WESTMINSTER HOSPITAL

Francis Mason
1869 The Lancet  
46 symptoms corresponded with the first division of symptoms described by Dr. Scott in THE LANCET of Dec. 19th, in his paper on the epidemic at North Shields, and I therefore do not recapitulate them. The sulphurous acid was given in one-drachm doses every four hours to children, and threedrachm doses to the adults, combined with orange syrup and water. Of course, it was in reality but the internal administration of sulphur in a form that could more readily assimilate itself with the other
more » ... with the other contents of the stomach. It was commenced on the first day of my seeing the patient, which was generally the second day of the attack. It did not at once relieve, but the progress of the disease seemed stopped, and after the fifth day improvement began, and rapidly continued to convalescence. If these results were due to the sulphur, then it only accords with the theory of the nature of the disease generally entertained: the germs of a fungus have entered the system. Its rapid growth and multiplication within would have poisoned the blood and the whole system, had it not been checked by the destructive action of the sulphur upon it, whereby it was rendered inert, and its further development checked. The disturbance of function and of nutrition already set up was recovered by the vis medicatrix naturœ as soon as the fever poison ceased to act. M. S-, native of Tracey, Devonshire, aged thirty-six, married; had six children born alive, two premature births caused by fright. A fine tall woman, looking younger than her real age, one of three sisters, none of whom have suffered from any uterine disease. About two years ago began to suffer palpitation; menses scanty, and often deficient. On Nov. 29th, 1866, was confined of a child, when she began to be very prostrate; never perfectly recovered, but always noticed that she was no smaller in size than before accouchement; in fact, she was larger a fortnight after than before. Never tapped. On April 9th, 1867, she was first seenbyme, and was evidently suffering from over-suckling ; abdomen a tremendous size, distended by a distinct tumour, but more to the left than right side; rests better on left side; not painful to touch; not movable; fluctuation distinct on palpation ; measures round the body opposite the umbilicus forty-eight incheseight inches from umbilicus to ensiform cartilage, fourteen from the anterior superior spinous process to the umbilicus ; no cedema of feet or legs ; no bearing down or pain in the groin; great sense of weight; on vaginal examination the os is in situ, but a distinct tumour can be felt pressing on the side of the vagina; obliged to pass water very frequently ; areola of breasts not darker than usual. On May 1st, 1867, she was put under chloroform in a room of a temperature of 60°, and an incision made eight inches long. The cyst was punctured, and nineteen pints of clear fluid drawn off, when the cyst was found adherent to the abdominal parietes internally; also to the omentum, but easily stripped off; then turned out of peritoneal cavity. The pedicle was clamped, being very short, and the wound was closed by nine sutures. On examination, the tumour consisted of a multilocular cyst, containing many smaller ones, and weighed two pounds and a half. May 3rd .-Removed clamp. 8th.-Passed water herself, and bowels relieved. 12th.—Sat up. October 20th, 1868.-She was confined of a fine male child ; natural labour, and made an unusually rapid recovery. FROM THE NECK. (Under the care of Sir WM. FERGUSSON.) Nulla autem est alia pro certonoseendi via, nisi quamplnrimas et morborum et dissectionum historias, tum aliorum, turn proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Caus. Morb., lib. iv. Proœmium. i A LAD was placed upon the table in the operating theatre on Saturday last, whose cleft palate Sir William had operated upon a twelvemonth since. There remained only a cleft of the uvula, the edges of which were now pared and brought together by a stitch. Sir William called attention to the great irritability which the patient then displayed as contrasted with his firmness under the former and more severe operation, and remarked upon the excessive sensitiveness of the uvula, which it was very common to see. He had performed the present operation in deference to the wishes of the patient and his friends, who believed that his speech would be thereby improved. He did not himself believe that a cleft condition of the uvula interfered with articulation. There were a great number of persons with congenital deformity of this kind, and their articulation was not impeded by it. The lad had improved in his speech since the first operation, and Sir William thought that he would still further improve. Indeed, it was his experience that many patients acquired unusually perfect powers of articulation after operations forcleft palate, probably because they educated the faculty with more than ordinary care. A grey-haired man was next presented, who had a tumour in the right side of his neck, just below the auricle, and behind the ascending ramus of the lower jaw. The tumour was readily movable, and covered with skin, which appeared very thin. Sir William made a crucial incision through the skin, reflected the flaps, and dissected out entire a tumour, which, when removed, was the size of a duck's egg. It consisted of a cyst or bag filled with sebaceous material, and the operator had adopted this by no means the readiest plan of removal, because he wished to preserve the cyst entire as a rare example, in regard of its size, of a sebaceous cyst. The tumour commenced so long ago as twenty-seven years. It was only within the last few years, he said, that it had grown rapidly, and there was nothing to be done for it that he could recommend except removal by the knife. No doubt the application of caustic would have taken it away, but at a great expenditure of time and suffering. WESTMINSTER HOSPITAL. CLEFT PALATE IN A CHILD AGED FIVE YEARS; OPERATION WITHOUT CHLOROFORM; SUCCESSFUL RESULT. (Under the care of Mr. FRANCIS MASON.) THIS patient was a boy aged five years, having a congenital fissure involving the whole of the soft palate, upon whom Mr. Mason operated in October last, without administering chloroform. The edges of the fissure having been pared, three silk sutures were introduced, which were removed on the third day. Union was complete throughout from the extremity of the uvula, with the exception of an almost imperceptible pin-hole near the hard palate.
doi:10.1016/s0140-6736(02)65372-3 fatcat:kyliqfzmrbbxvaw5kjnkdg5xv4