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treated by gaseous injection; Senn recommends hydrogen gas, and carbonic gas has been recommended by others.
Intussusception, too, may be cured by injection-injection with inversion of the patient if seen very soon; but if not immediately successful there is no alternative but section or the chance of the slough of the invagination. Of course, in hernia, after etherization taxis is to be employed, but only for a short time, and with the understanding that if not successful the stricture is to be relieved by cutting. It is worth noting that recent hernias require the most prompt action, as the bowel is more susceptible to the dangerous influence of pressure. So, too, small hernias are more to be dreaded than larger ones, as when several loops are included there is a chance for some circulation in the intestinal walls. I would call your attention to the fact that many with ruptures do not wear trusses, and impress on you the duty of forcibly urging upon all such the grave danger they
All other varieties require prompt surgical interference, by laparotomy, and if the attendant lives in a city and does not feel competent to deal with the case himself, he should either call the services of an abdominal surgeon or send the case to a hospital at once. Delays are fearfully dangerous; only those who have seen the results realize how rapidly destructive changes occur in these cases.
In case of hernia my experience induces me to say that it is bad policy, after the sac has been opened and the constriction released, to be in a hurry to get the intestine back. Infinitely better draw out more, and if not in a clearly healthy condition in a few moments, keep it under the influence and protection of hot cloths soaked with Thiersch's solution:
and so retained until its natural color and consistence are resumed. In case this does not occur, the opening might be enlarged and the necessary repair instituted at once: In a case seen several years ago, and brought from a neighboring city, a fæcal fistula had resulted as a result of too hasty a reduction,
necessitating a difficult operation for its cure, owing to numerous adhesions. Unfortunately we know of no means to prevent these conditions of obstruction, 15 per cent. or about one-sixth, however, due to abnormal contents, might perhaps be prevented by hygienic action to digestion-Dunglison's Col. and Clin. Record.
THE MANAGEMENT OF CLUB FOOT.
Dr. A. M. Phelps, of New York, gave a brief outline on this subject, recently. It was not until the fourth year of age that the cuneiform bones became ossified. Prior to that age the foot could be readily moulded into correct position, and the earlier the treatment was begun after birth the better. That treatment consisted in manipulation, carrying the foot with the aid of the hand as nearly around into position as possible, then fixing it with adhesive plaster, removing this next day, and repeating the treatment every succeeding day until the foot had been placed in a position of over-correction. This could be effected by the third month, but the treatment must not be relaxed as long as there was any tendency to deformity. If this method did not succeed, he divided subcutaneously the soft parts which offered opposition, but never went further with cutting than was necessary. It was seldom that bones had to be cut or broken.Med. Record.
Extracts from Home and Foreign Journals.
THE STERILIZATION OF CATGUT BY BOILING IN WATER.
Hofmeister (Centralbl. für Chir., 1896,) has modified his procedure for the sterilization of catgut by boiling, and now believes that the following method yields a perfectly sterile and in every way satisfactory preparation:
The raw catgut is to be wrapped evenly in a single layer upon strong glass plates, or nickel frames. The thread should be drawn as taut as possible and the two ends firmly knotted. If separate pieces of thread are wrapped upon the same plate or frame, the ends must be securely tied.
The catgut is then transferred:
1. To a solution of formalin in water, 2 to 4 per cent., for from twelve to forty-eight hours.
2. Wash in running water for at least twelve hours, to remove the excess of formalin.
3. Boil in water for from five to twenty minutes.
4. Preserve in absolute alcohol to which have been added 5 per cent. of glycerin and 4 per cent. of carbolic acid or 1 per cent. sublimate (in case metal frames are employed the sublimate should not be used). For use the holders have to be put upright in an oblong glass trough; in this way the thread can be drawn easily, but still will not loosen itself spontaneously.
While the exact strength of the formalin solution and the length of time of the boiling do not influence the result in particular, the careful wrapping and the thorough washing are in
dispensable to the attainable of a satisfactory result. The firm tension made in wrapping the gut is still further raised by the action of the formalin (therefore strong plates should be used) and must be maintained until the hardening is accomplished.
The plates must remain in alcohol some hours before the knotted end of the thread is loosened. If the tension has been deficient, the thread gets thick and elastic like rubber, and can not well be used for ligature-material.
If the formalin is not entirely washed out before boiling the gut, the thread will break easily.
The arrangement of the threads in but one layer permits of equal access of the formalin and of the washing and boiling water. The hardened and washed catgut may be preserved in alcohol indefinitely without injury before the boiling. It may also be boiled repeatedly, if the end of the thread is tightly knotted again, to maintain the tension.
The author claims for this procedure:
1. Absolute destruction of germs.
2. Preservation of the tensile strength of the catgut.
3. Avoidance of complicated methods and expensive instruments.
The thread, wrapped up once, need not be touched with the fingers from the beginning of the sterilization until used. The bacteriological examination of the gut thus prepared has proved it to be free from germs.
In Bruns's clinic the method has been in use since February, 1896, and has given satisfaction in every way.—Am. Journal of the Medical Sciences.
SEROTHERAPY IN CANCER.
In a closing remark at the end of an article which appeared in the Review under this title over a year ago (September, 1895,) the writer said: "I have commenced some clinical experiments according to a method which is a combination of those which I have just mentioned. The results which are obtained, whatever they be, will be published later."
I might write on the subject a long article in which I could describe at length nearly a dozen cases treated. It will suffice to say that in none of the inoperative tumors (carcinoma and
epithelioma) have I had the advantage of obtaining a permanent improvement. In every case, after an apparently favorable change in the general condition of the person as well as in the aspect of the tumor, the morbid process would set in again and carry away the unfortunate patient. In one case only-carcinomy of the breast-where the tumor was removed and the axilla carefully cleaned out was there no relapse after two years. After operation the patient received fifteen injections of serum prepared according to the methods referred to in the article.-P. G. in New York Therapeutic Review.
A NEW METHOD OF WOUND TREATMENT.
Sometime ago we called attention to the fact that Dr. C. L. Schleich, of Berlin, to whom surgery is indebted for a number of ingenious discoveries-notably infiltration anæsthesia-had introduced a new antiseptic dressing for wounds which promised to be a valuable acquisition to the resources of the surgeon. Glutol, as the new compound has since been called, is a whitish, granular powder, odorless, non-irritating and non-toxic, which is formed by dissolving gelatine in water and drying the solution in the vapors of formaline. The advantages claimed for it were that when applied to the surface of a wound the gelatine is slowly absorbed, with the continuous liberation of a small amount of formaline-a powerful, yet innocuous antiseptic. Despite the short time that has elapsed since the introduction of glutol, it has been submitted to extensive experimentation, and the high claims of its value made by Schleich have been fully corroborated. From the numerous reports that have appeared on the new antiseptic, we select that of Dr. H. F. Hoyt, Chief Surgeon, G. N. and C. B. and N. Railways, as well illustrating its utility in general surgical practice. It is his custom to employ it as follows: After sterilizing with either bichloride, boric acid, permanganate of potash, peroxide of hydrogen, as the contingency of the case may require, he irrigates the wound with sterilized water, drying the surface with sterilized gauze. He then applies glutol in the same manner that iodoform is used, covering the wound with sterile gauze, cotton and bandage. For the treatment of any variety of an uninfected wound, this method, in Dr. Haig's opinion, comes nearer being an ideal than any other he