LONDON HOSPITAL

Maunder
1874 The Lancet  
657 fluid was contained, at least as a superficial layer, beneath the upraised cuticle. A similar spot was observed under the chin, and a third on the forehead; on the right cheek were several acne-like places, and on the left cheek were four or five reddened patches, one the size and shape of half an almond, two lines or so in elevation; a second the size and shape of a fourpenny-piece, and two others much smaller. The patches were of a dullish-red hue, and on close examination were seen to be
more » ... studded over with minute openings beneath a superficial layer of cuticle. These openings were the I , mouths of the hair-follicles of the skin. The patches were I seen to be made up of a congeries of congested and closelypacked sebaceous glands, from which had escaped a certain amount of sebum, which still formed the superficial layer. It was'this appearance that gave the clue to the eruption. In some parts of the patches there was a speckled appearance, produced by the escape of milky-looking sebum, and by its confinement beneath the scales on the surface of the patches. The patches were not painful. On the left arm were some very large acne spots dying away. On the buttocks were about a dozen large spots of well-marked pustular acne, in various stages; there were a few similar spots on the back of the legs. The hands and feet were free from all trace of the disease. The anus was healthy. There were no moist tubercles about the mouth or elsewhere, and no other signs of constitutional syphilis. On inquiry, the mother stated that the patches on the face developed out of the acne-like spots by the crowding together of a number of them. In this case the disease was clearly acneiform. The larger isolated spots at the seat of vaccination, and about the ehin and forehead, were nothing more than large acneiform pustules distended by sebum of creamy consistence and aspect, confined by the epithelium. The patches on the cheek were made up of acne-like spots, whilst the rash on the buttock was still more distinctly acneiform in character. Knowing that bromide of potassium produces just such an eruption, Dr. Fox was led to ask the mother if the child had been taking medicine, and if she knew whether it had had any bromide of potassium, whereupon she replied, H No, it has not; but I have been taking it for the last eighteen or twenty months for epilepsy." There seemed to be no doubt that this was the cause of the eruption. The mother then discontinued the bromide and the disease at once began to disappear, by the subsidence of the spots and patches. She resumed the medicine, and very speedily a fresh outbreak of the eruption occurred. It may here be remarked that the mother had not herself had an eruption on the skin. LONDON HOSPITAL. (Under the care of Mr. MAUNDER.) AT p. 117 we recorded an instance in which Mr. Maunder treated a globular exostosis of the femur, with a narrow pedicle, by deliberate subcutaneous fracture. The result has been highly satisfactory, though but little success was anticipated. The osseous tumour has become reattached to the femur; but its head, instead of projecting externally, now lies towards the centre of the popliteal space. The original tenderness no longer exists, and the leg, which could not previously be fully extended, can now be straightened, and is perfectly useful. By an operation simple and devoid of danger, a result practically equivalent to that obtained by a more formidable proceeding (excision) has been gained. SOHO-SQUARE HOSPITAL. CASES OF OVARIOTOMY. (Under the care of Dr. ALFRED MEADOWS.) THE following report is concluded from page 352 :-CASE 3. Multilocular ovarian tumour ; operation ; recovery.-M. A. V-, aged thirty-two, was admitted under Dr. Meadows's care on March 5th, 1874. The patient never had very good health; menstruation had always been painful and scanty, lasting from four to six days. She has been married nine years, and has had five children, the last eighteen months ago. A year ago she noticed on the left side a small, hard, and tender lump, which has increased in size ever since, and has caused occasionally severe pains in the abdomen. She has got much thinner lately. Bowels open regularly; urine normal. On admission the abdomen was found occupied by a large, non-fluctuating tumour, nodular at the lower part, freely movable, and reaching upwards nearly to the sternum. Dulness on percussion all over the front part of the abdomen ; resonance in both flanks, but less on the left side. than on the right. On vaginal examination the cervix was found high up posteriorly in the hollow of the sacrum; the uterine sound was passed nearly three inches along the sacrum, and the uterus was slightly movable, and not moved by any pressure on the tumour from the abdominal wall. The case was diagnosed to be one of multilocular ovarian tumour. The catamenia appeared on the 13th and ceased on the l7th of March. Dr. Meadows operated on March 21st. After chloroform was given an incision was made through the abdominal walls. Three cysts protruded through the wound, and were found slightly attached together by some old peritonitic adhesions. The more prominent one was tapped first, but no fluid coming away the trocar was withdrawn, and pressure applied to the outside of the cyst, great care being taken to prevent any of the thick gelatinous mass which then escaped getting into the peritoneal cavity. The two other cysts were consecutively tapped, and some thin gelatinous fluid escaped from both. As there were no adhesions to the parietal peritoneum, the cyst walls were easily drawn out, and a new thick clamp was applied and kept on for some time to see whether continued pressure would stop the bleeding. On removing the clamp the ovarian artery began to bleed, but the hæmorrhage was at once stopped, and the pedicle transfixed and tied, and the wound sewn up and dressed as in the previous cases-that is, with lint saturated with carbolised oil, covered with oil-silk, and the whole abdomen strapped with broad strips of plaster, cotton-wool being placed over this, and a bandage above all. There was very little haemorrhage. The quantity of fluid drawn from the three cysts was fifteen pints. The patient had much pain after the operation, and at 11 A.M. and at 3.30 P.M. had a subcutaneous injection of one-sixth of a grain of morphia. At 2 o'clock next morning she was sick after taking milk, but she slept well afterwards. and had no pains in the abdomen on waking. The temperature in the afternoon was 102°, the skin was dry, and the pulse was 92. One minim of tincture of aconite was ordered to be taken twice in the first hour and once every hour afterwards. She suffered from flatus for three or four days, but she had no sickness, and was able to take plenty of nourishment. The sutures were removed on the 27th, and that evening the temperature went up to 101.1°, but next morning it was normal. The patient progressed favourably from this time, though her convalescence was somewhat prolonged by the . occurrence of some suppuration in the course of two or three . of the sutures and by the formation of a small abscess on ' the buttock ; but these healed quickly, and she was able to ' leave the hospital, feeling strong and well, on April 20th, ' one month after the operation. WILTS COUNTY LUNATIC ASYLUM.
doi:10.1016/s0140-6736(02)46251-4 fatcat:3yo5bfmysrbyblzxpwbbjhneiu