Billeder på siden

ticed in the direction of the return blood current, superficially with the whole hand, or deeply with the thumb and finger, with light movements which would relieve, not cause, pain and reduce the swelling. The best lubricant was olive oil. The duration of the seances was fifteen minutes. The treatment was more especially indicated in fractures near joints. Dr. Woolsey had begun treatment by massage rather cautiously a year ago, and had not allowed his patients to get up quite so early as do French and German surgeons. Most of his cases had been Pott's fracture, some of Colles', etc. One writer had had considerable experience with combined ambulatory and massage treatment, and considered it ideal. Dr. Woolsey's own results from massage had been so perfect that he had come to make it the routine treatment in fractures near joints. Bony union was obtained by the end of the third week. The patient was allowed to get up from the nineteenth to the twenty-fifth day, and within two or three days was able to walk about without a cane. The average stay in the hospital had been twenty-one days. Massage treatment was recommended by the author in fractures near joints, to be applied daily for fifteen minutes until consolidation occurred, say the first ten days. In fracture near the middle of the limb, he would immobilize and then let the patient go about on crutches-the ambulatory treatment; and carry out the same treatment in fracture of the neck of the femur in the aged.

In the discussion which followed Dr. Howard Lilienthal said he had employed the massage treatment in three cases of fracture of the patella, with excellent result. All the patients were kept walking after the tenth day.

Dr. A. E. Gallant testified to the excellent results of massage in the treatment of sprains, and he had no doubt it would be equally efficacious in reducing swelling and pain in fractures. Under the teaching of Dr. Van Arsdale he had learned to employ it from the moment that sprain occurred, commencing far above the sprain, rubbing the limb gently at first and toward the body, gradually reaching the injured joint and rubbing along the grooves instead of on the bones.

Traumatic Hæmarthrosis of the Knee-joint

John O'Connor, of Buenos Ayres, recommends that the following steps be taken in the treatment of this class of cases.

1. In cases of effusion into the knee-joint an aspirating needle should be introduced in order to arrive at a correct diagnosis.

2. If blood is present an incision should immediately be made into the synovial pouch, and every particle of blood and clot removed; in case of fracture into the joint, the frag

ments should be examined, and, if necessary, reduced and fixed.

3. A gauze drain should be inserted for a few days in order to make certain that no further re-accumulation shall take place; and, when it is evident that there is no further danger of this occurring, the external wound should be closed by "waiting" sutures.

4. When union is sufficiently firm active. movement should be encouraged; and when this can be painlessly executed, then, and then only, is massage a most useful adjunct in restoring the muscles to their normal condition. -Glasgow Medical Journal, December, 1896.

The Ritual of Abdominal Operations.

The writings of Mr. Frederick Treves are always entertaining and suggestive. A recent review of the surgery of the peritoneum, published in the British Medical Journal, begins with a criticism of the "ritual of an abdonimal operation." Mr. Treves ridicules the extensive preparations made in many hospitals for the performance of surgical operations, especially for those within the peritoneum. He says: "Those who come after us will read with interest of the operating theater built like a diving tank, of the glass table for the patient, of the exquisite ceremonial of washing on the part of the operator, of the rites attending the ostentatious cleansing of the patient, of the surgeon in his robes of white mackintosh and his india-rubber fishing boots, and of the onlookers beyond the pale who are excluded with infinite solicitude from the sacred circle, as septic outlaws."

"This exhibition," continues Mr. Treves, "may be scientific, but it is no part of surgery; it is more allied to a fervent, idolatrous ritual brought down to the level of a popular performance. Those who have been led into these uncomfortable extravagances are, no doubt, honestly assured that they are carrying out the 'strictest antiseptic precautions,' but in blindly effecting this end they appear to forget what is the prime purpose of the art of surgery. Can this extreme demonstration be necessary? Is it not piling Pelion on Ossa and slaying the already slain? The surgical ritualists appeal to the infallible tests of the bacteriological laboratory, and bring forth as conclusive evidence an array of cultivations and of inoculated tubes. Most English surgeons, on the other hand, are content to appeal to the test of the patient, and to bring forth records of results." Continuing in the same strain Mr. Treves advocates a kind of surgical preparation which we have insisted upon for a long time-a preparation which is at once simple and effective. The surgeon, who of necessity understands the principles of bacteriology (since no surgeon can successfully practice

without this knowledge), carefully bears in mind and carries out the doctrine that nothing that can convey bacteria is to be introduced into the wound. If the operator and his assistants bear this in mind always and carry out the idea systematically in practice, results will be all that can be desired. Unfortunately this is not always possible, and the reason for insistence upon every detail that is necessary, and even many that are not, is to prevent accidents of a septic character due to thoughtlessness on the part of nurses and assistants.

The conservative English for a long time did not accept Lister's theories; and many having accepted his theories have been unwilling to give them up, or to give up the details of surgical practice which Lister prescribed; hence it was that in February, 1895, the carbolic acid spray was still used in Guy's Hospital, London, only a mile or two from the London Hospital, in which Mr. Treves practices. An unwillingness to adopt new ideas is no less culpable when those ideas seem to be based upon reason and when no injury can result from them, than the refusal to give up ideas which are shown to be fallacious.

We willingly admit that the English surgeons, at least in their public clinics, do not err on the side of too much antiseptic or aseptic caution!-Medicine.

Surgery of the Lung.

The following resumé of this interesting subject appears in a recent issue of the Medical News over the signature of Dr. Andrew J. McCosh:

In the year 1710, nearly two centuries ago, Baglivus suggested that cavities in the lung might be successfully treated by operation. During the next century and a half, an occasional operation was performed for the relief of pulmonary affections, but the surgery of the lung was unsystematic and largely experimental until Graux in 1850 reported the results of thirteen operations. All these cases were, however, unsuccessful, and these results, combined with other similar failures, retarded the progress of pulmonary surgery for another quarter of a century.

A fresh impulse was given to this branch of surgery some fifteen or twenty years ago, when numerous successful experiments on animals, where portions of the lung, and even entire lobes, were excised, led to the hope that the same success might follow operations on the human lung. This expectation, however, has not been fully realized. Especially Especially is this true in regard to tubercular processes which would offer a vast field for operative interference, were success to follow such treatment. In this class of cases there seems to be but little hope of benefit to be derived from excision of tubercular foci. Reclus, in a most admirable address which he delivered

before the French Surgical Congress in 1895, said: "Resection of the lung for tubercular disease seems to me condemned past appeal." This judgment may be somewhat too severe and yet it probably expresses the view of most conservative surgeons on this subject.

The results of simple incision into tubercular cavities have been somewhat more favorable. A number of patients have been benefited by this procedure, and in certain cases this operation seems indicated. A successful termination must be exceptional, however, as the original focus of disease must still remain, and probably other foci also. Reclus reports eight such operations upon an equal number of patients, only two of whom died, while five were improved or cured. He states, however, that all were carefully selected cases. Laufert and Worth have calculated that out of 100 such cases, 5 die at once as the result of operation, 10 die within a fortnight, 15 more inside of a month, 10 are improved, and zero represents the number of recoveries. Paget reports 24 operations, with 9 deaths, 5 recoveries and 5 improvements.

Operation for pyopneumothorax, as the result of tubercular ulceration, has been performed on a number of patients, in two of whom the opening was successfully closed by suture. The difficulty, however, of locating the perforation must be great, and at best temporary relief only can be afforded.

The results of operation for growths in the lung are equally disappointing. When carcinoma or sarcoma occurs primarily, the growth is in all probability so extensive before the diagnosis can be made that extirpation is impossible. In some cases where the malignant tumor has extended to the pleura and lung from the chest it is possible that extirpation might be successfully accomplished.

In abscess, gangrene and hydatid cysts, sufficient experience has accumulated to enable us to judge approximately of the risks of operation and of the chances of recovery. The results are becoming more and more favorable and undoubtedly will be still more encouraging as soon as physicians can be convinced that operation is not attended with great risk and that it offers a fair chance for recovery.

The results of operation for pulmonary abscess are certainly full of promise. Thus Fabricant reports 38 cases, with 29 recoveries and 9 deaths. Reclus reports, out of 23 operations which have been performed within the past ten years, 20 cures and 3 deaths. The old idea that adhesions between the lung and parietal pleura were a requisite for successful operation is happily passing into oblivion. Adhesions are unquestionably of great advantage. When they exist the danger of infecting the pleural-cavity and thus exciting a pyopneumothorax is very slight and the in

cision into the abscess cavity is a comparatively simple operation. Many successful operations have been performed, however, where there are no such adhesions, as, for example, the cases recently reported by Smith and Frederick Treves in the Lancet, and by Northrup in the N. Y. Medical Journal. If adhesions are absent the operations can be carried out in two stages, at the first, suturing the two pleural layers; at the second, opening the abscess after a delay of a few days. Unfortunately, however, such delay is generally inadmissible. It means death. The abscess must be opened at once. In certain cases the parietal pleura may be sutured to the lung, but generally the patient's condition is such that the operation must be rapidly completed, the pleural cavity being protected as well as possible by sponges and gauze.

In gangrene the mortality without operation is about eighty per cent. In certain cases of diffuse gangrene operation is out of the question, and the case is hopeless. In circumscribed gangrene operation offers to the patient a fair chance of recovery. Excepting a few cases of gangrene occurring in young subjects, where the patch is small and near the apex, it is a question whether operation should not be advised as soon as the diagnosis is made in every case of circumscribed gangrene, where the general state of the patient or some intercurrent disease does not render all treatment hopeless. As in abscess so in gangrene; the operation, if otherwise indicated, should be performed, adhesions or no adhesions.

Another reason for delay which is sometimes advocated is that operation is not indicated until after the stage of consolidation has passed and deliquescence begun. The latter stage, however, is generally reached before the diagnosis has been made. Of course, the patient may recover without operation, but the danger of sepsis or the conversion of a circumscribed into a diffuse gangrene more than counterbalances the risk of an operation. These risks are not very great, as may be judged from the statistics of Heydweiller, who collected 40 cases treated by operation prior to 1892, with 22 recoveries, 4 improvements, and 14 deaths. The more recent cases of Reclus number 14 operations, II of the patients being cured, I being improved, and only 2 having died.

In cases of bronchiectasis the results of operation seem to be less hopeful. More than one cavity generally is present. One may be incised and healed but others are left. Reclus reports 12 operations, 8 of which terminated fatally, 4 of the patients being improved, but none cured. Paget reports 5 cases, all of whom were improved, but he adds that all were exceptional cases. The conclusion of Truc seems correct: "When the cavity in the lung is the essential lesion, when the

[blocks in formation]

New York, March 10, 1897. In a letter dated Moscow, February 14, the secretary-general, Professor W. K. Roth, communicates the following facts for the information of the American physicians who intend to participate in the Twelfth International Congress, which is to be held in Moscow from August 19 to 26.

The transatlantic steamship companies refuse one and all any reduction of the usual charges. In their replies, most of which are couched in courteous language (the originals are in the possession of the undersigned), they admit the existence of a trust, or contract, or agreement, which prevents them from lowering their prices; a few are so polite as to express their regrets.

Reductions of fares on Russian railroads are expected shortly. The French, Spanish, Swedish and Hungarian railroads promise a reduction of 50 per cent; so do the Italian, for a distance of 500 kilometers; less (down to 30 per cent) for shorter distances. The Mediterranean lines (Messageries Maritimes, General Italian Navigation Company, Austrian Lloyd) grant from 25 to 50 per cent.

The undersigned chairman is not authorized to issue certificates of any kind in favor of congressists. He will try to ascertain, however, in which way their movements may be facilitated, and may receive a reply in the second half of April. Extracts of papers to be

read before any of the sections ought to reach the secretary-general before June 1, in order to be printed in the preliminary volume.

A special prospectus containing the final details referring to traveling, lodging, festivities, etc., is promised for a near future. It will be communicated at once to the medical journals and to the press of the country.


Notices and Reviews.

A Treatise on Surgery. By American Authors., Edited by Roswell Park, A. M., D. M., Professor of the Principles and Practice of Surgery in the Medical Department of the University of Buffalo, etc. Volume I, General Surgery; Volume II, Special or Regional Surgery; 8 vo., pp. 1,600, with over 800 illustrations. Philadelphia and New York: Lea Bros. & Co., 1896.

Within the past few years the profession has been favored by the appearance of several new works on surgery. Some of these have partaken of the nature and scope of hand-books, others of text-books, and still others of treatises and encyclopedias. While each seems to have met the wants with a considerable degree of success, it has been left to Dr. Park and his collaborators to present a work which is both concise and reasonably complete, as well as both satisfying and authoritative.

The one great aim of the editor seems to have been the presentation of a thoroughly up-to-date work on modern surgery in its broadest sense. That he has succeeded to a remarkable degree in attaining the desired result must be conceded by every reader of these two volumes.

The work of the contributors has unquestionably been, in general, most excellently done, while the work of harmonizing the pathology, principles and practice of thirty prominent surgeons and presenting the great amount of material in one grand, harmonious system, has been so satisfactorily executed that to Dr. Park's enviable reputation as a pathologist, as a surgeon and as a teacher, we can add that of being a most successful author and editor.

Those who are acquainted with his clear, concise, forcible style of presenting a subject will be pleased to find the impress of his own personality in every part of the work.

Where the material has been secured from so many sources there naturally is some repetition and possibly disproportionate space has been given to some subjects, but considering the character of the work, we do not believe any serious detriment is occasioned thereby in this instance. Selections and limitations are purely matters of judgment and in that respect we are willing to abide by the decision of the *There were no meetings held by the Association during the years 1861 and 1862.

man who has given the subject special consideration.

The systematic way in which every subject is presented and the free use of heavy-faced headings and italics, makes the treatise more easy of consultation and of much greater value to the student of surgery. Our greatest admiration is occasioned by the character of the pathology presented, which is generally of the advanced modern type. In this particular, especially, do we note a degree of uniformity and excellency which is peculiar to this system of surgery. The scope of the work is so great that the consideration of the chapters in detail has appeared inadvisable.

The illustrations (both by the old and the new processes) are generally satisfactory, and with some exceptions, they do illustrate the text. While this is generally applicable, we desire to especially mention the chapter by Gerster, which is so ably presented by illustrations nearly exclusively. The colored plates are generally good, but as is usually the case, they are entirely too highly tinted. While the work is quite free from typographical errors, there are some; cuts Nos. 190 and 191, have evidently been changed, while cut 196 would be more readily appreciated if placed in the same position as 195, with which it bears a close relationship.

As a whole, this work is most satisfactory, and is fortunately of that size that both the medical student and the practitioner will find the most important facts of modern surgical principles and practice easy of access.

Notes of Societies.

American Medical Association.

The forty-eighth* annual session (fiftieth anniversary) will be held in Philadelphia, Pa., on Tuesday, Wednesday, Thursday and Friday, June 1, 2, 3 and 4, commencing on Tuesday at 10 a. m.


"The Presidential Address," Nicholas Senn, M. D., Chicago. "Address in Surgery," Wm. W. Keen, M. D., Philadelphia. "Address in Medicine," Austin Flint, M. D., New York. "Address in State Medicine," John B. Hamilton, M. D., Chicago.


H. A. Hare, M. D., 222 South Fifteenth street, Philadelphia.


Practice of Medicine.-J. H. Musser, M. D., Philadelphia, chairman; J. T. Priestley, M. D., Des Moines, Iowa, secretary.

Obstetrics and Diseases of Women-Milo B. Ward, M. D., Topeka, Kan., chairman;

[blocks in formation]

Dental and Oral Surgery.-R. R. Andrews, M. D., Cambridge, Mass., chairman; Eugene S. Talbot, M. D., Chicago, secretary.

Neurology and Medical Jurisprudence.W. J. Herdman M. D., Ann Arbor, Mich., chairman; Chas. H. Hughes, M. D., St. Louis, Mo., secretary.

Dermatology and Syphilography.-A. Ravogli, M. D., Cincinnati, Ohio, chairman; T. C. Gilchrist, M. D., Baltimore, Md., secretary. Laryngology and Otology.-Wm. E. Casselberry, M. D., Chicago, chairman; D. Braden Kyle, M. D., Philadelphia, secretary.

Materia Medica, Pharmacy, and Therapeutics.-W. B. Hill, M. D., Milwaukee, Wis., chairman; F. Woodbury, M. D., Philadelphia, secretary.

Physiology and Dietetics.-A. P. Clarke, M. D., Cambridge, Mass., chairman; Ephraim Cutter, M. D., New York, secretary.

Permanent Secretary.

The Florida State Railway Surgical Association.

An adjourned meeting of the State Association of Railway Surgeons was held at Palatka, Fla., April 22. The following officers were elected for the coming year:

J. Harrison Hodges of Gainesville, president; W. L. Hughler, Cocoa, first vice-president; F. P. Petty, Sanford, second vice-president; J. M. Jackson, Jr., Miami, secretary and


Executive Committee: Drs. S. G. Worley, St. Augustine; W. H. Cyrus, Palatka, and R. P. Izlar, Waycross.

As has been frequently noticed in the daily press, Dr. Nicholas Senn has offered his services to the Greek nation during the continuance of the war with Turkey. He is a great lover of Grecian history and literature and offers his services to the Greek army without expectation of reward, the only stipulation being that he be officially recognized by the government. If his offer is accepted he will sail upon the first vessel leaving for the Mediterranean.


To the Members of the Medical Profession.

I would be pleased to have an expression of opinion from you, either personally or through some medical journal, as to the relations of the lay publishing firms of medical journals and the profession. The request is suggested by the fact that Messrs. Wm. Wood & Co. of New York refuse to permit the editors of the "American Year-Book of Medicine and Surgery" to use in our abstracts of medical progress articles and illustrations first printed in the Medical Record and the American Journal of Obstetrics.

This decision seems to be wrong for the following reasons:

I. It prevents the dissemination of medical knowledge. The Year-Book condenses, systematizes and criticises the year's medical work in a shorter space and more permanent manner than the journals, and has thousands of readers no single journal can claim or hope to reach. Every physician writes and publishes articles in order that every member of the profession may, if possible, learn of his work, and that science and progress may thus be furthered and humanity benefited. To interfere with such dissemination of our literature in reputable publications is, I think, discourteous and unjust to the profession and an injury to medical science.

2. This injustice and injury to medicine becomes all the more striking when physicians do not receive a cent of pay for contributions, from the publication of which the lay publisher is supposed to make considerable financial profit.

3. No other publishers in the world, not even those who pay authors for their contributions, have in the least objected to our reproduction of quotations, abstracts and illustrations from their journals.

Do you wish to limit the dissemination of your contributions to medical science by such an exclusion of them on the part of publishers from reputable publications? Is this literature the property of yourself and of the profession, or not? Does your gift of it to a journal make it forever the private property of the publishers of that journal? Is it not rather a loan for temporary use only?

Will you not hereafter demand that there be printed with your article a statement that the right of abstracting the text or reproduc ing illustrations is guaranteed? Sincerely yours, GEORGE M. Gould. 119 South Seventeenth St., Philadelphia, Pa., December, 1896.

« ForrigeFortsæt »