1869 The Lancet  
508 by three orifices, two of which communicated with intrapelvic abscesses, the third with a large collection of pus in the right iliac fossa. The portions of innominate bone beyond the carious and blackened tissue suriounding the cotyloid cavity were quite sound. Both lungs occupied by very numerous nodules of miliary tubercle. Right kidney lardaceous; the left affected with extensive scrofulous disease. Liver pale; weight 2 lb. MISCELLANEOUS CASES. KING'S COLLEGE HOSPITAL. Herpes occurring
more » ... Herpes occurring during art arsenical course of treatment.-The following case seems to favour the views of Mr. Hutchinson regarding the production of shingles after the internal adminstration of arsenic. A woman affected with chronic psoriasis, who some time previously had been treated by large doses of arsenic, but had been compelled to discontinue the remedy in consequence of suspicious symptoms, came under the care of Dr. Duffin on Sept. 3rd. Smaller doses of the liquor arsenicalis (three minims to be taken thrice daily) were ordered; and this treatment was continued up to the 19th, when itching of the conjunctive and a whitish tongue indicated the full action of the remedy upon the system. At the same time the patient complained of an aching pain in the right shoulder and elbow, which on the following day was associated with a copious and wellmarked eruption of herpetic vesicles over the integument of the arm and forearm. No other part of the body was similarly affected. Spina bifida in an adult cured by puncture.-Mr. Henry Smith has recently had under his notice in the out-patient department of the same hospital a man whose history, from a surgical point of view, is of great interest. The patient, who is thirty-two yeaa-s of age, and the father of four children, had previously been affected with a large congenital swelling over the sacrum. The tumour was soft and fluctuating, extensively attached and without any constricted base, and covered by thin and tense integument, which frequently became inflamed in consequence of pressure or of slight blows. The tumour, which was undoubtedly due to spina bifida, had been punctured on several occasions, but without any permanent results. Some months since Mr. Smith again made a small puncture, and drew off 22 oz. of transparent serous fluid. This operation was followed by acute inflammation of the walls of the cyst, and severe general reaction, which placed the life of the patient in great danger. He made, however, a very good recovery, and now presents no trace of his former lesion, with the exception of a slight fulness of the integument and a distinct depression in the centre of the sacrum. GUY'S HOSPITAL. Repeated !M7M<om/!/.—By a singular coincidence there have been recently in the surgical wards of this hospital two patients who have each undergone on more than one occasion the lateral operation for stone. One case, under the care of Mr. Cooper Forster, was that of a man, sixty years of age, on whom lithotomy was performed in December, 1850, again in April, 1851, and, for the third time, on the 31st of August last. In each of the two early operations the cal-' , culus was of a brown colour, and crumbled under the ' , forceps. The one recently removed was phosphatic, and of ' , the size of a large kidney bean. This man had for some ' , years been affected with a tight urethral stricture, complicated with a perineal fistula, through which most of the urine was passed. Mr. Forster cut into the bladder with a probe-pointed bistoury, which was passed along the groove of a staff introduced through the perineal opening. This patient has since done well. The subject of the second case is a middle-aged man, who has been twice cut for stone, by Mr. Durham, since the commencement of the year 1868. The calculi in this case were also soft and phosphatic. The old symptoms have returned, and the patient is about to undergo a third operation. In consequence of the extremely sensitive state of this man's urethra, and of the intolerance of foreign bodies in this canal, lithotomy has been decided upon as a preferable proceeding to crushing. ' LONDON HOSPITAL. Malignant disease of the testicle.-Mr. Maunder has at the present time under his care a case which illustrates very well the rapid and disastrous progress of malignant disease of the testicle, and also indicates the great importance of a close examination of the inguinal and abdominal glands in the diagnosis and treatment of scrotal tumours. The patient is a pale, cachectic-looking man, twenty-seven years of age, whose right testicle was removed some three months since at another hospital. The corresponding side of the scrotum is now occupied by a large and foul ulcer, with exuberant granulations; the stump of the spermatic cord is much swollen; the inguinal glands on the same side are enlarged and indurated; and the hypogastric and right inguinal regions are distended by a large tumour, which is evidently formed by diseased glands. This case, moreover, shows the necessity of an examination of the scrotum in instances of obscure abdominal tumour; as an enlarged testicle, or an absence of the organ through surgical interference, will at once indicate pretty clearly the nature of the disease. Provincial Hospital Reports. ROYAL SURREY COUNTY HOSPITAL. COMPOUND COMMINUTED FRACTURE OF THE FEMUR. (Under the care of Dr. STEDMAN.) FOR the notes of this case we are indebted to Mr. Hopgood, house-surgeon. J. P-, aged forty-five, was admitted March 6th, 1869, suffering from the above fracture. The patient was knocked down by a horse, and the wheel of the waggon passed over his thigh. Upon admission he was found much exhausted. He was placed in bed, and hot brandy-and-water given to him. Upon removing his trowsers, which were covered with hlood, a severe fracture of the femur was discovered, the fragments moving about like a number of stones in a bag; there was also a large wound on the outer and under side of the thigh, and another on the anterior surface. The leg was placed on a long splint, the wound dressed with carbolic-acid lotion, and a bandage applied over it. In threehours' time the foot was very cold and feeling was almost entirely gone, but he did not complain of pain. The bandage round the upper part of the thigh was then loosened, hot water bottles applied to the feet, and twenty-nve minims of tincture of opium administered. March 7th. — Passed a comfortable night j foot warm; makes no complaint of pain. 8th.-Removed bandage and lint from wound; no suppuration; looks healthy. Bandage and lint-to be reapplied. 12th.-Removed carbolic-acid lint; there is a little sup puration, but the wound is now superficial. Small wound healed. To have it dressed daily. 29th.-Has continued to improve up to this time, and has felt no pain in leg from the first. Bandage and splint removed. Wound nearly healed. Splint resrpplied. May 20th.-Bandage and splint removed; wound healed; starch bandage applied. To get up. June Ist.-Allowed to use crutches. 6th.-Starch bandage removed. 10th.-He left the hospital this day, being able to get about with a stick and crutch. Leg a quarter of an inch shortened.
doi:10.1016/s0140-6736(02)66878-3 fatcat:tqhznfqg35cgzgzrv55uomhhcm