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two days. The convalescence was apparently not much disturbed, as she was out of bed in a week after operation. There has been no myxoedema following operation, despite the fact that in many of the cystic tumors there was very little gland left.
Removal of the diseased gland stops the introduction of toxic materials into the circulation, and all the symptoms are certain to improve. This can be safely done in fully 97 per cent. of the cases, and if many of these cases could have surgical relief earlier before great harm has been done to the heart, the mortality would be still lessened and a larger number of permanent cures reported.
Cases that come late for operation showing end results will not be satisfactory as far as operative results are concerned. They invariably improve of their main symptoms, put on flesh, and gain in strength, and are able to resume their former duties, but the heart may not be able to return to its normal condition, and the exophthalmus may remain to a certain extent owing to a weakened condition of the muscles involved in its production. These symptoms will continue sometimes after the cause of the trouble has been removed.
A small percentage of the cases of thyroidectomy, where one lobe and isthmus had been removed, will have a return of their symptoms and a slight enlargement of the other lobe, after a varying length of time, which will require for their relief either tieing of the superior thyroid artery and vein, or, possibly, a resection of a portion of the remaining lobe. This has given most satisfactory results in the three cases we have done.
DR. CORRIGAN.-The master minds of the profession have focused their thought on goitre, illumined its pathology and perfected its technique, until now its mortality is reduced to mere accident. The publication of large volumes and the delivery of long speeches were of little avail in this reduction of mortality. It was in the operating room where the goods were delivered and the results secured, secured by action, not by argument. Demonstration is the only proof. When a man can perform one hundred and twenty-five operations for goitre
with a fraction of one per cent. mortality, he has demonstrated his ability as a surgeon and established his claim to recognition in the foremost rank of the profession. Dr. Matlack is to be congratulated upon his achievement and the organization is fortunate in having among its membership a pace-maker, one who is capable of establishing such a high standard of surgical proficiency for the rest of us to imitate, for after all imitation is the sincerest flattery.
BY DR. A. L. HAUSLÖHNER, WILKES-BARRE, PA.
Having spent four months in the Röniglichen Clinic of the University of Berlin with Prof. Bier, I will try and tell the way they treat by Bier's hyperemic treatment.
Prof. Bier tells when his first thoughts were of this treatment. He says from observation of infected wounds he saw redness and congestion. He found this not a bad sign and not an aggravation of the disease, but merely the reaction of the tissue to protect itself.
Then he thought of applying and producing more congestion. He was helping the tissue and surrounding parts to combat the disease. Hyperemia may be produced in three ways. Hyp. Ist. Constriction.
By constriction we produce passive hyperemia. That is stagnation of the blood of the superficial veins of the part.
We apply this bandage with a rubber band, two or three feet long and two and one-half inches wide. Not like the Esmarch that is too thick and will cause anemia of the part. The bandage is put on above the seat of infection and is put on slowly so that hyperemia is not produced rapidly and that the patient has no pain. The bandage can be left on ten or twenty hours daily, and if the infection is in the joint, we can move the joint in a short time as the pain disappears. In gonorrhoeal infection of joints, when there is pus or serum,
by using this method, we avoid large incisions and at times we need no incision at all if applied early.
The pain disappears also, avoiding stiffness, which is often caused by immobilizing the joint and in this treatment we do not have to immobilize the part, as the pain soon leaves and the joint is made to move.
Slight edema is caused by this treatment and this neutralizes the poisons and the absorption is not so great and effective. If the edema is great, we elevate the part.
The temperature drops after the application of the rubber band. Releasing it, the temperature is higher than before, but it comes down in little while, so we do not take the temperature until we are ready to apply again, then we find it much lower than before the last application.
The indication to use the constriction method is in the tubercular and gonorrhoeal joints. Make a test by puncture. Bier makes a small puncture but does not pack the wound, as packing, he says, produces necrosis of the more vital parts. Sometimes it is not even necessary to open the joint; the purulent fluid, even the pus, will disappear. In a cold abcess he opens a very small opening, does not pack, and does not inject any fluid; here he applies cups and produces hyperemia by suction.
First, we apply vaseline around the wound; this caused the vacuum glass to stick. Leave the glass on three minutes, release three minutes; do this for three-quarters of an hour.
This gives very good results in mammary abcess. These heal in a very short time under this treatment.
I saw very good results in infected fingers, hands, etc. In these cases he uses both the constriction method and the suction method. Also acts well in diabetic patients, when the incision should be small, the suction glass does the rest. Very good results in tubercular fistulas of the neck.
Now, the only objection is that these vacuum glasses are so expensive; to allow the patient to have them would mean breakage and expense. So, in addition, I have pressed into service parts of the glass anti-toxin syringe, ordinary breast pump glass, glass funnel, attaching a rubber hose and a vacuum pump, rubber bulb, etc.
In the clinics the patients, after a few treatments, know just how to apply and use them themselves. They have their breast room, finger room, arm room, sick room, etc.
The suction method is also used in gynecology and obstetrics. For puerperal infection to avoid general pyemia, betterment of amenorrhoea, improve drainage of mucous and purulent discharge chronic discharges, ulceration of cervix, etc.
I saw very little of it in gynecology and very little results, as he says himself. It is impossible at this date to properly estimate the benefit derived from hyperemic treatment in these cases; further experiment and improved technique are needed.
Now, the hyperemia by baking produced by hot air.
This hyperemia is different from that induced by obstruction. The latter causes a venous hyperemia and the hot air an arterial one. Heat for the production of hyperemia has been employed as long as the art of healing exists. It has been used in the shape of hot baths, hot fomentation, hot poultice, sun baths, hot sand baths, electric light baths.
Hot air hyperemia has its own indication. Increased arterial blood to the part of the body favors absorbtion of chronic exudates, infiltration, adhesions, etc.
Hot air permits of the use of a very high degree of heat without injury or pain to the respective parts.
Hot air can be applied in two ways; by hot air boxes, by hot air douches.
These boxes can be made very easily. Ordinary wooden boxes sawed through the middle, then connected by a pair of hinges; a hole to permit the arm, will save insulating material; flap extending out of the opening and tied about the arm. Another opening for the point of the chimney, which is about two to three feet long, ending in a funnel shape and attached to a gas burner.
Two holes in the top to permit the circulation of air, also a thermometer-often this is unnecessary, as the patient feels the heat.
The thermometer often registers 230°-250° F. They can stand an awful lot of heat without serious results.
These boxes can be made by making the opening in different directions to put the hand, arm, elbow, leg, etc.
By the use of hot air douch. They make a long tin tube about thirty inches long, three inches in diameter; one end being made smaller into a nozzle form, the other with a funnel shape; this is connected with a burner. This tube is supported so that it can be directed into any affected area. This douche is used half hourly.
Electricity may be employed for heating.
Under this condition and management the patient can use this hot air treatment at home.
PERSONAL EXPERIENCE WITH ANTI-TOXIN.
BY DR. H. B. WILCOX, KINGSTON, PA.
Let it be understood before taking up this case, that my report is not to condemn the use of diphtheria anti-toxin, nor, in the least, to influence physicians or the laity against it. My object is to show what unusual symptoms may arise in certain cases where there is an idiosyncrasy or certain affections of the respiratory tract.
In December, 1909, it was my misfortune to contract a severe case of putrid sore throat, accompanied by the usual symptoms of chills, muscular soreness, pain in the back of the neck, dysphagia, etc. Ordinarily such a disturbance would have caused but little alarm, but owing to constant exposure for several weeks to diphtheria, it excited some suspicion as to the possibility of my having the dreaded disease. After an examination by two physicians, they decided to use anti-toxin as a safeguard. (In the meantime a culture of the exudate was made and found negative.) Five minutes after the injection of 4000 units of anti-toxin I was affected with incessant sneezing, nausea, and vomiting, marked itching of the nose and running from the eyes. Within ten minutes my face was cyanotic and so swollen that it was difficult for me to see. Immediately following this, my whole body became cyanosed, extremities cold, with severe itching of the palms of the hands and soles of the feet, and such intense dyspnoea that it seemed