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J. A. (Joel Asaph) Allen.

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ABDOMINAL SUBGSBY IN NORTH 6EBMANT. 673

and shoulders, the expulsion of muous can be effected, as in the
Schultze method. (See Fig. 4.)

12. That for alternating with Sylvester's and other methods it
possesses peculiar advantages, affording great relief to tiresome
positions in protracted oases.

13. That it possesses all of the advantages of the Schultze
method and none of its disadvantages.

14. That the method is prompt, reliable, easy to perform and
perfectly safe.

252 West Fifty-fourth Street.



ABDOMINAL SURGERY IN NORTH GERMANY.*

By CLINTON GUSHING, M. D.
Professor of Gynecology, Cooper Medical College, San Francisco, Cal.

In introducing the following remarks, upon what I saw of
abdominal surgery in Dresden and Berlin, during the short time
spent in those cities the past summer, I desire to pay a tribute to
the courtesy of the gentlemen with whom I came in contact. I
saw nothing but the greatest kindness shown to all who applied
for privileges and opportunities to see and to investigate in pro-
fessional matters. Socially, they evinced the most charming
hospitality, and among the agreeable memories of the journey are
the pictures of pleasant home life of the doctors in their own
houses, the predominating features of which were simplicity,
naturalness and sincerity.

The Royal Clinic for women, in Berlin, is presided over by
Professor Olshausen. It is a substantial brick and stone structure,
with all the modem improvements in the shape of electric lights
and the best forms of sewerage and ventilation, baths, tiled floors
and appliances for cleanliness. Special rooms are set apart for
out-patients and for the preparation of patients who are to be
confined. The Berlin Gynecological Society holds its meetings in
the building.

A fine amphitheater has also recently been completed, where
lectures and demonstrations are given by the professor and his
assistants. It is scarcely necessary for me to tell you that the
most scrupulous attention is paid to every detail, so as to insure
cleanliness of places, persons and things. Indeed, I have never



1. Read before the San Francisco Medico-Cbirurgical Society.



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674 SELECTIONS.



seen as much attention paid to the details, both before and daring
an operation, as in North Germany.

Operations are generally done early in the morning, six or
seven o'clock, and usaally the operation begins at the exact
moment that had previously been designated. The operator and
his assistants are dressed in clean linen garments, with long white
gowns, and when the operation begins the door is locked and per-
fect silence reigns, broken only by the orders of the chief to his
subordinates. No story-telling, laughing or anything else is per-
mitted that might distract the attention of anyone from his
duties. From what I could learn, ether is becoming more used in
Germany than formerly, except where diseases of the kidneys
exist.

Prof. Olshausen is a slender man of medium height, whom I
should judge to be about fifty years of age ; his black hair is get-
ting a trifle thin on top, and a little gray at the temples. His
eyes are bright and quick, and his expression very agreeable. His
manner, that of a man whose time is all occupied. He has written
one of the best books that we have on diseases of the ovaries. As
an operator, he is very careful and painstaking, and he evidently
believes that what is worth doing, is worth doing well.

One of the most noticeable features connected with his abdomi-
nal surgery is the almost universal use of catgut for ligatures and
sutures. In the vaginal extirpation of the uterus and in the liga-
tion of the pedicle after ovariotomy, only catgut ligatures are
used. In closing the abdominal wall, three rows of running cat-
gut sutures are made. The first one includes the peritoneum, the
second the muscular and fibrous tissues, and the last the skin. In
very fat women three or four retention stitches of silk are passed
through all the structures of the abdominal wall, as a matter of
security. The silk sutures are removed in a week, the catgut is
not disturbed and is absorbed in about ten days. Prof. Olshausen
showed me numerous cases where the union seemed to be all that
could be desired.

The dressing for the abdominal wound is dry benzoate of soda
and a layer of absorbent cotton, covered by a bandage. Drainage
of the peritoneal cavity is not common in Berlin. Great pains is
taken to control all hemorrhage and to cleanse the cavity as well
as possible, and then to trust largely to the absorptive qualities of
the peritoneum and the powers of the individual to resist any evil
tendencies. Personally I do not agree with those who decry



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ABDOMINAL SUBOEBY IN NORTH OBBHANT. 675

drainage, and am more and more conyinoed each year of its great
Talae in many oases, especially where the peritoneal cavity has
l)ecome infected with pas, and where there is much oozing of
i)lood and serum.

The opening in the abdominal wall is made decidedly larger
than with us, or by the English operators. This gives a larger
€eld to work in, but it increases the shock and causes greater
•exposure of the abdominal cavity to cold, in my opinion increasing
the risk, especially where the operation is a prolonged one. The
Trendelenberg position I saw used but once or twice, and in spite
-of its manifest advantages in certain cases, operators have found
that ordinarily the prone position is the best. I had come to this
<;onclnsion two years ago, after having used the Trendelenberg
position in several cases, being convinced that the gravitation of
blood and fluids into the upper part of the peritoneal cavity was a
serious disadvantage.

In the removal of large uterine fibroids by abdominal section,
there is a growing disposition to remove the entire uterus, includ-
ing the cervix, and thus far with very good results. My observa-
tion leads me to the conclusion that success by this method rests
almost entirely upon the fact of the free drainage below and the
prevention of the infection of the site of operation from the vagina,
^ith previpus thorough cleansing of the vagina and the removal
of the cervix, with its many diseased glands, and the subsequent
filing of the vagina with antiseptic tampons, the peritoneal cavity
is protected. Whether total removal will be followed by subse-
quent prolapse of the intestines into the vagina, can be determined
-only by trial.

If peritonitis develop after an abdominal section, no antiseptic
is given. Sufficient opium is used to control pain, and a saline
laxative is given every hour, assisted by large rectal enemas, until
purgation ensues. Personally, I have found calomel, in two-grain
<loses every hour, the most practicable and useful remedy in these
<sases. Reopening the abdomen and washing and draining after
the peritonitis has fully developed, has been followed by good
results in a few cases ; it is usually of little avail.

Dr. August Martin is one of the most prominent figures in
gynecology in Berlin, by reason of the large amount of work that
he does, and on account of his many writings. His father was the
<celebrated professor of obstetrics in the University of Berlin forty
jears ago, and was present at the accouchement of the Princess



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pi 6 SELBCTIOKB.

Victoria, when the present Emperor was bom. Dr. Martin is a
very large man, weighing, I should jadge, nearly 250 pounds, and
is endowed with untiring energy and industry. He has a large
private hospital and clinic, and I have seen him do five abdominal
sections in one morning. He has private classes attendant upon
his operations at certain seasons, and has a large following of
students from all parts of the world. He is a typical German in
appearance, is very busy, and has little time for anything outside
of his professional duties. He is evidently working much too
hard, and will break down unless he is more considerate for him-
self.

His methods in operating are different from any other that I
have seen. In doing an abdominal section, he sits on a stool at
the end of a low, iron table, with the patient's legs sticking out on
each side over the end of the table and unsupported. He open^
the abdomen rapidly, and, owing to his position, is enabled to use
either hand with equal facility, in exploring the abdominal cavity
and in operative manipulation. His assistants stand on each side
of the patient, and are so expert that the operator seldom is com-
pelled to ask for any instrument or appliance, for the proper thing
is placed in his hand immediately it is wanted. His matron, Fran
Horn, a short, thick-set, jolly, gray-haired, motherly-looking
woman, always assists him in his work. She is very intelligent,
and is the inventor of a number of instruments and appliances in
use at the hospital.

As in Olshausen's clinic, catgut is largely used. In extirpating
the uterus, per vaginaniy no compression forceps are used ; the
broad ligaments are tied in sections with catgut. In laparatomy,
he makes a large incision, and, with large, flat sponges, his assist-
ants hold the intestines out of the way. Frau Horn made a sug-
gestion that, in order, to prevent adhesions between the opposing
surfaces of peritoneum after operations, a sponge saturated with
olive oil, sterilized by boiling, should be introduced into the
abdominal cavity, and the peritoneal surfaces given a coating of
oil. This has been repeatedly done during the past few years, and
apparently with good effects, but the final conclusion as to the
value of the method has npt yet been arrived at.

Martin's method of dealing with sub-peritoneal fibroids of the
uterus is well known. The peritoneum over the tumor is laid open
and the mass shelled out with the fingers and the handle of the
scalpel, like a pea out of its pod, the sub-peritoneal tissues with



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ABDOMINAL SUB6EBY IN NOBTH GERMANY. 677

the line of incision in the peritoneum being carefully closed with
catgut and a running suture, a satisfactory method of dealing with
sessile growths.

Martin is an ardent advocate of yaginal extirpation of the
uterus for carcinoma. He has operated over 100 times, and in the
last English edition of his book, translated by Dr. E. W. Gushing,
of Boston, a most excellent work, he claims that in forty-four cases
where it could be shown that the disease did not extend into the
tissues outside the uterus, 70 per cent, remained well two years and
it half after the operation.

The work of Leopold, of Dresden, is descrying of especial men-
tion. His excellent hospital for women is under the patronage
iind control of the royal family of Saxony, and was formerly super-
"vised by Winckel, now of Munich, who did much to make it famous.
He was succeeded by Leopold, whose record in Cesarean section is
remarkable. His last statistics that have come to my notice show
forty-one Cesarean sections, with the loss of three mothers and the
eaving of a large proportion of the children. The frequency of
«uch cases in Dresden is due to the large number of dwarfed and
<leformed people in Saxony, on account of poor food and overwork-
Many of the poor women are brought in carts, long distances and
in a deplorable state, and it is wonderful that so large a proportion
recover.

Upon entering the hospital, the patient is taken into a large
room, all clothing is removed, and a number of nurses set to work
upon her, who scrub her with soap and hot water, inside and out.
This is followed by antiseptic washes and douches ad libitum.
The patient is then taken to the operating room, where antiseptic
precautions of every kind are observed. The abdomen and uterus
iire rapidly opened, the child extracted and given to an assistant,
the placenta removed and the incision in* the uterus closed by deep
interstitial silk sutures, unless there is reason to believe that the
uterine cavity has already become septic. In this event, a Porra
operation is done, the body of the uterus is removed and the stump
treated externally, which was the case in the instance where I saw
the operation last July.

I also saw Leopold operate in a case of extrauterine pregnancy
of two months' standing. His methods are admirable, decisive,
olean, rapid, and, what is most important, he is remarkably suc-
cessful in what he undertakes. He is very cordial to visitors, and
is surrounded by a large class of young graduates in medicine,



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678 SELECTIONS.

many of whom reside in the hospital where the material for obstet-
rical and gynecological work is abundant.

Compared with other parts of the world, the surgery of Nortb
Germany gives the impression of being yery satisfactory, the most
pronounced features being scrupulous cleanliness and the adminis-
tration of few drugs, the power of Nature and the absence of septic
infection being, in the main, relied upon for recovery of the patients

For the younger men in the profession, it is difficult to appre-
ciate the remarkable advances that have been made in surgery
during the past twenty-five years, especially since the era of Lister
— an era that will stand out in all future histories of medicine a?
one of the most brilliant and remarkable, to be compared only with
the great era of cellular pathology, and with the introduction into
our art of instruments of precision, such as the clinical thermome-
ter and the modern microscope.

The magnificent structure of modem surgery, that is being'
erected at the present day by active workers in all parts of the-
field, is likely to be enduring, from the fact that it is based, not so
much upon individual opinion and skill, as was so markedly the-
case in former years, but upon the use of these same instruments of
precision which leave no doubt as to the exact facts. There is now
no chance for an argument between educated men as to whether a.
given specimen of sputum contains the bacillus of tuberculosis*
The question of the exact temperature of the body in a given case
of disease is at once determined accurately, and much speculatioD
prevented and time saved.

We are, indeed, living in a golden age of progress and dis-
covery ; and the end is not yet, but great things are promised in
the near future to those who are investigating the causes of dis-
ease. One of the most hopeful signs of the times is the simplifica-
tion of methods and of ways and means of managing the sick,
especially in surgical matters. In other words, mathematical exact-
ness is slowly but surely taking the place of theory and guess-work*

To whom do we owe, in large part, these modern improvements
in exact methods and good results ? Undoubtedly to the plodding,
painstaking, patient work of the Germans. It does not seem pos-
sible that any one can go to their schools of pathology without
being filled with admiration for their labor and fidelity in working
out problems to a successful issue, that we may the better under-
stand the nature of disease. — Occidental Medical Times,

636 Sutter Street.



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COLLEGE COMMENCEMENTS. 679

BUFFALO MEDICAL AND SURGICAL JOURNAL

A MONTHLY REVIEW OF MEDICINE AND SURGERY.

EDITORS:
THOMAS LOTHROP, M. D. - - WM. WARREN POTTER, M. D.

All oommunioAtlons, whether of a literary or business nature, should be addressed
to the managing editor: 964 Fbamklxh Stbsbt, Butfalo, N. Y.

Vol. XXXIII. JUNE, 1894. No. 11.

COLLEGE COMMENCEMENTS AND ALUMNI ASSOCIA-
TION MEETINGS.

BUFFALO UNIVERSITY MEDICAL COLLEGE.

The exercises connected with the annaal commencement of
this institution fell this year on May Ist, and it was in every way
a fit day and a pleasant occasion. For forty-eight years these cere-
monies have recurred, and with increasing interest to our citizens
as well as the college authorities and pupils.

The Alumni Association began its nineteenth annual session at
1 1 o'clock A. M., with the president, Dr. W. C. Phelps, of Buffalo,
in the chair. The roster was read, and those in attendance
responded, after which the minutes of the last annual meeting
were read by the recording secretary, Dr. F. B. Willard, of Buf-
falo.

The committee on necrology reported the following deaths :
Dr. William F. Hutchinson, of the class of "73, at Providence,
R. I., on September 30, 1893 ; Dr. Warner C. Bush, Branchport,
N. Y., September 29, 1892 ; Dr. Ganson W. Croff, class '67, at
Bethany, N. Y., March 21, 1893; Dr. D. C. Case, class '66, at
Howard, N. Y., April 4, 1894 ; Dr. Charles L. Dayton, class '63, in
Buffalo, September 7, 1893; Dr. Charles W. Davis, class '87, at
Chautauqua, N. Y., April 9, 1894 ; Dr. William B. Gould, class '48,
at Lockport, June 20, 1893.

Dr. A. L. Benedict suggested an amalgamation of the several
alumni associations of the University for the purposes of social
entertainment and acquaintance. After a discussion of the sub-
ject, a motion prevailed to appoint a committee to confer with the
other organizations, and the president appointed Drs. Rochester,
Jones and Parmenter as such committee.



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680 EDITOBIAL.

In behalf of the committee appointed to secure snbscriptions to
the college fund, Dr. Rochester, in the absence of Dr. Putnam,
reported that $2,200 had been subscribed, and of this amount
$1,820.85 was available. The committee was discharged and a
resolution passed ordering the list of subscriptions and the moneys
paid in turned over to the officials of the University. The report
of the treasurer showed a balance on hand of $28.51 and that $59
had been expended during the year.

The following officers were elected : President, Dr. Ernest
Wende, Buffalo ; first vice-president. Dr. William Baker, Warren,
Pa.; second vice-president, Dr. P. W. Van Peyma, Buffalo ; third
vice-president, Dr. Jane W. Carroll, Buffalo ; fourth vice-president.
Dr. D. A. Currie, Knglewood, N. Y.; fifth vice-president, Dr. Mc-
Pherson, Tonawanda ; — permanent secretary. Dr. E. L. Frost, Buf-
falo ; — recording secretary. Dr. N.Victoria Chapell ; —treasurer. Dr.
H. U. Williams ; — executive committee. Dr. H. H. Bingham, chair-
man ; — Dr. A. T. Ly tie, secretary ; Dr. F. B. Willard ; — trustee,
Dr. Julius Wenz, Lancaster.

At the afternoon session an address of welcome was delivered
by Dr. M. D. Mann, Dean, which was responded to by the presi-
dent. The following program was then carried out : The Eti-
ology, Pathology and Prognosis of Certain Phases of Gonorrhea, —
Dr. George Emerson Brewer, assistant demonstrator of anatomy,
College of Physicians and Surgeons, New York, member American
Association of Genito-urinary Surgeons. Pancreatitis, — Charles G.
Stockton, M. D., professor principles and practice of medicine,
University of Buffalo. The Treatment of Several Common Ail-
ments and Particularly the Relationship between Croupous Pneu-
monia as an Infectious Process and its Therapeutics, — H. A. Hare,
M. D., professor of therapeutics in the Jefferson Medical College,
Philadelphia. The Medical Examination of the Living Human
Body when required by Courts, — Tracy C. Becker, Esq., professor
medical jurisprudence, law department, University of Buffalo;
president New York State Bar Association and legal editor of a
standard Treatise on Medical Jurisprudence, Forensic Medicine
and Toxicology.

The commencement exercises were held in Music Hall. After
an orchestral selection the exercises were opened by the presenta-
tion of the candidates for the degree of Doctor. of Medicine to the
vice-chancellor, Mr. George S. Hazard, who officiated in the place
of the chancellor, the Hon. E. C. Sprague, who was unable to be



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COLLEGE COMMENCEMENTS. 681

present owing to illness. Dr. M. D. Mann administered the Hippo-
oratic oath, which obligated the class to the strict fulfillment of
their duties as medical practitioners, after which the members of
the class marched upon the stage and received their diplomas from
the hands of Mr. Hazard. The graduates in medicine were the fol-
lowing : Nelson O. Brooks, Frank T. Carmer, Eugene T. Caswell,
John Chalmers, Timothy T. Clohessy, La Verne C. Colegrove,
Myron E. Fisher, Jane North Frear, William Gaertner, Ph. D.,
Benjamin A. Gipple, Frederick B. Green, Edward R. Hardenbrook,
M. D., A. E. Hubbard, J. Grafton Jones, Henry E. Long, Cyrus P.
Jennings, A. W. Jackson, M. D., Cora Billings Latten, M. P. Mes-
senger, John L. Miller, Harrison C. Potter, Herriot C. Rooth,
Ernest L. Ruffner, George W. Sales, Angeline D. Smith, Amelia
Earl Trant, Charles F. Tucker, Frederick J. Tnnmore, Lewis A.
Twining.

The announcement of the honors then followed, and as the
names of Messrs. Myron E. Fisher, William Gaertner, Ph. D.,
Frederick B. Green, J. Grafton Jones, Cyrus P. Jennings, M. P.
Messenger, Herriot C. Rooth, Ernest L. Ruffner, Amelia Earl
Trant, Cora Billings Latten and Jane North Frear were called, the
audience greeted them with applause, which was especially hearty
when the names of the women w^re announced.

The department of pharmacy granted diplomas to twenty-six,
and the department of dentistry to six students.

Dr. Lucien Howe, professor of ophthalmology, then addressed
the graduated classes. In the course of his remarks he quoted an
-editorial comment from the London Spectator y which, speaking
for England, said that of all who start on professional careers one-
third go under, that is, get sick, die or emigrate ; one-third barely
survive, fighting on without a hope of retiring in old age, and one-
third make a decent and comfortable living. Sir James Paget, who
had m^de a study of the subject and had compiled some important
statistics, had said that of 1,000 medical students whose careers
had been investigated, 23 had obtained eminence, 66 had consider-
able success, 507 were fairly successful, 124 had exceedingly
limited practice, 56 failed entirely, 96 or nearly one-tenth of the
number abandoned the profession and 87 died after entering upon
the practice of medicine, and 5 of these had committed suicide.

In conclusion, he spoke of the great debt of gratitude the world
OT^pd the medical profession for its discoveries and its scientific
advancement by means of which human life is prolonged. The



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682 BDITOBIAL.

average length of life is dow forty years. SeveDty years ago it
was thirty years, and this extension of ten years, or one quarter of
the average life, is dae to the persistent investigations of men who
worked in their profession for the love of it. His final words to
the students were an admonition to them to go forth with the
determination to work, and by that means become a credit to
their Alma Mater, as well as achieving a grand and glorious
success.

The annual alumni banquet was given at the Iroquois under
the toastmastership of Dr. F. P. Vandenbergh, whose function
was discharged with grace and wit. The following is the list of
subjects and speakers : The Class of '94, John Chalmers, M. D.;
The University of Buffalo, Dr. Roswell Park.; The Environs of
Buffalo, the Hon. Cuthbert W. Pound ; Tact and Opportunity in
Professional Life, Mr. Edward C. Randall ; Leisure Thoughts of
a Busy Man, Mr. Frank E. Blackwell ; Side-lights on Some Topics,
Mr. Samuel G. Blythe ; The Growth and Prospects of Buffalo,
Mr. William C. Cornwell.

Several women physicians lent the grace of their presence at
the banquet, which was altogether a most pleasant and inspiriting
addition to the festive scene.

NIAGARA UNIVERSITY MEDICAL COLLEGE.

The commencement exercises of this institution, like those of
its elder sister, began with the annual meeting of the alumni
association. The morning session was called to order at 10.30
o'clock. May 0, 1894, in the amphitheater of the medical college^
by the president, Dr. John M. Hewitt, of Buffalo, who delivered
an address upon medical jurisprudence immediately after Dr.
Cronyn's address of welcome.

Then followed a business session, at which the following
named were elected officers for the ensuing year : President, Dr.
E. M. Dooley, Buffalo ; first vice-president. Dr. J. F. Meyer ;
second vice-president, Dr. F. A. Hayes ; secretary. Dr. W. H.
Norish ; treasurer, Dr. E. E. Martin ; executive committee. Dr.
J. H. Dowd, Dr. C. J. Reynolds and Dr. S. A. Dunham.

During the afternoon session that convened at 8 o'clock, the
following program was carried out :

1. Maritime Quarantine, by William A. Wheeler, M. D., Sur-
geon U. S. M. H. S., formerly professor of surgery Niagara Uni-
versity. (See p. 659, this journal.)



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 68 of 78)