ORIGINAL COMMUNICATIONS. An easy Method of Bedmaking in Fractures. By E. D. Worthington, HOSPITAL REPORTS. MONTREAL GENERAL HOSPITAL. PAGE 345 346 Surgical Cases Occurring in the Practice of the Montreal General Hospital, under the care of G. E. Fenwick, M.D. Necrosis of the Humerus. Removal of the Sequestra. Recovery. Reported by Mr. Henry S. Wright..... Extensive lacerated wound of the hand and wrist-joint-amputation at the middle third of the fore arm. Reported by Mr. John Duncan........ 348 Extensive injury of Fingers by a Circular Saw. Cellulitis and subsequent removal of Fingers. Reported by Mr. Mathew Gardner.... 350 Fracture of the Fourth Metacarpal Bone. Reported by Mr. J. H. Mathieson. 351 Comminuted Fracture of the Leg. Reported by Mr. J. H. Mathieson..... 351 Proceedings of the Medico-Chirurgical Society of Montreal... REVIEWS AND NOTICES OF BOOKS. Lectures upon Diseases of the Rectum. Delivered at the Bellevue Hospital, 352 367 PERISCOPIC DEPARTMENT. SURGERY. Exophthalmic Goitre. By J. J. Chisolm, M.D., Professor of Operative Surgery and Clinical of Eye and Ear Surgery in the University of Maryland 368 Carbolic Acid in Skin Diseases.. 370 Almost complete severance of the Body without a break in the Skin...... 373 MEDICINE. Treatment of Pleuritic effusion. By Jas. Cumming, M.D., Professor of Practice of Medicine, Queen's College, Belfast... Prognosis in Chronic Diseases of the Heart.. MATERIA MEDICA AND CHEMISTRY. Notes on Chloral. By Dr. H. Y. Evans.. Cases of Alleged Malpractice EDITORIAL. .... 374 386 388 389 391 392 CANADA MEDICAL JOURNA L. ORIGINAL COMMUNICATIONS. An easy Method of Bedmaking in Fractures. By E. D. WORTHINGTON, M.D., Sherbrooke. I have a case of fracture of the neck of the femur in a lady sixty years of age, and weighing 160 pounds. At the time of the accident she received some abrasions of the skin behind the trochanter of the injurel side, but as she did not complain of them when the leg was "put up" they remained undiscovered. After a few days, however, these abrasions became so painful that it became necessary to ascertain their exact locality and extent. How to do this was a matter of some difficulty, as the slightest attempt at moving the patient caused excruciating agony. I therefore adopted the following simple plan, and not having seen any similar contrivance used for this specific purpose, beg to recommend it to the profession, even at the risk of repeating "an old story." My apparatus is as follows:-Eight pieces of pine-six of them being each thirty inches in length, four in breadth, and three-eighths of an inch in thickness. The other two are three in breadth, three-quarters of an inch in thickness, and the length of an ordinary bedstead; the ends and edges of them all being rounded, and perfectly smooth. When everything is ready I pass the short pieces separately under the patient from side to side, at regular intervals from the head to the feet— say one at the heel, the calf of the leg, the middle of the thighs, the hips, small of the back, and shoulders. The long pieces are then carefully inserted under the ends of the short pieces. The apparatus is put together in a minute, and one person at each corner lifts the patient steadily on this temporary stretcher. The bed underneath is arranged in two minutes more, without the least feeling of discomfort to the patient. In this way my patient has been moved every day for the last two weeks. As her bedstead is rather low, two ends of the long side pieces are lifted so as to rest upon the headboard, and a couple of hassocks support the lower ends until the process of bed making, &c., is completed. In all the stretchers I have seen used, the patient had to be lifted upon them, while in this plan the stretcher is made under the patient. As a matter of safety the four corners may be secured by a pin or screw, but the weight of the patient, and a little care on the part of the attendants, render this unnecessary in a sick room. It is sometimes difficult for nurses to pass the bed pan well under a patient, but by adopting the above suggestion either the bed pan or ordinary utensil,' according to the peculiar notions of invalids on this delicate subject, may be used without risk of making the sufferer a victim of misplaced confidence, In conclusion, I believe that for 'field use,' the above put together in sets, with a wooden pin to be dropped in a hole at cach corner, would be cheaper, more profitable, and in every respect better than the present army stretcher. HOSPITAL REPORTS. SURGICAL CASES OCCURRING IN THE PRACTICE OF THE MONTREAL GENERAL HOSPITAL, UNDER THE CARE OF G. E. FENWICK, M.D. CASE NO. 10. Recovery. Necrosis of the Humerus. Removal of the Sequestra, O -D. æt. 19, stone-cutter, admitted to the Montreal General Hospital, on the 12th October, 1870, for necrosis of the right humerus. History.-Parents living and healthy. He has always enjoyed good health until a year ago, when he suffered from a severe attack of typhoid fever, from which, however, he completely recovered. No scrofulous or syphilitic history. He first complained of a feeling of soreness and pain in the right arm in November, 1869, which he at the time ascribed to a blow. On the day following his first complaint, he noticed the arm somewhat swollen and more painful; these symptoms rapidly increased and on the next morning the whole arm from the shoulder to the hand was enormously swollen, and presented an erysipelatous appearance; was very painful, the pain being of a burning character. He suffered from headache, shivering and vomiting. In short he was the subject of a severe attack of acute ostitis. The inflammation gradually subsided. Two abscesses formed at the upper and anterior aspect of the arm, which after a short time burst, and a foetid pus was plentifully discharged; after about a week the discharge became less profuse and not so disagreeable. At this time two more abscesses formed at the lower part of the arm above the elbow, and ran a course similar to the above, so that there were four openings allowing the escape of pus; two at the upper and two at the lower part of the humerus; discharge comparatively little. Up to this time, was confined to bed, and suffered from a bed sore over the sacrum and a large abscess in the left groin, both of which rapidly healed under proper treatment. After the inflammation had subsided in the arm he found he was quite unable to move the elbow joint. He gradually recovered his strength, but the openings in his arm still continued to discharge pus. When admitted into the hospital on October 12th, 1870, his general health appeared good. On examining they arm it appeared to be of normal dimensions, but the humerus was so mach enlarged as to constitute nearly the whole thickness of the limb. Elbow joint firmly anchylosed. On passing a probe into the openings they were found to communicate with the interior of the bone, where several large sequestra were discovered, partly loosened. Dr. Fenwick considering the circumstances favourable, removed the sequestra on the seventh day after admission. Operation.-A free incision was made down the upper and anterior aspect of the arm. Two cloace were found in the new bone about two inches and a-half apart. The bridge of bone between these was removed, thus leaving a large opening through which three sequestra, varying in length from two to four inches, in width about half-an-inch, and in thickness three or four lines, were removed without much difficulty. The wound was then filled with lint soaked in carbolic oil, (one to thirty) covered with oil silk, and the arm was bandaged from the hand. The wound from the first week discharged copious foetid pus. Granulations grew from the bottom-the pus became healthier and less plentiful, and in a short time healed almost completely. 29th of October.-On examination of the lower opening dead bone was discovered, so that an incision was carried along the outer condyle of the humerus, and two or three small sequestra removed. The same dressing with carbolic oil was employed as on the former occasion. On the 20th of November a small abscess formed on the lower part of the humerus (anterior aspect); this was opened, and freely discharged matter. The discharge continued for some days, and the part was very painful to the touch. November 25th.-Was put under the influence of chloroform, and a free incision made down to the bone on the anterior aspect of the arm just above the elbow joint. With the finger could feel a large surface of the bone roughened, as if denuded of periosteum. A few small fragments of dead bone were removed. Two days after this last operation erysipelas set in, in the forearm, commencing in the wound. The lotio plumbi diacetatis was applied, and the arm kept well elevated. Iron and quinine given internally. Under this treatment the erysipelas disappeared in forty-eight hours without doing any injury. These three different wounds were washed daily with tepid water, and filled with lint soaked in carbolic acid lotion (1 to 40 of water) and the whole arm bandaged firmly. They granulated from the bottom and healed slowly and steadily. Dr. Fenwick stated that subsequent operative interference would without doubt be beneficial in this case with the view of remedying the position of the limb, as anchylosis had been allowed to proceed with the arm in a straight position. For this purpose he would propose in a few months excision of the elbow joint, and he believed that this operation would give to the man a useful limb. He did not regard it advisable to operate at once, as the process of repair was not altogether complete. The patient was discharged from the hospital on the 1st of February. All the wounds healed up with the exception of two small portions of the first incision, which continues to discharge a drop or two of pus. A few days after being discharged a spicula of bone came away from the upper opening. The pus has ceased to flow and the ulcer is cicatrizing rapidly. CASE NO. 11.-Extensive lacerated wound of the hand and wrist-joint -amputation at the middle third of the fore arm. Reported by MR. JOHN DUNCAN. Auguste Papineau, aged 32, native of Canada, was admitted into the Montreal General Hospital, on the evening of Friday, December 2nd, 1870, with extensive lacerated wound of the right fore arm and hand. He is an employee of the Grand Trunk Railway Company, and while engaged coupling the cars together, his hand was caught between the buffers, the soft parts were ex ensively lacerated, and the bones almost pulverized, so that no semblance of a hand remained. The wrist joint was opened, and the lower ends of the bones of the fore arm broken and exposed. There had been slight hæmorrhage, but not sufficient to occasion any depression of the vital powers. The man looked pale and depressed, but his pulse was firm. The attending surgeon Dr. Fenwick, having been sent or, he determined to amputate at once. |