Surgical Cases. By George W. Brown, M. D., of Port Car-
bon, Pa.
(Continued from No. VII )
Case IV. Jonathan D., a stable-man, fifty years of age, five
feet ten inches high, pretty well made, but of rather dis-
solute habits, came into my office November 9th, 1852, with his
arm supported in a sling, and desired me to examine his shoulder.
I stripped him, and at a single glance, I saw he had a dislocation
of the right os humeri into the axilla. The shoulder was flat-
tened, the acromion process of the scapula very prominent with
a depression immediately uhder it, the arm was immoveably fixed,
and the head of the bone could be felt in the axilla.
The history he gave of his case was that two weeks previous
he went to Pottsville for a load of feed, and he drank rather
freely, and 'when he came home he opened one of his bags, and
took hold of the mouth with his right hand, and placed it upon
his right shoulder, and in attempting to walk a plank from his
waggon to the stable with his load, he was precipitated to the
ground a distance of three feet, and as he fell he felt something
give way in his shoulder, and when he arose he suffered severe pain
in the part, and found the arm immoveably fixed. He immedi-
ately called in a neighboring physician, who came, and made ex-
tension for some time, and finally told him it was reduced. He
placed a pad in the axilla, put the arm in a sling, and then
forced the elbow as close to the side as he could with a bandage
placed around the arm and body, and left. He called the next
day, and as he was suffering acute pain he insisted the bone
was not in its place, but the Doctor gave him a liniment to
rub his shoulder, assuring him that it was reduced; and thus
things stood when he came to me, the pain never ceasing in his
shoulder for one moment. I placed him in a chair and applied a
proper apparatus, and after torturing my patient for some time,
and breaking the belts attached to it, I removed it, and placed
him upon his back upon a buffalo robe upon the floor, and
setting down beside him I placed a ball of wick yarn in his
axilla, and drew my boot and placed my heel upon it, and seiz-
ing his wrist wfith both my hands at the same time directing an
assistant to seize me by the shoulders from behind, and another
to seize him in the same way, and so on till I had the force of
four men, when at a given signal we all made gradual but con-
tinued extension for about three minutes, when the bone slipped
into its place with an audible snap, and immediately the patient
was relieved, and the free motions of the arm were restored. The
arm and hand were very much swollen, and he complained of great
numbness of the entire limb, with the total loss of the power to
contract his fingers, but this I attributed to the pressure of the
pad in the axilla upon the vessels and nerves of the arm ; but after
having applied such remedies as reduced the swelling, I discovered
a dislocation of two of the bones of the carpus, but the inflamma-
tion and consequent adhesions were such as to forbid any attempt
at reduction (if indeed that is possible under any circumstances,)
and to destroy almost entirely the use of the hand. He has at
this date very free use of the arm, but very little of the hand.
Case V. I was called to see Thomas D., a miner, 30 years of
age, about five feet ten inches high, and very large and muscu-
lar, at 8 o’clock, P. M., Sept. 21, 1852. On examination I
found a dislocation of the femur directly backwards upon the
dorsum ilii. He was suffering a good deal of pain, and upon
comparing the two bones of the thigh, the dislocated one was
from two to three inches shorter than the other, and immoveably
fixed. The history he gave of his case was, that as he was com-
ing out of the mines he stopped to talk to some one, and while
doing so he leaned his back against one of the gangway timbers,
and placed his left foot upon the bumper of an empty car that
was standing on the track, and while in that position a loaded
car came down the track and struck the car upon which he had
his foot, and carried it forward with such force as to flex his
leg suddenly upon his thigh, and thereby strike his knee, and his
back being firmly fixed against the gangway timber offered so
much resistance that the head of the femur was carried directly
backward into the position in which I found it. I secured a sta-
ple into the surface upon one side of the house, and into the
door casing upon the other, each being about three feet from the
floor. I then placed a bed upon the floor and placed the patient
upon the sound side upon it, and applied the compound pulleys
in the usual way, and kept up extension and counter extension
for nearly an hour with two men at the pulleys, when the pa-
tient positively refused to let me go on with my efforts, unless I
put him under the influence of chloroform. But having very
lately read of a number of cases terminating fatally from the use
of chloroform in the hands of those who were in the habit of use-
ing it constantly, I thought it best to have a consultation before
proceeding further. I therefore gave the patient an anodyne,
and directed him not to be moved, and adjourned the case until
nine o’clock the next day.
At the time appointed, Dr. Carpenter met mein consultation,
and I applied the pulley in the usual way, except that I ap-
plied the extending band to the ankle, instead of applying it im-
mediately above the knee, as is usual, in consequence of the ex-
cessive developement of the muscles of the thigh, which made
the link so tapering near the knee as to render it impossible to
keep the extending band in position, while applying the necessary
force. I now set the patient up in bed, with all the apparatus
properly applied, and tied up his arm and made a very large orifice,
and let the blood flow till he was on the point of fainting; when
I immediately arrested the flow of blood, and commenced admin-
istering the ether (thinking that less dangerous than chloroform)
and as soon he was completely under its influence, we placed him
in position and commenced gradual extension, but before we had
made it sufficiently long, the staples gave way and we were obliged
to desist. We now laid the patient down and sent for a carpenter,
and had the staples so secured as to prevent their giving way, at
the same time raising the one attached to counter extending band
to almost five and a half feet from the floor, so as to make it bear
in such a way, as to assist in lifting the head of the bone from its
malposition. We again placed him completely under the influence
of the ether, and put four men to the pulleys, and two to the
transverse band, when I took charge of the lifting band, and Dr.
Carpenter the leg. After applying our force very gradually and
keeping up extension for about five minutes, the head of the bone
slipped into its place, with a very loud snap, and in letting him
down the motions of the limb were restored, and it corresponded in
every respect with its fellow. I placed him in bed and applied a
bandage, so as to confine the injured limb to the sound one, and in
a few minutes (the effects of the ether having passed away,) the
patient expressed his gratitude for relief, in the warmest terms.
I gave him a liniment to be applied to his hip, and directed him
to be kept quiet in bed for a few days. At the end of ten days
he was walking about with a stick entirely restored except a feel-
ing of weakness in the vicinity of the joint.
Case 6.—I was called to a neighbouring beer house, in a great
hurry, Nov. 23,1852, to see Thomas C., a boatman 25 years of age,
stout, thick set and very muscular, whom I found very much in-
toxicated, and two or three of his comrades holding him to re-
strain him from injuring himself; and others around him. He
had a silk handkerchief bound tightly around his right arm, and
he was covered with blood, as was the floor, ceiling, and sides of
the room, and indeed everything in it. The history of his case
was, that some fifteen or twenty minutes previous, in attempting
to strike one of his companions, he drove his arm through a pane,
of glass in the window, dividing the muscles of the forearm down
to the bone, about the junction of the lowerwith the middle third;
at the same time dividing the radial artery. He drew his arm
back and drove it down a second time upon the sharp pieces still
hold in the sash, when a small pointed piece penetrated the fore-
arm about one inch above the first wound, and divided the radial
artery a second time. The blood was still flowing from under the
handkerchief, which had been bound around the arm by the by-
standers. I immediately placed the thumb of an assistant upon
the brachial artery, directing him to hold it firmly till I returned,
when I came home and procured my horse shoe tourniquet, and
applied it over the artery, and had him removed to his own house.
By the time he was taken home and placed in bed, he was so
overcome with the loss of blood and the effects of the liquors that
he offered no resistance whatever, but was as passive as a child.
I placed him upon his back in bed, near the edge, and drew his
arm out over the side, and had it held firmly by an assistant.
I now made an incision obliquely over the course of the artery,
about one inch above the upper wound ; but in consequence of
the tissues being bathed in blood, I found it very difficult to
apply the ligature, but I finally succeeded ; but as the flow of
blood still continued, I was obliged to apply a ligature to the
lower end, which I did in the large wound, without much trouble,
and then brought the wounds intact by several stitches of the
interrupted suture and adhesive straps. I also applied a bandage
pretty tightly, commencing at the ends of the fingers, and as I
passed up with the bandage I applied a compress over the wounds.
I ordered perfect quiet, and cold water dressings as soon as re-
action came on,
November 26th, 9 o’clock, A. M____Patient rested pretty well
till near morning, when he became restless and uneasy. He is
now very restless and feverish, with a good deal of pain in his
head and arm, pulse 112, tongue white, dry, and very thirsty.
To have calomel ^ss., to be divided into three equal parts, one
to be taken every two hours, and to be followed by senna and
salts, in divided doses till it operates freely. 10 o’clock, P. M.
The medicine has operated very freely, less pain in the head and
arm, less thirst, but very nervous and restless. To have one
fourth of a grain of the sulph. of morphia every hour until he rests
well, and to have cold lemonade for a drink.
November 27th, 9 o’clock, A. M-----Patient passed a very good
night. Better in every respect. Continue treatment. My pa-
tient from this time on continued to improve, the ligatures com-
ing away on the tenth day, and by the end of the third week he
had entirely recovered. He now experiences no inconvenience
in using his arm whatever.
Case 7____I was called to see Mary S-----, aged seven years,
a child with light hair, blue eyes, a very fair skin, and altogether
of a very delicate make. At the time I was called she was la-
boring under a very high fever, face flushed, with a purple spot
on each cheek, rapid breathing, short dry cough, pulse 120,
tongue covered with a white fur, and very thirsty, skin hot and
dry, and severe pain in the left breast.
Physical Symptoms_____Complete hepatisation of the left lung,
as shown by a dull sound over the entire lung, and the absence
of the healthy respiratory murmur, and the existence of tubal
respiration. Decubitus always upon the left side. I bled her
freely till near syncope, and gave her an antimonial emetic, to
be followed by calomel in five grain doses every four hours, with
mucilaginous lemonade for drink, and flying sinapisms to the
chest and back.
November 24th.—Patient somewhat relieved, pulse still 120,
but less corded, cough still dry, pain less acute, but still severe,
skin still dry and husky, and the tongue covered with a yellowish
fur, particularly near the root, and the physical signs much the
same as yesterday. Blood drawn yesterday cupped and huffy,
clot very firm. Emetic operated very freely, and caused her to
throw up large quantities of tough white mucus, but no blood.
The calomel has operated very freely upon the bowels. Continued
calomel and antimony in small doses every ten hours. Flying
sinapisms to the chest and back, and cold lemonade with gum
acacia for drink.
November 25.—Patient is still very much the same, but more
feeble in consequence of the bowels being very loose. Discon-
tinue calomel and antimony, and to have iodide of potassium, three
grains every four hours, with tinct. opii and camph. in the syr.
sarsaparilla compound. A liniment of equal parts of the ol.
terebin., acid acetic, and ol. olivce, to be rubbed to the chest, and
to be covered with carded cotton constantly. Dov. pulv. with
the hyd. c. creta at bed time. Continue cold mucilaginous
drinks.
November 26th______Patient considerably improved, but the
mother complains that she cannot give the medicine, as she is
very obstinate, and spits it out as fast as it is administered. The
same kind of treatment was ordered to be continued, but very
little could be done, as she would not take the medicines, and the
parents would not force her, as they had made up their minds
that she "was going to die, although I had assured them if they
could get her to take her medicines I thought she would recover,
and thus things continued up to the 6th of January, 1853; some
days taking one dose of her medicine, some two, and some none;
some days being a little better, and on others a great deal worse.
I had not seen her since the 21st of December, as I had discon-
tinued my visits in consequence of their not compelling her to
take the medicines. I now found her laboring under all the
symptoms of abscess of the lung. Pulse 130, small and weak,
cheeks flushed, skin bathed with perspiration, particularly when
she sleeps, bowels very loose, tongue clean, shining, and very
red, and on examining the chest I found the dulness much the
same as at last report, but in the intercostal spaces between the
sixth and seventh, and seventh and eighth ribs, immediately below
the axilla, I found a very considerable bulging, and I thought I
could detect fluctuation. I ordered a warm poultice to be kept
constantly to the side, and a continuance of the iodide of potas-
sium and syr. sarsaparilla, with the hydr. c. creta at bed time.
To have a good diet of animal broths, with a little wine or porter
three times a day.
January 10th.—The enlargement in the intercostal spaces be-
coming more prominent. Patient in much the same condition as
at last report, except that the appetite has improved some, but
her breath is very offensive, and a few evenings since, in an ef-
fort at vomiting, she threw up a small quantity of very offensive
pus. I now prepared to operate upon the child, and draw off the
matter with a trocar, but this the parents resisted, and would not
hear of such a thing. Continue treatment as before.
January 14th.—Patient still much the same as at last report,
except that she is becoming exhausted more rapidly. Friends
still resist an operation. Continue treatment as before, except
that she is to have the ol. jecor. aselli, in teaspoonful doses every
four hours, in porter, and the hyd. c. creta every four or six
hours, as may be necessary to restrain the bowels.
January 20th. The disease has progressed much more rapidly
towards a fatal termination since last report. Her breath has
become so very offensive, that the family can scarce remain in
the room with the door closed. Parents have now consented to
an operation, they being satisfied that she must die in a very
short time without an operation, and that she can but die with
it. Continue the treatment, with the addition of the elixir of
vitriol in ten drop doses, three times daily.
January 21st. In the presence of and with the assistance of
Dr. J. Carpenter, after drawing the skin directly upwards and
making it tense, I made a slight incision immediately over the
upper edge of the 8th rib, and then passed the trocar and canula
into the chest, and drew off about ten ounces of extremely offen-
sive pus of a greenish color. The air passed in and out of the
canula as she inspired and expired. Blood flowed freely from
the wound after removing the canula, but ceased upon closing it.
After closing the wound with adhesive straps, we applied a com-
press over it, and bandaged the entire chest from below upwards.
She bore the operation very well, and seemed much relieved
after it. Continue treatment.
January 26th. Diarrhoea nearly ceased, coughs but very little,
breath much less offensive, appetite becoming very good, and
she has become very fond of the oil. From this time forward,
my patient progressed favorably till March, when the abscess
partially filled again ; but an opening formed with one of the
bronchial tubes, and after a fit of coughing, she was seized with
vomiting, and threw up near half a pint of the same kind, of
greenish pus as before, with perfect relief to all of her symptoms.
Some time in April, the same thing took place, but to a much
less extent. I examined her lung in July, when I found healthy
respiration in all parts of the lung except that part occupied by
the abscess, which is dull and the side contracted. I have seen
her frequently in the last few days, and she appears to be per-
fectly restored so far as her delicate constitution will permit.