Page images
PDF
EPUB

Powell's treatment, which consists of the liberal use of carbolic acid and alcohol, followed by the drainage of joints which contain pus, is of great value and has been the means of saving a large number of limbs which would have been uselessly sacrificed before its general use. Some of our friends, however, feel that better results are obtained from the use of bi-chloride solutions. Powell's idea is of much value in the primary treatment of infected wounds, and if used early will surely prevent much suffering. I wish to add that I do not operate on acute fractures of the patella until other measures are tried.

Infected Wounds of the Index Finger. – The patient, an employe of a noodle factory, received a lacerated wound which became infected. Cellulitis developed and was intelligently treated, but persisted in spite of all efforts to control it. When he presented for treatment the index finger, down to nearly the third joint, was a dark brown color, denoting that gangrene had or was about to set in. The treatment consisted of immersion of the hand for fifteen hours in hot salt solution. The continuous immersion changed the color of the finger from a brownish black to a healthy red. A good finger was the result. There was some stiffness at first, but this cleared with passive motion. The fingers of this patient, as well as the fingers of all workmen, are of great importance to them and every effort should be exerted to save every phalanx. In certain instances, however, a finger with poor function may be the means of endangering the life of its possessor and he is, of course, better without it. This applies especially to railroad employes.

Compound dislocations of the ankle joint with or without fracture of the fibula have until very recently been most commonly treated by amputation or resection, though just why this condition has been further embarrassed by adding the removal of articular surfaces whose regeneration would never make up a normal joint, we cannot understand. Why is it not better to treat these cases, especially when they are due to indirect violence, by immediate closure? The joint is usually clean, as are also the tissues which are comparatively uninjured. In the few cases I have seen, the lower portion of the tibia in breaking the capsule and skin receives a greater part of the dirt, and by its new position protects the joint.

Probably the drainage habit in all sorts and conditions of wounds allows the surgeon to “feel easier,” still there are certain conditions that will allow him to feel even more easy if drainage is not provided. We can report more than one or two cases of compound dislocation of the ankle which were treated by cleansing the wound with salt solution, giving special attention to scrubbing the lower end of the tibia. with the same solution, the reduction of the dislocation and the application of wet dressings, that made good functional recoveries. If there had been a resection there would have been more or less shortening.

Fractures of the Neck of the Femur in the Aged. At the Cleveland City Hospital, where a number of homeopathic physicians are on the staff, we find many fractures of the hip. The unpleasant results attending this condition are so well known to you all that I will only say that during my first term of service on the surgical side we tried to adopt a dressing that would bring better results than those in common use, so in many of our cases, we use a plaster of Paris cast that extends from the toes to the axillary space. This cast is applied as it usually is, the patient being supported at the hips and rather forcible extension and counter-extension made by assistants. A general anæsthetic is sometimes given. One might think the cast when it sets would affect the respiration, but this is not so. In old cases, where bed-sores are present, these are properly dressed and the cast, after its application, exerting, as it does, equable pressure, the ulcers we have found to be entirely healed on the removal of the cast. The casts are allowed to remain two months. We are much pleased with the treatment in acute cases. In what may be properly termed chronic cases of fracture of the hip, we have decided to nail the parts together, provided, of course, the patient is in suitable condition. I do not use the cast in every case, but select those in which I deem it advisable. We have a large number of insane to treat, and when the cast is well applied they do not tend to become frisky, while with the ordinary dressing we always had poor results.

Compound Comminuted Fracture of Bones of the Forearm. The patient, an employe of a threshing machine gang, got his right arm tangled up in the machine. As a result there was a compound comminuted fracture of both radius and ulna, wrist joint laid open and hand nearly disarticulated. Upon examination the radial artery was found uninjured and it was decided that there was a slight chance of saving the arm. The patient understood his prospects and was willing to run any risk, though he had been told by two doctors he would surely die of blood poisoning if his arm was not amputated. So we decided to treat the condition conservatively. Small bits of bone were removed, tendons trimmed, and re-united. The larger fragments were wired in severad places. The wound was closed after allowing for drainage. The whole arm was then immersed in hot salt solution for fourteen days. During this time the arm was much swollen. Patient's temperature was elevated most of the time, but gradually came down. The recovery was protracted, owing to long-continued suppura

Powell's treatment, which consists of the liberal use of carbolic acid and alcohol, followed by the drainage of joints which contain pus, is of great value and has been the means of saving a large number of limbs which would have been uselessly sacrificed before its general use. Some of our friends, however, feel that better results are obtained from the use of bi-chloride solutions. Powell's idea is of much value in the primary treatment of infected wounds, and if used early will surely prevent much suffering. I wish to add that I do not operate on acute fractures of the patella until other measures are tried.

Infected Wounds of the Index Finger. — The patient, an employe of a noodle factory, received a lacerated wound which became infected. Cellulitis developed and was intelligently treated, but persisted in spite of all efforts to control it. When he presented for treatment the index finger, down to nearly the third joint, was a dark brown color, denoting that gangrene had or was about to set in. The treatment consisted of immersion of the hand for fifteen hours in hot salt solution. The continuous immersion changed the color of the finger from a brownish black to a healthy red. A good finger was the result. There was some stiffness at first, but this cleared with passive motion. The fingers of this patient, as well as the fingers of all workmen, are of great importance to them and every effort should be exerted to save every phalanx. In certain instances, however, a finger with poor function may be the means of endangering the life of its possessor and he is, of course, better without it. This applies especially to railroad employes.

Compound dislocations of the ankle joint with or without fracture of the fibula have until very recently been most commonly treated by amputation or resection, though just why this condition has been further embarrassed by adding the removal of articular surfaces whose regeneration would never make up a normal joint, we cannot understand. Why is it not better to treat these cases, especially when they are due to indirect violence, by immediate closure! The joint is usually clean, as are also the tissues which are comparatively uninjured. In the few cases I have seen, the lower portion of the tibia in breaking the capsule and skin receives a greater part of the dirt, and by its new position protects the joint.

Probably the drainage habit in all sorts and conditions of wounds allows the surgeon to “feel easier,” still there are certain conditions that will allow him to feel even more easy if drainage is not provided. We can report more than one or two cases of compound dislocation of the ankle which were treated by cleansing the wound with salt solution, giving special attention to scrubbing the lower end of the tibia. with the same solution, the reduction of the dislocation and the application of wet dressings, that made good functional recoveries. If there had been a resection there would have been more or less shortening.

Fractures of the Neck of the Femur in the Aged. - At the Cleve land City Hospital, where a number of homeopathic physicians are on the staff, we find many fractures of the hip. The unpleasant results attending this condition are so well known to you all that I will only say that during my first term of service on the surgical side we tried to adopt a dressing that would bring better results than those in common use, so in many of our cases, we use a plaster of Paris cast that extends from the toes to the axillary space. This cast is applied as it usually is, the patient being supported at the hips and rather forcible extension and counter-extension made by assistants. A general anæsthetic is sometimes given. One might think the cast when it sets would affect the respiration, but this is not so. In old cases, where bed-sores are present, these are properly dressed and the cast, after its application, exerting, as it does, equable pressure, the ulcers we have found to be entirely healed on the removal of the cast. The casts are allowed to remain two months. We are much pleased with the treatment in acute cases. In what may be properly termed chronic cases of fracture of the hip, we have decided to nail the parts together, provided, of course, the patient is in suitable condition. I do not use the cast in every case, but select those in which I deem it advisable. We have a large number of insane to treat, and when the cast is well applied they do not tend to become frisky, while with the ordinary dressing we always had poor results.

Compound Comminuted Fracture of Bones of the Forearm. - The patient, an employe of a threshing machine gang, got his right arm tangled up in the machine. As a result there was a compound comminuted fracture of both radius and ulna, wrist joint laid open and hand nearly disarticulated. Upon examination the radial artery was found uninjured and it was decided that there was a slight chance of saving the arm. The patient understood his prospects and was willing to run any risk, though he had been told by two doctors he would surely die of blood poisoning if his arm was not amputated. So we decided to treat the condition conservatively. Small bits of bone were removed, tendons trimmed, and re-united. The larger fragments were wired in severad places. The wound was closed after allowing for drainage. The whole arm was then immersed in hot salt solution for fourteen days. During this time the arm was much swollen. Patient's temperature was elevated most of the time, but gradually came down. The recovery was protracted, owing to long-continued suppura

Powell's treatment, which consists of the liberal use of carbolic acid and alcohol, followed by the drainage of joints which contain pus, is of great value and has been the means of saving a large number of limbs which would have been uselessly sacrificed before its general use. Some of our friends, however, feel that better results are obtained from the use of bi-chloride solutions. Powell's idea is of much value in the primary treatment of infected wounds, and if used early will surely prevent much suffering. I wish to add that I do not operate on acute fractures of the patella until other measures are tried.

Infected Wounds of the Index Finger.— The patient, an employe of a noodle factory, received a lacerated wound which became infected. Cellulitis developed and was intelligently treated, but persisted in spite of all efforts to control it. When he presented for treatment the index finger, down to nearly the third joint, was a dark brown color, denoting that gangrene had or was about to set in. The treatment consisted of immersion of the hand for fifteen hours in hot salt solution. The continuous immersion changed the color of the finger from a brownish black to a healthy red. A good finger was the result. There was some stiffness at first, but this cleared with passive motion. The fingers of this patient, as well as the fingers of all workmen, are of great importance to them and every effort should be exerted to save every phalanx. In certain instances, however, a finger with poor function may be the means of endangering the life of its possessor and he is, of course, better without it. This applies especially to railroad employes.

Compound dislocations of the ankle joint with or without fracture of the fibula have until very recently been most commonly treated by amputation or resection, though just why this condition has been further embarrassed by adding the removal of articular surfaces whose regeneration would never make up a normal joint, we cannot understand. Why is it not better to treat these cases, especially when they are due to indirect violence, by immediate closure? The joint is usually clean, as are also the tissues which are comparatively uninjured. In the few cases I have seen, the lower portion of the tibia in breaking the capsule and skin receives a greater part of the dirt, and by its new position protects the joint.

Probably the drainage habit in all sorts and conditions of wounds. allows the surgeon to “feel easier,” still there are certain conditions that will allow him to feel even more easy if drainage is not provided. We can report more than one or two cases of compound dislocation of the ankle which were treated by cleansing the wound with salt solution, giving special attention to scrubbing the lower end of the tibia.

« PreviousContinue »