Surgical and Gynecological Chair. SIMPLE, STRONG, ORNAMENTAL In the MCDANNOLD Surgical and Gynæ- uses that will suggest themselves to the practical physician. PRACTICALLY INDESTRUCTIBLE The motions of this chair are universal, including the ROTARY motion, raising and lowering, and there are no complicated mechanism, noisy or intricate fastenings. One important feature is the universal head rest which can be put in any position with a single set screw. Send for catalogue and prices of this improved Chair and The McDannold Cabinets. Manufactured by A. McDANNOLD, 1416 Sarah Street, ST. LOUIS, MO. Mention Clinical Reporter. GREEN GABLES FOR The Dr. Benj. F. Bailey Lincoln, Neb. OR THE TREATMENT of all non-contagious chronic diseases. Select cases of drug and alcoholic habitues received. In the suburbs of a most beautiful western city. In a section having the lowest mortality rate in the civilized world. A brick and stone building amid ample grounds. Every modern comfort and sanitary convenience. All forms of baths and every electric current useful in the treatment of disease. Thorough equipment and beautiful furnishings. Bright and sunny halls and reception rooms. amusement rooms. Cozy corners everywhere. A delightful place in which to get well Large No physician can afford to be indifferent regarding the accurate filling of his prescriptions. The To obtain immediate results in Anaemia, Neurasthenia, Bronchitis, Survival Fellows' Syrup of £353 The Fittest of Hypophosphites Contains-Hypophosphites of Iron, Quinine, Strychnine, Lime, Manganese, Potash. Each fluid drachm contains the equivalent of Special Note.-Fellows' Hypophosphites is Never Sold in Bulk. Medical letters may be addressed to Digestion First You must consider digestion. If foods pass through inert, all treatment necessarily will fail. The whole system of the emaciated, tubercular and neurotic patient cries out for fat. Nothing but fat will satisfy. Debilitated organs can not digest ordinary emulsions and plain cod-liver oil; while extractives are often irritants. Hydroleine is right in principle and presents the requisite fat in such a form that the weakest digestive organs accept it and grow stronger. Prescribe Hydroleine and you will know this to be a fact. Literature sent on application. Sold by druggists generally. THE CHARLES N. CRITTENTON CO. Sole Agents for the United States, 115-117 FULTON STREET, NEW YORK. A PLEA FOR CONSERVATIVE TREATMENT IN DISEASE OF THE KNEE JOINT. Of all points in the body that are exposed and subject to injury, yet have great reparative power the knee is the greatest; from the time of infancy almost it is the most thinly clad and the most bruised of all points of the body. Having a movement of nearly 180 degrees and two distinct portions of the synovia all quite near the surface, while it is well nourished by small vessels provided with no large artery that feeds the joint proper. Nature has acted wisely in thus arranging the blood supply, for if one of these little arterial twigs is bruised or broken, its work is immediately taken up and continued by numerous other like vessels and the important structures suffer but little if any. But every fort has a weak place and this is true of the knee joint, which from its very wealth of synovial membrane is the ideal seat for any sort of infection and though this membrane is well protected by soft yet dense cartilage, it at times suffers from traumatism of this self same structure. Once injured the harm takes often a serious nature and the process of repair is slow beyond all comprehension. Nature endeavors to keep the bruised surfaces away from each other, to do this she pours out an abundant supply of fluid which in time becomes a source of danger and a place where any stray germ in the system may grow and multiply as germs will, while the internal pressure of the distend. ed sack lessens the blood supply and hinders absorption. In brief, then, the knee joint once infected or bruised so as to cause distention of the synovial with fluid tends to grow worse with its duration and also toward destruction of the sack itself. 'I As a matter of fact the knee joint is a point not easily injured and a traumatic action upon it must be of unwonted severity either upon a portion or all of its elements to produce an inflammation of the deep structures; even then in many cases the repair is speedy and permanent. Wasting and febrile diseases are prone to cause affections of the long bones near the joint, the infection in not a few cases penetrating the 141394 joint and working havoc with all the parts it meets, fractures near to or extending into the joint may also set up a traumatic inflammation that will cause stiffening (ankylosis) either complete or partial in spite of the best attention and the utmost care that be used. It is not the purpose of this paper to deal with the entire treatment of all the conditions that may be met with in diseases of the knee joint but rather to speak of a method of treatment that is not new, though none the less effective in the conditions met with and one which is today of more utility than any other unless it be the knife; even doubtful it is, if the results from the use of the knife will in any measure compare with the one in question. Treatment by extension, physiological rest, "Hilton's Method" or the total non-use of the joint during the course of the disease has saved many a knee joint, has averted the necessity for amputation of many a thigh and even in those cases where its use must be reinforced by other measures, its value remains unquestioned and the comfort obtained from its use is grateful to the patient. Extension of the knee joint is easily accomplished and if properly applied is almost painless; in fact many patients will ask to have it reapplied if removed before the joint is healed; it does not prolong the period of confinement in bed and on the other hand is the means of allowing patients to leave their bed and room long before it would be possible for I them to do otherwise. It does not produce stiffening of the joint as does immobility with plaster of paris or splints though if deemed necessary plaster of paris and splints may be used at the same time and with much better effect than if used alone. Hilton's idea and teaching was that if functional and physiological rest could be secured, Nature would and did take care of the inflammatory process and healing would follow, though at that time he of course did not reckon upon, if indeed he realized the value of asepsis and antisepsis. Even in cases that are well known to be septic. he secured results and his followers today secure results that it must be admitted are better than can be secured by either, by immobilization or resection of the joints. It must not be understood from the above that we decry the value of medical measures or indeed all therapeutic measures; on the contrary a generous diet, the best of hygienic surroundings, the best constitutional treatment and best medication are to be used and in no class of diseases more than that of the joints do we see the beautiful results of the indicated remedy, administered homeopathically; even the older school is recognizing the good obtained from the use of tissue remedies and under one name or another giving the same medicines we so often use. Extension may be used in the very onset of the disease of a joint; in the knee joint it is indicated in any marked swelling of the synovial sack that has persisted after twenty-four hours of ordinary treatment, it will do no harm if used at once. It is well that all acute cases be confined in bed for a time at least but if this simple measure does not bring relief, apply extension without delay; many times the care afforded during the first forty-eight hours will determine the entire course of an injury to the knee joint. The execution of this plan is easy; a pulley is fastened to the foot of the bed, adhesive straps fastened to the lower part of the leg serve to hold a cord that passes over the pulley and is weighted with sand as may be needed. In severe injuries or long standing disease it is at times necessary to make strong extension, i. e use a heavy weight which contrary to the usual rule may cause a great deal of pain but this can be eased by relaxing the pressure for a few minutes at a time. Chronic cases that have gone from bad to worse often times show markel improvement as soon as the rest treatment and extension are employed; for examples of those in which the results are quickly and permanently obtained may be mentioned the following, arthritis, synovitis and inflammation of the cartilages. Sprains, contusions and incomplete fractures in the knee joint region are for the most part greatly benefitted by this form of treatment and in many cases its employment will arrest secondary involvment of the joint itself. Contractures of the tendons and deformity of the joint are prevented or overcome by a continued and reasonable use of extension. It is not the purpose of this paper to in any way cast reflection upon the good work that may be done by the appropriate use of surgical measures but it is rather a plea for a fair trial of this method before resorting to the more radical and brilliant operations of amputation or resection of the joint, but we will make the broad statement that in all cases whether it be simple synovitis, arthritis or even ostitis, this measure should be used to the exclusion of the more radical, unless diseased bone is present. Tuberculosis is the one joint disease that strikes terror to the heart of any surgeon, yet even this may be made to yield in time and in many cases a joint treated by the Hilton Method has served the owner reasonably well and been found better than other parts of the body at the time of the individual's death. TIME OF TREATMENT: As in all long lasting cases it requires a good deal of tact to keep the patient under treatment and a good deal of patience and courage for the surgeon to continue the treatment in the face of temporary reverses of the healing process, for while in an acute case we may expect a good, permanent result, in, from four to ten weeks according to the severity of the case in hand, in other of longer standing or where the injury is greater it may require four or five times as long and in tubercular cases it may be a matter of years ere a cure can be effected. Abscesses may form and require to be opened as the case progresses; sometimes by aspiration, sometimes by the "open method" but Nature, even where the whole synovial sack has been ravaged by sepsis or tuberculosis, will many times seal the joint ends together and form a "stiffjoint." |