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REPORT OF FIRST ASSISTANT PHYSICIAN

DR. WILLIAM T. SHANAHAN, Medical Superintendent:

DEAR SIR.— I beg to submit herewith the following notes on work done during the past fiscal year.

At the Peterson Hospital, the following surgical operations have been performed during the year: Appendectomies.

9 Aspiration of chest.

1 Amputation of fingers.

1 Amputation of left leg.

1 Amputation of left arm.

1 Choleocystectomy.

1 Colectomy.

2 Circumcision.

4 Dislocation of shoulder.

15 Dislocation of inferior maxilla.

4 Empyema, drainage

1 Fracture of clavicle.

4 Fracture of humerus..

3 Fracture of inferior maxilla. Fracture of metacarpal bones.

3 Fracture of phalanges.

2 Fracture of radius and ulna.

3 Fracture of tibia..

2 Fracture of ulna.

1 Herniotomy.

1 Hemorrhoids..

3 Impaction of fractured hip....

1 Intravenous injection of magnesium sulphate.

22 Infected axillary glands, removal...

2 Infected inguinal glands, removal..

2 Ileosygmoidostomy.

5 Lumbar puncture

17 Orchitis, acute, drainage.

1 Ovariotomy.

2

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The role of surgery in the treatment of epilepsy has been discussed for many years, in fact the unfortunate sufferer from this dread malady has been the prey of the surgeon since the earliest recognition of the disease.

And what has been accomplished by surgical therapy? Can we say that there is any well defined group of the epilepsies that should be given surgical treatment? We do not believe that it can be doubted by anyone who has seen any large number of epileptics that there are the well-defined group of intestinal toxic cases, those with intestinal torpor or stasis, who improve after brisk eliminative measures are practiced.

Whether or not this intestinal stasis or torpor, is primary or secondary, it would seem to us, is not to be considered, if we are to look at this subject from its broadest possible viewpoint, i. e., if we are to use our every effort to improve our patients general physical condition. Any surgery we have attempted at Sonyea, has been with this one thought in mind, to remedy any pathological condition that may present itself,

A complete radiographic outfit is installed on the second floor of the Peterson Hospital, and this has been of much service to us in our work. A suite of three rooms is used, the middle room as the transformer and operating room. On the west side, connecting with but protected from the transformer room by a heavy leadened wall, is the table room for both horizontal and vertical radiography and fluroscopy. On the east side of the operating room,

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is a library room for the viewing and storage of plates and films. A small closet nearby this suite is used as a dark-room. The equipment consists of a 20 K W Waite and Bartlett interrupterless transformer with complete Cooledge equipment.

The lack of a proper X-ray equipment for diagnostic purposes had been keenly felt in the past, and many times since the installation of our present equipment have we been greatly aided in the diagnosis and subsequent treatment of various conditions.

The following case might be cited to show the importance of the X-ray in diagnosis :

C. H. F., age 56 years. In June, 1917, complained of pain in the left forearm, with restricted motion, and a painful point on pressure at the mid-point of the forearm. Patient could give no history of a fall, but stated that about ten days prior, he struck his arm on the side of the bed when arising. There was increased local temperature, but no contusion or bruising of the forearm. A fracture was suspected and radiographs were taken with the forearm in full pronation and full supination. These showed no evidences of any fracture, but did show in the pronated arm a shadow along the radial side of the ulna, suggesting a periostitis which would necessarily require operative interference. However before anything of this nature would be attempted, other radiograms were taken. A radiogram taken in partial pronation, showed an incomplete fracture of the ulna, middle third, an unusual type of fracture in a man of his years. The application of a light plaster splint, which was worn for

four weeks, entirely cleared up all symptoms. This case is recorded mot only to show the importance of the X-ray in diagnosis, but also to show the necessity of radiographing from more than one angle in all cases of suspected fracture.

We have made it a routine procedure to take bismuth pictures in all cases, prior to any abdominal surgery, except in the acute cases, and have found various malpositions of the intestinal tract, bringing about a delay in the passage of the test meal. We have met with various types of angulations at the upper and lower portions of the small bowel, and have frequently noted a delay in the passage of the test meal past the hepatic and splenic flexures

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