Joseph Bradford Cox

“ Report on Surgery.
In presenting this report I will not attempt to give any historical data connected with the subject of surgery, since that has been ably done in the report of last year.
I shall assume, and that without hesitation, that surgery is a science, properly so-called. That it is an art, is also true. But what is science? What is art? Science is knowledge. Art the application of that knowledge. To be more explicit, science is the knowledge we possess of nature and her laws ”

“ I then introduced a trocar and canula, and drew off fifty ounces of pus, slightly tinged with blood. I re-adjusted the compresses and bandage over the sinus, hoping that a part of it at least would become obliterated before it became necessary to open it more freely.
Feb. 15th, 5 p.m.,—pulse 112, temp. 102.5. The inflammation [Pg 13] over that part of the sinus to the right of the spine is still about the same as yesterday; also that over the left ilium. The fluid has increased during the last twenty-four hours so that there is now nearly as much as was drawn off through the canula yesterday. ”

“ There was considerable tenderness on pressure; slightly accelerated pulse, and elevated temperature;—in other words, a well defined case;—one which would have resulted in caries and deformity within a few months. By the administration of ten grain doses of hypophosphite of lime for several weeks, I had the pleasure of seeing recovery take place. Reasoning by analogy, I am led to conclude that the nature of the wound should, to a great extent, govern the kind of food given the patient during the treatment. In many cases of surgery, medicines are not necessary. ”

“ The inflammation was but little influenced by this or any other treatment. The knee continued to slowly and surely enlarge. And this extended upward without first producing any great distention of the synovial sack under the patella. There seemed to be simply enlargement of all the tissues of the lower part of the thigh. This continued until about the 1st of Feb. when, from the general appearance of the patient, viz: a typhoid condition, feeble pulse, coated tongue, emaciation, loss of appetite, as well as from the local appearance of the inside of the knee, I suspected pus within the joint. ”

“ Patient has been complaining of pain and want of sleep; had a chill last night. He still takes beef tea twice a day, and eggs and other food twice a day, making four meals a day; also, continues the quinine and whisky.
Feb. 21st, 9:30 a.m.,—pulse 98, temp. 101. Feels more comfortable. Discharge of pus much less than yesterday. Wash out the sinuses and inject liquid vasaline.
Feb. 23d, 9:30 a.m.,—pulse 98, temp. 101. Complains of being “very sick.” Speaks English but poorly. Considerable discharge of laudable pus, but not so much as before the use of the liquid vasaline. ”

“ So also the organic compounds lactate of soda, lactate of lime, pneumate of soda, margarate of soda, stearate of soda, butyrate of soda, oleine, margarine, stearine, lecethine, glucose, inosite, plasmine, serine, peptones, etc., are found alike in the tissues and in the blood plasma. That they are in solution in the plasma is well known,—that they are in a solid or precipitated form in the tissues is also true,—and that the tissues are supplied from the blood is also evident,—because the blood is the only part that receives supplies of material direct from the food taken and digested. ”

“ That is, if the supply of nourishment can be kept up, and the waste prevented, which must result from the formation of such a large quantity of pus, there is no reason why he should not recover. [A]
At the time of putting him under the care of Dr. Cory, he was taking nine grains of quinia daily, about six ounces of whisky, beef tea twice a day, and eggs twice, with such other food as he might relish; taking four meals a day. ”

“ I supposed that it came from one of the lumbar or inter-costal arteries that had been injured by the supposed fracture of the process of the vertebra. If so, it comes from an artery inclosed in a bony cavity, and one that cannot contract and close spontaneously, and since its origin is so close to the aorta, it will continue to bleed until the patient dies of hemorrhage.
While I was thus examining the fluctuating mass, and conjecturing as to origin and results, I fancied that the quantity of fluid was [Pg 11] sensibly increasing. ”

“ Owing to the color of the blood, the rubor, or redness, is not produced by inflammation here as it already exists.
But to return to the patient. After the blood was withdrawn, compresses were carefully applied, and the body bandaged from the lower ribs as low down as the bandage could be applied with the legs flexed at right angles to the body. The patient stood on all fours, as it is called, while the bandage was applied.
Monday, Feb. 9th, 9:30 a.m., pulse 100, temp. 103.8. There appeared to be about one-half a pint of fluid in the sack. Monday, Feb. 9th, 6:30 p.m., pulse 100, temp. 102. ”

“ Why this is so, is simply because those very materials are furnished to the system which are required for the repair of the tissues injured, viz., the organic compounds. In flesh wounds of weak and debilitated persons which are slow in healing, a diet of beef tea, eggs, oysters, etc., will often bring about a rapid improvement. Thus, we see that chemistry, organic and inorganic, has something to do with surgery.
I will now present the following cases which have seemed of special interest to me:
Case First.—In 1874, while in the mountains on the Trinity river, Dr. ”