℞ Quiniæ sulphatis, gr. xxv. Quinidiæ sulphatis, Cinchoniæ sulphatis, āā gr. x. Sacchari, ℥xx. Olei anisi, Olei fœniculi, āā gtt. ij. Olei cinnamonii Zeylandici, gtt. vj. Olei cari, gtt. j. Olei aurantii, ♏︎xl. Spiritus Curaçoæ, f. ℥vj. Alcoholis deodorati, Aquæ rosæ, Aquæ, āā Oj. Caramel, ℨiij. Misce secundem artem!
Conservative Surgery, with Reports of Cases. By Albert G. Walter, M.D. Pittsburg: Johnston.
This is a very verbose treatise on the mode of dealing with lacerated wounds, &c. The author recommends free incisions along the whole length of the limb, and the subsequent application of poultices and fomentations, assisted by general and local supporting measures. As is usual in such cases, he cites a vast series of cases, which, as is equally usual, might be cited in evidence of a very large number of different and conflicting propositions. There is some sense in the author’s practice, but a terrible deal of nonsense in certain of his physiological speculations.
Clinic of the Month.
The Pressure and Ligature Methods of treating Aneurism.—In the course of a lecture on aneurism of the femoral artery Mr. Paget, adverting to these two methods, speaks of them thus: “Taking large numbers of cases of aneurism together, they are very nearly balanced, on the one side for pressure, and on the other for ligature. In favour of pressure there is the experience of the surgeons in Dublin. They seem to have a much larger number of aneurisms, especially of aneurisms of the popliteal artery, to treat than we have in England, and they have certainly a large amount of success. I have no doubt this is in part due to a well-arranged system, and to the house-surgeons and dressers acquiring a more special skill than we have yet achieved. On the other hand, there is the remarkable success attained by surgeons who have constantly practised, with great skill, the ligature. The success of Mr. Syme in the ligature of the femoral artery for popliteal aneurism has been so great that any one who might fairly expect to attain nearly the same measure of skill would undoubtedly follow the ligature rather than the pressure. I would prefer, however, to leave the subject open for your own observation, and say, endeavour to ascertain, as far as you may be able, which are the cases for the ligature and which are those in which pressure is more likely to lead to a good result. And in many cases in respect of which you are doubtful, pressure may be tried first and the ligature afterwards.” (See Lancet, April 24.)
Treatment of Atonic Dyspepsia.—Dr. Thorowgood, in a paper just published, refers to the existence of torpor of the colon as a complication in cases of this kind. In treating cases of dyspepsia occurring in those who work hard with their brains and have but little “tone” about the stomach and bowels, he is convinced that the more we refrain from the administration of purgatives the better. At one time he used to think that when the tongue was crusted a purgative could not be amiss; but to whatever degree this holds good with strong country people and over-fed townspeople, it does not apply to those who have feeble appetite and who work hard. In these cases he has seen an acid mixture or a chalybeate do more service in cleaning the tongue and promoting digestion than alkalies or aperients. If the colon be filled with scybalæ, the best evacuant is a table-spoonful of castor-oil in peppermint water. When the constipation takes on a less or more obstinate character, he uses a saline chalybeate in imitation of the saline chalybeate waters of Kissingen, Harrogate, &c. In addition he gives a zinc pill, with extract of henbane, at night. But he avoids the use of opium. (See Lancet, April 24.)
Anaemia and Chlorosis treated by Nickel and Manganese.—Dr. Broadbent lately read a paper before the Clinical Society (April 9th), in which, on the principle that chemical substances closely allied have similar action, he recommended manganese and nickel as substitutes for iron in the treatment of chorea. He recorded various cases, in some of which good results appeared to follow this method.
Operation for Chronic Inversion of Uterus.—At the meeting of the Royal Medical and Chirurgical Society, on the 13th of April, Dr. Barnes read a paper, in which he described a new operation for the relief of chronic inversion of the uterus. He gave the statistics of the different methods now in use. He stated that the ligature and excision were open to the double objection that, besides being very hazardous to life, success was only achieved at the expense of mutilating the patient. Forcible taxis was a violent and often fatal proceeding. Sustained elastic pressure had given remarkable results, but cases would occur where the constricted cervix uteri would resist simple pressure. He then described a case of inversion of six months’ standing, which had resisted elastic pressure kept up for five days, and in which he resorted to a plan then practised, he believed, for the first time, of making three longitudinal incisions into the os uteri, so as to relax the circular fibres; taxis then applied quickly succeeded, and the woman made an excellent recovery. He proposed, therefore, as the best proceeding where simple sustained elastic pressure fails, to make an incision on either side of the os uteri, and then to re-apply the elastic pressure, as being safer from the risk of laceration than the taxis. (See British Medical Journal, April 24.)
A Presse-artère for Compression of the Arteries, which may be found useful in some cases, has been described by Mr. B. Wills Richardson, of Dublin. The tubular presse-artère which he has invented is intended only for immediate compression, but it was used with good result in the amputation of the fore-arm. The new instrument is composed of two parts. (1) A fine silver or a fine German silver tube. To the upper end of this tube a small milled button is soldered. The button facilitates the turning or screwing of the tube by the fingers of the surgeon. A female screw is formed upon the upper half of the inside of the tube. (2) A steel stem having two jaws at its lower end. These jaws are perfectly smooth on their opposed as well as on their outer surfaces, and free from any cutting edge. They are so arranged as to open and close parallel to each other. At the upper end of the stem there is a handle nut. It is hexagonal only in the present instrument; but, for recognition in wounds, the handle nut of the presse-artère intended for large arteries should have some other form when more than one instrument is in use. The nut is fitted to the stem by means of a square mortise to prevent it from turning on the stem during the screwing or unscrewing of the tube. The handle nut is secured in its position by a smaller but screw nut. The upper half of the stem has a male screw cut upon it, and is adapted to the female screw on the inside of the tube. The inventor claims the following advantages for this piece of apparatus:—(1) The smallness of the space it occupies. (2) Facility of application and removal. (3) Accurate graduation of the compression by means of the fine screw arrangement. (See Medical Times, April 24.)
Catgut in the Ligature of Arteries.—In a communication to the Lancet, Professor Lister, after giving numerous pathological details, refers to the practical importance of catgut as a ligature. He states that by applying a ligature of animal tissue antiseptically upon an artery, whether tightly or gently, we virtually surround it with a ring of living tissue and strengthen the vessel where we obstruct it. This antiseptic animal ligature consists of catgut steeped in carbolic acid and oil. And with such a ligature Professor Lister says he should now “without hesitation undertake ligature of the innominate, believing it to be a very safe proceeding.” He thus expresses himself as to the necessary qualities of the ligature:—“The method which I have found to answer best is to keep the gut steeped in a solution of carbolic acid in five parts of olive oil, with a very small quantity of water diffused through it.” A larger proportion of the acid would impair the tenacity of the thread. If a mere oily solution is employed, the gut remains rigid, the oil not entering at all into its substance. But a very small quantity of water, such as the acid enables the oil to dissolve, renders the gut supple without making it materially weaker or thicker. And, curiously enough, the presence of this small amount of water in the oily solution gradually brings about a change in the gut, indicated by a deep brown colour; after which it may be placed in a watery solution for a long time without swelling, as a portion prepared in a simple oily solution does. This is a great convenience; for an oily solution is unpleasant to work with during an operation, and exposure to the air soon renders gut suppled with water rigid from drying. But when it has been treated in the way above recommended, it may be transferred to a watery solution at the commencement of an operation, and so kept supple without having its strength or thickness altered. “For tying an arterial trunk in its continuity, catgut as thick when dry as ordinary purse-silk will be found best. But for ordinary wounds, where, if one ligature happens to break, another can be easily applied, much finer kinds may be employed, and are convenient from their smaller bulk.” (See Lancet, April 3.)