Part 4.Selections.

ARTICLE I.

A new Method of rapidly uniting Wounds by first intention. By S. L. BIGLOW.

It is well known that common cotton, subjected for a certain length of time to the action of nitric and sulphuric acids, combined in stated portions, is so changed in its intimate structure as to acquire an explosive property.

Professor Schoenbein originally demonstrated this discovery, and ascertained the fact that prepared in a certain manner, this cotton is capable of solution in sulphuric ether.* It is known in the community by a name acquired from its explosive quality-gun cotton. I learned the manner of preparing this cotton, and of dissolving it in ether, from Dr. Chas. T. Jackson, who remarked upon it and exhibited specimens before the Natural History Society, in Dec. 1846, or Jan. 1847. He enumerated various uses to which it might be applied among others, for a brilliant varnish. For this use I soon after prepared a bottle, according to his directions. While engaged in employing it in this way, I accidentally smeared with it a fresh wound on my finger. The smarting called my attention to it, and I endeavored immediately to rub it off. It had dried, however, instantaneously, and remained on. The pain very soon ceased, and when the film was removed, perfect union had taken place. Since this time I have been testing the efficacy of this preparation, as opportunities have occurred, as a dressing for wounds, especially those which it is desirable to unite rapidly, by first intention. It will be seen to possess, very eminently, all the requirements for producing such a union.

st. By its powerful contraction, upon evaporation, it places the edges of an incised wound in much more intimate contact than is obtained by sutures and adhesive cloth unites them by equal pressure, throughout the whole extent of the wound, and maintains them immovably fixed.

2d. It preserves the wound perfectly from contact with the air-being impermeable to the atmosphere, while its adhesion

*It has been shown to be soluble in chloroform.

to the skin, is so intimate as to preclude the possibility of the air entering beneath its edges.

3d. The substance remaing in contact with the skin and wound, after the evaporation of the ether, seems to be entirely inert, so far as any irritating property is concerned, and this can hardly be said of any resinous adhesive cloth or preparation.

4th. It does away with the necessity for sutures in incised wounds of almost any extent.

5th. It is sure to remain in intimate contact with the skin until union is complete- and being quite impervious to water, and presenting a polished surface, it allows the surrounding parts to be washed, without regard to the wound or dressing.

6th. It is colorless and transparent, thus permitting the surgeon to witness all that goes on beneath, without involving the necessity for its removal.

7th. No heat is necessary for its application, and the presence of any moderate degree of cold is only objectionable, in retarding the evaporation of the ether.

It is not incised wounds alone, which are amenable to its use, though the mode of its application to a stump, or an ulcer, or any wound involving an extensive loss of skin, must be modified.

It is of the first importance that this preparation be properly made and applied. The process for the application is very simple.

For straight incisions of whatever length, provided the edges can be brought together without great difficulty, it is better to apply the solution in immediate contact with the skin as follows: The bleeding should be arrested, and the skin thoroughly dried. If the lips of the wound are themselves in contact, the surgeon has only to apply a coating of the solution lengthwise, over the approximated edges, by means of a camel's hair pencil, leaving it untouched after the brush has once passed over it till it is dry, during, perhaps, ten or twenty seconds. This first film will, of itself, have confined the edges together; but in order to increase the firmness of the support, more must then be applied in the same manner, allowing it to extend on either side of the incision, a half an inch or more. If, however, the wound gapes, an assistant is required to bring the edges in contact, and retain them so whilst the application is made. If the incision is so long that the assistant cannot place the edges in apposition throughout the whole extent, begin by covering a small portion at the upper end, and apply the solution

to the lower parts as fast as it becomes dry.* In this case, something more than the film which is adherent to the skin, will be necessary for a safe and proper support to the wound, which may have a tendency to separate. The transparency of the dressing may be maintained by adapting a piece of gold-beater's skin, or oiled silk, to the wound. This should be covered with the solution, and the membrane applied after the coating is on and already contracted. A dossil of lint, or a strip of cloth, or even a strip of tissue paper, which is thus rendered tough and water proof, will answer the same purpose, though not transparent. Where there is much separation, it is better to fortify the wound in this way at once, and as fast as the first coating is applied and dried.

In dressing the wound left by the removal of the breast, the preparation may be applied in the same way. If, however, adhesion by first intention, be not desired, the gum may be painted on in transverse strips, like adhesive cloth, letting the first strip dry and giving it the gold-beater's skin support before the second is applied. Thus room is left for the escape of pus, and the exposed portion may be watched. without removing the strips.

As a dressing after the operation for hare-lip, or cancer of the lip, where union by first intention and a narrow linear cicatrix are so desirable, this answers particularly well. The use of one or two sutures to the mucous surface, is not obviated, as the solution will not adhere to the moist ephithlium, or to a surface secreting mucus, with sufficient certainty. But this does not interfere at all with the satisfactory result upon the cuticle, as the skin will be probably united before the necessity for removing the sutures arrives.

In operations for the restoration of parts, as, for instance, the nose, where union by first intention is important, we have had no opportunity to see it applied, but from analogy, do not doubt that it would succeed perfectly, as it fulfils so entirely, many of the requirements for such union. The same of all plastic operations; and a drop placed upon a small cut, or the puncture of a sub-cutaneous operation, seals them hermetrically.

In dressing an ulcer, where there is, of course, a loss of soft parts, it is better to apply it through the intervention of some medium. Let a strip of cloth or gold-beater's skin be cut of sufficient length, then let the two ends be covered

*Having made a dog insensible with ether, I made an incision down the back, where the hair had been removed by an old scald six or eight inches in length, and dressed it alone with the preparation, without a suture. The union was perfect the whole extent, in about thirty hours, even in the old cicatrix.

thickly, an inch or more, with the solution. Apply this strip, like a strip of adhesive cloth, so that the middle of the cloth, where there is none of the solution, shall come over the ulcer. After all the strips are applied, the air may be excluded by painting the cloth upon the outside over the ulcer with the solution. The same contraction goes on in drying, and so approximates the edges of the ulcer, and gives it firm support.

These are a few points which may serve to illustrate the general plan of the application of the adhesive gum to wounds it must be left to the surgeon, to make special investigation, as particular cases may demand.

To anticipate an obvious objection; the momentary pain arising from the direct application of the ether, to an incised surface, may be in a great measure prevented by the intimate apposition of the edges of the wound. Again, this stimulus is brief, and probably more than counteracted by the refrigerating influence of the evaporating ether. There are, undoubtedly, cases when such a stimilus would prove beneficial. It is even possible that the rapidity of the union which takes place under a coating of this gum, may be due, in part, to the influence of this stimulus.

I will allude, in a few words, to some of the surgical uses of the solution of gun cotton, unconnected with the dressing of wounds. It may probably be applied instead of starch to a bandage enveloping a limb. Here, again, its power of contraction is a desideratum, as a snug casing is generally desired, and the force is exerted equally. Perhaps the limb may be immersed in the solution without the intervention of the bandage. Several coatings will here be required. Its use as a means of rendering pasteboard splints impervious to water, has been suggested to me by Dr. H. J. Bigelow; and a hundred other applications may be made of it at the bedside, by the surgeon who knows its nature and qualities. The pathologist, with his abrasions thus protected, may enter the inflamed peritoneal cavity with impunity, or examine fearlessly the products of inoculable lesions. In dissection, hang-nails, sores, or abrasions of any kind, will be thus fully protected.

ARTICLE. II.

On Chloroform. By Professors SIMPSON and MEIGS.

We have been favored by Professor Meigs with the following letter from Dr. Simpson, and his reply .A correspondence between these two eminent teachers of obstetrics on the use of this new agent in the practice of midwifery, will be read with deep interest:

EDINBURGH, January 23d, 1848.

Dear Sir:-By private letters from America, brought by the last steamer, I hear that in most of the cities of the Union, your chemists had failed in preparing proper chloroform; and that, consequently, most experiments tried with it, had been unsuccessful. In Great Britain and on the Continent of Europe, chloroform has everywhere entirely, or nearly entirely, superceded the use of sulphuric ether, as an anæsthetic agent. The want of success which has attended its employment in America, is perhaps, owing in a great measure to an error of my own, viz: to my not stating in my original account of it, the proper method of purifying it. This and other omissions were owing to the haste with which my first paper was drawn up.

I will feel, therefore, deeply obliged by your taking any measure that you may deem fit, to circulate amongst American medical men, the formula which I inclose for the preparation of chloroform. It is the formula used by Messrs. Duncan and Flockhart, our Edinburgh druggists, who have already manufactured enormous quantities of it. They always now are able to produce it as heavy as 1500 in specific gravity. Their first distillation of it is made in two large wooden barrels, with a third similar barrel as a receiver. They throw hot steam into the two first barrels, which serves to afford both sufficient heat and water for the process. They employ sixty pounds of chloride of lime at each distillation, and have been able to manufacture three hundred ounces of chloroform a day. Each ounce of the chloride yields, in the long run, about half an ounce of chloroform : consequently, to obtain three hundred ounces, (as above) about six hundred ounces of bleaching powder are required. At first they could only make ten or twenty ounces per diem, then they rose to sixty, and latterly, enlarging their barrels, they can make, as I have said, three hundred ounces in twenty-four hours.

Vol. I. No. 2.-8.