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NOTES ON PEAT AS A SURGICAL DRESSING.
By W. G. TREMAINE, M. D., of Erie County.
THE history of the treatment of wounds is, for the most part, a sad record of human folly and of the most absurd fantasies of the human mind. All kinds of materials have from time to time been accredited with healing virtue, and have been used empirically, by those practicing the healing art, with a blind faith in the efficacy of the application itself. Amid these absurdities, it is refreshing to find that there were those who thought for themselves and observed carefully the processes of nature. For instance, said Galen: "The first thing the surgeon has to do is to see to it that he may not inflict injury, and not interfere with Nature in her attempts to heal."
Wortz, a master-surgeon of the sixteenth century, said: "Many a wound, if only kept clean and dressed correctly, will heal better than if you apply all your pastes and herbs." With the more accurate knowledge of pathology in modern times, the whole philosophy of the treatment of wounds may be summed up in the term, physiological rest; or, in other words, the prevention of all disturbing influences, either from within or without, that may interfere with or retard the reparative process. All intelligent surgeons now recognize the value of non-interference with a wound except for the purpose of removing one or another of these disturbing influences. It is, therefore, clearly the duty of the surgeon to employ that form of dressing which will best carry out these principles. The
essentials, consequently, of a good dressing are: First, sufficient absorbing power to rapidly remove excessive wound-exudates; second, to prevent decomposition of these exudates; and third, to accomplish the preceding requirements with as little mechanical disturbance of the wound as possible. There are several substances now in use that carry out these indications in a more or less satisfactory manner.
About four years ago, a laborer, working in the neighborhood of Kiel, hurt himself badly in the hand and forearm. In the absence of any dressing material, the injured limb was surrounded with black peat obtained from a peat-moor where the man had been at work. The pain soon ceased. The dressing was not disturbed for eight or ten days, when the patient presented himself at the surgical clinic in Kiel. The condition of the man is thus described by Dr. Neuber: "A thick layer of dried, black peat covered the forearm. After the arm had been cleaned in several baths, and the parts sponged off, we saw, to our great astonishment, a wound partly filled with beautiful granulations; partly there was primary union. The surroundings of the wound were perfectly without reaction. Until now no suppuration had started. Later the patient had the full functions of his hand."
Suggested by this incident, peat was extensively used as a surgical dressing in the clinic at Kiel by Dr. Neuber, a full account of which is given by him in "Anleitung zur Technik der antiseptischen Wundbehandlung und des Dauerverbandes."
According to a chemical analysis, peat contains: moisture, 20.98; ash, 5·07; organic matter, 73.95; nitrogen, 0:46. Its absorbing power is remarkable. It takes up nine times its own weight in water. It has no irritating quality when applied to wounded surfaces. Some extraordinary stories are told of its preservative qualities.
In Germany, Moorish corpses have been discovered imbedded in the black peat, which have been preserved for centuries. A resident pupil in the hospital informs me he has seen, in Ireland, bodies of animals dug out of peat-bogs in a perfect state of preservation, where they must have lain for years. He
also says he has seen butter, perfectly fresh and palatable, packed in a crude form of tub, supposed to have been placed in the peat by the Danes.
About a year ago, I began the use of peat at the Buffalo Hospital of the Sisters of Charity, a hospital of one hundred and eighty beds, and also at the Emergency Hospital. From the large number of surgical cases received and treated during the year, nearly two hundred of them being cases of accident (railway and other), ample opportunity has been afforded to test the value of this dressing. The peat used was obtained in packages containing one hundred pounds, imported from Germany by M. Lienau & Co., No. 2 Jones Lane, New York. The manner of using it is as follows: Bags of different sizes, made of hygroscopic gauze, or the fabric known as cheese-cloth rendered hygroscopic by boiling in an alkaline solution, are filled with the peat, and, after being moistened with a solution of mercuric bichloride, 1 to 1,000 parts, are applied directly to the wound, after it has been thoroughly cleansed and irrigated with the mercuric-bichloride solution. This dressing is not disturbed until completely saturated with the discharges, unless pain or rise of temperature should indicate the necessity of removing it. Frequently one dressing will suffice. Possibly the best method of illustrating our results will be to relate a few cases taken from the records of the hospitals.
CASE I.-E. G., aged twenty-eight years; native of Germany. Admitted March 15, 1884. While coupling cars this morning, his right elbow was caught between the buffers, producing a compound comminuted fracture of the elbow-joint, with a lacerated wound on the anterior aspect of the joint, laying bare the brachial artery for three inches. The elbow-joint was resected, the internal and part of the external condyle being removed, with the coronoid and part of olecranon. A drainage-tube was inserted. The wound was thoroughly irrigated with mercuric-bichloride solution, 1 to 1,000. The wound was united with catgut sutures and wrapped in gauze-bags containing sublimated peat. In five days the dressing was removed. There was no suppuration. The wound was free from inflammation and fresh peat-bags were ap
plied. The dressings were not removed for ten days, when the wound was found completely healed. Three weeks after the operation, there were fair flexion and extension.
CASE II.-George L., aged twenty-five; native of England; admitted June 14th, with compound fracture of the tibia and fibula in the upper third. The wound was thoroughly irrigated with mercuric-bichloride solution. The limb was enveloped in sublimated peat-bags and placed in fracture-box. No surgical fever and no suppuration followed. Recovery was complete, with a useful limb, in six weeks.
Many other cases might be cited from our records, but the above will sufficiently illustrate the method of using the peat and the results obtained.
Finally, we have found it a valuable surgical dressing, particularly in lacerated wounds and compound fractures. In comparison with peat, we are now using wood-flour, charged with mercuric bichloride and naphthalin, with some advantages in favor of the latter; viz., greater absorbent power, the wood-flour taking up twelve times its weight of water, and, in addition, the stain of the discharges being more readily seen than in the darker peat.
FRACTURE OF THE FLOOR OF THE
By CHARLES C. F. GAY, M. D., of Erie County.
SURGEONS Concede the difficulty, if not the impossibility, of recognizing this fracture. There are no symptoms, except pain, indicative of this lesion; hence writers affirm that its presence can only be suspected. Furthermore, it is believed this fracture rarely exists, and that when it does occur it is caused by violent, rather than slight, blows over or upon the great trochanter.
Observation of cases of hip-injury in hospital and private practice, examination of cabinet-specimens, dissection, and limited experiments upon the cadaver, have led me to conclude that this lesion occurs much oftener than has hitherto been supposed, and that great violence is not an essential element in its causation.
Unable, as I am, to indicate any new sign of the presence of this injury, and since nothing more than rest can be advised for patients with suspected acetabular fracture, it would seem a waste of time further to agitate the subject; but, having seen cabinet-specimens of union of this bone, when, during life, fracture had not been recognized or knowledge obtained of serious injury, I am impressed with the importance of calling attention to the subject, of suggesting the possibility that slight causes may produce the injury and that it is not so rare as we may have believed, and of warning against the danger arising from too frequent examination and unnecessary manipulation in order to establish the nature of the lesion.