after the fifteenth application, the patient ate meat and bread and butter. In about three months I made twentyfive applications, obtaining most decided improvements. The contracting ring persists, but its irritability has disappeared. The patient eats, without regurgitation, of what others at the table partake, restricting herself in only one item of food-meat, which is cut fine for her. She drinks water and milk. freely. For a time the stomach, unaccustomed to such foreign substances as bread and butter, strawberries, cheese, etc., made the patient aware of its change in function by dyspeptic disturbances. had failed to accomplish any good results, I resolved to give a thorough trial to the galvanic current locally applied, and that experiment I proceeded to make. I employed from six to ten cells of a galvanic chloride of silver battery, placing a sponge electrode joined to the positive pole in one hand and an œsophageal electrode connected with the negative pole within the constricting ring. This electrode consisted of an ovoid shell, seven-sixteenths of an inch by three-fourths of an inch of perforated hard rubber, which could be unscrewed in the middle, and had sufficient space within for absorbent cotton which came in contact with a small expanse of platinum, and that in turn united by an insulated wire to a battery. The battery used gives a current absolutely constant in character; and a water rheostat served to differentiate the strength of the current. My applied presence of the stricture without its cations were made three times a week for a few weeks, then twice a week, each treatment lasting from six to twelve minutes. The interesting points in this case are these: The ease with which a diagnosis of dyspepsia could have been made, its long existence, its obstinacy under manifold treatment, the continu irritability, and the rapid change in character of the constriction under the influence of the galvanic current. FRACTURED PATELLA TREAT ED BY WIRING. BY J. J. BUCHANAN, M. D., PITTSBURG, PA. At the termination of the first treatment the following circumstance took place. The current had passed for as long as I thought best, when on attempting to withdraw the œsophageal THE patient is a German laborer and electrode, it came easily in response to my traction for a few inches, when it was seized by a contraction of the œsophagus and there firmly held for a few seconds. This peculiar accident did not happen the second time. After each treatment the patient placed herself in a recumbent position for a half hour. At the fourteenth visit the electrode was passed through and beyond the point of stricture without the knowledge of the patient, nor did I feel any sensation of opposition. At dinner, his fracture was the result of direct violence, caused by the stroke of a three hundred pound box which fell against his knee. He stated that the accident happened in the middle of the day of June 30th. He continued to do his laboring work till evening, but on the following day found that he was unable to stand on the limb. I suppose that the blow broke the bone, but the capsule held together till evening. When he was brought to the hospital, five days afterward, the joint was considerably distended and the fragment seemed to be very small. He was informed of the probable result by the use of external appliances, and the advantages as well as the risks attending the method by suture. With a full understanding of the circumstances he demanded the treatment which would give him the most useful limb, even though at some slight risk to his life. I accordingly operated on the eleventh day after the injury. Instruments The most scrupulous precautions against sepsis were taken. and appliances were put through the same course of preparation as for laparotomy. Continuous irrigation with 1-2500 sublimate solution was employed and the transverse incision was made to the full extent of the rent in the capsule. The lower fragment was not larger than a chestnut. The capsule was much lacerated, and a number of narrow shreds hung into the joint; the joint contained a great deal of clotted blood and bloody fluid. The joint was thoroughly washed out and all loose pieces and ragged ends and edges of capsule were cut away with scissors. The fractured surfaces were refreshed by the vigorous use of a curette. the inner extremity barely entering the joint. The silver wire was then twisted firmly, which brought the fragments into place, and the ends of the wire were turned down between the edges of the apposed fragments. The capsule was closely united over the whole length of the rupture with the continuous catgut suture. Interrupted silkworm-gut stitches were used for the soft parts down to the capsule. Sublimated dressings and a posterior splint completed the work. At the expiration of the third day the drain was exposed and withdrawn. The primary dressing was removed at the end of a week, when the wound of the soft parts was found to be soundly healed and the skin stitches were all taken out. The progress of the case was aseptic and of course absolutely devoid of pain and discomfort. At the end of four weeks the patient. was allowed out of bed, and at the end of five and a half weeks all dressings were removed and he was allowed to walk upon the limb with the aid of crutches. At the end of six and a half weeks he was permitted to rely on a cane without any support to the limb. When I last examined him four or five days ago, palpation of the patella gave no evidence of its ever having been fractured. The range of motion is not A single hole was drilled through each fragment, the drill entering about. three-eighths of an inch from the line of fracture, and emerging at the cartilaget great, but is rapidly increasing and ginous border of the fractured surface. As a motive power for the drill, I used the dental engine, which was kindly supplied and manipulated for me by Dr. Charles Phillips, a dentist of this city. A silver wire of No. 24 gauge was passed. An incision was made into the lower part of the joint on the outside of the limb and a rubber drain inserted, will, I doubt not, be completely restored. There is no question that the treatment of fractured patella by external retentive apparatus is extremely unsatisfactory. An occasional case of close ligamentous union encourages the surgeon, but the great majority of cases have a half inch or more of separation which gradually increases; a large pro portion have refracture or rupture of the ligament and almost all have limbs of greatly impaired usefulness. a This operation, when it succeeds, as it usually does, is said to leave the patient with bony union and with freely movable joint. It certainly is the most speedy and least troublesome of all methods of treatment. I myself think it is destined to be the treatment of the future. As our methods of securing asepsis of operative wounds become more certain and our skill in applying them increases, so will the patella suture become better established. In the present condition of the science the mortality of this operation is slight, but it still exists. I think it will be re duced practically to zero. As things now are I think the advisability of the operation in any particular case should depend on the wishes of the patient and the skill of the operator in securing asepsis. If the patient is unwilling or his attendant lacks the technical skill for rigid antisepsis the operation should not be thought of. On these points I can do no better than to quote the words of Dr. Frank W. Rockwell, of Brooklyn: "Finally I believe that so long as this form of fracture is treated by the ordinary methods employed, just so long will the present unsatisfactory results continue to obtain, and I believe it to be the duty of the surgeon, in any given case, to at least give his patient the benefit of deciding for himself whether he will have wiring done or not, and in event of his selecting the operation, to do it at the earliest proper time, if capable of performing a thoroughly aseptic operation, since I believe that by so doing he will obtain the best results in the largest number of cases." To the same effect has Dr. Lewis S. Pilcher, also of Brooklyn, expressed himself: "The whole principle of exposing the patella and refreshing the fragments and bringing them together is the outgrowth of the antiseptic principle, and to a very considerable extent it may be considered one of the most difficult achievements of antiseptic work. Now it seems to me that, in expressing an opinion upon the justifiabil ity of an operation of this kind, we ought to qualify it somewhat in this way: That a surgeon who has become a master of the practice of antisepsis, as well as the principles, and who is able to control with certainty the conditions which surround his patient, would be justified in opening the kneejoint in a recent case of fracture of the patella and bringing the fragments together; but I doubt very much whether, excepting under such circumstances, it would be justifiable." Venerable Bede whose name is so bound up with the well known Abbey of Lindisfarne. In the VIII. Century St. John of Damascus, Paul the deacon, Accuin, Egenhard the historian, Paulinus and the Emperor Charlemagne. In the IX. Century Alfred the Great, who enacted a law that every man owning two hides of land should send his children to school up to the age of 16. In the X. Century Grubert, Auselm, Lanfranc, St. Bernard, Albertus Magnus, Roger Bacon, Dun Sicotus St. Thomas Aqurnas. In the XII. Guido of Arrezzo, who introduced the gamut and to whom we owe the priceless boon of music in a scientific form. The Mariner's Compass is due to this period. XIII. Century, Spectacles invented by Salbima, a Monk of Pisa. In the XIV. Schwartz invented gunpowder. enquirer and to form an outlet for the literary activity of the XIX. Century. The literary activity of the XIX. Century has only been equalled by that of the schoolmen of the middle ages* though we are so much accustomed to hear of the ignorance which like a pall covered the fair face of Europe, from the year 476 to 1453, that it seems dangerous to compare the ages, but yet there is just ground for comparison. The superabundant activity of the present age is finding vent in discussing almost the very questions which were not only the favorite theme of the schoolmen, but of an age anterior to them. We read in the history of Hindoo philosophy17 how about five or six centuries before the commencement of the Christion era a mighty stir took place in thinking minds throughout the civilized world. Thus when Buddha arose in India, Greece had her great philosophical thinker in Pythagoras, In the XV. Printing invented or per- Persia in Zoroaster and China in Confected by Guttenburg & Faust. The influence of caste is well seen in India amongst the Brahmins who carry out by strict injunctions their laws against intermarriage with those outside their own caste; as a consequence cer tainly a superior race has been produced, when we compare them with other classes in India, though the Brahmins have not been able to hold their own, in the physical struggle with the Moslem or the Christian. fucius. Men began to ask themselves earnestly such questions as: What am I? Whence have I come? Whither am I going? How can I explain my consciousness of personal existence! What is the relationship between my material and immaterial nature? What is this world in which I find myself? How can I explain the deepest mystery of nature To the middle ages we owe the splendid gothic architecture, the ruins of which are still the admiration of the civilized world. Look at the leaning Tower of Pisa erected in the XII. Century, The art of illumination is due to the same age. In the Vatican library may be seen an illuminated MSS. copy of the New Testament as old as the XI. Century, in Greek, in letters of gold. The possibility of Heredity influencing race, nations, civilization16 has not been overlooked, so that it would seem as if the problem were capable of almost indefinite expansion; so many collateral questions spring from it to exercise the ingenuity of the philosophical Twelve Years in South Africa." To the middle ages we owe the preservation of Greek and Latin literature. the founding of the Universities of Oxford (880) Cambridge (915] Paris, Rome, Bologna, Padna. Pavia Pisa; the first dictionaries in the Latin tongue, the first treatise in Algebra, the first Greek work in Anatomy; the invention of the clock, etc. 16. Buckle. History of Civilization. To the middle ages we are indebted for the elevation of the female character. I may refer all who are anxious to know the truth about the middle ages to a lecture by D. Grimley, published in the Rev. J. O'Harres' 47. 17. Hindusom. Uonier Williams p. -the mystery of creation? Did a wise good and all powerful Being create the world out of nothing? or did it coalesce itself out of an eternal germ? or did it come together by a fortuitous concurrence of eternal atoms? If created by a being of infinite wisdom, how can I account for the inequalities of condition. in it-good and evil, happiness and misery? Has the Creator form or is He formless? Has he any qualities or none? ex We need not wonder that such questions found a place in Christian philosophy or that the great energy of the writers of the middle ages was pended in discussing them from every point of view. Wearied of the endless repetition of such questions, they invented new problems, upon which they argued, reasoned, syllogized, moralized and philosophized. Let us not flatter ourselves that we have so far advanced that we can despise that age, for if we consider the speculations of modern philosophy or the range over which they extend we shall find that there is a certain degree of harmony between them. The scholastic philosophy has discussed a large number of the subjects which puzzle our modern philosophers; their explanations are quite as satisfactory as those offered to us at the present day. As the schooimen descended into minutiæ, so science in our age leaves nothing untouched, and as an instance, of the minuteness with which her votaries follow her I may mention the enquiries made hy Crichton Browne18 in reference to right handedness. At first sight it does not seem very important whether we wink with the right or the left eye, whether we are right or left handed, whether we have any trick or mannerism, as playing with a button, whether we can move our external ears separately, etc., but yet these questions have been invested with a scientific interest, in order to solve some problems of Heredity. Dr. Browne was anxious to know how actions, which we might almost call automatic, are produced, or whether we inherit them from our forefathers. So that all these habits, seemingly so trivial, have an interest for the speculative. The very question submitted by Crichton Browne in the XIX. Century attracted the notice of Aristotle19 384 B. C., so that we have here a striking illustration of the limits within which human curiosity moves and of the recurrence in later ages of problems which were put forward in former ages. This is not by any means a singular instance and readers familiar with old literature can easily find many parallels. George Meredith20 would call this a rough truth, or as he puts it "Plato is Mose's atticizing, Aristotle had the globe under his cranium, the modern lives on the ancients and not one in ten thousand can refer to the particular treasury he filches. Taine21 would make us believe that there was little good in those middle ages, the reason is, he failed to understand the spirit of the age, and is so wrapt up in the literary mist which envelops so many scientific men, and which has not even been dissipated by such distinguished writers as Muratari, 18. Crichton Browne. Right Handedness: Circular 1879. 19. Aristotle. Paper contributed by W. Pearson to the Cambridge Philosophical Society, 1874, on Aristotle's notice of Righthandedness. 20. The Egoist, Vol. 3, p. 62. 21. Taine. History of English Literature, Vol. 3, p. 219. |
