REPORT OF ONE HUNDRED 
AND NINE OPERATIONS, PER- 
FORMED AT THE LONG 
ISLAND COLLEGE HOS- 
PITAL DURING THE 
REGULAR SESSION OF 
1892-3 
J. S. WIGHT, M.D., 
Brooklyn, N. Y. 
Reprinted from 
The Brooklyn Medical Journal. 
August 1893. 
New York: 
M. J. Rooney, Printer and Publisher, 
114-120 W. 30th St. REPORT OF ONE HUNDRED AND NINE OPERATIONS, PER- 
FORMED AT THE LONG ISLAND COLLEGE HOSPITAL 
DURING THE REGULAR SESSION OF 1892-3. 
J. S. WIGHT, M. D., 
Professor of Operative and Clinical Surgery at the Long Island College Hospital, Brooklyn, N. Y. 
Case I.-C. B., a sailor, eighteen years of age, was admitted to 
the hospital, September 16, 1892, on account of disability caused 
by incomplete descent of the left testicle. When he stood up, the 
testicle would appear at the external inguinal ring; when he lay 
down, the testicle went back into the abdominal cavity, where it 
could not be felt; and when the testicle was in the inguinal canal, 
it was compressed so as to cause more or less pain. The opera- 
tion of exsection was performed September 21st: The testicle was 
brought down; the inguinal canal and the spermatic cord were 
seized with a pair of forceps; the object was to keep the testicle 
from disappearing during etherization. An oblique incision over 
the inguinal canal exposed the spermatic cord and the testicle, 
which was small and only partially developed. The spermatic 
cord was transfixed near the internal ring, and ligated in two parts 
with a strong piece of catgut. The wound was completely closed 
with deep aseptic silk sutures, which acted as ligatures; then a 
compress was applied. At the end of a week the sutures were re- 
moved, when there was primary union, except a small point near 
the middle of the line of apposition of the cut surfaces. 
Case II.-A gentleman, thirty-three years of age, who had been 
suffering from hydrocele for several years, and who had been 
tapped by Dr'. Skene, his family physician, came into the hospital 
September 21, 1892, to get a radical cure. Assisted by Dr. W. H. 2 
J. S. WIGHT, M.D. 
Skene and the internes of the hospital, I operated September 22nd. 
After etherization, I thrust Aa long knife into the sac, from below, 
and then cut again from above, evacuating the fluid as the incision 
was made complete. Two large pieces of the enlarged tunica vagi- 
nalis were excised; the testicle was found quite normal, though 
smaller than usual under the circumstances; the wound was 
dressed aseptically, and very slight inflammatory disturbance fol- 
lowed. On the sixth day I found the tegumentary parts so much 
contracted as to leave the testicle practically exposed, and held so 
by adhesions. The next day I performed the following operation; 
The adhesions were simply torn through, liberating the displaced 
testicle; the edges of the tegumentary flaps were cut off, so as to 
afford a fresh surface; then the flaps were brought together with 
aseptic silk sutures inclosing the testicle; the parts were dressed 
antiseptically; primary union took place, with very little inflam- 
matory disturbance; the sutures were removed at the end of five 
days; and the patient left the hospital October 8, 1892, with a rad- 
ical cure. 
Case III.-G. O., a laborer, nineteen years of age, on May 10, 
1892, ran a tack through the middle joint of his left fore-finger. 
The injury was followed by severe septic inflammation. The re- 
sult was anchylosis of all the joints of the injured finger. The 
flexor and extensor tendons had become firmly adherent to their 
sheaths. The disability was complete. September 28th, the case 
came under my care, when I amputated the finger, sawing off the 
distal end of the metarcapal bone obliquely so as to form a shapely 
hand. As the tissues did not appear to be in a condition favorable 
for primary union, the wound was packed with aseptic gauze, in order 
to obtain secondary union. On the second day the wound was 
dressed, and the digital artery bled so as to require a suture-liga- 
ture.. The case did well, and the patient was discharged from 
the hospital on the 10th of October, being referred to the Dispen- 
sary for further treatment. 
Case IV.-Mrs. M. J., thirty-three years of age, about August 
15, 1892, had the inner side of the left hand caught by a closing 
door, causing a compound dislocation of the little finger and a 
fracture of its first bone. The case came to my Clinic, September 
28th. There was still septic inflammation of the hand, and the 
wound was discharging pus. The finger was entirely useless, and 
there was no way of restoring its function. I amputated it, re- 
moving the distal end of the metacarpal bone, so as to give the REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
3 
patient a presentable hand. I applied the electro-cautery to the 
entire surface of the wound, and applied an aseptic dressing; the 
patient went home. 
Case V.-MissC. T., seventeen years of age, the last week in' 
August, 1892, caught her left hand in machinery, and received a 
compound fracture of the terminal joint of the left index finger, 
accompanied by an outward dislocation of the end bone. On Sep- 
tember 28th, I exsected the fragments of the head of the middle 
finger-bone and a thin slice of the base of the end-bone, shorten- 
ing the index finger about one-half inch. The wound was dressed 
antiseptically, and the finger and hand were put on a well padded 
wire splint which was moulded so as to fit and support the index 
finger in good position. Then the case resembled one of com- 
pound fracture. I have found it useful to save a finger with two- 
bones, one of them being longer than a normal finger-bone, by 
means of union of the fragments of two bones. This case didi 
well, resulting in repair, that afforded only moderate disability andi 
slight deformity. 
Case VI.-E. D., a boy, eight months old, was brought to my 
Clinic, September 28, 1892, having a large congenital angeioma of 
the right hand, for the most part on the back of the carpus and 
metacarpus, the fingers being smaller than those of the other hand. 
I made a longitudinal incision along the middle of the back 
of the hand, and removed the larger part of the diseased 
structure, at the same time leaving the skin. The electro-cautery 
was applied to the entire surface of the wound, which was packed 
with aseptic gauze. On the third day, when the dressing was re- 
newed, there was no haemorrhage. On October 12th, the wound 
was nearly healed, and the growth was nearly as large as it was 
before the operation. The mother took the patient from the hosp- 
ital, and I have been unable to learn the result. 
Case VII.-J. Me-, a laborer, twenty-four years of age, 
October 1, 1892, slipped and fell astride the wheel of his truck, 
and had retention of urine. He came to the hospital the day after 
the injury, still being unable to pass his water, and had the signs 
of a severe contusion of the perinseum. Several attempts to pass 
a catheter failed. On consultation, it was deemed advisable to 
make perineal section and an external opening of the urethra. Af- 
ter etherization, I found no difficulty in passing a lithotomy staff. 
I made a median section of the perinseum, and found no wound of 4 
y. S. WIGHT, M.D. 
the urethra, which I exposed for nearly two inches. I did not think 
it best to open the urethra. The blood of the haematocele was 
evacuated and the wound was dressed antiseptically. The case 
progressed favorably, the surface of the wound presenting healthy 
granulations in a few days. October 4th, I put in six deep sutures 
in order to bring the granulating surfaces into apposition. Super- 
ficial sutures along the edges of the skin were required to complete 
the apposition. 
Case VIII.-October 3, 1892, a man, thirty-six years of age, 
was admitted to the hospital, in a state of shock and collapse, from 
having his "throat cut" with a razor, just above the hyoid bone. 
The cut extended from the right to the left, beginning just in front 
of the angle of the lower jaw on the right side and ending on the 
left side under lobe of the ear. Neither the throat nor the larynx 
was opened. The haemorrhage had been profuse, causing very 
severe shock. About nine o'clock on the evening of his admission 
to the hospital, I ligated the partly severed facial vein of the left 
side and the accompanying artery; also the facial artery of the right 
side, as well as several bleeding points. The wound was dressed 
open and antiseptically until the following morning. The next 
morning I put in twelve deep sutures closing the entire wound, to 
apply the sides of the cut to each other as accurately as possible ; 
ten superficial sutures were put in to adjust the cutaneous edges for 
the purpose of obtaining primary union. October 14, I removed 
the deep sutures, and instructed the house-surgeon to take out all 
the rest the next day. The union was good except at two points : 
one atathe seat of the left submaxillary gland ; the other near the 
right end of the "cut," where there had been some oozing of blood 
between the flaps. 
, Case IX.-Mrs. R., housewife, thirty-four years of age, was ad- 
mitted to the hospital October 3, 1892, for amputation of right 
breast. One year before, 1891, I amputated the left breast on 
account of a large sarcoma which was just ready to break down. 
There was a large growth on each side of the neck above the 
clavicle, and the right breast was considerably enlarged. This 
patient had been treated during the intervening year with the 
bromide of arsenic ; the dose had been one-fortieth of a grain, 
which was doubled from time to time; every two or three 
weeks the arsenic was omitted; occasionally she had carbonate of 
lime in ten grain doses with tr. of columbo. The growths on the 
neck had largely disappeared; the scar of the previous operation REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
5 
was quite as normal as one that follows the closure of a large 
wound in healthy tissue ; the right breast had diminished in size 
to some extent. As the patient desired to have it removed, I oper- 
ated October 4, the day after admission to the hospital. The 
operation was performed in twenty minutes. The breast was re- 
moved by an elliptical incision, the bleeding being averted by 
pressure made with the fingers of the assistants, and by the appli- 
cation of haemostatic forceps. Then the entire surface of the 
wound was irrigated with a 1 to 3,000 solution of mercuric chloride. 
No ligatures were applied, the sutures being so put in as to prevent 
haemorrhage. I use curved needles which are from three to six 
inches in length ; each ligature takes up a layer of tissue from 
side to side, so that, when it is tied, it brings the surfaces in con- 
tact and prevents the blood from escaping from the vessels.. One 
of these needles is put under or through the end of any bleeding 
artery, which can, in this way, be completely ligated. I have not 
used a ligature in an amputation of the breast for many years. 
This manner of closing the wound does away with the need of a 
drainage tube, which is certainly a very important advantage. 
Case X.--H. S., a groceryman, twenty-five years of age, was 
admitted to the hospital September 18, 1892. He had severe 
arthritis of the left knee ; it was treated in the usual way until 
October 5th, when I put a drainage tube through the knee-joint 
under the tendo-patellse, in the following manner : A long narrow 
bladed knife was pushed through the joint, at the place indicated, 
from side to side ; a pair of forceps seized the point of the knife and 
followed it as it was withdrawn ; the forceps then grasped the end 
of a drainage tube and pulled it through the joint; the joint was 
then irrigated with a 1 to 5,000 solution of mercuric chloride ; the 
irrigation was repeated every two or three days, and the tube was 
removed October 13th. 
Case XI.-A schoolboy, eleven years of age, was admitted to 
the hospital August 15, 1892, for disease of the right hip-joint, 
from which he had suffered since he was three years old. The 
thigh was adducted and flexed, as well as inrotated ; there was a 
sinus in front, going down to the location of the joint; pus was 
burrowing in the soft parts of the hip ; the upper end of the femur 
had formed a bony union with the acetabulum. October 5th, I 
performed the following operation : A free incision was made ex- 
ternally down to the great trochanter, letting out consider- 
able pus; about one inch and a half of upper end of 6 
J. S. WIGHT, M.D. 
the femur was cut off with the saw, bone-forceps, and 
chisel; the pieces were chiseled out of the acetabulum; then 
limb could be reduced to a position nearly resembling the normal; 
all the sinuses were "laid open" with the knife and scissors. 
Some of the bone was hard like ivory, some was so soft that it 
could be cut with the knife, and some was in a state of osteopo- 
rosis ; the head and neck of the femur had for the most part been 
absorbed. The wound was dressed antiseptically, and a long 
fenestrated splint was applied. 
Case XII.-R. L., a girl, four years of age, was brought to my 
clinic, October 5, 1892, having avascular growth about as large as 
the end of her little finger, on her face just above and near the left 
angle of the mouth. It had grown up from a small naevus during 
the three or four months before I saw her. I transfixed the base of 
the growth with a silk ligature, and tied it in two parts. My little 
patient declined to take an anaesthetic, and shed two or three large 
tears, not making any outcry during the operation. The growth 
came away in a few days, and a cure resulted. 
Case XIII.-R. T., an engineer, thirty-eight years of age, 
injured the end of the middle finger of bis left hand, in some 
machinery, and about three weeks after came to the hospital for 
treatment. A sharp piece of the end bone was projecting from the 
wound, which was delayed in healing. I separated the soft parts 
from the bony projection, which I cut off with a pair of bone- 
nippers. The wound healed up in a few days. This patient did 
not take an anaesthetic. 
Case XIV.-October 9, 1892, a woman, about fifty years of age, 
was severely kicked by her husband, and was conveyed to the 
hospital, where I found her suffering from shock. She had a con- 
siderable haematocele in the left inguinal region, in the location of 
an inguinal hernia. She gave the history of having had a hernia at 
the seat of the injury. She had great pain and tenderness. Assume 
that she had only a haematocele, and there would be no objection 
to cutting down and evacuating the blood; but if she had a hernia 
complicating the injury, an explorativeoperationwould.be impera- 
tive. The patient being put under ether, I opened the cavity of the 
haematocele and removed the blood, which was, for the most part, 
coagulated. There was no appearance of hernia. The wound 
was made antiseptic, and healed by granulation in about two 
weeks. REPORT OF ONE HUED RED AND NINE OPERATIONS. 
7 
Case XV.-Mrs. T., forty-five years of age, was seen by me, 
for the purpose of removing a tumor from the left scapula. I 
found the tumor was a sarcoma, and advised her friends to take her 
to the hospital, in order that she might receive constant attention. 
I told her friends that it might be necessary to remove the entire 
upper limb, as well as the scapula. On the 13th of October, 1892, 
assisted by Drs. Lewis, Cochran, Rogers, Rae, and the House 
Staff, I exsected the left scapula; Drs. Lewis and Rae compressed 
the subclavian artery. I made an incision from the outer end of 
the clavicle downward to the lower angle of the scapula; then I 
made another incision from the same point over the clavicle back- 
ward and downward until it reached the lower end of the first 
incision; these flaps were dissected up until the borders of the 
scapula were exposed well up toward its neck; the outer end of 
the clavicle was then severed with a pair of bone-cutters, not far 
from the acromion; the lower portions of the scapula were then 
cut from the ribs, with which they had formed strong adhesions; 
the acromion was seized with the lion forceps, and forcibly eleva- 
ted so as to sever the posterior part of the capsule of the shoulder- 
joint, the arm being drawn forcibly forward; the entire axillary bor- 
der of the scapula was detached with a pair of scissors, when the 
rest of the capsule of the shoulder-joint was cut through; the 
attachments of the soft parts to the coracoid process were severed, 
partly with the scissors and partly with the knife: finally the entire 
scapula was enucleated by cutting through connections its upper 
border made with the subjacent structures. The time occupied in 
the exsection proper was thirty-one minutes. 
Case XVI.-M. T. K., a clerk, fifty years of age, had stricture 
of the urethra. October 18, 1892, being unable to " pass his water;" 
an attempt to use the catheter having failed, he was brought to 
the College Hospital; he passed considerable blood; it was impos- 
sible to pass any instrument into the bladder through the urethra. 
Then aspiration was performed by Drs. Rogers and Swayze. The 
patient passed a comfortable night; but the retention continued 
the next day until about four o'clock in the afternoon, when he 
passed a considerable quantity of water. He said he felt all right 
and left the hospital. 
Case XVII.-G. L. F., a boy, sixteen months of age, had aeon- 
genital naevus on his right cheek; it was about three-fourths of an 
inch in diameter. After the administration of chloroform, I made 
an incision around the naevus with the electro-cautery knife down 
to its deeper portions, and then ligated what was left by trans- 8 
7. S. WIGHT, M.D. 
fixion. This little patient had serious chloroform narcosis. The 
treatment was elevation of the body; artificial respiration; hypo- 
dermic injection of whiskey; inhalation of nitrite of amyl. It was 
about twenty minutes before satisfactory recovery took place. 
The naevus was cured. 
Case XVIII.-Mrs. A. F., thirty-four years of age, had a fall 
August 15, 1892, and injured her right ankle; the fibula was bro- 
ken about three inches above the joint; the internal malleolus was 
broken off transversely; the foot was dislocated backward nearly 
two inches; the soft parts were greatly swollen. Dr. Shepard saw 
her and instituted correct treatment. But the patient persisted in 
going about house to attend to domestic duties. About the middle 
of October her doctor brought her to the College Hospital for ad- 
vice and treatment. She was put under the influence of ether; a 
sand-bag was placed under her heel; then I sat down upon the 
front of her leg; at the same time I took hold of the anterior part 
of her foot, and used the foot as a lever to break up the adhesions; 
the pressure upon the leg and the manipulations of the foot en- 
abled me to reduce the foot nearly to its normal position and remove 
the deformity of the fibula to a considerable extent. The result 
was better than I could have obtained by means of a cutting oper- 
ation. I put the foot and leg upon my modification of Dupuytren's 
splint for Pott's fracture. The case turned out well, giving the 
patient a useful limb with moderate deformity. 
Case XIX.-H. B., a janitor, forty-three years of age, having a 
moderate-sized epithelioma of the right side of the lower lip, came 
to my Clinic, October 19, 1892, and submitted to an operation with- 
out anaesthesia. I cut out a V-portion of the lip, including the can- 
cer, with a sharp pair of scissors, the haemorrhage being controlled 
by Drs. Swayze and Thomas. The cut edges were brought to- 
gether by means of four aseptic silk sutures, so put in as to control 
the flow of blood completely. The mucous edges of the lip were 
sutured also. In these cases, as a rule, I apply no dressings, no 
retentive slip of adhesive plaster. Primary union took place. 
Case XX.-Mrs. M. E., forty years of age, had a tumor grow- 
ing on the back part of the neck for four or five years; it was just 
to the left of the median line and the upper portion of it was close 
to the skull. Its general appearance was that of a fibro-lipoma. 
The growth was about three inches in diameter, and appeared to 
be firmly attached to the surrounding structures. The hair was 
cut off, and the field of operation made aseptic. The tumor was REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
9 
exposed by a longitudinal incision, and had to be dissected out; it 
had considerable vascular connections. The operation was quite 
bloody; the haemorrhage was controlled by deep silk sutures, 
which were put in to close the wound, and an aseptic dressing was 
applied. The wound healed by primary union, and the patient 
was discharged from the hospital at the end of a week. 
Case XXL-S. W., a clockmaker, forty-two years of age, was 
suffering from irritable and painful sphincter ani and serious haem- 
orrhoids; he came to my Clinic, October 19, 1892, for operation. 
After anaesthesia, I divulsed the sphincter with my thumbs and fin- 
gers, and then ligated the haemorrhoids by transfixion with a 
curved needle and double ligature. One row of ligatures encircled 
the anal orifice; the other row was applied within the anus. Then 
the ligated haemorrhoids were incised with the points of a sharp 
pair of scissors, in order to surely bring about their complete 
destruction. This patient made a good recovery in about two 
weeks. 
Case XXII.-A. B. W., a carpenter, twenty-two years of age, 
came, October 19, 1892, after having suffered eight days from 
inflammation of the palm of the right hand, and requested an 
operation for relief. Fluctuation and the presence of pus were 
detected. He said he would try to have the operation performed 
without an anaesthetic. I made two incisions; one between the 
tendons of the index and middle fingers, the other between the 
tendons of the ring and little fingers; pus flowed freely from the 
first incision. The operation was very painful. This patient left 
the Clinic and did not return. 
Case XXIII.-Mr. C., a car driver, twenty-seven years of age, 
had a large sebaceous cyst in the left occipital region. No anaes- 
thetic was administered. The hair was cut closely, and the part 
made aseptic. An incision was made down to the sac from side 
to side, so as to separate the super-imposed tissue from the outer 
surface of the wall of the sac;then with an aneurismal needle I enu- 
cleated the entire sac without breaking it. In some cases it is 
impossible to remove the cyst without rupturing it. After this 
operation the patient needs very little attention. 
Case XXIV.-M. N., a school boy, six years of age, had a 
considerable swelling in the left inguinal region; it was first seen 
by his mother about six weeks ago; he came to the College, Octo- 10 
7. 5. WIGHT, M.D. 
ber 26, 1892. The evidence excluded other affections and indi- 
cated the existence of hydrocele of the cord; the swelling was 
tense and firm, though somewhat movable; there was no impulse 
on coughing; and reduction was impossible. The sac was ex- 
posed, and found to contain such fluid as exists in a hydrocele; 
this was shown by means of an exploring needle. The sac was 
opened, and the fluid evacuated. The wound was left open in 
order that it might heal by granulation. The patient made an ex- 
cellent recovery in about two weeks. 
Case XXV.-J. R., a barber, twenty-nine years of age, two 
years previous, fell down seventeen steps of stairs, and abscesses 
and fistulae followed in the ischio-rectal and gluteal regions. I oper- 
ated upon them at that time. November 2, 1892, he returned, 
having a fistula on the right side extending downward to a point 
between the upper part of the coccyx and the ischium; I opened 
the tract as extensively as possible, causing free haemorrhage. 
Then I used the thermo-cautery freely, and packed the wound 
with aseptic gauze. This patient has posterior curvature of the 
spine-angular curvature, perhaps due to tuberculosis. 
Case XXVI-J. R., a school boy, twelve years of age, was 
boxing and fell upon his right elbow, breaking off the external 
condyle. When seen by the doctor, the forearm was dislocated 
backward and outward; the reduction was easily accomplished. 
The case was treated subsequently by another doctor, who em- 
ployed a right-angled splint. Four weeks after the accident the 
boy was brought to my Clinic, having on a posterior splint, with 
the forearm extended about twenty degrees beyond a right-angle 
with the arm; in this position the forearm was slightly movable. 
After the right-angled splint had been removed, the forearm be- 
came fixed in the above-noted position. Any attempt to move 
the forearm toward a right-angled position caused much pain. 
I operated as follows : I stood behind the patient so as to prevent 
him from moving or getting away; then I took hold of the hand 
and the forearm and forcibly brought the latter up to a right- 
angle with the arm; the force used was very considerable, and the 
adhesions were felt and heard "giving way." The limb was put 
upon a right-angled splint. In this place I will make the follow- 
ing statement: In some instances after fracture of the condyloid 
end of the humerus, I have seen the forearm have a constant ten- 
dency to become more or less extended; in other instances, I have 
seen the forearm have quite as constant a tendency toward flexion 
even beyond a right-angle. REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
11 
Case XXVII.-J. McK., a laborer, about sixty years of age, 
came to my College Clinic, November 2, 1892, having a swelling 
of the right side of the scrotum. The diagnosis of hydrocele was 
made, because the swelling fluctuated and was translucent. It 
was a small hydrocele, and did not cause much inconvenience. 
Itapped it with an exploring needle, and slowly "drew off" about 
two ounces of straw-colored fluid. It is safer at times to use an 
exploring needle than a trochar and cannula; when there is a small 
quantity of fluid, the trochar might easily wound the testicle. 
Case XXVIII.-L. C., a school boy, ten years of age, came to 
my Clinic, November 9, 1892, having bony anchylosis of the right 
knee, the leg was nearly at a right-angle with the thigh, and was 
outrotated; the knee-pan was absent, having been removed the 
previous year; the femur, in the lower third, had a considerable 
curve forward; and the soft parts over the anchylosed joint were 
notin good condition, having been bruised by a recent fall. The 
disability was very great; the patient had to use crutches. The 
case required amputation or exsection; an artificial limb would be 
required after amputation of the thigh, and then there would be 
much disability; exsection of the knee might leave the patient with 
a very useful limb. I made an anterior flap, exposing the lower 
end of the femur and the upper end of the tibia Then I sawed 
through the bone, and pushed the lower end of the femur forward; 
I cut off with exsection saw about two and one-half inches of this 
bone, leaving the surface convex ; the next step was to saw through 
the upper end of the tibia, so as to leave the cut surface concave; 
the convex surface of the lower end of the femur fitted into the 
concave surface of the upper end of the tibia. A drill perforated 
the anterior part of the upper end of the tibia upward and back- 
ward, so that its point came out near the centre of the lower end of 
the femur; a wire nail was then driven through the hole and made 
to penetrate some distance into the cancellous bone of the femur; 
this was to prevent lateral displacement. Finally the limb was 
laid on an angular splint which kept it moderately bent at the 
knee-that is, the seat of operation. The bend in the lower end 
of the femur had to be taken into account; so the angle at the 
junction of the tibia and femur was made somewhat less than 
usual. A drainage tube is important in such a case. The dress- 
ings were removed on the third day after the operation, also on the 
sixth day, and the parts were in excellent condition. 
Case XXIX.-A. H., a sailor, fifty-five years of age, had con- 
tracted sphincter ani, accompanied by haemorrhoids. At first he 12 
7. 5. WIGHT. 
declined to take an anaesthetic; but after the transfixion of one pile 
with the needle, he requested me to put him to sleep; ether was 
administered. Then the sphincter was stretched, and the piles were 
ligated in the usual way. 
Case XXX.-F. R., a builder, forty-five years of age, was ad- 
mitted to the hospital about November 18, 1892, for malignant dis- 
ease of the abdomen the case seemed to be favorable for explor- 
ation with the trochar and cannula. Four or five weeks before 
admission to the hospital, the patient was seen by Dr. Riggs, who 
aspirated the bladder four or five times for retention of urine, and 
drew off large quantities of urine. The abdomen was tympanitic 
on both sides, and was dull and fluctuating in front. High up on 
the right side there was considerable submural hardness. The 
opinion of those who saw the case was that explorative tapping 
would be proper. As nall trochar and cannula wereused; and when 
the instrument had penetrated more than half its length, a dark 
fluid containing dark flocculent matter oozed out. The trochar was 
removed and the patient carried to his bed. In the mean time the 
left lower limb had been greatly swollen, accompanied by consid- 
erable discoloration. This patient died in a few days. Dr. Van 
Cott made an autopsy, disclosing extensive cancerous disease of 
the abdominal organs. 
Case XXXI.-Dr. R., a physician, thirty-seven years of age, had a 
laige variocele on the left side; it had been developing for fifteen or 
twenty years. He suffered from despondency from time to time. 
He had been troubled with eczema of the scrotum. The operation 
was performed November 12, 1892. The varicose veins were ex- 
posed and separated from the artery and the vas deferens. A cat- 
gut ligature was put around the mass of veins just above the 
testicle, also one was put around it about three inches higher, the 
intervening portion was excised. The stumps were sutured end 
to end with fine cat-gut, a drainage tube was inserted, the scrotum 
was brought together with silk sutures, two of which were passed 
through the venous stumps in order to reinforce the structure, 
which would act as a kind of a suspensory ligament for the 
testicle. There was but slight swelling of the scrotum after the 
operation The drainage tube was removed November 18th. The 
patient continued despondent, and was very nervous; the peculiar- 
ities of the patient were in part derived from hereditary tendencies. 
This patient made a good recovery. 
Case XXXII.-J. R., a laborer, forty-two years of age, fell Novem- 
ber 12, 1892 and struck his head against the edge of the curb-stone. REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
13 
He was conveyed to the College Hospital, where an examination 
disclosed a compound fracture of left side of the vertex of the 
skull. The line of fracture was nearly straight, being about four 
inches in length. At a point near the middle of this line, it was 
found that some of the bone had been depressed. There were no 
signs of compression of the brain; slight evidence of concussion 
and laceration of the brain was present; the patient could walk 
and talk and give a good account of the accident. On consulta- 
tion with my colleagues, it was decided to operate the next morn- 
ing, November 13, 1892. The operation was performed.as follows: 
The wound was enlarged slightly in front; the flaps, for such they 
were, were drawn aside by retractors; at the central part of the 
fracture I cut away the bone on the right side with a sharp chisel 
and mallet, and picked out two spicula of bone which had lacer- 
ated the dura; then I had to cut out more bone to make an open- 
ing large enough to remove a rough piece of the inner table of the 
skull about an inch and one half in length; a considerable clot 
was found and broken up and washed out with an antiseptic so- 
lution; a drainage tube was introduced, and the flaps werestitched 
together. This patient made a good recovery. 
Case XXXIII.-T. H., a boy, three years of age, and somewhat 
under the normal size, had the usual symptoms of stone in the 
bladder; at times a slight click could be made out with the 
searcher, as if there was an encysted stone or a very small one. 
The urethra was very small, and would admit Only a No. 6 staff. 
I operated November 16th before the medical class, with my hos- 
pital colleagues present. The knife was held in the median posi- 
tion until it entered the grove of the staff, when it was lateralized 
to the left and made to increase the size of the cut as it was with- 
drawn. It was then pushed along the groove of the staff far enough 
to partly sever the fibres of the neck of the bladder; a grooved di- 
rector was then passed into the bladder, when I pushed my fore- 
finger between the director and the staff until the end of it felt the 
o 
stone; the staff was removed and the lithotomy forceps introduced 
but the stone was not grasped, then the scoop brought out a stone 
about one-half inch in diameter. The bladder was washed out 
with a warm carbolic solution, and the patient was put to 
bed. 
Case XXXIV.-Mrs. M. M., twenty-six years of age, about two 
years previous to her admission to the College Hospital had an 
abscess on the outside of the right thigh. A fistula extending from 
the knee to a point near the hip had been left. The patient had 14 
7. 5. WIGH7\ M.D. 
been treated in another hospital for about five months. After the 
administration of ether, I introduced a long grooved director into 
fistula, and laid it completely open by means of a pair of angular 
scissors. The ill-conditioned layer of granulations was scraped off 
the surface as completely as possible. The wound was wiped out 
with towels saturated with a i to 2000 solution of mercuric chlor- 
ide, and an antiseptic dressing applied. 
Case XXXV.-W. W., a clerk, twenty-one years old, had an exostosis 
on the inner aspect of the neck of the first left metatarsal bone; it was 
about an inch and a half in diameter, and had been growing from 
childhood. The right radius was much deformed, causing some 
disability. The skin on the summit of the growth was not in a 
condition to be saved. Two longitudinal flaps were dissected 
from the upper and lower sides of the projecting bone, and the 
tumor was partly cut off with a Hay's saw; the bone-cutter com- 
pleted the severance. The flaps were brought together with silk 
sutures. • 
Case XXXVI.-A. B., a sailor, forty years of age, came to the 
hospital, November 15, 1892, having a swelling on the right side of 
the neck over the middle part of the sterno-cleido-mastoid muscle. 
It had been about four weeks forming; it had a point of less resist- 
ance and there was some evidence of the existence of a wall of 
" limiting fibrin." The patient suggested that the swelling might 
have a specific origin. Without an anaesthetic I cut it open and 
found some ill conditioned pus and considerable necrotic matter. 
The haemorrhage was slight. The dressing was antiseptic. The 
treatment was tonic and anti-syphilitic. The recovery was 
speedy. 
Case XXXVII.-H. D., a farmer, fifty-one years of age, came to 
the hospital, November 9, 1892, suffering from pains in the branches 
of the left great sciatic nerve; medical treatment for nine days did 
not benefit him. In the spring of the same year his left foot had 
been wounded by the tooth of a harrow while he was at work in 
the field. The scar was somewhat hard and painful on pressure. 
On November 18th, I exsected this scar; it was located over the 
heads of the first and and second metatarsal bones. Deep sutures 
were introduced and primary union followed. The patient left the 
hospital, November 23d, improved, and I have not seen or heard 
from him since. REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
15 
Case XXXVIII.-J. C., a Norwegian sailor, had inflammation 
of the bursa in front of the right patella. I operated for radical 
cure, November 21, 1892. A vertical incision was made into the 
bursa; the fluid and the "rice-like" bodies were evacuated; the 
adventitious bands were excised, the entire surface of the cavity 
was scraped with a bone scoop. Deep sutures, six in number, 
were put in so as to make complete closure of the bursa, and the 
edges of the cut surface were brought together with superficial 
sutures. The deep sutures were tied over a compress made of 
aseptic gauze. On the ninth day the stitches were all removed; at 
that time complete union had taken place. The deep sutures pass 
under the fibrous tissue in front of the patella, and require con- 
siderable care and skill in their introduction. 
Case XXXIX.-R. F., a German sailor, thirty-eight years of age, 
was suffering from synovitis of the left knee-joint, and came to the 
hospital for treatment. The case had been about four weeks 
developing. After making the field of operation thoroughly aseptic 
I passed a long narrow bistoury through the joint just back of the 
tendo-patellse and in front of the femoral condyles. A long pair 
of catch forceps followed the knife as it was withdrawn, and then 
seized a drainage tube which was drawn through the joint. The 
joint was then irrigated with a 1-3000 solution of mercuric chloride, 
the accumulated fluid being thoroughly washed out. Antiseptic 
dressings were applied. At the end of four days the drainage tube 
was removed. 
Case XL.-Second operation in Case XXIX, A. H., fifty-five years 
of age, had two piles that did not become completely strangulated, 
and so did not slough off. Ether was administered, and the piles 
were removed with electro-cautery knife. The larger one of the 
two was supplied by a large hsemorrhoidal artery, nearly as large 
as the radial. A suture ligature had to be applied before the haem- 
orrhage ceased. This patient did very well, and was so far re- 
covered that he left the hospital in. about two weeks. 
Case XLI.-Eva S., three years of age, had congenital equino- 
varus of the left foot, with marked deformity. I severed the tendo- 
Achillis by inserting the knife back of the tendon and cutting forward. 
Firm pressure on the bottom of the foot separated the ends of the 
tendon fragments over an inch. Then I cut the plantar fascia 
which had contracted and caused nearly right angled flexion of the 
foot. The knife was inserted below the fascial band, which was 
severed by cutting upward. Using considerable force I crushed the 16 
J. S. WIGHT, M.D. 
foot nearly into a straight position. The foot and leg were firmly 
bandaged to a well-padded splint, fashioned after my modification 
of Dupuytren's splint for the treatment of Pott's fracture. The 
operation was performed, November 30. December 3rd, I removed 
the splint and reapplied it. The case was progressing favorably. 
Case XLII.-Mary C., one year old, had a naevus at the root of 
the nose just above a line between the eyes. It was of consider- 
able size and very vascular. Several injections of alcohol had 
failed to cure it. I cut out naevus with the electro-cautery knife. 
A large artery supplied blood to the growth at its lower part. I 
applied a suture-ligature which controlled the haemorrhage and 
put in another suture, closing up the wound almost completely. 
There was no haemorrhage except at the seat of the arterial supply 
mentioned. This case did well, and there was only a small scar 
left. 
Case XLIIL--W. D., five months old, had a small and very 
vascular nsevus over the region of the anterior fontanelle. An 
effort to cure it with injections of alcohol failed. I made an in- 
cision around it with the electro-cautery knife, and then, raising 
it up with forceps, sutured its basal connections. There was no 
haemorrhage during the operation. Just enough tissue was re- 
moved to encroach slightly on the normal structure. The wound 
was dressed antiseptically. The result was favorable, only an 
insignificant scar being left. 
Case XLIV.-J. F., about sixty years of age, five years ago had an 
operation for radical cure of hydrocele of the left side. The operation 
was by free incision, inflammation and granulation. The result 
was very perfect. On November 30, 1892, loperated for radical cure 
of hydrocele on the right side. The field of operation 
was made aseptic; a long, narrow bistoury was pushed 
through the bottom of the sac; it was then pushed out again about 
four inches higher up; a long pair of catch forceps followed the 
knife as it was withdrawn; a drainage tube was then seized and 
pulled through the cavity of rhe tunica vaginalis; a 1-4000 solution 
of mercuric chloride now washed out this cavity, and the drainage 
tube was fastened in, after which an aseptic dressing was 
applied. This case made a good recovery. 
Case XLV. -Mrs. C., about forty years of age, five weeks ago wound- 
ed her right hand over the metacarpo-phalangeal joint of the index 
finger, while opening a can of lobster. Septic inflammation followed, REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
17 
and resulted in necrosis of the first finger bone and destruction of 
the joint at its base. November 30, I made oval flaps and sawed 
distal end of the metacarpal bone off obliquely, in order to improve the 
shape and the utility of the hand. The entire surface of the 
wound of operation was seared with the electro-cautery knife, for 
the purpose of disinfection. The open dressing was applied. 
On December 4th, the wound was healing, and the appearance of 
the hand had improved. 
Case XLVI.-C. C., a three-year-old boy, hadphymosis, with ad- 
hesion of the prepuce to the glans, and accompanied by irritability 
and nervousness. The prepuce was not contracted, but adherent. 
The usual dorsal incision was made with the sharp point of a 
curved bistoury and with a pair of scissors. The adhesions were 
very firm, and required much force to separate the prepuce from 
the glans. The end-portion of the prepuce was cut off all around 
with a pair of scissors. A fine catgut suture began at the angle of 
the incision on the back of the neck and went continuously around 
the cut edge until it arrived at the point of outset, where it was tied 
with the other end of it. Two important objects are gained by 
this suture : The mucous and cutaneous edges are quickly brought 
together; the suture is absorbed and does not require to be removed 
by the surgeon. This case did well. 
Case XLVII.-December 1, 1892, Wm. S., fourteen years of 
age, had his right hand drawn into a press; the metacarpus and the 
carpus were crushed; the hand was torn from the forearm at the 
wrist-joint. The operation was performed about four hours after the 
accident. The forearm was extended and the anterior flap was 
made by transfixion; the forearm was pronated, and the posterior 
flap was made by incision. The radius and ulna were sawed 
oft from before backward, and the last stroke of the saw severed 
both bones at the same instant. The ulnar nerve was drawn out 
a little more than two inches and cut off, and then the ulnar artery 
was ligated. The radial nerve was drawn out and about two 
inches of it cut off. The radial artery was found under the integu- 
ment in an abnormal position and tied; the amputation was made 
near the middle of the forearm and the flaps were left longer 
than ordinary. The interosseous vessels were secured by a su- 
ture ligature; the needle was passed close to the outside of the 
ulna in one direction and returned in the opposite direction close to 
the inside of the radius, and then the ends of the ligature were tied; 
the haemorrhage ceased. The sub-tegumentary portions of the 18 
J. S. WIGHT, M.D. 
flaps were brought together over the cut ends of the bones by 
means of a continuous suture of catgut, and then a drainage tube 
was passed through with a pair of catch forceps. The stump was 
dressed in the usual way. December 5th, the drainage tube was 
removed, and another was inserted; the one removed contained a 
clot of blood, making it completely impervious. 
Case XLVIII.-J. M. F., twenty years of age, had an ischio-rec- 
tal abscess in May, 1892, and came to the hospital, and was operated 
on, December 2, 1892, by Dr. Rogers, for a fistula which extended 
into the rectum. The cavity of the fistula was opened and thor- 
oughly scraped and scarified. The case made a rapid recovery. 
Case XLIX.-Mr. B., sixty years of age, was admitted to the 
hospital December 1, 1892, with an opening in front of the patella 
from an abscess which began about three weeks previous. An ex- 
ploration showed that the knee-joint was not involved. The ab- 
scess cavity was very extensive. Counter openings were made in 
five different places around the knee, and as many drainage tubes 
were inserted. This patient improved rapidly and soon left the 
hospital nearly cured. 
Case L.-A very muscular policeman, forty-five years of age, 
fell into the hold of a vessel and struck on his left shoulder, Decem- 
ber 2, 1892, when he was brought to the College Hospital. He 
had a sub-clavicular dislocation of the left humerus. There was a 
severe contusion on the outer aspect of the left arm just below the 
acromion, showing that this was the part upon which he struck. 
After complete etherization, it required one of my assistants and 
the house surgeon to make the reduction by pulling on the limb 
downward, backward and outward. The patient was discharged 
from the hospital at the end of a week much improved. 
Case LI.-A. P., a seaman, twenty-two years of age, Novem- 
ber 29, 1892, fell and broke an earthen jug, a sharp piece of which 
made a lacerated wound of left elbow at the seat of the ulnar 
nerve. He came to the hospital on the 5th of December, with 
loss of sensation and very slight voluntary motion of the right 
ring and little fingers. On the 8th, I cut down upon the ulnar 
nerve where it passes the internal condyle, and found it bruised and 
nearly torn in two parts. I exsected the injured portion, about one 
inch in length, and sutured the ends with catgut, closing the wound 
so as to permit good drainage, and placing the limb on a nearly REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
19 
straight anterior splint. There was some improvement. After 
several weeks he left the hospital, with partial recovery. 
Case LIL-J. S., three years of age, fell and struck the left 
side of his head, and when he was brought to the hospital he had a 
haematocele covering about one-half the surface of injured side of 
the head, and showing some signs of fracture of the skull. On 
December 8, 1892, I made an explorative incision, large enough 
to admit my finger, and found the skull denuded of periosteum for 
about one-half the extent of the haematocele, but there was no frac- 
ture. After thorough evacuation of the blood, I put on an aseptic 
compress and did not remove it until the lapse of a week, when 
primary union of the surfaces of the entire cavity had taken place, 
leaving only the wound of exploration. 
Case LIII.-K. D., a seaman, twenty-one years of age, in a 
low state of health, had an ischio-rectal abscess four weeks before 
admission to the hospital, December 6, 1892; it had opened spon- 
taneously, and presented an unheathy cavity; the fistula extended 
to the mucous membrane of the rectum. On the 9th of Decem- 
ber, Dr. Cochran operated in the usual way, laying open the fis- 
tula and scarifying the unheathy tissue of its wall. Under tonics, 
rest, nutrients, and asepsis, the patient began to improve. 
Case LIV.-J. C., seventeen years of age, had been develop- 
ing a painful swelling in the right iliac region for four or five weeks; 
during this time I had seen him twice, and advised an operation. 
He came into the hospital December 8, 1892, and I operated the 
next day. The diagnosis was that of pelvic abscess. He had no 
difficulty with his bowels, and the abscess was circumscribed. 
Aspiration failed to bring out any matter. Then I made an incision 
about three inches in length over the centre of the swelling, begin- 
ning just below the superior anterior spine of the ilium and going 
downward and inward, nearly parallel with its inner anterior bor- 
der. There was considerable haemorrhage; and there came from 
the abscess cavity some blood, some pus, and considerable necro- 
sed tissue. My finger went down between the sub-peritoneal 
fascia and wing of the ilium. The peritoneal cavity was intact, 
and the vermiform appendix was not involved. Antiseptic irri- 
gation made the abscess cavity surgically clean. There was no 
elevation of temperature, and the patient made a rapid recovery. 
I have operated on several cases like this one. They are very 
interesting, and it is important to make a correct diagnosis. 20 
J. S. WIGHT, M.D. 
Case LV.-James McS., seventy-two years of age, came into 
the hospital December 13, 1892, and was operated on the same 
day. Ten years previous I operated on his lower lip for cancer, 
and the disease did not recur until the lapse of about four years. 
On the day of his return the entire border of his lower lip had 
grown up for some distance with epithelium which projected in a 
ragged fringe; about one-half inch of the border of the lip had 
become infected. I did not think it expedient to give him an anaes- 
thetic; nor did I think it would be safe to perform a long plastic 
operation. He lay down upon the table; I passed a strong silk 
suture just outside of and just below the angles of the mouth, to 
have control of the flaps; my assistants and the house surgeons 
were ready to control the hemorrhage; then, with a pair of curved 
scissors, I cut off the diseased border of the lower lip, by means of 
curved incision sutures; doubled up the cut edges, brought the two 
edges together and permanently arrested the haemorrhage; then his 
mouth was made out of his upper lip, and was not at all sightly. 
In about one week, union had taken place, and the house surgeon 
removed the sutures. On the 24th of December, the upper lip 
had been drawn around on both sides so as to make the under lip 
nearly as long as what was left of the upper one. 
Case LVI.-T. L., thirty-five years of age, in the habit of drink- 
ing, and occasionally having an epileptic fit, fell some distance 
and struck on the left foot about the first of November, 1892, 
severely injuring the left ankle. The diagnosis was fracture of the 
astragalus, fracture of the internal malleolus, with backward and 
inward dislocation of the foot. The swelling was excessive, ac- 
companied by a marked tendency to mortification and the forma- 
tion of extensive blebs. The parts were put into a wire-trough 
splint in order that the swelling might subside. Alcoholic delirium 
came on in a short time, and Dr. Rogers put on a splint of plaster- 
of-Paris to keep the limb from further injury. The soft parts over 
the lower end of the fibula sloughed, and the displacements could 
not be removed. December 13th, about five weeks after the acci- 
dent, I exsected the lower end of the fibula, the lower end of the 
tibia, and the upper half of the astragalus, using the osteotome and 
mallet, as well as the lion-forceps. Then the foot could be reduced 
so as to make its relations with the leg nearly normal. Improve- 
ment was slow, but eventually the patient recovered with a useful 
limb. REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
21 
Case LVII.-May N., seven years of age, with tubercular disease 
of lower end of the left fibula, was etherized, December 15, 1892, 
and the inflamed tissues were opened longitudinally with the 
electro-cautery knife, which was also used in making several ad- 
jacent punctures. The parts were dressed with iodoform and anti- 
septic gauze. This patient was much improved by rest, tonics and 
nutritious food. The local disease was for the most part arrested. 
Subsequently a small tubercular ulcer over the ankle was scraped 
out and cauterized with the galvano-cautery. 
Case LVIII.-C. H., thirty-five years of age, December 16, 
1892, was struck on the back of the head about midway between 
occipital protuberances and the mastoid process with a "sling shot," 
and soon after was brought into the hospital. He was suffering 
from concussion of the brain and shock. In the wound there could 
be felt an indentation of the bone. The hair was shaved off, and 
the skin was disinfected. The fracture was superficial, and 
trephining was not necessary. Primary union of the soft parts oc- 
curred, and the patient made a speedy recovery. Since the advent 
of antispetic surgery, explorative operations of the head can be 
performed without danger. The present practice is very different 
from the practice of years ago. 
Case LIX.-Captain C. had a chronic hydrocele of the left side 
of the scrotum. It had been tapped from time to time for about 
ten years. He desired a radical cure. I passed a drainage tube 
through the scrotum, that is, into and out of the tunica vaginalis, 
evacuated the fluid, and washed out the cavity with a 1-5000 solu- 
tion of mercuric chloride, and applied antiseptic dressings. He 
did not take an anaesthetic; he said there was only slight pain. At 
the end of a week, the tube having been drawn upward by the 
contraction of the scrotum, I put in another from the lower punc- 
ture to another one lower down. This patient left the hospital, 
January 1, 1893, in excellent condition, having a radical cure. He 
came to the hospital, December 13, 1892. Some time after leaving 
the hospital, an adventitious sac developed on the same side. I 
opened it, and there is no further trouble likely to arise. 
Case LX.-J. E. W. had an ischio-rectal fistula, following an 
abscess that had occurred a year ago. I operated on December 
16, 1892, in the usual way, opening the fistula and scarifying the 
surface, so as to get anew granulating surface. He made a very 
rapid recovery, going out of the hospital in about ten days. 22 
J. 5. WIGHT, M.D, 
Case LXI.-M. K., a lawyer, thirty-two years of age, had a 
compound fracture of the forefinger and middle finger of the left 
hand. The point of special interest in this case was an attempt to 
suture the tendons into the flaps after amputation through the 
continuity of the first bones of the fingers. The finger stumps have 
no tendons to move them. They are practically in the way. I 
have often had patients beg to have such stumps removed that 
had been carefully saved under the rules of conservative surgery. 
The rule is save all you can of a finger-all that you can make 
useful. 
Case LXII.-J. W., a laborer, twenty years of age, had suffered 
for some years with an ingrowing nail of the left great toe. Under 
ether, the entire nail was removed by incision and avulsion. The 
diseased parts were cauterized with the electro-cautery knife. The 
relief was immediate, and the recovery was speedy. When a toe- 
nail is so diseased that it becomes a foreign body, it is better to 
removed, and save your patient both time and annoyance. The 
nail must be thoroughly removed, or it may grow again and cause 
trouble. 
Case LXIII.-J. B., a machinist, thirty-eight years of age, had 
been disabled by haemorrhoids for several months, and came to 
obtain relief. An operation was performed, December 21, 1892. 
The haemorrhoids were seized with forceps, and then cut off with 
the electro-cautery knife. There was slight after-haemorrhage, 
which was controlled by the further use of the electro-cautery. 
The patient made a rapid recovery. The usual operation performed 
by me is ligation. It is not my purpose to condemn anyone's 
operation, yet I incline to advise against injecting piles for the 
purpose of curing them. 
Case LXIV.-W. R., aged fifteen years, had a lacerated wound 
of the right hand, caused by a sharp piece of glass penetrating it at 
the bifurcation of the ulnar artery. December 26, 1892, I applied 
suture-ligatures at the seat of the injury. The secondary haemor- 
rhage returned on the second day after. The ulnar nerve was im- 
plicated, and further operation in the wound did not seem to be 
advisable. On December 28, 1892, I ligated the brachial artery in 
the middle third. Subsequently there were two or three times 
when considerable haemorrhage occurred at the seat of the injury. 
Then the radial pulse was good, but I could not detect any pulsa- 
tion in the ulnar artery above the wrist. This patient was pale REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
23 
and not well nourished; he seemed to be prone to haemorrhage. 
His recovery was slow, and the ulnar nerve did not fully regain its 
functions. The seat of the wound was sensitive and tender. 
Case LXV.-C. G.» a married woman, twenty-two years of age, 
December 28, 1892, was shot in the left breast and the upper part 
of the left thigh. Dr. Rae removed the ball from the soft parts 
over the ribs on the left side. The wound did not penetrate the 
thoracic cavity. The wound on the front of the thigh was about 
two and one-half inches below Poupart's ligament. I made an 
exploratory incision, and found that the ball had passed just ex- 
ternal to the femoral artery on its way upward and backward. 
It did not seem practicable to continue the exploration. The dis- 
infection was made as perfect as possible, and the wound was 
dressed aseptically. Septic fever developed, and it was not con- 
trolled by medication. January 9, 1893, the inner aspect of the 
thigh was opened, and a considerable quantity of sero-purulent 
fluid oozed out. The patient died January 13, 1893. 
Case LXVI.-J. S, an engineer, thirty-nine years of age, had 
a compound fracture of the end bone of the right thumb. Opera- 
tion, December 29, 1892. It was possible to disarticulate the end- 
bone, and cover the distal end of the second bone with good flaps, 
thus carrying out the rule to save as much of the thumb as pos- 
sible for an opponent to the fingers. 
Case LXVII.-B. K., work-girl, eighteen years of age, had suf- 
fered for some months with obscure pains in the abdomen. I saw 
her with her family physician, Dr. McManus, and confirmed his 
diagnosis of appendicitis. As her surroundings were very un- 
favorable, we had her taken to the College Hospital for operation. 
The prognosis was very bad. I operated December 30, 1892, 
performing laparotomy along the right side of the rectus muscle. 
I came down upon an abscess, partly saculated, partly diffuse, 
with the folds of intestine extensively adherent to each other and 
to the abdominal wall, the pus having found its way into the 
peritoneal cavity. The pus was evacuated as far as possible, and 
then all the parts were irrigated with a warmer aseptic fluid. The 
drainage was made as good as the circumstances would permit; 
and the patient was sustained by such means as are appropriate 
in such cases. After the operation the shock continued. She 
seemed to suffer in spite of all that could be done for her, not so 
much from pain, as from an indefinable and severe distress. It 24 
J. S. WIGHT, M.D. 
was a case of diffuse suppurative appendicitis, in which general 
sepsis had taken place, probably from the pus finding its way into 
the peritoneal cavity. Expectant treatment would have ended in 
death; the operation did not reach any better result Yet it seems 
to be best to operate on such cases. If the abscess had not been 
diffuse an operation would have been more likely to bring relief. 
Case LXVIII.-K. K., a four-year-old girl, January 18, 1893, 
was playing on the floor with some other children, when a pistol, 
they had in their possession, went off, shooting her in the left side. 
She was brought to the College Hospital, where an examination 
showed that there was a penetrating wound of both the chest and 
the abdomen. An incision at the seat of entrance of the ball 
showed that the seventh rib had been perforated. I excised about 
an inch and a half of the rib where it had been perforated, and 
found that the ball had passed through the edge of the left lung, 
and then gone on through the diaphragm into the abdomen. There 
was, on exploration of the abdominal cavity, no evidence of any 
wound of the viscera, there being no blood to remove. It ap- 
peared as if the ball had largely spent its force in perforating the rib, 
and that it had become quite harmless on entering the abdominal 
cavity. The air passed in and out the opening during respiration. 
The intercostal arteries bled freely, but the haemorrhage was con- 
trolled by catch-forceps. A drainage tube was put into the abdom- 
inal cavity, and another into the lung; the external ends of both 
were stitched to the integument. The drainage tubes were re- 
moved January 14, 1893. The abdominal wound closed in a short 
time, but the wound in the lung did not heal completely for a 
number of weeks. The patient finally recovered and was taken 
from the hospital in good condition. 
Case LXIX.-R. E., a laborer, thirty-five years of age, came to 
the hospital January 2, 1893. having fallen and received a wound 
of the face and forehead; he had a depressed fracture at base of 
the skull on the right side just posterior to the orbit. An explor- 
ative incision showed only an indentation of the outer table of 
the skull. The wound was closed and repaired by primary union. 
The patient left the hospital in a few days in good condition. 
Case LXX.-O. H., a sailor, twenty-seven years of age, broke 
his left patella transversely, and was treated in the ordinary way, 
recovering with fibrous union. About the middle of December, 
1892, he fell and refractured his patella, and came into the College REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
25 
Hospital with his knee much swollen from extravasated blood. I 
had his knee bandaged in the figure-of-8 fashion, and put his limb 
upon my patella-splint. I operated on his patella January 4,1893. 
Over the centre of the patella a longitudinal incision was made 
long enough to permit sawing off the broken ends of the fragments. 
The fragments were drilled through, the lower one from below, 
upward and backward; the upper one from above, downward and 
backward; the wire-after being inserted-came just in front of 
the condyloid groove of the femur; the cut surfaces of bone were 
accurately adjusted; the wire was twisted in front; a drainage tube 
was passed through the flaps on either side; the flaps were sutured 
over the "united'' fragments, and the dressings were applied; then 
the limb was placed upon my patella splint. The next day I re- 
moved the drainage tube, and reapplied the dressing. On the 15th 
of January everything was going on favorably. January 16th the 
sutures were removed and there is good motion of the knee- 
joint. 
In about six weeks this patient was discharged from the hospi- 
tal in good condition. He went out on the icy streets a few days 
after that, and fell, breaking his patella nearly in the same place 
as before. He returned to the hospital, and I operated again. The 
fractured surfaces only required careful scraping to make them fit 
well. The wire suture was still in, but had become brittle from 
twisting it, and from pulling on it at the time of refracture. I put 
in a new wire, and got primary union of the soft parts as well as 
speedy union of the fragments. 
Case LXXI.-J. McD., a sailor, thirty-two years of age, came 
into the hospital January 4, 1893, with a large inguinal hernia of 
the right side tightly strangulated. The hernia was irreducible, 
and of long standing. An immediate operation was necessary. 
The usual incision was made over the neck of the sac, which was 
opened. Even then the hernia was irreducible. Upon examina- 
tion the sac contained the caput coli and the appendix, which was 
nearly four inches in length and unusually large. A considerable 
part of the ileum accompanied the caput coli. The appendix had 
a mesentery, which was removed after ligation. The appendix 
was amputated; silk sutures were used to invaginate the serous 
membrane. The adhesions of the contents of the sac were dis- 
sected through, and then the reduction could not be made. And 
the reduction was only accomplished after cutting the abdominal 
wall upward about two inches, and having the foot of the table 
elevated materially. Then the stump of the appendix presented 26 
J. S. WIGHT, M.D. 
at the opening. The hernial sac and the structures of the sperm- 
atic cord were interwoven in inextricable confusion, so I brought 
down the sac and ligated it at the neck including the structures of 
the cord. Profuse haemorrhage soon occurred, and it was found 
to come from the cord, which was seized and a ligature applied. 
The incision in the abdominal wall was closed with strong silk su- 
tures after aseptic irrigation. This did well in every respect. I re- 
moved thesutures on the 15th of January. They had "cut in" to 
a considerable extent. On the 16th of January the patient got out 
of bed and went to the "water closet." Then he kept in bed for 
several days, and the tissue in the wound became firmer from day 
to day. In a little time he was allowed to get up and go about 
the ward, and finally left the hospital with a radical cure. 
Case LXXII.-G. G., a laborer, thirty-five years of age, had 
painful stumps of the second, third and fourth toes of the left foot. 
The ends of the stumps projected upward, and were pressed upon 
by the boot. Dr. Cochran and the house surgeon operated, dis- 
articulating the toe-stumps. The wound was completely closed, 
and primary union followed. 
Case LXXIII.-H. M., a girl eleven years of age, while at 
play, fell upon her left hand, and was brought to the hospital by 
her father. She had a "bent fracture " of both bones of the left 
forearm. The lower ends of the radius and ulna were bent 
backward nearly forty-five degrees. The lower radial fragment 
was about seven-eighths of an inch in length. The lower ulnar 
fragment was about five-eighths of an inch in length. I made 
the reduction by putting my thumbs upon the angle of displace- 
ment, and applied my fingers against the dorsal aspect of the parts 
above and below, and then using considerable force. There was 
some crepitus when the bones were straightened. The parts were 
put in a trough-splint made of wire cloth. 
Case LXXIV.-M. D., a colored girl, four years of age, had 
triple displacement of the left leg from tubercular, disease of the 
knee-joint. On January 11, 1893, I exsected the knee, and found 
the femoral condyles containing suppurating cavities. The 
lower end of the femur was cut off, as well as the upper end of 
the tibia. The cut ends were adjusted and nailed together. The 
limb was put on double inclined plane, having a large obtuse 
angle, in order that the limb might be slightly bent when the 
bones were united. On the evening of the day of operation, the 
patient pulled and kicked the dressings nearly off, so that they had REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
27 
to be readjusted. This operation was completed in twenty min- 
utes. It took nearly three months to obtain bony union of the 
femur and tibia. 
Case LXXV.-J. R., a laborer, twenty-three years of age, had 
his right leg amputated at the knee-joint for osteo-sarcoma of the 
leg. The operation was performed at my Clinic of last year. He 
came into the hospital for the removal of a sarcomatous growth 
from the back part of his thigh about four inches above the end of 
the stump. I operated January u, 1893. The enucleation of the 
growth from the nerve, artery and muscles was easy enough. The 
wound was packed with aseptic gauze. The patient was given 
the bromide of arsenic in one-fortieth grain doses three times a 
day. At the time of the previous operation the bromide of arsenic 
was given. When he had improved materially, he refused to take 
the remedy, and after that he did not do as well. He did not 
keep up the treatment. In May, 1893, I saw this patient, and he 
had a large, rapidly growing osteo-sarcoma of the sacrum. 
Case LXXVI.-Wm. W., forty years of age, was operated upon 
at last year's Clinic for an abscess of the left mastoid process. 
The operation was incision and linear-osteotomy. A fistula had 
been left. He returned for another operation. A free incision 
was made, and the scar was scarified. This patient left the 
hospital the next day, and has not been heard of since. 
Case LXXVII.-C. L., a laborer, twenty-four years of age, 
while "tying up" bags in a factory, November 23, 1892, cut the 
little finger of his left hand, and suffered from septic inflammation 
which resulted in necrosis and anchylosis. The finger was am- 
putated, leaving the head of the metacarpal bone. The wound 
was closed completely. There was primary union, giving a good 
result. The operation was performed on the 12th of January, 
1893. 
Case LXXVIII.-J. W., a nine-year-old schoolboy, was run over 
by a truck January 16, 1893, and had the leg and the knee of the 
right side crushed, and also had a compound, comminuted fracture 
of the left thigh in the middle third. He was brought to the 
College Hospital in a state of extreme shock. I made a rapid 
amputation of the right thigh in the lower third, as low down as 
possible, and, after ligation of the arteries and excision of the 
sciatic nerve, a deep, continuous suture was applied so as to pre- 28 
J. 8. WIGHT, M.D. 
vent oozing. The left thigh and its wound were disinfected, and 
a long, straight splint applied on the outside. No traction was 
used, for the other side would only have a stump, and the repair 
would no doubt be speedier than under an attempt to remove the 
shortening. The operation added to the shock, which continued 
for three days. This patient did not get out of bed for nearly 
six weeks. The left limb shortened; how much is unknown. 
Case LXXIX.-J. C., a fireman on a tug, thirty-two years of 
age, had his left foot burned from falling between the boiler and 
the side of the boat; and, after some weeks, the fifth metatarsal 
bone and the bones of little toe suffered from necrosis. On the 
18th of January, 1893, I removed the dead bones, and then the 
repair was rapidly completed, leaving the man a useful foot. The 
rule in such cases is: Do not operate until the furrow of separa- 
tion between the living and dead parts is well established. I have 
often applied this rule to advantage in cases of frost-bite, as well 
as those of burn. 
Case LXXX.-H. B., a sixteen-months-old girl, had a tumor on 
the back over right scapula. It had been noticed about four 
weeks by the mother. On removal it was found to be a vascular 
cyst, resembling a cystic sarcoma. The haemorrhage was profuse, 
but was arrested by means of suture-ligatures and packing the 
operation-wound with aseptic gauze. The growth began to recur, 
but the new tissue went away after the administration of bromide 
of arsenic, in one-hundredth grain doses. 
Case LXXXI.-J. S., sailor, forty years of age, had a com- 
pound comminuted fracture of the bones of the right middle- 
finger, followed by necrosis and total disability of the injured 
finger, which was in the way of the other fingers. On January 
20, 1893, the finger was disarticulated by the oval method. The 
operation wound was packed with aseptic gauze, and when 
granulation took place the flaps were brought together, so that 
union by "second intention" took place. 
Case LXXXII.-H. S., machinist, twenty-eight years of age, 
caught the ends of the first, second and third fingers of the right 
hand, between the cog-wheels of moving machinery, and had 
compound fractures of their end-bones. On the 20th of January, REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
29 
1893, the base of each one of these end-bones was extended, so as 
to save the tips of the fingers. The middle finger-bone was made, 
as it were, longer by so much of the end-bone as was left, and the 
normal tactile surfaces of the injured fingers were preserved, mak- 
ing the patient a more useful hand than he would have had with 
an amputation. 
Case LXXXIII.-T. S., a lad, thirteen years of age, Jan. 20, 
1893, had fallen from a height, and struck on his right foot, driv- 
ing the astragalus upward so as to produce a vertical posture of 
the lower end of the tibia. The ankle was enlarged, and the foot 
was everted, there being a fracture of the fibula, about three inches 
from its lower end. After anaesthesia, I succeeded in removing 
much of the deformity by means of forcible manipulation. The 
parts were kept in place by means of my modification of Dupuy- 
tren's splint. The result was very good, there being slight dis- 
ability of the ankle left. 
Case LXXXIV.-C. D., an intoxicated man, fifty-three years of 
age, for the purpose of drawing off his water, took a hat-pin six 
inches in length, and pushed the glass head of it through his 
urethra into the bladder, its sharp point being lost in the pendu- 
lous part of the penis. On the 24th of Jan., 1893, the day after the 
accident, I saw the patient, and found the point of the hat-pin 
lodged in the soft part, just at the anterior limit of the scrotum, the 
head of the pin being in the bladder. I made every preparation 
for a cutting operation. Then I pushed the skin so as to make 
the point of the pin protrude, when I seized it with a pair of for- 
ceps and pulled the pin out, so as to bring the head of it into the 
urethra, under the place where it emerged, and then reversing the 
direction by carrying its point downward and backward, it was 
easy enough to push the pin's head out of the meatus, and so pull 
the entire pin out. Then the patient went home-"all right." 
Case LXXXV.-Mrs. M. D., twenty-six years of age, had a 
fracture of the left leg just above the ankle, twenty years ago. In 
the meantime there had been occasions when she had suppurating 
sinuses at the seat of injury. She had a considerable enlargement 
over the front of the lower end of the tibia, on which I operated 
Jan. 25, 1893. A vertical incision was made down to and into the 
bone, the saw being required for cutting the bone, and then the 30 
J. S. WIGHT, M.D. 
growth was partly sliced out with the scalpel. The wound was 
dressed open, and the patient was given the bromide of arsenic, 
1-40 gr. after each meal. The rest of the growth disappeared in a 
few weeks, and an apparently perfect recovery followed. 
Case LXXXVL-A man about seventy-five years of age, in 
feeble health, came to my clinic, Jan. 25, 1893, having a large 
hydrocele of the left side of the scrotum. He did not seem to be 
strong enough to have a radical cure undertaken, so he was tapped 
and the fluid drawn off with trocar and cannula. 
Case LXXXVII.-A nine-year-old school boy had tubercular 
disease of the foot. An incision was made into the infected parts 
including the diseased bones. The infected parts were scraped 
out as far as possible, and the excavations were well washed out 
with a 1 to 1,000 warm solution of mercuric chloride. Drainage 
tubes were inserted, and antiseptic dressings were applied. The 
carbonate of lime was given the patient before meals, and the 
syrup of the iodide of iron was given after meals. The progress 
of this case was very favorable. 
Case LXXXVIII.-Captain B., seventy-three years of age, had 
an ulcerating epithelioma upon his right cheek, and was too feeble 
to take an anaesthetic. He lay down upon the operating table, 
and the electro-cautery knife was used to cut a circular furrow 
around the neoplasm, which had a surface a little larger than the 
thumb-nail. Then the mass was ligated, as thoroughly as possible, 
by passing a strong ligature under its base in several directions. 
It sloughed away in a few days, and he left the hospital much im- 
proved, with the surface of the excavation granulating. He re- 
turned some weeks later exhibiting a nearly normal scar. 
Case LXXXIX.-A laborer, thirty years of age, came to the 
clinic, with a sebaceous cyst, having a very thick wall on the back 
of the head. It was adherent to the peri-cystic tissue, and had to 
be dissected out. There was considerable haemorrhage, requiring 
the use of the suture-ligature, which is best inserted by a curved 
Hagedorn's needle. Sebaceous cysts of the scalp can generally 
be easily enucleated. REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
Case XC.-T. M., a girl, eighteen years of age, had an abscess 
of right axilla. The abscess was opened, and irrigated with a 
warm solution of mercuric chloride. The healing was rapid and 
satisfactory. 
Case XCI.-This was the same patient as Case XXIV. New foci 
of pus-formation were found in the tissues adjacent to the incisions 
made previously. They were thoroughly opened. Then the 
patient was treated with ten-grain doses of carbonate of lime given 
three times a day. No other pus foci have been developed, and 
the patient has been recovering in a very satisfactory manner. 
Operation performed Feb. i, 1893. 
Case XCII.-On the same day, Mr. D., thirty-three years of 
age, had the little finger of his right hand amputated for incurable 
deformity caused by a burn. The head of the fifth metacarpal 
bone was cut off obliquely, in order that the hand might have a 
better shape. The flaps were brought together with deep sutures, 
and primary union was obtained. 
Case XCIII.-J. M., farmer, thirty years of age, on evening of 
Feb. 8, 1893, had his left foot crushed by the wheel of a trolley 
car, and was brought to the College Hospital. On consultation it 
was found that the foot could not be saved. The day after the 
accident I amputated the leg in the middle third. The posterior 
flap was made by transfixion, and the anterior by incision. The 
anterior tibial artery was secured by a suture-ligature. The two 
principal nerves were drawn out and cut off as closely as possible. 
The general health of this patient was not good, and the soft parts 
were bruised. Repair went on slowly. 
Case XCIV.-T. B., a woman, about fifty years of age, was ad- 
mitted to the hospital Feb. 17, 1893, suffering from cancer of the 
liver, accompanied by dropsy. A large quantity of fluid was 
drawn off by tapping, and then the disease of the liver could be 
surely traced. Such cases are hopeless. We know of nothing 
that will save the life of such a patient. Our appeal is, let physi- 
cians never cease to make every attempt to find some medicine 
that will give our patients relief. It is to be hoped that a cure for 
cancer will some day be found. 
31 32 
y. S. WIGHT, M.D. 
Case XCV.-Mrs. M., forty-nine years of age, had a femoral 
hernia of the left side, which had caused her more or less trouble 
fifteen years. The hernia became strangulated, and could not be 
reduced. After the lapse of three days, and when several attempts 
at reduction had failed she was brought to the College Hospital on 
the evening of Feb. 15, 1893. I operated just before midnight, and 
found a very tight constriction biting the intestine, which had a 
small loop protruding. The intestine appeared to be almost gan- 
grenous. It was adherent to the entire sac, which had to be dis- 
sected off. The patient was in such a collapse that a very speedy 
operation was required. The opening was made large enough to 
place the damaged part of the intestine just within the abdomen. 
An exsection would have been fatal, for the patient barely sur- 
vived the operation under the circumstances. It was thought that 
if sloughing of the intestine occurred, it would be well to have the 
wound left open. So the parts were dressed in such a way as to 
permit a free drainage. It was three days before this patient 
showed any material signs of reaction. She slowly improved 
after this time. The wound healed by granulation, making a firm 
scar. The patient went home at the end of about five weeks, and 
will have a radical cure. 
Case XCVI.-H. B., twenty-four years of age, had a compound 
fracture of the end-bone of the right index finger, caused by a cir- 
cular saw. A circular flap amputation was made at the middle of 
the second finger bone. There was primary union. 
Case XCVII.-F. L., seventeen years of age, had an ingrowing 
nail of the right great toe. It acted as a foreign body, and the 
"flesh''had grown up over each side of it. The nail was split 
with a pair of scissors and the parts everted, and then the fleshy 
granulations were cut off. 
Case XCVIII.-T. S., a ship's mate, fifty years of age, on Feb. 
3, 1893, had an attack of vomiting, and then he noticed a swelling 
in the right groin, just below Poupart's ligament. He was brought 
to the hospital, where an exploratory operation was advised. It 
was not easy to say how much of the swellling was hernia, how 
much was adenitis, how much was abscess. Hence, it was thought 
best to make an exploration. After anaesthesia, an incision was 
made down to the sac which was very thick. The end of a 
foreign body presented itself to the touch of the finger, and on re- 
moval it was found to be a wood-sliver about two inches in length, 
sharp at either end and generally somewhat rough of surface. It A'AT't'T??' OF ONE HUNDRED AND NINE OPERATIONS. 
33 
was a sliver of hard pine wood. It had worked its way from the 
intestine out through its wall and the wall of the hernial sac. 
The parts were freely opened to let out the pus, and afford good 
drainage. Repair took place in the wound, and after two weeks 
the bowels were moved by injections and laxatives. In about 
three months the patient was sent home to England. His general 
condition, while not very good, had improved. At no time did it 
seem advisable to undertake further operation. At the time I 
operated upon him, an exsection of the intestines would have 
caused his death, on account of his feebleness. In the future it 
may be deemed advisable to operate further. 
Case XCIX.-T. R., an Italian sailor, came to my clinic, Feb. 
27, 1893, having tubercular infection of the glands of the neck. 
An incjsion was made into them, and they were thoroughly 
scraped out with the curette. In such cases, the bronchial glands 
in the upper part of the chest are involved, and cannot be removed. 
An operation for the removal of tubercular gland of the neck is 
more or less serious. And it often happens that some foci of infec- 
tion cannot be reached safely; but the process of repair more 
frequently removes the peri-glandular bacilli, and the cases do re- 
markably well. Having this experience, I am not so anxious as for- 
merly to remove all suspected points. 
Case C.-J. C., a driver, twenty-two years of age had peri- 
ostitis of the left tibia. An incision was made down to the bone, 
allowing free haemorrhage. Then linear osteotomy was performed, 
so as to permit the escape of inflammatory products from the bone. 
The wound was dressed open, and the case improved for a time ; 
then pus formed in the tissues adjacent to place of the operation. 
The administration of the carbonate of lime arrested the work of 
the pus-organisms. 
Case CI.-H. W., three years of age, had symptoms of stone in 
his bladder. A sound confirmed the diagnosis. On March 1, 1893, I 
performed the medio-lateral operation. The stone was an inch in 
length, half an inch in thickness, and five eighths of an inch in 
width. One of its sides was attached to the mucous membrane of 
the roof of the bladder, and detachment was necessary before I 
could grasp the stone with the forceps. While the right hand 
pushed backward and downward the abdomen over the bladder, 
the left index finger detached the stone. Here I must repeat the 
advice : To pass a grooved director through the wound into 34 
7. .S'. WIGHT, M.D. 
the bladder, before the removal of the staff, in order to guide 
the finger safely into the bladder between the two instruments, 
thus preventing the possibility of pushing the neck of the bladder 
away from its connections with the deep fascia. This case made 
an excellent recovery. 
Case CH.-A colored man, only sixty years of age, was admitted 
for an operation ; removal of the left breast which had devel- 
oped a small cancer about as large as the fist. The disease had 
been about two years developing. Cancer of the male breast is 
rare. There was nothing very special in the case, except that there 
was not integument enough to close up the wound of operation. The 
tumor was small and circumscribed. Much care was taken to 
make this case successful ; but in a few days after the operation, 
pneumonia "set in" and the patient died in forty-eight hours. 
Case CI 11.-Mr. F., twenty-one years of age, had the end of his 
right thumb crushed by machinery, and after bruised portions 
mortified, they were trimmed off, so as to leave as much of the 
thumb as possible, a small part being left to granulate. The re- 
sult was a useful thumb. 
Case CIV.-C. P., a boy fourteen years of age, March 3, 1893, 
was accidentally shot, just internal to the left eye, the ball going 
through the left nasal bone, and into the cells of the ethmoid 
bone, where it was decided to leave it after a careful exploration. 
There were no special symptoms developed. The patient made a 
rapid recovery. The ball, which was fired by a small pistol, be- 
came encysted. 
Case CV.-J. S., a laborer, forty-five years of age, in a fit of 
despondency, because he had failed to get work and earn bread for 
his family, cut his throat. The wound opened the larynx, but did not 
sever the large blood-vessels of the neck. The wound in the larynx 
was closed with cat-gut sutures. The wound of the neck external 
to the larynx was closed by deeply inserted sutures, and a drain- 
age tube was employed. The wound had been injected while the 
patient was waiting to be conveyed to the hospital, and so there 
was some suppuration. The patient made a good recovery. 
Case CVI. - J. F., a laborer, thirty-eight years of age, July 3, 
1892, had a strangulated hernia of right side, accompanied by 
dropsy, and was operated for its relief by Dr. Lewis. It was not 
possible to make a radical cure at that time, and the wound was REPORT OF ONE HUNDRED AND NINE OPERATIONS. 
35 
left open so as to permit the fluid to run off from the peritoneal 
cavity. He returned in March 1893, having a recurrence of the 
hernia. An operation was undertaken for radical cure. The sper- 
matic cord was very short, and could.not be well separated from 
the tissues arouild it. I pushed it firmly to the inner side of the 
opening and fastened it here with cat-gut sutures, and closed 
up the vaginal canal. The result was very encouraging, but after 
a time there was a recurrence of the protrusion in the meshes, so 
to speak, of the spermatic cord. He was very anxious to have a 
cure so that he could continue his work of a stone-mason. He 
gave permission to remove the testicle, if it were found necessary. 
In operating the next time, I found on exposing it, his testicle very 
small, with the epididymis nearly gone, and the cord was so 
involved in its surroundings that it could not be separated to any 
extent, nor was there any sac that could be dissected up. The cord 
was ligated on a level with the internal ring, and the testicle was 
removed. The stump of the cord was fastened in situ, and the 
ring was completely closed with cat-gut sutures. Then the wound 
was closed with deep silk sutures. The repair was by primary 
union, and the condition good. He left the hospital the last of 
April, having a radical cure. 
Case CVH.-B. F., a workwoman, had a painful and ulcerating 
stump of the right leg, which had been amputated in the middle 
third, twenty-six years before, when she was twelve years old. A 
re-amputation gave her an excellent stump covered with integu- 
ment. There was a kind of fatty condition of the stump, the 
adipose tissues being abundant, and the bones being quite soft. 
She can now have an artificial limb applied, and be able to lay 
aside her crutch. 
Case CVHI.-Same as Case XXXIII. Adventitious cavities con- 
taining pus were opened as freely as possible. The administration 
of ten-grain doses of carbonate of lime arrested the extension of 
the infection and the patient recovered. 
Casc CIX.-T. H. B., a sailor, forty-six years of age, had some 
indolent swelllings in the upper part of the front of the left thigh. 
They had opened and discharged, leaving sinuses. Ether was 
given, the sinuses were opened and the cavities were irrigated with 
a solution of mercuric chloride. Under a tonic and alterative 
treatment, this patient slowly recovered.