Thomas, of Liverpool, has recommended a procedure, which is known as the percussion method, to hasten the repair in delayed bony union, in cases of imperfect union, and in ununited fractures. This consists of percussing, once in a day or two, the site of the injury with a small copper hammer for five minutes or more, and subsequently bandaging the parts firmly.
It is suggested that the formation of varicose veins may be an objection to the method of Helferich. Further, it is quite clear that the method is not to be thought of in tuberculous subjects, as well as in cases of large open wounds at the site of fracture, or where a gap is left by resection of bone, removal of tumors, etc. The question of its applicability to atrophic members is an open one.
COMMUNICATION OF TUBERCULOSIS BY RITUAL CIRCUMCISION.
F. S. Eve (The Lancet, January 28th, 1888), relates the case of a Jewish child, in whom, six weeks following the usual rite, a small swelling appeared in each groin. They were found to be filled with caseous material, which, upon being inoculated beneath the skin of guinea pigs, gave rise to tuberculosis in the latter. The “Mohl,” or person performing the rite, had ejected some wine from his mouth over the cut surfaces of the prepuce. It was subsequently learned that this person had died of pulmonary consumption shortly afterwards. Another child in the same house, operated upon by the same person, suffered from the same infection. Both children finally recovered.
Similar experiences have been recorded by Eisenberg (Berlin Med. Woch., No. 35, 1886), and Meyer (Centralblatt f. Chirurgie, No. 46, 1887). Of greater importance, because of a probably greater frequency, is the transmission of syphilis in this manner. A group of cases of this kind were recently collected and made the subject of study at the London Hospital.
TRANSPLANTATION OF THE SKIN.
Baratoux and Dubonsquet (Progres. Med., No. 15, 1887). D. treated two extensive wounds caused by burning, in which no attempt at cicatrization seems to have been made, although granulation was progressing well, by transplantation. Simultaneous auto-transplantation, and pieces of skin from a frog’s back the size of a thumb-nail, was practiced. Most of the latter lost their pigmented aspect after ten days, and adhered well, taking on the natural color of the human skin. The wound where the frog’s-skin transplantation had been performed healed more rapidly than the other where human skin was used, the cicatrix being softer as well. B. treated cases of ulceration of the nose, and also perforations of the membrana tympani, successfully by transplantation of frog’s skin, healing taking place in from one to two weeks.
In three old cases of perforation of the drum membrane, the margins were freshened by touching them with nitrate of silver, and a piece of frog’s skin attached. In three days a cicatrix had formed, with considerable improvement in the hearing. Transplantation must be practiced with a healthy granulating wound, hæmorrhage being avoided. According to the authors, the wound should be irrigated with a strong solution of carbolic acid, and dried; the pieces of skin should also be washed in a weak solution of carbolic acid.
It suggests itself to the abstractor that still better results would be obtained by substituting a sterilized solution of chloride of sodium, say of the strength of 6 to 1,000, for the strong carbolic solution recommended, to be used just prior to the operation. The changes produced in the vessels and their contained blood by the use of strong disinfecting solutions are calculated to prevent early adhesion of the new skin. At least such is the general experience of recent observers. Reliable disinfection of the ulcerated surface may be obtained by keeping the parts covered with gauze wrung out of a 1 to 12,000 solution of potassio-mercuric iodide for a day or two previously.