Page images
PDF
EPUB

had failed to accomplish any good re- after the fifteenth application, the patisults, I resolved to give a thorough ent ate meat and bread and butter. trial to the galvanic current locally ap- In about three months I made twentyplied, and that experiment I proceeded five applications, obtaining most decided to make. I employed from six to ten improvements. The contracting ring cells of a galvanic chloride of silver persists, but its irritability has disapbattery, placing a sponge electrode peared. The patient eats, without rejoined to the positive pole in one hand gurgitation, of what others at the table and an æsophageal electrode connected partake, restricting herself in only one with the negative pole within the con- item of food-meat, which is cut fine stricting ring. This electrode consisted for her. She drinks water and milk of an ovoid shell, seven-sixteenths of an freely. For a time the stomach, unacinch by three-fourths of an inch of per- customed to such foreign substances as forated hard rubber, which could be bread and butter, strawberries, cheese, unscrewed in the middle, and had suf- etc., made the patient aware of its ficient space within for absorbent cot- change in function by.dyspeptic diston which came in contact with a small turbances. expanse of platinum, and that in turn

The interesting points in this case united by an insulated wire to a battery. are these: The ease with which a diag

The battery used gives a current abso- nosis of dyspepsia could have been lutely constant in character; and a made, its long existence, its obstinacy water rheostat served to differentiate under manifold treatment, the continuthe strength of the current. My applied presence of the stricture without its cations were made three times a week irritability, and the rapid change in for a few weeks, then twice a week, character of the constriction under the each treatment lasting from six to twelve influence of the galvanic current. minutes.

At the termination of the first treat- FRACTURED PATELJA TREATment the following circumstance took

ED BY WIRING. place. The current had passed for as BY J. J. BUCHANAN, M. D., PITTSBURG, PA, long as I thought best, when on at- A paper read at Allegheny Couuty Medical Society,

VIIE

is a German laborer and electrode, it came easily in response to his fracture was the result of direct my traction for a few inches, when it violence, caused by the stroke of a three was seized by a contraction of the æso- hundred pound box which fell against phagus and there firmly held for a few his knee. He stated that the accident seconds. This peculiar accident did happened in the middle of the day of not happen the second time. After June 30th. He continued to do his each treatment the patient placed her laboring work till evening, but on the self in a recumbent position for a half following day found that he was unable hour. At the fourteenth visit the elec- to stand on the limb. I suppose that trode was passed through and beyond the blow broke the bone, but the capthe point of stricture without the know- sule held together till evening. When ledge of the patient, nor did I feel any he was brought to the hospital, five days sensation of opposition. At dinner, I afterward, the joint was considerably

tempting to withdraw the asophageal The patient is a German laborer and

distended and the fragment seemed to the inner extremity barely entering the be

very small. He was informed of the joint. The silver wire was then twisted probable result by the use of external firmly, which brought the fragments appliances, and the advantages as well into place, and the ends of the wire as the risks attending the method by

were turned down between the edges of With a full understanding of the apposed fragments. The capsule the circumstances he demanded the

was closely united over the whole length treatment which would give him the

of the rupture with the continuous catmost useful limb, even though at some

gut suture. slight risk to his life. I accordingly

Interrupted silkworm-gut stitches operated on the eleventh day after the

were used for the soft parts down to the injury.

capsule. Sublimated dressings and a The most scrupulous precautions

posterior splint completed the work. against sepsis were taken. Instruments

At the expiration of the third day the and appliances were put through the drain was exposed and withdrawn. The same course of preparation as for laparo- primary dressing was removed at the tomy. Continuous irrigation with

end of a week, when the wound of the 1-2500 sublimate solution was employed soft parts was found to be soundly and the transverse incision was made

healed and the skin stitches were all to the full extent of the rent in the cap- taken out. The progress of the case sule. The lower fragment was not

was aseptie and of course absolutely delarger than a chestnut. The capsule void of pain and discomfort. was much lacerated, and a number of

At the end of four weeks the patient narrow shreds hung into the joint; the

was allowed out of bed, and at the end joint contained a great deal of clotted of five and a half weeks all dressings blood and bloody fluidl. The joint was

were removed and he was allowed to thoroughly washed out and all loose walk upon the limb with the aid of pieces and ragged ends and edges of crutches. At the end of six and a half capsule were cut away with scissors.

weeks he was permitted to rely on The fractured surfaces were refreshed

cane without any support to the limb. by the vigorous nise of a curette.

When I last examined him four or five A single hole was drilled through days ago, palpation of the patella gave each fragment, the drill entering about

no evidence of its ever having been three-eighths of an inch from the line fractured. The range of motion is not of fracture, and emerging at the cartila- get great, but is rapidly increasing and ginous border of the fractured surface. will, I doubt not, be completely restored. As a motive power for the drill, I used There is no question that the treatthe dental engine, which was kindly ment of fractured patella by external supplied and manipulated for me by Dr. retentive apparatus is extremely unsatisCharles Phillips, a dentist of this city. factory. An occasional case of close

A silver wire of No. 24 gauge was ligamentous union encourages the passed. An incision was made into the geon, but the great majority of cases lower

part of the joint on the outside have a half inch or more of separation of the limb and a rubber drain inserted, which gradually increases; a large pro

|

a

sur

portion have refracture or rupture of To the same effect has Dr. Lewis S. the ligament and almost all have limbs Pilcher, also of Brooklyn, expressed of greatly impaired usefulness.

himself: “The whole principle of exThis operation, when it succeeds, as posing the patella and refreshing the it usually does, is said to leave the fragments and bringing them together patient with bony union and with a is the outgrowth of the antiseptic prinfreely movable joint. It certainly is the ciple, and to a very considerable extent most speedy and least troublesome of it may be considered one of the most all methods of treatment. I myself difficult achievements of antiseptic think it is destined to be the treatment

work. Now it seems to me that, in exof the future. As our methods of pressing an opinion upon the justitiabilsecuring asepsis of operative wounds ity of an operation of this kind, we become more certain and our skill in ought to qualify it somewhat in this applying them increases, so will the way: That a surgeon who has become patella suture become better established. a master of the practice of antisepsis, In the present condition of the science as well as the principles, and who is the mortality of this operation is slight, able to control with certainty the conbut it still exists. I think it will be re

ditions which surround his patient, duced practically to zero. As things would be justified in opening the kneenow are I think the advisability of the joint in a recent case of fracture of the operation in any particular case should patella and bringing the fragments todepend on the wishes of the patient and gether; but I doubt very much whether, the skill of the operator in securing excepting under such circumstances, it asepsis.

would be justifiable.” If the patient is unwilling or his attendant lacks the technical skill for | IIEREDITY—A PHYSIOLOGICAL rigid antisepsis the operation should not AND PSYCHOLOGICAL STUDY. be thought of. On these points I can do no better than to quote the words of

BR THOMAS M. DOLAN, M. D., FELLOW Dr. Frank W. Rockwell, of Brooklyn: "Finally I believe that so long as this

EDIN, ETC.

A Lecture delivered to the Halifax Scientific form of fracture is treated by the ordin

Society and Geologists Field Club, ary methods employed, just so long (Continued from page sirteen.) will the present unsatisfactory results continue to obtain, and I believe it to I may mention a few of the eminent be the duty of the surgeon, in any given men who flourished, and some of the case, to at least give his patient the inventions we owe to the midelle ages. benefit of deciding for himself whether In the VI. Century flourished Virhe will have wiring done or not, and in gilius Tapensis, Dionysius Exiguus event of his selecting the operation, to astronomer, historian, the inventor of do it at the earliest proper time, if cap- the Pascal Cycle, Gregory of Tours able of performing a thoroughly aseptic Cassiodorus, and Boetius. operation, since I believe that by so In the VII. Century Theodorus who doing he will obtain the best results in introduced Greek literature into Eng. the largest number of cases.

land, St. Isodore of Scirlle, and the

OF TILE ROYAL COLLEGE OF SURGEONS

ETC.

NOTE.

Venerable Bede whose name is so bound enquirer and to form an outlet for the up with the well known Abbey of literary activity of the XIX. Century. Lindisfarne.

The literary activity of the XIX. In the VIII. Century St. John of Century has only been equalled by that Damascus, Paul the deacon, Accuin, of the schoolmen of the middle ages* Egenhard the historian, Paulinus and though we are so much accustomed the Emperor Charlemagne.

to hear of the ignorance which like a In the IX. C'entury Alfred the Great, pall covered the fair face of Europe, who enacted a law that every man oun

from the year 176 to 1453, that it seems ing to hides of lond should send his dangerous to compare the ages, but yet children to school up to the age of 16.

there is just ground for comparison. In the X. Century Grubert, Auselm, The superabundant activity of the presLanfranc, St. Bernard, Albertus

ent age is finding vent in discussing alMagnus, Roger Bacon, Dun Sicotus

most the very questions which were not St. Thomas Agurnas.

only the favorite theme of the schoolIn the XII. Guido of Arrezzo, who

men, but of an age anterior to them. introduced the gamut and to whom we

We read in the history of Hindoo owe the priceless boon of music in a philosophy17 how about five or six censcientific form. The Mariner's Compass turies before the commencement of the is due to this period.

Christion era a mighty stir took place XIII. Century, Spectacles invented in thinking minds throughout the by Salbima, a Monk of Pisa.

civilized world. Thus when Buddha In the XIV. Schwartz invented gun

arose in India, Greece had her great powder.

philosophical thinker in Pythagoras, In the XV. Printing invented or per- Persia in Zoroaster and China in Confected by Guttenburg & Faust.

fucius. Men began to ask themselves The influence of caste is well seen in

earnestly such questions as: What am India amongst the Brahmins who carry

I? Whence have I come? Whither am out by strict injunctions their laws

I going? How can I explain my conagainst intermarriage with those outside

sciousness of personal existence! What their own caste; as a consequence cer

is the relationship between my material tainly a superior race has been produced, and immaterial nature? What is this when we compare them with other

world in which I find myself? How can classes in India, though the Brahmins I explain the deepest mystery of nature have not been able to hold their own, *To the iniddle ages we owe the splendid gothic in the physical struggle with the Moslem or the Christian.

In the Vatican library may be seen an illumiThe possibility of Heredity influenc

To the middle ages we owe the preservation of ing race, nations, civilization 16 has not

Universities of Oxford (880) Cambridge (915) Paris, been overlooked, so that it would seem as if the problem were capable of al

Algebra, the first Greek work in Anatomy; the inmost indefinite expansion; so many col

tion of the female character. lateral questions spring from it to exercise the ingenuity of the philosophical "Twelve years in South Africa."

architecture, the ruins of which are still the ad-
miration of the civilized world. Look at the
leaning Tower of Pisa erected in the XII. Cen-
tury, The art of illumination is due to the same
ape.
nated MSS. copy of the New Testament as old as
the XI. Century, in Greek, in letters of gold.

Greek and Latin literature, the founding of the

Rome, Bologna, Padna. Pavia Pisa; the first dictionaries in the Latin tongue, the first treatise in

vention of the clock, etc.

To the middle ages we are indebted for the eleva

Grimley, published in the Rev. J. O'Harres 16. Buckle. History of Civilization.

17. Hindusom. Conier Williams p. 47.

I may refer all who are anxious to know the truth about the middle ages to a lecture by D.

ex

—the mystery of creation? Did a wise left handed, whether we have any

trick good and all powerful Being create the or mannerism, as playing with a button, world out of nothing? or did it coalesce whether we can move our external ears itself out of an eternal germ? or did it separately, etc., but yet these questions come together by a fortuitous concur

have been invested with a scientific inrence of eternal atoms? If created by terest, in order to solve some problems a being of infinite wisdom, how can I of Heredity. account for the inequalities of condition

Dr. Browne was anxious to know how in it-good and evil, happiness and actions, which we might almost call misery? Has the Creator form or is lle automatic, are produced, or whether we formless? Has he any qualities or

inherit them from our forefathers. So none?

that all these habits, seemingly so We need not wonder that such ques. ' trivial, have an interest for the specutions found a place in Christian philo- lative. sophy or that the great energy of the The very question submitted by writers of the middle ages was

Crichton Browne in the XIX. ('entury pended in discussing them from every attracted the notice of Aristotle19 384 B. point of view. Wearied of the endless C., so that we have here a striking illurepetition of such questions, they in- stration of the limits within which vented new problems, upon which they human curiosity moves and of the reargued, reasoned, syllogized, moralized currence in later ages of problems which and philosophized.

were put forward in former ages. This Let us not flatter ourselves that we

is not by any means a singular instance have so far advanced that we can des and readers familiar with old literature pise that age, for if we consider the

can easily find many parallels. speculations of modern philosophy or George Meredith20 would call this a the range over which they extend we

rough truth, or as he puts it “Plato is shall find that there is a certain degree Mose's atticizing, Aristotle had the of harmony between them.

globe under his cranium, the modern The scholastic philosophy has dis- i lives on the ancients and not one in ten cussed a large number of the subjects i thousand can refer to the particular which puzzle our modern philosophers; treasury he filches. their explanations are quite as satisfac Taine21 would make us believe that tory as those offered to us at the present there was little good in those middle day.

ages, the reason is, he failed to underAs the schooimen descended into stand the spirit of the age, and is so minutiæ, so science in our age leaves

wrapt up in the literary mist which nothing untouched, and as an instance envelops so many scientific men, and of the minuteness with which her which has not even been dissipated by votaries follow her I may mention the such distinguished writers as Muratari, enquiries made by Crichton Browne18

18. Crichton Browne. Right Handedness: Cir. in reference to right handedness. At

19. Aristotle. Paper contributed by W. Pearson first sight it does not seem very im

to the Cambridge Philosophical Society, 1874, on

Aristotle's notice of Righthandedness. portant whether we wink with the right 20. The Egoist, Vol. 3, p. 62.

21. Taine. History of English Literature, Vol. 3, or the left eye, whether we are right or

p. 219.

cular 1879.

1

« PreviousContinue »