Boston City Hospital

W. H. HOLMES
1880 Boston Medical and Surgical Journal  
were together affected in 16; there were ruptured perinasi in 103 ; condylomata and syphilitic ulcérations were seen to be more or less torn in 10. In only 22 could no laceration be found.¿Among the 54 multíparas 16 had a lesion near the urethra, 23 a laceration of the perinasum, five condylomata or syphilitic ulcération, and in 10 nothing could be seen. The treatment was such as would tend to reduce the spasm. Pieces of ice were introduced into the vagina, and the meatus was irrigated with
more » ... irrigated with douches of warm water. The passage of large-sized bougies into the urethra was often very useful. While investigating these cases Dr. Engle observed that a distended bladder had considerable influence on the involution of the uterus, and also predisposed to secondary haemorrhage. In the 278 cases of dysuria examined there were 52 in which there was more or less secondary haemorrhage. Condition of the Uterus at the Placental Site. -Dr. George Roper calls attention x to the fact that, no matter where the placenta is attached, there is always an induration and thickening of the uterine tissue at the site of its attachment. In cases of placenta prasvia there will be found a well-marked induration around the entire circumference of the internal os uteri. In cases where there is only a partial placenta prasvia the obstetrician can easily detect this induration by comparing the feel on the side to which the placenta is attached with that on the opposite side. The result of this induration is to render that part of the uterus unyielding ; and hence Dr. Roper calls the notice of the profession to the necessity of using great care in effecting any forced delivery in such cases of placenta prasvia, the tissue being much more liable to serious lacerations than in other cases where there is no low placental attachment, and no induration of the tissues. an indurated mass in hisleft groin the size of a hen's egg. There was a creamy discharge from the urethra ; there was no sore to be seen on the penis, nor could any history of infection be obtained. A blister was applied over the bubo, but with no beneficial effect. August 31st, Dr. Gay made an incision four inches long and removed a mass of indurated and enlarged glands. Full " Lister " precautions were observed, except that on one occasion a non-disinfected hand was brought into contact with the wound. Then carbolized silk sutures were put in, a drainage tube inserted, and a Lister dressing applied. On the fifth day after operation, the scrotum and penis were attacked by phlegm onous erysipelas, which lasted about two weeks. At no time did there appear to be any erysipelas about the edges of the wound. Sutures and drainage tube were removed on the tenth day. No pus was seen until the seventh day, and there was only a very small amount during the progress of the case. The Lister dressing was omitted on the fifty-sixth day, having been changed seventeen times. On four or five occasions only were the dressings stained through when they were changed. The wound had healed at the end of the eighth week. Case II. Nicholas Q., aged twenty-three, was admitted to hospital August 25, 1879, with a bunch of indurated glands in the left groin. Three weeks before entrance he had had suspicious connection, but gave no history of any sore on the penis. October 5th, Dr. Gay made an incision three and a half inches long over the bubo and removed a mass of suppurating glands. The surrounding tissues were boggy and infiltrated with pus. The operation was done strictly according to Lister's method, and carbolized gauze dressings were applied. On the evening of the same day, the patient had a chill, and the temperature reached 106°F. The dressings were changed, and the temperature fell to 100°the next morning, going above that point only three times in the progress of the case. The sutures and drainage tube were removed on the fifth day, as the discharge, which had been very slight, had nearly ceased. Lister dressing was omitted on the fifteenth day, as at that time there existed only a small superficial ulcer, which had healed on the twentieth day. The dressings were changed eight times, being stained through only once. Case III. Edward M., aged thirty-four, entered hospital August 26, 1879, with a hard chancre on the left side of the prepuce, and a large indurated bubo in the left groin. The patient last had sexual intercourse three months before admission. September 5th Dr. Gay made an incision four inches long, and removed a large mass of indurated glands under full Lister precautions. On the seventh day, the wound was nearly healed, and the sutures and drainage tube were removed. A long narrow sinus remained, which did not heal till the twenty-second day, when the Lister dressing was omitted. Dressings were changed sixteen times, being stained through only two or three times. Secondary syphilitic symptoms appeared on the twentieth day after admission, and were successfully treated by the protiodide of mercury, half a grain ter die. In all the foregoing cases the dressings were kept in place by means of elastic webbing applied as a spica bandage. Abscesses. -Case I. Dennis C, aged thirty, entered hospital September 22, 1879, with a large fluctuating tender swelling in the left lumbar region. September 26th Dr. Gay made an incision one and a half inches long into the swelling under carbolic spray, which gave exit to about a pint of thick curdy pus. The finger entered the abscess its entire length over the crest of the ilium backward and downward toward the lumbosacral articulation. A diagnosis of periostitis of the crest of the ilium and perhaps of the transverse processes of the lower lumbar vertebrae was made. A Lister dressing was applied, which was stained through on the fourth day after operation and was then renewed. There was scarcely any discharge of pus after the first emptying of the abscess. The Lister dressing was omitted on the thirtieth day, having been changed nine times. No fever followed, the operation, nor any constitutional symptoms. November 30th, a probe passed three inches into a sinus. A dressing of carbolized gauze wet in carbolic acid, one to forty, applied without spray, was put on about every fifth day. There was very little discharge and that perfectly healthy. Case II. Timothy D., aged thirty-five, entered hos- The Boston Medical and Surgical Journal as published by The New England Journal of Medicine.
doi:10.1056/nejm188001011020105 fatcat:ys7zkhzyfzhwpewk3muwjx4wpu