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National Eclectic Medical Association.
SCIENTIFIC REPORTS, PAPERS FROM
"The President, within three months from the holding of the Annual Meeting, shall designate members to prepare papers or reports to be submitted at the Annual Meeting next ensuing. Every member of this Association SHALL, at his earliest convenience, communicate to the Association or its Secretary all interesting cases, improvements, discoveries and suggestions, as he shall consider useful, and prepare papers and essays upon topics connected with Medical Science or Practice; which may, whenever judged of sufficient importance, be published with the Transactions.” CONSTITUTION, Article VI.
Resolved, That in future sessions of this Association, all papers submitted to it shall be referred by the President to the proper Section.
"Resolved, That the Secretary of each section shall submit to the Secretary of the Association a list of all papers in the possession of such Section, with the recommendation of the Section thereon, and shall deliver to him all such manuscripts at the close of the session."-Resolution Adopted June 17, 1881.
"No report or paper presented to the Association, as herein provided, shall be excluded from the printed volume of Transactions except for the following reasons: 1. Imperfect preparation. 2. Indecorum of language. 3. Unfriendly expression toward the Association. 4. Want of importance or of pertinency to the subjects within the province of the Association. 5. Insufficient means in the possession of the Treasurer to liquidate the expense of publication."
"All papers read or submitted to the Association are its property and shall be deposited with the Secretary within thirty days, or else they shall not be acknowledged, except by express vote or authorisation, in any Journal of Proceedings. But this Association is not to be regarded as approving unqualifiedly or sanctioning to their full extent the several doctrines or sentiments set forth in the papers thus presented and published by its direction."-By-Laws, Article X.
"Resolved, That the papers and Articles included in the published Transactions shall be restricted, except in extraordinary cases, to twenty printed octavo pages."Resolution Adopted June 17, 1881.
SURGERY, GENERAL AND SPECIAL.
MILTON JAY, M. D., Chairman; LORENZO E. RUSSELL, M. D., Secretary.
PROGRESS OF SURGERY.
Address by MILTON JAY, of Chicago, Illinois, Chairman.
Antiseptic Surgery is still claiming the attention of surgeons in this as well as all other countries. Indeed, as time passes, there seems to be no diminution of interest. It actually appears to be an abnormal interest which is being manifested by surgeons the world over. Probably no subject in the wide domain of surgery is calling forth more thought and scientific invesigation than this subject of antiseptics; not only as applied to the treatment of operations and wounds, but also to the internal administration of remedies, hypodermically and otherwise, for the alleviation and radical cure of any and all toxic conditions of the system. If one-half is true that has been written upon this subject during the five years last past, one would be forced to the conclusion that all diseased or pathological conditions are septic in their nature and origin, and all that is required for a radical and perfect restoration to health is the free use of antiseptics. The only wonder seems to be that any one should prematurely shuffle off this mortal coil while antiseptics are so abundant and easily obtained. For when we view the gorgeous array of agents that are classed as antiseptics, by those who have been the fortunate discoverers of the same, we find the Materia Medica rather sparsely occupied with agents claiming any other name.
To Lister the glory belongs of the introduction of antiseptics into Surgery so far as carbolic acid is concerned. Improvements, however, and modifications, and combinations, and the introduction of other agents have been so numerous and complex that we now inquire not what is the antiseptic,
but which is the agent, or combination of agents, constituting the best antiseptic.
All are willing to admit the efficacy of this class of agents; some to the fullest and others to a limited or circumscribed degree. To "make haste slowly" has always been a golden rule in surgery, and might, with a good degree of propriety, be adopted in arriving at conclusions upon this subject; the fact that surgeons and physicians do not agree as to what agent or combination of agents will accomplish the most general, beneficial and satisfactory results, is evidence that this subject has not yet been reduced to any exact scientfic formula. It is still open for investigation and discussion. That fact renders it all the more interesting: the truth has already been fully demonstrated that attention to details and cleanliness, during an operation as well as in the after treatment of wounds and injuries, is of paramount importance. Upon the strict observance of these will depend much of the surgeon's success. To prevent the admission or formation of bacteria or micro-organisms in wounds, is a desirable end to be attained. To accomplish this end one will use carbolic acid, another pyroligneous acid or creosote, another Listerine. Others prefer zinc, or iodine, or collodion, or sulphur, or baptisia, salicine, salicyilc acid, salicylate of soda, or antiseptic gauze, or bismuth, which has lately been extolled as the very best antiseptic agent by the noted surgeon Kocher, of Switzerland. A host of other agents might be named. But whatever the agent employed, the object is to keep the wound clean and give nature a chance. Oftentimes Nature accomplishes wonders in this respect, without the aid of antiseptics; and not unfrequently there is failure where antiseptics have been freely used.
We might here speak of the internal use of the so-called antiseptics, for the cure of tuberculosis, scrofula, syphilis and malignant diseases, both local and constitutional, but all are familiar with the literature of the day upon this subject. Many believe with Pasteur, De Clare, and others that by the hypodermic injection of phenic acid, and by its internal administration, either or all of those conditions are curable. Nevertheless,
up to the present time the reliable records of cures do not foreshadow conclusively the ultimate triumph and success of the remedy.
Closely related to this subject is the new method of assisting ulcers and wounds with loss of substance to heal. The subject of skin-grafting has received its share of attention. from the surgical world during the past; at times seeming to make advancement, then to retrograde and fall into disuse. This subject has been revived by the introduction of what is known as SPONGE-GRAFTING. This method was first brought before the profession by Prof. D. J. Hamilton, of Edinburgh, in 1881. When a wound is made in any part of the body, if unaccompanied by loss of substance, our object is generally to procure a healing of the wound as rapidly as possible. But if there has been loss of substance, cicatrisation is not enough. It would, in general, be far better if we could accomplish the restoration of the part which has been destroyed, a re-formation of the tissue which has been lost. Sometimes, no doubt, an ulcer may heal level with the skin; but oftener it cicatrises, leaving a distinct and unsightly depression.
What this new method proposes to do, in cases where there exists a loss of substance, is to afford a scaffolding in which the new tissue can be built up. This scaffolding is supplied by a fine porous substance, like sponge. There are no special inherent properties in the sponge itself which render it essential to the process. It takes no active part in the growth of tissue. Its part is purely a passive one. It is simply the material which proves to be the most suitable for the purpose; and up to the present time no better has been found. When a sponge is placed upon a granulating surface it soon becomes fixed there.
It is now established beyond doubt that new tissue forms in the interstices of the sponge. The manner in which it forms has been carefully studied, and the startling histological conclusions which have been arrived at by microscopical examination of the pieces of excised grafts, seem to court further
investigation. It has not yet been demonstrated whether different kinds of tissue can be reproduced in this way. Up to the present the cases in which it has been tried have shown the formation of granulation-tissue, but whether under certain conditions this tissue may not subsequently be transformed into the same material as that which surrounds the sponge, is a question. It will be interesting to know whether the material which has formed in the sponge-meshes will eventually develop into bone, cartilage, muscle and the various structures respectively. If so, the experiment is a success.
ARREST OF HEMORRHAGE.
In no department of practice is the surgeon's courage, presence of mind and skill, called forth in so positive a manner, as when suddenly required to arrest and control a frightful and dangerous hemorrhage. Many methods have been adopted as surgical, yet but few are reliable. Torsion or pressure will answer for small vessels. Styptics, such as persulphate of iron, perchloride of iron, alum and tannic acid, should not be used where the hemorrhage is from an open wound or where the vessels can be reached, as their action is only temporary, and hemorrhage is apt again to supervene. In that case the pasty clots which they have formed render the ligating of the vessels very difficult. Most of the styptics prevent union by first intention, because they irritate the raw surfaces, causing inflammation and suppuration. Ligature is the only safe method where the vessel is of any considerable size. The old plan is to cut the ligature long, so that it will reach beyond the surface of the wound or flap, and by traction remove it after the artery has healed, the ligature acting all the while as a drainage-tube and preventing the perfect union of the flaps. Some two years ago, after amputating the femur near the hip-joint, the femoral artery was securely ligated, and by mistake both ends were cut close to the knot. This was not discovered till the flaps had been closed and the ligatures counted. The flaps healed nicely and the ligature is still there. Since that time, when I have applied a ligature to a deep artery, whether in a wound or in amputating, I cut the ends