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Nussbaum, of Munich, tried, but without success, every surgical dressing known, in his endeavour to combat hospital gangrene and pyæmia, with which 80 per cent. of his wounds were attacked ; “ but,” he says, “ when we applied to all our patients the newest antiseptic method, now in many respects improved by Lister, and did all operations according to his directions, we experienced one surprise after another ; everything went well; not a single case of hospital gangrene occurred, and pyæmia and erysipelas completely disappeared.”
The pioneer of “ Listerism” on the continent of Europe, Saxtorph, of Copenhagen, says, “ he is sure that if he does not carry out the antiseptic treatment to its full extent, it is of no use whatever to apply carbolic acid to a wound, at least as regards the dangers that always accompany putrefaction."
Callender, of St. Bartholomew's, who operates without the spray, has certainly had admirable results, showing a mortality in a series of amputations of only 2.27 per cent.; but Volkmann, of Halle, one of Lister's most faithful followers, is not far behind with a percentage of 2.87, and a large majority of his cases were frightful machinery accidents.
Mr. Bradley, of Manchester, has recently published statistics of a series of operations performed by him after a “modified method,” showing a mortality per cent. of 11.42; but one of the followers of Lister in the Royal Infirmary, of Glasgow, has since shown his hand, giving statistics of thirty of the most serious operations in surgery with only one death, or a mortality of 3.33 per cent.
But antiseptic surgeons will not be satisfied hereafter with the bare mortality statistics. They will demand, and with justice too, the range of temperature in the various cases, the average number of days under treatment, and the cost of the dressings. In hospital practice, especially, the length of time required for the cure is a matter of the utmost importance. If, as our reports prove we could have done, cases of amputation of the limbs can be discharged with safety in less than fifteen days, what a saving is made, even though the cost of the dressing far exceed in value any other that might be employed for the same length of time,
A NEW SOUND FOR EXAMINING THE BLADDER
IN CASES OF SUSPECTED STONE.
By G. CUTHBERTSON Duncan, M.D., L.R.C.S., Edin. The following description of a new sound was sent to us last October by Dr. Duncan, just before he left Canada for England : it was mislaid and overlooked, but we now publish it with pleasure. We may remark that, with Dr. Duncan, we tried the sound on the dead subject, and the presence of a minute fragment of stone which had been placed in the bladder was readily made out. The trial was quite satisfactory, and we are inclined to believe that the instrument given us by Dr. Duncan is a valuable aid to diagnosis of stone in the bladder, more especially in those cases where the fragments are small, or where symptoms of stone are persistent and failure to ascertain its presence from some cause attends the search.-(ED.)
Description of Sound.—The sound is made of solid steel, similar, in most respects, to the short-beak sound in ordinary use, with the exception of a modification in the handle, which is round, and a little larger than the rest of the sound. Situated at about two inches from the end of this is a circular disc at right angles to the curve of the beak, to indicate in what direction it is pointing and to facilitate its rotary movement both in its introduction through the urethra and while in the bladder. The whole nickel-plated, being smooth, bright, and not liable to become discoloured. The beak is blackened by being held in the smoke of an ordinary oil-lamp, and when perfectly cool is dipped into a solution of collodion, thinned to a proper consistency with ether and alcohol, which, when dry, forms a black film on the sound capable of being introduced into the bladder without being injured, but if brought in contact with any hard substance it is immediately scratched, and the bright metallic surface appears, thus indicating the presence of the foreign body.
Advantages Claimed. This method of preparation does not impair the conducting power of the sound or its sensitiveness in any way, as is the case with Mr. Napier's leaden-pointed instrument; also, the film is much more easily scratched than the lead. The handle, being small and round, is held between the index finger and thumb (the most sensitive part of the hand), thus giving greater facility in its rotary movements, and a greater chance of detecting the slightest contact with a foreign substance.
A piece of a calculus weighing about five grains was introduced into the bladder, and the sound was introduced and withdrawn several times to shew that the film was in no way injured, it was then made to sweep the floor of the bladder from side to side, and withdrawn, when it shewed evident traces of having come in contact with some hard body.
MEDICAL AND SURGICAL CASES OCCURRING IN THE PRACTICE (F THE
MONTREAL GENERAL HOSPITAL.
Tumour situated over the Parotid Gland.—Removal. By
G. E. FENWICK, M.D. Reported by Mr. Thos. GRAY. A. McL., a large-framed, robust-looking Scotchman, was admitted into the Montreal General Hospital, on the 19th Oct., 1878, suffering from a large, firm, somewhat nodular growth, situated in the left parotid region. The patient states that he is 73 years of age, but he bears his age well. The history he gives is as follows: Ten years ago he had a severe cold, and the glands of his neck swelled. There remained a small, hardly perceptible growth on the side where the tumour is situated, but it never gave
any concern, nor any pain. For the last three months it has grown rapidly, and for several weeks past it has given him great pain, more especially at night.
The tumour is situated on the left side, over the parotid region, the lobule of the left ear being pushed upwards, and somewhat stretched over the growth. It is about the size of a hen's egg ; is hard, firm, but quite movable, apparently unattached, and has projecting from its surface several nodules. Although to all appearance free, it has implicated the branches of the portio dura ; some of the muscles of the left side of the face are paralyzed; he is unable to close the left eye-lid ; the
angle of the mouth is slightly drawn down ; he can, however, close his mouth, bringing the lips firmly together, but he states that the growth has interfered with mastication. His speech is a little thick, but sensation in the face is perfect throughout. From the fact of the rapid growth of the tumour, from its implicating the facial nerve, and from the tumour being nodular, having a tendency, apparently, to push through its fibrous envelope and infiltrate the parts in the immediate vicinity, it was regarded as of very doubtful character. It was, however, perfectly free and movable, and was distinctly encapsulated. The tumour interfered with the man's rest, as he suffered nightly from neuralgic pains shooting up the side of the face and scalp, and as he insisted on the removal of the growth at all risks, the operation was determined on, the patient being made fully aware of the possible return of the tumour before the end of many weeks.
The patient having been placed under the influence of sulphuric ether, the operation was commenced by a straight incision, made from above downwards, the entire length of the growth, commencing at the anterior part of the lobule, and extending vertically downwards for about 31 inches. The capsule of the tumour was reached and the soft parts readily reflected. The growth was then carefully dissected from its bed, one portion passing behind the ascending ramus of the jaw. In this dissection the sheath of the vessels was laid bare, but was not implicated. Several vessels were tied, and the main vessel at a little above where the internal maxillary is given off was ligatured. There was not much blood lost, as the vessels were secured and ligatured as the operation proceeded. Every particle of the growth was removed, and after removal the parts did not look as if there were any infiltrating nodules in the tissues. After all clots were removed, the edges of the wound were brought together with fine cat-gut sutures, a piece of drainage tube being allowed to hang out at the lower edge and the wound was dressed with dry boracic lint. edge of the wound united by first intention, but the lower part, which was kept open by the drainage tube, filled up by granula
tion tissue. There was a continuous discharge of fluid, like saliva from the lower edge of the wound. This, however, diminished, and in the course of ten days the man was able to leave the Hospital. There still continued inability to close the upper lid of the left eye, but the patient stated that he felt more movement in the part than before the operation, and, moreover, that he was better able to chew his food on the left side. Moreover, his speech was not so thick. The man left the Hospital and returned to his home on the twelfth day after the operation.
Dr. A. F. Ritchie, curator of the Museum of McGill University, gives the following report of the microscopical appearance of the tumour :
The removed gland is surrounded by a well-marked fibrous capsule. The surface is somewhat nodular, but the general shape of the organ is fairly normal. It measures 2 inches by 11, with a thickness of about an inch. On section it presents a mottled appearance, the lobules being separated by dark trebeculæ, which in some places are thin and sharply defined ; in others, shade off into the surrounding tissue. A number of reddish patches are seen pretty uniformly distributed over the surface of the section. They vary in size from about inch in diameter to mere points, and on microscopic examination prove to be carcinomatous nodules, having well marked loculi of rather scanty fibrous tissue, filled with large cells, with well defined nuclei and nucleoli. The cancerous growth infiltrates both the secreting part of the gland and the septa, which contains in addition an excess of fibrous tissue. The dark colour mentioned above is due to a large amount of dark brown granular pigment contained pretty uniformly in the substance of the cells and in the intercellulous tissues of the affected part.
Note.—We have heard quite recently from this patient. He has much improved in health. No return of the growth has occurred, nor are there any enlarged glands in the neighbourhood. The result is so far satisfactory.-ED. NO. J.XXIX.