Imágenes de páginas

extremely difficult, for the prepuce overlapped the gland by more than an inch, and left scarcely space for the passage of the instrument; the orifice could, of course, not be brought in sight. Next, there was the wound, which is so apt to misdirect the point of the catheter. Nevertheless, after repeated and unsuccessful attempts which, however, affirmed my diagnosis in reference to the transverse laceration of the urethra, I at last effected a proper lodgment.

Directing the catheter to be retained, I left my patient in a comfortable situation, at about three o'clock a. m., anticipating no further difficulties in the management of the case; but in this I was doomed to disappointment.

It seems that a few drops of urine had found their way into the space alluded to, in spite of all precaution ; the formation of an abscess was the consequence. The opening of the same disclosed a free communication with the floor of the urethra. For three weeks the catheter was used ; during this time the abscess firmly closed. The discoloration had likewise disappeared, and thus it seemed as if the status ante had been re-established. From some cause or other, the abscess opened again, with the usual preliminaries, after a closure of some six weeks. A free division will yet be needed to conclude the trouble. Beyond the singularity of the injury, there is no instructive feature in this case.-Philadelphia Medical and Surgical Reporter.

[ocr errors]


[ocr errors]

SYPHILITIC PHARYNGITIS AND LARYNGITIS. On a former occasion I laid before you one or two cases of syphilitic laryngitis. The severity of this disease and its frequency in general practice is my only apology for presenting two interesting cases this morning. I wish you to become so thoroughly acquainted with the ravages produced by syphilis, and with the means of properly combating it, that you may never be at fault when called upon in civil practice.

Mary Ann S-, æt. 27, was admitted to the medical wards on the 21st of November, suffering from severe sore throat. A few months ago she was under treatment in the venereal wards, but now denies ever having had a chancre. A sudden loss of memory is a characteristic of nearly all the patients treated in that ward. I never saw but one or two after being discharged, who would acknowledge that they had ever had a chancre : but here we have the most conclusive evidence.

Upon opening her mouth you observe that the uvula, arches of the palate, and a part of the roof of the mouth have been destroyed; the


[blocks in formation]


lower portion of the vomer has even been attacked by this ulcerative process.

This other case, the one on the table, is that of a delicate old female. Mary McB., æt. 62, Ireland, was admitted on the 16th of November. Her husband has been dead nineteen years. She also denies ever having had a primary sore. In this case the ulcerative process has not proceeded so far as in the former. She complains of severe pain "in her bones," restlessness at night, and loathing of food. You may observe that her face is covered with peculiar copper colored blotches, characteristic of a specific cause. The ulcers produced by syphilis in the pharynx or larynx, are usually stellated in form, small at first, and seldom attract attention until severe injury to the parts has been done.

When a patient comes to you complaining of sore throat, and upon eramination you find a peculiar eruption, copper coloured blotches, pain in the head or limbs, and an ulcer in the throat, no matter how small, make up your mind that there is a specific cause. Place him at once upon the internal use of the iodide of potassium, ten grains three times daily, and at bed time a pill of corrosive sublimate, one-eighth of a grain.

The best gargle, as I mentioned in a former clinic, is that of Sir Charles Bell, viz. R. Ilyd. chlor. corros.,

gr. ij. Sp'ts. rectificat.,

Tr. cinchonæ,

f. 3 iij.
Mel. rosæ.
Tinct. myrrhæ,


f. 3j. M. When the ulceration has proceeded so far as in the first case (Mary Ann), an operation might be deemed advisable. But, gentlemen, the truth requires that I should warn you against the operation.

Staphyloraphy consists in paring the edges of the cleft, passing ligatures, through them, and bringing them together. It has been performed by many distinguished surgeons, and in a few cases with gratifying success. Of late years the operation has fallen into disrepute, and I would not advise you to try it.

A few years ago I had a severe case of ulceration from syphilis; after having tried the usual remedies without success, I called in aid the services of a distinguished surgeon of this city, who at once advised an operation. It was immediately performed with but little inconvenience to the patient. The next evening I found that the stitches had given way and the gap was wider then ever.

As a last resort, I concluded to apply an ointment made by rubbing up Donovan's solution with lard, directly to the surface of the ulcer.


The resulting inflammation was terrific. I certainly thought that instead of benefiting my patient, I had indiscreetly placed him beyond hope of remedial aid. But in a few days the inflammation subsided, the ulcer healed, and my patient went away rejoicing. I have since repeatedly tried this same remedy with good results.

A peculiar huskiness of the voice frequently troubles the patient long after the disease has been subdued. It is owing to a change in the mucous membrane ; a puffy condition of the lining membrane of the larynx.

I have often found serviceable in these cases the external use of collodion and ether, not to blister but to keep up a constant irritation. R. Collodii,

f. 3j. Æther,

f. v.

At the same time administer internally
R. Potass chloras,

3 ss.
Syr. scillæ,

f. 3 ij, Aquæ,

f. 3j. S. Teaspoonful occasionally. - Philadelphia Medical and Surgical Reporter.


ON ANÆSTHETICS. By J. M. Carnochan, M.D., Surgeon in Chief to the State Emigrants' Hospital,

New York, etc., etc. I desire to present through the pages of the Medical and Surgical Reporter a general statement of the facts respecting three surgical operations which I performed, using nitrous oxide gas, administered by Dr. Colton, as the anæsthetic, and my opinion on the value of this agent as compared with chloroform and ether.

The first operation took place on the 22d of last July, and was the removal of the entire breast, and glands of the axilla, for cancer.

The patient, a lady in feeble health, was suffering from disease of the throat and lungs and general debility. In thirty-five seconds from the time she began inhaling the gas, she was in a profound anæsthetic sleep. She remained insensible for sixteen consecutive minutes, until the operation was completed, and in forty seconds, from the time the bag was removed, awoke to consciousness without nausea, sickness, or vomiting, as is so often the case with the inhalation of chloroform and sulphuric ether.

The second and third capital operations occurred at the State Emigrants' Hospital, on the 2d of December, and consisted of two amputations of the leg. The time required to produce an anæsthetic sleep in the first

[ocr errors]

patient, a male adult, extremely debilitated and worn out by disease, was forty-five seconds; whole duration of the operation and influence, two minutes and a quarter. No nausea or unpleasant symptoms.

The third operation was on a boy of about 13 years of age. The time consumed in the inhalation, operation and recovery from the anæsthetic sleep was two minutes, the gas working equally as in the other cases, and the patient, after complete anästhesia, awaking entirely free from un pleasant symptoms.

For minor operations, or for capital operations, such as amputations which when properly performed should require but a few minutes, I have no hesitation in stating that the nitrous oxide gas, as an anæsthetic, is far superior to either chloroform or ether. Insensibility is suddenly pro duced, and the patient recovers consciousness quickly, the operation being attended by no nausea or sickness, and without the dangerous effects often incident to chloroform and ether.

It is worthy of remark that the nitrous oxide gas approximates, in its chemical combination, to the composition of the ordinary atmosphere, and we may thus, inferentially, account for its more favourable influence. Whether it can be used in operations which from their nature require from half an hour to an hour's time, remains, till to be proved by actual experiment.

The duration of the anesthetic influence in the case of the first opera. tion, previously alluded to, is the longest on record; and I may here state that this is the first capital operation performed under the influence of the gas, since the great discovery of Wells of Hartford, twenty-two years ago, that a harmless sleep could be produced by a chemical agent, which could annul for the time being the greatest suffering. It is not at all improbable that had Wells lived and had the boldnees to follow up his early successful experiments, chloroform and ether would never have been thought of as ánæsthetics.

To G. Q. Colton is due the credit of reviving the use of this important agent, in the practice of dentistry, after a lull of twenty-two years.

The value of a safe anæsthetic agent, which can be used without anticipation of danger by the patient, is a great boon to suffering humanity, and I have related thus minutely its action in my own cases, in the belief, that if similar favourable results are met with by others, the nitrous oxide

gas will supersede all other anæsthetics now in use.


VARICOSE VEINS. Maisoneuve, writes the correspondent "J." of the Chicago Medical Examiner, gave me the statistics of his operations for the cure of vari

cose veins, by injections of per-chloride of iron. He reports 365 operations, 364 cures, and one death. In the fatal case, the tr. of iodine was used by mistake for the per-chloride of iron. A surgeon of large experience, who has had good opportunity to observe his cases, expresses some doubt as to all the others being cures. The operation, if carefully conducted, seems to be safe, and is probably as suecessful as any other.


Mr. Spencer Wells exhibited to the Pathological Society (Nov. 21, 1865) an enlarged spleen removed by excision the day before the meeting. The patient was going on tolerably well when Mr. Wells saw her (thirty hours after operation) on his way to the meeting. When removed it weighed six lbs. five ounces, but as nine ounces of blood had drained from its vessels, it now weighed five lbs. twelve ounces.

It was eleven inches long, eight broad, and three to four thick. It appeared to be simply hypertrophied, though some spots on the surface appeared like commencing amyloid or lardaceous change. It was not cut into, however-as being the first case in which the operation had been done in this country, it was to be sent to the museum of the College of Surgeons. Mr. Wells added, that when Mr. Nunn showed a large spleen in that room two or three years ago, and he (Mr. Wells) had suggested that the patient's life might possibly have been saved if the spleen had been removed, Dr. Wilks had approved of the suggestion, and he (Mr. Wells) determined to try what could be done if he met with a suitable

Soon afterwards he attended a lady, with Dr. Jenner, who had a very large spleen; but there was such extreme leukhæmia coexisting, that operation was never seriously thought of. The lady died near Bristol, and Mr. Clarke, of Clifton, who examined the body, was specially requested to do so with reference to the removal of the spleen. He informed Mr. Wells that it was done quite easily, and that, in his opinion, all the bloodvessels might have been easily secured. Mr. Wells afterwards saw cases of enlarged spleen with Dr. Budd, Dr. Boulton, of Horncastle, and Dr. Gill, of Bow; but in these cases they were the result of intermittent fever, and not in a state of health to render a hazardous operation necessary or justifiable. At length the patient whose spleen was before the society consulted him six weeks ago. She was married, 34 years of age, and the mother of two children. She had only been ill about a year, and the tumour had only been discovered six months. Its growth had been slow at first, but very rapid lately. Mr. Wells prescribed bromide of potassium and quinine. This proving useless, iron was given ;



[ocr errors]


« AnteriorContinuar »