History of medical practice in Illinois - Bushnell Historical Society

General Surgery 161Dr. Brainard advised a subcutaneous operation by means of agimletor needle, hoping thus to avoid devastating suppuration. He spoke of theearlier use of ivory pegs that had been employed in these 1 ases as interferingwith callus formation between the bone fragment ends. He started 1)\using a small instrument through a minute skin puncture, then makingthree punctures across the non-union in the bone through such a hole.Ten days later, using a longer drill or gimlet, he made more traversingholes and continued thus until some tenderness and heat appeared in thepart. He often required as main as eight such local operations to succeedin finally establishing bony union. He obtained union in 16 out of 17patients of ununited or delayed union of long bones. He also recordedtwo cases of ununited femora in which the bone ends were fixed togetherin open operation by a metallic substance. Both of these resulted in bonyunion but only after much suppuration. He did not recommend the procedurefor ordinary use. He reviewed the known methods employed up tothat date for this condition, citing Malgaigne's method of rubbing thefractured bone ends together, the use of acupuncture needles, setons, ligature,resection, abrasion of fragments and cauterization. He cited Hamilton's"Textbook on Fractures" which advised "the practice recommendedby Brainard, namely, perforation of the soft parts and bone with an awl"and "if in the lower extremity, allow the patient to walk about after theplan of White or Smith." We can understand, therefore, that Dr. Brainardof Illinois not only had a national reputation, but also an influence insolving at least one of the most difficult problems of surgery of his day.Dr. Brainard also reported at this time the wiring of bone ends togetherwith three successful cases, and treatment of malunion after fracture withdeformity by weakening the bone on one side by perforation to soften itin order to permit easy breaking by forcing it back into position with splintpressure. Finally, he described an operation for ankylosis of the knee jointwhich might be considered the first arthroplasty of this joint performedin Illinois.Brainard prophesied that when instruments were found capable of effectinga neat and perfect division of the bone with so little injury to the softparts as not to give rise to suppuration, his method would become obsolete.He had contrived several different kinds of saws to effect this but none hadsucceeded. He related a method of manual reduction of dislocated hipswithout the help of pulleys or other mechanical power then employed. Healso described an operation for ankylosed mandible, removal of jaw sequestra(mostly from mercury poisoning), and removal of parotid andsubmaxillary glands for a scirrhus carcinoma of the parotid which he hadoperated upon in 1857; to accomplish this, he divided the external carotidartery and facial nerve. Finally in his report he gave the technic of an opera-