ST. BARTHOLOMEW'S HOSPITAL, CHATHAM

A.W. Nankiwell
1873 The Lancet  
264 Hutchinson's care at the Ophthalmic Hospital. The patient is a woman of about forty-five, and suffers from a very large rodent ulcer of the skin of her right temple, eyebrow, and outer part of cheek. Here again the diseased surface has cicatrised over a large part of the temple, where the skin is comparatively thin and loose, while on the eyebrow and cheek, where the skin is thicker, it has eaten more deeply and has not healed. (Under the care of Mr. A. W. NANKIVELL.) IN the following case
more » ... the following case the injuries were most extensive and the subsequent shock great, but notwithstanding this, the patient's health bore up, and recovery was as rapid and as perfect as could be reasonably desired. The case illustrates very well the amount of injury from which a human being may; when placed in moderately good hygienic conditions, survive and recover. T. B-, aged twenty-six, admitted Feb. 12th, 1873. The patient, a shunter at Chatham Station, was run over by the slip coach of a down express. On admission it was found that the bones of the right leg were smashed into many pieces, the skin-wounds extending posteriorly as high as the popliteal space, anteriorly to within two inches and a half of the patella. The left foot and lower third of the left leg were also completely disorganised. There was also a fracture of about an inch in length of the external plate of the frontal bone. The right thigh was amputated just above the condyles of the femur by a long anterior and short posterior flap, the patella being dissected out. The left leg was removed at the lower part of the middle third by antero-postprior flaps. Carbolised catgut was used for the ligatures. The man bore the double amputation remarkably well, and soon recovered from the effects of the chloroform. Feb. 14th.-The anterior flap of the left stump threatens to become gangrenous. Poultices ordered. 24th.-The anterior flap has sloughed away. The right stump is perfectly healthy. Carbolic-acid lotion (1 in 40) applied to stumps. March 2nd.-Scalp wound healed. 8th.-A small portion of the tibia is denuded of periosteum. 31st.-Necrosed bone removed from end of tibia. April 10th.-Stumps healing rapidly. 29th.-Patient was lifted into a chair and carried about the ward. May 30th.-Since last report the patient has been progressing favourably; has been of late taking daily exercise in the grounds. Discharged to-day, only a small ulcer of the left stump remaining unhealed. Remarks.-This case well illustrates the severe injuries that the sharp edge of a railway tire is capable of producing when a limb gets between it and the iron rail. The man was standing in the four foot-way when knocked down, and the fracture of the skull was probably produced by the heavy slip coupling hitting him as the carriage passed over him. When admitted the patient seemed almost in a hopeless condition, but, thanks to a vigorous constitution, he recovered without a bad symptom. LIVERPOOL WORKHOUSE HOSPITAL. ACUTE INFLAMMATION OF THE SPLEEN ; ABSCESS ; PERITONITIS ; DEATH. (Under the care of Dr. WM. ALEXANDER.) THE following case is interesting on account of the rare occurrence of the disease in this country, as well as on account of the obscurity of the symptoms and the difficulty of diagnosis in this particular case. P. R-, aged twenty-five, was admitted on the evening of the 26th of May complaining of slight pain and tenderness over the left hypochondriac region, of slight hmmoptysis, and of general malaise. The appetite was fair; bowels constipated ; temperature 1005° F.; pulse 88. Stethoscopic examination of his chest showed the presence of dry bronchitio rales. Ordered tannic acid mixture for the haemoptysis and some aperient medicine. May 31st.-Temperature 100° F.; pulse 84; pain less ; appetite fair. June 2nd.-Bowels still costive; fever increased. Ordered a castor-oil enema, which acted soon after, and from which the patient expressed himself much relieved. During the evening the fever increased suddenly, and symptoms of acute peritonitis set in, to which the patient succumbed the . following day. Previous history.-A fortnight before admission he arrived here from America, where, for the last year, he had lived a most drunken and irregular life. He had an attack of intermittent fever some months ago, from which, he says, he fully recovered. Since his arrival in Liverpool he had been drinking heavily, until the advent of his present illness compelled him to desist. The autopsy was performed twenty-four hours after death. Body well nourished; dark coffee-coloured matter oozing from the mouth and nose. On opening the abdomen evidence of general peritonitis in the shape of lymph and pus appeared; these inflammatory products radiated from the splenic region as a focus over the entire peritoneum. The spleen was adherent to the diaphragm, covered by false membranes, and bathed in pus. On attempting to lift it out the capsule was ruptured. The splenic substance was softened, studded with minute abscesses, and its bulk very slightly increased. Part of the capsule adhered to the diaphragm, at which spot a tolerably large abscess had formed. The other organs of the body were healthy, with . the exception of the base of the left lung, which was par-, tially consolidated, showing that pneumonia had just commenced. MANCHESTER ROYAL INFIRMARY. INTRA-THORACIC ANEURISM TREATED BY ELECTROLYSIS. (Under the care of Dr. BROWNE.) THE treatment of intra-thoracic aneurism has always been regarded as one of the great difficulties of surgery, but a more exact knowledge of the nature of the healing processes is gradually removing many of the obstacles to success, and operative measures are now had recourse to for the cure of cases which were formerly left to the care of nature. Whether electrolysis will ever become a common method of treatment of intra-thoracic aneurism remains to be seen; but hitherto the results, although varied, have on the whole been sufficiently good to justify the continuance and even an extension of its use. William M , aged thirty-three, a gardener, of fair complexion and healthy appearance, was admitted on the 26th of October, 1872, when the following notes were taken by Mr. A. Cosgrave := Has led a rather temperate life, but never refused a glass of spirits when it came in his way; has been a smoker since he was eighteen, generally consuming two or three ounces of twist per week. He has worked in all sorts of weather, both in greenhouses and out of doors; has been wet to the skin, sometimes two or three times during the same day. Seven or eight weeks ago he first noticed a swelling in the right side of his breast, but it did not inconvenience him till ten days since, when it began to be painful, and he thought it was time to see about it. The pain was sharp, shooting up into his neck and shoulder." On examination, a pulsating and expanding tumour was seen over the second and third costal cartilages on the right side of the_ sternum; the size was about that of a small orange. A very distinct double shock on auscultation. It was more easy when in the upright position than when 1 lying down; therefore he was allowed to sit up by day, and to have a bed-rest at night. A support of thick sole leather, padded, also relieved him somewhat. He was ordered ten grains of iodide of potassium in infusion of quassia, three times a day. '. On Oct. 31st it is reported that he attended the con--sultation, and thinks that the swelling is larger since. It is equal to half a moderate-sized fist. The pain is of a
doi:10.1016/s0140-6736(02)69423-1 fatcat:gqazcgngrza65okgw6ojuzjo6q