Vol. 60, 1909 - University of North Carolina at Chapel Hill

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The Charlotte Medical Journal
Vol.. LX CHARLOTTE, N. C, NOVEMBER, 1909. No. 5
Constructive and Imperative Operative
Surgery, Extraordinorily Unique
Cases, with Successful Results.
I Wilmington,
RrssEti, Bellamy,
N. C,
Ex-Captain and Senior Surgeon of Squadron A., N.
Y. Cavalry, Late Instructor, etc., in New
York and Cornell Universities— lo
years. Alun. mis iiellevue Hospital,
N'ew York City and at University
of Vienna, Austria.
Since my return to my native State, North
Tarolina. (1908) after an absence of eigheeu
years, principally spent in New York,
Colorado, and Europe, it has been my good
brtune tonandlefive cases which were and
ilways will be especially interesting, intructive,
and novel to me. It seems that
he time is now ripe for the surgical world
o know about them.
Dr. William T. Hull said to me three
ears ago, when I told him of the enormous
mount of work I was doing and the seven
ears' experience in one of the hospitals in
Cew \'ork in Lesser Surgery, "Vou are doiig
just the thing. So few surgeons know
nything about minor surgery; they only
;uow about major work, ['"ewer lives would
e lost, if more attention were paid to cases
[Ot in the category of major surgery."
' Will
the operative surgeon enlarge his
phere of action and become as well the
onstructive surgeon, doing the combined
'ork of architect and builder? Are these
le fantastic images of a prophetic vision?
he history of the development and growth
f surgery in the past gives reality to our
icpectations and hopes of what the future
ay unfold, and is this, in truth, not the
eat work of surgery in the future?"
Swing Mears).
To save every part of the organism should
: the aim of the surgeon, and to remove
ily those parts which by leaving will prove
detriment to the body. Often it becomes
icessary to substitute, and as a covering
id filler I have found the egg membrane
be most satisfactory. It is easier to apy
than skin and seems to have a special
tion in filling of concavities, as the fol-
—
vania a considerable time attempting to
learn some things relative to egg membrane.
Sad to relate, I have found almost nothing.
Egg membrane is added to the egg while
it is in the thick-walled terminal part of the
hen's oviduct, just before the egg is laid.
It is the hardening of the oviduct secretions;
likewise is the shell. The egg membrane
is a non-cellular, interwoven, and
keratin substance like formation containing
C, 49.78; H., 6.54. N., 16.43; S., 4.25;
and O., 22.90. (Lindvall)."
Technique.—The egg is secured the day
it is laid and thoroughly washed and scrubbed
with green soap, a stiff brush, and
warm water, followed by a solution of bichloride
of mercury 1-1000. It is then
cracked with a sterilized hammer and the
shell removed by pieces, or it is cracked
and divided, the yolk and white emptied,
and with fine forceps and scissors the membrane
is removed in strips ]-2 inch wide to
two inches long. The inner or albuminous
surface is laid on the surface of the wound,
a sterile salt solution dripped on and rubber
tissue placed over it, which is held in position
by sterile gauze.
One of the interesting things about the
membrane is that it in every case has grown,
no pus ever having shown itself. The great
annoyance, liability of infection, and subsequent
suffering of the patient is avoided.
Dr. J. ^L T. I'inney in a recent
article on skin grafting, cites cases
which he classifies as unsuccessful. One
feels like suggesting that an area, even as
large as the cases he mentioned, could be
covered with membrane, a number of eggs,
it is true, being required.
In all the cases, from time to time, new
membrane was added to facilitate the healing
of the granulating surfaces, and increase
new tissue cells. In some inexplainable
way, the membrane seemed to act as
a filler as well as a surface covering.
CASE I., E. W., CRUSHED AND TORN LAST
PALMA PHALANX MIDDLE FINGER
This patient had a box weighing over 100
pounds fall for a distance of some inches
cases will lend to show. After on his finger literally crushing out, at least,
iwing hausting the libraries here and finding one-third of the end of the finger. After
isolutely nothing as to its histology, the using every known method for some days,
Hewing information was iqailed me by a deep gaping wound, going almost to the
y friend, Dr. S. H. Schotz, Jr., Medical phalanx, still remained. At the eame time
ispector for the F.quitable, to whom I am the nail was removed.
pecially grateful. He writes in a letter, In order to get the opening to heal, I,
ijed July 9, 1909.
from time to time, placed pieces of mem-
"My Dear Doctor: I have spent at brane over the end of phalanx, as described
'e libraries of the University of Pennsyl- by me under head of technique. The finger