Dr. H. TUPPER, of Michigan, referred to a case which was operated on twice by Dr. T. A. McGRAW, of Detroit, by the Warren method, the last time successfully.

JUNE 7, 3 P. M.

Minutes of previous session read and approved.

Drs. B. A. WATSON, of New Jersey, W. F. PECK, of Iowa, and J. W. CARPENTER, of New York, were appointed a sub-committee to whom all papers read in the Section should be referred.

Chairman announced a paper by Dr. E. CUTTER, of New York, which was referred to sub-committee. A Description of Splint for Fracture of Elbow Joint by Dr. STEWART, of Illinois, was read by Chairman, in absence of the author, with exhibition of splint. Referred to sub-committee.

Dr. GEORGE W. NESBITT, of Illinois, read a paper on Ununited Fracture of the Femur Treated by Exercise.

Dr. J. M. KELLER, of Arkansas, asked when he saw patient. Answer, December, and accident occurred September. Dr. KELLER stated that the mistake was in the first place; that adjustment and fixation should be used at first, and that fracture of long bones should be treated only by some dressing which becomes fixed and moulded to the parts. Do not use movable splints.

Dr. J. M. CARPENTER, of Kansas, used plaster splints for fifteen years, and his experience was similar to that of Dr. KELLER, Referred to a case sent to him where non-union existed, and recommended plaster, which was put on in February, and patient put on his feet, and in May, when splint was taken off, union was complete. Thinks the reason why plaster was not more frequently used was because surgeons did not understand how to apply them; when properly applied, instead of causing strangulation and gangrene, they have the opposite effect.

Dr. J. L. ATLEE, of Pennsylvania, spoke of the flannel used in the dressing referred to, and recommended the use of woolen next the skin under the plaster.

Dr. A. GARCELON, of Maine, reported case of fracture below the knee, at end of ten or twelve weeks non-union existed. In six months, brought suit for malpractice against the doctor who dressed it, and, while working up the case, made a leather split, which fitted closely, and hobbled around with a cane. When the case came to trial, union was found complete.

Dr. S. F. FORBES, of Ohio, opposed the use of plaster primarily, but recommended it when swelling, etc., had subsided.

Dr. T. U. FLANNER, of Michigan, reported several cases, and stated that non-union might result with any kind of dressing.

Dr. KELLER does not wait for swelling to subside, but puts on the primary dressing at once, using cotton wadding where there is any danger of excessive swelling. Uses Bavarian splint in compound fractures.

Dr. L. A. SAYRE, of New York, stated that plaster dressings were used by him in cases of ununited fractures in Bellevue Hospital since his connection with that institution. He explained his method of applying a plaster dressing, and strongly advocated the immediate application of the plaster dressing, moulded carefully to the part over flannel or woolen cloth. If there is a great deal of swelling before seeing the case, then let the swelling subside before putting on the fixed dressing.

Dr. D. MCLEAN, of Michigan, asked if non-union took place where fixed dressings were used.

Dr. SAYRE replied that in his own practice no cases of non-union had occurred, and only one had been seen by him, and that where the dressing had not been properly applied.

Dr. T. F. PREWITT, of Missouri, stated that the inference was that Dr. SAYRE dressed all cases of fracture of the femur by plaster. Would like to know how he got extension in that way, and if he permitted his patient to be up and about.

Dr. L. A. SAYRE stated that he used his judgment in all dressings, and explained his method of dressing the thigh. He allows his patient to go about on crutches all the time.

Dr. MCLEAN, of Michigan, stated that from the tenor of discussion the outsiders might get the idea that non-union would not take place if proper dressings were employed, and thought it would be unfortunate if such an impression went out, as nonunion occurs when all the care possible had been taken.

Dr. SAYRE stated that constitutional difficulties had a great deal to do with non-union, and that we could not guarantee union in any case.

Dr. FREEMAN, of Illinois, and Dr. NESBITT, made remarks in closing the debate.

VOL. XXXIII.-17.

Dr. STILLMAN'S paper read by title, Advances in Surgical Mechanics of Local Joint Extension.

Upon objection by Dr. SAYRE, this was laid on the table.

Dr. MCLEAN, of Michigan, presented a case of pulsating tumor of the orbit and eyelid extending to the forehead, and invited members to examine the same.

Dr. E. M. MOORE, of New York, recommended the excision of the tumor.

Dr. PREWITT concurred with Dr. MOORE.

Drs. HALLEY and BYRD strongly recommended electrolysis.

June 8, 1882.

Reading of minutes of previous day dispensed with. Paper of Dr. L. TURNBULL, of Pennsylvania, read by title, referred to sub-committee: Fatal Influence of Anaesthetics in Disease of Kidneys.

A paper by Dr. J. RANSOHOFF, of Ohio, Contribution to the Surgery of the Liver, was read, and referred to the sub-committee.

Dr. E. ANDREWS, of Illinois, read a paper, entitled Proper Points for Incision in the Drainage of Suppurating Knee Joints. Referred to sub-committee.

Dr. BYRD'S Address in Surgery was then taken up.

Dr. RANSOHOFF referred to the method of Dr. BYRD in closing artificial anus as the application of an old operation in other parts of the body to a new use; being the method used in closing extrophy of the bladder and injuries to the urethra, converting skin into mucous membrane, and spoke of Dr. BYRD's recommendation in removing the adjoining sections of the bowel in order to prevent a spur being formed as theoretical, and feared gangrene from the removal of so much tissue as this would necessitate.

Dr. PREWITT agreed with Dr. RANSOHOFF in the danger of the operation recommended by Dr. BYRD; thinks that after the surgeon has removed the cause of obstruction to the bowel, and opened it freely, he should not disturb the adhesions, but leave the bowel where nature has fixed it.

Dr. BYRD said he was glad the let-alone treatment had been advocated, but was glad he had not followed it, as in eighteen cases of strangulated hernia he had lost only three cases.

He

illustrated his idea of operation on the bowel where he would endeavor to prevent the formation of a spur.

Dr. PREWITT stated that the idea that he advocated the letalone plan in strangulated hernia was entirely erroneous. He only referred to breaking up inflammatory adhesions after relieving the stricture and opening the bowel. Do not interfere with nature's method of cure.

Dr. GARCELON asked Dr. BYRD, in cases of strangulated hernia where gangrene has occurred and a portion of the bowel is dead, if he would take away all the dead bowel, and dissect up the bowel and bring the parts together?

Dr. BYRD: If the two parts of the bowel are in apposition, and the place good for an artificial anus, then leave; but if not dissect up and bring together, or bring to a favorable place for artificial anus.

Dr. ELLIS, of Michigan, Dr. VAUGHN, of Missouri, Dr. NORRIS, of Illinois, reported cases of spontaneous cure of artificial anus. Dr. E. P. ALLEN, of Pennsylvania, recommended operation for closing artificial anus, and did not think that the let-alone treatment should receive any endorsement.

Dr. E. M. MOORE, of New York, asked, Is it better to interfere with nature's adhesions, or is it well to tear up the adhesions and get a more convenient place for the anus? Strongly recommended leaving alone the anus in femoral hernia, for feces are frequently fluid in this place.

Section adjourned.

H. MCCOLL,

Secretary.