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THE GERMAN SURGICAL

(FROM OUR BERLIN CORRESPONDENT.) met- D

THE twenty-seventh Congress of the German Surgical of

Association was opened as usual in Langenbeck House, und

Berlin, on the Wednesday after Easter. That day happened intethis year to fall on April l8th and the meetings were con- the;tinued till April 16th. The chair was taken by Professor him

Trendelenburg of Leipsic, who in his inaugural address the

informed the meeting that the family of the late Professor patvon Langenbeck, the founder and honorary president of theassociation, had bestowed on the association an endowment Iof 50,000 marks ( £2500) in order to enable German surgeons, Drcivil and military, to study military surgery in countries thewhich might be the theatre of wars in which Germany was dirnot engaged. In time of general peace prizes payable out - of the annual proceeds of the endowment would be awarded a to the authors of the best theoretical works on military thEsurgery. The first subject considered by the congress was we

The Improvement of the Aseptic Method in Surgery. 21Professor MIKULICZ (Breslau) said that in order to avoid

infection of operation wounds by the hands of the surgeons paland the assistants he recommended the wearing of gloves of thwhite thread which must be sterilised before use. To protect wtthe wounds from germs coming from the mouth he and ’

his assistants cover their mouths with gauze bandages. He ca:

stated that this precaution was necessary owing to the fact inithat in 33 per cent. of 48 cases bacteriological examination showed that staphylococcus aureus was present in the mouths su

of healthy persons. Speaking during the course of an di

operation ought to be avoided as much as possible. To pcensure the sterilisation of dressing materials he has devised lasome methods which are apparently very useful. The most re

simple and efficacious way of control is to put inside the - dressing-box a piece of paper on which the word I I steri- re

lised " is printed, and the paper before being sterilised is oc

made blue by a solution of iodine, so that the printing dis- wappears. When a temperature sufficient for complete sterili- nsation is produced within the apparatus the iodine goes offand the word sterilised " reappears on the paper. 2f

Professor LANDERER (Stuttgart) recommended that C

’bandages treated with a 1 per cent. solution of formalin w

should be applied to the skin from twelve to twenty-four dhours before an operation, b

Dr. DÖDERLEIN (Tiibingen) said that he had found that p,gloves such as those worn by Professor Mikulicz became filled a

with bacteria during operations. Gloves of caoutchouc were pless infected. He did not think that gloves were of any use e

,and he advised that surgeons should wash their hands frequently during their operations. t’

Dr. FRIEDRICH (Leipsic) stated that the views of the late dDr. Schimmelbusch, although correct from a theoretical c

point of view, were not applicable in practice. Dr. Schim- Imelbusch found that the bacteria present in a traumatic lesion very quickly penetrated into the blood-stream, so that a

,the local application of an antiseptic was according to himquite useless, but it must be remembered that he made his c

’experiments with cultures of anthrax and not with the com- paratively few and innocuous germs ordinarily present inwounds. Dr. Friedrich inserted small portions of earth in the muscles of rabbits and found that the bacilli of malignant 1- oedema did not penetrate from the wound into the circulation in less than six hours, from which it is evident that infectionmay be avoided if an antiseptic is applied within six hoursafter an injury.

Local Anæsthesia.Dr. HACKENBRUCH (Wiesbaden) recommended injections

- of cocaine and eucaine especially for operations on the fingersand toes.

Dr. BRAUN (Leipsic) said that the physical ’properties ofthe injected compound were very important for efficaciousanaesthesia. Only fluids which have the same freezing pointas the lymphatic fluid in the tissues produce anaesthesiawithout either irritation or paralysis ; a solution consistingof cocaine and eucaine dissolved in 0’8 per cent. salt solutionwould be the best. To add morphia as recommended by Dr.Schleich would not be an improvement because of the pro-duction of oedema. Local anaestheaia might even be used inmajor operations when general anaesthesia was either toodangerous or not possible owing to the general state of the

patient. In children it is, of course, not to be used. Inoperations on the fingerq and toes circular anmsthesia asrecommended by Dr. Oberat is preferable to Schleich’amethod.

Dr. GOTTSTEIN (Breslau) said that in the surgical clinicof that town 233 major operations had been performedunder Schleich’s local anaesthesia and he mentioned theinteresting fact that affections of the lungs developed as

frequently after local anaesthesia as after general anaes-

thesia produced by chloroform and etber. According tohim this frequency of pulmonary affections is due, not tothe anaesthetic compound, but to the pain which hinders thepatient from expectorating.

Operations on the Stomach.Professor KRÖNLEIN (Zurich) said that his assistant,

Dr. Schlatter, had last year performed a total extirpation ofthe stomach for carcinoma and had united the oesophagnsdirectly with the duodenum. 1 This operation, which hadbeen very severely criticised by American surgeons, proveda complete success. The patient is now, five months afterthe operation, in a good state of health, has increased inweight, and is able to eat and diink like other people. Of21 cases operated on according to Billroth’s method 5 diedwithin a fortnight after the operation. Of the 16 remainingpatients 2 died from other diseases, 8 relapsed in from one tothree years after the operation, and 6 are still alive, ofwhom 4 were operated on four years ago.

Dr. SCHUCHARDT (Stettin) said that three varieties ofcarcinoma of the stomach must be distinguished, the

infiltrating, the nodular, and the cauliflower-like forms. Thelatter is moveable and is comparatively late in extending to

snrronnding structures. The first two varieties are verydifficult to remove completely and as a rule the greaterportion of the stomach has to be excised in these cases. Thelast variety is more easy to operate upon and gives the bestresults. Dr. Schuchardt showed a stomach the whole of; which, with the exception of only a small portion, was. removed three years ago for carcinoma. Death ultimately9 occurred from pleurisy and it was then found that the piece. which was left had become dilated almost to the size of a- normal stomach.f Dr. STENDEL (Heidelberg) gave an account of a series of

290 operations on the stomach performed by Professort Czerny during the last eight years. The average death-raten was 24-8 per cent. ; in the first year it was 45 per cent., butr decreased to 16 per cent. in the last year. Pylorectomy was

but seldom performed, as pyloroplasty had proved to be,t preferable. Of 8 cases of pylorectomy 2 are still alived after seven and eight years respectively. Of 9 cases ofe pyloroplasty 4 were successful, but in one case gastro-;e enterostomy had to be performed subsequently. The opera-ia tion of gastro-enterostomy has been very much improved by

the employment of Murphy’s button and the mortality bas;e decreased by 12 per cent. ; it was found that the button

came away in the faeces and no ill effects followed its use.Dr. Stendel finally mentioned the fact that some cases of

ic carcinoma were cured by mere laparotomy, in the same wayas has been observed in tuberculous peritonitis.

m Professor MIKULICZ (Breslau) strongly urged the removalis of the surrounding structures, especially the lymphaticn- glands, in the neighbourhood of the stomach.in Dr. DOYEN (Paris) showed his new method of pyloricin operation consisting in isolation and resection of the pylorusnt by the aid of a pince invented by him, ligature of the

duodenum and the stomach, and gastro-enterostomy.on Calot’s Treatment of Spondylitis.

Dr. HOFFA (Würzburg) stated that 6 deaths have beenreported as a sequel of Calot’s treatment of spondylitis. It

is especially dangerous when the spinal curvature is ofseveral years’ standing, when many vertebrae are involved,and when suppuration is going on. In other cases the

of method may be tried cautiously. Paresis of the lowerextremities is generally improved by it. Dr. Hoffa referred

int . to 23 cases treated by Calot’s method without fatal results,but in two instances abscesses developed. The operationing is generally followed by an immediate improvement in theion symptoms, but it is not yet possible to give a definite opinion

as to the permanency of the result.Professor LORENZ (Vienna) said that Dr. Calot un-

l in doubtedly had the merit of having proved that an angular

A translation of Dr. Schlatter’s paper recording this case published in THE LANCET of Jan. 15th 1898.

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curvature of the spine will bear rough handling, but hismethod of treatment is unfortunately wanting in precision.Professor Lorenz has devised an apparatus by which theamount of extension is brought more directly under control;he advises that the curvature should not be straightenedabruptly and by force and he is strongly of opinion that thetreatment should be applied only to cases in which thevertebral column is capable of relaxation. His views havebeen already reported in THE LANCET of Nov. 20th, 1897(p. 1360).Dr. WULLSTEIN (Halle) said that he had made observa-

tions on dead bodies in which the vertebral column had beenbroken in accordance with Calot’s directions and he hadfound laceration of the pleura and the lungs, haemorrhage ofthe dura mater, laceration of the spinal cord, &c. Thecurvature ought to be straightened gradually, as the applica-tion of great force is liable to produce the lesions justenumerated. New formation of bone in the space betweenthe vertebral fragments was not possible, as has been allegedby Dr. Calot.The majority of other speakers, such as Dr. SCHEDE, Dr.

K6NIG, Dr. KÜMMELL, &c., were of opinion that Calot’smethod was not universally applicable and that angularcurvature of the spine could be successfully treated only inthe early stage of the disease and by a less energeticprocedure.

Operations for Empyema.Dr. JORDAN (Heidelberg) said ,that Estlander’s method

of subperiosteal resection of the ribs had not given goodresults, for of 8 cases only 2 were successful. In pro-tracted cases Schede’s operation is preferable as all thefistulæ are made visible. The resection must be a radical

one. Of Dr. Jordan’s patients 9 were cured, 5 were

improved, and 1 is still under treatment. In children theresults are still better than in adults. The operation maybe performed on tuberculous patients provided that theirgeneral state is not bad. On one occasion Dr. Jordansuccessfully carried out Delorme’s method of removingfibrinous masses on the pulmonary pleura. Of 27 casesdescribed in the medical press 11 were cured in this way.

Dr. PERTHES (Leipsic) recommended that a Bunsen’s air-pump, which is worked by a column of falling water, shouldbe connected with the cannula in the pleural cavity bymeans of a caoutchouc tube, so that the rarefaction of airproduced by the pump might make the lung dilate.Dr. KAREWSKI (Berlin) showed patients on whom he had

operated for abscess of the lung as well as a patient sufferingfrom actinomycosis who had been nearly cured by resectionof the thoracic walls and cauterisation of the affected portionof the lungs by Dr. Paquelin’s thermo-cautery.

The Serum Treatment of Diphtheria.Professor KRÖNLEIN (Ziirich) exhibited Statistical Tables,

which showed (1) that the prevalence of diphtheria in thecanton of Zurich had been nearly uniform during the pastfifteen years; and (2) that the mortality rapidly decreased assoon as antitoxin serum was used on a somewhat large scale.In his clinic all the patients were examined bacteriologicallyand serum was administered in every case of diphtheriawithout exception. This was the only way of arriving ataccurate statistical results. Of 1336 cases treated beforethe serum-period 554 (=394 per cent.) died, whilst duringthe serum-period there were 55 deaths among 437 cases(=12 per cent.). In cases of tracheotomy the death-ratesbefore and during the serum period were 66 and 38’8 percent. respectively ; and,...moreover, the operation is now per-formed much less frequently than before. The good effectsof antitoxin serum were shown by rapid improvement ofthe patient’s general state, decrease of temperature, loosen-ing of the croupous membranes, decrease of glandularswelling, absence of tracheal croup and stenosis, and absenceof diphtheritic infection of the tracheotomy wound.

Rifle Bullets of the British Army.Professor VON BRUNS (Tubingen) made a communication

relative to the bullets used by the British army in recentwarfare. These projectiles were originally coated with nickel,but as, it was found that the enemy when wounded werenot invariably disabled the nickel coating was filed awayfrom the top of the bullet. In fact, the nickel coveringenabled the bullet to pass through the body making only a

. relatively small wound, but when this covering was removedfrom the top the lead was flattened out as soon as it struckthe body, by which flattening the remainder of the coveringwas burst open in an explosion-like way, inflicting wounds ofan astonishingly severe character. These bullets, which are

termed Dum-Dum bullets, are now officially introducedinto the British army. In experiments made with them ondead bodies Professor von Bruns found that shots fired atdistances of from 25 to 50 metres (from 80 to 160 yards) causedwounds of the skin as large as a band, the muscles werelacerated, great pieces of bone were torn out, and the woundwas filled with fragments of lead and nickel. Professor vonBruns said that these bullets were in accordance with theletter but not with the spirit of the Convention of St. Peters-burg, by which the use of explosive projectiles was pro-hibited. The convention would therefore have to be amendedand he would be glad if the discussion of the question bythe Surgical Association would have the effect of inducing-the German Government to take the necessary steps.

Operations on the Liver and Gall.bladder.Dr. PETERSEN (Heidelberg) gave an account of 162 Opera-

tions on the Liver and Gall-bladder performed in the surgicalclinic by Professor Czerny. In 65 cases single cholecystotomywas performed, in 1 case cystotomy by two successive opera-tions, in 6 cases dialysis, in 3 cases cholecystopexy, in 10cases cholecystectomy (with 2 deaths), and in 20 casescholedochotomy (with 4 deaths). Choledochoduodenostomywas performed on 11 patients, with 4 of whom Murphy’s.button was used. Single cystotomy must be the normaloperation. Cystectomy must be resorted to in cases of

malignant growths. In 2 of the cases of cholecystotomysome calculi were left behind; the other patients did not.relapse. Biliary fistulæ were established in 8 instances,but it was found that they did not occur when drainage-tubes were inserted in the gall-bladder after the operation.In 50 cases the bile was examined bacteriologically, withthe result that colon bacilli were found in 38 cases, strepto-cocci in 6, and staphylococci in 4. After the operation thebacteria usually decreased rapidly. Carcinoma was presentin 30 cases and sarcoma in 3 cases.

Dr. RIEDEL (Jena) said that death after operation may be°caused by infection of the bile. In the great majority ofcases the bile is aseptic, so that it may penetrate into theperitoneal cavity without any harm, but on the other handit may contain pathogenic bacteria. It is difficult to saybefore the operation whether the bile is infected or not, butpatients with healthy bile generally feel well when thefit is over, whilst those whose bile is infected becomecachectic. Patients of this kind are lost with or withoutoperation.

Dr. FRANKE (Brunswick) showed some Gall-stones-which had been broken by a medical man who had appliedmanual force through the abdominal walls withoutlaparotomy. The fragments lacerated the gall - bladderand an abscess of the liver developed.

Space permits only a passing reference to the other papers.read at the meetings of the association, the principal of thembeing as follows : by Dr. VON ZOEGE MANTEUFFEL (Dorpat)on Volvulus ; by Professor VON BRAMAN (Halle) on Intes-tinal Resection for Carcinoma; by Dr. DOYEN (Paris) onOperations on the Brain ; by Professor CAERE (Rostock) onResection of the (Esophagus, &0.At the final meeting Professor Hahn of Berlin was elected

president. Of British members Mr. Arthur E. Barker ofLondon and Professor Alexander Ogston of Aberdeen werepresent.

LITERARY INTELLIGENCE. - Messrs. Baillière.Tindall, and Cox inform us that they have the English agencyfor Kobert’s " Practical Toxicology " which was noticed inour columns last week. They will publish during the nextfew days a "Manual of Surgery " by Professor Wm. Rose ofKing’s College Hospital, and Mr. Albert Carless, Teacher ofOperative Surgery in King’s College. The work will take a.

place between the large text-books and the smaller manualswhich are not now deemed sufficient for examinationalpurposes. They will also publish " Outlines of PracticalSurgery " by Mr. W. G. Spencer of the Westminster Hospitaland a new edition of Pearmain and Moor’s " Manual ofApplied Bacteriology," with coloured plates, the first editionof which has run out in a few months.-Messrs. Munns andAllen, Broad-street, Birmingham, have published a bookletof 48 pages containing a useful collection of annotations onthe British Pharmacopoeia of 1898, with remarks on theimportant differences between the present Pharmacopoeia andits predecessor of 1895 and the additions of 1890. The priceis 1s. The author is Mr. Thomas Chase, pharmaceuticalchemist, Five Ways, Edgbaston, Birmingham.