Billeder på siden
PDF
ePub

ence of the ether (which proved a very difficult undertaking on account of her long use of opiates), Dr. Helmuth spoke of the history and character of the proposed operation substantially as follows:

[ocr errors]

"This peculiar method of treating certain diseases of the nervous system is new to the profession, it having been introduced about the year 1872. Since that period it has been practised with success in this country, and especially in Europe. Dr. Paul Vogt has given great attention to the subject, and has been remarkably fortunate in the results he has obtained.

"From the severity and intractability of the case now under consideration, I think I am warranted in performing the operation.

"The diseases to which the procedure is applicable are traumatic tetanus, intense neuralgia, reflex epilepsy, and partial paresis. "Billroth laid bare and stretched the great sciatic for spasm of the leg. Von Nussbaum, for neuralgia and spasmodic contraction of the muscles of the arm, stretched the brachial plexus with success, the same nervous trunks being operated upon for traumatic tetanus in its last stages by Vogt. The operations were all successful."

Dr. Helmuth then gave minute directions for finding the great sciatic, and described the methods of operating, the main features of which are found described in the following quotation, which can be found in an extensive article on the subject in the "Medical Times and Gazette" for Sept. 15, 1877:

"The actual accomplishment of such an operation appears very simple, and yet from a study of all the published details it is clear that final success depends very much on attention to small matters, which sometimes are apt to be forgotten. The operation may be divided into three stages: 1. Laying bare the nerve. within its sheath. 2. Drawing forwards and stretching the nerve. 3. Reposition and application of dressings. The first act of the operation is a most important one. In the case of traumatic tetanus, before reported, some important changes were found, not only in the nerve itself, but also in the surroundings of its sheath. In all such cases it is recommended directly to free the nerve sheath on all sides as far as one can reach; stretching them accomplishes the rest. The second act of the operation may be performed either manually or instrumentally. For the drawing forward of the nerve one naturally uses a blunt hook, or an eleva

tor, or for a small nerve an ordinary aneurism needle. The actual stretching is best accomplished by passing the forefinger, appropriately curved, beneath the nerve, and using it in conjunction with the thumb. By this means we secure as much force as is necessary, provided we place the limb in a suitable position. Were a hook used for the stretching, there would be a danger of locally injuring the nerve itself, which is not possible when the finger is used. In the case of small nerves it would be impossible to pass the finger beneath them, and hence a thin elastic band may be substituted. In this way an elastic traction can be exercised without the risk of bruising or otherwise injuring the nerve itself. The last part of the operation consists of the dressing. If the stretched nerve does not recede when the limb is placed back in its normal position, or if the part operated upon is one (the face) in which these movements would be impossible, the operator must gently tuck in the nerve into its bed. A small bit of drainage tube is to be placed at the bottom of the wound, which may then be appropriately closed by a few sutures. Lister's dressing and spray ought to be used in these cases, as rapid union and a small scar must be tried for."

The patient was now brought in, fully etherized, and incision through the integuments was made in the locality and direction above described, the muscles separated with the fingers and handle of a scalpel, down to the sheath of the nerve. The nerve in its sheath was then raised upon the finger and lifted out of the cut, till it was drawn at least four inches out of its regular position, and held there for a few seconds, when it was allowed to spring back into its former place. The hemorrhage during the operation was very slight, and the wound was closed up with silk sutures and adhesive straps. A cold-water dressing was applied and Aconite1x ordered, a dose every hour. The temperature at the close of the operation was 100.7°, pulse 124. When recovered from the effects of the anaesthetic, the patient complained of most intense and agonizing drawing pains, paroxysmal in character, recurring every three to five minutes, and felt from high up in the spine, all down the leg, nearly to the foot. To allay these pains for the night she required one fourth grain Sulphate of Morphia, ten grains Morphia Sulph.TM, and two hypodermic injections, each containing twenty minims Magendie's So

lution of Morphia. During the night the temperature rose to 102.6° with a pulse of 150 (nine P. M.) She had frequent attacks of chilliness and shuddering, with convulsive twitching of the muscles of the whole body. The following morning the temperature had fallen to 101.5°, pulse 110; the chills and shuddering had ceased, and she was much more quiet and comfortable. Continued giving the Aconite1x hourly and stopped all narcotics. She rested some during the day, but, missing the narcotics, the pains all down the leg became very severe, especially during the night.

December 16.- Patient somewhat easier after a restless night, dozing and sleeping some during the day. The wound is closing well, by first intention, under simple cold-water dressing. There is considerable pain, of a drawing, tensive character, felt from the cut downward to the knee, and also in the spine and left side as far up as the chest, but no pain whatever in the hip, at the location of all the former pains, and she can move the leg herself more freely than she has done before for four years. She has occasional chilly sensations up the back, followed by flashes of heat; some thirst; not much appetite; temperature ranging from 99° to 99.5°, pulse, 85 to 90. Has Potassium Iodide, five grains, after each meal. When the pains are very severe she has a hypodermic injection of pure water (five minims) every three hours over the sacrum, with apparent temporary relief, but she has no narcotics of any kind whatever.

December 18.- Bright, cheerful, and hungry; the pains are very much relieved. Has had no pain since the operation in hip or knee, as before. The pains are now more of a heavy, aching character, and felt mostly in the sacrum and up the spine, with occasional chilly feelings in the back, and sensation of smothering and oppression of the chest, with at times slight nausea. Had some drawing, aching pain in the location of the cut in the leg, but this was relieved by removing the sutures and renewing the adhesive straps. The patient is more restful at night, though the sleep is light and easily broken. Temperature, 98.6° to 99°; pulse, 80 to 85. Gave internally, Arnica1x every two hours, with occasional hypodermic injections of pure water over the sacrum. December 20. Has no pain at all, to-day, in the leg, and much less in the spine; some slight return of the old pains in and under the hip. Rests better, and her appetite is improving.

[ocr errors]

Gave Colocynths and stopped the hypodermic injections of

water.

December 22. The pains about the hip growing more severe, Dr. Helmuth thoroughly manipulated the leg in all directions to prevent adhesions forming again about the nerve. Patient rather feverish and hysterical. Hyoscyamus every two hours.

[ocr errors]

December 25. — Improving steadily. Has had the leg freely manipulated, rubbed, and moved about in all directions, for ten minutes daily, at first under ether and later on without it. The motion of both hip and knee joints is perfect, but the muscles are somewhat atrophied from long disuse. She can now flex, extend, and rotate the leg and foot, and freely bend the hip and knee joints without any of the former pains. Tried sitting up, out of bed, but the cut is rather tender and painful to the touch and causes distress when sat upon.

December 31.- Patient still doing finely. She sits up most of the day, and with the aid of a crutch walks about the ward. She has only slight pains in the leg and back, and these felt only at times. The cut is thoroughly healed and is but slightly tender or painful to the touch. She can step on the heel now, as not done before since her first accident four years ago. Eats well and sleeps well, though rather restless and nervous at night. Has had no narcotics of any kind since the operation.

[At this time Dr. Helmuth's term of service in the ward expired, and the case passed into other hands, but with every prospect of a complete cure, the operation in itself having been entirely successful.]

February 12, 1879. — I learn to-day that the patient was about the hospital and down stairs, takes no narcotic, eats and sleeps well; occasionally has pains, which however are not sufficient to give her inconvenience.

(To be continued.)

THREE CASES ILLUSTRATING THE USE OF VIBURNUM PRUNIFOLIUM IN MISCARRIAGES.

BY M. V. B. MORSE, M. D., MARBLEHEAD, MASS.

[Read before the Massachusetts Homœopathic Medical Society, Oct. 9, 1878.]

CASE I. On the morning of Dec. 4, 1876, I was called to see

Mrs. G., at the third month of gestation.

She had been taken the night previous with strong labor pains which had resulted in producing quite a flow, that was gradually growing worse.

I had recently read an account of the action of Viburnum prunifolium in cases of threatened miscarriages in Hale's "New Remedies" (third edition), in which Dr. Phares, speaking of the action of Viburnum, says, "It is a preventive in habitual miscarriages. It prevents miscarriages from any cause, especially when attended by severe pain. It has never failed to prevent a threatened miscarriage, as far as I can learn."

I therefore prescribed Viburnum 1st dec. dil. in water, teaspoonful doses, repeated each half-hour, with directions to keep her quiet in bed. The following day she was nearly well; but I continued the Viburnum, at lengthened intervals, for some time. She had no more pain or sickness of any kind up to the time of her confinement.

CASE II. - Jan. 31, 1877, was sent for to attend Mrs. C., who had just passed the fourth month in gestation.

She had been overtaxing herself with hard work for a number of days, which brought on labor pains, followed by a profuse flow. I prescribed Viburnum 1, in water, to be taken each half-hour, and enjoined rest in bed, as in the first case. The Viburnum was continued for two days, after which time she felt quite well up to the time of her confinement.

CASE III. — On the 25th day of April, 1877, I was called to attend Mrs. W., thirty years of age, in her fifth pregnancy. She had always menstruated regularly up to that time (except during gestation), and ordinarily enjoyed the best of health.

On the twelfth day of January she ceased to menstruate for the last time, and now had passed the third month of gestation.

At this time her sister was taken very suddenly ill, and died on the seventeenth day of April. The shock caused by the death of her sister was such as to induce slight labor pains, which had increased without interruption for nearly a week, and were attended with a slight flow, which had continued four days when I was sent for on the 25th.

I now enjoined rest, and prescribed Viburnum1x, to be taken in water every half-hour.

I called the following day and found that the pains and flow had ceased, and she was feeling much better.

« ForrigeFortsæt »