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very useful. The operation was difficult, and protracted for one and a half hours. The patient was put (just where she was wanted) into positions impracticable by any other means known to the writer. The facility with which the operator placed himself in a suitable relation with the patient, relieved the arduousness of the trying dissection.
As a gynecological chair. The writer has placed women upon their backs and sides in the chair, and then depressed their heads, so that the sun's rays shone directly on to the os uteri through the speculum. Direct or reflected artificial light may be used for the same purpose, as follows: Drop the leg portion to a right angle with the thigh portion, the back being slightly elevated. The patient sits down on the seat, then lies down in the dorsal or lateral position. A few turns of the endless screw depresses the head and elevates the buttocks so that the operator, sitting or standing, can look downwards just as in writing or eating, i. e., the most natural position for observation. I have used the chair in exploring the uterus by Simon's method—that is, by passing the whole hand and half the forearm into the rectum and large intestines. The peculiar position given by the chair was found to be very favorable.
I have also used the chair in measuring and fitting a pessary. The following statement indicates what the patient herself can do with the chair. A lady suffered much from an ulcerated and hyperästhetic condition of the uterine cavity, which intrauterine topical applications alone benefited. Circumstances of time and distance forbade the frequent attendance of the writer, as often as was necessary. The patient asked, if she could not be instructed to make applications herself. The attempt was made with perfect success. Lying on the chair on the back, opposite a window, she applied the Storer speculum, held a mirror between her knees, saw the os in the mirror (this I verified,) and applied hier medicament with a Pinkhanı’s scarificator. This instrument, like a uterine sound, is grooved longitudinally, the medicament is rubbed up with lard and deposited in the groove near the extremity. A small pledget of cotton is placed in the groove next the proximal end. A wire traverses the groove, and one end of it rests on the cotton, the other projecting. When the instrument is introduced into the uterus to the point desired, it is only necessary to push forward the wire. This advances the cotton pledget, and extends the ointment.
The same patient has applied slippery elm tents, in a similar manner through the speculum.
In convalescence. Sometimes patients exbibit a determined inclination not to sit up in an ordinary chair, after a long sickness, when it seems as if they might do so. An instance of this occurred to the writer. The patient was induced to use the chair. At first the bed position was used. The erect position for the trunk was gradually assumed, then the legs were . dropped. The spell was broken; the invalid went down stairs to dinner after two days use of the chair.
Another lady, suffering with fibroid tumor, found the chair a great relief to her pain and weakness.
Indeed it is useless to multiply the histories of such cases. As a resting chair for over-worked persons, it has produced practically the happiest results.
The chair is not a proper locomotive chair. It does not answer every imaginable purpose, but in the instances that have been named, the expectations raised were, humanly speaking, fully realized.
A NEW METHOD OF TREATING FRACTURE OF
HENRY VAN BUREN, M. D., Chicago. While one of the visiting physicians of the Central Free Dispensary about two years ago, I treated a patient for fracture of the clavicle, adopting the plan of my friend Dr. Lewis A. Sayre, of New York, using two strips of adhesive plaster without any axillary pad.
I became convinced at once, that the principle advocated by Prof. Sayre, was undoubtedly the correct one; but before I had gone very far in the use of the adhesive strips, I fouud that my patient, a young native of Ireland, began to tear them off. The weather was warm, and, to use the language of the lad, they “itched him.”
Finding this difficulty in holding the arın and shoulder back by a hitch around the body with adhesive plaster, the thought struck me, that I would make a hitching post of the sound shoulder instead. Not as in the old plan of a figure of eight around both shoulders, but upon that which I will now lay before my brethren in the profession.
To make known my plan in a sentence—I make attachment to the middle of the arm on the fractured side; draw the arm backward until the clavicular portion of the pectoralis major muscle is put sufficiently on the stretch to overcome the sternocleido-mastoid, and then make a hitching post of the sound shoulder to hold these muscles in extension, and by this extension with the sling, which will be hereafter described, the ends of the fractured clavicle are held in apposition.
I make the first bandage 3 or 4 inches wide out of unbleached cotton, of double thickness and sufficient length. On one end of this bandage a loop is made, by returning the bandage on itself, and fastening the end with a few stitches. The hand on the injured side is then passed through this loop, and the loop carried up to a point just below the axillary margin. This bandage is then passed directly across the back, and under the sound arm and over the sound shoulder, and returned across the back, and pinned or stitched to itself at the point where the loop is formed. See figure 1.
Figure 1. VanBuren's first bandage for fractured clavicle.
The second bandage is then made and applied as follows :
I flex the arm of the injured side, and place the hand on the chest, pointing in the direction of the sound shoulder ; I then take a piece of the same material as used in the first instance, and make a bandage 4 inches wide, of double thickness and sufficient length, and pin or stitch one end of this bandage to the lower margin of the first bandage, in front of the sound shoulder. It is then passed diagonally downward, and across the chest under the hand and forearm which has been flexed upon the chest, and carried around the arm at the elbow, and back on the dorsal surface of the forearm and hand to the point from which it started, and this end also pinned to the first bandage.
I then stitch the lower margins of this bandage together for a distance of about three inches at the elbow, thus forming a trough for the elbow to rest in. I also do the same at the upper end of this bandage, which forms another short trough for the hand to rest in. See figure 2.
Figure 2. Van Buren's second bandage for fractured clavicle.
Front view. This bandage or sling may be made as described above, before it is applied, and the elbow placed in the lower trough and the hand in the upper one; and the upper ends of the bandage pinned to the lower margin of thé first bandage, at a point opposite the sound shoulder, as above indicated ; indeed I prefer this plan because more convenient.
This sling serves the triple purpose of drawing the lower end of the arm forward and upward, and thus throwing the injured shoulder backward. It supports the fore-arm and hand in a comfortable and quiet position, and last, it prevents the first bandage from cording under the sound arm by its attachment to its lower margin.
To prevent the first bandage from producing excoriation in the axilla of the sound side, I usually cushion the bandage at this point by stitching on two or three extra thicknesses of the cotton cloth. The same may be done at the loop,-around the arm of the injured side, if necessary.
What is presented, then, for the consideration of the profession in this method is
1st. The great simplicity of the appliance. 2d. The complete retention of the fragments in apposition. 3d. The comparative ease with which the bandage is
The deformity which takes place in fracture of the clavicle is too well known to require any description; viz., that the shoulder falls downward, forward and inward, and that the outer end of the sternal fragment overlaps the inner end of the acromial portion of the clavicle.
The indications to be fulfilled in the treatment are also well known; viz., to draw the shoulder upward, outward and backward, and retain it there, and thus by virtue of this position, hold the fractured ends in apposition.
It will be observed that the first bandage, as presented in Fig. 1, not only draws the shoulder backward, but has a lifting tendency, the bandage being at a higher point, where it passes over the sound shoulder than where attached to the arm on the injured side, hence the shoulder is drawn upward; also that the deltoid and biceps muscles are quieted by the loop around the arm.
Let the surgeon himself stand erect and thrust backward and upward his own shoulder, the one supposed to be the injured one, and flex the fore-arm upon the chest, with the hand pointing in the direction of the sound shoulder, and he has at once secured the position and fulfilled all the indications desired in fracture of the clavicle; and the bandages presented