cutaneous wounds joined without suture

1375

NOTES, COMMENTS, AND ABSTRACTS

CUTANEOUS WOUNDS JOINED WITHOUTSUTURE

To obviate the disadvantage, in joining the edgesof a wound, of making a series of new puncture woundsfor the passage of the threads, Dr. EJNAR DUJARDIN,of Copenhagen, proposes the following method, whichhe has practised successfully.At a distance of about I cm. from the edges of the

wound (W) slips of adhesive plaster (L-L1) are attachedto the skin, their borders being shaped according tothe shape of the wound. A narrow border (B-Bi)of the plaster strips is left unattached to the skin,and through these free borders silk threads (T1- T6)are sewn from slip (L) to slip (Ll). The borders are

Diagrams illustrating the closure of wounds without sutureby Dr. Dujardin’s method.

then stuck together (B to B 1) and on tightening andknotting the threads the wound edges are carefullyapproximated. Care must be taken that the adhesiveplaster slips are placed in such a way that the pull islongitudinal and not transverse. If the wound isparticularly deep the tension may be reduced byapplying through the subcutaneous tissue (G-G1)ring-shaped countersunk catgut sutures (C) whichdo not touch the epidermis (E) and which are tightenedand knotted before sticking the adhesive plaster slipstogether. Dr. Dujardin says that this method,apart from the good result from a cosmetic point ofview, has the advantage of being painless.

LEPERS IN MALAYA

EvERY leper in Malaya is required by law to besegregated, and this law is strictly enforced. Withthe object of providing model conditions of housing,control, and treatment, the Government of theFederated Malay States opened in 1930 a free lepersettlement at Sungei Buloh, 12 miles north-east ofKuala Lumpur, an account of which has been pre-pared for publication by Dr. G. A. Ryrie, the medicalsuperintendent. The settlement, which covers 57acres, has accommodation for about 1000 lepers,who are housed in 13 large wards and some 150separate dwelling houses. There is a school for80 children, hospital wards are provided for advancedcases and for the sick, and out-patient buildings forexamination and treatment of ambulatory inmates.All patients, except a few patently beyond aid,receive regular treatment, and they are encouragedto look forward to ultimate discharge, which ispermitted when they have been clinically andbacteriologically free from symptoms for six months.

1 The Leper Settlement at Sungei Buloh in the FederatedMalay States. Printed for the Government by the MalayaPublishing House Limited, Singapore, 1933.

Dietetic, biochemical, and serological experiments,and investigation into the action of new drugs, arecarried out with the aid of two volunteer groupskept under ward supervision.An interesting feature of the settlement is the

endeavour to control the lepers without any coercion,physical or mental. Dr. Ryrie says : " The settle-ment is not on an island; there is no wall—only ademarcating wire fence-and any of these legallydetained patients could escape if they wanted to.There are no outside guards or police, and thesettlement is only a mile from the main road to thecapital. In spite of this, very few ever attempt toescape, and most of these return voluntarily in ashort time." This is effected by giving the patients

responsibility and a share in themanagement of the institution, by pro-viding them with plenty of suitableoccupation and recreation, and by sur-rounding them with an atmosphere offairness and naturalness. Four shopsmanaged by the inmates are subjectto only two restrictions-that no

opium or alcohol is on sale, andthat nothing but metal money, whichcan be easily sterilised, may pass as

- currency.Married quarters are supplied in each

section. The birth-rate is low, and,as no child is ever born with leprosy,those born in the settlement are pro-tected by being removed at the age oftwo weeks to the general hospital inKuala Lumpur, where they are

cared for at Government expense.When parents are discharged fromthe settlement their children are

returned to them; others are adopted.The work of the settlement is un-doubtedly an advance in interna-

tional endeavour to secure suitable conditions andadequate treatment for lepers, and when it isrealised that the patients are of many differentnationalities and at least half a dozen religions, itsays much for the methods employed that adminis-trative trouble is avoided and that a courteous andcheerful atmosphere prevails.

TRAINED NURSES FOR PATIENTS OFSMALL MEANS

THE chairman of committee of the Nursing Sisters’Institution, 10, Collingham-road, London, S.W.5,calls our attention to the facilities provided by thisinstitution. It was founded by Mrs. Elizabeth Fry,in 1840, for providing fully trained nurses at a reducedfee for those of small means. All members of thestaff are fully trained State-registered nurses and arefully competent to undertake the nursing of all acutecases of illness : those sent to maternity patients hold,in addition to their certificate for general training,the certificate of the C.M.B. The fees charged arefrom £2 12s. 6d. per week, and a billeting fee of21 Is. to £1 10s. is charged for boarding out nurseswho cannot be accommodated in the patient’s home.Our readers will be glad to have the address of theinstitution for the benefit of patients unable to affordthe full fees for the services of a private nurse. Furtherparticulars may be obtained from the lady superin-tendent at the institution.

LONDON OUT-PATIENT TIME-TABLE

King Edward’s Hospital Fund has brought outa new edition, revised to May, 1934, of a hospitalout-patient time-table, setting out the hours at whichmedical, surgical, and other special cases are dealtwith at the voluntary hospitals within the radius of11 miles from St. Paul’s. The time-table should beof assistance not only to the various social agencies,