Графични страници
PDF файл
ePub

medicine will be likely to occupy for another century. Antiseptics have really made a new science of surgery, so much so that antiseptic surgery is the name given to it by some of the authorities of medicine. The principles and practices of modern antiseptic surgery have reached such a high plane of excellency that it is a question whether surgery has not reached its limit of perfection as a science.

There is a distinction without a difference between aseptic and antiseptic surgery. The former includes a series of measures calculated to absolutely exclude every living germ from lodgement on the surface of the wound by making the patient surgically clean, and to prevent living germs from reaching the wound by making the surgeon, the assistants, the surroundings, the instruments and the dressings surgically clean or sterile. The latter depends more on the destruction of germs by means of such remedies as corrosive sublimate, carbolic acid, iodoform, etc., although it includes all that we have mentioned in the definition of aseptic surgery. The antiseptic methods are based on the germ theory or fermentation and putrefaction, and antiseptic methods should be followed, because thereby we exclude bacteria from wounds, and so avoid putrefaction. The forms of antiseptic surgery as practiced by different surgeons of the various civilized countries of the world may vary, but, of course, the principles of antiseptic surgery are always the same.

In former times, blood-poisoning and other terrible results used to follow almost unfailingly certain sorts of wounds. Simple fractures in which the skin was unbroken used to heal easily and well, but if there were even a slight break of the skin, the wound would fester and cause great trouble. Amputation was considered necessary in numerous cases which the surgeon of to-day finds simple. Such amputations were followed appallingly often by gangrene or other putrefactive processes, because the basis of modern surgery, the study of bacteriology, was neither understood nor appreciated.

Diseases of the bones and of the joints, diseases of the organs of the chest and of the abdomen, injuries and diseases of the

skull and of the brain, injuries and diseases of the spinal column, are wonderfully dealt with. Humpbacked people are straightened, club feet are made symmetrical by the use of the knife applied to contracted tissues or misshapen bones. Bow-legs and knock-knees and other deformities of the limbs are straightened by the surgeons cutting boldly across the crooked bones, putting them in proper position and ensuring their correct growth by encasing the limbs in an immovable dressing, and leaving them to nature. If a fracture refuses to unite, or is of a complicated nature, the surgeon cuts down, under antiseptic precautions, and drills and joins the broken bones together.

Ligation of Large Arteries.-The United States has led the way in the ligation of the larger blood vessels. Some of the Americans who have gained distinction by the performance of such feats-each one of which was a triumph in surgery— are: Amos Twitchell (1781-1868), first to tie the primitive carotid artery; William Gibson (1784-1868), first to tie the common iliac artery; John Syng Dorsey (1783-1818), first to tie the external iliac artery; Valentine Mott (1785-1865), first to tie the arteria innominata; J. Kearmey Rodgers (1793-1857), tied the left subclavian artery between the scaleni in 1846; John Murray Carnochan (18171857), ligated the femoral artery in 1851; Hunter McGuire tied the abdominal aorta in 1868, which, however, had been accomplished in 1817, by Sir Astley Cooper, an English surgeon.

Operations on the Nerves. In dealing with nerves, the modern surgeon has none of the dread which forbade the oldtime practitioner to touch them. Nerves are spliced and sewed so that evil results from accidents to them are entirely prevented; and for the cure of obstinate neuralgia, surgeons actually penetrate to the root of the disease in the spinal column or the skull, that is, the spinal cord or the brain. In 1856, John Murray Carnochan performed the exsection of the superficial maxillary nerve beyond the ganglion of Meckel.

[blocks in formation]

supplied with healthy cuticle transplanted in small parts from other parts of the human person or other individuals-and injuries which were formerly incurable are thus now readily healed. The French surgeon, Reverdin, is especially celebrated in connection with skin-grafting on ulcerated surfaces.

Brain Surgery.-The modern surgeon does not hesitate to remove tumors from the brain, after locating them from the accompanying symptoms. The skull is opened for the purpose, as well as for the stopping of intracranial hemorrhage, and for the treatment of intracranial abscesses; and, in traumatic epilepsy the operation of trephining has been performed to remove the pressure on the brain. Professor Mathew Kempf, of the Kentucky School of Medicine, performed this operation successfully in a case of traumatic epilepsy in 1876, and reported the case fully in the Cincinnati Lancet and Observer. This surgeon also successfully tied the external iliac artery for an aneurysmal varix of the femoral vessels in 1875, the patient still living, in 1902; he performed the radical cure for inguinal hernia in 1876, the patient still remaining cured in 1902; he removed a tumor from the stomach in the year 1867, the patient dying the day after the operation; and he removed necrosed ribs from a patient for empyema in 1866, the patient living many years afterwards. Most of these cases were reported in the Louisville Weekly News, Professor Cowling's paper.

Surgery of the Thorax.-The thorax is penetrated by the modern surgeon for various reasons, sometimes for banishing empyema, and sometimes for operations on the lungs, on the pleural cavity, or on the ribs, or for tumors. A wound of the heart has been considered absolutely fatal, throughout all the ages, but Dr. Rehm, of Frankfort-on-the-Main, successfully demonstrated that such is not the case. He sewed up a cut in the heart occasioned by a knife-thrust, and his patient recovered. Thus the very "tripod of life," as Bichat called the brain, the heart, and the lungs, are the field of modern surgery, and the surgeon over and over saves a life by his surgical skill where death was the only chance.

X-Ray.-Probably the most recent advance in surgery of great moment was the discovery of the X-ray by Roentgen, and its use in surgery, mainly in diagnosing a hidden injury or disease. F. S. Kolle, a prominent specialist in radiography, gives eight uses to which the X-ray can be applied in medicine and surgery. They are: To study anatomy; to preserve the relations of fragments in fracture of the bones; to study and diagnose its locations; to study and diagnose diseased bone; to diagnose anchylosis of joints; to locate foreign bodies, i. e., bullets, needles, wood, etc., in flesh or bone; it is of diagnostic value in cases of tumors or enlargements of inner organs, such as the spleen, liver, kidney, heart, etc., and perhaps, in obstetric diagnosis.

The First Aid Packet.-The first aid packet, for the introduction of which the world is indebted to Esmarch, of Germany, is of vast importance, especially in case of war after a battle has taken place. At the suggestion of Esmarch, the German soldiers who took part in the Franco-Prussian war of 1870 were supplied with what was know as Esmarch's triangle, the forerunner of the modern first aid packet.

This packet has been sterilized, i. e., steamed or exposed to heat great enough to kill all germs, before it is sealed, and the packet is never opened until needed. The soldiers who took part in the campaign around Santiago, July, 1898, were supplied each with a first aid packet. Notwithstanding the terrible tropical climate and the lack of proper shelter, from sun and rain, there was never before less blood-poisoning from infected wounds, and this happy result was due wholly to the use of the first aid packet.

Suture of the Veins.-Suture of the veins was first attempted by Nicaise, in 1872, since when it has been done about a hundred times. Clermont reported a case upon which he operated for tubercular cervical lymphadenitis. As he had separated the internal jugular vein, he applied temporary catgut ligatures, while he sutured the opposing edges with fine silk. This healed well. The lateral and circular suture can only be attempted in large veins. A round needle and fine silk are needed. Clermont thinks that from

this now simple operation it is but a step to suturing the wall of the heart.

Adhesive Plaster.-Howard Lilienthal, M. D., of New York, introduced a method of closing all wounds, however large, whether on the abdomen, or after amputations of the hip, removing of the breast. and large tumors, by means of adhesive strips previously sterilized, doing away with external silk sutures altogether. The advantage of this plan is supposed to be the impossibility of the occurrence of stitch abscesses. This method can, however, only be used in perfectly aseptic operations, and for this reason it is not likely to come into use in country practice, where the risk of a faulty technique always exists.

Recent Advances in Surgery.—The advances in surgery during the last few years have been very important, according to Dr. Wm. Rodman, a Philadelphia professor of surgery. In the first place, our means of diagnosis have greatly improved. A better technique in the Roentgen rays has enabled the careful and skillful applicator not only to avoid disagreeable burns, but also to make better discoveries of fractures and dislocations, the localization of bullets, and the mapping out of some of the soft tissues, both in health and disease.

Gall-stones, aneurisms, and the tumors of soft tissues as well as bone, are no longer elusive, but may be recognized by one skilled in the use of the instruments producing the X-rays. Improvements have also been made in the Roentgen rays not only of diagnostic import, but also of a valuable means of treating lupus and epithelioma, as many cases of the former and a reasonable number of the latter have been permanently cured by their use. When we reflect that cancer is alarmingly on the increase all over the civilized world, any method which makes possible an earlier diagnosis in some cases and supplies a means of successfully treating others is indeed an inestimable boon. Calculi in the lower third of the ureter can be located by the Roentgen rays and surgically removed, under the modern aseptic surgery.

Substantial advances have also been made in the past few years in the treatment of appendicitis and strangulated

hernia; the stomach has been successfully operated upon, ulcers being surgically treated in cases of alarming hemorrhage from the stomach, and cancers of the stomach are safely removed, aye, indeed, even the entire stomach. However, we are still impotent in the treatment of malignant neoplasms, tetanus, hydrophobia, anthrax, actinomycosis, and rapidly spreading gangrene.

The Modern Surgeon.-The modern surgeon is thus described by Dr. J. H. Carstens, of Michigan: "He must be a welleducated physician, must have been a general practitioner, and a good therapeutist. He must take up surgery early and gradually develop a surgical hand; he must have been an assistant to a firstclass surgeon for at least a year, where he will see hundreds of operations of various kinds."

The Requirements of Modern Surgery. -The requirements of modern surgery Carstens summarizes as follows: "(1). A patient brought to the highest state of resistance to microbic influence of infection and made as clean as possible. (2). An operating room, preferably in a hospital, where everything has been made thoroughly sterile; this includes anesthetizers, assistants and nurses. (3). A surgeon with a mechanical hand, and has received a long and thorough training." Surgical dressings, sutures and ligatures, etc., used in the dressing of wounds are preferably prepared by experts in a wellequipped laboratory.

(To be continued.)

[Written for the MEDICAL BRIEF.] How the Indians Cure Lock-JawA Fact Intertwined With Romance and Therapeutics.

BY J. ZACHARY TAYLOR, M. D., Baltimore, Md.

About the year 1830, a promising young man left the eastern shore of Maryland to settle in the State of Missouri. At that time the migrating fever had set in, and many farmers and mechanics pulled up stakes in Maryland to make their homes in Indiana, Illinois and Missouri. Before making up his mind to leave home, he had gotten all ready to enter college, when an

unforseen trouble overtook his father, who, in order to save his valuable estate from being sold for a security debt, which he had to pay, deprived the son of the cash with which to further his college course. Being energetic and ambitious to make name and reputation, he concluded that the best and quickest way to do so was to go West. So, bidding his parents and sweetheart an affectionate and loving good-bye, he mounted his horse and rode away. During his travel of many hundreds of miles he saw much that interested him, and met with no little rough experience.

When he entered the State of Kentucky, he sought out a rich uncle, and upon arriving at his place of residence was received with open arms. The uncle was so pleased with his nephew that he insisted upon his staying, promising him his fortune at death. This the nephew consented to do after long persuasion on the part of his uncle and aunt, the wife, as they were childless.

The first Sunday in the town he accompanied his uncle and aunt to church. He was told that an accomplished young lady would be there that they were more than anxious for him to see, and if favorably impressed to have him meet her. The services being over, the church-goers left the house of God for their respective homes, and in passing down one of the principal streets, his uncle pointed out the young lady in question, and while he was casting "sheep-eye glances" at her across the street, his feet slipped out from under him, and down into a cellar that was being dug out of red clay he went end over end. Imagine his chagrin and shame, when he crawled out, his nice black clothes covered over with red clay that had been made into a putty of mire by the rain that was then falling. Upon reaching the home of his uncle, he said that that was a bad omen, and he would remain no longer, but make a start for Missouri.

Finding the young man's mind made up, his uncle gave him a well filled purse, and the next morning he began his journey.

At a certain town, now a city, in the State of Missouri, he made up his mind to stop and begin the study of medicine, as he wished to become a physician. One

of the most successful physicians in this town was a half-breed Indian, and this young Marylander applied to him to be his instructor or preceptor.

This half-breed Indian doctor had had the advantages of good city schools, and had spent several years at a certain medical college and hospital. Leaving the college, he went back among the tribes of his own blood, to learn all he could that instinct and Nature had taught his people of successfully treating and curing diseases. With a storehouse of valuable knowledge gotten from his tribesmen, he felt that he was able to cope with competitors in the field of medicine, and leaving them he located in the rapidly growing town where our Eastern shore hero found him.

During the following year his preceptor, the half-breed Indian doctor, was assassinated in cold blood by an outlaw, and this put an end to the young Marylander's studies for the time being. But our young friend had learned muchmuch that physicians in Eastern cities would have esteemed with great favor and value.

Getting homesick and love-sick, he concluded to return to his native heath, the eastern shore of Maryland.

On his return trip, he called by to see his uncle, who gave him a purse of ten thousand dollars with the proposal that if he would come back to Kentucky and live he should be the sole heir to his fortune.

The young man is back on the Eastern shore, and his work is so marvelous that the whole territory learn of him and send for him from far and near. It is now that jealousy on the part of other physisians begins to show itself; for on more than one occasion he cured cases that were given up to die by other doctors.

Among the diseases that he learned to treat successfully from his Indian preceptor were dropsy, asthma, flux, lockjaw, etc. In fact, the jealousy on the part of physicians was turned to hate, and one wonders now how he ever escaped assassination; but being a fearless fellow, as most all men are who ever lived on the frontier, he paid but little attention to his enemies.

There was a severe case of lock-jaw in his county, which had baffled the skill of all the doctors for many miles around, and they, after exhausting their skill, informed the owner of the old negro that he could not possibly live, and that death was only a question of a brief time. The owner of the old darky had heard of the young doctor from the "West" and of his marvelous skill. He sent for him. He went in answer to the call and cured the negro slave. After this, so intense was the feeling against the young doctor by the physicians within knowledge of the fact, that they proposed to have him arraigned before the Circuit Court on the charge of "being in league with the devil.”

These physicians (and I am ashamed to tell it) had him cited to appear before the Court to defend himself. The physicians making the charge were highly educated and intelligent, and the Court was presided over by one of the most learned jurists in the State of Maryland. This citation to appear in Court on the charge of "being in league with the devil," was made in the vain hope of compelling the young doctor to tell what he did to cure the old negro of lock-jaw. This procedure was rotten and base; for if the doctors had allowed their prejudices and jealousies to depart, and had gone to the young doctor in a professional and honorable manner, he would certainly have made known to them the secret; but after doing as they did, it so maddened the young doctor, and so irritated was he at their damnable treachery and indignant assault under cover of the courts, that he refused to even make known what he did to cure the lock-jaw, except to his wife, and she to me.

The doctor stood before the Court and gave his testimony. The old negro was called to tell what he knew and what was done by the doctor to cure him. Looking at the Judge and then at the young doctor that had cured him, he said: "Mistah Jedge and gemmen, de doctors who fust treated me sed I had to die-de doctor yonder (pointing to the young hero) he cued me, and telled me nebber to tell what him did, an ef I done tell it and should tuck sick agin, he wuld nebber tend me enny moah. Now den surs, ef you wuz in my fix, and had to die, and

annudder cumes long and saves your life un condishuns, wud you tell? Den surs, you may kill me befo' I'se tell what he dunn."

After viewing the facts in their proper light, the learned judge dismissed the case, and congratulated the young physician, telling him that this "was a land of the free and the brave, where he had as much right to practice medicine unmolested as any other physician in the land."

The physicians who were foolhardy enough to trump up such a charge in order to find out what had cured the old negro, were loudly denounced by the public, who had by this time taken sides with the hero of this true story. This court affair was the making of the young physician, and he actually killed himself from overwork before he reached the age of fifty-four years.

The hero of this story married one of the most beautiful and lovable young ladies on the Eastern shore, and raised up a family proud to refer to the days of his sufferings and triumph.

I am now at liberty to reveal the secret of cure that saved the old negro from death by lock-jaw. On arriving at the home of the negro, and after a careful examination of the case, he saw that no time should be lost. The first thing he did was to break out several of the front teeth of the old darky so as to get the medicine into him. This would not have to be done now, as we possess facilities of injecting medicines under and through the skin without resorting to the mouth. After breaking out his front teeth, he held the old darky's nose, and poured the medicine into his mouth, then slapping his hand over his mouth, in order to breathe, the old darky had to swallow.

The medicine consisted of lobelia tea and brandy, the selective action of which is easily understood by intelligent physicians, who know how lobelia affects a patient. After giving him a good sized dose of the above relaxant, he had him dipped into a large barrel of hot water (not hot enough to scald). Into this he was kept fifteen to thirty minutes, and then lifted out, laid flat on his face on a plank, the ends of which rested on two chairs, and a flannel doubled up several thicknesses was laid over his spine, and

« ПредишнаНапред »