subject to physical fitness and to acceptance of conditions of service when promulgated :Wing Commanders : H. V. Wells, C. E. C. Stanford, A. W. Iredell, H. Cooper, A. V. J. Richardson, J. McIntyre, M. W. Flack. Squadron Leaders: H. M. S. Turner, E. C. Clements, W. W. Shorten, W. A. S. Duck, B. A. Playne, R. H. Knowles, H. A. Treadgold, J. MacGregor, H. A. Hewat, H. B. Porteous, T. S. Rippon, F. N. 13. Smartt, H. E. Whittingham, D. Ranken. Flight Lieutenants: A. S. Glynn, A. E. Panter, H. W. Scott, P. M. Keane, T. J. Kelly, R. S. Overton, D’Arcy Power, J. Rothwell, K. Biggs, A. J. 0. Wigmore, J. H. Porter, A. F. Rook, T. C. St. C. Morton, G. S. Marshall, E. W. Craig, R. A. G. Elliott, T. J. Thomas, P. H. Young, R. S. Topham, T. R. S. Thompson, P. C. Livingston, P. J. Flood, J. T. T. Forbes, J. Kyle, C. T. O’Neill. The following promotions are made :Squadron Leaders to be Wing Commanders : H. M. S. Turner, E. C. Clements. Flight Lieutenants to be Squadron Leaders: A. S. Glynn, A. E. Panter, H. W. Scott, P. M. Keane. The undermentioned are granted short service commissions, subject to physical fitness and to acceptance of conditions of service when promulgated :Squadron Leaders (whilst so employed): R. L. Roe, H. Harvey, F. C. Jobsou. Flight Lieutenants: E. P. Punch, E. N. H. Gray, R. E. Bell, C. H. B. Thompson, E. A. Lumley, D. G. Boddie, R. J. Aherne, W. F, Wilson, F. J. P. Saunders, W. A. Malone, F. J. Murphy, H. MeW. Daniel, A. E. Barr-Sim, P. A. Hall, H. B. Troup, R. Mugliston, J. C. Smyth, J. P. Hosford, J. J. O’Mullane, J. P. Wells, T. Montgomery, A. Briscoe, E. G. O’Gorman, T. J. X. Canton, W. F. Shiel, A. Watson, C. H. Young. Flight Lieut. F. J. P. Saunders is seconded ’for duty with the Director of Research.