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FRACTURES, DISLOCATIONS, INJU

RIES, TUMORS, &c.

tion. was unable to walk erect; then he gave way on the right side so much, that he

These increased steadily till he

Mollities Ossium in the Male, with Spon- thought his right hip was either wholly

taneous Fractures.

DR. JAMES A. RIGBY (British Medical Journal):

William G., æt. 43, married, a schoolmaster, with no family history of any

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softening of the bones, about eight years ago began to suffer from severe pains in his knees, attributed to rheumatism. Then pains came in his feet and shoul

Fig. 2.-CHEST.

ders. He was also dyspeptic, and always of a costive nature. Four years ago he began to be much troubled with pains in his hips, and difficult locomo

1886.-No. 11 b.

a more or less complete absorption of the muscular tissue of the hands; the ungual phalanges are all shortened in a marked degree; the articular extremities of the other phalanges are enlarged at the base. This is most distinctly perceptible in the thumb, of which the base of the first phalanx is so much enlarged, that it causes the extensor tendon to run in a curved direction, something like the course of the string passing over the bridge of a violin; the obvious effect of this is to cause insufficiency of length of tendon, and so dislocation backwards of the ungual phalanx of the thumb; the pad of the thumb is thus placed transversely on the end of the thumb, and looks upwards, instead of forwards, towards the palmar aspect. (Fig. 1.)

The chest has altered much in shape. It is now more or less rounded in every diameter, compressed laterally, and bulging forwards, more particularly at the lower part. (Fig 2.) There are well marked swellings at the junction

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of the ribs with the costal cartilages. The sternum is sickle-shaped, the handle being upwards, and the convex surface of the sickle looking forwards. Two years ago, the patient sustained a fracture of the right humerus, through simply trying to prevent a man from jostling him in the street.

On Dec. 29th last, the patient came under my care. He was then quite unable to walk without a crutch and stick. He had been bending down to tie his boot lace, when the right femur

Fig. 3.-FRACTURED FEMUR.

broke through the middle of its shaft. (Fig. 3.) The fracture united distinctly in six weeks. Meantime, the patient suffered from considerable pain in the left thigh, the muscles of which wasted. While he was still in bed, the left femur bowed outwards, and seemed to rotate on its axis, so that the front aspect of the knee turned outwards. Soon after its reunion, the fractured right femur became subject to very similar alterations in shape, though a little more marked.

The bones of the head remain unaltered. The organs are quite healthy. The mental faculties are perfect. He has no cough, diarrhoea, or perspirations; no pyrexia or hectic.-New York Medical Abstract.

[We print this article more especially as an illustration of the extreme degree of disease to which a patient may reach with such slight premonitory symptoms, showing the necessity of a careful diagnosis, particularly in those cases whose first symptoms of suffering are referred to the knee joint.]

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Ether; an Improved Method of Adminis tering It.

After describing several methods of administering ether, in a paper read before the Hampden District Medical Society, Dr. D. E. KEEFE, of Springfield, Mass., said:

I now come to the fourth and last method, which I claim original to myself. It may have been used by others, but I fail to find any account of it in the books or medical journals. Not that it is prima facia very different from that usually employed, but still there is a difference, an essential and important difference, and bespeak your careful attention while I describe it. It consists in the following points: Ist. In the ordinary method air is admitted at all times. 2d. In the "chokedown method," it is excluded at all times. My method resembles the ordinary in the first part and the "chokedown" in the remainder of administration, only there is this difference-I provide for a freer access of air than the cone and sponge can do, for I discard the sponge and use an open cone. I consider this of incalculable advantage over both

(*) The cone consists of a good-sized towel, folded with a paper next to outside fold, and having four times thickness of towel on inside, on which the ether is poured. It is as widely open at one end as the other, and since there is nothing between sides it can be closed at pleasure.

methods just mentioned. What then is this advantage? If a close cone is used, it must be held a short distance from the face; the mouth and nostrils representing, so to speak, only a small segment of the cone. The ether vapor having almost three times the specific gravity, as air is diffusing downward out side the face. Especially is this true during expiration, whereas, if held close down on face the vapor being wholly unmixed with air will be so irritating, that after first sniff coughing is induced, and all the respiratory muscles are put in a state of tetanic rigidity, in which they remain until patient is nearly asphyxiated. The only remedy is to remove the cone, when he breathes more air than ether, and physician inhales nearly as much as his patient. The open cone and sponge (usual method) if held away from face is more objectionable on account of allowing escape of ether into room than the close one; but if held against face, and being of proper size, the face acting as a cushion prevents loss downward, while on inspiration a draft is caused through cone; the ether being the heavier keeps the lowest plane, and is driven by ingress of air into the lungs, accompanied by a large quantity of air. It is self-evident that a cone without a sponge has as much advantage over that containing one as the latter has over the close cone, for here, there is nothing but the diffusing ether to obstruct the ingress of air. More. over, evaporation of the ether takes

METHOD PURSUED.

place more rapidly, and there is no danger of liquid ether running down the trachea and causing death, as in the case reported by Dr. E. L. Holmes, in Chicago Medical Journal, 1876.

Another and great advantage is that the patient gets such a large percentage of air with first inspiration, and that so intimately mixed with ether that little or no irritation is caused, and he has not so keen an appreciation of the want of air and does not stop breathing as when air is completely excluded; you are thus enabled to gauge the toleration of mucous membranes at once and finding them tolerant, the administrator can close the cone at once and completely exclude air, which he is generally able to do after two or three inspirations. This is just what he could not do if ordinary cone and sponge were used without first removing sponge, and he would remove most of his ether with it.

(Ordinary method) Open cone and sponge, free access of air.....

(Chokedown) Close cone, complete exclu

sion of air....

Dr. Adams' inhaler.

My new method, open cone.

Shortest time, I minute; longest, 10.

It is right here I claim the prime advantage and originality; for here my system merges into complete exclusion of air or "choking down." I think the foregoing sufficiently explains my method, and any careful and disinterested reader can understand and appreciate its advantages. In 105 105 cases where this plan was pursued results were average time required, 23 minutes; average quantity of ether, 1 oz., vomiting, before, 2%; vomiting, after, 12%. For the better comparison I submit the following results:

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Surgical Relations of the lleo-cecal Region.

DR. J. MCF. EASTON (Weekly Medical Review): A thorough investigation of the morbid conditions of the ileocecal region leads to the following con

clusions:

1. That certain modifications are corrected spontaneously, or by the process of involution under treatment.

2. In this early stage of ileo-cecal disorders, medicinal or mechanical means are advantageous.

In further explaining the pathology of this affection, we must consider for a moment its causes. Dr. Little believes that the prime factor in the etiology is atony of structure and the unfavorable action of gravity. This atony of muscles and ligaments is often due, according to Little, to improper or insufficient feeding, and is most often seen in the children of feeble parents, or in those who are hand fed. Such children are not rhachitic, but simply feeble, and their

3. That extra peritoneal punctures tissues lack tone. He remarks that and incisions are beneficial in cecal inflammation with or without fecal abscess.

4. Disorders involving the peritoneum, when not promptly, relieved by general treatment, warrant exploratory opening of the abdomen.

5. Impediments to the intestinal the intestinal canal, or morbid accumulations in the abdominal cavity, accompanied with meteorism, call for immediate surgical interference with laparotomy.

6. In cases of simple stenosis or malignant growths involving the ileo-cecal connections, ileo colostomy is indicated.

7. Gangrenous portions of the intestinal canal necessitate resection, and either direct restoration by suturing the ends, or the formation, temporarily, of an artificial anus.

8. Operative measures in ileo-cecal derangements should not be delayed until the physical powers have become prostrated, but resorted to while there is capacity for reaction of the vital forces.

Report of Five Cases of Knock-Knee

Treated by Macewen's Method. In an article written for the Albany Medical Annals, by DR. S. R. MORROW, in speaking of the pathology of knockknee, says:

atonic genu valgum is related to several other disorders in which weakness of fibrous and muscular structure exists; for example, prolapsus ani, prolapsus uteri, ectropion senile, hernia, flat-foot, etc. In such atonic subjects, the action of gravity is very unfavorable; consequently in their limbs we are apt to see the ankle and tarsal joints first affected (causing flat-foot), next the knee (genu valgum), next the hip (a certain waddling gait), lastly the spinal column (scoliosis).

There are two periods in the age of man when growth is extraordinarily rapid. The first period is from birth until the ninth month, and the second is at the approach of, or during puberty, say from the tenth to the sixteenth year. Now, it is near these two periods of rapid growth that genu valgum is most often developed, but the cause differs somewhat with the two periods. In the earlier period, up to five or six years, rickets is the predisposing cause, although, as before stated, Little holds that many cases, even in this period, are simply atonic. As to the cause of the deformity at puberty, it is probably, as Poore states, that the formation of new bone elements is more rapid than the ability of the system to furnish the earthy salts necessary for their calcification. Hence, the new material is liable

to yield in any direction under persistent force. At any rate, rickets cannot be the cause of these late developing cases, for that is a disease of childhood rarely seen after the sixth year.

Psoas Abscess; When and How to Open It.

At a recent meeting of the British Medical Association, MR. EDMUND OWEN read a paper on the above subject. Mr. Owen said there was no disease the treatment of which had derived a greater impetus from the introduction of antiseptics than psoas abscess. By By antiseptics he did not mean the use of the spray. The spray was now cooling down in more senses than one, and the surgeon did not now have to look through a cloud of carbolic vapor at his patient. By the use of antiseptics, he meant antiseptics as used by the great masters in surgery, whether by Tait, Gamgee, Savory, or Lister. Twenty years ago every surgeon preferred to leave a psoas abscess alone, so long as it remained unopened. Stanley, writing forty years ago, said a psoas abscess might disappear. Could it? Mr. Owen said that in an extensive out-patient experience, extending over years, he had only seen one case in which, after a fusiform tumor had been detected ascending along the iliac fossa, he had seen it disappear. Aspiration was useless, for it refilled. When evacuation of the abscess was performed, it should be done thoroughly, and no useless temporizing measures made use of. During delay the pus would be burrowing out for itself an extensive ramifying cavity. A free anterior and posterior opening should be made, and the wound thoroughly drained. The sac should be washed out with a warm antiseptic lotion, and a drainage tube the size of a cedar pencil passed through. The

wound should be covered with sublimate gauze, then some oakum placed over it and the dressings changed as seldom as possible. He had employed as the antiseptic lotion a warm solution of corrosive sublimate (1 in 1,000). He should, however, in future, discard the use of the sublimate, as he had had a case which died in four hours with black urine, due, he believed, to the absorption of the sublimate. Mr. Owen, in concluding, summed up his conclusions as follows;

1. Spontaneous absorption of psoas abscess is impracticable. Sooner or later it must be evacuated, either by nature or art, and the advantage is on the side of art.

2. The sac should be opened both in front and at the back, and irrigated. For a small abscess a single opening at the back might suffice.

3. Antiseptics should be employed. 4. The operator should bear in mind that pus might collect on the opposite side after evacuation of the abscess.

If

any rise of temperature take place, a second abscess should be suspected, and, if found, evacuated at once. Bilateral abscesses should be attacked simultaneously, as their cavities frequently communicate. In reply to a query from a member as to the source of his method, Mr. Owen replied that it was neither English, French, Scotch, nor Italian, but Welsh, thereby signifying that the idea was his own, and that he had not borrowed it from any one.Medical Record.

Anal Fissure.

DR. J. P. LYTLE writes to us as follows: Anal fissure, or irritable ulcer of the rectum, is almost, if not quite, as easily treated as ulceration elsewhere, if the application is made directly to the ulcer. This cannot be done without a

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