1201

active ingredient, which should reduce the time of exposurenecessary to the allegedly sensitising chemicals, or enable areduction in their amount.

Although we cannot agree with the conclusions drawn,we are glad that they have been contradicted by the dataquoted in the body of the paper which so well support theefficiencv of locan treatment.

H. C. STEWARTW. HOWARD HUGHES.

Departments ofPharmacology and Bacteriology,

St. Mary’s Hospital Medical School,London, W.2.

TREATMENT OF TENSION PNEUMOTHORAX

A. M. MACARTHUR.Regional Thoracic Unit

Brook Hospital,London, S.E.18.

SIR,-The immediate treatment of tension pneumo-thorax seems still to be widely misunderstood by thosewho see this condition in its early stages. The necessityfor continuous pleural decompression is appreciated butthe method commonly used to achieve this is inefficientand dangerous. An emergency not infrequently seen bythe thoracic surgeon is the patient, bloated with surgicalemphysema and gasping for breath, with that anachronism" the indwelling needle " dangling uselessly from hischest. Any needle from lumbar puncture to French’stransfusion seems to be used. All, even including Foster-Carter’s which was designed for the purpose, are ineffi-cient, uncomfortable, and dangerous.The objections to the use of a needle are threefold:(1) Whatever its size, by its very nature, a needle cannot be

big enough to cope with the large volumes of air coming from amajor leak. The insertion of a needle brings immediate, buttemporary, relief Air, however, cannot escape fast enough,pressures again rise, and air is forced into the tissues along theneedle track. Soon the whole apparatus is floated out of the

pleura into the chest wall as the skin lifts on a rising tide ofsurgical emphysema. Decompression ceases and the tensionpneumothorax is re-established.

(2) Whether the point is sharp or blunt the rigid needle maypuncture the lung as it expands-particularly the fragile tissueof bullous emphysema.

(3) A needle cannot be fixed satisfactorily into the chest.Adhesive tape, corks, perforated bottle caps, or plastic shieldsare some of the favourite methods. None is secure or comfort-able.

The only safe way to decompress the pleural space isthrough a rubber catheter about size 10 Jaques inserted,usually, in the second intercostal space anteriorly. The

technique is simple provided that the position for thecatheter is checked by the preliminary aspiration of air.The tube is inserted through a stab wound with the aidof a trocar and cannula. A generous length is passed intothe space, the catheter is attached to the skin and is thenconnected to an underwater seal. Such a tube will carryoff large volumes of air, cannot slip out, will not damagethe lung, and by its flexibility permits the patient to bemoved in comfort. A similar tube can be used in an infantsuffering from a staphylococcal tension pyopneumo-thorax.

I do not apologise for labouring a point that may befamiliar to many. There are still too many patients whoselives are jeopardised and whose treatment is unnecessarilyprolonged by the use of these inefficient methods.Tension pneumothorax is usually a simple mechanical

problem which will respond to the application of simplemechanical principles. The apparatus necessary for theinsertion of an intercostal catheter should be part of thestandard equipment on every medical ward.

Obituary

JAMES BURNETT RAEM.B. Aberd.

Dr. Burnett Rae, who died on Oct. 31 at the age of 80,was for many years vice-chairman of the ChurchesCouncil of Healing, which, with the late ArchbishopTemple, he helped to found. A few days before he diedhe was elected vice-president of the Council.He was born in Edinburgh; but his father, the late John

Rae, j.p., was an Aberdonian, and he was educated in Aberdeen.He graduated M.B. in 1902, but after postgraduate studies intheology at New College, Edinburgh, he spent several years asassistant minister at Sefton Park Presbyterian Church, Liver-pool. Against this background, his service with the R.A.M.Cduring the 1914-18 war not unnaturally led him to share in thepioneer work on the treatment of functional and nervous dis-orders. He became consulting psychotherapist to QueenAlexandra’s Hospital, Millbank, and medical officer in chargeof the psychotherapy department at the Cambridge Hospital,Aldershot.

After the war he continued to work in this new specialty,and he was a member of the staff of the Croydon GeneralHospital and the Institute for the Scientific Treatment ofDelinquency. He also lectured for the National Associa-tion for Mental Health. But his interest in pastoraltherapy was the centre of his practice, and of this side ofhis life E. E. C. writes:

"Burnett Rae was a superb example of a man who practisedwhat he preached. Not that he preached often, though he wasalways willing to occupy a pulpit on such occasions as Hos-pital Sunday, St. Luke’s day, or a series of addresses on healthand faith. He believed that Medicine and the Church have

complementary tasks, and he strove to help Medicine to realisethat its work was incomplete if the spiritual factor was omittedin treatment. He was always open to believe that God wouldand did intervene in the course of illness. So much, he used tosay, occurs which we cannot explain, let us therefore rejoicewhen a patient learns the vital secret of faith and his illnessclears up. He himself once had a spot on the lung which hefirmly believed resolved through prayer and his own faith.He believed that when he was examining his patients he was infact ’laying on hands ’-such was his approach. He was awonderful raconteur and always had a fund of apt illustrations.He was also a good listener, and many found that just to talkto him did them good. A dear loving friend and truly a’beloved physician’."

AppointmentsROLAND, MARY K., M.B., N.U.I., D.C.H. : assistant M.o.H., St. Helens,

Lancashire.CONSTABLE, F. L., M.D., B.sc.Durh.: consultant bacteriologist, Royal Victoria

Infirmary, Newcastle upon Tyne.HuGHEs, J. T., M.B.Manc., M.R.C.P., D.C.P.: assistant neuropathologist

(S.H.M.O.), Radcliffe Infirmary, Oxford.ORR, J. M. B., M.B.: assistant M.o.H. and school M.o., Ipswich.PEARSON, VERONICA, M.B. Cantab., D.OBST., D.c.H.: assistant M.o., Halifax.WOODMANSEY, A. C., M.D. Leeds, M.R.C.P., D.P.M., D.C.H. : consultant in

child psychiatry, Sheffield Regional Hospital Board and UnitedSheffield Hospitals.

Leeds Regional Hospital Board:DAVID, J. D. P., M.D., B.SC. Wales: consultant in geriatrics, Pontefract

and Wakefield area hospitals. ’

ELLETT-BROWN, HAROLD, B.M. Oxon., D.P.M. : consultant psychiatrist anddeputy physician-superintendent, De la Pole Hospital, Willerby.

HAMILTON, MARGARET G., M.B. Belf.: S.H.M.o. in pathology, Harrogatearea hospitals.

LAMONT, S., M.B., F.F.A. R.c.s., D.A.: consultant in anaesthetics, Leeds areahospitals.

NEWCOMBE, JOHN, M.B. Lond., D.P.M.: consultant in psychiatry and medicalsuperintendent, York group of mental-deficiency hospitals.

Colonial Appointments:BLACKMAN, VICTOR, M.B. Lond., D.P.H., D.C.P. : specialist (clinical patho-

logist), Uganda.DOS SANTOS, W. A., M.B. Cantab., DIP.BACT.: government bacteriologist

and pathologist, Barbados.GEMMELL, W. R., M.B. Glasg.: D.M.s., Bechuanaland.SANSOME, J. F., M.B. Lond.: M.a., B.S.I.P.STEVENSON, MAUDE, M.D. Belf., D.c.H.: M.o., Bahamas.