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wounded, almost all died with the too obvious signs of septicæmia. The icteric skin, the scanty dark colored urine, the fatid breath and high temperature were the ordinary forerunners of an inevitable collapse.
Operations for hernia we sider to be devoid of danger, provided the intestine is not gangreneous.
In these cases we have never met with septicæmia.
We have successfully performed the radical cure of hernia, by stitching the neck of the sac firmly together with catgut and cutting away the sac itself.
Ovariotomy was followed by the same train of symptoms and a like result, even when an uncomplicated operation and the absence of symptoms indicating peritonitis seemed to warrant a favorable progress.
The operation of ovariotomy is three times as successful as formerly. The healing of the wound now takes place in quite a different manner, and we have repeatedly observed cases in which during the short period of twenty or thirty days convalescence, the temperature did not once exceed 100-4 and the patient never felt unwell.
In cases of resection and ampu- Cases of resection, in which there tation, the mortality from pyæmia is not free suppuration and septiwas, as already mentioned, some- cæmia before the operation now thing appalling. Although every- heal for the most part by first inthing seemed to be going on well tention. If such cases are already for several days, a sudden and in a septic condition one or two violent chill, followed by perspira- applications of chloride of zinc tion, put a damper on all hope of often suffices to bring about the success ; for in the course of a few antiseptic state, and if we succeed hours all the healthy granulations in this, healing takes place in an had disappeared, and in the place astonishingly short space of time of a creamy pus was a watery fætid and the condition of the patient imjohor. Pleuritic stitches, shortness proves in a most satisfactory manof breath, liver pains, and swelling ner. (Edematous infiltrations whereof the joints soon became manifest, ever occurring, loss of appetite, indicating the different localities in unhealthy color of tbe skin, &c., &c., which metastases had occurred. The all these disappear entirely in the Jungs and pleura were the favorite course of a few days. Amputations seats of pyæmic deposits. In some now usually heal in from eigbt to post-mortems we found as many as ten days by first intention, an event one hundred abscesses and infarc- which I have never once observed tions distributed throughout the in the previous seventeen years. body, some of them were found even The pain which used to occur durin the muscles of the extremities. ing some hours or days after ampuIn seventeen years of clinical ser- tation is now unknown. The patient vice I had never once seen a patient now and then complains of a slight recover if a metastatic deposit oc- burning sensation, after amputation; curred after a chill, although every generally there is entire freedom remedy recommended for pyæmia from pain, cheerful demeanour, and received a fair trial, from Quinine a good appetite. and purgatives to infusion and transfusion of blood, removal of The patient recovers in about oneaffected bones, &c., &c.
tenth of the time formerly required.
Incision into joints can, as is well. known, be made antiseptically without danger. In inflammatory affections the sooner this is done and the exudation allowed to drain off the better will be the result.
Anchylosis then never ensues. The immediate and brilliant result. of incising inflamed joints in which there was no exudation, and therefore no necessity for drainage, has often astonished me beyond measure; after incision the violent pain and constitutional disturbance disappear magic. The immediate relief can, I think, only be accounted for by the relaxation of the joint capsule.
I even tried inunction of strong perchloride of mercury salve, as recommended by Heime, until enormous ulcers and bloody stools occurred, but the slight benefit seemingly thereby obtained, lasted only a few hours.
As things were I scarcely ventured to make an incision into the joints, and when impelled thereto by dire necessity, death from pyæmia was the usual result.
Incision of joints now performed, with so much suecess, is the best test of the merits of the two methods of treatment.
Incision of joints and laparotomy have done more than any other surgical procedure towards overcoming the last rival of the antiseptic method. I refer to the “ open treatment,” for no surgeon would now think of trusting to the open treatment of incised joints. In my humble opinion, the inefficacy of the open treatment is hospital gan. grene such as raged in my wards, was enough to condemn it.
Ulcerations of the feet and legs necessitated a very long sojourn in the hospital, and were often complicated with erysipelas, hospital gangrene, and exfoliation of bone.
Those ulcers upon which I performed my operation of circumcission, did not suffer from relapses, but this operation is so measuse, that it is only justifiable in very bad cases, upon the principle that the remedy must never be more dangerous than the disease. The duration of treatment in Hospital was almost interminable.
Ulcers of the feet and legs which formerly remained unhealed for an indefinite period, and furnished many victims to erysipelas, and hospital gangrene, recovered under the boracic lint treatment with extraordinary rapidity.
Wet boracic lint, covered with gutta-percha, cleans the foulest ulcers in five or six days.
The ulcer when thoroughly cleaned and healthy may be disinfected with an 8 per cent. solution of chloride of zinc; the surrounding skin washed with a 5 per cent. solution of carbolic acid, and the heal. ing process much accelerated by Reverdin's “ Skin Grafting.” The treatment in Hospital of wounds
and injuries which remain antiseptic, is very much shorter than it was under the old system. Nevertheless, it may appear strange at first sight that the average duration of days in hospital has not diminished. The explanation is easy. Many severe injuries, and complicated fractures, with purulent periostitis, laceration of muscles, &c., which used to perish from pyæmia in a few days, now escape with life after a long period of careful treatment. Many complicated fractures of the lower extremities, which formerly died in
from 8 to 14 days, now remain in the If a case of amputation or resec- hospital from 60 to 80 days, and at tion was fortunate enough to escape length recover and are able to pyæmia, it was only to suffer again resume their employment. and again from attacks of erysipelas Although the death rate is now or Hospital fever, or the wounds be- just half what it used to be, it must came covered with an unhealthy be borne in mind, that with the ex. exudation which had to be destroy- ception of the local treatment of ed by caustics or ferrum candens. I surgical cases, everything else has often felt like abandoning all opera- remained unaltered. Of those who tions in despair, but there was no die, a large proportion are from the choice, and I had to content myself nature of their maladies, beyond the as best I could with never-ending reach of surgical aid, such as tubercomplaints, and petition after peti- culous subjects and cancer patients tion for the construction of a new who come to the hospital in the last Hospital as the only hope of doing stages of the disease; persons who away with this lamentable state of have been fatally stabbed or shot, things. Still more remarkable are suicides, fractures of the skull, &c., the mortality statistics. Among an &c., of so severe a kind, that neither equal number ol patients, with the the antiseptic nor any other mode same hospital accommodation there of treatment can possibly be of any were exactly twice as many deaths, avail. and this is the most conclusive The antiseptic method has not argument that can be urged in favor only been of service to those who of the antiseptic treatment.
are treated by it, but all the other Forinerly strong and healthy patients suffering from wounds or young people died from the most injuries, which, from their nature, trivial wounds.
cannot be healed antiseptically, also Nearly all complicated fractures, derive benefit, inasmuch as their amputations and resections were surroundings are more favorable. fatal, for this reason alone it seems They remain free from pyæmia and to me quite worth while to compare hospital fever, because the air they the pictures of the past and the now breathe is vastly more free present.
Popliteal Aneurism treated by Esmarch's Bandage.—Mr. J. Hutchinson, at a meeting of the Clinical Society of London, related the following two
The subject of the first was a robust gentleman, aged 26, who had never had syphilis. The tumour filled the right popliteal space, and pulsated strongly. There had been pain for three months, but the pulsation had been recognized only a month.
He had been placed under Mr. Hutchinson's care by Mr. Drew. After three days rest in bed, ether was given, and Esmarch’s banding was applied to the entire limb. It was put on tight below the knee, very lightly over the tumour, and tightly again on the thigh. The elastic strap was applied as tightly as possible in the upper third, and after a little time the bandage was removed. The tumour was left full of blood, which was completely stagnated. Anästhesia by ether was kept up for an hour, and at the end of that time the strap was removed and a horseshoe tourniquet substituted. No pulsation returned in the tumour, but as a matter of precaution the tourniquet was retained for a few hours. The subsequent recovery was rapid and complete. The second case was less speedily successful. Its subject was a gunnery instructor from Shoeburyness, who had been treated by pressure for an aneurism in the calf two years previously. On that occasion, success had been obtained by thirteen days' compression. The aneurism on the second occasion filled the popliteal space, and was of the size of a large orange.
It pulsated strongly. Esmarch's bandage, under ether, was used for one hour in exactly the same way as in the previous case, but with no benefit. The tumour beat as before. Three days later, another trial was made of the same plan, but on this occasion arrangements had been made, by relays of students, to keep up digital pressure after removal of the constricting strap. The man was kept under ether for two hours. At the end of that time the strap was removed, and during the change of hands it became evident that pulsation was still present, but it was more easily controlled than before. Manual compression was kept up for about seven hours, at the end of which time pulsation had quite ceased. The tumour remained solid, and rapidly diminished in size, and the man left the hospital a few weeks later quite well. It was thought that in this case, although the Esmarch's bandage did not produce consolidation, yet it conduced to the cure, and certainly on neither occasion did it do any harm. Mr. Hutchinson stated that he had brought forward these cases, in neither of which was there anything original in the treatment, in order to elicit from surgeons statements of their experience and opinions in reference to this novel and important method. He acknowledged his obligation to his colleague Mr. Warren Tay, Mr. Price, and Mr. Bennett, for their assistance in carrying out the details.—Mr. Thomas Smith, by the use of Esmarch's bandage, applied as he had seen Mr. Croft applied it at St. Thomas's Hospital, had cured two cases, and had failed with two. In a recent case, no chloroform was given, and the bandage was applied tigbtly below and above the tumour, and left in place. He considered this better than constricting the limb by the cord—a proceeding which, on the continent, had been followed by permanent paralysis from injury to nerves. The pressure was more diffused by the bandage. In the last case, which occurred to a member of the medical profession, the bandage was alternated with pressure by a tourniquet over the artery, and the treatment lasted from 9 a.m. to 6 p.m., at which time great pain was felt in the swelling, and coagulation probably took place. Pressure was kept on for an hour and a half after this, and the result was entirely successful.- Mr. Morrant Baker had had an unfavourable case in a man aged forty or fifty, where some blood had escaped from the aneurism, which he had treated successfully. After a preliminary imperfect application, the bandage was kept on for three-quarters of an hour, followed by half-an-hour's compression with the finger, and was re-applied for twenty minutes, and compression again kept up for nearly two hours. No anästhetic was employed, no pain was complained of; and at the end of that time the aneurism was consolidated.—Mr. Maunder thought that there was no single certainly successful method of dealing with these cases. He had tried Dr. Reid's