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Afternoon Session.

Dr. J. J. McKone read a paper on “Phelps' Operation for Club-Foot," and exhibited two photographs showing a club

a joot on which he had operated.

Dr. Hickman stated that there is a matter in connection with club-foot generally that is too frequently overlooked, and that is the muscles generally have very little power and that is a point that perhaps should be looked after more frequently than it is. The subject is a very interesting one, an:

, has been landled from a practical standpoint, and eight cases ought to form a sufficient basis for practical deductions and to put the matter upon an intelligent footing. It seems to me that it is a subject that the society might get a gool (leal out of by discussing points that are in doubt and bringing up questions about which there may be legitimate doubt.

Dr. Burns-One thing occurs to me; that is, the frequency withi which, after these operations, the lesser toe turns downward to a great extent; that is being flexed and the child some time after walking apparently on the side of the foot.

The president called the attention of the society to the fact that Dr. S. D. Brooks, official representative of the United States Marine Hospital Service, was present in the meeting, and he, with Dr. Miles, Dr. Simonton and Dr. A. Harris, were offered the privileges of the floor as visiting physicians.

Dr. W. C. Cox read a paper on "Treatment of Burns."

Dr. Coe—During the past year I had a case, a quite extrensive burn, involving the inner and posterior surfaces of both legs and thighs, the burn reaching from the groin to the ankles on each side. First I tried the grafting of dry epithelium raised by blister. I did not have room enough on the patient to get the skin for grafting. I succeeded in getting some good blisters. Well, I applied them and treated the case as well as I knew how, but got no results at all from the grafting of the dry skin. I afterwards found a patient who

. was willing to yield up the surface for grafting. I tried cutting of the surface with a safety razor, but it did not do good work and left the skin all rough. I finally returned to the old method of using a microtome knife, and covered the new surface with fresh grafts and succeeded.

Dr. Hickman—I must express my surprise at hearing the white lead and oil treatment mentioned: in other words

the white paint method. As far as I know, everybody condemns that treatment. I want to lay special emphasis on the matter; I think the very best treatment for burns of great extent or small extent is white lead paint.

Dr. Miles—I would like to ask a question of Dr. Cox as to the treatment followed where we have dynamo burns and what treatment gives the best results to stop the excessive pain, especially where the skin has been destroyed.

Dr. Sims—I tried carbolic acid, full strength, on one of my patients, and he said it did not hurt him any, and he recovered without any trouble; a very severe burn.

Dr. Cox-So far as a burn from a dynamo is concerned ! scarcely know of anything better than the tincture of opium. It has always answered my purpose well in burns where the cuticle is not destroyed, and I think the same treatment would apply to burns of that character.

Dr. R. L. Thompson read a paper on “Suppurating Ears."

Dr. Coe- I want to ask if there is any use of applying glycerine or glycerine tampons to the ear in acute stages?

Dr. Thompson—I have no experience in that.
Dr. Coe—What kind of hot applications do you use?

Dr. Thompson-Flannel cloths wrung out of hot water and applied to the side of the head.

Dr. Kibbe—If we liave a neurotic bone with a sinus leading down to it, we do not confine ourselves to simply injecting medicated solutions down there. We used to do it in the early days of surgery, but now we attack it in a rational common sense way, cutting down to it and removing the focus of disease.

Stocker has operated, in his last report, on one hundred cases with a death-rate of three per cent. Of this number three were afflicted with cerebral abscesses, and eliminating these cases we have a cleath-rate of nothing, presenting a total recovery with complete eradication of the disease.

Dr. Musgrove-Doctors are a little afraid that they will not find support from their brother practitioners in recommending radical operations on simply running ears. titioners will say that it is nonsense; patients object to it.

Dr. Simonton-I was very much pleased with the paper of Dr. Thompson, and I believe he confined his paper particularly to acute conditions of the ear and not to chronic suppuration, No doubt there are occasions, in general practice, when bleeding would be very valuable, very important; but it is out of fashion, and you dare not resort to it. It is stated

Other prac

that in the use of leeches there is some difficulty in managing them. I think, in the application of a leech, if you make a puncture of the tissue and allow a drop of blood to present itself and present the leech to that region there will be no difficulty in getting the leech to take hold.

In regard to mastoid diseases, I think there are a good many cases that result from acute diseases of the mastoid. Cases of this disease extending to the brain are common and we ought always to be on the alert in regard to them. I think we have nothing better probably than warm applica tions or douche of warm water (in acute cases). It is remarkable how quickly it will relieve pain. But we ought to resort to some measures that might prevent suppuration. Morphin and atrophin have a controlling influence over the circulation and they have a beneficial effect in preventing suppuration in an acutely inflamed region like the middle ear. Take, for instance, acute coryza, inflammation of the membrane of the nose; administer an eighth of a grain of morphin or a fifteenth of a grain of atropin and repeat it in two or three hours probably, and the whole trouble will subside.

Dr. Thompson—There is no question but that in certain cases we have to operate, but I am inclined to go slow on the operating. This paper I read for the purpose of discussing more particularly what came under the observation of the general practitioner.

Dr. Thompson announced that he had a paper by Dr. Semple, of Spokane, on “Depressed Cranial Bone Returning to its Position without Operation," and on motion it was directed that it be received and read at this time.

Dr. Whiting—I had a case I was called to see about two years ago. A boy fell off of a wagon and the wheels passed over his head and pushed in both temporal bones until the parietal overlapped. He remained unconscious for five hours. He recovered entirely with the exception of paralysis of one facial nerve, but you can very plainly feel the parietal bone overlap the temporal.

Dr. McKone—Did you attempt to replace the bones?

Dr. Whiting—No; the boy was perfectly healthy, and I considered it better to leave them as they were.

The program for the Tuesday evening session having been exhausted, on motion it was decided to proceed with the program for Wednesday morning.

ter pus

Dr. J. W. Hickman read his paper on “Drainage in Abdominal Surgery."

Dr. Sharples —I take exception to some things that Dr. Hickman said. First, in regard to getting the abdomen thoroughly mopped out. You cannot mop out everything that there is there. Take desperate cases to be operated on at the last minute that we sometimes get hold of. If you attempt to take the time to thoroughly mop out the abdomen you are going to have a funeral before you get through.

Dr. McKone said that the stand taken by Dr. Hickman on drainage, perhaps goes a little too far, and he would prefer to take sides with Dr. Sharpless as being a little more conservative in this respect. While it is true that the peritoneal cavity will take up a great deal, still when we encoun

cavities it seems to me that we will have to use drainage.

Dr. Hickman—It seems to me that the general trend among operators is to use drainage less and less. In the cases I think there is a particular division running through them of chronic on one side and acute on the other, and in the acute abscesses we will have to use drainage perhaps in nearly all at present. With reference to chronic cases, as I remarked in my paper, it has been found by careful work upon the part of bacteriologists that most chronic accumulations of pus are sterile of germs, and that if these be reasonably taken care of that we can get along without drainage.

Applications for membership of Dr. Charles E. Taylor, of Tacoma, and Dr. M. Robb Stapp, of Aberdeen, were presented and approved by the board of censors.

On motion of Dr. Thompson the rules were suspended and they were declared elected members of the society.

The society then adjourned till 8 P. M.

Evening Session.

Dr. Bean read a paper on “Relation of Certain Diseases of the Kidneys to Abdominal Operations."

Dr. Hickman—I hardly feel competent to discuss that paper. It is very interesting clinical history. The deductions which he draws are probably correct, yet I do not believe that they are past the possibility of a doubt. That very mysterious and protean-shaped thing we call shock covers so much ground that it is difficult to distinguish it from some other conditions. I am sure it is very important to know

the condition of the excreting organs, particularly the kidneys. I think suppression of the urine might cause the death, and that total inactivity of the kidneys might have been noticed by close observation. The doctor said one thing, with reference to anæsthetics, that I am doubtful about We are taught that ether is excreted largely by the kidneys. I think it is the rule that where operations are necessary in chronic diseases of the kidneys of a certain kind that chloroform is the anæsthetic to be selected.

Dr. Willis—Dr. Hickman said ether irritated the kidneys and chloroform did not. Now it was my teaching that they were both excreted through the kidneys; they were both irritating; chloroform was more irritating than ether, but it was less irritating because you gave less of it, but there is more irritation from chloroform, taking the same amount than there is from ether.

Dr. Musgrove—The subject of renal complications before and after serious operations is one that has not been given sufficient attention by the average physician. My experience in regard to anæsthetics has been about this: that'ether, when given for a great length of time is almost sure to produce kidney trouble after an operation. That was a long operation, two and a half hours, and ether given for almost two hours will most invariably induce suppression of the urine. Chloroform is less dangerous for some reasons.

I do not know whether it is because of less quantity or not. For my own part I have been in the habit of giving the A. C. E. mixture for the last ten years, and I have seen less trouble than that from ether. In regard to abdominal operations, it is said that some French operators are performing the operation in five to ten and ten to fifteen minutes without difficulty. If that be the fact it is time for us to get a move on us and do things a little faster.

Dr. Axtel—I cannot speak from experience in the abdominal operation because I have never performed any, but I have administered chloroform alone over eight hundred times, varying in time from a few minutes to the longest time, five and a half hours. One recently, a very serious operation on an old man seventy-seven years of age, for one hour and three-quarters, and I have never yet, except in two instances, had to change from chloroform to ether. I therefore am firmly of the belief, from my own experience anyway, that death following these operations is not so much due to

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