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i October 21, 1S93J MEDICAL RECORD. 537 the colon and give only sterilized or boiled milk. The improvement was rapid and remarkable. He had learned of the value of salicin from the elder Flint. Bismuth was useful in children. Bloodless Amputation at the Hip-joint ; A Eecord of Cases Operated upon by the Author's Method. — Dk. John a. Wveth, of New York, read this paper. The first part was devoted to a brief historical review of attempts to render amputation at the hip joint a blood less operation. It had been only about four years since the author had first operated in the manner about to be described, and since that time he had collected thirly- nine cases. I'nder strict antisepsis the operative tech- nique was as follows : 1. With the patient in the usual position for hip joint amputation, the limb should be emptied of blood either by elevation of the foot and lowering the trunk, or by the Esmarch bandage applied from the toes to the trunk. Under certain conditions the bandage can be only par- tially applied, or may not be applied at all. When a tumor exists, or when septic infiltration is present, press- ure should not be exercised quite to the diseased portion for fear of driving septic matter into the vessels. In in- juries with great destruction, Fosamax 70 crushing, or pulpification, of course the Esmarch bandage is not applicable, and one must trust to elevation to save as much blood as possible. 2. While the member is elevated, or before the Es- march bandage is removed, the rubber-tube constrictor Fosamax Lawsuit is applied. The object of this constriction, and it is the chief point in the method, is to have absolute occlusion of every vessel at the level of the hip-joint above the field of operation. To prevent any possibility of the tourni- quet slipping, I employ two large mattress-needles, or skewers, about three-sixteenths of an inch below the an- terior superior spine of the ilium, and slightly to the inner side of this prominence, and it is made to traverse super- ficially the muscles and fascia on the outer side of the hip, coming out on a level with and about three inches from the point of entrance. The poiiit of the second, smaller needle, is entered one inch below the level of the crotch, internal to the saphenous opening, and, passing squarely through the adductors, comes out an Fosamax Mg inch below the tuber ischii. The points are shielded at once by bits of cork to prevent injury to the hands of the operator. No vessels are injured by these skewers. A piece of strong white-rubber tube, one half inch in diameter, and long enough when tightened to go five or six times around the thigh, is now wound very tightly around and above the fixation needles Alendronate Fosamax and tied. If the Esmarch bandage has been used it is now removed. 3. In the formation of flaps the surgeon must be guided by the condition of the parts in the field of operation. When permissible the following method seems advisable : About six inches below the tourniquet a circular incision is made, and this is joined by the longitudinal incision commencing at the tourniquet and passing over the trochanter major. A cuff, containing the subcutaneous tissue down to the fascia, is dissected off to near the level of Buy Fosamax the trochanter minor. At about the level of the trochanter minor the remaining soft parts, to- gether with the remaining blood-vessels, are divided down to the bone by a circular cut, and in order Fosamax Online to facilitate the search for the vessels the soft parts are rapidly re- moved from the femur for several inches below the line of the divided muscles. At this stage of the operation the larger vessels, veins as well as arteries, can be tied with good sized catgut. As suggested by Professor Murdoch, of Pittsburg, he now left the entire extremity intact, Fosamax With Vitamin D and used the full length of the limb as a lever in dislodging the head of the bone When the larger and easily recognized vessels have been secured, the muscular attachments of the upper extremity of the bone are re- moved with the scissors or knife, keeping along very close to the bone. Holding the soft parts away with retractors, the cap- sular ligament is exposed and divided Fosamax 70 Mg Weekly in its circumfer- ence. Forcible elevation, abduction, and adduction of the thigh permits the entrance of air into the socket, and at the same time ruptures the ligamentum teres, and the dis- location is then easily and rapidly Fosamax 35 Mg effected. Properly conducted up to this point, not a drop of blood has es- caped except that which was in the limb below where the constriction was applied. If now the tourniquet be carefully and gradually loosened, each bleeding point may be easily determined and the forceps applied as required, until the tube is entirely removed. 4. The closure of the wound with Price Of Fosamax the usual precaution of drainage remains. Dr. Wyeth preferred silk-worm- gut ; one good-sized rubber drain from the acetabulum passed out at the most dependent part of the Fosamax With D wound. When by reason of proximity of epithelioma or destruc- tion of Fosamax 10 Mg parts, use a modified method. The author had been able to secure statistics of thirty nine amputations by the foregoing method. There had been a death-rate of 23.7 per cent, (five were reamputa- tions) ; sarcoma, 16 cases, 2 deaths, 12.5 per cent. ; in- flammatory bone diseases, 18 cases, 3 deaths, 16.6 per cent. ; violence, 4 cases, 4 deaths, 100 per cent., all very severe and extensive injuries ; nerve injury, one, no death. Thus it would be seen that there had been thirty- five am- putations for disease with five deaths, 14.2 per cent.; four amputations for injuries and four deaths. This was in marked contrast with Ashurst's list of 633 cases with a mortality of sixty-four per cent. It was not claimed, how- ever, that the reduced mortality-rate was due entirely to avoidance of hemorrhage which this method implied. Antiseptics, etc., had something to do with it. By this method bleeding could be as successfully controlled as in amputation of the thigh at any point below. Dr. Joseph D. Bryant said the results of this method spoke for themselves. Dr. Wyeth was to be congratu- lated for devising the means by which hemorrhage in amputation in the hip-joint could be so successfully con- trolled. Dr. Donald McLean, of Detroit, said he appreciated Dr. Wyeth's method of controlling hemorrhage, but he mustexprsjss the conviction, with due modesty, that there was even a better method, which was to make pressure upon the abdominal aorta by means of a tourniquet. He had operated, controlling hemorrhage in this manner, a number of times with entire satisfaction. Scarcely a drop of blood need be lost. Dr. Reginald H. Sayre, of New York, feared the skewer would, in some Fosamax D cases at least, be too near the line of incision. Dr. Wyeth said the technique of the procedure which he had described was applicable in all cases. He had op- erated in nine minutes. The Treatment of Angpular Deformities of the Hip- joint. — Dr. Reginald H. Sayre, of New York, prefaced his remarks on this subject by the statement that the best thing was to prevent angular deformity by proper treat- ment at the outset. In any case of hip joint disease there should be recovery, if the recovery took place at all, with the legs parallel. The treatment varied with the nature of the disease and the condition of the joint when seen. The history of a few illustrative cases was given. Bony anchylosis sometimes existed when it was supposed to be fibrous, and vice versa. When Fosamax Plus D bony union existed, at- tempts at motion would not produce pain. The con- trary was likely to occur when there was fibrous union, although the motion was very slight. In many cases the use of some force would break up the attachments, and by degrees we would succeed in securing a fair amount of motion. In other instances we had to resort to osteo- Fosamax Price tomy. Third Dav, Wednesday, October iith — Morning Session. Opposed to a Change in the Code. — The Secretary offered the following resolution : In reply to the notice of the American Medical Association requesting that the 538 MEDICAL RECORD. [October 21, 1893 State medical organizations in affiliation with that body express their wish in reference to any changes in the Code of Ethics, the New York Medical Association has to say that it has made that Code one of its foundation-stones, and it is entirely opposed to any alteration therein. This is the result of a full reconsideration of the subject, and after an experience of ten years of organization under that Code. The resolution was adopted without a dissent- ing voice. Treatment Indicated after Trachelorrhaphy. — ^Dr. William H. Robp, said that in the majority of cases trachelorrhaphy restored the parts to their normal condi- tion and the patient to health. In a few instances, how- ever, this result did not follow, and in order to trace the reason therefor, Dr. Robb described briefly the anatomy of the pelvic organs, especially of the uterus, the changes which take place during pregnancy and subsequent invo- lution. Laceration of the cervix, when of sufficient sever- ity, left the womb in a state of subinvolution, and was fol- lowed by various pathological changes in the cervix and neighboring parts. Treatment after trachelorrhaphy was general and local. Of many drugs, he wished to mention two from which he had obtained particularly good re.sults when administered internally — they were mercury and iodide of potassium. Fosamax 70 Mg The local treatment required the patient to be put to bed, position, hot douches, glyceride tampon, tincture of iodine, abstraction of blood from the cervix, etc. Three months of this treatment often started an im- provement which terminated in Fosamax Buy Online recovery. The condition most frequently found in his practice had been endome- tritis, often complicated with fungous degeneration. Scraping of the entire endometrium and draining with gauze were indicated. In case of inflammatory pelvic deposit galvanism had spared the necessity for abdominal section. If there were imperfect union of the cervix a second operation would be called for. When all treat ment failed, the woman could be promised removal of the appendages after the menopause. Dr. a. Palmer Dudley, of New York, thought that if the after treatment described by Dr. Robb were carried out before trachelorrhaphy, there would be no failures from the operation itself. Then, in repairing the cervix, he divided the uterine artery on both sides and ligated it with the sutures, so that the blood-supply to the hyper- plastic organ was cut off during about forty days. By that time great reduction in size had ensued. In the prelim- inary treatment Fosamax Femur of the diseased and enlarged uterus he touched the parts with pure carbolic acid. Free drain- age was essential. He advised that the cervix be re- paired immediately after labor where possible. He had done this in a few cases, employing reflected light. Dr. Robb said slight lacerations of the cervix healed without any operation, and Dr. Ferguson doubted whether immediate repair would be an easy procedure in primipara. Voluntary Commitment of the Insane to Asylums. — Dr. W. D. Granger sent the paper, which was read by the Secretary. Up Fosamax Alendronate to recent times asylums for the in- sane had been merely places of incarceration — prisons,

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