COMMINUTED FRACTURE OF TIBIA AND FIBULA: AMPU

TATION.

BY F. C. TERRILL, M. D., MILLBROOK, MICHIGAN.

Peter Statfield, aged fifty, a German farmer residing at Wheatland Centre, Michigan, while at work in the woods May 1st, received an injury while passing under a lodged tree which resulted in a comminuted fracture of both tibia and fibula at and below their heads.

The patient was seen a few hours after the accident, placed under the influence of chloroform, the fractures reduced, and the limb dressed; the double inclined wire splint rack applied as a permanent support to the injured limb.

The only marks of external violence was an ecchymosis over the tubercle of tibia and a still larger one over the fibular head. There was great tumefaction in and around the joint with feeble circulation in the tibial arteries.

The patient lived some ten miles distant which rendered it impossible for him to be seen more often than every alternate day and when seen at the time appointed, the limb was found greatly tumefied and blistered from the knee down, the result of using strong vinegar which, the patient had been told by some sympathizing friend, would afford relief if thoroughly applied.

The outer aspect of limb turned dark and in a few days began to slough, the limb at this time turning cold, there being little or no circulation below the line of fracture. Applications were now made of poultices consisting of linseed meal and charcoal which afforded almost instant relief. On the third day following this application, not being satisfied with its appearance, examination was made with the exploring needle, which plainly told the condition and satisfied me as to termination of the case. The patient being at this time informed that there was no possible chance for saving the limb and amputation was advised, as the only proper course. The patient from this course demurred. A line of demarcation had formed around the line of fracture, and nature's processes were actively at work preparing for an amputation.

The parts were kept thoroughly cleansed, use being made of carbolized water in the dressings until May 20th, when there being no hopes of saving the leg, amputation was the only resort. At the request of the patient I performed the operation, removing it at the juncture of the middle and lower thirds of the thigh, making the anterior and posterior flap operation.

Chloroform being used as the anesthetic and all hæmorrhage being controlled by the use of Esmarch's bandage so that not a spoonful of arterial blood was lost during the whole operation. The operation was made under carbolized spray and the after dressings were made every time under antiseptic precautions.

The ligature was removed on the fifteenth day following, there being no suppuration only at the point where the ligature came out. No drainage tube was used and very little pus discharged at anytime thereafter. This result I attribute to the great antiseptic precautions taken throughout, so much so, that at no time was the stump exposed, only under the use of spray.

Patient discharged June 25th, with a good healthy stump. Examination of leg afterward confirmed the diagnosis above mentioned. The popliteal artery was found destroyed at the point of bifurcation. There was necrosis of both condyles of the femur; one as the result of slight fracture. Considering the age of patient and extent of injury, along with the period which elapsed prior to amputation, I deem it a successful result, which I am incline to attribute to antiseptic treatment and thus record it as another triumph for that principle of practice.

SCIATICA CURED WITH ELECTRICITY.

BY CHARLES TERHUNE, M. D., ANN ARBOR. MICHIGAN.

History.-A. G., Ann Arbor, Michigan, age thirty-three, married. Is a merchant. Constitution and general health good up to within two years ago. At that time while lifting a stove, was attacked with a severe pain in the region of the lumbar vertebræ which immediately followed down the tract of the great sciatic nerve in both thighs. From that time up to the 10th of August he received medical treatment of all kinds from several different physicians without the slightest relief. As to the patient's habits, I can say that up to the time of the commencement of his sciatica he was temperate. Since then he has not denied his appetite for beer and tobacco, but has rather sought them as a means to forget his sufferings. On the above mentioned date he called at my office and begged of me to "do something". It seemed ridiculous enough to attempt anything except cutting down upon the nerve and stretching it, but this he would not submit to. I was about to dismiss him without giving any encouragement when the idea of the continuous application of electricity came to my mind, so he was told to call again in the evening. In the meantime an electric battery was constructed consisting of zinc and silver plates about two inches in diameter, connected by a coil of insulated copper wire long enough to allow the silver plate to rest on the anterior portion of the thigh, the zinc resting over the sciatic nerve. A thin slice of sponge was placed between the plates and the integument and these were kept saturated with a solution of chloride of sodium. This apparatus was retained in its position by means of adhesive straps and rubber bandage. It was necessary to change its location every other day on account of the irritation caused by the formation of chloride of zinc and the electric current.

In a week's time the patient was so much better that a battery was placed on the left leg also, and these were kept on constantly only when it was necessary to replace the zinc as it would become corroded.

September 1st: The battery was taken off from the right leg as there was no more pain and felt perfectly natural. The battery is still kept on the left leg which was always the worst, simply on account of a little numbness of the toes, otherwise this leg also is free from any unnatural sensation. Whenever convenient I applied the following preparation the whole length of nerve.

R. Menthol.

Spirits vini recti.......
Ole caryoph.........

gr. xij.
mp vj.

3viij.

This mixture I have known to be of almost immediate benefit in neuralgic affections.

Considering the long standing of the disease, that it was located in both legs and the patient's habits, and the great obstinacy and severity of sciatica even under the most favorable circumstances, I feel it my duty to report a treatment so simple and easy which has been of such signal service.

TOXIC DOSES.

BY MARY L. BRIGGS, M. D., OBERLIN, OHIO.

If one thinks of making a laboratory of humanity, they should be personally acquainted with the chemicals. I have tested the physiological action of a few drugs. The maximum medicinal dose of nux vomica, as set by best authority, seems to me too large. In myself it caused jactitation, though after a longer time, than is usually mentioned for beginning of toxic action-being very nearly three hours. The twitching which followed was quickly controlled by inhalations of chloroform, suspending the anæsthetic between the paroxisms, which occurred for six hours, perhaps once in two minutes, having gradually increased in frequency and severity. The intervals after this perceptably lengthened. The spasms did not entirely disappear under thirty hours, and returned forty-eight hours subsequently, after exertion, which seemingly occasioned the reappearance. These however quickly subsided under small doses of bromide of potassium, which I may mention had failed to subdue the severer convulsions.

Carbolic Acid Internally Used.- Sweet oil was found utterly useless to prevent its irritating effect-white of eggs proved more efficient. It seemed to produce anesthesia of the stomach in about one hour, and I discovered that employed externally it did not produce its full effect as to insensibility under about that time. I suspect many have been discouraged from its local use, because they have not waited sufficiently. It controls a larger surface than would be anticipated; applying it to the hand, it numbed the whole fore-arm,

Colchicum.-The dose of this could hardly be said to be toxic. It seemed to stimulate the stomach at least, and one tablespoonful of mustard could not cause vomiting for the first one-half hour. The face looked more sunken, the eyes more hollow than I ever saw even in a cadaver; it was about what I had imagined a cholera patient in stage of collapse might present. The hands had the same look. Skin of most of the surface seemed dry and parchmentlike, although there was a cold sweat on the forehead. All this was before any marked abdominal symptoms and, strangely enough, before excretion of water had been noticably increased. The following day albuminuria was noticed.

CASE OF PERITONITIS APPENDICULARIS.

BY C. V. PORTER, M. D., LANSING, IOWA

July 16th, I was called to see a boy aged four years who had been ill for less than twenty-four hours. Found child dying; pupils widely dilated and a dark fluid oozing from nostrils. Was informed by attending physician that the day previous when called to see another member of the family he found the deceased feverish and gave small doses of tincture of aconite. Twelve hours before the boy's death he was again called and at the request of the parents gave a dose of castor oil, and an enema of asafoetida, which produced a movement of the bowels.

The symptoms during this time were pain in abdomen on pressure, vomiting of a green fluid, and dilated pupil. Coffee was given frequently as it was thought the child had eaten stramonium.

The day following, on postmortem examination we found the peritoneum in the right iliac region, pale and covered with coagulable lymph, which in several places had glued the membrane together. In the appendix vermiformis was found a hard body the size and shape of an ordinary bean. It proved to be a kernel of wheat surrounded by several layers of hardened fecal matter. The central starchy portion of the grain had been absorbed, leaving the outer portion for a nucleus. The appendix was imperforate. The foreign body simply filled the tube which seemed but little inflamed.

Two points of interest in this case; one in regard to its rapidly fatal termination. The other, in regard to the treatment, which would have been different had it been possible to diagnose correctly.

EDITORIAL BRIEFS.

THE next meeting of the International Medical Congress will be held in London from the third to the ninth of August, 1881. The Queen and the Prince of Wales have consented to take the congress under their special patronage. A large number of delegates is expected. The work will be done in fifteen sections, the

officers of which have been appointed. We hope that the profession in America will be well represented.

READ Dr. Smith's article in this issue, then turn back and read Dr. Terrill's article in the July number, then decide whether Michigan needs a law to protect the lives of its citizens from ignorant men who pretend to practice medicine. Be sure to turn back and read Dr. Terrill's article. Many people are not able to distinguish between the true physician and the pretender, and these people should be protected by the State. Would it be humane for the parent to allow the child to be torn to pieces by the savage beast, when the child was not capable of distinguishing between the harmful and the harmless animal? Is it humane for the State of Michigan to allow its citizens to be murdered by these wolves that come in sheep's clothing?

BUCHANAN'S GRADUATES.-The Philadelphia Record publishes a list of four thousand names of graduates of Buchanan's College, contributors to his journal and recipients of express packages from him. We give the list of graduates credited to Michigan. We hope that our readers, who know of the whereabouts of any of the bearers of these names, will please inform us. We take the list from the Record and will be glad to make any additions or changes that are necessary. Of course this genus of animal is a roving one, and the places which once knew him may now know him no more. The following is the list for Michigan with the year in which they are credited with graduation:

With regard to the recipients of express packages, The Record has the following:

"The sixteen express-receipt books captured in Buchanan's office at the time of his arrest disclose many interesting points.