A Case of Abdominal Pregnancy

GEORGE W. KAAN
1896 Boston Medical and Surgical Journal  
decided that, under the circumstances, excision of the head of the bone would relieve the pressure upon the nerves, aud that possibly, to a certain extent, their functions might be restored. With the patient's consent, therefore, I excised the head of the humérus on October 17th, through an incision in the anterior margin of the deltoid. The muscles in this operation were the supraspinatus, teres minor, and suliBcapularis. The long tendon of the biceps was dislocated from its groove, but not
more » ... groove, but not divided. The wounel healed rapidly by first iuteution, and the patient was very soon able to use his arm to a far greater degree and with a much greater range of motion than was possible before the operation. He was very much pleased with the result of the operation. The condition of the nerves, also, improved considerably, but I am told by the neurologist that six months or a year will have to elapse after the operation before any very marked improvement can be noticed. Even if no further improvement actually does take place in the condition of the nerves, I should feel satisfied with the result of the operation, in that the patient has thereby secured a much greater range of motion and a corresponding increase in the usefulness of his arm. It may be interesting to note that the head of the bone was very much atrophied, aud that, on being removed, it could be easily crushed iu the bone forceps, showing pretty conclusively that had an attempt been made to reduce the dislocation by manipulation, a fracture would probably have taken place at the neck of the bone, aud thus a uew complication would have beeu added, and no good whatever accomplished. In view of the good result thus far obtained in this case, I think I should be in favor of excising the head of the bone iu any case of old-standing irreducible dislocation of the humérus, where the function of the arm has been seriously interfered with as in this case. The method of removing adenoid vegetations from the vault of the pharynx as practised in the clinic of Prof. B. Fraenkel in Berlin, appears to the writer so much better than any other that he has seen that he feels sure a description of it will be appreciated by those, not already familiar with it, who are interested in this subject. The chief feature of the method is to have the patient so lightly anesthetized that although consciousness is lost, reflex action is not abolished, and blood or mucus is therefore voluntarily expelled. The patient, if a child, is held in the arms of an assistant in the upright sitting position, the operator sitting in front of the patient. The anesthetic is administered to the primary stage of anesthesia ; the mouth is opened, and tho tongue depressed with a rather long and slender tongue depressorno gag is usedand with the Gottstein curette the growths are rapidly removed. Usually the larger portion of the separated growths is brought out with the instrument, and then the patient, on account of the most decided irritation of the fauces, begins to expel the blood, mucus and portions of the growtliB which have been cut off. The finger is now passed into the naso-pharynx ; if there still remain more vegetations, the curette is again used. It is often better to use the curette of Hartmann for the removal of these last remnants and tags of tissue. The operation done in this wayduring the short duration of the primary anesthesiamust be done very quickly ; the average time required is not far from one minute, although one fiequently does it in less time. The obviouB advantages of the method are its safety and the speed with which it can be done. After the necessary practice it can be done very thoroughly. The anesthetic useel very satisfactorily in Fraenkel's clinic is bromide of ethyl. The writer has used ether in all his cases, and likes it better than the ethyl. Patients who are not excessively nervous, nor too young to control can be treated without general anesthesia. The benefit from the removal of these lymphoid masses from the naso-pharynx is so great, so quickly seen, and so permanent, that there are few surgical procedures so satisfactory to the patient and the doctor. The opinión has been expressed, however, that notwithstanding the appreciation on the part of specialists and by very many general practitioners, of the exceedingly large number of children who suffer from the trouble, there still remain a great many cases which are not recognized and thus are debarred from the benefit of operative treatment. Mouth-breathing, earaches, " winter colds," nasal intonation, are symptoms that call for investigation, and simple palpation of the naso-pharynx will settle the question of the existence of adenoids. This case occurred in Brockton, Mass., in the practice of Dr. E. L. Frost, through whose kindness I was permitted to see it ; and by his request I make this brief report. The patient, a strong, well-nourished woman of thirty-six years, had one child and a history of a miscarriage some eighteen months before the present pregnancy, followed by recurrent pelvic pain. Dr. Frost was called May J, 1895, the patient complaining of pain in the right groin. The last menstrual flow was about April 1st, and this was considered one of her usual attacks. She apparently recovered from it, as sin; had from previous attacks. One mouth later Dr. Frost was called for another attack of pain in the right side, much more severe than the previous one ; but there was no collapse and nothing to indicate a ruptured tubal pregnancy, beyond a distinct tumor at the right side of the uterus, about the size of an orange, which could be felt from the outside. This gradually disappeared and the patient recovered slowly. At about this time she began t°h ave morning vomiting. There is nothing further to note until December o, 1895, when Dr. Frost was called at noon and found the patient in labor. Examination of the abdomen showed a tumor of about full term with a sulcus across the lower third, and the part below the sulcus w0Ui, harden as the pains came on. The fetal parts «>u be detected through the abdominal walls more distinct y
doi:10.1056/nejm189604301341807 fatcat:h45yljrazrh6bhucp6va3pacua