THE COLLEGE AND CLINICAL RECORD. 49 ture of moderately fine black silk, which I generally use in operations upon the face, as fine black silk produces less irritation, and the sutures are much more readily distinguished than JEFFERSON MEDICAL COLLEGE HOSPITAL. ordinary white silk, when it becomes necessary CLINIC OF PROFESSOR WILLIAM H. PANCOAST. to divide or remove them. [Reported for the COLLEGS AND CLINICAL RECORD.] HEAD. Held February 25th, 1850. The wound has united throughout by first in SPINDLE-CELLED SARCOMA REMOVED FROM THE FORE- tention, and the sutures can now be removed, but the edges shall be still supported by adhesive strips. PLASTIC OPERATION FOR CLUB PENIS AND HYPOSPADIAS. A CASE OF FRACTURE OF THE NECK OF THE Scapula. CASES OF NECROSIS OF HUMERUS, TIBIA, AND ANKLE JOINT. CASE OF INGROWING TOE-NAIL; METHODS OF OPERA TION. THREE CASES OF TUMORS OF THE NECK; (1) CYSTIC NOMA. CASE OF SARCOMA OF SUPERIOR MAXILLA, INVOLVING ANTRUM OF HIGHMORE. Spindle-celled Sarcoma removed from the Plastic Operation for Club Penis and This case of incurvation and malformation of the penis was also before you at our last clinic, when I performed a plastic operation for its relief, dissecting up two flaps of integument from the inferior surface of the penis and Scrotum in front of the abnormal opening of the urethra, which is near the perineum, and sliding them along over into the incision on the concavity of the penis. A soft catheter was then introduced into the bladder, and retained. Never put an adhesive strap entirely around the penis any more than you would encircle a limb with it after an operation, as swelling may be looked for, and strangulation may ensue. order to prevent erection, he was given twenty minims of spirits of camphor twice during the night-a tablespoonful of camphor water I have found to be sometimes effective;-it may be repeated every hour. The case is now doing very well, and promises to be a success. part of the penis seems elongated an inch. I will complete my operation when the flaps are healed, and take out a wedge-shaped piece in the dorsum penis to correct the incurvation. In The under Treatment of Hare-Lip after Operation. GENTLEMEN: I will first show the man from whose forehead we excised a sarcomatous tumor at our last clinic. You recall his history: Henry S., thirty-eight years of age, about eight years ago noticed two papules, or small, hard elevations in the skin, over the front part of the left temporal region, which, persisting, and increasing in size, were removed by surgical operation three years subsequently; the portions removed were hard and dense. About four years ago (one year afterward), there came a growth in about the same situation, just above the centre of left supra-orbital ridge, which grew slowly, and had the appearance of a wen, and, indeed, This boy, seventeen years of age, was opewas so pronounced by a physician who removed rated upon for hare-lip two weeks ago, and the it two years ago. He told us further that, a few result was most satisfactory. But immediately weeks after the operation, a new growth ap- after the operation secondary hemorrhage ocpeared, of a firmer consistence, which steadily curred from the cut mucous surfaces to such an enlarged; but especially during the last three alarming degree that the resident physicians months had it grown with increased rapidity. were obliged to open the incision, and pack the The summit was congested and vascular, and lip with lint, saturated with Monsel's salt. I bled on several occasions. Hard, nodulated reached the patient's bedside as soon as I relumps, distinct from the main growth, and im-ceived the message, but did not disturb the packmediately below it, had existed for about three years, and were slowly enlarging also. In performing the operation, I made the double-curve (S) incision, which I prefer for the removal of tumors, as it afforded the most room for the removal of the growth. The tumor was subsequently examined microscop ically by Dr. W. G. MacConnell, who pronounced it a spindle-celled sarcoma. The wound was approximated by the interrupted suVOL. 1.—6 ing. I let it remain until it became loosened by suppurative discharge, and did not attempt a second operation for a week longer, so as to allow the lip to become sufficiently healthy to bear a second operation. I think this is important. When from any cause an operation for hare-lip has not resulted successfully, I deem it best to wait a sufficient number of days after the wound has opened, before repeating the operation, so as to have the tissue in as healthy a condition as the scapula. Moving the arm to and fro also causes pain. The glenoid cavity itself is not injured, but the crepitus is excited very near this place. The neck of the scapula evidently must have been fractured, just behind the glenoid articulating surface, and a moderate amount of repair has already occurred. This is a very rare condition, but is perfectly explained by the history of the manner in which he received the injury. possible. In performing this operation the the humerus; there is no fracture of the clav1 second time before you, I demonstrated the icle, and the scapula seems intact; but upon advantage of making the lip-flaps lie easily and manipulation, deep, but decidedly rough creploosely, and paring the portion cut from each itation or grating is heard in the neighborhood side of the fissure, which I allow to hang down of the glenoid cavity, and the articular head of and utilize as the projecting under surface of the lip at the middle, making a projection where there was a depression. As this was so done at first, and I had reduced the inflammatory condition of the wound, I simply drew the flaps together with two pins, and a figure-of-8 suture around them, and the edges down to the projection, and on the inside of the lip, with fine black silk suture. You see, in spite of the trouble we have had, that the result is excellent. When the pins are removed, in the course of a couple of days after the operation, the wound is sometimes apt to separate upon any slight ordinary strain, as in laughing, crying, or yawning. To prevent this accident, and support the parts, I have been in the habit of taking a rather long, narrow, adhesive strip, and rolling up each end on itself towards the middle, until reduced to the proper length. I form in this way compresses, held in place upon each side of the wound by the remainder of the strip, which unites them by passing around the back of the neck. A second short strip is now applied over from one compress to the other, across the wound, which now makes the dressing selfsustaining and complete, and prevents any strain upon the recent cicatrix. This expedient I have found very useful, especially in young children. A Case of Fracture of the Neck of the Scapula. I will now pass to some new cases. This very interesting one is a patient of Dr. Woodbury, who brings the case to show you, on account of its unusual character. I advise that he should have a pad in the axilla, a compress over the lower angle of the scapula, to hold it firmly in place, and the arm retained by the roller bandage, in the ordinary position in treating injuries of the shoulderjoint. Cases of Deformity produced by Swelling and In this man, sixty years of age, we have chronic swelling of the hand and stiffness of the fingers after injury of the wrist. Giving him ether, passive motion is adopted for the fingers, and multiple punctures for the congestion and oedema. This has been performed several times lately, and you can all see the immense improvement which has taken place already. Here is a similar case. This young married the right hand, which produced disease of the woman, three years ago, received an injury of middle metacarpal bone, which articulates with the os magnum. There is a good deal of swelling and induration, due to impaired circulation; the inflammatory exudation has, to a The patient is a German, about forty years certain extent, strangulated the vessels; we have of age, thin, but with good muscular develop- also considerable elevation of temperature. ment. He is a porter, and is accustomed to This case is thought to be due to a specific handling heavy boxes. Nearly a month ago, taint, and originally one of syphilitic thecitis. while reaching up to take a large case of goods Multiple punctures have been made here several down from on top of another, he felt a sud times, and I will now repeat them. You obden pain in his right shoulder, as if something serve already a great improvement since she gave way, and the case fell to the ground. came under treatment a few weeks ago. After the accident, he could not lift his hand to multiple puncture I find a most admirable means his head, nor use the saw nor hammer with this of unloading the congested blood vessels; and hand. He received no treatment until yester-sufficiently deep punctures also allow any effuday. In the mean time he kept his arm quiet, sion to escape. I constantly employ it in my and he regained nearly all the movements of surgical practice, and sometimes name it "the the limb, although the shoulder was still weak; antiphlogistic use of the therapeutic knife." he sought medical advice on account of pain in I show you here a case of a little different the shoulder joint, which was particularly troublesome at night, and which waked him up whenever he turned over upon the injured side. Upon examination, we find no dislocation of This kind-one of syphilitic dactylitis in a young child. The entire finger is immensely swelled, and looks like a ripe balsam-apple. The bone here is soft, and you see my knife, in making |