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25. Hemoptysis may be absent in the 9. Many lacerations of the lung without most severe lacerations of the lung.

fracture of the bony chest can and should #: 25. If bleeding from larger pulmonary be treated by suture, compression with vessels results, forceps should be applied ; gauze or forceps. if not, gauze should be securely packed 10. Puncture of the lung from any cause in the cavity.

(such as stab and gunshot), resulting in 26. Drainage of pulmonary cysts of any hemorrhage, should be treated by opening character can be done with the same suc- the chest and the application of ligature cess as in


or compression. 27. Incision for drainage should be done 11. Rupture of the lung should be with or without the presence

of adhesions. treated as a laceration. If without adhesions, the opening in the Pneumonectomy.-1, A portion or all chest should be at lowest point of pleural of one lobe, or the entire right or left lung, cavity for gravity drainage.

may be removed without causing death. 28. Many incisions of the lung may and 2. For complete or partial lacerated should be made with or without even local portions of the lung, when severe, pneuanesthesia.

monectomy is necessary and should be 29. It is probably but a few that will done. necessitate the use of general anesthesia. 3. Gangrene of the lung requires in

30. Abscess of any character and of any many cases removal of all necrotic tissue. location in the lung should be found and 4. Hernia of the lung, when sudden opened.

and of but few hours' duration, should, 31. Gangrene of the lung demands most a rule, be amputated, and the stump fixed radical surgical measures, such as opening in the chest wall, as there is no sac. the chest, drainage, and the removal of 5. Hernia of the lung coming on graduall necrotic tissue.

ally has a sac, and should be returned to 32. Polypi of bronchia seldom necessi. the pleural cavity, if possible without amtate removal, but they may cause condi- putation. tions which may require surgical inter- Pneumonopexy.—This is the safest and vention.

most rapid way of dealing with the stump Pneumonorrhaphy.-1. Silk, silkworm- of lung tissue in the majority of cases gut and animal tendons are the most de- necessitating excision for any cause. sirable materials for lung surgery.

2. Adhesions of the parietal and visceral 2. Absorbable sutures and ligatures are, pleura have without exception taken as a rule, not to be relied upon as to place, whether there have been lacerated strength and durability.

or incised wounds, with or without suture. 3. Silk and silkworm gut may become 3. The degree of adhesion corresponds encysted in the lung and remain harm- with the degree of injury. less.

4. Cysts of the lung of any character 4. The tug, and a combination of the can best be drained through viscera-parietug and tobacco-pouch sutures, constitute tal adhesions. In the absence of adhesions the most desirable ones to use in the the wall of the cyst may be sutured to the lung.

edges of the opening in the chest wall, 5. Ligatures and sutures may be dis- drainage to be at once accomplished or at lodged by sudden expansion of the lung some subsequent time. due to sudden closing of the opening in the chest wall.

6. The blood-vessels, bronchia and lung In gunshot wounds of the skull, even tissue should be ligated separately, great when the external opening into the skull care being taken not to include too much is quite clean cut, there is nearly always tissue of any kind in one ligature.

an extensive fragmentation of portions of 7. Needles to be employed in lung tissue inner table. Loose pieces of bone should should be round, with a rounded point. always be sought for, and trephining for They should never have a sharp point, or


is advisable if the patient's sharp edges.

condition will stand it, and if fragments 8. Not all ruptures, punctures or lacer- may be felt which cannot be removed ations of the lung require sutures, or any

through the bullet hole.- International surgical intervention whatever.

Journal of Surgery.

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THE UPS AND DOWNS OF A PHYSICIAN'S the information I had given him and inLIFE.

formed me who he was. He neglected, Thoughts and Incidents.

however, to ask me to visit him, which I BY GEO. J. MONROE, M.D.,

think was a great oversight. I never felt

more at my ease in talking with any body. LOUISVILLE, KY.

He seemed to possess the wonderful fac(Concluded from December 20.)

ulty, even as a boy, to interest and make

everyone comfortable who was in his HOBNOBBING WITH ROYALTY.

presence. If I go over to England, I beWhen I was in Chicago attending lec- lieve I will call upon him and remind him tures, in 1860, the Prince of Wales visited of our boyish conversation in Chicago. the city. I was at the Richmond House Of course, such an insignificant matter (since destroyed by the great fire), where has long since passed out of his memory. he and his suite stopped. John Went- I remember it well, for it is not a frequent worth was then Mayor of Chicago. He occurrence for me to talk with royalty. I was then known as “Long John," on believe King Edward VII will make Great account of his great stature.

He was

Britain a good King. over seven feet tall. The Mayor made a short reception address. The Prince re- I might say right here that it fell to my plied. Although I was not very far away lot to treat the “Jersey Lilyfor hemorfrom him, I could not hear a word. The rhoids while she was here. I did not conDuke of Newcastle also made a short sider her a remarkable beauty. Some of speech, which everybody heard. I am our Kentuckians very much surpassed her told the King can now make a good speech. in beauty. I could not see any difference On the following day I was at the depot between Lily Langtry's piles aud hemorawaiting a train to take me home. Being rhoids I have found in many other women. ahead of time I was listlessly walking I treated her the same as others, and she around in the depot, studying emigrant did not seem to possess any more courage character. There were a lot of Norwe- than others. gians just in, and I remember I envied In a drug-store-my brother owned a them their brawn, health and physical de- drug-store, and a part of my second sumvelopment. The first Norwegians and mer I spent in his store-I gave a good Swedes that came to this country had

deal of attention to the appearance as no knowledge of disease, for they were well as the taste of many medicines. I never sick. The second and third genera- tried many experiments.

tried many experiments. Some of them tions are not that fortunate, for life in surprised me. One day I took it into my America, and assimilating American ways, head that the combination of chlorate of are making them much like Americans. potash and sulphur powdered together

The Prince of Wales was also in the would be a good application for a sore depot waiting for his train to start for throat. It is good, but it should not be Dwight, Illinois, the famous whisky.cure mixed, only as you use it. I decided to city, to shoot prairie chickens.

mix them together, so put quite a quantity man, or rather boy, approached me, and of each in a mortar and began to powder introduced conversation. He asked me them together. The result was an explomany questions relative to the prairies of sion, breaking my mortar and burning my Illinois, about the shooting of prairie chick- hand. ens, the methods of the inhabitants, etc. One day a prescription came in from a In fact, we became very well acquainted. horse doctor-train oil and soda mixed ; I believe we must have talked nearly half to this add nitric acid. I mixed the oil an hour. I saw a gentleman approaching and the soda and then began to add the us whom I recognized by his tall beaver nitric acid. Away went my combination hat to be the Duke of Newcastle. All at and bottle. Fortunately, I was not burnt, once it dawned upon me that I had been but my clothes were literally destroyed, talking with the Prince of Wales. He and the counter had to be repainted. came to inform the Prince that the There were a number of other things I break in the engine had been repaired learned from actual experience while I was and they would start in a few minutes. in that drug-store. My brother concluded The Prince very genteelly thanked me for I was an expensive clerk on account of

A young


the number of medicines and bottles I de. anatomy, however, because some one might stroyed.

hear his remarks and make sport of his At one time in my practice I had in the mistakes. This really good-hearted gentlesame village a physician who exaggerated man was gathered to the sainted flock every case he had. Nearly everyone he above a good many years ago, where I was called upon to treat was in articulo presume surgery and anatomy are not mortis, according to his prognosis, when practiced or discussed. He had quite a

a they came into his hands. I think I have family, and they are all prominent and of seen a few physicians of the same kind good standing and report. since. I am sorry to say the breed is not extinct. That class of physicians, I am

SORE THROAT FREQUENTLY INDI. aware, are not yet in articulo mortis. I remember at one time he stated he had A few years ago I made the statement forty cases of diphtheria. I had not a that many uterine diseases could be diag. single case. I had a good many cases of nosed by examining the throat. Such a sore throat. I presume they would come statement created a good deal of criticism, under the head of ulcerated sore throat or mostly against. I have nothing to retract acute tonsilitis. He called all his cases a in that statement. I have not seen a case malignant type of diphtheria. There of metritis, endometritis, amenorrhea or didn't seem to be any malignancy about dysmenorrhea in years but what I have them, however, as they all recovered. He found more or less disease of the throat. got a great deal of credit for being able to In suppressed menstruation we will always cure diphtheria--a credit very deserving find the tonsils inflamed and enlarged. had it been true.

That I can say by examining the throat A somewhat noted physician of our city, just what the disease of the uterus is I a professor in one of our medical colleges, never have claimed, and do not now, but at one time told me he had over a hundred I do claim to be able to assert that the cases of diphtheria on his hands that he uterus or its appendages are diseased by had to visit every day. Take this in con- examination of the throat. If there is no nection with his other practice, he said, womb disease I believe we can so assert kept him very busy. He told me he had by looking at the throat. I do not wish to make about a hundred and fifty visits to be understood that we have no sore a day. I began to figure. In this event throat in women unless the uterus is dishe had to visit one about every ten min- eased, for we do, yet there is a difference utes. His patients were located in several in its character from that produced by parts of the city. Look at the consistency sympathyzing with the womb. of such a statement! But he has gone to Not long ago I was called upon to treat his fathers, yet I am in hopes the judge an old German. He was suffering from will let him off easily, for he was a clever cancer of the rectum. Realizing that he fellow and a good physician.

had not long to live, I advised him to ar. Shortly after this epidemic of sore throat range his business so that he would have we had genuine diphtheria, and my neigh- nothing to regret at the time of his debor lost over a dozen cases. His stock parture. The next time I visited him I went down. As far as I was concerned, saw that he could live but a few days. I it did not effect me much, as I never made asked him if he did not want to see a any claim of being able to cure all cases clergyman. His reply was that he was of diphtheria.

not acquainted with any.

After some I had this physician assist me one day time he said he had heard Rev. Mr. W. to amputate a man's leg below the knee, preach a few times, and he believed he who had the leg crushed in a railroad acci- would send for him. I said Mr. W. dent. When he was reporting the nature a good Christian gentleman, and I thought of the injury afterwards he said the hu- he had better call him in. Rev. Mr. W. merus and the acetabulum

both was sent for, and after talking with him badly crushed, and we had to disarticulate for some time the minister asked him who and amputate the femur. Yet he was a was his physician. The old German told real good fellow, a kind, pleasant com- him, and at once Rev. W. said, “Let us panion. I never felt like doing him an


The old German saw the ridicuinjury. I did advise him to study his lous point that might be made out of it,



so the next time I saw him, although too I will wind up these rambling, desulfeeble almost to articulate, he had to tell tory papers by saying a few words about me.

a very important subject, and that is life. The medical politician, I am sorry to

We may divide life into four periods. say, is an octopus that is always with us. Childhood, youth, middle age, and the We can by surgery remove diseased or- time when the teeth loosen in the sockets gans and membranes. We can eradicate and the hair is white, when the grassand destroy disease by the use of medicine, hopper ceases to be a burden and the leaf but this loathsome cancer, the medical is sere and yellow, when the blood is not politician, we cannot destroy by any active in its course through the veins and means. Sometimes we may think he is arteries, and when the eye becomes dim dead, but at the next State medical associ- and passions cease. Let us first examine ation, especially if several medical colleges childhood. This we may say is the whiteare represented, he bobs up serenely and bread time of life. This is the period will not down. They do not seem to care

where there are no cares or worries that a grain of sand for any outside of them- mother cannot soothe or overcome, unless, selves and their medical college. I think perchance, we have eaten green gooseit a little singular that a large State like berries or green apples; then calon el and Kentucky, having probably between four castor oil have to be called in to assist and five thousand physicians, should only mother. In the greater number of chilbe able to muster from two hundred and dren childhood is a happy period, a happy fifty to three hundred at the State Medical thing. Of course, unfortunately, there Society. The only way, in my opinion, are exceptions to this, for some lives have that this can be accounted for is that the never known happiness. Their food has physicians in small places have not the been from the refuse of ash barrels, their least chance in the world to take any part lodgings have beed the ash barrels themin the State Medical Society. A few selves. Where their clothing has come from the large cities run the State Society from I have never been able to solve. entirely. At the last meeting at Paducah Many are not aware they ever had parents, there were, I believe, about forty papers, and many would be better off did they not twenty-six of them by physicians from know it. The feeling of many parents Louisville. The country physicians have towards their children is that they are an become tired of attending these State con- encumbrance which they would prefer to ventions simply as lookers-on. They, do without. Yet the child of loving paknow very well that this is all they have rents has very few cares to contend with, an opportnity to do if they attend.

and what few they have do not annoy It seems to me that it is simply for bun- or perplex them. There is but very little combe when we have physicians claiming in the majority of children's lives ihat is they are practicing medicine alone for the absolutely disagreeable. They have their benefit of suffering humanity. That kind little troubles and vexations, to be sure, of talk I look upon as mere twaddle and yet they are not lasting; they are like claptrap. In this commercial age we find Burns' snowflake upon the river-a movery few, even amongst physicians, who ment seen, then gone forever. The rule work for charity alone. Why not come out is happiness, contentedness and pleasure. like men and say that we practice medicine They awaken in the morning, bright and principally for the money there is in it? shining as the sun on a beautiful day in Self comes first, and I believe should. June. They are busy all day long as the

ant, or the honey bee in summer time. IRISH SAYINGS.

At night they are tired and sleepy. They I was once called to see a boy who had are hardly in bed before they are in a fallen out of a tree and broken his arm. dreamless, quiet, refreshing sleep. In the His mother had told him not to climb morning they are fresh the the tree for fear he might fall and kill washed in the morning dew, as bright as himself; that she would whip him se- the well cut diamond. They are brilliant verely if he id. When came near the and musical as the singing birds. Happy boy he said : 6. Do not let me die, and contented children make all in their Doctor, for mother will whip me if I immediate presence also happy. To the die."

sorrowful they are a brightness, to the




mourner they bring joy and gladness; SURGERY OF PROSTATE, PANCREAS they make the cast down buoyant. They

AND DIAPHRAGM. raise all to a higher and more agreeable

BY B, MERRILL RICKETTS, PH.B., M.D., plane. No household can be complete without the prattle and annoyance of children. Annoyance did I say? No, far

(Continued.) from it. Joy or joyousness is the word.

I. SURGERY OF THE PROSTATE. Some hard-hearted, senseless mortals look upon children as encumbrances, vexations and nuisances. This same class of people

(1727-1902). no doubt are nuisances themselves. These Morel - Lavelle. Hypertrophie partielle et a people would pass by a beautiful fragrant

peine marquee do la prostate causant a la fuis

l'incontinence et la retention d'urine. Bull. soc. rose and look upon it as a waste of Mother

de chir., Paris, 1856, ix, 173. Earth. They would simply see a rose and Emmert and Sohnle. Fall von harnverhaltung nothing more. They would, if they could, durch hypertrophie der prostate bedingt und shut out the sweet songs of the birds, the

durch uremic todlich endigend. Ztschr. f. wun

darzte u. geburtsh., Stuttg., 1859, xii, 104. rustling of the ripening grain or leaves of

Thompson, H. Long-Standing Disease of the the trees. They would escape from the Prostate and Bladder; Retention of Urine to the melody of a rippling brook; even the Amount of Five Pints, Lancet, Londor, 1859, beautiful sunshine is a prick to their in

i, 610. Disease of ihe Prostate Gland, Lancet, significant, worthless brains. They pre

London, 1859, i, 639.

Isaacs. Enlargement of the Middle Lobe of fer a life among the cold tombs of the

the Prostate Gland. New York Journal of Medigraveyard. They would prefer a desert cine, 1859, vii, 196. of sand, barren and bare, rather than a

Messer, J. C. Report on the Condition of the beautiful landscape of trees, rivers, grain

Prostate in Old Age Found on the Dissection of

One Hundred Specimens in Individuals Over and flowers. What an uncomfortable and

Sixty Years of Age. Med. Chir. Tr., London, discouraging life this would be if all were 1860, xliii, 155, so constituted! No, let us be thankful for Stapleton. Disease of the Prostate and Blad.

der. Dublin Med. Press, 1860, xliii, 155. the brightness and joy a little child throws

Guerlain, M. De la prostatorrhee dans ses around us. Let us be grateful for the rapports avec la prostatite. Paris, 1860. beautiful, glorious and fragrant rose, for Hughes, J. S. Complete Retention of the the sweet melody of the singing birds-in

Urine from Senile Enlargement of the Prostate.

Dublin Med. Press, 1860, xliii, 321-323. fact, let us be thankful for everything that

Robertson, C. A. Review of the Last Illness can add to our pleasure and happiness. of Dr. Alden March” (retention of urine from What can do this more effectually than a enlarged prostate). New York Med. Journal, little child?

1860-70, x, 355 374. But I find that I cannot control my

Gross, S. D. Practical Observations Upon

the Nature and Treatment of Prostatorrhea. thoughts, and should I go on and describe Tr. Med. Society Pennsylvania, Philadelphia, the three other periods of life I would 1860, ", 39 45. have to write another paper. I may at some

Schuh. Hypertrophy prostat'. Ztschr. f. time take them up, but not now. I thank

nat. u. heilk. in Ungarn., Oedenburg, 1860,

xi, 162. the readers of the LANCET-CLINIC for Mallez. Indications des douches_perineales bearing with me so patiently in reading dans le prostatorrhee. Gaz, d. hop., Paris, 1861, these articles. I did not expect to extend

xxxiv, 607.

Nouvelles recherches sur certains etats pathothem over four papers when I commenced,

logiques de la prostate tels que l'hypertrophie but here I have lengthened them out to ten. l'atrophie et les tumeurs simples d'apres l'obser. I still have more to say, but for fear I will vation analytique de prez de deux cents peices hear the comment, “a diarrhea of words

examinees suivant la methode numerique et

suivies d'une note sur l'anatomie de cet organe. and a constipation of ideas,” I think I had

Union med., Paris, 1861, xii, 313-339. Rap de better quit. I also tender my thanks to Dr. Mercier, 340-345. Culbertson, of the LANCET-CLINIC, for the Launay. Hypertrophie considerable de la courtesy he has shown me in publishing prostate difficulties du catheterisme fausses

Bull. the articles.

routes considerable peritonite autopsie.
soc, anat., Paris, 1861, xxxvi, 223-225.

Johnson. Prostatic Tumor Projecting into the MURIATE of ammonia has a specific in- Bladder; Disease of the Bladder; Fatal Result. fluence over trigeminal neuralgia, from

Lancet, London, 1861, i, 628. Chronic Inflamma

tion of the Prostate. Assoc. Med. Journal, Lonthree to eight grains being administered

don, 1861, ii, 29. persistently.--Med. Summary.

Charles. Une anomalie des rapports de l'ure.

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