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excluded from the raw surfaces produced in operations for hare-lip, vaginal fistulæ, laceration of the perineum, etc.?
All the effective antiseptics hitherto tried by Lister and his followers are open to the grave objections that they irritate the wound and are very apt to give rise to general toxic symptoms from unavoidable absorption into the circulation. Carbolic acid, the antiseptic preferred by Lister, frequently causes very grave renal irritation, particularly in subjects. whose kidneys are not quite sound.
A liquid perfectly adapted to antiseptic wound dressing must be competent to completely prevent putrefactive change in wounds, from whatever cause the decomposition may arise. It should not unduly irritate the raw surfaces, nor should it be poisonous or volatile. I believe that dilute alcohol possesses all these desirable qualities in a higher degree than any other liquid or solution of which we have any knowledge at present. Its power to prevent decomposition in all organic substances is too well known to need comment. When applied to raw surfaces a slight smarting is caused for a few moments, which soon passes away without subsequent irritation. It never produces poisonous symptoms however freely it may be applied to wounds of the most extensive character, and it is not unduly volatile.
During operations no care need be taken to exclude airgerms from wounds; these do no harm if they be not allowed to live and increase between the cut surfaces, and they can be perfectly and permanently destroyed by the free application of a mixture of 25 to 30 parts alcohol and 70 to 75 of water.
After the edges of the wound have been approximated and secured, cloths saturated with dilute alcohol should be applied and covered with oiled silk or rubber sheeting. As often as these become dry they should be again moistened with the dilute alcohol. If these simple directions be carried out wounds scarcely ever suppurate and never become septic, the discharges never decompose and the healing process will go on as quickly and steadily as if the Lister dressings had been applied in the most perfect and successful manner.
If the surgeon desires to examine the wound no injury can
possibly result from the entrance of air and its germs during examination, if he carefully saturates the still unhealed surfaces with the dilute alcohol and completes the simple dressings as already described.
The antiseptic method of wound-dressing here advocated is not new. The good Samaritan could not have been ignorant of it because he poured wine into the wounds of his neighbor, who had been attacked by robbers on the road from Jerusalem to Jericho, as mentioned in the Gospel according to Luke.
By A. J. Howe, M. D.
It is not uncommon for minute calculi to form in the mouths of the ducts of the prostate, or in a sac or pouch that may be developed in the gland through an aggregation of calculous bodies at some point. Probably the sinus pocularis is oftenest the receptacle of a minute urinary calculus, that develops at length into a stone of considerable size.
In March I was introduced to James Ross, a baker by trade, who had suffered many years with a urinary difficulty, and had found considerable relief by drinking freely of the water from Eureka Springs, in Arkansas. After a few minutes' conversation I became impressed with the idea that a calculus existed somewhere along the urinary conduits, and asked the privilege of "sounding" the bladder. The patient demurred at first on the ground that such explorations made his symptoms worse, to say nothing of the hemorrhage provoked and the pain temporarily inflicted. However, I persuaded him that the soundings should be gentle, and that no blood would probably be seen. As soon as an instrument reached the prostate, the grating of a stone was encountered, hence the implement was not carried into the bladder. The patient, with sound manipulated by himself, felt the calculus, and
detected its situation. He said it was near the bladder, but not in it. I measured the stone carefully enough to determine it was one of considerable size.
About a year previously a surgeon in St. Louis had explored the bladder on two occasions to see if a vesical calculus did not exist, but he failed to find what he sought. How he could pass a sound through the urethra and not hit the rock is a mystery, for it was then as large as at present, or nearly so. The patient then took medicine under the assurance that his disease was ordinary cystitis. However, he got no relief from pelvic pain and a teasing inclination to void urine frequently, except the partial exemption obtained at Eureka Springs.
On the 18th of March I gave the patient an anesthetic, and endeavored to seize the calculus with urethral forceps, but the body was so hard and large that it could not be moved. A lithotrite could not be made to do its accustomed work in so restricted a space, and Bigelow's Evacuator could not be employed with success. Having tried several ineffectual methods, I resorted to excision. A lithotomy-staff was cut upon at a point a little to the left of the center of the perineum, and the stone easily reached. It was found in the floor of the prostatic urethra, and removed by the aid of forceps. The bleeding was not considerable. The vesical sphincter was not cut; hence the urine was under the control of the will from the first, though a large part of it escaped through the incision-the external wound-for several days. As the passage healed the urethra resumed its accustomed functions; and at the end of fifteen days the patient had entirely recovered.
The calculus was an inch and a quarter in length and a little over a half-inch in diameter. A pointed end presented to the neck of the bladder, and must have turned the urinary flow into a funnel-shaped stream. The lower end was conical, and the body was smooth and cylindrical. In some respects the calculus resembled an elongated acorn with the cup attached.
This was one of the largest calculi of the prostate ever removed. I had taken one as large as a white bean from the fossa navicularis, and a still larger one from the pocket in the
floor of the urethra just in front of the scrotum. The one in the fossa was dislodged by enlarging the meatus upward and into the glans; the other, in the urethral pouch, was removed through an incision made to evacuate the pocket. The incision was made under the impression that the tumor was a cyst.
The accompanying diagram represents the size and general aspect of the calculus. The crosses indicate the course of the incision through the perineum.
MEDDLING AND MISTREATING OF A CASE.
By G. C. CHANEY, M. D., Independence, Kansas.
I was called sometime since, in consultation with Dr. C., to see a young man that had been thrown from a horse, alighting on his right shoulder, producing a fracture of the acromian process and dislocation of the humerus. Dr. C. administered chloroform and attempted to reduce the luxation, but failed. I arrived about five hours after the accident occurred. The patient was a young man about nineteen years of age, a heavy, muscular fellow, weighing about one hundred and sixty pounds. His right shoulder was greatly swollen, and almost black from extravasation of blood. It could not be handled or examined without causing him severe
pain. Dr. C. and I administered chloroform to complete anæsthesia, and on examination I concurred with Dr. C.'s diagnosis. By manipulation, a la Dr. Howe, we had but little difficulty to replace the head of the humerus in its socket with the characteristic thug. I saw no more of the case for about three weeks. At that time he had not gained perfect motion of his shoulder, and there was a lack of the prominence as is naturally given by the acromian. I explained to him that the impediment was caused by the injury to the process of the scapula, and directed him to exercise the arm gently, assuring him that in a short time the motion of the joint would be perfect. He followed my advice and in a few weeks he had a perfect joint.
During the time of this impediment to motion in the boy's shoulder, Dr. G., an Old-School man, said to be the best anatomist in the State of Kansas, met him and availed himself of the opportunity to examine the case. He declared to the boy that we had not reduced the luxation. Dr. G. also called Dr. M. to diagnosticate the case. He told the patient that anybody who said that that shoulder was set was a d-ned fool; and that Dr. C. and myself were liable for malpractice. They succeeded in getting him somewhat anxious in regard to his condition. The boy reported the Doctor's language and assertions to us, took our advice, and came out as above stated.
During the time that he was thus crippled, and while two Old-School doctors were waging war on us, he visited his lady-love; and while standing behind the chair in which she was sitting with her right arm elevated above her right shoulder, he affectionately grasped her hand, gave it a quick jerk backward and downward, producing a sub-glenoid luxation of the humerus. Although Dr. C. was nearest and was their family physician, Dr. G. was called to reduce the dislocation. The doctor manipulated the shoulder, and told her that the luxation was reduced, but could not understand why the border or base of the scapula persisted in standing out so prominently. He requested the lady to lie on the floor, face downward, and he would press the shoulder-blade to its place