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in this paper retain this position in a very simple and practical manner.
A patient of mine under treatment for this injury, was brought before the Chicago Medical Society, at one of its regular meetings in May last, after union had taken place; and I think the gentlemen who were present can say that there was little or no deformity in the case before them.
I also had the privilege of doing what was so much desired before submitting this paper for publication, that of bringing this method before a number of surgeons of high standing in the profession, at the late meeting of the American Medical Association, among whom were Dr. Lewis A. Sayre, of New York; Drs. Gunn and Powell, of Chicago; and Drs. Bridge and Hyde, associate editors of the MEDICAL JOURNAL AND EXAMINER, who approved of the plan laid before them.
I was eager for the opinion of Prof. Sayre, who was the first to put into practice the principle laid down in this method, and the plan received his hearty approval.
I have treated every case of fractured clavicle upon this plan, which I have been called upon to attend for the past two years, modifying the appliance from time to time, until the indications sought after were more perfectly acquired.
At the beginning of the third week, or earlier, the bandages should be removed occasionally, and passive motion of the elbow and shoulder made.
We are of the opinion that judicious movement of all fixed joints has been too long delayed, by most surgeons in cases of fracture. In the fracture presented in this paper, with the bandages used, early movement is indispensable, inasınuch as the parts are held so completely quiet.
And now, if any apology is needed for trying to present a new way for treating an old fracture, the excuse must be found in the fact, that we think the old plans were failures, notwithstanding the many and complicated means devised to secure retention.
Dr. Sayre has quoted, in his pamphlet on this fracture, froin a dozen authors, running back to the days of Hippocrates, showing that this injury has always been attended with deformity. :
In Prof. Hamilton's work on Fractures and Dislocations, the author quotes from fifty-seven different authors, to sustain his own observations, that this fracture is nearly always followed by deformity.
Miller, Ferguson, Simpson, Hancock, South, and many others of England, and a grand array in other countries, have all had their wedged-shaped pads, and never-ending turns of the bandage around the body, but I cannot see that they accomplished more than to keep the fracture quiet, and thus facilitate a kind of union with, as they all acknowledged, more or less deformity.
South says that he does not like any apparatus which draws the shoulders backward. If the author means both shoulders, we are agreed; but I want one shoulder, and that the injured one, drawn backward and well backward at that,---for herein we get extension and counter extension too, if you please, the thing so essential in fractures of all long bones, and we cannot get this in any other way. The pad under the arm does not cause adequate extension, nor will it ever do so, no matter how large or in what manner placed.
The figure of 8 bandage of modern use, is to me exceedingly objectionable, for one important reason, if for no other. If the fracture is in the middle third of the clavicle, or near the middle at all, the bandage presses down over the site of injury, and particularly over the inner end of the outer fragment, the very end already dragged down by the weight of the shoulder, and just here is one of the valuable points in what we have. termed a new method. The injured shoulder is entirely free from any depressing or other bandage. I do not even allow the patient to wear a suspender over the injured shoulder.
DeSault, Dupuytren, Cloquet, Salamon, and Jæger, all carry their bandages over the injured shoulder, and all admit, as they must do, that they get angular deformity.
The “postural position” might do quite well for an indolent man, but even then we might fail in getting union again. This is an age of fresh air and hygiene, and every patient, as far as practicable, should have the advantages of out-door exercise.
I am no stickler for any particular apparatus in the treatment of fracture, any more than I would be for any particular medicine in disease. Whatever accomplishes the end in the most simple manner under existing circumstances, is generally, if not always, the best, and the plan for treating fracture of the clavicle, as presented in this paper, is in keeping with this doctrine, and is brought before the profession with confidence, and we believe that a good result can be attained in the hands of any surgeon, if the method is faithfully and intelligently carried out.
Chicago, August 1st, 1877.
THE APPLICATION OF THE CORN SWEAT IN
DISEASE. By FRANK ALLPORT, M. D., OF SYCAMORE, ILLINOIS. In the February number of the JOURNAL AND EXAMINER, for 1877, appeared a short article on the “ Corn Sweat.” To that article I must refer those who read this, for the method of adininistering the “sweat," and confine myself now to its application in disease, and to a brief resumé vf a few cases in which it was the chief remedial agent used.
I would not be understood to mean that the true nature of this remedy is to be found only in the “Corn Sweat.” There is no particular virtue to be attributed to the corn. It is merely a simple, efficacious and convenient method of administering the principle; viz., "external heat.” Perhaps the chief value of external heat is in the treatment of the "pyrexiæ," and among these, it is in scarlet fever that I am more especially prepared to urge its use.
I have treated twenty-six cases of this disease, in which my main reliance was the “Corn Sweat," and have not lost a patient. Among these, only one was left with any of the troublesome sequelæ. This was a slight otorrhea, which was easily cured in a few days, and in which the “Sweat” was not applied as soon as it should have been. No dropsy occurred in any of them.' From my twenty-six cases, I have selected a few of the most typical, of which I will give a brief synopsis.
CASE I. A. J., aged 10 years, taken sick Feb. 8th, I was called Feb. 10th, and found a well marked case of scarlet fever, with the exception of the eruption not having yet made its appearance. Patient was delirious; urine suppressed, temperature in axilla 107° F., pulse 144. The severity of the case was at once apparent, and the most active treatment was re
In three-quarters of an hour, the patient was in “Corn Sweat," and had taken fifteen drops of the sweet spirits of nitre, and twenty grains of the sulpho-carbolate of sodium. In a quarter of an hour after the “sweat” was commenced, a slight moisture was felt on the surface, which in half an hour developed into a profuse perspiration.
The sweat" lasted about an hour and a half, at which time a distinct rash could be seen all over the body. The temperature was reduced to 102°, and the pulse to 140. The delirium had ceased, although perfect consciousness was not restored, and after the administration of ten drops of sweet spirits of nitre, and ten grains of sulphocorbolate of sodium, she slept three hours and awoke perfectly conscious, although much prostrated. At this time she passed about a pint and a half of very high colored urine. The eruption was now quite distinct, temp. 103°; pulse 132. The nitre and sodium were ordered, ten grains, and ten drops respectively, every four hours. Calling again in nine hours, I found the patient a little fighty. Only about a quarter of a pint of urine had been passed. Temp. 104°; pulse 136. Another “sweat” was administered, lasting about an hour and a half. Half an hour after it was finished, the temperature stood 102°, and the pulse 120. She now slept quietly six hours, and awoke perfectly conscious. About five o'clock of this day, (Feb. 11th), about 12 hours after the administration of the second "sweat," the patient was in good condition. Temp. 102°; pulse 120. About a quart of urine had been passed since two o'clock, and several smaller discharges before that time, and a free operation from the bowels had occurred. I administered another "sweat," however, which lasted for about an hour, and which reduced the temp. to 101o. She passed a quiet night. She went on to make a good recovery, and in two weeks and one day, after the attack (Feb. 8th), the rash had disappeared, the
patient was up and around the house. I
her a short "sweat" every day, until Feb. 18th. Administered the nitre and sodium till Feb. 15th, when I substituted for them iron and quinine.
Case II. B. F., aged three years, Nov. 15th, was taken sick in the afternoon. I was immediately called and found the patient, although not very sick as yet, still with some of the symptoms of scarlet fever. At any rate, as the disease was prevalent in the neighborhood, I resolved to treat the child, as if I could diagnosticate scarlet fever without any difficulty. The temperature stood 100°, and the pulse 115.
I prescribed a diuretic, and placed the patient in a “Corn Sweat,” not without some trouble, however, as she was so young. I kept her there for about three-quarters of an hour, at the end of which time a faint efflorescence had appeared. The temperature was still 100° and the pulse 110. In about fifteen hours, the temperature had reached 101', and the pulse 120. The secretion of urine had been scanty and high-colored. I placed the patient again in a “Corn Sweat,” which lasted for about an hour. A very free perspiration took place, and the rash was now very bright all over the body. Half an hour after the “sweat," the temperature was 100°; pulse 110. In about ten hours I called again, and found no change. Gave another “sweat” of about half an hour's duration, which made no difference in either temperature or pulse. Between the two last visits, she had had, twice, a plentiful discharge of urine, and an injection of castor oil had produced an evacuation from the bowels. In about twelve hours, after a night of quiet sleep, the temperature was 100°, and the pulse 106. The urine was now plentiful, and the child was doing well in every respect. This was on the third day. The temperature kept steadily at 100° until the seventh day, (with the exception of one day, when it was 101°) when it began to decline, together with the pulse ; and a week and a half after she was taken sick, all symptoms of the fever had disappeared. I gave her tonic treatment at the latter end of the disease, under which she made a good recovery.
The case that I am about to describe, is the severest one that