Some weeks after this, Dr. Lowery called me to see a woman about 30 years of age, who had received a fracture of the skull with depression of the bone. The trephine was successfully used as in the preceding case; but one of the branches of the middle meningeal artery was cut by the trephine, and for a while gave a little trouble; but the bleeding was effectually controlled by careful compression. freely dusting iodoform over the part; the patient made a good recovery. EXHIBIT FIV E. In September, 1891, at Washington, D. C., was read before the American Orthopedic Association, and published in its Transactions for that year a paper by the writer entitled, “On the Best Means to Prevent a Loose Joint, or Dangling Limb, After Resection at the Shoulder Joint; with an Illustrative Case." Often the operation for resection at the shoulder joint, instead of gracing the annals of surgery, is an opprobrium to the surgeon's art; should any one doubt this statement let him visit the makers of surgical appliances, make inquiry for and examine the numerous contrivances devised to hide a very poor surgical result, after resection at the shoulder joint. These appliances give at best some little usefulness to the forearm and hand; but they reveal the fact that they are intended to make somewhat useful, otherwise quite useless, dangling arms and loose shoulder joints. Without a support to the arm by means of the subsequent use of some sort of mechanical appliance, this operation of exsection often leaves the patient in a very pitiable condition. By the use of an elastic bandage during the after treatment of such exsection, the writer has pointed out the means to avoid, in future, a loose shoulder joint and dangling arm. At the time of the publication of his paner in 1891, it was stated therein that his patient had repeatedly driven a four-horse team; had thrown a fourteen-round weight to a distance, lifted seventy-five pounds and was improving rapidly. is condition now, January, 1898, is excellent as ryards the useful gauze, and over this a circular piece of very thin rubber tissue cloth, and overlapping the rubber on all sides for several inches I put a dressing of borated cotton, and applied a double-headed bandage, securing it under the chin, not having with me any elastic bands. EXCISION AT THE SHOULDER JOINT. Cured: Good useful arm, without aid of any apparatus. Showing exact size of diseased bone removed; four and three-quarter inches long, and ball attached with silver wire. Trans. Amer. Orthopedic Association of 1891. These illustrations are not there given, except one, which shows how a Russian felt sount was shaped to suit this case. ness of his arm that was resected at the shoulder joint. and is due to the proper use, in the after treatment, of an elastic rubber bandage which, so far as the writer knows no one has heretofore ever though of or used for this purpose, or at least given any recorded account of it, in any such manifest and conspicuous manner as reported by the writer in the Transactions of the "American Orthopedic Association" of 1891. Vol. IV., P. 21, et sq. EXCREPTS FROM THIS PUBLISHED REPORT. Says the writer of this report: "The main feature to which I allude, and which may in future be established as a principle of treatment in excision at the shoulder joint, is the use of an elastic pressure by means of a simple rubber bandage, five yards long and three inches wide, applied over the dressing like the third bandage of Dessault for fractured clavicle, together with the use of an immobilized Russian felt splint, shaped and fitted to the sides of the chest, arm, and forearm." "In all cases of shoulder joint resections, the cotton bandage, however accurately applied, carefully watched and readjusted, yields to the pressure of the arm. But with the rubber bandage properly used, an elastic support and desirable elastic pressure are unceasingly acting during the healing process." "Case-April 13, 1891, in the presence of, and assisted by Drs. Geo. B. Packard, Lowery, and G. H. Gobson, all of Denver; I resected four and three-quarter inches of the humerus; see fig. as exhibited by the accompanying specimen. Appended is the ball, the cause of the injury. I. C. Palmer, aged about 36 years, of Dillon, Colorado, in the act of firing at a railroad robber received from him, fired from a Winchester rifle, a ball that split the head of the humerus, and lodged deeply in the glenoid cavity of the scapula and remained there for twenty months, or until the date of the exsection at the joint, which was a few weeks after he was first seen by me." "During the, after treatment an old sinus gave some trouble, having led to suppuration of the wound. The most trouble and delay during the operation, however, were occasioned by a firm, bony union, or ankylosis, which made the operation quite difficult. Some days afterward, the temperature arose and suppuration appeared. The wound was ripped open; large counter-openings made; the one made during the operation enlarged, and large setons of gauze. saturated with balsam of Peru of good quality. inserted. A tin gutter lined with oakum and secured to the arm with gauze bandages, and the limb supported by a pillow, formed the dressing each dav until a Russian felt splint and the elastic bandage were resorted to." CASE OF I. C. EXCISION AT SHOULDER JOINT: Fig. 23. From a photograph during treatment. Showing the elastic rubber bandage applied over splint; first used by the writer in such cases, and reported in Trans. of American Orthopedic Association, 1891. Diagram of splint used, shown in Trans. Amer. Orthop. Assn., of 1891, Vol. IV., p. 21, with description, which is too long for insertion here, as are also other details. Memorandum note made in 1898: Last August, 1897, the patient with the exsected shoulder joint had photographs taken of himself by a tourist traveling through the mountains of Colorado, who kindly made them for hi.n, and Palmer sent them to me. He was at work in the vicinity, and one of the pictures shows him holding a heavy sledge hammer in his right hand, steadied by his left. He possesses great strength in shovelling dirt or ore, and in pitching hay and ricking it during harvest time with a hay fork. A four-horse team ran away with him recently which he effectually controlled and stopped. The muscles of his arm. of which he has retained the use, are enormously developed, and he is a very powerful man in the use of his two arms, needing no braces or appliances of any sort. |