1915 The Lancet  
have been using colloidal gold in a whole series of infected traumatisms in which the phenomena of infection persisted in spite of the usual surgical measures. The gold was injected intravenously, intramuscularly, or hypodermically in the peripheral zone of the infected region. The clearest and most valuable results have been obtained in large wounds of limbs with infection by anaerobic microbes. In these cases a marked fall of temperature ensues, together with considerable diminution in the
more » ... iminution in the number and quality of pulsations and a return towards normal of the arterial pressure. Local modifications may also be observed in the wound; a diminution of the foetid odour and secretion and attenuation of the oedema. These latter phenomena are even more influenced by local injections of colloidal gold. In penetrating wounds of the abdomen medically treated the authors have used this remedy as a preventive measure. In pyogenous infections the results of injections of colloidal gold have been less clear, perhaps because the authors have been led to employ them more in cases of infection of the serous membranes, where a local reaction sufficient to stop the processes of suppuration was not to be expected. The intravascular injections are followed by violent reaction; a severe rigor may last for 40 minutes. Sometimes the countenance becomes slightly cyanosed, the temperature rises, and the pulse is quickened. An abundant perspiration sets in later and may last sometimes several hours. When given intramuscularly colloidal gold gives rise to no reaction. It may be injected by this route up to 50 c.c. at a single time and several days in succession. Used thus the gold has a mode of action milder but also slower than that by the intravascular route. These injections may be also made by means of a long needle around the limits of the infected tissue, avoiding the vessels so as not to provoke by the entrance of some drops of the liquid directly into the blood the violent reaction of an intravenous injection. Intravenous injection is definitely indicated only where rapid effect is sought. In individuals with lowered tension recourse had better be had, at first at any rate, to the intramuscular route. Injections around the wound are especially indicated when a local action is desired. Conservative versus Radical Operations in the Surgery of the Limbs. M. Mauclaire has reported to the Societe de Chirurgie on the work of Dr. Lapoi te, who between Oct. 26th and Feb. 7th was at the iront on medical duty, ten miles from the firing line. Here he saw more than 4000 wounded pass through his ambulance, and close on 800 operations were done, nearly all by himself. Out of this number, 547 presented fractures, crushings, and lacerations (arrachements) of the limbs. In the upper limb, out of 317 wounded 145 that were not operated on gave 9 deaths ; out of 172 operated on, 104 by conservative operations gave 34 deaths, 68 by radical operations 11 deaths, or a total of 54 deaths. In the lower limb, out of 228 wounded, 90 not operated on gave 11 deaths; out of 138 operated on, 75 conservative operations gave 34 deaths, while 63 mutilating operations gave 28 deaths, or a total of 73 deaths. In the upper limb among the radical operations performed there were 68, with 11 deaths, or a mortality of 16 per cent. Three disarticulations of the wrist, 5 amputations of the forearm, 2 disarticulations of the elbow, all primary, had no deaths. Out of 42 amputations of the arm there were 6 deaths, of which 2 out of 33 primary amputations and 4 out of 9 secondary, 16 disarticulations of the shoulder gave 5 deaths, of which 2 out of 12 primary disarticulations and 3 out of 4 secondary disarticulations. Total, 4 deaths out of 55 primary radical operations, and 7 deaths out of 13 secondary. In the lower limb 65 mutilations out of 63 wounded, with 28 deaths, mortality 43 per cent. Three economic operations on the foot gave 3 cures; 21 amputations of the leg gave 5 deaths, of which 3 were in 17 primary and 2 in 4 secondary amputations ; 40 amputations of the thigh gave 22 deaths (or 55 per cent.), of which 12 occurred in 25 primary and 10 in 15 secondary amputations. One primary disarticulation of the hip was followed by death. Nearly all the amputations were done by the circular method. For the disarticulation of the shoulder and for some high amputations of the arm and the leg, M. Lapointe employed " racket" " amputation. He left the greater part of the stumps uncovered, because most of the wounds at the time of arrival at the ambulance were very seriously infected. For the sterilisation of instruments and gloves M. Lapointe employs sodium borate. The site of operation and the dressings have been treated in the same method up to the day when M. Lapointe was able to procure trioxymethylene and to prepare dry dressings instead. He has used oxygenated water, permanganate of potash, formol solution, 5 per 1000, and tincture of iodine. Death of Dr. Thoinot. Dr. Thoinot, professor of legal medicine at the Faculte de Medecine, and a member of the Académie de Medecine, has died very suddenly. In 1906 he succeeded his teacher, Brouardel, in the professorial chair. He was physician to the Hopital Laennec, and from the beginning of the war medecin principal at the Val-de-Grace and head of the service of contagious diseases. His writings are of importance, while as an expert he was highly esteemed in the judicial world, and his medico-legal work had gained for him an international reputation. May 8th.
doi:10.1016/s0140-6736(01)65629-0 fatcat:km7qwudf4verzaero2i7htbk2q