History of medical practice in Illinois - Bushnell Historical Society

used to fillGeneral Surgery 191bone cavities after the sequestrum was properly removed, theperiosteum being closed over the chips. Experiments were reported byDrs. Hopkins and Penrose using bone dowels to pin fractures together;these were said to hold for five or six weeks and then became absorbed.For abdominal surgery, Schaefer referred to the meeting of the BritishMedical Association in August 1889 where Treves discussed typhlitis, alocal form of peritonitis; he advised an incision after the first week of theattack as sufficient for most cases as an encysted abscess was usually foundand there was no danger of opening the peritoneal cavity. This was contraryto Murphy's hard fought contention, and it was the subject of discussionbefore the American Surgical Association. Treves described thetechnic of his operation and referred to the article by Murphy and Lee,saying that perityphlitis vermicularis always belonged tothe province ofsurgery and that two points were proven: (1) perityphlitis is always accompaniedby a pus cavity, and (2) with the present plan of noninterference,the patient was more liable to a return of the disease. Theirstatistics indicated that the mortality rate was greatly reduced by earlyoperation. Murphy operated upon 12 patients with 10 recoveries. Heclaimed that the appendix was uncovered by peritoneum one-eighth of itscircumference (contradicting Treves). "As pus within the base of the appendixaccumulates, it meets the least resistance at the uncovered point,and therefore it frequently ruptures through this point of least resistanceinto the pelvic cellular tissue, making the perityphlitic abscess extraperitoneal."Herniotomy and digital divulsion of the pylorus for cicatricial stenosis(Loreta's operation) were discussed, and a new method was described ofgastrostomy through the thoracic wall through the eighth intercostal space.Gastroenterostomy was the next subject. Four such operations performedby Selenkow of Russia were discussed, these making a total of 35 knowncases up to that time. The operation was considered useful in prolonginglife in carcinoma of the stomach and in incurable pyloric stenosis. The needto determine exactly the fossa of Treitz (plica duodenojejunalis) to identifythe beginning jejunum was stressed.For perforating wounds of the abdomen, Senn's method of diagnosis forruptured intestine by inflation with hydrogen gas administered via therectum was presented; the method was not received favorably. Discussionson nephrolithotomy and malignant disease of the rectum followed. At thistime some surgeons were excising the rectum and were discontinuing theuse of Kraske's posterior operation. The advantages of colostomy wereadvanced, but it was admitted that the operative mortality of these rectaland colon operations was very high.