LONDON HOSPITAL

1832 The Lancet  
638 evaporating-spirit lotion is consequently substituted. 12. Pain and swelling nearly in statu quo. The redness and tension are perhaps a little diminished; the foot and ankle a r e oedematose; tongue pallid and flubby ; bowels I freely moved ; pulse 100, tolerably full. 14. The pain, redness, and tumefaction, have rapidly diminished since the use of the spirit lotion. Tongue clean ; bowels open; pulse 88. 17. The limb is perfectly easy whilst the patient remains quiet, but in the slightest
more » ... in the slightest attempt at motion, the pain returns as se-1 verely as ever. Tongue clean, but flabby ; bowels open ; pulse 80, full. ! 18. The patient was seized with rigors about an hour ago, and still continues shivering. The limb, too, has rapidly swollen since that time, particularly in the groin, and he cannot bear the slightest touch tongue furred ; bowels open once ; pulse 120; twelve leeches to the groin; ten grains of Dover's powder exhibited i m m ediately. Eiglit o'clock p.m. Pain relieved by the leeches, but the swelling remained unreduced ; the pain. however, returning as severe as formerly. Venesection to 16 B ounces was had recourse to, and proved effectual in removing the pain. 19. The limb has remained easy since the venesection, but the intumescence has rather increased. Erysipelas has made its appearance in the leg from the foot to t h e knee, and appears to be occasioned hy the leech-bites. Tongue pallid ; bowels open once ; pulse 102, full and hard. A strong purging draught with alkali to be given; to continue the antimonial mixture. 20. The erysipela3 is subsiding ; swelling of groin smaller; pain less severe tongue furred; pulse 80, full and soft , , B countenance cheerful ; to repeat the alkalina purge. B 23. The swelling in the thigh, and the erysipelas in the leg, are gradually disappearing ; tongue clean, but flabhy; bowels open; pulse 84, full. The patient can move the limb without pain. He sleeps well, and his appetite is reviving. 24. A resuscitation of the erysipelas on the dorsum pedis; bowels constipated; the thigh is still rather tumefied, but there is no pain ; six leeches to be applied to the foot, and an alkaline purging draught to be swallowed immediately. Aug. 3. The erysipelas has nearly gone : the tumefaction still unremoved; the p a i n and inflammation have subsided; the emunctories apparently act well, but the ensemble of the patient presents an unhealthy leucophlegmatic eharaeter. 10. The patient's general condition has improved; his appetite is good; the pain and tumefaction of thigh-hone abated, and are scarcely appreciable, but the œdema, of the leg has very much augmented. The use of the evaporating lotion is continued, and occasional purges are administered; his colour is slightly improved. This is a case somewhat analogous to those described by Sir Henry Ilalford at one of the evening converzatione in the College of Physicians. The exciting cause, viz. the sudden application of cold, was the same, but in the present case no remarkable slowness or intermission of pulse has bei n observed, probably because no obliteration of the veins has taken place, although a suspicion of such a fact is excited by the increased oedema of the affected, and a certain hardness perceptiole in the course of the femoral vessels. This is a circumstance, however, which remuins to be proved by the subsequent history of the case. LONDON HOSPITAL. STRICTURE OF THE URETHRA, PRODUCED BY EXTERNAL VIOLENCE. H.1., seaman, ætat. 34, scas admitted into the hospital about three months since on aecount of difficulty in voiding his urine. The patient stated, that abnut t enweeks previous to his admission,he fell across a plank, which passing between his legs, struck the perineum violently, there was considerable he. morrhage from the urethra immediately after the accident, which was arrested bv means of cold applied to the part, and he continued for some time to pass blood with his uiine. In a short time he found considerable difficulty in passing his urine; this gradually increased. At the time of his admission the urine flowed in a very small spiral stream. There was a very firm stricture at the membranous portion of the urethra. After considerable difficulty, Mr. Scott succeeded in introducing a catheter (No. 2) through the stricture into the bladder which was kept in the bladder by tapes, and withdrawn at the esairation of two days, when the next size was introduced, continuing to increase the size every second or third day, each catheter being allowed to remain in the bladder until succeeded
doi:10.1016/s0140-6736(02)82478-3 fatcat:qnh7tql2xbautmgmamszsidczi