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three-quarters of an inch of the pubis. The patient was placed under chloroform. Assisted by Dr. Wilkins, I then first opened the urethra wih a scalpel in the healthy portion, and introduced a No. 12 elastic catheter into the bladder. Then with a sawing movement of the cautery knife, I removed the entire organ flush with the pubis, leaving a little more of the spongy portion than the corpora cavervosa. Not a drop of blood was lost. The catheter was shortened and secured in situ by means of this very ingenious little arrangement devised by Dr. Bell, the Assistant House Surgeon of the Hospital, and which can be adapted to any part of a catheter, and to an instrument of any size. The urine was carried off by a piece of elastic tubing. Putrid infection, so very apt to ensue here, was avoided by the constant application to the burnt surface of carbolic oil. The catheter was removed for the first time on the third day, and subsequently introduced for an hour daily in order to prevent undue contraction of the urethral meatus. On the twenty-first day (July 23rd) the patient was discharged cured, and has reported himself in good shape on two or three occasions since.
CASE V.—Removal of Enlarged Gland.—Thomas Butler, aged 27, was admitted with a gonorrheal bubo, which had been incised some time previous. I enlarged the original wound, and found a gland of the size of a hen's egg separated from the skin and underlying structures, firm and apparently having no disposition to break down. The man stated that things had been in very much the same condition for two months. I applied first chloride of zinc paste, but finding that method of treatment of little avail, I dissected out the entire gland with the hot knife. After the removal of the slough,t he part healed from the bottom with marvellous rapidity, and the man was discharged cured on the twenty-ninth day after the operation.
CASE VI.-- Tracheotomy.-On the 24th of February last, Dr. Ross and I were summoned to the Hospital to perform tracheotomy in a case of diphtheria under his care. The child was in extremis, and the veins of the neck were very turgid. With his concurrence I made the ordinary incision through the
soft parts with the cautery knife, opening the trachea, however, with the scalpel. The operation was absolutely bloodless. The child rallied for some hours, but at length succumbed to blood contamination.
CASE VII.—Hæmorrhoids.—Mary Kelly, aged 27, came under treatment July 29, 1878, for several very large hæmorrhoidal tumours. An operation for their removal was performed with Mr. Henry Smith's clamp, the platinum point of the thermo-cautery being substituted for his more cumbrous irons. A large mass of thickened tissue fringing the anus was removed with the hot knife. The patient was allowed to sit up on the eighth day after operation, and was discharged August 14.
CASE VIII.-Phagedenic Ulceration.-Philip Gilison, a lad of 19, having a distinct history of chancroid, was admitted January 9 of this year with an enormously swollen condition of the penis and a most offensive discharge. The prepuce, which was so edematous that the glans could not be exposed, was slit up freely along the dorsum, when a state of things which only phagedenic ulceration can induce, was brought to view. Nearly one-half the glans was already destroyed, and not a little of the body of the penis beyond the corona. As soon as the pressure exerted by the prepuce was withdrawn, the bleeding became furious, and, indeed, he had already, on two notable occasions, lost large quantities of blood. I rapidly removed the sloughs, divided any bridges of tissue that remained, and applied the cautery unsparingly. An uninterrupted convalescence ensued, and the patient was discharged on the 31st day of the same month.
CASE IX.-Subacute-Synovitis of the Knee-joint. — (Reported by Mr. McArthur.)— This is a case that came under my care on the 3rd of the present month, and which I think worthy of notice here. From the notes of my clinical clerk I gather that the patient, Edward Foley, 24 years of age, has long been of intemperate habits, but never had any ailment, with the single exception of an attack of gonorrhea two months ago, which lasted a very few days, and has never shown any signs of recurrence. The right knee became swollen some ten days before admission, and now measures (I quote from the report) in circumference an inch and a half more than the healthy joint. The patella foats in the fluid, so that on percussion it is heard to click against the condyles beneath. There is very little heat, and no pain elicited excepting when he attempts to walk.
October 5th.—The joint was to-day scored on either side with the thermo-cautery, and the limb was placed at rest in a Macintyre splint. Iodide of potash in ten grain doses thrice daily was also ordered,
7th.—Everything looking improvedAlready on measurement there is a reduction in size of of an inch since the cauterization. Poultices are made to replace the lead lotion.
9th.-Knee-joint increased in size of an inch since the operation, on account of the cellular infiltration induced. Some enlargement of the glands in the groin, . No pain in the joint.
14th.—The superficial sloughing consequent on the cauterization is almost gone ; circumforence diminishing rapidly ; joint has now almost a normal appearance.
17th. -- Perfectly well ; will be discharged in a couple of days.
CASE X.-Extensive Ulceration following Small-pox.(Report furnished by Dr. Gardner.)—Mrs. B., aged about 30, at the eighth and a half month pregnancy, was taken with small-pox. The proper rash of the disease which made its appearance at the usual time, was preceded twenty-four hours by an erythematous rash on the abdomen, groins, inner aspect of thighs and arm-pits. This faded gradually, disappearing in a few days. The patient was delivered in about fifty-two hours after the setting in of the initial fever. Six hours after the delivery when I first saw her, the temperature was 104 ° Fah. The case throughout was marked by persistent high temperature, which however, was easily reduced temporarily, by quinine in antipyretic doses. Diarrhoea occurred more than once during the course of the attack. There was nothing at any time abnormal in the lochia. At the commencement of the stage of pustulation, bullæ of the size of a shilling, appeared in considerable numbers on both shins, the outer surface of the right and the posterior aspect of the left thigh. These enlarged and burst, but instead of healing, proceeded to ulcerate rapidly by their edges, the whole thickness of the true skin being involved in parts, until they coalesced, forming large painful ulcers. Constitutional symptoms in the shape of high fever and debility became alarming, rendering it necessary to act with decision and promptitude if the patient's life were to be saved. In consultation with my friend, Dr. Roddick, it was decided to apply the actual cautery to the whole of the now extensive ulcerating edge, by means of Paquelin's Thermo-Cautère. The patient being under the influence of ether, this was accordingly done most thoroughly. The length of ulcerating edge thus cauterized could not have been less than three feet. Linseed poultices were then applied, the sloughs separating in due time displayed healthy granulations. The ulcerating process was arrested from the time of application of the cautery. After the separation of the sloughs the sores healed very quickly; this seeming to be much hastened by the little islands of undestroyed skin. which represented the centres of the bullæ. Six weeks after the application of the cautery, (the ulcers had been healed for some time), the patient had nearly regained her ordinary health and strength, but suffered on walking from a feeling of heat and tension in the cicatrices-due doubtless to their contraction.
I have been furnished by Dr. Burland of the General Hos. pital with brief reports of other fifteen cases in which the cautery has been employed as a counter irritant in sciatica and in spinal and joint affections, especially morbus coxæ, where I invariably use it; and as a cautery in cases of lupus and other suspicious ulceration, and for the removal of vegetations and small growths of all kinds. It is invariably ready at hand to assist, if necessary, in the arrest of hemorrhage during major operations. A few days since I found it eminently serviceable
in arresting the oozing from the stump of a penis amputated in the ordinary way. In operations on the tongue, and for the removal of ovarian and fibroid tumours, it makes a most excellent substitute for the hot iron. In one of the Dispensaries for Women in London I found the surgeon using the probe cautery in preference to the ordinary escharotics, in cases of extensive uterine ulceration, and all polypoid growths were removed with the knife or guillotine. For the alarming hemorrhage of uterine cancer, nothing could be more prompt and effectual than the actual cautery applied in this way.
There are cases however, in which I am not inclined to advocate its employment. I should be disposed, for instance, in cases of malignant disease of the tongue. and especially when the floor of the mouth was involved, to remove the organ either with the knife or chain ecraseur, trusting to the cautery to arrest hæmorrhage only. An inordinate amount of cellular and lymphatic inflammation is almost certain to follow such extensive burning of tissue in this neighborhood. In fact in one case already published by myself—alarming cellulitis followed the removal with the hot knife, of a small epitheliomatous growth from the floor of the mouth. In tracheotomy also when skilled assistance is available, I think it should be employed only as a styptic. In Dr. Ross' case already referred to in which the hot knife was used, I had great difficulty in keeping track of the anatomy of the parts on account of their charred condition, and when reached, the trachea was with difficulty cleaned up and made ready for opening. I would perform tracheotomy with the hot knife, only in the case of a very fat child, where the venous engorgement was intense, or where, in any case, I had no skilled assistant.