XIV.

PITTSBURG HOSPITAL CASES.

BY L. H. WILLARD, M.D., ALLEGHENY CITY, PA.

CYSTO-CARCINOMATOUS TUMOR.

ON Nov. 14, 1867, Mary Lynch, married, aged thirty-five, was admitted to the lying-in department of the Homœopathic Hospital, Second Street, Pittsburgh. She had a tumor of the right breast, which was increasing gradually. Dr. Rousseau, the accoucheur, called a consultation, when it was determined to postpone operating till after her confinement. This took place on Dec. 9. The tumor now began to increase rapidly, became darker, of a bluish color; threatening destruction to all the surrounding tissues. The pulse was getting weaker, and the appetite less. Dec. 17. The patient was placed under the influence of chloroform, and an elliptical incision was made, ten inches long, embracing all the diseased parts. The mamma, with the surrounding diseased tissues, was dissected out. The integument and underlying fascia above and below the wound, were dissected up; edges approximated with sutures and adhesive straps; body-bandage applied, and the patient placed in the recumbent position. The tumor weighed twelve pounds. Aconite and China were administered alternately, while Calendula lotion was applied externally.

Dec. 20. Wound looked well; discharge offensive. Calendula continued; Bell. and China alternately.

Dec. 26. During my absence, styptic colloid was applied to the wound with very good effect.

Feb. 22, 1868. The wound having almost entirely healed, and the discharge being scarcely noticeable, she left the hospital.

As soon as this woman left the hospital, she started for her home, several miles up the Connellsville Railroad; walked two miles through the mud and slush, in a cold, drenching rain. The next day she had a high fever, with a cough.

Two months after the operation, she again applied for admission to the hospital, the carcinoma having made its appearance in the wound and in the axillary region. Great constitutional disturbance; no appetite, but unquenchable thirst. But little hope is entertained for her recovery.

CARIES OF THE TIBIA.

Dec. 27, 1867.-J. D., aged ten years, while playing shinty, about six weeks ago, was struck by one of his playmates with a stick on the right shin. An allopathic physician was called; the limb, somewhat swollen, was laid on a pillow, and poultices applied to allay the inflammation.

When brought to the Homœopathic Hospital, the leg was swollen considerably. Crepitation within an inch and a half of the ankle, and about an inch from the knee, revealed the fact that the blow had produced a comminuted fracture of the tibia. A profuse discharge of serous pus from openings corresponding to the seats of fracture led to the belief that the bone had become carious, which the probe verified. The examination was made by Dr. McClelland, who at once gave Silicia 30 three times per day.

Jan. 14, 1868.—The patient being under the influence of chloroform, an incision was made down to the bone, along the internal face, connecting the openings before mentioned. Placing my finger under the bone, it came out without any resistance: the portion taken away was four inches long, and badly carious. The jagged ends of the remaining portions were smoothed off with the bone-nippers. The wound was washed out, the edges

approximated with sutures and adhesive straps, and the limb placed in a fracture-box, with loose bran dressing. Aconite was given internally; Calendula lotion applied externally.

Jan. 23. Patient placed on nutritious diet, and Calc. phos.30 given three times per day.

Jan. 28.- No pain; discharge healthy. Calc. phos.3o continued. Jan. 30. On examination to-day, I found that the entire track of the tibia occupied by a substance hard and firm, like bone.

Examinations since have satisfied me entirely that the formation felt on Jan. 30 was bone.

A slight contraction of the tendo Achillis occurred during the after-treatment; which, although relieved, disappearing gradually the more the limb is used, prevents the heel from touching the floor by three-quarters of an inch, but does not prevent him from walking without the aid of crutches.

§ V.-7*

XV.

SURGICAL EXPERIENCES.

BY T. G. COMSTOCK, M.D., ST. LOUIS, MO.

ACUPRESSURE IN AMPUTATION OF LEG.

IN the surgical wards of the Good Samaritan Hospital, in October, 1867, there was a young man who had been a soldier and who had suffered for more than two years from caries of the bones of the tarsus. In April, 1867, Chopart's operation was performed for his relief. After this amputation, the flap did not heal; and, upon a careful examination, the astragalus was found to be carious. A second amputation was found to be requisite.

October 17, 1867. In the presence of the surgeons of the hospital and several others, I amputated at the lower third of the leg, making the flap operation of Mr. Ferguson. The anterior tibial artery was immediately secured, by means of an acupressure needle, without any difficulty. The posterior tibial and peroneal arteries were also similarly secured, although some little delay and difficulty was experienced in finding them, from the fact of their retracting to an unusual degree. I stated, before making the operation, that I employed acupres sure in preference to ligatures, in order to effect union by first intention, and hence this first trial; for, previous to this date, this new means of dispensing with the ligature of Ambrose Paré had never been tried in the wards of cur hospital. The needles were inserted into the cutaneous surface of the flap, so as to. cross over, and compress the bleeding artery a few lines above

its open mouth, in the same way that a rose is pinned to the lapel of a coat. The needle was then pressed through the flap, from its cut surface outwards, so that its point issued through the cutaneous surface. The flap was not closed for three-quarters of an hour, until all the little blood-vessels had ceased to bleed, as by this delay union by first intention becomes much more certain. The flaps were then brought together, and secured by metallic sutures of silver wire, instead of silk. Forty-eight hours after the operation, the acupressure needles were withdrawn without any accident. The case went on well; no great suppuration supervened.

The stump healed by first intention; and the patient left the hospital a few weeks after, perfectly well. The great advantage of acupressure over the ligature is, that the ligature, being left as a foreign body in the wound, will of course act as a focus of irritation, and can only be cast off by means of suppuration; in addition to this, the extremity of the artery, at and below the point where the ligature is applied, must die, and be also eliminated, by suppuration. All this is obviated by acupressure. It is found by experience that it is safe to remove the needles in from eight to twenty-four hours after their application; and that, in the majority of cases where this means is used, union of the flaps by first intention will be the result. Acupressure may be employed in several different ways; and we believe it may be advantageously applied in the ligation of arteries, without even cutting down to them. This may be done by introducing the needles from the surface, by transfixion, and partial rotation, thus compressing the artery, and bringing the point only of the needle through the skin.

In aneurisms of the popliteal, carotid, and other smaller arteries, this proceeding is worthy of a trial. In fine, it is safe to predict that acupressure will be used more frequently and will be found far safer than the ligature. I believe it to be one