Surgery.

Contributed to the SOUTHERN JOURNAL.

PARONYCHIA-BONE FELON.

BY HOWARD LINDLEY, M. D., BALTIMORE.

THE ancients gave the name parony

chia, or, as it is commonly known, bone felon, to an inflammatory tumor seated near the nail, and involving the pulp or matrix; but moderns have extended it to inflammation of the hand and even of the fore-arm. It usually means, however, a phlegmonous tumor of the fingers, or toes, (most frequently the former) and especially of the first phalanx.

The subject may be divided into four kinds or heads:

First, that seated between the epidermis and skin, commonly called "run round," and requiring but little and simple home attention.

Second, that seated in the sub-cutareous areolar tissue.

Third, that occupying the sheath of a tendon.

there must be no half-way measures:: clean cut down to and along the bo will give almost instant relief and the wound, healing kindly, is soon wel leaving little or no scar.

Last summer ('91), I had five cases d bone felon; three by being taken in tine I fortunately aborted, but the the other! two I had to open freely; both healed promptly and the patients have the full use of their joints. I mention this because within the last two weeks I have seen three cases treated by the poultice. etc., method, in which the victims have no use or command of their thumbs None of them were opened until the pus came to the surface, when a slight pick of a needle, or curved bistoury liberated it. They all required a long time to heal and the joints are still stiff.

Last spring a lady came to me with the first finger of her right hand "looking like a spoiled sausage,” as she said. She had been under the care of an Allopath for ten weeks, then gone to one of our school who said, "he was no surgeon, but could cure it by internal reme dies;" but failed to do so in a month, so she came to me. I found the finger

The last three are only different degrees of the same disease and constitute "whitlow" or "felon."

The inflammation generally commences in the sub-cutaneous areolar tissue and, spreading to deeper parts, occasions excessive lancinating pain, owing to the parts being stretched nearly to bursting by the incarcerated pus.

Palliative treatment will, if taken in time, abort very many, in fact, nearly all cases, but it must be begun early; for if once pus is formed I do not believe there is any satisfactory remedy but the knife, and in the use of this

color, and discharging freely from three openings. The patient was so run down by her long siege of suffering that she was "nervous as a witch," to use her own expression, and could not bear to have a probe introduced any where. However, by the use of Cocaine I did succeed in convincing myself of the complete necrosis of the first phalanx, and of the neces sity of its removal.

The lady had suffered so much that at first she was unwilling to submit to this, but did so at last.

On making an incision, I found the first phalanx in three pieces, while the approximal head of the second was dis

1

eased. This being snipped off with the bone forceps and the old synovial membrane scraped from the pus channels, I closed the wound, and to-day the lady has a fairly good finger.

The nail has turned down, partly covering the finger end, and a slight puckering or drawing in has occurred. where the cicatrix formed in the track of the incision and removed bone, otherwise the finger looks and feels well.

Now, my object in speaking of this case is to show the almost criminal absurdity of waiting and trying to palliate or backen what was inevitable. Had the first, or even the second, doctor cut boldly down to the bone, I venture to say my patient would have had a perfect finger to-day. It was long incarceration of the pus that at last rotted the bone and made its removal necessary.

Undoubtedly, in my mind, as soon as pus is certainly there, and I am inclined almost to say as soon as pus may reasonably be expected, cut for it and your patient will thank you-afterward.

As to remedies, Hughes says, whitlow may certainly be arrested by the timely administration of Silicia or its analogue, Fluoric Acid, but adds, if the disease is fully established you can conduct it through its course with considerable mitigation of suffering by the use of Hepar Sulphur, or Silicia, if the bone is involved. Schlüssler recommends Ferrum Phos. in all cases where there is fever heat and throbbing pains, and claims it will often abort suppuration. He follows this by Kali Mur., but when suppuration appears exhibits Silicia at once. If the wound is indolent after the evacuation of the pus, he recommends Calcarea Sulph. If the suppurative process affects the bone, he recommends Calcarea Fluor., internal and as a lotion. Lilienthal adds to this list Graph., Natr.

Sulph., Lach., Merc., Sulph., Rhus., Ledum and a dozen others, but they all seem superfluous to me. I believe that when Hepar Sulph., Calcarea Fluor., Silicia or Phytolacca will not stop a case the only reliable remedy is the lancet, and when they have failed the sooner it is used the better.

Gynecology.

Contributed to the SOUTHERN JOURNAL.

COMPLETE LACERATION OF THE PERINEUM.

BY F. P. GREEN, M. D., MEMPHIS, TENN.

IN operations on the perineum, in order

to obtain good results it is necessary to get union by first intention. That this may be accomplished it is dedesirable to make the operation as near sub-mucous as possible and especially is this the case where the laceration is complete. The operation I shall describe here fulfills this indication and at the same time relieves any hemorrhoidal condition that may exist.

The first step in the operation is to dilate the sphincter ani as thoroughly as possible, then make a circumpheral incision around the anus just within the mucous tissue, dissect up the gut far enough back to admit of the removal of all the torn portion of the gut, just as is done in excision of the rectum. The torn ends of the sphincter ani are carefully brought together with cat gut sutures and the sphincter itself divided on either side of the coccyx. Now the dissected portion of the gut is cut away clear up to the angle of the laceration and the gut brought down and stitched in place at the verge of the anus, the stitches in the sphincter muscle being

covered. We now repair the perineum by making another incision along the margins of the mucous membrane well up on the labial wall on one side, carrying the cut to a corresponding point on the opposite side, dissecting up the tissue covering the entire perineum and posterior and lateral walls of the vagina until enough tissue has been loosened to allow stretch enough to cover the wound. All the vaginal tissue is cut away up to the angle of the original tear, leaving sufficient mucous membrane to close the wound. The perineum is now sutured, the flap of vaginal mucous membrane is brought down and stitched to the edges of the wound, covering every portion of denuded surface. exactly as is done in Schroder's operation.

A few stitches should be taken here and there in the floor of the vagina to hold the denuded tissue in close contact and to prevent a clot from forming from any small vessels that might be oozing blood. The operation, when properly done, consists essentially of an excision of the lower inch of the rectum and the lower posterior portion of the vagina, together with the suturing of the torn perineum and sphincter ani, and will yield most excellent results, making a perfect sub-mucous operation, closing the cut surfaces completely against any discharges that would otherwise interfere with primary union.

All my sutures are taken with cat gut.

Berberis Vulg.—Chronic nasal catarrh; discharge from one nostril-thick, yellowish. Speedily relieved by Berberis 6.

Sanguinaria Can.-For mucous polypus. Keith's Sanguinarin, diluted with flour in equal proportions, snuffed up the nose for fœtid smell. By injecting the tincture with a hypodermic syringe into the base of the tumour it will cause it to wither away.

Obstetrics.

Contributed to the SOUTHERN JOURNAL
A CASE OF PUERPERAL CON-

VULSIONS.

BY V. H. HALLMAN, M. D., HOT SPRINGS, ARL

ONE night about 12 o'clock, I w

called to assist Mrs. E., aged 17. medium-sized, stout and rather fine pearing young woman, in her first com finement. By way of preliminaries i inquired somewhat as to her conditic during pregnancy and at the prese time, and was informed by herself ar! husband that she had gotten along ver nicely. She had had skirmishing pass for several hours and, upon examina tion, I found the os patulous and dilanble, the position normal, and, altogether, the condition very favorable. The pains were of a stitching character and she drank large quantities of water, so I gave her a few doses of Bryonia 6x, and awaited results.

Thus far her labor was that of an av erage case, and at 3 a. m, she was deliv ered of an asphyxiated child, but 4 minute later she said: "Doctor, every thing looks dark in the room, I can not see anything." This at once aroused my suspicions, and yet, being busily er gaged resuscitating the child, I really did not surmise what was coming, whe suddenly she was seized with violent convulsions. I quickly severed the card and as soon as the spasm abated, It moved the placenta, which proved to be quite a task on account of hour-glas contraction, and was followed by profuse hemorrhage.

She was now in a semi-conscious and considerably exhausted condition, ap peared pallid, bluish around the eye

with cool perspiration on her face. I watched her a few minutes when another convulsion, the most violent I have Fever seen, came on; she clinched her rhands, champed her teeth, and, frothing at the mouth, turned her head and eyes to the left, her whole body convulsing. violently for a few seconds, then becoming rigid and, in a short time, beginning to gradually relax. I prescribed Veratrum Album 3x, about fifteen drops, in a half glass of water, to be given every thirty minutes.

I anxiously awaited results and was happy to note that she became more quiet, the intervals between attacks grew longer and after a time she was free for over an hour. I now left her in the care of the nurse for awhile, with considerable assurance that the remedy would control the spasms; during my absence, however, she had several severe attacks and, on my return, I found she had fired up, her face was flushed and hot, arteries throbbing, and she seemed more nervous. I prescribed Belladonna 3x, feeling that I had certainly struck the right remedy now.

I again left her for about two hours, and on my return was met at the gate by one of the ladies beckoning me to hasten, that the patient was certainly dying; the attacks were violent, with but short intermissions. I sat down by the bed-side with all the composure possible, and, in spite of the solicitations to do something quickly, I studied the case carefully through two convulsions, and noted that the convulsions commenced in the face and spread from there all over the body.

The lips and mouth were distorted and convulsive; eye lids winked and quivered, head and eyes turned to the left, shock spread through the body with shaking and jerking, followed by rigidity; face

appeared flush and besotted, dark around the eyes, and lower extremities cold and somewhat clammy.

I finally decided on Secale Cornutum as the remedy, put twelve drops of the 30th in half a glass of water, and as soon as she was sufficiently relaxed so that I could separate her jaws, I gave her one teaspoonful. The result was magical; she at once became quiet, had no more convulsions and improvement progressed from that time on. from that time on. I am satisfied in my own mind that if I had not allowed mysalf to become somewhat confused by its violence and had coolly and closely observed the symptoms when I first prescribed, the same gratifying results might have been attained.

Ophthalmology.

Contributed to the SOUTHERN JOURNAL.

SENILE CATARACT.

BY A. GIVEN, M. D., LOUISVILLE, KY.

MRS. M., aged 72 years, consulted me

on account of cataract of both eyes which incapacitated her from reading or sewing with the most powerful glasses. She had consulted a specialist who told her that nothing except an operation would ever enable her to see to read again.

I gave her some encouragement to try Homœopathy, but explained that it might take from three to eighteen months to benefit her. I put her on the use of Silicia and Sanguinaria 3x, one an hour before meals, the other an hour or two afterward.

In three months she could again distinguish large print through her old glasses. Within six months she could see to read well by gas light.

THE petition of countless women and female associations, as well as as of those men who are just now interesting themselves in the question of the woman doctor, which was recently presented to the German Reichstag; a petition pivoting on the desire to secure to women the study of medicine in the universities and to approve them as physicians," has doubtless found the ready, if silent, endorsement of many a woman reader of these pages. Not a few women are convinced that the female physician, so educated and approved, would find an emphatic support from the ailing sisterhood; for the reason that so many a woman will undergo certain suffering, postponing medical consultation rather than challenge modesty, and by such postponement is often rendered incurable. Judging casually, one might be pardoned the verdict that these se

quential disasters could be averts. timely recourse to a female phys that our sick lady would trust be and aches to a sympathetic ste more easily and less reluctantly de a man and, moreover, would find berx quite as well treated and as gra cured; and that the great majority female disorders would then bet speedy retreat from the medical perqu tive, so that, by and by, only strong healthy human beings would be v into the world. But, alas, for a us judgment and the exaggeration of hope! To demonstrate: It is an ta thing for you to go to your grocer buy your coffee or sugar; an easy the to run to your baker's and get y bread; but you can hardly go to y doctor and with the same certainty chase a cure, or even alleviation of pat Thus far has medicine not yet pr gressed, least of all in the cure of wor an-kind and in that almost purely lo and chirurgical treatment of peculia feminine troubles.

Just here I take the stand that th same vigorous method of treatment pe manently benefits but few women, art radically injures many more. less, this would be exactly the art irt which our future lady doctor would be primarily initiated and which she would use in practice. With a good shar knife in her hand she would endeavor carve for herself that awed respect which the sick woman timidly yields her ge tleman doctor; wherefore, else, the learn ing of these things, if she does not the use them and show to the world that she too, is skilled in handicraft! So the woman doctor would endeavor to wrest something of fame in the old way; and indeed, success would attend her efforts, in the curtailed fashion in which it come to her masculine colleagues, because,