Abbildungen der Seite
PDF
EPUB

Good per

a lump of sugar, and 'this method has the did not get any better, he was advised to come advantage of being small in bulk and easily to London. When admitted, on September carried about by the patient, so as to allow 4th, a sinus was found 1/4 inches deep and 12 of its being repeated as often as may be inch in diameter, on the inner side of the tibia, thought advisable. It is best to begin with below the level of the tuberosity. The walls five or six drops on sugar, every four hours, of the sinus were covered with granulations. and gradually to increase this dose to twenty No disease of bone detected. Some thickening minims. This is, for most people, the max- of the tibia on the inner aspect. imum quantity, but the drug, Dr. Murrell says, sonal and family history. Drainage tube was inhas little or no toxic action, and considerably serted, and the wound dressed with iodoform. * larger doses have been taken without the pro- On the oth he complained of headache and duction of any untoward symptoms.

pain in leg. A smaller drainage tube was subChemically, terebene, C1H16, is derived stituted for the other. 12th>A piece of from oil of turpentine, either by the action of sponge, carefully prepared and desilicated, was one part of concentrated sulphuric acid on cut to the exact size and inserted into the sinus. twenty of the oil, and subsequent distillation, 16th—Patient is progressing favorably. There or by one of the other processes known to is slight pain over the inner tibial tuberosity chemists. When terebene is submitted to the and some discharge oozes through the sponge. action of dry hydrochloric acid gas, a white October 9th— The pain on the inner side of crystalline mass results, the hydrochlorate of the wound has been more severe and of a terebene, commonly known as turpentine cam- lancinating character the last two days, and phor, or terpine, which resembles ordinary there is pain at the back of the knee. No apcamphor, and has also been employed in the pearance of granulations in the sponge. 12th treatment of the same class of complaints as —Pain is less to-day; wound is dressed daily. terebene.

17th-A little discharge to-day just above the Some difficulty was experienced in obtaining wound. No granulations have appeared in the an adequate supply of the pure drug when first sponge as yet. 20th—The wound continues brought forward, and attempts were made to to discharge a little, it is dressed daily with pass off one or more patent preparations on the boracic lint. Patient has not complained so public as the only pure terebene, but it is to be much of pain, for the last few days, except hoped without much success.

just above the wound. 24th—Pain less than last week. No appearance of granulations in sponge.

November 3d-No granulations in sponge. HOSPITAL REPORTS.

Patient discharged, to attend twice a week.

Epithelioma of Tongue; Removal ; Septic

Pneumonia; Death.Fred. P-, æt. 49, CHARING CROSS HOSPITAL. fishmonger, applied, on July 15th, with a hard

nodulated mass on the left side of the tongue, UNDER MR. J. ASTLEY BLOXAM, F.R.C.S.

which appeared to be bound down. The Necrosis of Tibia; Sponge Grafting.- glands in the sub-maxillary region are enlarged. Michael B-, æt. 24, laborer, was thrown Patient suffers great pain from the passage of from a horse six years ago, falling on his food, and had much difficulty in getting it past hands and striking his knee against a sharp that part of the tongue. The quantity of saliva stone, causing a bruise with pain. This was secreted is greater than usual. He had gonorfollowed by swelling of the leg, extending from rhæa, when young, but not badly. This was a little above the knee to half way down the accompanied by enlarged glands, which did leg. He was told that he had a dislocation of not suppurate. Has never had any sores on the patella, and was treated for this during six the penis or rash. Three months ago he months, when the swelling went away and he noticed that his tongue was rather sore, and felt all right except for a sharp, throbbing pain that he could only extrude it with difficulty. which he had at intervals. Twelve months ago This increased, and as it did not subside, under he had a swelling, with great pain, over the site treatment, he came to the hospital. On July of his present sore, into which an incision was 20th, Mr. Bloxam decided to operate. He made, giving exit to a quantity of pus. As he began by tying the lingual artery on the affected side, and then removed the diseased half of the methods. Both the flaps were taken from the tongue by cutting through the median line skin and the bone and muscles divided cirwith scissors and crushing through the base with cularly about a hand's-breadth above the knee. the écraseur. There was not much hemor- After division there was great retraction of the rhage. The sub-maxillary gland was removed soft parts about the bone, and the periosteum at the same time. Patient had a disturbed was accordingly reflected and another inch of night, notwithstanding m xxx of tinct. opii. the bone removed. The vessels being ligatured, 22d-Patient was fed with an oesophageal tube, the flaps were stitched together and the wound owing to the difficulty he had in swallowing dressed antiseptically. On examination of the food. His throat was mopped out every hour limb it was found that the seat of the disease with a sponge. Later in the day the breathing was in the synovial membrane, which was became embarrassed with a troublesome cough. greatly thickened and infiltrated with pus.

The Slight elevation of temperature. 23d-Patient bony surfaces were comparatively healthy. seemed a little brighter in the morning. He 25th—Patient was unable to pass his urine, and was unable to take food in the usual way. He five or six ounces were drawn off by means of was ordered an enema, which cleared out the a catheter. Temperature 100° Fahr. March bowels, to be followed by an nutrient enemata 4th_Stump looks well, but owing to reevery four hours, with four ounces of Port-wine. traction of soft parts, the bone is pressing Marked dulness at base of right lung. 24th— against the anterior flap and some of the sutures Patient is much weaker. Dulness at base of have parted. The flaps were brought together lung increased. Respiration 38. Pulse 128. with isinglass plaster and the wound dressed. He sank and died at 1.46 A.M.

The boy's general condition is much improved. Case of Chronic Strumous Disease of the He has gained in weight, and his temperature Knee-joint; Amputation; Recovery.--William is normal. The stump was completely healed T-, æt. 16, errand boy, was admitted on by April 12th, and on the 20th patient was January 7th for disease of the right knee, which able to leave the hospital. was much swollen, and discharged pus from Case of Coccydynia; Operation.-Emma the site of an old incision on the inner side of C-, æt. 21, domestic, fell down stairs about the joint. Patient was in the hospital a year fourteen months ago, but says she felt no ago for the same cause, when a large quantity inconvenience for two or three months, when of pus was evacuated by means of free incis- she noticed a hard lump forming in the coccyions on the inner and outer side of the joint. geal region, which rendered her unable to sit He apparently recovered, after a stay of some down. Patient had an abscess in the right months in the hospital, and resumed his occu- gluteal region, about a year since, but it soon pation of errand boy for some time without healed up. On examination per rectum, the any untoward result. Early in the present coccyx seemed rather thrust forward, movable month he noticed a swelling on the inner side and very painful, but the last was the only of the joint, where one of the incisions had really noticeable symptom. Patient says she has been previously made. Patient's general health pain sometimes on passing; a motion of a throbis

poor and he is thin and pale, but there is no bing and shooting character. She was ordered evidence of phthisis. His father died of glycerine and belladonna, to be rubbed over the "bronchitis,” but the rest of the family are painful site twice a day, and this afforded her alive and well. There is no albumen in the a good deal of relief for a time. As the pain urine, but he sweats a good deal at night. did not, however, disappear, she was put under Patient was put on a liberal diet and tonics, ether, on February ist, and the structures and the limb was put on a McIntyre's splint. around the coccyx were divided by Mr. Bloxam. He passes restless nights and complains of a The patient felt weak after the operation, but good deal of pain. His evening temperature as soon as the effect had passed off, she said she averages 103.2° Fahr.

felt much better. The old throbbing pain had As several fresh openings formed, and the gone, and there only remained a little pain at joint appeared thoroughly disorganized, on the seat of the operation. The incision was February 24th Mr. Bloxam removed the leg dressed the following day and touched with above the knee (patient being under ether) nitrate of silver. 23d—A small fissure was disby a combination of the flap and circular covered at the orifice of the anus, which was

touched with nitrate of silver. March 3d— Last July the pain became more marked and Pain almost gone; patient was discharged to a persistent and a lump formed in the groin, convalescent home.

which was poulticed and suppurated. It closed Suppuration in Antrum from Carious Teeth. after a time but had to be reopened. Patient -Amelia B, æt. 22, dressmaker, com- menstruates regularly, but has suffered for years plained of a swelling over the right superior from dysmenorrhea, with pain of a bearingmaxillary bone. It does not infringe on the down character. She has noticed that when orbit or nose. Patient appears to have had a the discharge from the wound ceases, she gets small abscess in the same situation when four- leucorrhea. She has no pain on moving the teen years of age, which left some induration hip, nor on tapping the foot, and walking after it. This remained stationary until about is not much interfered with. Patient is pale six months ago, when it began to increase in and delicate looking. There is no pain in the size. The present swelling is smaller than it back or other indication of any affection of the was some time since, when, as she says, it vertebræ. She starts a good deal during sleep seemed to push the eyeball back. On looking and perspires abundantly at night. On exinto the mouth, the two upper bicuspids on amining the wound in the groin, a sinus was the right side were found to be much decayed. found at about the middle of Poupart's ligaPatient says she has never had any discharge ment which may be traced for a considerable into the mouth or nose, but last Sunday, for distance backwards. Temperature 103° Fahr. the first time, a little blood welled up into the Pulse 130. April 11th-Patient was examinner canthus of the right eye. The following ined by Dr. Black, who found traces of periday Mr. Bloxam examined the patient, under metritis with adhesion of uterus and left ovary. chloroform, and found that the tumor was 26th-Patient seems better, the depth of the connected with the antrum. The carious teeth wound is decreasing and the discharge is slight. were removed and about an ounce of watery She still complains of a burning pain in left pus drained away. The antrum was washed groin. 29th-On probing wound with a porout by injecting a weak solution of permanga- tion of catheter a considerable quantity of nate of potash, and this was continued for a day grumous pus escaped. May ad—Patient comor two. The swelling disappeared, and patient plains of much pain, extending to the iliac left the hospital, cured, on the eighth day after region, which prevents her sleeping. A piece admission.

of drainage tube, five inches long, with thread, Bulbous Nerve Ends in Old Stump of Leg. which was placed in the wound, unaccountably -Alice D-, æt. 23, seamstress, was sent to disappeared, and is supposed to be in the the hospital to be treated for a painful stump, wound. 8th—The drainage tube has been left left after removal of the leg sixteen months out of the wound for three days and it has ago on account of gangrene following a wound healed over. There are, however, indications of the big toe. It is a very good stump, a of accumulation of pus, and patient says she little red at the margin of the cicatrix but no has a great deal of pain on micturition and desinuses are present. There are two painful fecation. The temperature oscillates between spots on the anterior flap. Mr. Whitehead 980-102° Fahr. The tongue is coated and the dissected down on the anterior seat of pain skin is dry. She has not menstruated since adunder antiseptic precautions, and cut away a mission (a month), though previously she did piece of tissue which comprised a nerve bulb of so every two or three weeks. On probing the some size. The edges of the incision were wound a large quantity of greenish pus escaped. brought together by strapping, and dressed with 11th--Patient was placed under chloroform red lotion. Patient says she has no longer any and digital exploration was made of the wound. pain in the stump, but complains of pain in her The sinus could be traced in an upward diright leg. The wound suppurated a little but rection towards spinal column, and a large eventually healed up and patient left the hospi- quantity of pus was evacuated. No abnormal tal relieved.

growth was discovered, nor was the missing Perimetritis followed by Suppuration.- tube found. A large size drainage tube was Rose C-, æt. 18, buttonmaker, admitted inserted and poultices constantly applied. April 5th. Patient says that as a child she was 19th—The discharge is free, but patient says subject to attacks of pain in the side and spasms. she is comparatively free from pain and on the whole much better. She is on a liberal diet, | A further incision on the left side of the with five ounces of wine daily. 26th—The scrotum did not give exit to any pus. May abdomen, on the left side, feels tense and some 7th–Mr. Grindon succeeded in passing a No. what hard and is painful on pressure. August 5 elastic catheter to-day 14th-The edges of Ist— The patient's condition has remained the fistula are less indurated, but there is more about the same. She has been allowed to get ædema of the scrotum. A No. 3 silver catheup for a few hours daily, and takes her food ter was passed to-day 19th—A longitudinal pretty well. September—Patient has gained incision was made over the anterior part of the in flesh and is much better; very little pain scrotum, which was frozen by the ether spray, or discharge now. She was discharged to a a small quantity of pus exuded, and a poultice convalescent home in October.

was applied. 26th-No. 4 silver catheter passed Urinary Fistula and Cellulitis of Scro. to-day. 27th– The patient had a rigor to-day tum.—Henry B—, æt. 48, domestic, was ad- on a No. 4 catheter being passed. Another mitted in November, 1879, under Mr. Barwell, abscess is forming on the under aspect of the for stricture of the urethra, and was treated by scrotum, on the left side, which was incised on rapid dilatation, leaving the hospital, much re- June 2d. Very little urine escapes by the fislieved, three months later. He had a chancre tula. Several other abscesses formed in differtwenty years ago, and gonorrhæa since. He ent places on the left side of the scrotum. then went abroad, where he was again troubled 18th–Mr. Bloxam succeeded in passing a No. by retention of urine. In October, 1880, he 6 silver catheter to day: July 23d-To-day a first noticed a hard swelling in the perineum, No. 8 silver catheter was introduced. There which he described as very painful. It rapidly is still a good deal of discharge from fistula, increased in size, and in December of the same but the patient's general health has greatly imyear he applied at a hospital for relief. He proved. August 6th_No. 9 silver catheter was given an ointment, but it did not get any was passed to-day, followed by a gum elastic better, and on January 7, 1881, he was ad- instrument to be left in for two hours. Sepmitted as an in-patient. He was then told tember 6th-Patient passes about thirteen that it was an abscess, and was ordered warm hip ounces of urine, without any escaping by the baths and poultices. On the fifth day after ad- fistula, which is disposed to close. The stricmission it burst, and there resulted two patulous tures are still very tight. October 6th—Toopenings which could not be induced to heal. day, internal urethrotomy was performed. The two were converted into one with the knife, 10th—Patient has no pain, and can pass his in the hope of getting them to close. Eleven water freely, none escaping by the fistula. days ago his scrotum began to swell, and, being 18th—Patient is unable to retain his urine very painful, he was sent over to London to well, but this improved under iron and strychbe treated. When admitted, on March 19th, nia. There is still some discharge of pus, the whole scrotum was enormously swollen, mixed with blood, from the scrotum, and a tense, and ædematous. The edges of the little urine comes away occasionally through wound were indurated and everted. There the opening in the scrotum. November 2dwas no distention of the bladder nor swelling Patient complains of pain on defecation, No. of the parts beyond the abdominal rings. Tem- 22 bougie passed easily, but No. 24 was firmly perature high, pulse rapid, tongue glazed. The gripped. 18th-A little pus still discharges parts were punctured with a needle, and ordered from the sinus, which runs up for some two and to be poulticed. 23d—Scrotum is much di- a half inches towards the urethra. No. 24 minished in size, and his general condition is bougie passed without much difficulty. 21stmuch improved. Fluctuation could be plainly A little nitrate of silver was introduced into the felt in the front of the scrotum, and on making sinus on a probe. December 7th-A little an incision a large escape of blood and pus took urine comes through the fistula when the paplace. He was put on tonics, and ordered tient passes his water in bed, but a great deal charcoal poultices. Temperature, 101° Fahr. comes through when he micturates standing. 25th_The scrotum is decreasing in size, but a He left the hospital on the 15th much improved good deal of pus and blood continue to drain in health, but with the sinus unclosed.

30th—Patient complains that the urine Pelvic Abscess.-Alice W-, æt. 22, govtrickles out through the incision in the scrotum. erness, was admitted on January 12th. There

away.

was a history of her having had pleurisy five with both testicles symmetrically enlarged, the years ago. A swelling appeared in the left epididymis and cord, however, not sharing in groin directly after, which ultimately burst, with the enlargement. He had two ulcers on the a free discharge of pus lasting some weeks and inner side of the left leg, and one on the outer then ceasing. Two years later, however, it re- side of the right thigh. They are circular in appeared again for a month. In April last the shape, with a raw. beef colored induration surdischarge appeared once more, and has con- rounding an elevated seat. He had a chancre tinued off and on ever since. Appetite is bad, with the usual sequelæ some years ago. and the pains in the pelvis interfere with sleep. Patient states that nine months ago he noThe bowels are confined, catamenia regular. ticed a swelling of the right testicle, followed Onexamination a fistulous opening, with everted six weeks later by a similar increase of size of edges, was found one inch below the anterior the left testicle. This slowly increased until superior iliac spine, on the left side, which ap- six months ago, when they attained the size of pears to be discharging freely. A tent was an average melon. As he experienced no pain placed in the wound. 15th-On removal of and but little inconvenience, he followed no the tent to-day, a quantity of putrid pus es- treatment. They then became somewhat less caped; the wound was syringed with carbolic swollen, and latterly have remained stationary. lotion. 25th—Mr. Bloxam explored the sinus He was put on fifteen grain doses of iodide of to-day, and made an incision between the potassium, with half drachm doses of liquor last rib and the crest of the ilium, and passed hydrarg. perchlor., in an ounce of decoction a drainage tube through this incision and out cinchonæ, three times a day, together with two of the wound in the groin. No albumen in and a half grains of blue pill, and one quarter urine. Temperature rose to 103.20 Fahr. this grain of pulverized opii at bedtime. morning. 300h— Temperature, 97.4° Fahr.; The pill was subsequently discontinued, and not much pain, free discharge from the in a drachm of mercury ointment was ordered to cision, patient sleeps well. Poultices are being be rubbed into the scrotum every night. 23d applied February 27th. Temperature keeps –The testicles are reduced to about half their down, and patient's general health is improved. former size. Patient complains of pain in the Drainage tube has been removed. March 13th left side. 24th_The left testicle is smaller -Poultices were ordered to be discontinued, and harder than the right. Patient's gums are as the wound seems to be healing up satisfac- beginning to get sore, so the liquor hydrarg.. torily, and there is very little discharge. 15th was discontinued. 26th—He is now fully --Wounds are now completely healed, and pa- under the influence of mercury, and the inunctient was allowed to get up, and was discharged tion was temporarily suspended. The testicles a few days later (March 21st).

are very much smaller, and on the 27th patient April 4th—Patient was readmitted to-day. was discharged to attend as an out-patient. Cicatrix in lumbar region having reopened, Cystic Disease of the Left Breast.-Annie and is discharging slightly. The probe was I–, æt. 29, stationer. Patient first noticed a introduced, but only passed a short distance. swelling in her left breast about seven years 21st—The wound has quite healed, and all ago. She had diphtheria about six months discharge has ceased, but patient complains of before the swelling was first remarked. Since feeling sick, with pain over the region of the that time it has increased somewhat in size. She cæcum. Temperature 102° Fahr. As bowels went to St. Thomas's Hospital two years ago to have not acted, she was ordered Ziss of castor have it removed, but they refused to operate. oil, with mxy of tincture opii. 23d— The There was nothing of interest in the family hissickness has continued, as also the pain. Tem- tory. Patient is well-nourished, and of very perature 102° Fahr. The old incision was dark complexion. She says she has been losing opened up afresh, and about an ounce of pus flesh the last few months, and suffers a good escaped, with great relief to the patient. Poul-deal from indigestion. On inspection a slight tices ordered. 27th—Wound has again healed. bulging of the left breast was seen just over the Patient was discharged, and was ordered to third rib. On palpation a hard mass can be take quinine mixture and cod-liver oil. felt at the upper and outer part of the gland; Case of Syphilitic Sarcocele.-George L-irregular in shape, nodulated, very hard.

It is æt. 24, sailor, was admitted on October 18th, | freely movable on the subjacent tissues, and the

« ZurückWeiter »