752 



SURGERY. 



ney be found extensively diseased, it may itself 

 be removed. Another affection until lately 

 considered beyond tbe reach of help is what 

 is known as floating kidney, in which the or- 

 gan, on account of the laxity of its attach- 

 ments, changes its position from one side of 

 the abdomen to the other, and can easily be 

 felt by the hands, first in one place, then in 

 another. Such a condition is enough to render 

 the sufferer's life of no value to himself, and 

 justifies almost any attempts at relief. Up to 

 a few yenrs ago nearly all such attempts ended 

 fatally. Now they are recognized as legitimate 

 surgical operations, and are attended by a 

 very fair percentage of success. 



Extirpation of the Gail-Bladder. Not at all an 

 uncommon affection, and one which a few 

 years since was entirely beyond relief, is the 

 formation of gall-stones and their retention in 

 the gall-bladder, where they cause an amount 

 of suffering and inflammation often leading to 

 death. In such cases the usual treatment now 

 is to cut down upon the disease and not only 

 to remove the calculus, but to remove the gall- 

 bladder with it, and such operations are at- 

 tended by exceedingly good results. 



Rapid Lithotrity. The old and well-known 

 operation of crushing a stone in the bladder by 

 seizing it with instruments especially designed 

 for the purpose has been signally modified by 

 Bigelow, of Boston. Formerly such an opera- 

 tion was only completed after several sittings, 

 and was attended by great danger of inflam- 

 mation from the presence of the sharp frag- 

 ments resulting from the crushing. The opera- 

 tion is now done at a single sitting, the calculus 

 is completely crushed, and all the fragments 

 are removed before the patient leaves the 

 table. This operation of u rapid lithotrity," 

 as it is called, is not original with Dr. Bigelow, 

 it having long been known though seldom 

 practiced. But he has brought it again into 

 popularity, and has added to the facility of its 

 performance by the invention of a new instru- 

 ment for drawing the fragments out of the 

 bladder by the force of suction, after the crush- 

 ing has been completed. The operation, as 

 now practiced, constitutes one of the greatest 

 advancements in the surgery of the bladder. 



Drainage of CaTities in the Lungs. To whom 

 belongs the honor of first suggesting the bold 

 plan of opening into cavities in the lungs of 

 consumptive patients, and treating them on 

 general surgical principles, is a question which 

 will never be decided. Probably many men 

 have considered the practicability of it without 

 attempting it. Recently it has been accom- 

 plished with a considerable measure of success. 

 The walls of such cavities are generally ad- 

 herent to the chest- wall, and may be opened 

 into without any immediate danger ; and there 

 would seem to be no reason in the nature of 

 the case why, when such a cavity is laid open, 

 cleaned out, drained, and properly dressed, it 

 should not heal. The number of cases in 

 which drainage has been resorted to is consid- 



erable, and, although only a few have resulted 

 in the entire recovery of the patient, most of 

 them have been sufficiently relieved to justify 

 the operation. A soft drainage-tube is intro- 

 duced into the bottom of the cavity, which is 

 syringed out daily with carbolic acid, while the 

 wound is dressed antiseptically. 



Internal Illnmination of the Body. The desire 

 to see within the body for the purposes of diag* 

 nosis is a very natural one to the surgeon, and 

 with modern instruments much may be seen 

 which formerly could only be guessed at. With 

 the laryngoscope, for example, the whole ac- 

 tion of the larynx, the production of sound, 

 and morbid processes down to the bifurcation 

 of the trachea, may be exposed to the eye; as 

 with the ophthalmoscope the deeper parts of 

 the eye may be examined. Milliot, in 1867, in- 

 vented an instrument for lighting up the ab- 

 dominal cavity so that its contents could be 

 seen through the abdominal wall, but only 

 used it on animals and dead bodies. His ex- 

 periments led Lazarewitch to apply the same 

 thing to gynaecology. He, however, failed to 

 get light without at the same time getting an 

 amount of heat which rendered the instrument 

 both useless and dangerous. More recently 

 Dr. Nietze, of Vienna, originated the idea of 

 illuminating the interior of the bladder by 

 passing into it a white-hot platinum wire, and 

 the idea has been practically carried out by 

 Leitner, the surgical-instrument maker of that 

 city; hence the name Nietze - Leitner endo- 

 scope. The instrument consists of a platinum 

 wire heated by electricity, and surrounded by 

 a current of water to keep it from burning the 

 tissues. Sir Henry Thompson, though speak- 

 ing very cautiously, says there are some con- 

 ditions the existence of which we sometimes 

 suspect, but can not positively affirm to exist, 

 whose presence may now be ascertained by this 

 instrument. He refers to the identification of 

 sacculated stone as the cause of existing and 

 unrelieved symptoms; to the detection of 

 growths removable by operation ; and to the 

 investigation of the nature of foreign bodies 

 other than calculi which have become lodged 

 there. He says he has recently seen a fatal 

 case of vesical growth which might have been 

 easily removed by operation ; and in such a 

 case the new endoscope may possibly render 

 essential service. 



Carbolic-acid Poisoning. The almost universal 

 use of carbolic acid as an antiseptic for the 

 dressing of wounds has resulted in the knowl- 

 edge of a peculiar form of poisoning. It has 

 been proved that too much of the acid applied 

 to an open sore may be absorbed into the cir- 

 culation and cause death, with high tempera- 

 ture, a peculiar dark, smoky appearance of the 

 urine, convulsions, and symptoms of heart- 

 trouble. The peculiar diagnostic appearance 

 of the urine is supposed to be due to an escape 

 of the coloring-matter of the blood in the form 

 of indicin. Carbolic acid, when taken into the 

 circulation, is quickly eliminated by the kid- 



