The Treatment of Healthy Ulcers of the Extremities by

"Sealing."

BY W. B. SLATER, M. D., OF CHICAGO,

Graduate Royal College of Physicians, England, Royal College of Surgeons of London and Dublin, Late House-Surgeon of Westminster Hospital, London.

THE treatment of healthy ulcers of the extremities by sealing, has received little or no attention from the profession in this part of the country, although in many of the eastern cities and Europe, it is employed by many of the most eminent surgeons.

The treatment consists in applying around the ulcer and in the sound skin, narrow strips of adhesive plaster. A piece of thin oil silk is then placed over the ulcer and affixed to the plaster by means of collodion; the part is then bandaged and kept as quiet as possible. The advantages of this treatment are: 1st. Healthy ulcers heal more rapidly than by the ordinary methods of treatment. 2d. It gives very much less trouble. 3d. The surface of the ulcer can always be seen without removing the dressings.

1st. Numerous cases have been published in "Braithwait's Retrospect," and other journals, clearly showing that ulcers which are inclined to heal slowly, have, under this treatment, very rapidly put on a healthy appearance and filled up; and in my own practice at the Westminster Hospital and other places have witnessed the marked success which has attended its use. In the Westminster Hospital, where numerous cases are always to be found, the various treatments have been tested, and in the majority sealing has been found most beneficial; so much so that in fact, in most of the London Hospitals it is employed as a local dressing almost altogether. It prevents access of the air to the surface of the ulcer, thereby assisting materially in rapid cicatrization.

2d. It gives far less trouble both to the surgeon and patient, as it requires to be removed only once in three or four days, or where there is little suppuration, once in a week or ten days. Every surgeon knows the importance of leaving an ulcer undisturbed as long as possible, so that the new skin as it forms may not be pulled off with the dressings. Independent of these advantages this treatment in some cases very materially relieves the dull aching pain attending some forms of ulcers.

In conclusion, I would strongly recommend it to the notice of the profession, as I am convinced that in the majority of cases they will be pleased with it, and inclined to use it to the exclusion of all other local dressings. -Chicago Medical Journal.

CONSERVATIVE SURGERY.-In operations on the lower jaw, conservatism may be, and is, displayed in a manner to which few give much heed. But I beg your attention to this fact, that tumors of great size have been removed from this bone. The whole of one side thus implicated has been cut away by incisions across the bone, and the portion left has remained healthy throughout life. I have myself taken away by a horizontal incision as much of the aveolar margin of this bone as contained ten teeth, yet there was no return of the tumor for which the operation had been performed. In the last of these proceedings there was conservatism in not interfering with the base of the bone, and thereby preserving the face or chin from considerable deformity. In the first there was the like display in not taking away more than was necessary. How few have reckoned on the value of cases like these, as showing that in tumors of osseous tissue it is not necessary to remove the whole bone! Yet such a doctrine of destruction has got strangely, and, in my opinion, alarmingly prevalent.-(PROF. FERGUSSON, Lancet.)

PERMANGANATE OF POTASH IN GONORRHOEA.-By JOHN G. RICH, M. D., Beachville, Canada West.-For the last two years I have frequently employed the permanganate of potash as an injection in the treatment of gonorrhoea, and the constant success derived from its use has been extremely satisfactory. My usual method had previously been to administer, first, a hydragogue cathartic, then to give a mixture of cubebs, copaiva, nitre, &c., with injections of sulphate of zinc, tannic acid, &c. But since employing the permanganate my treatment has been much more circumscribed, for with this remedy alone I have frequently cured very bad cases in forty-eight hours, and this too without its being followed by any evil effect from the sudden arrest of the discharge. My usual mode of treatment, however, is as follows:

R Potassæ Bitart. Dj Podophillin, gr. j. M. In chartulas quatuor dividendus. S. One every two hours until free catharsis is produce i. After which:

R Potassa Permangan, gr. vj; Aquæ Fontan, 3j. M. S. To be used as an injection three times a day.

I direct at the same time the free employment of mucilaginous drinks, as althœa, ulmus, acacia, &c., and put the patient upon a non-stimulating regi

men.

Out of sixty-four registered cases this course of treatment has failed in but two instances. And I find that recent attacks usually become arrested by it after from three to six injections. I have found it advisable to continue the demurcents for at least a week after the cessation of the discharge. In none of these cases was the injection continued after the fourth day.

When accompanied by chordee, I usually employ the following :

B Lupulin, jss; Pulv. Camphora, j; Mica Panis, q. 8. M. Ft. mass in pilulas, xvi, dividenda. S. Two, three, or four on going to bed.

I think that the permanganate of potash is a remedy deserving of more notice than physicians have hitherto given it, and hoping that my experience may produce for it a more extended trial in cases of gonorrhoea,

I remain, &c.,

J. G. R.

RESTORATION OF PICTURES.-Professor Pettenkofer, of Munich, who, it may be remembered, has invented a method for restoring pictures, has just patented his invention in this country. The nature of the process, which has been for some time an object of much speculation, is extremely simple, and is mechanical, not chemical. The change which takes place in pictures, he says, is "the discontinuance of molecular cohesion," which "process begins on the surface with microscopical fissures in the varnish, and penetrates by and-by through the different coats of colors to the very foundation. The surface and body of such a picture become, in the course of time, intimately mixed with air, and reflect light like powered glass, or loses its transparency like oil intimately mixed with water or air." The process consists in causing these molecules to re-unite, which he does as follows: The picture is exposed in a flat case, lined with metal, to an atmosphere saturated with vapor of alcohol at the ordinary temperature, which vapor is absorbed by the resinous particles of the picture to the point of saturation. The different separated molecules thus "re-acquire cohesion with each other, and the optical effect of the original is restored solely by self action, the picture not getting touched at all" Other substances besides alcohol-such as wood-naphtha, ether, sulphuric and other ethers, turpentine, petroleum, benzine, &c.-may be used. The process seems to have been very successful at Munich, where Professor Pettenkofer restored some almost invisible pictures to very nearly their original freshness. Liebig has reported favorably on the method, and has given it as his opinion that it cannot injure the paintings, which, indeed, is almost a consequence of its extremely simple nature.-Chemical News, [London], Am. Journal of Pharmacy.

Report on Chloroform.

THE report of the Committee of the Medico-Chirurgical Society on Chloroform has been produced, and an abstract of it was read at a special meeting of the society, recently held. The labors of the committee have been very protracted; upwards of seventy meetings having been held, and a very large number of experiments performed. The report is of so great a length that we shall find it difficult even to present it in abstract, since it will involve so considerable a demand on our space. We shall, however, endeavor in our next impression to print a satisfactory abridge of the more important parts of the document. Meanwhile we may mention some of the leading facts.

The committee have especially investigated the important question of the influence of chloroform on the heart and on respiration. Here are the most important conclusions on this point. They say that the first effect of chloroform vapor is to increase the force of the heart's action, but this effect is slight and transient, for when complete anesthesia is produced, the heart in all cases acts with less than its natural force. The strongest doses of chloroform vapor, when admitted freely into the lungs, destroy animal life by arresting the action of the heart; while by moderate doses the heart's action is much weakened for some time before death ensues; respiration generally, but not invariably, ceasing before the action of the heart, death being due both to the failure of the heart's action and to that of the respiratory function. The danger attending the use of chloroform increases with the degree of stupor it induces; the apparent irregularities in the action of the anaesthetic mainly depending on the varying strength of the vapor employed, on the quality of the chloroform, and on the constitution of the patient. In order that it may be administered with comparative safety, it is necessary that the percentage of vapor should not exceed three and a half per cent., that its effects should be carefully watched, and the inhalation suspended when the required anæsthesia is induced. In many respects the action of ether is similar to that of dilute chloroform. At first its vapor increases the force of the heart's action, an effect which is both greater and of longer duration than that observed with chloroform. The stimulation is followed by a depression of the force of the heart's action, but, at the same degree of insensibility, ether does not depress the action of the heart to the same extent as chloroform; eventually ether kills partly by enfeebling the action of the heart, but chiefly by arresting the movements of respiration. Thus the energy with which chloroform acts and the extent to which it depresses the force of the heart's action, render it necessary to exercise great caution in its administration, and suggest the expediency of searching for other less objectionable anaesthetics. Ether is slow and uncertain in its action, though it is capable of producing the requisite insensibility, and is less dangerous in its operation than chloroform. On the whole, however, the committee concur in the general opinion which in this country has led to the disuse of ether as an inconvenient anæsthetic. A mixture of ether and chloroform is as effective as pure chloroform, and a safer agent when deep anprolonged anesthesia is to be induced; though slow in its action, it is sufficiently rapid in its operation to be convenient for general use. A mixture composed of ether three parts, chloroform two parts, alcohol one part (by measure) is to be preferred on account of the uniform blending of the ether and chloroform when combined with alcohol, and the equable escape of the constituents in vapor, and the committee suggest that it should be more extensively tried than it has been in this country. As to resuscitation, they find that the most

certain means of restoring life after poisoning with anæsthetics is by artificial respiration. By this means resuscitation may generally be accomplished after natural respiration has ceased, provided the heart continue to act; and it may sometimes be effected even after the cessation of the heart's action, but this result is exceptional. Galvanism resuscitates within the same limits as artificial respiration; it is, however, far less to be relied on than artificial respiration in equal cases. With either remedy it is found that animals quickly rendered insensible by a strong dose are more easily recovered than those which have been gradually narcotized even by a small percentage of the anæsthetic.

In their rules for the administration of chloroform, they state that an apparatus is not essential to safety if due care be taken in giving the chloroform. Free admission of air with the anesthetic is the one thing necessary, and guaranteeing this, any apparatus may be used. Three and a half per cent. is the average amount, and four and a half the maximum proportion of chloroform to atmospheric air which is either needful or safe. In case of accident in the more threatening conditions, artificial respiration is advised to be commenced instantly, and this equally in all cases, whether the respiration has failed alone, or the pulse and respiration together. Galvanism may be used concurrently; but artificial respiration is on no account to be delayed or suspended in order that galvanism may be applied. The uses of chloroform in natural and abnormal labor are very carefully discussed. There are considerable appendices, giving lists of selected experiments, an analysis of accidents with chloroform, statistics of surgical operations, selected experiments on resuscitation, and on obstetrical report. The whole document is one which will be read with great interest, and gives evidence of industry and ability such as committees rarely lavish on their joint-stock productions.-Lancet.

*It does not appear that the committee either tried nitrous ozide, or had any knowledge of its use in such cases for the removal of the asphyxiated ondition. Z.,

The most efficient means of restoring arterialization, circulation, respiration, innervation, and general life action in asphyxia, is by the administration of nitrous oxide, either by the lungs or alimentary canal, as before mentioned.-Z.

Fibrous Tumours of the Uterus Treated by Surgical

Means.

MR. BAKER BROWN, in a paper before the Obstetrical Society of London, (Feb. 4, 1864,) reminded the members that on December 7, 1859, he had read a short paper on this subject, containing a case of fibrous tumour of the uterus treated successfully by surgical means. Also on March 6, 1861, he had read a second paper on the same subject, giving six cases, four of which were cured, one was relieved, and one died. The object of the present paper was to confirm the practice previously advocated, by fourteen more cases, and at the same time to show that in most cases a very modified surgical treatment was sufficient; for whereas Mr. Brown had hitherto divided his operation in two parts-viz, first preliminary incision of the os and cervix; and, secondly, gouging or breaking up the tumour; he now finds that the first step will always arrest the hemorrhage and the development of the tumour. In some cases the tumour decreases, and when small it will entirely disappear, more especially if of recent origin; and even when gouging is required a much slighter operation is sufficient. Mr. Brown, therefore, now never uses Harper's instrument," but only a pair of long-handled, b`unt-pointed, curved scissors. The author entered minutely into the mode of operating,

and laid great stress on carefully and thoroughly plugging the incisions and whole vagina with oiled lint after the operation, as on this point depended the chances of hemorrhage, and exposure to air, and consequently hysteritis, and even peritonitis. Mr. Brown then read fourteen cases occurring in the London Surgical Home, illustrative of his remarks. Of these fourteen, ten were cured of hemorrhage by the incision of the os and cervix uteri alone, and one was relieved; in two only was it necessary to perform the second operation, both resulting in cure of the tumour; in six cases the tumour had either entirely disappeared or materially decreased after incision alone. Of the three deaths, one had occurred from peritonitis, resulting from exposure to cold and the restlessness of the patient; one from organic disease, independent of the operation; and one from pyæmia. Out of between twenty and thirty cases occurring in his private practice, the author stated that he had had one death, in a patient whose case was complicated with hematocele, and that in his public practice he had had as many more as were now given, with no more deaths. The following practical conclusions were drawn: 1. That the fact of the curability of these tumours is materially confirmed by these cases. 2. That it is not necessary in many cases to do more than incise the os and cervix, thereby lessening the danger of the operation. 3. That the hemorrhage is almost invariably arrested by the incision of the os and the cervix. 4. That the cure of these fibrous or fibroid tumours by surgical means, without the danger of enucleation, is now firmly established, as proved by Dr. M'Clintock, Dr. Routh, Dr. Dawson, of Newcastle-upon-Tyne, as well as by himself (Mr. Brown).

Mr. Brown stated that care was taken to prevent the incisions in the os and cervix from uniting. The oiled lint in the first instance, and the injunctions afterwards, generally prevented union; but if any bands of lymph were thrown out, he always broke them down with the finger. He had never seen a case in which the patient had been confined after the operation, but it was only reasonable to infer that parturition would be accelerated after these incisions; for in the case of a primiparous woman, where the os is torn, the subsequent labors are always exceedingly quick. As to the rationale of the operation, Mr. Brown had avoided the question, for fear of giving too wide a field for discussion. He thought the action was twofold. The tumours were of very low vitality, and the slightest interference with them stopped their growth. Thus, in the first place, the initiatory blood vessels were cut through by incising the os and cervix; and, secondly, the tumour was grasped more firmly by the contraction of the uterus, which always takes place after the os is incised; and thus the tumour was confined, could not grow, and often died. He was obliged to Dr. Routh for alluding to the authenticity of his (Mr. Brown's) cases, as some doubt had on more than one occasion been thrown on the subject. He could only repeat that his practice at the London Surgical Home was open to every member of the profession. He had only given cases where severe hemorrhage was present as the most urgent symptom, and in almost all the cases which came to him, the patients had been previously treated without success.-Med. Times and Gaz., March 19, 1864.

TRICHINE IN MEAT.-It is stated in the London Lancet that a thorough boiling or roasting, or also perhaps intense salting and smoking, will kill the trichinæ; but an imperfect preparation by these methods will not affect the parasites, at least not those in the interior of the meat. Even putrefaction to a certain extent will leave the trichinæ intact.

B