Universidad de Buenos Aires. Facultad de Derecho y.

The American practitioner online

. (page 36 of 109)
Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 36 of 109)
Font size
QR-code for this ebook

an epitaph which will live among epitaphs so long as our language

shall last:




A Master in Surgery.

His life, which neared the extreme Limits of the Psalmist,

was one unbroken process of Laborious Years.

He filled Chairs in Four Medical Colleges in as many States of the Union,

and added Luster to them all.

He recast Surgical Science as taught in North America,

Formulated anew its Principles,

Enlarged its Domain,

Added to its Art, and imparted fresh Impetus to its Study.

He Composed many Books, and among them

A System of Surgery,

Which is read in different tongues, wherever the Healing Art is practiced.

With a Great Intellect, carefully trained and balanced.

He aimed with undivided Zeal

At the Noble End of Lessening Human Suffering

and Lengthening Human Life,

And so rose to the Highest Position yet attained in Science

by any of His Countrymen.

Resolute in Truth, he had no Fear, yet he was

both Tolerant and Charitable.

Digitized by


3IO The American Practitioner and News.

Living in Enlightened Fellowship with all Laborers in the

World of Science.

He was greatly Honored by the Learned in Foreign Lands

and deeply loved at Home.



Sixth Day of May, 1884.

his memory

Shall Exhort and his Example shall Encourage and Persuade

those who come after him to Emulate Deeds

which, great in themselves,

Were all Crowned by the Milkwhite Flower of a

Stainless Life.

The epitaph is engraved upon the tomb of Gross, where it will stand
as long as fame shall weave garlands for that immortal brow.

Master and pupil "were lovely and pleasant in their lives.'*
Let us hope that in their death, they are not divided; for of them it
may be said with far more reaching truth than of Saul and Jonathan,
" They were swifter than eagles ; they were stronger than lions."

We pause for a moment to ponder the lesson of this eventful life,
which, like a star of the first magnitude, so long shed lustre on the world
of medicine. Terar dum prosim wrote the great Carlyle over the
picture of the burning candle, which symbolized his life. "May I be
wasted that I may be of use." Let every young man who enters
medicine resolve to be more than a candle or rush-light. Let him be
a star. It is of little moment whether you shine with the diamond-like
light of Sirius or the soft firefly-like luster of a pleiad, so that you
shine for all that is in you, and thus help to make the medical constel-
lation a poem in the heavens, to be read forever in letters of living
light. As naught from nothing comes — so no thing returns to naught.
And though a star may waste away in shining, not the faintest vibra-
tion of its tiniest beam can in the nature of things be lost.

** Alike are life and death,
When life in death survives,
And the uninterrupted breath
Inspires a thousand lives.
Were a star quenched on high,
For ages would its light
Still traveling downward from the sky
Shine on our mortal sight.
So when a great man dies
For years beyond our ken,
The light he leaves behind him lies
Upon the paths of men."

Digitized by


The American Practitioner and News. 311

ileports of Societies*



Meeting of February 17, 1899.

Hypertrophy of the Tibia. Dr. S. Ketch presented a girl, four years
of age, whose right tibia was greatly lengthened and thickened, with
decided anterior bowing. He had first seen the patient in December,
1898. The epiphyses were thickened, but the enlargement was not
confined to them. It was most marked at the middle of the shaft, but
included the whole bone, as was seen by the X-rays. Length : Right
l^g> 19)^; l^ft leg) 18^/^; right tibia, 9 J^; left tibia, 8 5^. Circumfer-
ence: Right thigh, 9>^; left thigh, \oy^\ right calf, 85^ ; left calf, ^^^.
The disease had begun eighteen months ago with a small lump on the
leg and pain at night and when she walked. This was Dr. Ketch's
second patient of the kind. The first one was a girl, eleven years of
age, who had been presented to the Section in November, 1897 ; had
been operated on for the purpose of shortening and straightening the
bone, and had again been before the Section in March, 1898, with
resulting improvement and ability to walk about. (See American
Practitioner and News, January i, 1898.)

The bone had been found to be solid, the cavity being obliterated.
Neither of the patients had received any benefit from anti-syphilitic
treatment. There was doubt as to the cause of this growth of the
bone. It was not improbable that the trouble began in the periosteum.
It was a question whether som*?thing ought not to be done early in the
way of an operation to arrest the process, such as an incision through
the periosteum, which might at least relieve the tension.

Dr. T. H. Myers said that this aflFection was extremely rare. He
did not think that any drug could produce a material improvement,
though it might prevent further progress of the disease. Such cases
were sometimes assumed to be syphilitic for lack of better informa-
tion, though no history or symptoms of that infection could be elicited.

Dr. V. P. Gibney suggested a linear incision through the periosteum,
and if that could be done with perfect safety, going further by denuding
the bone from the anterior surface and shaving off the redundant por-

Digitized by


3 1 2 The American Practitioner and News.

tion, suturing the periosteum and letting it heal primarily. The
growth in length could not be stopped except by attacking the epi-
physis, which would be hazardous.

Dr. H. Gibney said that in addition to the treatment which had
been suggested, he would go further and complete the operation,
straightening the leg by the removal of a wedge-shaped piece of the
bone and maintaining the correct position by plaster-of-paris dressings.
* Dr. Myers thought that incision would only relieve the pain. He
would not operate until the child had attained its growth or the dis-
ease had stopped.

Dr. G. R. Elliott said that it was of pathological interest that the
tibia alone was affected, while the fibula remained normal. There was
but little deformity compared with the decided bowing which had been
an indication for operation in Dr. Ketch's former patient, in whom the
patholo^cal findings were diffusely distributed throughout the entire
thickness of the bone. He asked what effect tying the nutrient artery
of the bone would have on the progressive atrophy.

Dr. Ketch said it would probably stop the growth of the bone.

Dr. Elliott suggested the possibility of resulting necrosis.

Dr. A. B. Judson said that if the whole limb were affected, symmetry
might possibly be promoted during the growing period by checking
the vascular supply of the larger limb, by bandaging or lacing the
whole limb, and increasing the vascular supply of the smaller limb by
venous compression. At the same time the functional activity of the
one could be lessened and that of the other increased by the use of an
ischiatic crutch or other apparatus having the same effect, with a high
sole under the shorter limb. But as the diagnosis was absent and the
pathology unsettled he could not suggest a reasonable treatment.

Dr. Ketch said that at an earlier stage some of the operative pro-
cedures suggested might have arrested or prevented the abnormal
growth of the bone, but, on the other hand, they might have promoted
it. He was opposed to the removal of a portion of the bone during
the growing period. As the parents of the child desired active treat-
ment, an incision might be recommended as likely to stop the pain,
which he thought was due to tension.

Enlargement of Epiphyses. Dr. Myers presented a girl, sixteen
months of age, whom he had seen for the first time on January lo,
1899. The epiphyses of the radii, femora, tibiae, and the entire

Digitized by


The American Practitioner and News. 313

phalanges of several fingers were enlarged. The joints of the ankles,
knees, fingers, wrists, and the right elbow were swollen and somewhat
restricted in their motions. The enlargement at the ankle-joint was
peculiar, several of the tarsal bones sharing in it. She walked with
diflSculty, with knees and hips flexed. Flexion of the knees and unwill-
ingness to walk had been observed immediately after an attack of
cholera morbus in October, 1898. The knees were kept a little flexed,
and there was a very slight eflFusion in these joints. The child did not
sleep well, but otherwise seemed to be in good health. Potassium
iodide, gr. iv-viii, had been given t. i. d. for a month without improve-
ment. The teeth were not notched. There was no syphilitic history.
It was not typical scurvy. The child had been for three months on a
general diet, including eggs, meat, potatoes, and fruit. It was certainly
not a typical case of rickets. She had cut teeth early and walked at
ten months; the head was well formed and the abdomen not prominent.
The diagnosis remained uncertain.

Dr. Ketch said that the obvious feature of the case was a very
exaggerated change in nutrition — an overgrowth of some kind, the
effect of some not so obvious diathetic cause. He had seen localized
changes in scorbutus which were very similar.

Dr. V. P. Gibney said that the changes were similar to those seen
in chronic rheumatoid arthritis, which he had repeatedly seen in typical
forms in children seven and eight years of age, and he did not see why
it should not attack a child sixteen months old. This, however, would
not explain the growth of the long bones and phalanges. His first
thought was of scorbutus, but the condition would have disappeared
with the child on the diet stated. Syphilis could be excluded. If
pushed for an opinion he would say it was a case of multiple bone
tuberculosis, a condition which could be less easily excluded than any
of the others mentioned. The boggy feeling of the joints, the fact that
there was effusion in the joints, and the statement that flexion of the
knees and an unwillingness to walk had followed an attack of cholera
infantum, all supported the view that it was an instance of bone tuber-
culosis. He would raise the question whether synovitis was not one
of the earliest signs of tuberculosis in a child. He advised putting the
child in a wire cuirass and keeping the limbs extended. It was not
good to allow the child to walk.

Dr. Ketch said that primary synovial tuberculosis was rare in

Digitized by


314 The American Practitioner and News.

Dr. Judson had noticed the contraction of the knees and hips, but
thought it was not the result of the reflex muscular action of joint
disease, and that the fact that the contractions were nearly symmetrical
pointed to a more general cause than tuberculosis of the joints aflFected.
He did not think that synovitis was an early incident of osteitis, and
that primary synovitis could be diflFerentiated by the absence of the
usual signs of osteitis, which were muscular atrophy and reflex action
and a prolonged history of inconstant lameness and pain. Synovitis
should not be considered as liable to run into osteitis, although prac-
tically it was well to relieve a synovitic joint from weight-bearing.

Dr. Ketch said that he had rarely seen synovitis as an early sign
of tuberculosis.

Dr. V. P. Gibney said that the focus of diseased bone might suffer
a traumatism and thus cause an extension of the process and give rise
to this outward manifestation. He recalled a case seen twenty years
ago. The child's knee was full of fluid. It was thought sure to be
synovitis, and a glowing prognosis of recovery in a few weeks was
made, but after six or seven years' treatment recovery took place with
a stiff* knee. Primary osteitis with secondary synovial distension
occurred before the gross signs of the osteitis which called the attention
of the practitioner to some trouble in the knee. At this stage the
trouble could be cured.

Dr. Elliott said that fluid in a joint immediately after a traumatism
pointed clearly to a synovitis directly due to traumatism. If tubercu-
losis followed, it resulted from a further injury to the bone itself which
made, a proper nidus for the tubercular growth. In other words, a dual
injury and the fluid in the joint was entirely distinct from the true
tubercular lesion and in no way connected with it. The later tubercu-
lar development might delay the absorption of the primary synovial
excess, and thus the latter might come to complicate the tubercular

Dr. Myers had seen effusion early in tubercular joint disease, but
did not consider it of diagnostic value. In spite of the fact that the
patient had had apparently an anti-scorbutic and anti-rachitic diet, he
could not help thinking that the trouble was due to one of these dis-
eases rather than to tuberculosis. The child was not very sick. The
principal changes were in the epiphyses and phalanges, and seemed to
him to be due to some form of nutritional disease. The congested
epiphyses could fully account for the pain and tenderness, but he

Digitized by


The American Practitioner and News. 315

would adopt the suggestion made and protect the joints by keeping
the child quiet.

Cases of Coxa Vara. Dr. Myers also presented a boy eight years of
age who had waddled, and was walking worse every year since he
began to walk. His muscles were strong. A certain rigidity of all the
muscles of the lower extremities made examination somewhat difficult.
The motions of the hip-joints, especially flexion and abduction, were
somewhat limited. There was no dislocation, but the neck of the
femur was seen in the skiagram to be bent down as in coxa vara. The
diet had been very good. The boy was a little bow-legged and flat-

Dr. H. Gibney found no shortening and trochanters but slightly
above the line. He thought the waddling might be due to flat feet.

Dr. V. P. Gibney said that the radiograph showed forward rotation
and a little bending backward of the femoral neck at its junction with
the shaft.

The opinion was expressed by several speakers that the boy had
coxa vara in a mild and not strictly typical form.

Dr. Elliott thought that the condition dated from early rachitis, in
all probability. The picture was a logical one, and the femoral neck
had changed simultaneously with the bowing of the legs, both having
been more or less plastic.

Dt. Ketch said that the traces of rachitis were obvious. Coxa vara
was sometimes made to include cases that were not dependent on
bending of the bone. Some cases were due to deviations caused by
abnormal epiphyseal growth, resulting in a change in the angle of the
neck of the femur. On the other hand, the peculiar gait of coxa vara
was not infrequently attributed to knock-knees or bow-legs.

Dr. Judson said that coxa vara might be considered to mean an
abnormal or varous relation of the neck of the shaft, caused by lesions
of different kinds, all of which were not yet recognized.

Dr. V. P. Gibney said that in coxa vara we had found one new dis-
ease or condition to rule out in our study of hip disease. Many cases
of " hip disease " in adolescents which recover and have relapses, but
never get very bad, having from one half to three quarter inch short-
ening, were really cases of coxa vara.

Dr. Ketch presented a boy, aged eleven years, who had had a limp
(left leg) in winter but not in summer for three years. Pain and ina-

Digitiz'ed by


3i6 The American Practitioner and News.

bility to walk on rising disappeared entirely in the afternoon. There
had been no history of rickets or rheumatism. Abduction was limited,
especially in flexion. Outward rotation abnormally free, trochanter
one half inch above the line ; no atrophy. R. 28, L. 275^. The
skiagraph showed a change in the angle of the neck.

Treatment of Coxa Vara. Dr. Judson suggested mechanical means
for permitting locomotion, while the affected part is relieved from the
weight of the body, as long as the bone was in a growing or plastic

Dr. V. P. Gibney said that when the affection was single, good results
could be obtained from the use of the hip-splint. He saw no objection
to the wearing of a jointed splint for some months, affording not abso-
lute but modified protection ; enough to shut out traumatism.

Dr. H. Gibney said that the ischiatic crutch for this purpose was
easily adjusted and comfortably worn, and allowed the limb to hang free.

Dr. Myers said that when both femora were affected mechanical
protection was attended with difficulties, and it was not easy to keep
the adolescent patient, like the one he had presented, quiet.

Dr. Judson suggested the use of a bicycle.

Dr. Ketch, in such a case, would improve the general nutrition and
prepare the parents for a long wait.

Pain Relieved by Traction. Dr. Myers related the history of a patient,
twenty-six years of age, who had suffered five and a half years from
rheumatism in the ankles, neck, shoulders, elbows, and wrists, and the
right hip. For the first year improvement had followed massage and
medical treatment. For the past four and a half years the right hip
had gradually become stiff and painful in walking. When first seen by
Dr. Myers, in February, 1898, there was some spasm but no shortening.
Motion of hip : Flexion, 16 degrees ; abduction, 10 degrees ; external
rotation, 10 degrees. A short traction hip-splint was at once applied,
and is still worn. There had been no pain since June, 1898, and the
man considered himself greatly improved.

Dr. Ketch recalled the case of a man in whom the terrific pain of a
sarcoma of the femur had not been relieved by powerful narcotics, but
had been relieved for a time by traction made with a long hip-splint,
and afterward, as more convenient, with a short splint.

Fracture of Neck of Femur in an Infant. Dr. Myers showed a speci-
men of fracture of the neck of the femur in a child eight months old.

Digitized by


The American Practitioner and News. 317

A large amount of callus was present within and without the perios-
teum. There was a lateral displacement of the lower fragment inward
one third the diameter of the bone. There was no change in the length
of the bone. No history could be obtained except that the injury must
have occurred before the fifth month.

A New Pelvic Rest, Dr. Myers also showed a pelvic rest, especially
well suited for the application of spica bandages, which included the
trunk and thighs, as it could remain in place until the spica was fully
applied, and could then be easily withdrawn. It was made of a piece
of sheet steel, J^ x i^ x 14 inches, bent upon itself so as to form three
sides of a square. The ends were hammered out so as to form oblong
planes about three inches broad and five inches long. When in use,
one of the planes rested upon the table and the other supported the
sacrum, while the upright connecting them was directed toward the

A Compend of Human Physiology. Especially Adapted for the Use of Medical
Students. By Albert P. Brubakbr, M. A., M. D., Adjunct Professor of Physiology
and Hygiene in the JeflPerson Medical College, etc. Ninth edition. Revised and
enlarged. With illustrations and a Table of Physiologic Constants. 266 pp.
Price, 80 cents. Philadelphia : P. Blakiston's Son & Co. 1899.

In his modest preface to this the ninth edition of his ** compend," the
author says : ** The continued demand for the Compend of Physiology, which
has led to the preparation of a new edition, has furnished opportunity for
a revision of the text in various parts of the book. The changes, it is
hoped, will increase the value of the book to the student as a compact
statement of some of the essential facts of physiology." The great popu-
larity of the work shows very conclusively that the author's claims are
more than verified. The press- work is excellent, and the binding just what
is needed in a book intended for the character of use for which this is
designed. d. t. s.

A Handbook of Obstetric Nursing. For Nurses, Students, and Mothers. Compris-
ing the Course of Instruction in Obstetric Nursing Given to the Pupils of the
Training School for Nurses Connected with the Woman's Hospital of Philadelphia.
By Anna M. Fullbrton, M. D., Obstetrician, Gynecologist, and Surgeon to the
Woman's Hospital of Philadelphia, etc. Fifth edition. Illustrated. 262 pp.
Price, li.oo. Philadelphia: P. Blakiston's Son & Co. 1899.

This book is intended to cover and does well cover all the points
relating to the puerperal condition and to labor that it is requisite the
nurse should understand. It hardly need be said that the author marches
in the very front line of intelligent progress.

Digitized by


3 1 8 The American Practitioner and News.

First of all, she is insistent throughout on the most rigid asepsis,
which is but another word for cleanliness. The topics of the book are then
taken up in their order, and in a terse, pure language and a style that is
rhythmical each is apportioned its due attention. After a brief allusion to
the anatomy of the pelvis and its contained organs, the author takes up in
order the signs of pregnancy, its management, preparations for labor, the
management of the lying-in, the care of the newborn, and the ailments of
early infancy, with the care appropriate to various conditions and circum-
stances. That the work has reached a fifth edition is abundant proof that
the author has not missed her mark. d. t. s.

Diagnosis by the Urioe, or the Practical Examination of Urine with Special Refer-
ence to Diagnosis. By Allard Mbmminger, M. D., Professor of Chemistry
Urinology, and Hygiene in the Medical College of the State of South Carolina,
etc. Second edition. Enlarged and revised, with illustrations. 124 pp. Price,
$1 00. Philadelphia: P. Blakiston's Son & Co. 1899.

Advantage has been taken of the exhaustion of the first edition of this
little work by the author to make a thorough review and a careful adap-
tation to recent advances in urinology as applied to diagnosis. The most
distinctive feature in the work is the chapter on Differential Diagnosis of
Chronic Bright's Disease as Based on a Classification of the Normal Abso-
lute, the Absolute, and the Relative Absolute of Solids and Urea. We
must confess that we fail to appreciate the appositeness of the terminology
used. Withal the work has claims for simplicity of style and arrangement,
and it is to be hoped that the author will write more and not less carefully.

D. T. s.

Surgical Nursing. By Bbrtha M. Voswinkbl, graduate of Episcopal Hospital,
Philadelphia, etc. Second edition. Revised and enlarged, with 112 illustrations.
206 pp. Price $1,00. Philadelphia: P. Blakiston's Son & Co. 1899.

The second edition of this work has been enlarged by the addition of
a chapter on wounds and their complications. The nursing in special
cases has also been dealt with more in detail. The well-sustained aim of
the author is to give a concise outline of surgical nursing in general,
together with necessary knowledge of agents used in aseptic surgery and
the application of splints and fixed dressings.

It is believed there is no other work of its scope and character in the
market with which it does not make a favorable comparison. d. T. s.

A JVUnual of Bacteriology. By Hbrbbrt U. Wii^i^iams, M. D., Professor of Pathol-
ogy and Bacteriology, Medical Department University of Buffalo. With seventy-
eight illustrations. 263 pp. Price, I1.50. Philadelphia: P. Blakiston's Son &'
Co. 1898.

In this manual the author has described the technique which the
beginner must follow, and at the same time he has given a concise sum.
mary of the facts in bacteriology most important to the physician. The
author disclaims originality for his book, offering it purely as a compilation.

Digitized by


The American Practitioner and News. 319

And yet in a most important feature it is original in that a vigor of style
and a warmth of enthusiasm are shown that evidence the fact that he has
entered into the spirit of his subject and made it all bis own. The author
writes as one who wants you to understand what he is teaching and intends
that you shall understand it, and furthermore with the confidence of one
who feels that you do understand it.

He is possessed in a high degree of the powers of clear and vivid
description, a most important thing in a work of this character. In addition

Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 36 of 109)