SURGERY OF SELMA AND VICINITY.

BY A. S. GARNETT, M. D., OF SELMA.

In accordance with the task imposed upon me, I now present you with a report of the surgery and surgical diseases treated by the members of the Selma Medical Society. And before doing so, I must beg your indulgence for the inadequate manner in which the task is performed.

Harpocrates, the Egyptian God of Silence, was represented with finger on lip, and may be considered one of the few heathen deities worthy of imitation. "Be swift to hear and slow to speak," is an apostolical injunction impressed upon us by the reiative organs of hearing and of speech. As expressed by Zeno, "Men have one tongue and two ears, and should hear much and speak little." The example of the God, and the precepts of the Christian and the philosopher, combine with a natural, unaffected difference on my part, in attempting to produce such a paper as might prove interesting or instructive.

I cannot be charged with exageration, I think, in claiming for our profession, that no other presents a wider field for thought, or includes topics demanding more intelligent investigation and research. The modesty and self-distrust of some individuals draws a veil over their fine intellects, and varied experience and accomplishments. Others of great professional learning and research acquire habits of silent thought, the expression of which becomes difficult amid the increasing cares and toils of a physician's life.

The following cases are reported by Dr. L. E. Locke:

Case First.-On December 14th, 1869, I was called to see Bella, (octoroon,) aged 26, with a fracture of the leg, the result of a fall from a height of fifteen feet. An examination revealed the tibia and fibula of the left leg fractured transversely, about two inches above the maleoli; and also an oblique fracture of the tibia at the junction of its middle and upper third, with a dislocation of the ankle joint. I put the patient under the influence of chloroform, (Dr. H. N. Roper assisting,) and reduced the dislocation and fracture by extension and manipulation, applying a roller bandage and straight board splints, well padded with cotton, as a temporary dressing. The dressing was hastily applied at night, under extremely difficult and trying circumstances, and I intended on the next day to remove

it for a better and a more permanent one; but on subsequently visiting her, and ascertaining the absence of tumefaction and severe pain, I concluded to leave her in statu quo.

January 1st, 1870, removed the splints, bathed the leg in camphorated spirits, and reäpplied the dressing. January 7th, some ulcerative tendency manifesting itself, I made the following application: R. carbolic acid 10 grains, distilled water 4 oz., and then encased the leg in an accurate mould of book-binder's board, and kept it in position by a roller bandage. This was done by first wetting the board and moulding it to the leg, and letting it dry in situ. When thus used, it makes a capital splint, being strong and uniform in its pressure and support. For the first five days, this patient was kept quiet with morphine, and during that time no application of any kind, save the splint and bandage, was made to the fractured limb. Her vital powers were supported with stimulants, and a uutritious diet. Result.-Perfect recovery with no perceptible shortening.

The novel feature in this case arises from the fact that this woman was three months advanced in pregnancy at the time of the acci dent, and that she went to her full time, giving birth to a healthy and vigorous child. That a woman should receive so severe a shock and sustain so serious an injury without detriment to the contents of the womb, must be without a parallel.

Case Second.-B. S-, child, aged three months, with veinous tumor on the occiput. This child had been treated in the country by a physician who cauterized the tumor and dressed the eschar with simple cerate. When I first saw the patient, the tumor, according to the history given, had greatly enlarged, and was discharging a dark, bloody fluid, which, when permitted to dry, formed a hard, irritating crust on the scalp, productive of much pain and annoyance. Having the diseased surface washed and cleansed, I applied a paste of glycerine and sub nitrate of bismuth, which had a most happy effect, causing a most speedy cure. I have tried this paste in many instances, and for indolent suppurating surfaces I know of no application which acts more promptly and kindly.

Milton K, aged thirty, with a compound comminuted fracture of left arm, result of a railroad accident. Twelve hours after injury I amputated the arm at a point two inches below the elbow. On the fourth day after operation, a tendency to slough manifesting itself, I ordered a lotion of carbolic acid and zinc, and cold water dressing. On 15th day after operation, removed ligatures, and the patient improved rapidly.

The following cases are reported by Dr. C. F. Fahs:

Case First.-Millie Stafford, aged about twenty-three years, colored, married three years, never had a child, severe dysmenorrhea of two years standing; attributes it to a bad cold taken at that time, it being her menstrual period; says her courses always lasted a week or more; small in quantity, often pale in color, and the pains so

violent she was compelled to go to bed and take large doses of morphine for relief. Pain always commenced several days before the flow began, and increased as it approached. She was pale, emaciated, and complained of debility and want of appetite. Examination by speculum showed that the cervix uteri was elongated and indurated, and the os was not more than an eighth of an inch in diameter. With the aid of my accomplished friend, Dr. W. P. Reese, I performed Sims' operation of dividing the cervix bi-laterally, to overcome the stricture. The cervix was an inch and a quar. ter long, by three-quarters of an inch in diameter, and was divided to a quarter of an inch of the reflection of the vagina. The hemorrhage was slight, and the pain not at all severe. No fever or any other bad symptoms followed, and she was walking about as usual on the third day. The operation was performed on the ninth day of March, 1867, and on the twenty-first her menses returned. They were not preceded by any pain, and she said she was not aware they had come on until she accidentally discovered the blood. The flow was very full, and of a healthy color. In the night she had some paroxysms of pain, and says some clots came from her, almost black in color, and very hard. On the 22d, slight pain during the morning; free flow, no pain in the afternoon and night. On 23d, says pains, in paroxysms, returned again about 4 A. M., and that black, hard clots came from her similar to those described above. By 10 A. M. they disappeared entirely, and did not return. The flow continued until the 25th, when it ceased, having lasted little more than four days. She says she has never menstruated so freely before; that she has no more weakness in her back; feels stronger, and like a different person. She says before her menses came on this time, her uterine region was enlarged, and her breasts swollen-due, without doubt, to retained menses. I think the paroxysms of pain were due, they having coagulated, and the clots being too large to pass the stricture. I believe the operation has been entirely successful, and that at her next menstrual period, she will have no pain. Her barrenness, I think, was due to the physical obstructions named, and that she is now very likely to conceive.

Case Second.-Frances Stevenson, aged twenty-eight, colored— married two years-barren; has had severe dysmenorrhea for more than two years, and her general health very much impaired. The menstrual discharge was very small in quantity, and generally pale in color. The paroxysms of pain preceding and accompanying the menses, very violent, requiring her to lie down, and take large doses of opiates for relief. Her general health finally became so much deranged that she had to spend most of her time in the bed. By a speculum examination, I soon discoved that she had an indurated conical cervix, with a contracted os. I attempted to pass a very small bougie, but only succeeded partially. The pain and irritation were so great that I feared pelvic cellulitis would follow, and I con

cluded to perform Sims' operation. By measurement the cervix was one inch long, and gradually come to a point, the os occupying the centre. On the 10th of March, assisted by Dr. W. P. Reese, I made a bi-lateral division of the cervix, to a quarter of an inch of the reflection of the vagina. More hemorrhage followed than in the other case, but not at all alarming. She remained in a recumbent posture. In five or six hours pain began to be developed in the uterine region, which steadily increased until fomentations were applied, and opiates administered. 11th.-She rested badly last night; still complains of pain; pulse frequent, skin hot and dry; prescribed a purgative, to be followed by an opiate, and the fomentations continued. 12th.-Improving; pain less severe, and fever subsiding. She continued to improve from day to day, and in four or five days after the operation, she was sitting up. I omitted to mention that in this case, after dividing the cervix, I introduced Simpson's sound into the cavity of the uterus very easily, showing that the stricture had been overcome. She was now put on a tonic treatment, and rapidly gained flesh and strength; her spirits improved, and she said she could walk without having pain in her back, or feeling fatigued. March 21st.-Her menses returned without the slightest pain, pure blood, she said, and a free flow, which continued two days. At this time she is enjoying as good health as she ever did in her life, and seems to be restored to a condition in which all her functions may be regarded as fully and physiologically developed.

Case Third.-Case of gun-shot wound of right thigh, two inches below the groin. The femoral artery was cut, and the hemorrhage was very profuse, but was arrested by the attending physician by compression. I did not see the case until one week had elapsed, and then his whole condition was very bad. There was no suppuration, and the whole system was very much prostrated. He had phthisis, and, finally, after five or six weeks, he died of the latter disease.

Case Fourth.-Case of necrosis of the spine of the scapula. The patient, a white woman, aged about thirty, has had primary and secondary syphilis. The disease was in the central part of the spine of the scapula. I enlarged the opening leading to the bone, and cut out the diseased portion by means of bone forceps. The case has entirely recovered.

The following cases occurred during the months of January and February, 1871:

Case First.-A negro man was accidentally shot by a companion in the early part of January. The ball entered the abdominal walls, several inches below the sternum, and to the right of the median line. It ranged down towards the cavity of the pelvis. I found the patient very much prostrated, and suffering a great deal of pain. I ordered him to be kept perfectly quiet, and gave him a full dose of morphine. My prognosis was unfavorable. He died in less than twelve hours.

Case Second.-J. L. K—————, fell from the iron bridge of the Selma & Montgomery Railroad, that crosses the Alabama river. The height was thirty-five feet. He fell headforemost, and fortunately threw out his arms, which saved his head from striking a stringer. The violence of the fall resulted, however, in producing a fracture of the left radius and ulna of the right arm; fracture of the left radius and compound dislocation of the left ulna at the wrist. All the fractures were near the wrist joints. I reduced the fractures and dislocations, and applied two splints to each arm, extending from the ends of the fingers to the elbow joints. As he suffered very violent pain, I had to keep him under full doses of opiates for the first few days. He improved very rapidly, and at the end of three weeks I sent him to his home, at Dalton, Georgia.

Case Third.-A negro child, fifteen months old, got on the Selma, Rome & Dalton railroad track as an engine was backing down to the depot, and had his right leg cut off just below the knee. I amputated in half an hour afterwards, about two inches above that joint. He bore the operation very well, and has had no bad symptoms since the accident occurred. It is now about three weeks since I operated, and the child is nearly well.

The following cases were reported by Dr. B. H. Riggs:

Case First.-Patsy McDonald, colored, chronic conjunctivitis ; transparency of the right cornea very much injured, almost blind in this eye; there was also some opacity of left cornea; photophobia severe and constant headache; attributed her disease to cooking with cooking-range; had been under treatment in Mobile; disease of three months standing. I put her upon the following treatment, with the result of a rapid cure: Collyrium of corrosive sublimate one grain to four ounces of water; mix thoroughly, let it stand for twenty-four hours, then strain through fine muslin; a crescentic blister behind each ear; slippery elm meal poultices to be kept constantly applied to eyes, renewing them three or four times a day, and using the collyrium between times. Take at bed time 10 grains of Dover's powders, and five grains of nitrate of potass: to take three times a day a pill of-quinine two grains, calomel one-half grain and ext. hyosciamus one-half grain, before meals. These were kept up until the gums were slightly "touched," diet farinaceous, and to keep strong light excluded. Progressed steadily to recovery.

Case Second.-George Garrett, freedman. The index and middle fingers of his right hand were so lacerated and torn as to require amputation. With the assistance of Dr. S. H. Hudson, who administered chloroform, I amputated these two fingers, making a long flap on their surface, severing the bones just above the second joint, bringing the flaps over their ends and sewing them to the dorsal skin. Dressing of cold water, adhesive straps used, the digital ar