notes on Practice 
IN THE 
NEW YORK HOSPITAL. 
[Servtce of De. R. F. WEIR.] 
{REPRINTED FROM THE NEWYORK MEDICAL JOURNAL, MAY, 1879.] 
NEW YORK: 
D. APPLETON AND COMPANY, 
549 & 551 BROADWAY. 
1879. MEDICAL TEXT-BOOKS, 
FOR THE STUDENT AND THE PRACTITIONER, 
PUBLISHED BT 
D. APPLETON & CO., 
S<LO & 551 BROADWAY, IsTKW YORK CITY. 
Complete Catalogues will be forwarded upon application. All 
communications promptly answered. 
ON PUERPERAL DISEASES. By Eordyce Barker, M. D. 1 vol., Bvo. Cloth, 
$5.00; sheep, $6.00. 
LECTURES ON OBSTETRIC OPERATIONS. By Robert Barnes, M. D. Ivol., 
Bvo. Cloth, $4.50. 
MATERIA MEDICA AND THERAPEUTICS. By Roberts Bartholow, M. D. 1 
vol., Bvo. Cloth, $5.00; sheep, $6.00. 
PRACTICE OF MEDICINE. By Roberts Bartholow, M. D. (In press.) 
SURGICAL PATHOLOGY AND THERAPEUTICS. By Theodor Billroth, M. D. 
A new and revised edition. 1 vol, Bvo. Cloth, $5.00; sheep, $6.00. 
HUMAN PHYSIOLOGY (TEXT-BOOK OF). By Austin Flint, Jr., M. D. Ivol., 
Bvo. Cloth, $6.00; sheep, IG.OO. 
DISEASES OF THE NERVOUS SYSTEM. By W. A. Hammond, M. D. 1 vol., 
Bvo Cloth, $6.00 ; sheep, $'7.00. 
SKIN-DISEASES (HAND-BOOK OF). By Dr. Isidor Neumann. Translated by 
L. D. Bulkley, M. D. 1 vol., Bvo. Cloth, $4.00; sheep, $5.00. 
TEXT-BOOK OF PRACTICAL MEDICINE. By Dr. Felix von Niemeyer. 
Translated by Drs. Hackley and Humphrey. 2 vols., Bvo. Cloth, $9.00; 
sheep, $ll.OO. 
OVARIAN TUMORS (TREATISE ON). ByE. Randolpli Peaslee, M. D. 1 vol., 
Bvo. Cloth, $5.00 ; sheep, $6.00. 
ORTHOPEDIC SURGERY. By Lewis A. Sayre, M. D. 1 vol., Bvo. Cloth, 
$5.00; sheep, $6.00. 
TREATMENT OF CLUB-FOOT. By Lewis A. Sayre, M. D. l vol., 12mo. 
Cloth, $1,25. 
MANUAL OF MIDWIFERY. By Karl Schrocder, M. D. 1 vol Bvo Cloth 
$8.50; sheep, $4.50. 
COMPENDIUM OF CHILDREN’S DISEASES. By Dr. Johanns Steiner. Trans- 
lated by Lamson Tait, F. R. C. S., etc. 1 vol., Bvo. Cloth, $3 50 ; sheep 
$4.50. 
DISEASES OF THE RECTUM. By W. H. Van Buren, M. D. 1 vol., 12rno. 
Cloth, $1.50. 
SURGICAL DISEASES OF THE GENITO-URINARY ORGANS WITH 
SYPHILIS. By Win. H. Van Buren, M. D., and E. L. Keyes, M. D.' 1 vol. 
Bvo. Cloth, $5.00; sheep, $6.00. 
OiS DISEASE s OF CHILDREN. By Alfred Vogel, M. D. Translated by H. 
Raphael, M.D. 1 vol., Bvo. Cloth, $4.50; sheep, $5.50. 
DISEASES OF THE OVARIES. By T. Spencer Wells, M.D. 1 vol, Bvo. 
Cloth, $4.50. 
Any of the above will be sent, post-paid, to any part of the United States or Canada, 
upon receiot of the price. NOTES ON PRACTICE 
IN THE 
■ 
NEW YORK HOSPITAL. 
[Service of Dr. R. E. WEIR.] 
I REPRINTED PROM THE NEW YORK MEDICAL JOURNAL, J/AE, 18700 
NEW YORK:: 
B. APPLET 0 X AND COMPANY, 
54 9 & ft o 1 BEOADWAt, 
1879. NOTES ON 
PRACTICE IN THE NEW YORK HOSPITAL. 
[Service of Dr. R. F. Weie.] 
TREATMENT OF ULCERS. 
The method found most serviceable has been a combina- 
tion of that used by Lister with the india-rubber bandage of 
Martin. The ulcer is first washed with a 1-20 solution of 
carbolic acid, then covered with a piece of the “ protective ” 
oiled silk, over which is placed one or two larger layers of 
lint or felted paper, which has been previously dipped in a 
saturated solution of boracic acid. The whole is then covered 
with an elastic bandage, which is only changed when it be- 
comes soiled by the discharge. Occasionally it is found 
better to take off the elastic bandage at night, but not the 
other dressing, which is then covered by a piece of imper- 
meable tissue, such as thin gutta percha or waxed paper se- 
cured in situ by an ordinary bandage. In sloughy ulcers a 
layer of iodoform is put over tbe surface before applying the 
“ protective.” The rapidity of cure by the combination treat- 
ment has been found to be much greater than when either 
the Lister dressing or the rubber bandage is used alone. 
Two cases of quite large varicose enlargement of the sper- 
matic veins were treated by a modification of the plan pro- 
posed by Mr. Wood, of King’s College, London. It is best 
explained by a reference to the figure. In Wood’s operation, 
VARICOCELE. 4 
tension upon the wire passed around the veins is made by a 
spring shaped like a horse-shoe, one arm of which, by means 
of a short foot-piece, rests against the scrotum, and through 
which the wires pass to be attached to the other arm of the 
spring. The effect of the pressure is sometimes to bury the 
foot-piece in the tissues of the scrotum, and to give rise to an 
abscess. To secure the same traction upon the encircling 
wires, Dr, Weir uses, it will be seen, a steel bent spring, the 
ends of which do not, however, touch the scrotum, but stretch 
by its elasticity wires (c, c) passed after Ricord’s method around 
the veins (f). Moreover, instead of leaving in the wire, as sug- 
Fra. 1. 
Dr. Weir’s Variococelr Spring. 
gested by Wood, until it cuts its way out, it has been found 
by experience best, after eight or ten days, to remove the 
wires, as by that time a sufficient amount of inflammatory 
action will have been excited to obliterate the veins satisfac- 
torily. Inasmuch as this removal is attended at times with 
considerable difficulty, Dr. Weir has adopted the plan which 
originated at St. Luke’s Hospital, of passing a reserve wire (d) 
through one of the loops before the latter is drawn around 
the veins, so that, when the encircling wire of one side is cut 
loose from the spring, the imbedded portion can be readily 5 
withdrawn from the other side by means of this same reserve 
wire, and then the remaining wire, being thus set free, can 
also in its turn be removed without difficulty. 
In the cases referred to, the wires were in this way re- 
moved on the seventh and eighth days respectively, and the re- 
sults obtained were satisfactory. The patients have been 
seen several times since leaving the hospital, and no relapse 
lias occurred. Notwithstanding the apparently trifling nature 
of the operation, antiseptic dressings were resorted to. 
FRACTURES OF THE THIGH. 
Much difficulty has frequently been encountered, in the 
treatment of fractures of the thigh by means of Buck’s ex- 
tension apparatus, in keeping the foot upright. The natural 
tendency to turn outward is so strong that the usual expedi- 
ents of having the plaster strip on the outer side of the leg 
placed more posteriorly than on the inner side, or of having 
the cords attaching the foot-piece to the pulley and weight 
so contrived as to twist the foot somewhat in an inward di- 
rection, or of the use of sand bags, or of a loop of bandage 
over the foot, are often inefficient, and tax the patience of 
the surgeon to a severe degree. This trouble has lately been 
obviated by the use of a railroad foot-piece, which was devised 
Pig. 2. 
A Modified Yolkmann’s Railroad Foot-piece. 
by Yolkmann, and is depicted in Esmarch’s recent “Prize 
Essay on Military Surgery.” It has, since it was introduced 6 
into use in the hospital by Dr. Weir, been slightly modified 
in having it extend a little further up the leg than in the 
original, and in having added to it a second bar or traveler. 
A reference to the figure shows that it consists of a foot- 
piece fastened at a very slight angle to a leg-piece, which lat- 
ter runs up to the top of the calf, and is cut away for the 
reception of the heel. To this leg-piece are attached two 
cross-bars or “ travelers,” which, in turn, rest upon the apices 
of two parallel strips of beveled wood, in such a way as to 
afford the least possible contact and consequent friction. 
Not only is the foot kept in position by the splint, but the 
comfort of the patient is materially enhanced by the greater 
freedom of motion accorded to him. This has been fully 
proved in the experience of twenty-two patients treated in 
this manner. The results of these cases of fracture of thigh, 
as to the weight employed and the ensuing shortening, are 
that in thirteen an extension of ten pounds weight was used ; 
in six, fifteen pounds; and in three, five pounds. The short- 
ening in two cases was nothing; in seven, one quarter of an 
inch or lees; in five, half an inch ; and in the rest it was not 
stated. In the later cases it was found that less than the 
ordinary weight sufficed to accomplish a satisfactory result. 
The measurements were made, as usual, by a steel tape, from 
the anterior superior spine to the inner malleolus. The splint 
has also been used with advantage in the treatment of com- 
pound fracture of the leg, etc. 
SUTURING A TENDON. 
The rule of the hospital is, in incised wounds, to approxi- 
mate and hold together the divided ends of both nerves and 
tendons. The rule was followed in the case of a negro who 
had received, several days previously, an incised wound on the 
dorsum of the right hand, sufficiently deep to divide some of 
the extensor tendons. The wound had been closed antisepti- 
cally by the House Surgeon, and union had become fairly 
established, but Dr. Weir deemed it advisable, when the case 
came under his observation, to attempt the drawing together 
of the separated ends of the tendons, and therefore, under 
ether, he broke asunder the freshly united surfaces, and, on exploration, ascertained that the tendon of the extensor carpi 
radialis longior had been divided. The upper end of this was 
found to have retracted within its sheath one and a quar- 
ter inch ; but, when seized with a forceps, it could be readily 
drawn down to, so as to be opposed to the distal end of the 
tendon, where it was held by means of two carbolized silk 
sutures. This material was used rather than catgut, as it was 
feared that the gut would melt away before sufficient union 
would occur to prevent subsequent retraction. The hand, after 
the antiseptic dressing had been applied, was bent upon the 
wrist, and secured in this position by a plaster-of-Paris band- 
age. The dressing was changed at the end of a week, when 
union was found to have taken place superficially, and the 
sutures of the tendons, which had been cut long to admit of 
their ready removal, with those in the integuments, were re- 
moved. The patient progressed satisfactorily, and had full 
use of his hand. After the suturing of the tendon, he experi- 
enced, for a day or two, considerable pain in the belly of the 
muscle. 
FEMORAL ANEURISM CURED BY BANDAGE, 
A second case of aneurism was successfully treated by elas- 
tic compression, after the method suggested by Walter Reid, 
in 1875. The aneurism was an idiopathic one, and involved 
the junction of the femoral with the popliteal artery. 
It had only existed a few weeks, and interrupted instru- 
mental compression had been resorted to, with decided bene- 
fit, prior to his entrance into the hospital. The tumor pul- 
sated feebly, its walls were thick, and its size that of the 
doubled fists. 
A delay of a few days showing that the pulsation was not 
diminishing, it was decided to resort to the elastic pressure as 
used by Mr. Ferguson, of Cheltenham Hospital, England;* 
and therefore a piece of rubber tubing was drawn around the 
thigh above the aneurism, sufficiently tight to stop the pulsa- 
tion, without, however, bandaging the limb at all. This was 
left on ninety minutes, when it was removed and a Signoro- 
ni’s tourniquet applied for two hours and forty-five minutes. 
* “ Lancet,” September 28, 1878. 8 
At the end of this time, no pulsation being detected in 
the tumor, the compression was abandoned, and a cure be- 
lieved to have been effected by this simplified method of using 
pressure. But it was found, the next day, that the pulsa- 
tion had recurred, though very faint in character. The tub- 
ing was again applied' in the same way for one hour, and the 
tourniquet subsequently for sixteen hours ; but failure ensued. 
It was afterward learned that the patient, in this trial, 
loosened the tourniquet slyly from time to time. So far, no 
anaesthetic had been resorted to, but in a third trial, eight 
days later, ether was given ; the foot and leg were bandaged 
by a rubber bandage up to, not over, and above the aneurism, 
and the tubing tightly drawn around the limb in the middle 
of the thigh. This compression was kept up two and a half 
hours, when the tourniquet was applied, and retained two and 
a half hours longer; and to make assurance doubly sure, and 
also to avoid too much localized pressure, a broad elastic 
bandage (ISTicaise’s excellent tourniquet) was secured tightly 
Fig. 8. 
Nicaise’s Elastic Tourniquet. 
around the thigh for five hours longer, making a total arrest 
of the circulation of ten hours, without any detriment to the 
limb save a little tingling of the foot, which passed off in 
twenty-four hours. The ether was kept up for two and one 
half hours only. The solidification of the aneurism was com- 
plete, and no pulsation was subsequently perceived. 
A foot-sling foe feactueed legs. 
In employing a fracture-box in the treatment of a leg 
broken in its lower third, it is a matter of some care to prop- 
erly support the foot, and at the same time to avoid bringing 
too great and prolonged pressure on the tendo Achillis. 
Properly, the direction is given that the oakum, jute, bran, 9 
or other material, used to form the bed upon which the injured 
leg rests, should not come lower than the malleoli; but, when 
this is done, the foot, supported by the usual tigure-of-eight 
turns of a bandage around the ankle and foot-piece of the 
box, is apt to slip and permit displacement of the fracture, 
and discomfort to the patient. To obviate this, the foot, in 
the hospital, has usually been held up by a sling made of ad- 
hesive plaster, and an experience of more than twenty years’ 
duration testifies to its efficacy and safety. 
The method, as lately modified by Dr. Slaughter, while 
house surgeon, is shown in the annexed woodcuts. Two pieces 
Fig. 4. 
Fig. 5. 
Foot-sltno. 
Foot-sling after Angles a a 
HAVE BEEN OVERLAPPED. 
of adhesive plaster (and preferably that known as the rubber 
adhesive plaster of Seabury or Grosvenor), the width of the 
foot, are overlapped so that the lower portion is left with its 
sticky surface to be applied to the sole of the foot and to the 
heel, and the upper part to the outer surface of the foot-piece 
of the fracture-box. To lend additional security to the foot, 
the part of the plaster covering the heel is cut out as indicated 
in the figures, so that, by superimposing the angles (a, a), a cup- 
shaped receptacle is formed. Practically it might be objected 
to this, as it has been to-the sling formed from a piece of band- 
age and passed under the heel up to and over the end of the 
foot-piece, that sloughing of the heel is liable to occur. But 10 
the weight of the foot is, by the plaster, distributed over a 
considerable surface, and damage to the heel from this method 
of suspension is really unknown. It is to be understood that 
this sling is intended to supplement and not to take the place 
of the support given by the bed upon which the leg rests. 
When it is necessary to raise the limb for any purpose what- 
ever, the plaster is simply stripped from the foot-piece, which 
sets free the fracture-box. This sling is in general use, both in 
the treatment of simple fractures, until they are put up in the 
plaster-of-Paris splint, and also in the case of compound frac- 
tures. 
Usually the foot is additionally secured to the foot-piece 
by a few turns of a muslin bandage, as a precaution against 
the effects of sudden jumping or starting of the limb. To 
aid in controlling this symptom it has also been found of ser- 
vice to make pressure upon the upper part of the leg by means 
of a large pad of oakum, or of numerous folds of a piece of 
an old blanket, held in situ by a strip of bandage passing 
around the box. HEALTH, 
AND 
HOW TO PROMOTE IT. 
BY 
RICHARD Me3KERRY, M. D , 
PROFESSOR OF PRINCIPLES AND PRACTICE OF MEDICINE, UNIVERSITY OF MARYLAND; MEMBER OF 
AMERICAN MEDICAL ASSOCIATION ; PRESIDENT OP BALTIMORE ACADEMY OF MEDICINE. 
“L’aisance et les bonnes moeurs sont les meilleurs anxiliaires cle rhygidne.”—Bcuchardat, 
Extract from Preface. 
“ Hygiene, public and private, has become, of late years, one of the most important 
elements of modern civilization. It is a subject in which all mankind has an interest, 
even if it be, as it too often is, an unconscious interest. 
“ The present work is addressed to the general reader, no matter what his pursuit, 
and the language is such as any physician may use in conversation with an intelligent 
patient; it is therefore as free as such a work can be made from scientific technicalities. 
It is intended to be rather suggestive than didactic, dealing rather in principles than in 
minute details; for the last must always be modified by existing conditions, which will 
vary more or less with every individual, or in every household. 
“It is offered as a contribution to a great cause, and the writer trusts that it will 
have some influence in promoting the health, happiness, and welfare of all who may honor 
it with a careful perusal. The principles advocated have been, to a great extent, put in 
practice in the personal experience of the writer in various parts of the world, and under 
many vicissitudes, and he has found them to be not vague theories, but practical truths 
of the greatest importance.” 
CONTENTS. 
Hygiene the Better Part of Medicine.—The Four Divisions of Human Life: The First Quarter, or 
the First Score of Years. The Young Man; the Young Woman. The Man; the Woman. 
The Declining or Old Man. 
PART I.—INTRODUCTORY REMARKS. 
Race. Temperaments, and Idiosyncrasies.—lnheritance. Habit.—Constitution—The Air we 
breathe. Sewers and Cesspools —Ozone.—Malaria.—Animal Emanations.—Devitalized 
House-Air.—Water.—Clothing.—Exercise or Work.—lnfluence of Occupation upon Lon- 
gevity.—Limit to Labor.—The Food of Man.—Accessory Food.—Manner of Eating.—Tea and 
Coffee.—Alcohol.—Use and Abuse.—Ardent Spirits.—Wines.— Malt-Liqnors.—Tobacco.— 
Chewing and Smoking should be forbidden in School.—Report of Naval Surgeons. 
PART lI.—HYGIENICS IN SOME DETAIL. 
One volume, 12mo. Cloth. 185 pages. Price, $1.25. 
For sale by all booksellers, or will be forwarded by mail, post-paid, on receipt of price 
D. APPLETON & CO , Publishers, 
549 & 551 Broadway, New York TO THE MEDICAL PROFESSION. 
We beg to call your attention to the merits of the 
New York Medical Journal. In doing so, we can 
say with confidence that this journal occupies a higher 
place in medical literature than any other monthly pub- 
lication in this country, and that henceforth no effort 
will be spared to enhance its value, and render it indis- 
pensable to every practitioner who desires to keep up 
with the times. Trusting you will favor us with your 
support, 
We are, yours truly, 
D. APPLETON & CO. 
The foremost American Monthly. 
THE 
New York Medical Journal, 
Edited by JAMES B. HUNTER, M. D., 
Surgeon to the New York State Woman's Hospital; Consulting Surgeon to the New York 
Infirmary for Women and Children; Member of the New York Obstetrical Society, etc. 
7he leading features of this Journal are the following: 
Original Communications from Eminent Members of the Profession. 
Reports of Interesting Cases in Private Practice. 
Notes op Practice in Metropolitan Hospitals, illustrating the Use of New 
Methods and New Remedies. 
Translations and Extracts giving the Cream of all the Foreign Journals. 
Reports on Medicine, Surgery, Obstetrics, Gynaecology, Laryngology, Pathology, etc. 
Critical and Impartial Reviews of all New Medical Books. 
Proceedings op Medical Societies. 
Copious Illustrations by means of Woodcuts. 
The Latest General Medical Intelligence. 
A new volume of the New York Medical Journal begins with the numbers for 
January and July each year. Subscriptions received for any period. 
Terms, $4.00 per Annum, postag-e prepaid by the Publishers. 
Trial Subscriptions will be received at the following rates: Three months, $1.00; six 
months, $2.00; specimen copy, 25 cents. 
A General Index to the New York Medical Journal, from its first issue to June, 
1876—including twenty-three volumes—now ready. Price, in cloth, 75 cents, post-paid. 
Remittances, invariably in advance, should be made to 
D. APPLETON & CO., Publishers, 549 & 551 Broadway, N. Y.