Transactions of the Maine Medical Association, 18__, pp. 140-143.

SURGICAL CASES

ARTICLE XV.

Cases Reported by WM WARREN GREENE, M.D., of Portland,
Professor of Surgery in the Medical School of Maine.

Case I.  Urinary Calculus.  This specimen was taken from a man aged 63 years, and is especially interesting from the fact that the patient had always resided in Cumberland County, where the disease is very rare.  It is composed of a uric acid nucleus, surrounded by a phosphatic crust.  It was sacculated in the anterior wall of the bladder, and was removed by the lateral operation performed in the usual manner.
     The etiology of this affection is still very obscure, and much light may be thrown upon the subject by a careful study of its relation to different localities.
     That it is not wholly due to water, is shown by the fact that there is a very marked difference in regard to its frequency in places having the same geological formation, and where the water gives the same analysis, as I have seen abundant proof.
     The history of the disease, in this state, is worthy the attention of the Association.

Case II.  Removal of Caput Femoris, with Operation for Relief of Anchylosis.
     The second specimen is the articulating surface of the head of the femur, which has the following history:
     In August, of 1867, a young man aged 30 was thrown from his seat on a reaper, the point of the blade catching him behind the right trochanter, and dragging him, as the horses ran, for quite a distance.  The result was a severe, lacerated wound, penetrating the capsule, and producing a compound luxation.  This was seen and reduced by the family physician, and for a time the case did well, the external wound nearly healing.  Subsequently, however, the parts became more or less painful, a fistulous opening remained and discharged profusely, his strength and flesh wasted, and in the following December I found him with well-marked, hectic fever.  There was no deformity, but perfect immobility of the hip joint.  A probe introduced through the fistula, struck bare bone which appeared to be in the acetabulum.
     An incision was made as in the usual operation of excision, exposing the head and much of the bone.  These were found precisely in their proper position, but with a complete solution of continuity between them, the epiphysis lying loose in the socket.  A sufficient portion of the upper part of the cervix, which was carious, was removed to admit of the extraction of the sequestrum, when it was found that the bone was firmly fixed in its position by a new bony deposit, that was thrown around its upper portion, between the trochanters and the rim of the acetabulum.  Through this involucrum a perforation was carried several times, and then sufficient force used to break up the adhesion and restore motion.  This was done with the utmost care, and only sufficient motion made to be sure that separation was accomplished.  Extension was then applied with weight and pulleys, and he was thoroughly supported with tonics and nourishment.  He improved slowly, the limb shortening a little, and the motion gradually increasing under daily passive exercise, until the external opening finally healed; and the limb is now sound, shortened  1 ¼ inches, in good position with free motion, and the man walks with ease.

Case III.  Ovariotomy.
     The third specimen to which I call the Society’s attention, is an ovarian cyst which weighed 40 lbs., removed from a patient aged forty.
     I do not propose to give a detailed account of the case at this time; and my principal object in exhibiting the specimen  is to illustrate the wonderful preservative power of carbolic acid.
     This tumor, removed eight months ago, was well washed in clear water, and then soaked for several hours in a solution of carbolic acid, in the proportion of one drachm to two quarts of water.  After this it was placed in a weak solution (about one scruple of the acid to an ordinary wash bowl of water), and allowed to stand in an open vessel in a room, the temperature of which has ranged quite uniformly from 70 to 80 degrees, Fahrenheit.
     Several times the solution has evaporated, so that portions of the cyst have been exposed to the air long enough to become dry and hard; but these have been perfectly restored  by covering again with the fluid.  Nearly three weeks ago, I found the liquid had evaporated, and, as an experiment, I allowed the specimen to remain uncovered until yesterday, when it was dry and hard, like sole leather.  There was, however, no unpleasant odor; and on putting it again in a fresh, weak solution of the acid, it has become for the most part entirely soft and pliable.  The few dark spots which mark points still somewhat hard, will probably disappear in twenty-four hours more, and the entire mass be as soft and yet as firm as when taken from the abdomen.
     An interesting fact in connection with this case is, that both ovaries were removed, the other being the seat of incipient cystic disease; and yet in just four weeks after the operation the lady had all the symptoms which she was accustomed to experience before menstruation, which were followed by a considerable sanguineous discharge, lasting several hours.  This has not been repeated.
     In another case, in which I also removed both ovaries, the same phenomena presented at the expiration of both the first and second months after the operation.