Billeder på siden

fissure; and with a hand smeared with boroglyceride I felt for the foreign body. The fingers quickly and readily felt a firm bar, seemingly three-quarters of an inch in diameter and seven or eight inches in length. This was evidently the needle enveloped in omentum. The firmness came from exudations of lymph in the vicinity of the implement. By gentle manipulation the lower end of the indurated mass was tilted into the abdominal aperture and the needle made to appear.

"The intruder, smooth, yet blackened, was then seized and easily drawn from its embedded position. No blood nor other fluid came from the aperture, though the narrow passage led clear into the stomach. The contractility of the surrounding tissues must have closed the canal occupied by the needle.

"The borders of the incision in the abdominal walls were drawn together with four or five silver sutures, and the seam was dressed with a compress of soft cloth, which was occasionally wetted with dilute boroglyceride with thymol. No blood was allowed to enter the cavity of the abdomen, and very little disturbance of viscera was produced. The attending physician reported for the two following days a pulse and temperature of 100 each, and a gradual subsidence afterward to normal states, with a happy recovery."

I have other cases to report that are worthy of your attention, viz.:


Prof. Howe's description of the operation is as follows:

"On the 2d of May, Dr. S. W. Thompson presented a patient, Mr. William Sebring, aged sixty, who had a large tumor of the right parotid gland. The lump was movable, somewhat nodular, and quite hard. It had some of the characteristics of malignancy, yet there was hope for a better state of things. The patient was a farmer who lived five miles from Allegan, Michigan. Five years previously a small nodule appeared on the parotid, yet it did not take on activity of growth till the last of February. The operation for removal was executed before the class in the amphitheater of the Eclectic Medical Institute.

"After anæsthesia was apparent, an incision was made the entire length of the tumor, and the work of loosening the mass begun. The facial nerve was seen, but no effort was made to save it intact. As the work of displacement went on, a brisk hemorrhage kept up, yet no exhausting amount of blood was lost. A ligature was thrown around the temporal vessels, and a severance of them took place above the point

of ligation. The latter stroke gave mobility to the gland and exposed the inferior maxillary artery. The vessel was seized with snap forceps, then broken and tied. With a little care the tumor was detached from everything except the external carotid and an accompanying vein. Around these a silk ligature was thrown, and a severance made above the point of ligation. The chasm from which the adenoid tumor was removed soon exhibited some bleeding. Yet an arrest was made by stuffing the cavity with surgeon's lint, and covering all with a compress and bandage.

"The patient recuperated from the anesthetic and the shock, and passed a not uncomfortable day. In forty-eight hours after the operation the original dressing was removed and a lighter one substituted. The lint was kept wet with dilute boroglyceride which had been thymolated. The wound healed from day to day, and closed within four weeks. The ligatures were slow to come away, yet at length yielded. The face drew to the opposite side. This defect is unavoidable in the removal of the parotid gland. The inconvenience arising from the paralysis of expression is not great. A somewhat improved state of the features is to be expected, but not entire recuperation.

"Dissection of the tumor revealed signs of malignancy. The prognosis, then, is not assuring for the future. However, constitutional remedies will be vigorously pushed.

"The disengagement of the tumor from its deep and narrow bed was accomplished with less trouble than might have been expected. The enlargement of the hard body had forced the gland from its greater depth, hence the tumor moved as if it lay on the parotid. The morbid growth extended downward upon the external carotid artery. There was seemingly no danger from secondary hemorrhage. Only moderate inflammation attended the traumatism. The exhaustion was not marked."


"Erichsen, in his Science and Art of Surgery, says: Excision of the parotid gland itself is occasionally spoken of, but is very rarely, if ever, done. I believe that in most, if not all, the cases in which it is stated that complete removal of this. gland has been accomplished, tumors overlying and compressing it have been mistaken for it. It is evident that a diseased parotid could not be removed without the division of the external carotid artery and facial nerve.'

"In the case which I have reported, every vestige of the parotid gland was removed. There was no tumor distinct

from the gland. The facial nerve crosses the gland near its surface, yet cannot well be saved. Of course the external carotid artery is divided, for it is embedded in the gland. But if it be managed as I have directed, there is no trouble in ligating the vessel.

"Gross, in his System of Surgery, says: 'Considering the narrow space in which the parotid gland is situated, and the complexity of the relations which it sustains to the surrounding structures, is it possible to extirpate it in the living subject? This question, so interesting in every point of view, has been answered differently by different writers. Allan Burns thought the operation impracticable, and a simular opinion has been strenuously advocated by other authorities. That the operation is difficult of execution, requiring the most accurate knowledge of the anatomy of the parts, and the most consummate skill, is certain; and unless the surgeon is fully possessed of these important qualities, failure, if not disgrace, will be sure to attend his efforts. It should be added, however, for the encouragement of all, that it is much easier, in almost every instance, to remove a diseased than a healthy gland of this kind'

"I have italicised the last few words quoted to call particular attention to what I found to be the case. The induration assists in the delivery from the frightfully deep chasm. Prof. Gross very properly cautions against the use of a knife in making the deeper dissections. A thin lever of steel, set in a strong handle, is the instrument to pry the gland from its surroundings. The lever is not sharp, yet its edges are thin. The snap forceps, made for compressing arteries, give the surgeon confidence. With these he can pinch a vessel and tie it at leisure.

"Dr. Gross recommends that the dissection be commenced below the gland, for the purpose of securing the external carotid, and finished by going upward. In cases coming under my observation the tumors have extended down the neck an inch or two; therefore it would have been difficult to reach the artery, and secure it. In my opinion it is easier and safer to begin above and end by ligating the artery and severing itan act which finishes the operation.

"In the dressing of the wound no attempt should be made to close the chasm by drawing together the edges of the incised integument. A large aperture is needed to introduce and remove pledgets of lint. The cavity is gradually filled by granulation."


A novel procedure was performed by myself recently. It consisted in the aspiration of the stomach. A worthy man had, with suicidal intent, swallowed a large quantity of laudanum. He was brought to my office in a profound stupor, stertorous breathing, purplish face, and in the advanced stages of the poisoning.

Flagellation had no effect, and there seemed no way of arresting the fatal results. Spasms of the muscles were so great that I could not open the mouth to use the stomach-tube. I therefore entered a Jaques catheter into one of the nostrils and pushed it downward into the œsophagus, and through this I injected a large quantity of water and liquid emetics. The walls of the stomach were so completely paralysed that emetics had no effect. The stomach was now enormously distended with water and fluid, and every avenue of escape sealed. I therefore conceived the idea of aspirating the stomach. I thrust the large aspirating needle into the pit of the stomach and removed the liquid which was heavily charged with laudanum. I then injected water through the needle, and removed the same, till I was positive that no poison remained; after which I injected into the stomach a good quantity of whiskey, and used subcutaneous injections into the arms and body. Flagellation was resumed and other means at resuscitation followed. The patient made a perfect recovery.


A middle-aged business man consulted me some months since in regard to an affliction which he attributed to a fall. The sterno-cleido-mastoideus muscle was contracted, having the effect of turning the head, drawing the occiput slightly downward and the chin upward. Other muscles, such as the scaleni, splenius and trapezius, were also affected, and the inconvenience, pain and discomfort inflicted by this lesion became very troublesome.

The operation of tenotomy had been performed by two eminent surgeons at different times, but with no beneficial results. I thrust a threaded needle deeply into the tissues of

the neck and ligated the muscles, by piece-meal, until all the muscles of the afflicted side of the neck had been severed. The results of the operation was successful.


Silicate of soda is made by fusing one part of silica (fine sand or powdered flint), and two of dried carbonate of sodium, mixed in powder in an earthenware crucible and pouring out the fused mass on a stone or marble slab to cool. This is pulverised and treated with boiling water to disolve the soluble parts. This solution is filtered and concentrated so as to form crystals on cooling. These are then purified by dissolving in water at 100° Fahrenheit, filtering the solution so that it may re-crystallise on cooling.

The commercial solution of silicate of sodium contains 20 per cent. of silica and 10 per cent. of soda, and is also known to the trade under the German name, "water-glass."

The commercial silicate is of a syrupy consistency, and is an inexpensive article. It is one of the best; in fact, I will say it is the best surgical preparation extant. If you will purchase for yourself a small can of this liquid glass and experiment on its use and value in surgical cases, when a splint, starch or plaster-of-Paris dressing is required, I am satisfied you would not attempt to practice surgery without it. It is always ready for immediate use, and is applied to the bandage with an ordinary painter's brush, which is left immersed in the can containing the solution. If you desire the speedy sealing action all that is required is to warm the solution, by placing the can in a dish of hot water and apply The heat thus imparted to the solution causes immediate evaporation of the water and almost an instant sealing of the applied liquid to the bandages. You therefore have in this agent all the advantages of any other, and none of the objectionable features of the starch or plaster-of-Paris dressing.


When called to attend any surgical injury I always take the can of silicate of soda, a few bandages, tar board or tin strips, and I am prepared to make or adjust a splint perfect in adaptation to any part of the body. There is no waiting for the

« ForrigeFortsæt »