Billeder på siden

I. A. Abt, Chicago, Ill., "The Clinical Significance of the Child's Fontanelle."

W. W. Allison, Peoria, Ill., "Proprietory Prescriptions."

Truman W. Brophy, Chicago, Ill., “A New Operation for Cleft Palate."

Carl Barck, St. Louis, Mo., "Some Rarer Forms of Keratitis."

A. C. Bernays, St. Louis, Mo., "The Results of Operations per se in Cases of Tubercle and Cancer."

S. S. Bishop, Chicago, Ill., "Mastoid Diseases; Their Medical and Surgical Treatment."

J. H. Buckner, Cincinnati, O., "Rupture of the Choroid Coat."

Eduard Boeckmann, St. Paul, Minn., "Operative Treatment of Pterygium.”

Gustavus Blech, Detroit, Mich., "Treatment of Some Inflammatory Diseases of the GastroIntestinal Tract."

Gustavus Blech, Detroit, Mich., "Kola."

R. H. Babcock, Chicago, Ill., “A Report of a Case Illustrating the Value of Secondary Physical Signs in the Diagnosis of Cardiac Diseases."

B. M. Behrens, Minneapolis, Minn., "Rhinoscopic Examinations in General Practice."

Guido Bell, Indianapolis, Ind., "Irregularities in Delivery Due to Short Umbilical Cord." A. H. Cordier, Kansas City, Mo., "GastroJejunostomy in Gastrectasis."

Ephraim Cutter, New York, "Conventional Treatment of Heart Disease versus Positive Treatment."

J. Homer Coulter, Chicago, Ill., "Tonsillotomy by Means of the Cautery Blade." Discussion opened by H. W. Loeb, St. Louis, Mo.

G. I. Cullen, Cincinnati, O., "The Newer Remedies in Otology and their Results."

M. F. Cupp, Edinburg, Ind., "Infant Feeding; the Anti-dyscrasic Action of Cow's Milk."

W. S. Caldwell, Freeport, Ill., "Ether and Chloroform, their Comparative Merits as Agents for the Production of General Anæsthesia."

[blocks in formation]
[blocks in formation]

H. P. Newman, Chicago, Ill., "Multiple Operations in Pelvic Disease."

"A. J. Ochsner, Chicago, Ill., "Nerve Sutures and Other Operations for Injuries to the Nerves of the Upper Extremities."

N. H. Pierce, Chicago, Ill., "Submucous Linear Cauterization; A New Method for Reduction of Hypertrophies of the Conchae."

Paul Paquin, St. Louis, Mo., "The Treatment of Experimental Tuberculosis in Animals by the Use of Blood Serum."

Frederick Peterson, New York, "The Pathology of Idiocy."

Curran Pope, Louisville, Ky., "Chorea." Hugh T. Patrick, Chicago, Ill., "ElectroDiagnosis and Electro-Therapeutics Simplified."

"Hugh T. Patrick, Chicago, Ill., "Trunk Anæsthesia in Locomotor Ataxia."

C. B. Parker, Cleveland,O., "The Use of Notes, News and Personals.

Oxygen in Chloroform Narcosis."

H. O. Pantzer, Indianapolis, Ind., Paper. D. C. Mamsey, Mt. Vernon, Ind., "My Favorable Experience with Diphtheria Antitoxin." Byron Robinson, Chicago, Ill., "The Physiology of the Peritoneum from Experiments." Leon Straus, St. Louis, Mo., "Some Fads and Fallacies of Modern Rectal Surgery."

R. Stansbury Sutton, Pittsburg, Pa., "Pregnancy Complicating Operations on the Uterus and its Appendages. Remarks with Cases."

A. E. Sterne, Indianapolis, Ind., "The Significance and Occurrence of Capillary Pulsation in Nervous Diseases."

E. W. Sanders, St. Louis, Mo., "Twentyseven Cases of Croup."

E. B. Smith, Detroit, Mich., "The Necessity of Vivisection."

J. H. Taulbee, Mt. Sterling, Ky., "Gunshot Wound of the Liver; Report of Case Involving Diaphragm and Lung; Operation Successful but Fatal Termination Two Weeks later from Pneumothorax."

Fenton B. Turk, Chicago, Ill., "Further Report on the Treatment of 500 cases of Gastritis." (Demonstrations.)

Ferd C. Valentine, New York, "The Rapid Cure of Gonorrhoea."

Weller Van Hook, Chicago, Ill., “Some Unusual Cases of Appendicitis."

K. K. Wheelock, Ft. Wayne, Ind., "Mastoidectomy in Caries of the Temporal Bone."

W. E. Wirt, Cleveland, O., "A Further Contribution on the Use of Dry Heat in the Treatment of Chronic Joint Affections.

Casey A. Wood, Chicago, Ill., "A Further Contribution to the Ocular Treatment of Epilepsy."

D. S. Maddox, Marion, O., "The Decadence of the General Practitioner and the Reign of the Specialist."


The various passenger associations have granted a round trip rate of one and one-third fare on the certificate plan. Those who desire to attend should obtain receipts for the amount paid for tickets (of members and their families) to St. Paul. These receipts must be presented to the secretary, Dr. H. W. Loeb, upon arrival in St. Paul. The return trip must be made within three days after the close of the meeting; however, the time will be extended for those who take the Yellowstone excursion. By special arrangement, the Burlington route will place at the disposal of those who desire to go from St. Louis, or through St. Louis, a well appointed sleeper, leaving St. Louis at 11:50 a. m., Sunday, September 12, and Monday, September 13, and arriving in St. Paul Monday and Tuesday morning. Reservations may be made at any time.

D. C. B. Fry has been appointed chief surgeon of the Peoria, Decatur and Evansville, with headquarters at Mattoon, Ill., vice Dr. G. M. Young, resigned.

Post Graduate Medical School of Chicago Moves.

The Post Graduate Medical School of Chicago moved into its new building and new location, at 2400 Dearborn street, September 1, 1896. The new building is an ornate structure seven stories in height, constructed as a clinical school and a clinical hospital. The school is complete, having the most modern lecture rooms and laboratories. The hospital has accommodations for 100 beds. One floor is artistically furnished for private patients. There are four operating rooms of the most modern construction, including an amphitheater operating room which will accommodate 300 students. The building is lighted with electricity and is provided with elevators. The new location is at 2400 Dearborn street (Dearborn and Twenty-fourth street). This is selected because of its superior clinical advantages. Within a distance of 10 minutes' ride from the school proper are the St. Luke's, Charity, Michael Reese, Mercy, Woman's and Wesley hospitals. Clinical instruction will begin in the new quarters at once.

Abdominal Section by Cow's Horn.

Skilling (Amer. Jour. Obstet., July, 1895) records a case in which this accidental operation was performed without a fatal result in a non-pregnant woman. The injury is of interest in relation to well-known instances of succesful cesarean section carried out in the same manner. Skilling was called in shortly after the accident. The patient lay in bed, her clothing saturated with blood. Her countenance was anxious and pale, but there was only slight evidence of impending shock. The cow's horn had entered the abdomen just above the symphysis, a little to the right of the median line, and ran obliquely to the right, making a rent six inches long. The peritoneum was involved; the intestines protruded; loss of blood was relatively trifling. The intestines were replaced, the peritoneum closed by a continuous suture of fine silk, and the remaining layers of the parietes by interrupted silk sutures. The wound healed almost throughout by first intention except at the lower angle, where slight suppuration took place, probably from unavoidable contamination with dirt during or after the accident. Recovery was rapid and complete.British Medical Journal.

Extracts and Abstracts. tically. In extensive burns the necessary dry

condition of the wound cannot be maintained and infection occurs; again, certain antiseptic powders cannot be used on large surfaces owing to their liability to cause toxic effects. And where protection of the surface against contact has necessitated the use of gauze dressings, the pain on removal of the tightly adherent material from the raw surface is enough to compel one to abandon their use. The fatal objection, however, is the failure of this method to maintain asepsis.

The Modern Treatment of Burns.

BY HENRY J. KELLY, M. D., Lecturer on Surgery. New York Polyclinic.

When we find suppuration, putrefactive decomposition of discharges, and sloughs, with the attendant septic fever, commonly accepted as necessary accompaniments of the healing process in wounds caused by burns, and that indifferent rags soaked in carron oil is a favorite dressing for such cases, it would seem that the methods successfully employed to prevent infection in other wounds are looked upon as of no avail when applied to burns.

This acceptance of infection as a necessity in these cases is all the more singular when we consider that a burn, because produced by a high degree of heat, is always primarily an aseptic wound. Could we maintain this condition of asepticity not only would we spare our patient the dangers of a septic process, but we would prevent his becoming the source of disgusting odors very evident to the surgeon during the change of dressings.

In the case of surface wounds caused by burns, i. e., wounds having no pockets or cavities to drain and being essentially aseptic in origin, are we not justified in the belief that a plan of treatment which would prevent infection in other classes of surface wounds would be equally successful? My own experience leads me to believe that in so far as we are able in any given case to practically apply the principles upon which success depends, in so far will we be able to maintain an aseptic condition during healing. There will be no putrefaction of sloughs or discharges, no fever, and in thoroughly successful cases the discharges will not be purulent; of course, where the vitality of tissues is destroyed, sloughing cannot be prevented, but a slough free from infection is not only inodorous but is a quite harmless foreign substance and not a septic focus.

The dry dressing of wounds, which has been recommended for burns, is a method which has been more or less in use for some time and which aims to prevent infection or the development of germ activity by desiccation of the surface and discharges, the bacteria being thus deprived of the moist field necessary for their propagation.

[blocks in formation]

The method of dressing which in my hands has given the best results is one for which no originality is claimed, it being simply the moist dressing so generally used in surgery, somewhat modified to fit it to the practical' necessities of the case in burns. The materials are all easy of procurement, are easily sterilized or impregnated with antiseptics if required, and are easy of application.

The dressing is most efficient in controlling or at least mitigating sepsis, is comfortable to the patient when applied, and its removal is absolutely painless.

These advantages are sufficiently decided to warrant a rather minute attention to details since in that rigid attention will be found to lie the success of the method.

It would not seem from my own experience that the use of antiseptics was of as much service as thorough asepsis, for in cases where the extent of the burned surface was such as to preclude the use of strong solutions, the results have been satisfactory.

In a burn of moderate severity, when the kidneys are sound and the patient not an alcoholic, what shock is present will most probably be slight, and will be well controlled by the injection of a full dose of morphia; this will also help to obtund the sensibilities during the dressing, the first step of which must be a thorough preparatory cleansing of the wound and its vicinity. If the wound be recent and we have no especial reason to believe infection has already occurred, corrosive sublimate solutions may be altogether omitted and sterile water or Thiersch's solution used in large quantity, or weak solutions of bichloride (not stronger than 1-3,000) may constitute the first washing, the wound being afterward douched with sterile water or borosalicylic solution. The use of sterile water at a temperature of 110 degrees F., to which sufficient sodium chloride has been added to make the normal salt solution (a heaping teaspoonful to a quart of water), will be found less irritating to the patient that plain water; this must be used in large amounts, thorough and repeated flushings of the surface being advisable, and is a most efficient means of cleansing the wound.

In burns already infected, and where suppuration has been established, it is safer to use a

preliminary washing of sublimate solution; possibly as strong as 1-1,000. If the burn be extensive, this must be followed by copious douching with sterile water or non-poisonous antiseptic solutions.

During the cleansing of the wound, and indeed during the whole treatment, the greatest care should be exercised to prevent the rupture of unbroken blisters. So long as the epidermal covering of the vesicle remains intact, infection of the surface beneath cannot occur, and that portion of the burn at least may be regarded as a subcutaneous lesion, protected by that very fact from infection, and will go on to heal as such. When on examination we find a blister so large and tense as to interfere with bandaging, or which threatens rupture, we might aspirate a portion of the contents by the subcutaneous method. A sterile needle is introduced through a small fold of skin, pinched up at a little distance from the blister, pushed on into its cavity and sufficient serum allowed to run out to reduce tension; the needle is then quickly withdrawn, and the skin fold allowed to slip back into place, when the opening into the skin and that into the blister will no longer be continuous.

When we proceed to the dressing proper of the wound, we must adjust our treatment to the different degrees of severity which will probably be found; portions simply hyperæmic may be anointed with a five per cent. solution of phenol in sterile olive oil, which will greatly reduce the heat and subsequent itching; all denuded surfaces are to be covered with strips of gutta-percha tissue. This material must be kept in cold carbolic acid watery solution, two per cent., and as it is ruined by placing it in warm water, if before applying it to the wound it is desired to wash off the carbolic acid, cold sterile water should be used. Gutta-percha may also be fitted over unbroken blisters, which it will protect from rupture. Over areas in which slough is impending a moist gauze compress covered with rubber tissue to prevent evaporation forms an antiseptic poultice retaining heat, favoring suppuration and preventing putrefaction. Over all, a large, thick layer of sterile absorbent cotton through which no penetration of germs can occur is applied and the dressing finished with a well-fitting bandage.

It is needless to add that the same faithful and scrupulous attention to cleanliness of hands, instruments, etc., is as necessary as in an aseptic operation, and that these same precautions must be kept up until the termination of the case.

The dressings should be changed frequently, during at least the first week say once dailylater, once every two or even three days will be sufficient.

It may be noticed that no mention has been made of iodoform, and very little stress laid upon the use of any particular antiseptic, except a caution as to the use of strong solutions of poisonous antiseptic drugs. Personally I do not undervalue the use of iodoform, and when the burned surface has not been extensive have always used it; indeed, under a moist dressing, iodoform finds the field necessary for its best action. It must, however, be borne in mind that in all cases of extensive burns the emunctories, especially the kidneys, will be overtaxed, and I have felt safer in redoubling my efforts at asepsis rather than in risking the use of toxic antiseptics.-Polyclinic.

The Fluoroscope.

The laboratory of Thomas Alva Edison has been the scene of active work during the present period of interest in the Roentgen discovery. Mr. Edison early began his investigations on the subject, feeling that he needed but one or two weeks to determine the controlling factors of success. As guide he had Roentgen's original paper, and his path seemed short and clear. Now, after two months' active work, his goal is reached, and he has succeeded in devising a simple apparatus by means of which the skeleton of the limbs may be observed as in a photograph.

His work has taken two principal directions one the perfecting of the Crookes tube; the other the production of an apparatus, the fluoroscope, for enabling the X-ray phenomena to be observed directly without the intermediation of photography. After endless trials with different glasses, shapes and sizes of Crookes tubes and disposition of electrodes, he has adopted as final shape an ellipsoisdal tube about five inches long. At each end are internal disk electrodes of aluminum slightly inclined to each other. The outside of the tube ends are coated with metallic caps, forming external electrodes. Of the effect of such a tube, about 60 per cent. is due to the internal electrodes and about 40 per cent. to the external ones. He next found that at a particular point of exhaustion the effect was best. This point is when the band spectrum begins to disappear and the spectrum becomes continuous. Accordingly he has adopted the system of using a tube sealed at the ends and with a short tube entering its side. The latter enables connection to be made with an air pump of the Geissler or Sprengel type. After connection with the pump, about half an hour's exhaustion gives the vacuum best for development of the Xrays, the object being to hold the exhaustion at the point of maximum during the period of observation.

One very curious tube experimented had

internal wire electrodes only, and these were sealed into a rod or tube of glass extending from end to end of the tube. This tube gave good X-ray effects, although the electrodes were embedded in glass. In another experiment, a metallic tube half an inch in diameter and two feet long was provided with a metallic shield at one end. The shield end was placed against a plate-holder containing a photographic plate. The other end was pointed at the Crookes tube. It was found that whatever part of the tube the testing apparatus was pointed at, the X-ray produced the image of the aperture through the long steel tube. This showed that they radiated in all directions from an active tube.

Combination tube glass was chosen as material for the Crookes tube, which is blown as thin as possible. The second element of the problem reached was the fluorescent screen apparatus, its construction and fluorescing material.

Mr. Edison was early convinced of the importance of the visual as against the photographic method of observation. Dissatisfied with the barium salt used by Roentgen, he bent all his energies to the development of a new apparatus which should be superior in construction and fluorescent material to any yet suggested. During his researches he examined some eighteen hundred chemicals. To test them he used a pasteboard cylindrical box about two inches in diameter and four inches long, with a sighting hole in its bottom. His assistant started at his laboratory shelves and brought him, one by one, every chemical in the place. Some of the chemicals to be tested were placed in the inverted cover of the box, the inverted box was put in place over it, and Mr. Edison through the eyehole in the bottom looked down toward an excited Crookes tube. For four days and nights the tests went on, many salts were laid aside as fluorescent, but calcium tungstate proved incomparably the best-it is about eight times as powerful as platino-cyanide of barium.

The salt is made by fusing together a mixture of sodium chloride, sodium tungstate, and calcium chloride. The calcium takes up the tungstic acid, sodium chloride being the other product of the double decomposition. Treatment with water dissolves out the sodium chloride and leaves the insoluble crystals of calcium tungstate. These are dried and sifted. Such as go through a No. 30 mesh are the coarsest used. The largest are distributed over a pasteboard screen coated with wet celluloid varnish, then finer ones are added until a smooth, uniform surface results. The screen is mounted at the end of a sighting box of pasteboard, with the prepared surface inside. The other end of the box is shaped to fit the contour of the face around the eyes.

On holding the hand over the end of such a box, if X-rays fall upon it, the surface will fluoresce, except where the shadows due to the Roentgen effect are produced, with the same perfect detail that is seen in the best of Roentgen's photographs. One grain of tungstate per square inch of screen is required for the coating.-American Medical Compend.

The Use of Silver Wire.

Halsted, in an article on "Operative Hernia," states that for a year he has sewed all of his hernia wounds with silver wire and has covered them with silver foil. Without exception, the wounds have healed absolutely per priman. Not a single stitch-abscess has been observed either during or subsequent to the healing of the wound. Such absolutely perfect healing of the hernia wounds we have not had heretofore, and he is convinced that the use of silver as a suture material has contributed somewhat to this result. The effect of silver on the growth of the more common pyogenic organisms has been tested. He states that he has two Petri plates which Dr. Bolton has kindly prepared for him. They have both been inoculated with staphylococcus pyogenes aureus. In the center of each plate is a piece of silver foil, such as is used in our wounds. Just outside, and completely surrounding the foil, is a perfectly clear zone several millimeters wide. Except for the clear zone and a slightly intensified zone just outside of this, the agar is quite uniformly clouded. The cloudiness is due to the growth of the micro-organisms with which the agar has been inoculated. Dr. Bolton has studied the effects of various metals on the growth of bacteria, and has recently read a most interesting paper on this subject before the Association of American Physicians. With cadium, zinc and copper Dr. Bolton observed that the inhibitory action was greater than with silver. Prior to his knowledge of Dr. Bolton's experiments, Dr. Halsted tried to use copper and brass foil as a protective and copper and brass wire for sutures, but these metals corroded the tissues so much that he soon stopped using them. We do not hesitate to employ buried sutures of silver wire in sewing tissues on the confines of an infected region. In cases of acute suppurative appendicitis, for example, we close the wound in the abdominal wall with deep, interrupted, buried sutures. These wounds are drained by a few strips of gauze. Two of the sutures are taken very close to this gauze, and sometimes must pass through tissues which are infected. Not even in such cases has a stitch-abscess ever occurred. Once a silver stitch and once a silver bone-plate, having been exposed to view and to the air by necrosis of the overlaying tissues, were al


« ForrigeFortsæt »