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Dr. C. H. RICHARDSON then read a paper on “The Best Methods of Preparation, Sterilization and Preservation of Materials Used in Surgical Operations."
The President declared D Richardson's paper open to discussion.
Dr. Root: I don't know that I want to speak on this paper in the line of discussion, but I feel that it has been so complete and instructive that I cannot allow it to go by without offering my personal thanks. Those of us, who are not so intimately associated with surgery as the writer and Dr. Vander Veer and Dr. Macdonald, especially appreciate the benefit of such a paper. I offer my sincere thanks as one member of the Society, to Dr. Richardson.
Dr. VANDER VEER: Mr. President, it has been a source of pride for me to listen to this paper. The surgery of to-day is not the surgery of thirty years ago. The advances which have been made have always come under my attention, and I have devoted a good deal of study to them. The methods described to-night have been the source of many conversations between Dr. Macdonald and myself for many years, and on many occasions. Infection has always been the terror of the surgeon, and was with us, when working under exceedingly unfavorable circumstances in the old hospital building. I remember many years ago, after a visit to Lawson Tait, bringing the Gamgee pad over to this city. This is the only old thing left in the dressings shown to-night, and even it is made in a different way from what it originally was. Everything else is new. When I introduced the Gamgee pad many years ago I was made the object of some merriment in connection with it, in the form of a humorous poem on the subject. If you read carefully the recent discussions on the subject of technique, you will find that the efforts of the surgeons have been, not only toward sterilization of the dressings, but also careful preparation of the hands, and of the patient. One Swiss surgeon even goes so far as to recommend the use of two knives, one for the skin incision and one for the deeper cuts. He does this because he believes that infection takes place from the skin, which must be very carefully prepared to avoid this. With regard to rubber gloves, Kocher thinks that some surgeons are so careful that the gloves are not needed, but that the gloves should be used by most surgeons. They interfere with the delicacy of touch, to a slight degree, in some abdominal operations, but still I agree with Kocher fully. We have had the nurses use them in the hospital lately with satisfactory results. There are many other points which might be discussed. Technique is of the greatest importance, and requires an amount of care and time which the surgeon of fifteen years ago did not dream of. The more we study technique, the better it is for the patient. The cylinders which Dr. Richardson showed are of great help, especially in work out of the city. They are of especial help, as by this means a complete outfit can be taken in a sterile condition. The outfit which we take to-day is very different from that which we took fifteen years ago. The Kumol method of sterilizing catgut required much investigation, but it is doubtless the best method. I recently talked with Dr. Clinton Cushing, of San Francisco, who said that he had good results with the catgut prepared in the old way with ether. Dr. Fowler, of Brooklyn, gets good results with catgut prepared with alcohol. There are a number of methods of preparation, but none so safe, I believe, as with Kumol. I shudder when I think of the care of instruments for office-work a number of years ago. Even now we see cases of infection of the scrotum after tapping with a dirty trocar, or of abdominal wounds after tapping, or cases of urethral infection following the use of unclean sounds. The general practitioner can gain a great deal by noting how these instruments should be cared for.
Dr. SWAN (of Saratoga): I have listened with interest to Dr. Richardson's paper. I listened for breaks in his technique, but did not find any. I am interested in the sterilization of catgut by Kumol, as I was present at the Johns Hopkins Hospital during the evolution of this method. I am glad that it is used in Albany. I know that it sterilizes the catgut and does not weaken it. It is important to have the apparatus used in surgery as simple as possible. Halstead has shown that catgut is not necessary. He uses silk and silver wire, still catgut is convenient and perfectly safe after sterilization with Kumol. I was interested in Dr. Richardson's description of preparing silk. In Dr. Kelly's operating-room the silk is not only sterilized by superheated steam, but it is also boiled with the instruments just before being used. This, I consider, an extra safeguard. I also boil silk worm gut. The sterilization of rubber gloves with formaldehyde gas interests me. I have had some doubt of the safety of this method, and have always boiled the gloves. If the formaldehyde method is safe, it is a great saving, for the gloves last much longer. I should have to have a good deal of personal experience with the formaldehyde method before I gave up boiling. I think that where we have pus, in a clean case, it is, as a rule, the fault of the surgeon.
Dr. MACDONALD : Perhaps I might be allowed to say a word or two about one or two matters connected with this subject. I feel personally hurt at Dr. Richardson's reference to the Kumol method in use here as the Clark method. The method used here is not the Clark method; it is modified in several particulars. The method of Clark is reliable for small-sized gut, but not for the larger sizes. We have the evidence of the Bender Laboratory that the larger sizes are not always sterilized.
Dr. Richardson was not very clear in his description of the details in the preparation of silk. The silk is dried and spooled and put in tubes, and after that is a second time placed in the autoclav for fifteen minutes. We have experimented a great deal with silk and our efforts have been toward the use of the smallest size compatible with safety. I think that in Albany we use smaller silk than at most places and are able to do this because our method of preparation does not weaken it. We have reduced the size used for tying large pedicles from No. 5 to No. 2. I think that where a non-absorbent ligature is used it should be the smallest possible. If you boil silk more than once, you destroy its strength. Our rubber gloves, after formaldehyde sterilization, we have
had tested several times and we have had no growth. They have been tested immediately after the action of the formaldehyde and also after use, and were always sterile. They should, perhaps, be exposed rather longer than the time mentioned by Dr. Richardson. I consider this method of sterilization perfectly reliable. It lengthens the life of the glove one hundred per cent. The methods presented here to-night were long in developing, and the result of a great deal of labor. They are largely the result of a fight against an outbreak of sepsis, which occurred in Albany several years ago.
The PRESIDENT: The Chair has been very interested by Dr. Richardson's paper. As methods of sterilizing instruments, Dr. Richardson only mentions boiling in soda solution. This has the effect of destroying the edges of the finer instruments. In a recent number of the Philadelphia Medical Journal I saw an account of some experiments with liquid formaldehyde as a sterilizing agent. The author found that ordinary solutions had a corroding effect, but, if the formaldehyde solution is alkalinized, the instruments can be kept in it for months without corrosion. I would like to ask Dr. Richardson if he has seen the method tried?
Dr. RICHARDSON : With regard to Dr. Swan's remarks on the boiling of silk with the instruments, I cannot see that this is necessary. The silk is sterilized and boiled once and transferred to sterile tubes with proper precautions. With regard to the rubber gloves, I made a number of experiments with these with eight or nine different varieties of bacteria. These were published in a paper by me in the New York Medical Record, I have forgotten for what date. The gloves always proved absolutely aseptic. They have been used in the Albany Hospital for some time and we rarely have pus. I have not tried the alkaline formaldehyde mentioned by Dr. Van Allen, so cannot say much about it. The PRESIDENT : A movement to adjourn is in order.
It was moved by Dr. Macdonald, and seconded, that the meeting adjourn. (Carried.)
GEORGE BLUMER, T. F. C. VAN ALLEN,
THE ALBANY MEDICAL COLLEGE ALUMNI ASSOCIATION OF GREATER New YORK.— The fifth annual meeting of this Association was held Wednesday, December 6, at the residence of Horace T. Hanks, M. D., No. 766 Madison avenue, for the purpose of electing officers for the ensuing year and to make arrangements for the annual banquet.
The following officers were elected for the ensuing year: President, Major James P. Kimball, M. D., Surgeon, U. S. A., Governor's Island, New York city (A. M. C., '64); Vice-President, Robert Macfarlane, '88, Long Island City, N. Y.; Secretary, Warren C. Spalding, '81; Assistant Secretary, Bernard Livingston, '99; Treasurer, H. F. C. Müller, '87, Brooklyn; Governors, one year, M. L. Rhein, M. D., D. D. S., '80; A. Parker Muir, M. D., '96; two years, Frederick Loughran, '90; William F. Holcombe, '50; James Mitchell, M. D., '80, Cohoes, N. Y., President of the Albany Medical College Association, Member ex-officio.
On December 14, a special meeting was held, when it was decided to hold the fifth annual banquet at the Hotel Savoy on Friday evening, January 19, 1900, at 7 o'clock sharp. The previous banquets have been most successful and every effort will be made to make this banquet a most enjoyable one. All graduates, or those who have ever attended the College, are cordially invited to attend. Any information concerning membership in this Association or regarding the banquet will be gladly furnished by the Secretary.
DETENTION WARD FOR THE ALBANY HOSPITAL.— The Committee on Public Buildings of the Board of Supervisors, to which was referred the petition of the physicians of Albany county for a house of detention for insane patients in connection with the Albany Hospital, has recommended the following act for passage:
“Resolved, By the Board of Supervisors of Albany County:
“Sec. 1. There is hereby appropriated the sum of $20,000, or so much thereof as may be necessary, to be paid by the County Treasurer out of funds in his hands applicable thereto, and as hereinafter provided, for the construction and furnishing of a reception pavilion in connection with the Albany Hospital, for the detention and care of persons afflicted with mental and nervous disorders.
"§ 2. The construction and furnishing of the pavilion shall be under the supervision of a committee of three members of this Board, two of whom shall be appointed by the President. The President of the Board shall be ex-officio a member and chairman of the committee.
"§ 3. Such Committee is authorized to adopt plans and specifications, and let contracts after due advertisement for the same, as in their judgment shall seem advisable for the construction and completion and furnishing of the said building. Said contracts shall be let only to residents of the county of Albany.
"§ 4. The County Treasurer is hereby authorized and directed to pay, upon the certificate of the said Committee, from time to time, the moneys hereby appropriated, not exceeding in all the sum of $20,000.
"§ 5. No plans shall be adopted by said Committee until there shall be executed and filed in the office of the County Treasurer a contract between the Albany Hospital and the County of Albany, that the said Hospital will maintain and manage the said pavilion, and will agree to receive and accept for detention or treatment, in said pavilion, all public patients from this county, or any of the cities or towns thereof, upon the same terms as public patients are received and cared for from the various towns of this county at such Hospital, until relieved therefrom by act of the Board of Supervisors of said county. The President of the Board of Supervisors is hereby authorized to execute such agreement on behalf of the county of Albany.
"§ 6. The title of the said building shall be and remain in the county of Albany, and the building shall be subject to the inspection of this Board, and any of its Committees thereunto authorized by the Board. "All of which is respectfully submitted.
“ PHILIP BENDER,
Committee on Public Buildings.” The bill was adopted as presented by the Public Buildings Committee, the only change being the reduction of the amount appropriated from $20,000 to $18,000.
CORONERS' PHYSICIANS OF ALBANY COUNTY.- At the meeting of the Board of Supervisors of Albany county, December 21, the following Coroners' Physicians were chosen for the year 1900: Drs. Mark S. Leavy and James M. Moore, of Albany; Frank Hinckley, of Westerlo, and Edward M. Bell, of Cohoes.
BUSINESS COMMITTEE OF THE MEDICAL SOCIETY OF THE STATE OF New YORK.— The President of the Medical Society of the State of New York has appointed the following Business Committee, to whom all communications concerning papers to be presented at the next annual meeting, January 30, 31 and February 1, 1900, should be sent: Dr. Wendell C. Phillips, 350 Madison avenue, New York city; Dr. Henry L. Elsner, Syracuse, and Dr. Chauncey P. Biggs, Ithaca.
MATERNITY HOSPITAL AT NIAGARA FALLS.- Well-known architects of Buffalo are engaged in preparing plans for a Maternity Hospital, which is to be constructed and presented to the city of Niagara Falls by Benjamin F. Thurston, as a memorial of his wife, who died recently. The Hospital will be as well equipped and complete as any in the State. It will be located to the left of the Memorial Hospital, and will be of the colonial style of architecture. It will be divided into private and public wards.
SUSPENSION OF MEDICAL STUDENTS. The entire senior class of the Medical School of Boston University was suspended from all recitations and lectures by the faculty on November twenty-fifth. The cause was the boisterous conduct of the class on two occasions when they were on their way to attend clinics at the Westborough Hospital for the Insane. This conduct was reported to the Hospital authorities, who made complaint to the school, charging the class with insubordination, and refusing to allow them to continue their clinical work at the Hospital. Dr. J. B. Sutherland, Dean of the School, requested an apology, which was refused. The suspension of the students followed.
PROFESSOR VIRcHow's JUBILEE.— The fiftieth anniversary of Virchow's labors as Professor Ordinarius in the University of Berlin, was cele