SURGICAL EXTRACTS. Which
operation
is
the
Haemorrhoids.
best
for
most
MedicoChirurgical Journal).?In this country where piles are so common amongst all classes and races, the opinion of so well-known an authority as Dr. Kelsey cannot but be of interest. He is strongly in favour of the operation by clamp and cautery. He has operated by this method exclusively for the last ten years without having ever had haemorrhage or any serious accidents; and always with success. The patients were generally allowed up on the third day, and many of them left hospital 011 the fourth or fifth day. He sums up his personal experience as follows : (1) If you wish to radically cure your patients with the least possible pain, loss of time, confinement to the house, and risk of accidents, use the clamp and cautery. (2) If you wish to accomplish the same result with no more risk, but with more pain, more local and general disturbance, and longer confinement, use the ligature. (3) If you wish to take an hour to do what can as well be done in a minute and gain nothing by it in results, use Whitehead's operation. This summary forms a useful offset to the statement made by Allingham years ago that the clamp and cautery is at least six times as fatal cases
of
(Bristol
August
1895.]
CURRENT MEDICAL LITERATURE?SURGICAL EXTRACTS.
the ligature?a statement frequently repeated often challenged, and for which neither, of the Allinghams seem ready to furnish any proof, in spite of the fact that when last repeated (by which time the figure had grown to eight instead of six) three public requests for proof appeared almost simultaneously in British
as
as
journals. Rose's Operationfor TrigeminalNeuralgia AND
OTHERS, WITH RESULTS AND REMARKS. Medical and Surgical Journal).?In attempting to compare Rose's operation with that of Hartley, it seems to be generally admitted that the latter gives a freer view of the ganglion and more certainty in its removal, though it limits the removal of the branches to the portion within the skull; in Rose's operation the nerves can be removed up to the bony canals they enter. In both operations haemorrhage is a prominent feature, but it occurs under different conditions in each. In the Hartley method it occurs after the skull is open and the brain exposed, conditions which may lead to most serious results. In Rose's method the haemorrhage is simply embarrassing and prolongs the operation; it can at any time be controlled by pressure, and must, to a large extent, have ceased before the skull is opened. In Hartley's method the htemorrhage is at the end and dangerous part of the operation; in Rose's at the beginning. Mr. Rose writes of his seven cases:?"The results have been most gratifying. In only one instance, and that a highly neurotic woman, has there been any return of the pain, and then not at all severe. I have noticed a little stiffness of the lower jaw, easily tolerated in comparison with the terrible pain from which relief has been obtained." Rose's cases were operated on in 1890,1891 and January 1892, so that three to five years have elapsed. Parks reports that his two cases operated on nearly three years ago are all right. Andrews has had two relapses after being cured for a good while;" and one in which there is still "complete relief after three years." Parkhill reports recurrence after full relief for two years. Eskridge reports one case, which continues quite free from pain two jTears after the
(.Boston
"
operation. Altogether twenty-three cases operated on by Rose's method have been reported, and of these only three have died from the operation. Fowler gives some figures in the Annals of Surgery, on the results of removal of the infraorbital nerve, which will be interesting to compare with those given above. In twentysix cases in which the infraorbital nerve was removed together with Meckel's ganglion, there was complete relief for over three years in three cases, for over two years in six cases, and for The average relief over one year in nine cases. in all was one year and five and-a-half months. In twenty-six cases of neurectomy of the infraorbital without removal of Meckel's ganglion,
31
immunity for three years in five cases, years in three cases, and over one year in seven cases. The average was one year three and-a-half months. The results thus far obtained in the intracranial operations do not justify the abandonment of the more superficial neurectomies in persistent neuralgia, but certainly justify the expectation that they will afford great and probably permanent relief where recurrence takes place?a relief so great as to fully justify the danger they involve. there
was
over two
a Vesical Analgesic.?{The Surgical Reporter).?Yignerous' experience leads him to think that antipyrin will prove a valuable vesical analgesic. Injected into the bladder, the remedy is free from harmful effects, even when employed over a protracted period. As an antiseptic the author believes ib
Antipyrin
as
Medical and
superior to solutions of boric acid. When the solution of antipyrin is allowed to remain in the bladder, it not only relieves the pain, but checks spasmodic contractions. A 4 per cent, solution left in the bladder for ten minutes is sufficient to diminish the pain attending subsequent washing or instillation. Antipyrin may be emplo37ed in all cases of cystitis in which local treatment induces pain. When the bladder is not distended, two and-a-half to five drachms of a 4 per cent, solution, left in the bladder for ten minutes, is sufficient. When the bladder is much distended, fifteen to thirty drachms of a one or half per cent, solution should be injected and allowed to remain in the bladder. to be
H. W.
Pilgrim,
m.b., Lond.
operation
is
the
Haemorrhoids.
best
for
most
MedicoChirurgical Journal).?In this country where piles are so common amongst all classes and races, the opinion of so well-known an authority as Dr. Kelsey cannot but be of interest. He is strongly in favour of the operation by clamp and cautery. He has operated by this method exclusively for the last ten years without having ever had haemorrhage or any serious accidents; and always with success. The patients were generally allowed up on the third day, and many of them left hospital 011 the fourth or fifth day. He sums up his personal experience as follows : (1) If you wish to radically cure your patients with the least possible pain, loss of time, confinement to the house, and risk of accidents, use the clamp and cautery. (2) If you wish to accomplish the same result with no more risk, but with more pain, more local and general disturbance, and longer confinement, use the ligature. (3) If you wish to take an hour to do what can as well be done in a minute and gain nothing by it in results, use Whitehead's operation. This summary forms a useful offset to the statement made by Allingham years ago that the clamp and cautery is at least six times as fatal cases
of
(Bristol
August
1895.]
CURRENT MEDICAL LITERATURE?SURGICAL EXTRACTS.
the ligature?a statement frequently repeated often challenged, and for which neither, of the Allinghams seem ready to furnish any proof, in spite of the fact that when last repeated (by which time the figure had grown to eight instead of six) three public requests for proof appeared almost simultaneously in British
as
as
journals. Rose's Operationfor TrigeminalNeuralgia AND
OTHERS, WITH RESULTS AND REMARKS. Medical and Surgical Journal).?In attempting to compare Rose's operation with that of Hartley, it seems to be generally admitted that the latter gives a freer view of the ganglion and more certainty in its removal, though it limits the removal of the branches to the portion within the skull; in Rose's operation the nerves can be removed up to the bony canals they enter. In both operations haemorrhage is a prominent feature, but it occurs under different conditions in each. In the Hartley method it occurs after the skull is open and the brain exposed, conditions which may lead to most serious results. In Rose's method the haemorrhage is simply embarrassing and prolongs the operation; it can at any time be controlled by pressure, and must, to a large extent, have ceased before the skull is opened. In Hartley's method the htemorrhage is at the end and dangerous part of the operation; in Rose's at the beginning. Mr. Rose writes of his seven cases:?"The results have been most gratifying. In only one instance, and that a highly neurotic woman, has there been any return of the pain, and then not at all severe. I have noticed a little stiffness of the lower jaw, easily tolerated in comparison with the terrible pain from which relief has been obtained." Rose's cases were operated on in 1890,1891 and January 1892, so that three to five years have elapsed. Parks reports that his two cases operated on nearly three years ago are all right. Andrews has had two relapses after being cured for a good while;" and one in which there is still "complete relief after three years." Parkhill reports recurrence after full relief for two years. Eskridge reports one case, which continues quite free from pain two jTears after the
(.Boston
"
operation. Altogether twenty-three cases operated on by Rose's method have been reported, and of these only three have died from the operation. Fowler gives some figures in the Annals of Surgery, on the results of removal of the infraorbital nerve, which will be interesting to compare with those given above. In twentysix cases in which the infraorbital nerve was removed together with Meckel's ganglion, there was complete relief for over three years in three cases, for over two years in six cases, and for The average relief over one year in nine cases. in all was one year and five and-a-half months. In twenty-six cases of neurectomy of the infraorbital without removal of Meckel's ganglion,
31
immunity for three years in five cases, years in three cases, and over one year in seven cases. The average was one year three and-a-half months. The results thus far obtained in the intracranial operations do not justify the abandonment of the more superficial neurectomies in persistent neuralgia, but certainly justify the expectation that they will afford great and probably permanent relief where recurrence takes place?a relief so great as to fully justify the danger they involve. there
was
over two
a Vesical Analgesic.?{The Surgical Reporter).?Yignerous' experience leads him to think that antipyrin will prove a valuable vesical analgesic. Injected into the bladder, the remedy is free from harmful effects, even when employed over a protracted period. As an antiseptic the author believes ib
Antipyrin
as
Medical and
superior to solutions of boric acid. When the solution of antipyrin is allowed to remain in the bladder, it not only relieves the pain, but checks spasmodic contractions. A 4 per cent, solution left in the bladder for ten minutes is sufficient to diminish the pain attending subsequent washing or instillation. Antipyrin may be emplo37ed in all cases of cystitis in which local treatment induces pain. When the bladder is not distended, two and-a-half to five drachms of a 4 per cent, solution, left in the bladder for ten minutes, is sufficient. When the bladder is much distended, fifteen to thirty drachms of a one or half per cent, solution should be injected and allowed to remain in the bladder. to be
H. W.
Pilgrim,
m.b., Lond.
