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tissue contractions varying in different structures. He has noted the fact that the stomach makes sixteen contractions per minute; the intestines from thirty to forty; the larger muscles of the body as high as one hundred or more; in the smaller structures, those of the inner ear
–very many more,-the contractions of the inner ear being about three thousand per minute, this being necessary in order that we may appreciate sound.
We can quite readily see that the practical application of this is that in applying treatment to diseased structures we must give to each individual structure its normal vibrations. Hence, we would use a current interrupted about sixteen times in the treatment of the stomach; from thirty to forty times in constipation and other conditions of the intestines; three thousand or more in the treatment of conditions of the ear, etc., etc. This brings me to the narration of an experience through which I passed the ,other day.
There was brought to me from a city in Illinois, a child aged two, with the following history:
At birth she was perfectly normal apparently, with one exception, and that is that the discharges from the bowel were green, this beginning with the first discharge. About the time she was six weeks old she had an attack of cholera infantum, which culminated in convulsions. From that time until the present she has not developed mentally beyond that of a six weeks' old babe. When she was brought to me, some three or four weeks ago, there were all the marks of lack of mental development. I need not enumerate these, because you know them. She took no cognizance of anything in the room or anything that was going on about her. She could not sit up straight-not because of a lack of muscular strength, but because of a lack of knowledge of how to co-ordinate muscular movements.
Now for the practical application of our knowledge with regard to vibrations. The coarser structures of the body vibrate from sixteen per minute up, and the finer ones, such as the ear, vibrate from three thousand per minute up. While we do not know the number of vibrations required for the development of mental action, we can argue that this being the finest and the most complex of the actions of the body, vibrations must come with exceeding rapidity in order to produce normal action. Here was a case where there was no vibration at all, the structure of the brain was dormant. There had been no development. There was no action. Applying the principle brought out in the experiment of the tuning forks, my endeavor was to place that child within an atmosphere which was being subjected to the highest possible number of vibrations per minute. We know that from the static current and from the alternating current we obtain high vibrations. I had constructed a solenoid. A solenoid is a cylindrical-shaped apparatus made by winding spiral wire, which is thoroughly insulated on both sides. When completed the apparatus is simply a cylinder of the size desired, made from insulated wire, the free ends of the wire being connected at each end of the cylinder with a binding post. Now by attaching to these binding posts the wires from the alternating current and turning on the current, we set the air contained within the cylinder in motion corresponding to the number of vibrations made by the current made in the electric wires.
I obtained for this patient such a cylinder-thirty inches long and about eighteen inches in diameter and gave instructions to have the child placed upon a pillow within the cylinder and allow it to take its morning nap there, keeping it there from one and one-half to two hours every day. This I shall expect to aid in the development of that child mentally, in rousing to action the dormant structure of the brain.
In addition to the lack of mental development we had also epileptoid seizures occurring frequently. These, however, were not of a violent character, being very slight and not amounting to a true epileptoid spasm. As a special treatment for this I applied galvanic electricity, placing the negative sponge to the nape of the neck, the positive to the forehead, giving three milliamperes four times daily. After keeping the child under treatment for two weeks I sent her home, with arrangements and instructions for continuing the same.
NOTE. — Under date of December 7th I received the following letter, which explains itself:
Dear Doctor:-I desire to write you in regard to the baby's present condition.
We have been home one month and have had two treatments daily, that is, the solenoid and galvanism. She has had nineteen spells (epileptoid seizures) during the month, and before we went to see you she had from thirty-five to forty every month. She seems much brighter, more playful, and stronger in the back of her neck. She sits up erect and has sat up for two or three minutes alone on the floor. Taking her whole condition into consideration we think she has improved wonderfully during this short time. Very sincerely yours.
If you have on hand none but old plaster-of-Paris for your dressings you can render it effective once more by placing it over the fire for half an hour in an iron pan.
CONSERVATIVE SURGERY OF THE EXTREMITIES. By Newman T. Nobles, M. D., Cleveland, Professor of Surgery, Cleveland Homeopathic Medical
College, Attending Surgeon, Cleveland City and Homeopathic Hospitals. It gives me great pleasure to invite attention to a subject which has been of much personal interest, and I trust may interest many of those present, namely, the conservative treatment of injuries which are usually regarded as requiring amputation or resection.
The possibilities of the subject were thrust upon me while in charge of the surgical dispensary of the Cleveland Homeopathic Medical College, where there are treated from 40 to 60 patients daily. The first patient came in with his finger cut off by a sharp-cutting instrument, carrying the fragment in his hand and asked to have it “stuck on.” The stump and finger were carefully cleansed, sutured and dressed. The ultimate result was good, as the patient had fair motion, besides the cosmetic effect of the hand. The success of the treatment brought similar cases, but now and again one fails to unite.
In our classes we insist that in all crushing, lacerating injuries of fingers and toes, the first and most urgent duty that presents itself to the surgeon is to resort to a very vigorous and thorough primary disinfection, which consists in free exposure of all the injured parts; cleaning off the margins, converting the torn and contused wound as nearly as can be done by most conservative measures into an incised wound and applying to the raw surface thorough disinfection, using antiseptic agents that are known to possess the most potent antiseptic quilities, such as peroxid of hydrogen, then a solution of two per cent. carbolic acid or 1-2000 solution of corrosive sublimate. This constitutes the treatment of primary infection, but it can only prove thorough and efficient after the wound has been thoroughly exposed and transformed as nearly as can be done into an incised wound. All crushing and lacerating injuries of any part of the body must be recognized, regarded and treated as infected injuries, and this rule applies strongly to the extremities.
A case of considerable interest was one of laceration and crushing of the toes. The result shows the propriety of resorting to more conservative methods in treating cases of this class. The big toe was cut off almost completely, lacerating and tearing away the distal covering, making a very extensive lacerated wound, a large flap remaining by a pedicle on the plantar side. Upon this flap we relied in our procedure with the expectation that the vascular supply would be adequate to nourish the part so severely detached from the remaining part of the toe. The tissues were given a vigorous and thorough primary disinfection and the margins trimmed, thus converting as nearly
as possible a lacerated into an incised wound. Rough bone fragments were snipped off and the soft parts brought into correct apposition. The wound healed by primary intention.
In the treatment of railroad employes we have been struck with their well formed notions that the surgeon to whom they are referred will reach for a knife almost as soon as he sees their injury. There is undoubted foundation for their suspicions that needless operations are performed, and what might become useful members are sacrificed altogether too frequently.
We cannot help feeling that the ordinary physician does not realize the importance of drainage and wet applications in treating injured extremities. These two methods are of the very greatest importance, and I cannot speak too strongly in favor of their use. The writer was called to Pleasant Home, O., to see a young man who had had an iron bolt forced into the ankle joint. There was a large, unhealthy, suppurating wound and multiple sinuses. The physician remarked that he was very careful about treating this case. He washed his dusty hands, fished around under the bureau and found a marine sponge much the worse for wear, and then deliberately washed the wound with the water in which he had bathed his hands. He had previously added some of Seiler's tablets to make, as he said, "an antiseptic solution." His after treatment had been a dry dressing powder and gauze pads that prevented what was most desirablegood drainage. He and two others had decided upon amputation. We suggested incision of the sinuses, the introduction of carbolic acid and alcohol, wet dressings of a 2 per cent. carbolic solution, and also gently reminded him that he use a real antiseptic and sterile water for his solutions. A good joint was the final result.
By wet dressings we do not mean the application of gauze wrung out in various fluids. To gain the desired effect the pads must be soaking wet and often it is of importance that the parts be kept wet in order that ample drainage be secured. Deep incisions are very frequently necessary in order to provide drainage, and these should be made early. If there is much blood loss the incisions may be packed with dry gauze, as wet packs favor hemorrhage, while dry gauze tends to its control. In a short time the wet dressings may be substituted. Again we wish to remark that drainage obtained by liberal incisions and soaking wet dressings are imperatively indicated in lacerated and infected wounds.
The benefits of continuous immersion are illustrated in a case that came to our dispensary. The patient had her thumb bitten several days before by “another lady," so she said. At the time of her appearance there was present a phlegmonous cellulitis and all of the constitutional symptoms of profound sepsis. Pressure at the elbow caused pus to exude at the initial wound in the thumb. The treatment as carried out by her physician had been hot air baths and antiphlogistine. He finally realized the seriousness of the case and advised amputation. We made deep incisions in a generous fashion, the length of the incisions being in the aggregate, over three feet. We were afraid the patient would die from sepsis and knew it would be useless to amputate. She was transferred to the Cleveland Homeopathic Hospital, where the whole arm was immersed in salt solution and constitutional treatment instituted. The salt solution was used hot, and its value is due to the heat and the mechanical effects of the fluid, for as fast as pus was made it was washed out by the water and absorbed by it, and not by the patient. After several months of suffering, during which time multiple abscesses formed, including one of the liver, the patient was discharged.
Stellate Fracture of Patella Due to Direct Violence.- Operation ten hours after the injury. Silver wire sutures were introduced and the patient seemed to be progressing nicely till the twelfth day after the injury, when there appeared symptoms of pus. We decided to drain the joint. This was opened laterally and washed out with salt solution, followed by carbolic acid (95 per cent.) and alcohol. A final rinsing, with salt solution and the introduction of a cigarette drain completed the treatment. The subsequent treatment consisted of daily irrigation and drainage, the skin and capsule being kept open with the small drain. In two weeks the discharge ceased and the wounds closed. The fragments of the patella remained in good apposition and bony union resulted. Finally there was good knee-joint function. We have an idea that more radical measures might have been adopted, as we remember seeing a resection of the knee done for a similar condition.
Many of the modern text-books on surgery speak of the use of drainage tubes passed through the joint, to remain till the discharge 'has stopped. Allowing a tube to remain in a joint for a week or two is sure to result now and then in much damage. We would like to offer our humble protest against doing so. Once we saw a pus joint which had been opened, drained and a half-inch rubber tube passed through in a lateral direction. Shortly after a resection was deemed necessary, and upon opening the joint it was easily seen that the drainage tube had caused a necrotic channel in the articular cartilage of the femur by its pressure, so if it is really necessary that a joint be drained, this can be accomplished by keeping the skin and capsule open by the use of the cigarette drain and irrigation.