« PreviousContinue »
The Medical Society of City Hospital Alumni
President, LOUIS H. BEHRENS, 374! Olive Street
Secretary, FRED. J. TAUSSIG, 2318 Lafayette Ave.
CHAIRMEN OF STANDING COMMITTEES :
Scientific Communication, Wm. S. Deutsch, 3135 Washington Ave. Executive, A. Ravold, Century Building
Publication, W. E. Sauer, Humboldt Building Entertainment, Frank Hinchey, 4041 Delmar Ave.
Public Health, R. B. H. Gradwohl, 522 Washington Ave.
A NEW PROCEDURE IN TENDON AND method offering better assurance of success MUSCLE TRANSPLANTATION APPLIED was finally devised.
This was to interpose IN A CASE OF INFANTILE CEREBRAL the palmaris longus and flexor carpi radialis PALSY.
between the source of power and tbe point of
its application. These muscles are superfic. DRS. PHIL HOFFMANN AND SIDNEY I, SCHWAB.
ial, and being long avd slender, approximat
ing a tendon in shape, offered a good medium Read before the Medical Society of City Hospital Alumni, through which to transmit the biceps' pull. St. Louis, February 1, 1906.
They being paralyzed, were used simply as DR. HOFFMANN.-In presenting this case passive structures to connect the tendon of I shall limit my remarks to its orthopedic the biceps, where it crossed the elbow, with aspect, leaving the neurologic side to Dr. the tendons of the finger flexors, where they Schwab, with whom I have been associ- crossed the wrist. After the biceps tendon ated in its care. The patient, a boy of had been detached from its insertion at the seventeen, was afflicted with a left bemi. radius, it was sewed into a longitudinal slit plegia of cerebral origin, dating from a in the bellies of the flexor carpi radialis and few days after birth. He had entire loss falmaris longus, which had been previously of power in the flexors of the band and detached from their common origin at the wrist, and barely enough in the extensors to inner condyle of the humerus. Next, the extend the fingers, but not the wrist. The tendons of the flexor carpi radialis and pal. little extensor power present offered no possi. maris longus were cut from their insertions at ble chance of success from the ordinary the wrist and sewed, en masse, to the tendons method of tendon transplantation, i.e., at- of the deep und superficial finger fexors, intaching the tendons of the paralyzed muscles cluding the long thumb flexor. Now, the bito contiguous healthy
ones in the same seg. ceps in contracting pulls primarily on the ment of the limb. The extensor muscles flexor carpi radialis and palmaris longus, and were so weak that it was useless to try to di. secondarily, through them, on the tendons of vide their power with the flexors. There was, the flexors sublimis and profundus digitorum however, fair power in the flexors and exten and flexor longus pollicis. The operation was sors of the elbow. The boy had never used performed at the Jewish Hospital, September his hand, and there was no possibility of in. 1,1905, and the splint removed November 10. juring its function by any procedure, as the No sign of flexor function was observed until hand could not have been worse functionally. November 26. Since then there has been The thought occurred that possibly we might gradual improvement. He is now able to draw upon the intact upper arm for power grasp a fork or spoon and carry it to his with which to supply the paralyzed segment mouth; and can lift a five-pound flat-iron below. The first thought was to cut away and hold it for thirty or forty seconds. In the biceps from its insertion into the radius order to prevent the biceps from also flexand insert it directly into the central ends of ing the elbow when it is flexing the fingers, the deep and superficial flexors of the fingers. he must synchronously contract his triceps. This idea was abandoned because the great None of the fingers have independent movebulk of the muscle bellies of the finger ment but all, including the thumb, are flexed flexors would afford but a poor medium together. Having no power in his wrist exthrough which the biceps could exert a pull tensors, and the finger extensors being too upon the fingers, and because the dissection weak to extend the wrist by a continuance necessary to detach the origins of the superfi. of their action, he must wear a splint to cial and deep flexors from the humerus, bold the wrist in the fextended position, so radius and ulna would result in such exten- that his new finger flexors can act to good sive scar formation as to probably altogether advantage. He will later be relieved of the prevent transmission of the biceps' pull. A necessity of wearing the splint by an oper- .
ation to anchylose the wrist in the extended cal method of treatment, and that is surgical. position, a so-called arthrodesis.
orthopedio interference. The sooner this is Dr. Hoffmann then exhibited the patient. understood the better the results are bound
to be. In this case the result does not apDR. SCHWAB.—My interest in this case is pear to be unusually brilliant.
The patient chiefly concerned with the pleasure I have still has his deformity and the restoration of had in working with the orthopedist. There function has been slight, comparatively speakare several points in connection with this ing. The grasp of the band has been in a case that are of importance. It is one of in
measure restored. This case, however, may fantile cerebral palsy in which the mentality be taken as an example of the way we should is almost normal. In the greater number of go and the method of attacking the problem. these cases there is some mental involvement, The thing is to get these cases early before but in a certain small percentage there is no joint changes have taken place and before the apparent mental defect. In such cases the atrophy and succeeding contractures of the presence of a physical deformity will neces- muscles have produced a deformity too exagsarily tend to interfere with the patient's gerated for easy correction. In a case of an. success in life, and we are, therefore, moved terior poliomyelitis, if in a year a full restorto greater efforts to aid in the removal or ation of function is not obtained, then it is betterment of this deformity. Therapeutic the duty of the physician to call an ortho. measures in the usual acceptance of the term, pedist to consider the advisability of surgical such as strychnine, electricity, etc., are of no interference. In the very old cases it is avail, and dependence upon them alone is uphill work to get good results. Spiller, nothing short of a therapeutic crime. If this Frazier and Taylor have in this country patient, some years ago, had been placed un- worked out the nervous-surgical aspects of der the care of an orthopedist who under. these cases, and they and others have obstood fully the mechanics of the arm and had tained good results by tendon-muscle nerve been willing to make use of that knowledge, transplantation and suture.
transplantation and suture. Dr. Schwab, in the results might have been much more grat. closing, insisted that great care be taken in ifying than is the case now. The sad feature making the differential diagnosis. Oppenof the case is that the boy has been allowed heim last year had called attention to cases to reach nineteen years of age without the of progressive muscular atrophy which had attempt being made to afford him any logical been operated upon with the idea that ansort of relief. The boy is sufficiently bright, terior poliomyelitis was present, of course no but any position that he may apply for he improvement had taken place. It was ab. will have to overcome a prejudice created by solutely necessary in all these cases that a his deformity. He is able to write fairly well differential diagnosis be made, and in some and has received a good enough education, cases this might be a hard task and at times but in spite of this any chance of advance- inj possible. ment is practically denied to him. An at
DISCUSSION. tempt should be made in this class of cases first to correct deforwity and then to restore Dr. Norvelle Wallace Sharpe thought the function. If by any chance the two together results were quite encouraging, for the boy can be obtained a most gratifying result will was, certainly, a great gainer by what had follow. The results in tendon work which been done. It was, as Dr. Schwab had said, Dr. Hoffmann has done in cases
an object lesson for all of us. The profession seen together have been on the whole encour. was derelict in this class of cases; as an ex. aging, and we have felt that even in this ap- ample he mentioned à colleague who had parently hopeless case an attempt was justi- bimself bad a congenital deformity. Some fied. The great trouble that we have found years ago Dr.Sharpe had tried to induce this is that cases hopeful in the beginning for gentleman to have something done by tendon surgical interference are kept under treat. or nerve transplantation, but found that he ment for years and years until the plastic was strongly opposed to such treatment, at period of youth or childhood is passed, and least for his individual case; and Dr. Sharpe then it is frequently too late to obtain the believed that this man's view point was the best results. An example of this sort of result of his training in college years ago therapy is the common custom of treating and the additional fact that the profession as spastic types of paralysis with electricity, at- a whole, fails to realize the actual possibili. tempting apparently to increase the muscle ties, for this unfortunate class, by an intelli. tone in an already hypertonic muscle. There gent intervention. It seemed, too, almost a is one thing that can be positively asserted, crime to fill these patients with the convenand that is, that when such a condition exists, tional therapeutics of the neurologist. He as in the present case, there is only one logi. wondered if sometbing might not be done in
developing this boy's extensor power by must first be determined what power retransplantation.
mained, and how that power could best be Dr. A. E. Taussig, said that the compara
transferred to the point desired. In this tive weakness of the fingers might be due to
case, the boy had the main funotion of the the weakness of the biceps, tbe young man
hand, the power to grasp.
In the operation not baving been trained to use the biceps, if
the pronator radii teres and the pronator so, an increased finger function might be ex
quadratus were divided because they were pected as a result of education of that mus.
short and held the forearm in strong prona
Dr. Francis Reder mentioned an experience Dr. Schwab, in closing, insisted upon the of his which had occurred some ten years care to be taken in a differential diagnosis. ago. A patient was brought to him, a lad of Oppenheim last year bad called attention to some fifteen years, who stumbled frequently cases of muscular atrophy operated upon by while walking. The boy was found to have orthopedists. Of course no improvement bad suffered from infantile paralysis when three taken place. If the cases of anterior polioyears old, the muscles affected being the an. myelitis were seen by the orthopedist early terior set of muscles of the leg. It occurred enough there was room for all sorts of mato him that some good might result by slic- nipulative interference. From the standpoint ing off a piece of the tendo Achilles and at- of the neurologist it was absolutely necessary taching it to the tendon of the tibialis anti. that he be able to exclude progressive muscucus. Inexperienced as he was at that time in lar atrophy, and this, from the neurologist's this work the result was reasonably satisfac- standpoint, was sometimes a very difficult tory, and in six months the boy was able to thing to do. But in all cases the diagnosis walk without falling. The result was most between the spinal and the cerebral types of gratifying to those interested in the boy. He paralysis must be made. wished to know what experience Dr. Hoffman had had with the extensor muscles of
Dr. Hoffmann said tbat this was the leg, and would be not feel more encour.
doubtedly a case of the cerebral type and had aged as to a successful outcome to perform a
at one time been spastio, but the condition tendon transplantation upon the leg than
of the boy when they got hold of him was upon one of the upper extremities?
such that there was no spasticity of the
were Dr. Hoffmann, in closing, said that opera- flacoid. tions upon the lower extremity were as a rule more successful, because in the upper extremity there was required a finer adjustment of the muscle balance. In the lower extremity,
MYOMA OF THE UTERUS. – when one supplied the ability to lift the foot,
B Ext. mammae siccati. .... 3 ij a great deal was accomplished, as the main Ft. in capsulae No. xxiv Sig. One to four functions of the lower extremity were to bear capsules t. i. d.-Ex. the weight and clear the ground in a satis.
THE WHISKY HABIT.-It is factory manner. In the upper extremity claimed that a person cannot take the followthe function required much more intricate
ing and drink whisky at the same time, i. e., muscle co-ordination. Replying to Dr.
it will cure the whisky habit if a patient will Taussig's remarks, Dr. Hoffman said that in the biceps in his case, the power was per- R Apomorphine haps 50 per cent of the normal.
This was Strychnine enough, if it could be transmitted without
3 68 any interference at all, to give a good grasp. Tinct.cinchona comp., q.s.ad. 3 ij But it also required training, and this would
M. Sig. One teaspoonful every three probably accomplish a good deal. The pa
hours.-Burnett, Med. Summary. tient had already learned to use a fork and could bring it to his mouth. He could ex. DIET IN DIABETES.–Osler says: Reduce ert quite a pull temporarily, but not for a starches and sugars to a minimum-gluten long time, so it appeared that training ought bread or a few ounces of ordinary bread daily. to do much for the boy. As to tendon trans- Avoid alcoholic liquors and restrict diet gradplantation, there was danger of it falling into ually to nitrogenous and hydrocarbon foods, disrepute because in many cases it had not outting off one thing after another. Sac. been a success on account of the operation charin, glycerin or levulose may be used in being done without due consideration of what place of ordinary sugar. A more liberal reg. power remained in the limb, and how best to imen may gradually be allowed within a redistribute it. In order to obtain success it month or two.-Denver Med. Times.
gr. ij gr. ss
THE MEDICAL FORINIGHTLY ing well.directed
stake, and no time should be lost in executing well-directed and positive measures.
The measures selected will depend upon the Issued Tenth and Twenty-Fifth of Every Month. cause, location and extent of the laceration. Under the Editorial Direction of
Such ruptures are said to be "complete" or FRANK PARSONS NORBURY,
"'incomplete," that is, whether they pass enTHOS. A. HOPKINS, CARL E. BLACK.
tirely through the uterine wall, inoluding the With the following staff of Department Editorg
peritoneum, or whether the peritoneum is 0. E. LADEMANN, Internal Medicine.
only stripped up and not lacerated. Also JOHN MCHALE DEAN, Surgery. R. B. H. GRADWOHL. Pathology and Bacteriology.
they may be classified as to whether or not W. H. VOGT, Obstetrics and Gynecology.
any or all parts of the obild are entruded into WALDEMAR FISCHER, Ophthalmology. A. LEVY, Pediatrics.
the peritoneal cavity. . The object of treatW. T. HIRSCHI, Therapeutics. A. F. KOETTER, Otology.
ment must be the immediate delivery of the HERMAN STOLTE, Laryngology and Rhinology. child. This will usually be accomplished by F. P. NORBURY, Nervous and Mental Diseases. T. A. HOPKINS, Genito-Urinary Diseases.
forceps, by version, by embryotomy or lapar. ROBERT H. DAVIS, Dermatology.
otomy. In only about 10 per cent of the
cases is the child saved. In complete rupEDITORIAL
tures the life of the mother is saved in only one-fifth of the cases, w
ment and in less than fifty per cent of the WE print in this issue a paper on the above cases which receive the most prompt aud effi. subject in which two cases are reported by cient treatment. In incomplete ruptures the
the author as ocourring prognosis is more favorable, athough even in in his own obstetrical
these the mortality is high. C.E.B. Rupture of
experience of less than the Uterus.
that any practitioner, wherever located, may have such experiences leads us to call attention to it. In 1875 TAE UROLOGICAL SOCIETY.-At a meeting Bandl called attention to the faot that rup- held at the Blue Grass Hotel, St. Louis, on ture was usually due to two principal causes: Friday evening, March 16, a society to be First, there is some malposition of the child, known as the St. Louis Urological Society wbich interferes with its descent and at the
The first contribution was a same time furnishes angular parts of the child
paper by Dr. Bransford Lewis, which was fol. against the uterine wall. Second, in such
lowed by an interesting discussion partici. cases the lower segment of the uterus becomes
pated in by all members. Dr. Bransford overdistended in Nature's eflort to overcome
Lewis was elected president, and Dr. E. A. the obstacle, and the wall becomes corres- Scharff secretary-treasurer, by the following pondingly thinner until the wall is ruptured named gentlemen, who constitute the charter by the angular prominence.
members: Drs. J. L. Boebm, C. E. Bur. A second, and much rarer cause of this ac- ford, T. A. Hopkins, H. Jacobson, Brangcident, is the presence of projecting promi.
ford Lewis, G. M. Phillips, A. R. Ravold, enences from the pelvio bones which tear the
Wm. Robertson, E. A. Soharff, H.J. Soherck, uterine wall as the descent of the child forces
O. L. Suggett, A. S. Wolf. it out against them or pelvic tumors which obstruct the passage and lead to overdisten- IODINE AS AN ANTISEPTIC. —Nicholas Senn, sion of the lower segment by undue uterine professor of surgery in Rush Medical College, contractions. Ruptures rarely ocour above Chicago, concludes a scholarly study of the "contraction ring,” because that part of iodine in surgery, with special reference to its the uterus is in active contraction, and is use as an antisentic, with the following summuch thicker than the lower segment. There mary: 1. Iodine is the safest and most po. is great difference of opinion among authori. tent of all known antiseptics. 2. Iodine in ties as to the frequency of this accident. proper dilution to serve its purposes as an Some place the ratio as low as 1 in 1200 antiseptio does not damage the tissues; on
; cases, while others say 1 in 5000 cases, It is the contrary, it acts the part of a useful tisso infrequent that it makes little difference sue stimulant, producing an active phagocy. to the average practitioner. He is likely to tosis, a process so desirable in the treatment only meet one or two, at most, in a lifetime of acute and chronio inflammatory affections. practice.
3. In the treatment of simple hyperplastic The treatment of such an accident requires goiter actinomycosis and blastomycosis, the the greatest care and expedition on the part local use of iodine is made more effective by of those in attendance. Two lives are at oataphoresis.-Ex.
THE REVIEWER'S TABLE Books, Reprints, and Instruments for this department, should
be sent to the Editors, St. Louis.
REPORTS ON PROGRESS Comprising the Regular Contributions of the Fortnightly De
THE DOCTOR'S RECREATION SERIES. Vol. IV. A Book About Doctors. By John Cordy Jeaffreson, Author of
SURGERY. "The Real Lord Byron," "The Real Schelly," “A Book About Lawyers.” etc., etc. Fourth of series of twelve volumes compiled for the amusement, rest and relaxation of
JOHN MCHALE DEAN, M. D. medical men. Akron, Ohio: The Saalfield Publishing Co. (Price, Silk-Cloth, per vol. $2,50, Half-Morocco, per vol. $4.00. By Subscription Only.)
Common Duct Cholelithiasis.-In Journal It is indeed fortunate that this interesting of Surgery, Gynecology and Obstetrios, W. and valuable contribution to the literature Mayo Robson discusses the subject of comembracing bistory and tradition has been in- mon duct cbolelithiasis. Many new and incorporated in this series and placed at the teresting points are brought out by the aucommand of American readers. Mr. Jeaffre- thor. The author finds the occurrence of son's Book About Dootors, beyond any other stone in the common duot in 40 per cent of of his numerous works, made his reputation
The synptoms of common duot in literature in Britain, it was his greatest stone are repeated "spasms” and jaundice. success.
American readers will find it of in. The jaundice is not as deep as we find in can. tense interest from cover to cover. Though cer of the pancreas or common duct, and is largely bistorioal, dealing principally with more intermitting. This changeable jaundice characters of the seventeenth and eighteenth is caused by the movable stone in the duct centuries, it seems to picture present condi- Acting on the principle of a ball valve. tions and characteristics and depict them
The author claims all cases of cholelithiasis immutable of the medical person, even though are accompanied by more or less inflammathe armamentarium is vastly enlarged and tion, and we frequently find as a result ad- . cbanged with the years. The book is quite hesions. The obstruction of the duct is the equal in point of literary worth and vital seldom complete, and in consequence disinterest of its fellows in the very attractive tension of the gall bladder is not always series.
present, as we would suppose from backward pressure of bile.
The muscular coat of the
gall bladder contracts in an effort to expel "'INDIVIDUALISM VERSUS SOCIALISM."-Any the stones. This contraction continues un. expectation of sensationalism in William til atrophy of the gall bladder ensues. The Jennings Bryan's discussion of "Individual. author olaims that the differential diagnosis ism versus Socialism” in the April Century of common duct stone and cancer of the is likely to be unfulflled. The paper, it is head of pancreas is not always an easy task. said, is a succinot presentation of the claims By some elaborate chemical examination of and objects of individualism and socialism, the urine brought out by Dr. Cammidge cerwhich Mr. Bryan defines as tendencies tain acicular, sharp edged crystals arranged rather than concrete systems.
in rosettes are found. If these dissolve in also urges that there should be no unfriend- dilute sulpburio acid in 30 to 40 seconds im. liness between the honest individualist and pacted stone or pancreatitis diagnosis is the honest socialist, since both are seeking made. If these crystals are tbick and rounded that which they believe to be best for so- and dissolve in sulphuric acid in 1 to 5 min. ciety; and he points out how the one may utes cancer of the pancreas is the diagnogreatly aid the other in the common aim of sis. It is lamentable that the author did not both, the harmonious development of the bu- in his valuable article describe this elaborate man race, physically, mentally and morally. chemical process to enable others in using it But he holds that the socialist is inclined to in making a diagnosis. The author mentions . support monopoly, believing that it leads to twenty-eight different conditions that may governipent ownership of monopolistic indus- threaten the life of a patient suffering with try; whereas individualists contend against common duct stone. The operation is renconsolidation of industries and stand for a dered easier if with a longitudinal incision morality and for a system of ethics which the liver is turned upwards and outwards. they are willing to measure against the ethics In this rotation of the liver we bring into and morality of socialism.'
view the common duot and the duodenum and an otherwise difficult and deep opera
tion is rendered more superficial and easier INFLUENZAL VERTIGO.-Stewart directs to in execution. Drainage of the common keep patient recumbent, and give tonics and duot by a rubber tube fastened by catgut nutrients with moderate doses of alcohol dur. suture in situ is used by the author, toing the later stages.
gether with drainage of the kidney pouch.