622

R.J. Shaw et al. / British Journal of Oral and Maxillofacial Surgery 45 (2007) 617622 14. Shaw RJ, Liloglou T, Rogers SN, Brown JS, Vaughan ED, Lowe D, et al. Promoter methylation of P16, RARbeta, E-cadherin, cyclin A1 and cytoglobin in oral cancer: quantitative evaluation using pyrosequencing. Br J Cancer 2006;94(4):5618. 15. Shaw RJ, Akufo-Tetteh EK, Risk JM, Field JK, Liloglou T. Methylation enrichment pyrosequencing: combining the specicity of MSP with validation by pyrosequencing. Nucleic Acids Res 2006;34(11):e78. 16. Ross GL, Shoaib T. Role of sentinel node biopsy in the management and staging of the N0 neck. Odontology 2005;93(1):16.

11. Guo M, House MG, Hooker C, Han Y, Heath E, Gabrielson E, et al. Promoter hypermethylation of resected bronchial margins: a eld defect of changes? Clin Cancer Res 2004;10(15):51316. 12. Goldenberg D, Harden S, Masayesva BG, Ha P, Benoit N, Westra WH, et al. Intraoperative molecular margin analysis in head and neck cancer. Arch Otolaryngol Head Neck Surg 2004;130(1):3944. 13. Colella S, Shen L, Baggerly KA, Issa JP, Krahe R. Sensitive and quantitative universal pyrosequencing methylation analysis of CpG sites. Biotechniques 2003;35(1):14650.

INTERESTING CASE: Walter Whitehead: A brief history of the man and his varnish Whiteheads varnish is popular in oral and maxillofacial surgical practice, where it has a long history of use as an intraoral or buried dressing pack. Despite its longstanding and common use few surgeons will know of its inventor and how it was originally applied. Whiteheads rst recorded description of his varnish is in a paper in the British Medical Journal in 1891 entitled A hundred cases of entire excision of the tongue.1 In this paper, Walter Whitehead states that he rst started using the dressing 10 years previously. A varnish is a transparent, hard, protective nish or lm primarily used in nishing wood but also other materials. Varnishes are traditionally a combination of a drying oil, a resin, and a thinner or solvent. The varnish that Whitehead made was composed of iodoform, (a compound tincture of benzoin Friars balsam which is commonly used as an antiseptic, or for inhalation with steam as an expectorant) and turpentine. He wrote that the preparation had both antiseptic and anaesthetic properties, the turpentine component having a very marked inuence in promptly checking capillary oozing. In addition to these properties, he went on to say that it lessened the discomfort which follows surgery and also enables the patient to take food in the ordinary manner. Today Whiteheads varnish (pigmentum iodoform compound: BPC) consists of: iodoform10 g, benzoin10 g, prepared storax (a resinous exudate of the Sweetgum tree) 7.5 g, Balsam of Tolu 5 g (a resin obtained from South American balsam trees) and solvent ether mixed to 100 ml. Although turpentine is no longer used as the volatile liquid, Whiteheads varnish is still advocated for many uses including dressing of skin graft donor sites,2 packing after exposure of unerupted canine teeth,3 jaw cavities,4 and nasal packing.5 Whiteheads varnish has a benet over a number of other dressings in that it remains clean and uninfected in potentially contaminated environments. It contains a number of aromatic resins, which are slowly broken down to produce benzoic acid. It is this slow release of a potent antiseptic, together with the waterproong property of the compound, which many surgeons suggest makes it superior to other media.6 Walter Whitehead was born in 1840 at Halsam Hey, Bury, where his family had lived for over 200 years. At the age of 16, he entered his fathers business and began to train as a bleacher, dyer, and nisher. This is probably when he learned about chemicals and is perhaps what led him to develop his varnish. One day, aged 19, and still an ordinary workman, he was invited by a medical student to observe some operations at the local inrmary. It was while watching these operations that Walter Whitehead decided that he wanted to practice medicine. He had already provided emergency dental extractions for his brothers and sisters in the past, and was eager to operate from an early age. On the day he decided to enrol in medical school, he did not even inform his parents. He borrowed some money from his cousin instead to pay his way. After qualifying from medicine and nishing his residence in 1864, he bought a general practice in Nottinghamshire, but surgery was his real passion and he became a fellow of the Royal College of Surgeons of Edinburgh in 1866. He was honorary surgeon at St Marys Hospital, Manchester from 1867 to 1873 when he joined the Manchester Royal

Inrmary, rst as assistant honorary surgeon, and he became consulting surgeon in 1879. In 1894, he became professor of clinical surgery at the Victoria University, Manchester. Walter Whitehead was acknowledged as one of the most distinguished surgeons of his day. His operating style was certainly bold, and he was known to have said that the greatest drawback under which a surgeon can suffer is knowledge of anatomy it makes him timid. Like many surgeons of his time, Walter Whitehead did not practice antiseptic surgery. He did however practice clean surgical techniques with use of soap and water. Once when the apron of his assistant touched the leg he was operating on, he damned and blasted him to hell!7 He is most remembered for two operations that he devised, which for many years were associated with his name. The rst, The surgical treatment of haemorrhoids, he described in the British Medical Journal in 1882. The second was the remarkable series mentioned above, A hundred cases of entire excision of the tongue, published in the British Medical Journal in 1891.1 This latter operation was said to have been invented one morning when he arrived at the hospital with a hangover. He looked with despair and disfavour at the selection of instruments that the nurse had put in front of him and said for Gods sake give me a pair of scissors The operation he described used scissors only to excise carcinoma from the mobile tongue and of the 100 cases he presented in the paper, 20 patients died postoperatively. Walter Whitehead retired from practice in 1903 and went to live at Colwyn Bay, where he spent the rest of his days yachting, gardening, and entertaining friends. He died in 1913 aged 73. He was survived by his second wife and daughter. Although his surgical techniques are now largely obsolete, his varnish is still going (and smelling) strong.

References
1. Whitehead W. A hundred cases of entire excision of the tongue. BMJ 1891:9614. 2. Stanley D, Emerson DJ, Daley JC. Whiteheads varnish and Jelonet a better dressing for skin graft donor sites than Jelonet alone. Ann R Coll Surg Engl 1988;70:36971. 3. Iramaneerat S, Cunningham SJ, Horrocks EN. The effect of two alternative methods of canine exposure upon subsequent duration of orthodontic treatment. Int J Paediatr Dent 1998;8:1239. 4. Lee SMG, Cooper JC. Noonan syndrome with giant cell lesions. Int J Paediatr Dent 2005;15:1405. 5. Lim M, Lew-Gor S, Sandhu G, Howard D, Lund VJ. Whiteheads varnish nasal pack. J Laryng Otol 2007;121:5924. 6. Banks P, Brown A. Fractures of the facial skeleton. Edinburgh: Wright; 2001. p. 134. 7. Brockbank W. Honorary staff of the Manchester Royal Inrmary 18301948. Manchester: Manchester University Press; 1965. Roshi Frafjord Luke Cascarini Andrew E. Brown