INDEX OF SURGICAL PROGRESS.
GENERAL SURGERY.
I. On the Occurrence of Micro-organisms in Operative Wounds Under Antiseptic Dressings. By Dr. A. Bassowski (Cracow). A series of investigations carried out at Mikulicz’s Clinic are here reported. The previous observations of Rosenbach, who also worked after Koch’s methods, that three principal forms—staphylo¬ coccus pyogenes aureus, albus and streptococcus pyogenes—are reg¬ ularly found in suppuration, either alone or together, have been cor¬ roborated by various later observers. B. thus examined some fifty cases of acute suppuration in various organs without finding other organisms than those described by Rosenbach and not even R.’s mi¬ crococcus pyogenes tenuis. Other forms were only found in ab¬ scesses with putrid pus, near mouth or intestine. ' It was apriori prob¬ able that in primary union of wounds free from suppuration none of these organisms would occur. Still it has long been known that mi¬ cro-organisms did occur even in aseptic wounds, and to determine these was B.’s endeavor. For this purpose he examined fifty wounds which presented conditions favorable to primary union, complicated wounds and those near natural orifices being excluded. The wounds had been well, washed with carbolic (3%) and put up in iodoform dressings. Only these were classed as strictly aseptic where entire primary union occurred without a drop of pus even later around a suture. The material for examining he took from the drains, making flat cultures at first and secondarily pure cultures in tubes. The wound secretions were also suitably stained and examined.
Since beginning his work very similar results have been published by Stahli (Dissertation from Socin’s Clinic in Basel, 1886).
B.’s final conclusions are: (r) Under antiseptic iodoform dressings
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GENERAL SURGERY.
533
only a part (*/ 5 ) of the wounds remain quite free from micro-organisms. In another portion (about ■/,) non-pathogenic organisms are present. All of these give perfect primary union. (2) In a larger proportion (about ■/,) the staphylococcus albus is present. Nevertheless a primary intention results in about ’/a of these, a limited slight suppu¬ ration occurring in the others. (3) In nine cases the staphylococcus aureus and in two the streptococcus pyogenes occurred. Both cause certain suppuration, but by suitable drainage from the start this may be limited to the vicinity of the drain openings.— Wien. Med. IVoc/i. 1S87. Nos. 8 and 9.
NYm. Browning (Brooklyn).
II. Cases of Tetanus Following Local Frost-Bite. By Dr. Paul Wagner (Leipsic). Gueterbock asserted in a recent article 1 that tetanus was a rare complication after frost-bite, contrary to gen¬ eral opinion, and could only find fifteen cases represented in literature which he analyzed and commented upon.
Partly to prove that hisconclusions did not hold good in respect to the patients treated at the Leipsic Hospital, and partly also to en¬ courage other observers to publish their cases, the author gives five new cases of tetanus occurring after frost-bite, and adds some general remarks of extreme interest.
During seven years and a quarter 164 cases of local affections due to cold were treated at the Leipsic hospital, and of these five were complicated with tetanus, making a percentage of 3.4. In the same period 23,770 patients were treated in the surgical ward in all, and 15,540 after subtraction of the skin, and genito-urinary affections. Of these 15 patients were attacked with tetanus, so that a percentage of 0.096 results for general surgical injuries. Fully one-third then, of all cases of tetanus occurring in the Leipsic hospital were due to frost¬ bite, or 337, per cent. The cases are as follows:
- Laborer, tet. 33 years. Right foot swollen, red. Tees black, covered with vesicles; admitted November 14. Nov. 22, pains in muscles oflower jaw. Nov. 21, opisthotonus. T. 37.8°, P. 72, R. 20.
Wide Annals of Surgery Vol. (2, p. 499.
534 1NNEX OF SURGICAL PROGRESS
Contraction of recti. Nov. 24, suffocatory paroxysms. After one of these, lasting ttvo minutes, death. Treatment, acid salicylic in large doses, morphine. Post-mortem, wounds granulating ; nerves of lower extremity, brain and medulla normal.
Laborer, tet. 27 years. Froze his hands while loading stones. Finger tips had turned black and the skin fallen off. Admission two weeks afterwards, with trismus. In the evening and next morning respiratory cramps. T. 39.5 0 , P. J72. Death. Treatment, morphine in large doses. Post-mortem, gangrene of fingers; line of demarca¬ tion middle of second phalanx. Nothing abnormal in the nerves, spinal marrow or brain.
Weaver, tet. 60 years. Gangrene after frost bite of toes of one foot. Admitted Feb. S. Feb. 28, trismus, tetanus. March 2, death. Post-mortem revealed normal condition of nerves, cord and brain.
Laborer, tet. 49 years. Both feet frost-bitten, bluish-red, swollen. Admitted October 26, with contraction of masseters and temporals, of muscles of neck, back, abdomen and lower extremities. Difficulty in swallowing. On following days improvement. T. 39.5°, P. too, R. 30. Lower extremities still stiff. Nov. 5, weakness; delirium. Nov. 6, death from debility. T. 40.2 0 . Lobular infiltration of lower portion of lungs. Normal condition of nervous system.
Laborer, tet. 20 years. Slightly frost-bitten toes. Admission after five weeks, Feb. 17. Contraction of muscles of side of face, of neck, abdomen, back and lower extremities. Urine 600 gm., density 1030, contains no albumen. Feb. 20, urine contains '/• albumen, granulated casts, haemoglobin. T. 39.o°, P. 135. Debility of heart. Feb. 2i, collapsed condition. Death. Treatment, salicylic acid; morphine. Post-mortem, pericardial petechias, endocardial and pleural and mediastinal haemorrhages. Cerebral pyramids pale, no haemor¬ rhagic foci in brain or cord.
The author explains the rarity of the occurrence of tetanus after frost-bite of the hands and fingers by pointing out that the hands are never so severely frost-bitten as the feet.
His cases also prove that tetanus may occur even when the damage done by the cold is not excessive. The time when tetanus first ap-
OPERATIVE SURGERY.
535
peared varied from four to thirty days. Contraction of the muscles of the upper extremity was not observed, nor had it ever been observed In the Leipsic clinic (Prof. Thiersch). Hemoglobinuria has never yet been observed to the knowledge of the author, and is explained by at¬ tributing it to the effect of the same infectious matter which causes tetanus.
The author laments that no treatment has as yet been found which could effectually combat the disease. Amputation, opium, morphine, chloral, salicylic acid and curare (the latter in large doses, continued till respiratory paralysis ensued) had all been tried and discarded.
In the text casual mention is made of a number of other unpublished cases of tetanus.— Deutsch. Zcitschr.f. Chir. Bd. 23. Hft. 5 and 6. June 1S86,
\V. \V. Van Arsdale (New Yoik).
OPERATIVE SURGERY.
I. Socin’s Method of Removing Tumors of the Thyroid by Intraglandular Enucleation. By R. F. Weir, M.D. (New York). As complete extirpation of the thyroid in case of tumors of that gland involves danger of consequent myxcedema, Socin of Basel has called attention to the fact that in most cases the new growth of thyroid tissue or neoplastic elements can readily be separated from the normal gland tissue ; to do this, it is only necessary to cut through the overlying stratum of healthy thyroid tissue until the capsule of the tu¬ mor is reached, when enucleation can be easily accomplished; the divided gland tissue might give rise to considerable venous oozing, but this is easily controlled. Socin’s experience now embraces over fifty cases without any subsequent cachexia. In case of a dwarf, aet. 21, mentally deficient and presenting the appearance of commencing myx¬ cedema, an enlarged irregular thyroid gland had existed from infancy on the left side of the neck; on the right side, no general enlargement was felt or seen, but, nearly on a level with the larynx, was a roundish movable tumor—afterward found to be adenomatous—of the size of a hen’s egg, which had appeared within the past eighteen months, had caused considerable pain on that side of the head, and had also been