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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 suppuration, which burrowed in various places and had to be opened and drained. Finally, after many weeks of treatment, the patient was discharged with a member that is not so very pretty to look upon, but still has fairly good function. Flexion and extension of the fingers is impaired and the wrist motion is much limited. The larger bones healed well and the wire was left in. The arm is far more valuable than an artificial one.
A St. Louis surgeon has reported the case of a patient whose foot was run over by a whole train of cars. He did not amputate the crushed member, but by treating the condition by continued immersion, reports a useful foot.
Lately Dr. A. V. Fried, of Cleveland, treated a patient whose ear had been completely severed. Dr. Fried sutured the tip back in position and the result is good. So much for conservatism.
603 The Osborn.
A UNIQUE REFLEX!
By L. K. Maxwell, M. D., Toledo, Ohio. Nov. 21st, 1902, I was consulted by Miss D., aged 23 years, who gave the following history:
“Commenced teaching the fall of 1897. I was then 18 years of age. At that time I was well with this exception-suffered intense pain at each menstrual period, suffered much from headaches.
The school was two and a half miles from the street car, often necessary to walk this distance. The fall and winter were very stormy and often walked the full distance in rain and snow. In December commenced urinating oftener than normally, no pain. Gradually micturition became more frequent. It was so gradual that it was scarcely noticeable until about February, when it began to cause considerable inconvenience. Urinated during the night as well as the day.
Commenced taking patent medicines—Lydia Pinkham's, Warner's Safe Cure, Swamp-Root, etc., with no relief.
Continued teaching, but it became necessary to give up all social pleasures. When I would urinate as often as I felt the desire to do so, I would feel no pain; but when I would retain the urine too long, it would cause intense pain, severe headache, dizziness and nausea.
Eyes commenced bothering me, at times all objects seemed covered with spots; often when reading could see only one letter at a time; three times was not able to see anything for about five minutes. Became alarmed and went to see an oculist. Upon explaining the condition of my eyes, the oculist immediately asked me if I had any kidney trouble. Told her that my back did not trouble me any, but that I was suffering from frequent micturition, which by that time had become so frequent that life was almost a burden. The oculist felt sure that it was kidney trouble that was affecting my eyes, put me on lithia, treated my eyes and advised me to see a physician at once. This was in November, 1898, but did not go to a physician until January, 1899. This physician asked for an examination. I refused this and he then put me on medicines. He treated me with medicines for four months. In April he refused to doctor me any longer without an examination. Said he felt confident that the foundation of the trouble was in the uterus; cause, repeated colds; did not think I could be cured without an operation, as the trouble had already been of so long standing.
I objected to the operation, so did not doctor any from April till August. Then went to another doctor, a gynecological specialist in Cincinnati. This physician insisted upon an examination. After examination said the same as first physician, that the uterus was much inflamed from repeated colds, that the cervix needed dilatation, and that the uterus must be curetted at once before the tubes became inflamed.
I did not wish the operation, so went to another specialist and consulted him. After examination this physician said the same as the two previous physicians. I then consented and had the operation in August, 1899.
After operation, menstruation was less painful and more regular, had fewer headaches, but the urinary symptoms were not improved. Still urinated as frequently as prior to the operation. The physician then irrigated the bladder twice each week for about five weeks, with little relief.
Became discouraged and changed physicians. This physician prescribed douches, and local uterine treatments. Continued this treatment for over a year. Still grew worse, general health became impaired, became quite nervous, was urinating ten and fifteen times during the night and very often during the day, often urinating six and seven times in succession, almost a constant desire to urinate. Doctor advised a second operation.
In preference to undergoing a second operation I gave up teaching, thinking that rest might cure me. This was in May, 1901, had taught four years, three and a half years of this time having suffered from frequent micturition.
The rest toned up my general health. It was not necessary now to aggravate the bladder during the day by retaining the urine too long, as I had been compelled to do when teaching. In time the urinary symptoms were somewhat improved, now urinating five or six times during the night; about every hour during the day, at times could retain the urine two hours, still often urinated five and six times in succession.
Aside from urinary trouble felt quite well and strong again, but was not able to enjoy any social pleasures, nor attend church. Each time that I would attempt to do so, I would suffer several days, headache, nausea, often vomiting, dizziness, also suffered sharp twinges of pain and scalding sensation when urinating.
Became utterly discouraged, as I had been out of school six months and no prospects of urinary trouble ever being cured. Life was a burden. Last of November of that year, 1901, the physician advised a second operation, claimed that I did not take sufficient rest after first operation (had rested eight weeks after first operation before resuming work).
Finally consented to operation. Operation was curettment, dilatation of rectum. Had suffered considerable during this time from constipation, at times there was profuse mucus discharge from rectum. At one time the doctor cauterized an ulcer of rectum. At the time of this operation physicians examined bladder at my request. After operation they told me that the cause of the trouble was not in the bladder. After the operation my general health was improved, constipation cured, but urinary symptoms remained the same.
In February I commenced work, book-keeping. This did not aggravate the urinary symptoms as the teaching had done, as it was now always possible for me to urinate when I so desired.
In June, 1902, my general health being good with the exception of the urinary trouble, I entered the Toledo training school for nurses. For a short time I got along fairly well, but was soon put on night duty, and being unable to void the urine as frequently as necessary, I soon got in such a condition that I was compelled to give up my work."
I examined the uterus and found it in a nearly normal condition. I commenced to irrigate the bladder and irrigated it every morning for two weeks, with no relief. Urination was so frequent and so painful that I presumed there might be residual urine and had her catheterized immediately after urinating and obtained seven oz. I made a cystoscopic examination of the bladder, without anæsthesia, and found the organ to be in a normal condition, except at the base, where there seemed to be slight inflammation or severe congestion, and I touched