THE CALCUTTA MEDICAL SOCIETY.
Meeting of 1881 was held at the Medical Wednesday, 9th November; Dr. Cayley presiding-
The Eleventh
College
on
Haldar read notes of a Cask op ANTISEPTICALLY, for the purpose of showing the efficacy of carbolic gauze dressing and explaining how easily antiseptic management can be carried out in such cases in private practice. Benode Bihari, a Hindu lad set. 14, thin and sickly, had an abscess nearly 11 weeks ago in the abdominal wall in the situation of the left external abdominal ring. It was opened a week after the setting in of the inflammation, when about let out ; it Was then dressed an ounce of thick healthy pus was with carbolic oil and cotton wool. The abscess closed up after nearly three weeks, the dressings being changed every morning. When nearly well the patient had suddenly an attack of fever without any apparent cause. There was no re-accumulation of pus nor any fresh formation of abscess .as far as I could see ; examination of the different organs did not reveal the existence of any abnormal condition that might give rise to fever; after a few days however I could feel a hai'd painful swelling in the middle of the left iliac fossa. It continued to increase and filled nearly the upper two-thirds of the same fossa. The fever continued to increase, and was accompanied at times by delirium. On the 24th October last (Monday) the patient was put under chloroform and the abscess was opened by Dr. McLeod below Poupart's ligament under antiseptic precautions ; about ten ounces of healthy pus welled out of the opening. A drainage tube about 5 inches long was put in. It was dressed with two loose pieces of carbolic gauze placed directly over the opening and a large dressing about a foot square was placed over that. I may here mention that the carbolic gauze, which was obtained from a private dispensary, was impregnated with too much resin, and was therefore too hard to absorb pus satisfactorily. There was free oozing of pus during the day, with which the bandage was soaked in the evening- Instead of changing the dressings at once, as I ought to have done, I soaked the bandage with strong carbolic lotion, preventing thereby the decomposition of pus. Next morning I changed the dressings and put on fresh ones of the same kind with the addition of a boracic placed directly over the opening. After thirty-six hours I had the mortification to find that the bandage was soaked again. However I delayed twelve hours, and changed the_ dressings after 43 hours. There was soaking again after thirty-six hours. I found that the loose pieces as well as the large dressing had not absorbed any pus at all ; so I determined on preparing the carbolic gauze myself. After a little trouble I succeeded beyond my expectation. I shall presently have the satisfaction of showing to you a specimen of the carbolic gauze prepared by me, leaving to you to determine how far I may have been successful. On the first occasion I kept this new dressing on for nearly eighty hours. Even then there was no soaking, but I was obliged to change it in order to shorten the drainage tube, which I feared would interfere with the process of healing. On opening the dressings I found that the loose pieces had taken up the little pus that had been secreted ; the tube was jammed by the rapidly forming granulations. After three changes of the new dressing the abscess has filled up completely and turned into a superficial ulcer. There was not the slightest constitutional disturbance after the operation. I beg to draw your attention to the fact that a small parietal abscess treated in the usual way took nearly three weeks to heal, while an iliac abscess was cured in little more than a fortnight?under the antiseptics. I do not however presume to say that this case conclusively proves the superiority of antiseptic dressing over all others, but I submit this only aa one of the many evidences in its favor. Baboo Nitai Churn
ILIAC ABSCESS TREATED
protective
/
December 1,
It is
THE CALCUTTA MEDICAL SOCIETY.
1881.]
generally supposed
that it is very difficult to carry out
But my experience any practitioner can
practice. antiseptic dressing in private to believe that in this case leads me
with
a
little perseverance adopt this decidedly superior
and of dressing to the great comfort of his patient The following things are necessary to his own credit. for antiseptic dressing :? 1st. A spray producer. 2nd. Carbolic gauze prepared in the manner described below, which costs annas 3-5 pie per yard. 3rd. Carbolic lotion of two kinds of strength, viz., one in twenty and one in forty. 4th. Some impervious material as gutta percha, varnished leaf. Of these gutta percha paper or a piece of tender plantainis much cheaper than the is very costly; varnished paper in the College Hospital This former, and is at present used is prepared simply by soaking bamboo" paper in linseed oil and then drying it m the air. Plantain leaf may the though imperfectly, in the absence of the
system
'boiled
serve
others.
5th.
purpose,
Drainage tube of i
to J inch diamater is cenerallv J
used.
6th. A non-irritating protective. 7th. An ordinary roller. at any All these are easily
procurable
respectable dispen-
sary.
Preparation of carbolic gauze. Mr. K. Knight, late Apothecary Gf the College Hospital, of carbolic gauze almost to has brought the preparation is as follows : perfection. His formula 5 oz. 3 ? 3 4 5
Resin
Paraffin Acid Carbolic Rectified spirit
...
for l5 yards of These materials are enough .t_ n I first melted resin and paraffin too-pfi,Q? -a and then strains] ti r. v en vessel called chatar ?? and * I dissolved the oil inspirit I added carbn resin and paraffin. Lastly A piece up the fluid carefully. the fluid and two such now soaked in side of .he were put ?? each t t ? this into a tin casn nrnna tightly; then I put fitting lid. j next nlnppr? a good purpose with full of boilm- water for nearly large earthen vessel (Harid)i itSdf thoroughly into thG miXtUie '
?
'
'th
^ addeTtL^t* ?i oftS TlSf?n^ iVaJ
m'o/
^h |* ti^
the0clothUntil
?
Retail price of the articles 5 oz. 3 ? 3 ? 10 drams 5 ? 15 yards
Resin
Paraffin Acid Carbolic Spirit Rectif. Castor oil Muslin cloth Coal
P.
Rs.
A.
0 0 0
2 6 9
0 0 0
q
n
X
^
Sulphate of quinine (Howard's) with citric acid in 4 pills to given to her every hour, as the next paroxysm was expected within 4 or 5 hours. i. e. 15 grains of Sulphate of The patient took three pills, minutes after the last dose, she bequinine, and about 30 with impairment of the power of gan to' talk nonsense after an hour or so she became tosight and hearing, and be
tally insensible, and convulsive movements of the limbs set i. e. about two hours after the apin. "When I saw her again, I found her quite insensible, pearance of these symptoms, both hands fast clenched together. lyin" on her face with turned upwards, keeping only the white sclevessels of the sclerotic injected, rotics visible ; pupils dilated, so that the muscles of mastication spasmodically contracted be separated. The muscles of the lower jaw could scarcely state in a of tonic extremities were arms hands and lower induced by stimucontraction No reflex-irritation could be and even the eye-lids did lation the soles and the palms, of the sclerotics ; skin of natural not wink by the touch natural ; pulse full and frequent. warmth and respiration for nearly three hours, when she She was in this state senses by the application of cold gradually recovered her ice to the nape. douche to her head and so far as we could study by The above case is interesting H flip' pxtreme physiological action of the quinia, produced its sulphate. The symptoms described by the poisoning of studied or observed m every day above can scarcely be does not lie in the production of The peculiarity nractice but in the dose the symptoms of the poisoning by quinia, them. We are all accustomed C15 (Trains') which even 40 grains daily, continued for to nrescribe 20, 30 and davs together without any very unpleasant symptoms being was m At first, it appeared that the patient nroduced there remained no but on minute examination no fit of hysteria in her life as I doubt. She had had remains whether the learnt afterwards. The only question Howard's sulphate of quinia quinine itself was adulterated. was not analysed chemically. If we are was dispensed, but it s name and reputation, there could to believe in Mr Howard at all. Prom my own experience have been no adulteration and then patients come under treatI can iudee that now the effects of quinine. Only last year ment who can ill bear under my treatment for simple was a gentleman's wife she evinced symptoms of fainting intermittent fever, and 4 grains of sulphate of quinia and collapse after taking only of collapse and syncope subsided Although the symptoms milk to drink, but since then I her some hot her a gram of quinine, and the fever genernever prescribed for to plain cinchona mixture. Often ally yielded in her case which have a peculiar idiosyncrasy for a we meet with cases Some cannot take a grain of mercury witho particu a drug. affected, and in some a few grains of All these ri nntnssium .are sufficient to produce iodism. and the 4 grains of the 15 rfven owe their origin, in my opinion, to the of
Her~eyeballs
?
produced
hysterics,'
j'rachmg
Meeting of 1881 was held at the Medical Wednesday, 9th November; Dr. Cayley presiding-
The Eleventh
College
on
Haldar read notes of a Cask op ANTISEPTICALLY, for the purpose of showing the efficacy of carbolic gauze dressing and explaining how easily antiseptic management can be carried out in such cases in private practice. Benode Bihari, a Hindu lad set. 14, thin and sickly, had an abscess nearly 11 weeks ago in the abdominal wall in the situation of the left external abdominal ring. It was opened a week after the setting in of the inflammation, when about let out ; it Was then dressed an ounce of thick healthy pus was with carbolic oil and cotton wool. The abscess closed up after nearly three weeks, the dressings being changed every morning. When nearly well the patient had suddenly an attack of fever without any apparent cause. There was no re-accumulation of pus nor any fresh formation of abscess .as far as I could see ; examination of the different organs did not reveal the existence of any abnormal condition that might give rise to fever; after a few days however I could feel a hai'd painful swelling in the middle of the left iliac fossa. It continued to increase and filled nearly the upper two-thirds of the same fossa. The fever continued to increase, and was accompanied at times by delirium. On the 24th October last (Monday) the patient was put under chloroform and the abscess was opened by Dr. McLeod below Poupart's ligament under antiseptic precautions ; about ten ounces of healthy pus welled out of the opening. A drainage tube about 5 inches long was put in. It was dressed with two loose pieces of carbolic gauze placed directly over the opening and a large dressing about a foot square was placed over that. I may here mention that the carbolic gauze, which was obtained from a private dispensary, was impregnated with too much resin, and was therefore too hard to absorb pus satisfactorily. There was free oozing of pus during the day, with which the bandage was soaked in the evening- Instead of changing the dressings at once, as I ought to have done, I soaked the bandage with strong carbolic lotion, preventing thereby the decomposition of pus. Next morning I changed the dressings and put on fresh ones of the same kind with the addition of a boracic placed directly over the opening. After thirty-six hours I had the mortification to find that the bandage was soaked again. However I delayed twelve hours, and changed the_ dressings after 43 hours. There was soaking again after thirty-six hours. I found that the loose pieces as well as the large dressing had not absorbed any pus at all ; so I determined on preparing the carbolic gauze myself. After a little trouble I succeeded beyond my expectation. I shall presently have the satisfaction of showing to you a specimen of the carbolic gauze prepared by me, leaving to you to determine how far I may have been successful. On the first occasion I kept this new dressing on for nearly eighty hours. Even then there was no soaking, but I was obliged to change it in order to shorten the drainage tube, which I feared would interfere with the process of healing. On opening the dressings I found that the loose pieces had taken up the little pus that had been secreted ; the tube was jammed by the rapidly forming granulations. After three changes of the new dressing the abscess has filled up completely and turned into a superficial ulcer. There was not the slightest constitutional disturbance after the operation. I beg to draw your attention to the fact that a small parietal abscess treated in the usual way took nearly three weeks to heal, while an iliac abscess was cured in little more than a fortnight?under the antiseptics. I do not however presume to say that this case conclusively proves the superiority of antiseptic dressing over all others, but I submit this only aa one of the many evidences in its favor. Baboo Nitai Churn
ILIAC ABSCESS TREATED
protective
/
December 1,
It is
THE CALCUTTA MEDICAL SOCIETY.
1881.]
generally supposed
that it is very difficult to carry out
But my experience any practitioner can
practice. antiseptic dressing in private to believe that in this case leads me
with
a
little perseverance adopt this decidedly superior
and of dressing to the great comfort of his patient The following things are necessary to his own credit. for antiseptic dressing :? 1st. A spray producer. 2nd. Carbolic gauze prepared in the manner described below, which costs annas 3-5 pie per yard. 3rd. Carbolic lotion of two kinds of strength, viz., one in twenty and one in forty. 4th. Some impervious material as gutta percha, varnished leaf. Of these gutta percha paper or a piece of tender plantainis much cheaper than the is very costly; varnished paper in the College Hospital This former, and is at present used is prepared simply by soaking bamboo" paper in linseed oil and then drying it m the air. Plantain leaf may the though imperfectly, in the absence of the
system
'boiled
serve
others.
5th.
purpose,
Drainage tube of i
to J inch diamater is cenerallv J
used.
6th. A non-irritating protective. 7th. An ordinary roller. at any All these are easily
procurable
respectable dispen-
sary.
Preparation of carbolic gauze. Mr. K. Knight, late Apothecary Gf the College Hospital, of carbolic gauze almost to has brought the preparation is as follows : perfection. His formula 5 oz. 3 ? 3 4 5
Resin
Paraffin Acid Carbolic Rectified spirit
...
for l5 yards of These materials are enough .t_ n I first melted resin and paraffin too-pfi,Q? -a and then strains] ti r. v en vessel called chatar ?? and * I dissolved the oil inspirit I added carbn resin and paraffin. Lastly A piece up the fluid carefully. the fluid and two such now soaked in side of .he were put ?? each t t ? this into a tin casn nrnna tightly; then I put fitting lid. j next nlnppr? a good purpose with full of boilm- water for nearly large earthen vessel (Harid)i itSdf thoroughly into thG miXtUie '
?
'
'th
^ addeTtL^t* ?i oftS TlSf?n^ iVaJ
m'o/
^h |* ti^
the0clothUntil
?
Retail price of the articles 5 oz. 3 ? 3 ? 10 drams 5 ? 15 yards
Resin
Paraffin Acid Carbolic Spirit Rectif. Castor oil Muslin cloth Coal
P.
Rs.
A.
0 0 0
2 6 9
0 0 0
q
n
X
^
Sulphate of quinine (Howard's) with citric acid in 4 pills to given to her every hour, as the next paroxysm was expected within 4 or 5 hours. i. e. 15 grains of Sulphate of The patient took three pills, minutes after the last dose, she bequinine, and about 30 with impairment of the power of gan to' talk nonsense after an hour or so she became tosight and hearing, and be
tally insensible, and convulsive movements of the limbs set i. e. about two hours after the apin. "When I saw her again, I found her quite insensible, pearance of these symptoms, both hands fast clenched together. lyin" on her face with turned upwards, keeping only the white sclevessels of the sclerotic injected, rotics visible ; pupils dilated, so that the muscles of mastication spasmodically contracted be separated. The muscles of the lower jaw could scarcely state in a of tonic extremities were arms hands and lower induced by stimucontraction No reflex-irritation could be and even the eye-lids did lation the soles and the palms, of the sclerotics ; skin of natural not wink by the touch natural ; pulse full and frequent. warmth and respiration for nearly three hours, when she She was in this state senses by the application of cold gradually recovered her ice to the nape. douche to her head and so far as we could study by The above case is interesting H flip' pxtreme physiological action of the quinia, produced its sulphate. The symptoms described by the poisoning of studied or observed m every day above can scarcely be does not lie in the production of The peculiarity nractice but in the dose the symptoms of the poisoning by quinia, them. We are all accustomed C15 (Trains') which even 40 grains daily, continued for to nrescribe 20, 30 and davs together without any very unpleasant symptoms being was m At first, it appeared that the patient nroduced there remained no but on minute examination no fit of hysteria in her life as I doubt. She had had remains whether the learnt afterwards. The only question Howard's sulphate of quinia quinine itself was adulterated. was not analysed chemically. If we are was dispensed, but it s name and reputation, there could to believe in Mr Howard at all. Prom my own experience have been no adulteration and then patients come under treatI can iudee that now the effects of quinine. Only last year ment who can ill bear under my treatment for simple was a gentleman's wife she evinced symptoms of fainting intermittent fever, and 4 grains of sulphate of quinia and collapse after taking only of collapse and syncope subsided Although the symptoms milk to drink, but since then I her some hot her a gram of quinine, and the fever genernever prescribed for to plain cinchona mixture. Often ally yielded in her case which have a peculiar idiosyncrasy for a we meet with cases Some cannot take a grain of mercury witho particu a drug. affected, and in some a few grains of All these ri nntnssium .are sufficient to produce iodism. and the 4 grains of the 15 rfven owe their origin, in my opinion, to the of
Her~eyeballs
?
produced
hysterics,'
j'rachmg
