MINUTES OF THE SECTION ON SURGERY AND ANATOMY. JUNE 6, 3 P. M., 1882. MET pursuant to adjournment. Section called to order by the Secretary, Dr. WILLIAM A. BYRD, of Illinois. On motion, Dr. WILLIAM A. BYRD was elected Chairman (Dr. J. C. Hughes, Iowa, Chairman, deceased). Dr. H. MCCOLL, of Michigan, was elected Secretary. Dr. CARL SEILER, of Pennsylvania, spoke of the uses of electricity in surgery, and of the electro-motor in connection with the dental and surgical engine. He also referred to a method of regulating the strength of the current by raising and lowering the elements in the fluid by an attachment worked by the foot. Dr. D. PRINCE, of Illinois, used the galvanic wire to a considerable extent, but used the thermo-cautery in many of the cases where he formerly used galvano-cautery, except where operations are delicate. Dr. SEILER pointed out that thermo-cautery could not be used in many places where galvano-cautery could, as in the nasal cavities. Dr. PRINCE asked whether Dr. SEILER had any experience with dynamo-electricity. Dr. SEILER stated that the power was too great, and required to be regulated. A paper on Gastrotomy, by Dr. HILL, of Illinois, was read by the Chairman in the absence of the author. Dr. W. F. PECK, of Iowa, referred to a case of a young man suffering from constipation, with temperature and pulse normal, but countenance indicated impending collapse; made incision in median line three inches in length, found colon congested, the appendix vermiformis twisted and adherent to the vertebral column, causing strangulation of the bowel; attempted to tear it from its attachment, but could not by any reasonable force; then put on a double ligature and cut between; relieved the obstruction, and the patient is still living and improving. Dr. GEO. HALLEY, of Missouri,-first case, negress, July, 1870, -proposed abdominal section, but was refused. Patient died. At autopsy found obstructions caused by a bony growth at cæcum. Second case, 1879, a young man. On section of the abdominal walls, found a complex volvulus of the splenic section of colon, causing obstruction. Dr. A. G. FIELD, of Iowa, asked whether bone proper ever formed in the mucous membrane itself. Dr. HALLEY replied that it was not in the mucous membrane, but in the tissues under that membrane, sections were made and osseous tissues found. Dr. E. W. LEE, of Illinois, spoke of the proper time to operate, and referred to the spontaneous cures in many of the cases of obstruction. He stated that too much reliance could not be put on the condition of the pulse and temperature. Dr. PRINCE, of Illinois, reported a case similar to that of Dr. PECK. Spoke of the use of the soft rubber bougie, and, after carrying up as far as possible to inject water, then carry still higher. In this way many obstructions can be overcome. not successful, then operate. If Dr. CHARLES T. PARKS, of Illinois, spoke of three reasons usually given for not operating: First.-Fears of opening the peritoneum, which were not reasonable. Referred to cases of accidents, where peritoneum was torn and patients got well. Second.-Difficulty in determining the seat of the obstruction. Third. The difficulty of determining the proper time to operate. The serious time, in these cases, is about or previous to the sixth day. In feculent accumulations, use large doses of opium. Dr. BEECHER, of Wisconsin, stated that he should have less fear in opening the peritoneum on account of the antiseptic means at our disposal. Dr. BYRD recommended early operation. Dr. HILL recommended the early operation. Dr. W. F. GAY, of New York, volunteered a paper on Anchylosis of Hip-joint Treated by Fracture. Dr. WM. HILL, of Illinois, reported a case where fracture of the neck occurred in the attempt to break up the anchylosis; suppuration following, and resection became necessary. Recommended non-interference if the limb was at all in a comfortable position. Dr. PRINCE recommended fracture where the tendons were not much contracted, but, where they were, let it alone. Dr. C. T. POORE, of New York, thinks it dangerous to break up the anchylosis, but recommends osteotomy. Dr. J. E. OWEN, of Illinois, agreed with Dr. POORE that the day for fracture of the femur in anchylosed hip is passed, and that there is neither shock nor danger in osteotomy, as compared with fracture. Dr. E. ANDREWS, of Illinois, reported a death from shock where osteotomy of the neck of the femur was performed. Dr. JAMES MCCANN, of Pennsylvania, advocated the division of the resisting tendons before operating. Dr. LEE spoke of the difficulty of getting a joint. Dr. J. RANSOHOFF, of Ohio, gave credit to Illinois for originating the operation of osteotomy. In thirty cases seen by him, only one case died, not from shock, but by caries and gangrene. Section Dr. HALLEY, of Missouri, operated on both sides in one case, got good hip-joint on one side, not good in the other. made through the neck. Dr. GAY closed the debate. A paper by Dr. J. H. WARREN, of Massachusetts, entitled, A New Anatomical Truss in the Treatment of Rupture, was read by the Chairman, in absence of the author. Dr. PRINCE, of Illinois, in discussing the subject, referred to the operation as the reviving of an old operation. Dr. E. ANDREWS, of Illinois, stated that Dr. Pancoast was the first to use the subcutaneous operation in treatment of rupture ; that there is little or no risk in Warren's operation for inguinal hernia, and that you will cure a proportion of the cases, but in femoral hernia considers it dangerous. Dr. W. H. PHILIPS, of Ohio, used a double canula instrument, the union with a dome point; used Dr. Heaton's formula; believed the operation a good one. |