« ForrigeFortsæt »
Dr. John H. Brinton, Lecturer on Operative Surgery in the summer school of the Jefferson Medical College, holds this year the Mütler Lectureship on Surgical Pathology at the College of Physicians, and is now delivering before the College a very interesting and instructive course of lectures on the subject of Gunshot Injuries. During the late war Dr. B. occupied the position of surgeon of volunteers, and was attached, during the greater portion of the time, to the staff of the General commanding the armies. His experience in the field was, therefore, ample, and enables him to speak with authority upon the subject of gunshot injuries and their effects on the soldier performing duty in the different parts of the country. At the close of the war he was assigned to duty as officer in charge of the army anatomical museum at Washington, where he enjoyed increased facilities for the examination of specimens illustrating the effects of gunshot lesions. The following synopsis of the course will furnish some idea of the way in which the subject is treated.:
Fire Arms and Projectiles—Theory of Fire-General Phenomena attendant upon Ball-Wounds-Death-Ratios of Casualties in Battle - Local Effects of Ball-Wounds - General Prognosis — Gunshot Injuries of Bones-Gunshot Injuries of Joints—Gunshot Injuries of Chest.
Under the head of Fire-Arms and Projectiles, he gave an interesting account of the invention and use of arms and projectiles, ancient and modern—the improvements made in their construction up to the present day, and the kinds employed during the late war.
He proved, by reference to official documents and by his own experience, that the explosive bullet was but rarely used, and then not for the purpose, as frequently averred, of disabling troops, but rather with the design of exploding caissons and destroying ordnance stores: the fragmeuta so frequently found in wounds, and designated as portions of the explosive ball by surgeons, were, in truth, parts belonging to the English conoidal bullets which were principally used by the Southern troops.
The circumstances modifying General Prognosis he illustrated by reference to campaigns—that of General Grant up the Cumberland and Tennessee rivers, afforded him a typical illustration of the combined influence of three causes modifying in a marked manner the general prognosis. Rendezvousing in the autumn at Cairo, the troops became saturated with malarial poison-at the seige of Fort Donaldson, deprived, by the exigencies of the service, of fresh meat and vegetables, scorbutus made its appearance. Transferred from Fort Donaldson up
the Tennessee river in crowded transports to Pittsburgh Landing, ochlesis was developed. Thus, the prognosis in cases of wounds received at this period, was extremely unfavorable, and was distinctly modified by the combined influence of the caoses alluded to. Numerous drawings and diagrams, varieties of arms and projectiles, and specimens from the museum of the College, and the Doctor's private collection, assist him in presenting his subject in a clear and instructive manner.
An interesting case of surgical injury, in which transfusion of blood was successfully employed by Dr. Thomas G. Morton, one of the surgeons of the Pennsylvania Hospital, has been recently under treatment in the surgical wards of the hospital. The patient, a young man possessing a hemorrhagic diathesis, was wounded ten days previous to admission, by falling on the fragments of a pitcher which he had been carrying in his hands, one of the fragments being forced up between the tissues covering the left superior maxilla, having entered on the inner surface of the upper lip. The efforts made to control the hemorrhage, which resulted by means of styptics and pressure, having failed, and the patient becoming much exhausted by the large loss of blood, it was deemed advisable to remove him to the hospital. On admission, Dr. Morton endeavored to occlude the bleeding vessel by acu-pressure, using for that purpose a long hair-lip pin, which was introduced on the right side, and carried beneath the base of the nose, emerging some distance on the other side. This being ineffectual, both fascial arteries were acu-pressed as they pass over the border of the inferior maxilla. The hemorrhage still continued, notwithstanding the application of pressure to these arteries, and the left common carotid artery was ligated. The ligation of this artery was successful in controlling the hemorrhage, though the patient was by this time in such a state of extreme exhaustion that death was imminent, and Dr. M. decided to try the effect of transfusion of blood. Two medical students furnished the blood that was required, which, after being strained and placed in a vessel surrounded by water at a temperature of one hundred degrees, so as to prevent coagulation, was injected by means of a large hypodermic syringe (2 ounce) into the medeaii basilic veins of each arm. In this manner eleven ounces of blood were infused, the good effects of which were experienced in five minutes by a rallying of the pulse, and other indications of beginning re-action. No more hemorrhage occurred, and the patient rapidly recovered.
In this connection it will be interesting to note that transfusion
was first practiced in the early part of the seventeenth century, although its use in England and on the continent generally dates from the middle of this century. The first operations were on animals, and the first instance of its performance on man, if we except that described by Lebrarius, was in Paris, by Denys and Ennuerez, in 1666. In this, and in subsequent cases, the blood of animals was employed, but owing to the discovery of the difference in the character of the blood corpuscles of animals and of the human subject, the transfusion in later times were from one individual to another of the same speceies.
Dr. Blundell, the eminent accoucheur of England, has showed the value of this operation in obstetrical practice, by means of which many lives are saved in cases of exhaustion from hemorrhage. Prof. Landors, of Greiswald, has tabulated ninety-nine cases in which transfusion was performed on account of hemorrhage, with the following results: In eleven case there was, from the first, no hopes of successin twenty the operation failed-in three the result was doubtful, and in sixty-five, or nearly three-fourths, it was successful. Such results should commend the operation to practitioners, and should induce its employment in all cases where death from hemorrhage is imminent. The operation is sufficiently simple, care being taken to avoid the introduction of air into the vein. A case has been recently on trial in one of our courts, in which an attempt was made to establish a eharge of mal-practice against Dr. Addinell Hewson, one of the surgeons of the Pennsylvania Hospital, for the employment of the dry. clay as a surgical dressing. The patient was admitted into the surgical wards under the care of Dr. H., for severe injuries sustained by the explosion of a coal oil lamp thrown at him with evil intent by the prisoper on trial, a young man of nineteen. Dr. H. testified that the patient, on admission, was suffering from severe burns of the whole face, chest and upper extremeties; part of the burn was superficial, but the greater portion of it was a deep burn, such as is constantly seen in accidents resulting from coal oil explosions. Death occurred on the sixteenth day after admission, from tetanus. In a long crossexamination in regard to the effect of the earth treatment, Dr. H. stated that the object in this case was to exclude the air, but other than this he was unable to tell the effect—that the pressure of the dressing did not affect the tissues beneath—that the tendency of the earth.dressing in case of this kind is to assist nature—the first four days the dry-earth was used, after that it was discontinued on the face, but kept on the arm, and then resumed on the seventh day on
the face, at the earnest wish of the patient. On the sixth day waterdressings, with glycerine and carbolic acid, were resorted to, and mag. gots began to appear in consequence of the flies, resulting from painting the shutters of the ward.
In opening the case for the defense, the counsel stated that it would be shown that the only effect of the earth was to exclude the air-in all other respects it was a negative dressing, and therefore did positive harm-that the disinfectant qualities of the dry earth were entirely lost when it becomes saturated with fluids—that the use of the earth in this case led to the prescnce of the maggots, and that in removing them by a stream of water, the system of the patient sustained a severe shock, and tetanus was produced. The principal witness for the defense, by whom the above points were to be established, was one of the resident physicians on duty in the surgical wards ander Dr. Hewson, who testified that his experience as a medical practitioner (a graduate of a few years' standing) led him to believe that the clay did no good in any instance. After the testimony of the resident physician, and of other physicians, who testified that they did not know enough of the earth-treatment to express an opinion, the charge of mal-practice was abandoned, and it was agreed to leave the case wit the jury, with recommendation for a verdict of guilty of voluntary manslaughter. The jury returned a verdict in accordance with this recommendation, and the Judge, in passing the sentence, stated that he felt called upon to remark that nothing developed on the trial had in the least tended to show that death resulted from the medical treatment.
We have received from Prof. Rand, Dean of the Jefferson Medical College Faculty, a catalogue of graduates of the Jefferson Medical College, from its organization in 1826. Of the five thousand, six hundred fifty-one students graduated during this period, one thousand, six hundred and eighty-two were from Pennsylvania ; Virginia, nine hundred and forty-two; Georgia, two hundred and eighty; Kentucky, two hundred and forty-five; North Carolina, two hundred and thirtyeight; Ohio, two hundred and five; New Jersey, one hundred and eighty-three; New York, one hundred and eghty-two; Tennessee, one hundred and seventy-two; Alabama, one hundred and seventy; Mississippi, one hundred and fifty-one; Maryland, one hundred and fortynine; South Carolina, one hundred and thirty; Missouri, one hundred and six; Indiana, ninety-nine, and a varying number from the other
States. The East Indies, Hungary, Turkey, Switzerland, New Foundland, Costa Rica, St. Cruz, Wales, Sweden, Corsca, Mexico and Nicaragua are each represented by one, while England, Scotland, Ireland, France, Barbadoes, South America, Germany and Cuba contributed from two to eleven each. The list contains some of the most distinguished names in the profession, men who are eminent as teachers and practitioners. One of the oldest graduates of the college is Prof. Mears of the Indiana Medical College, who was a member of the class of 1827. Prof. Gross graduated in 1828.
On the 20th ult. a special meeting of the College of Physicians was held to hear Prof. Gross' memoir of the late Prof. Robley Dun glison. The subject was treated in the easy and graceful style so characteristic of the distinguished memoirist, and the memoir was a perfect portraiture of the character and achievments of his late illustrious colleague. As an evidence of the amount of literary work performed by Prof. Dunglison, and of the high estimation in which his writings were held, Prof. Gross stated that up to the period of his death, one hundred and sixty thousand volumes of his various books had been issued from the press. Notwithstanding the time and labor required for the accomplishment of the many self-imposed duties, he always had time to receive those who called upon him, and so well regulated were all his movements that he never appeared to be in a hurry. Distinguished for his bonhomie and generous hospitality, he enjoyed to the fullest extent the pleasures of social intercourse, and often terminated a hard day's work with a party of friends at the opera or theater.
The woman-question, in its medical aspect, has been very vigorously discussed in our public journals during the past ten days. The immediate occasion of its prominence at this time was the reception tendered to a number of "lady students of medicine” who, in accordance with a' resolution of the Board of Managers of the Pennsylvania Hospital, granting them the freedom of the Hospital, attended the medical and surgical clinics on the 6th inst. It appears that this resolution of the Board was adopted without paying the medical staff the compliment of consulting it in reference to the expediency of introducing mixed classes at the clinics. During the progress of the clinics there was a good deal of hilarity prevailing, which a member of the Board, who was present, attempted, with a mistaken idea of his duty, to repress.
At the termination of the clinics, and as the “lady students of medicine" were departing, some of the male students indulged