ROYAL MEDICAL AND CHIRURGICAL SOCIETY. MR. J. A. KINGDON, VICE-PRESIDENT, IN THE CHAIR

1872 The Lancet  
742 15th.-The patient has a fair appetite and clean tongue. Pulse 84; temperature 98'4°. The wound was dressed today. The upper third of the wound is covered with healthy granulations; the middle third is quite closed, and the lower third is kept open by a piece of antiseptic silk introduced for that purpose. 18th.-Has complained of some aching pains in the knee, which have now passed off. The oedema, of the leg and foot, which has been considerable ever since the operation, is now beginning to
more » ... subside. From this time the patient progressed favourably; the antiseptic dressings were continued until October 30th, when a small poultice was applied to the wound; and on November 2nd simple water dressing was ordered. At this time the cedema of the limb had entirely subsided after light bandaging. The tumour in the ham is considerably reduced in size and is very hard; the knee is constantly kept somewhat flexed, and is not yet capable of much motion. The patient has been up for several hours during the last few days, but does not yet attempt to put her foot to the ground. WORKHOUSE HOSPITAL, LIVERPOOL. CANCEROUS TUMOUR OF PELVIS ; COMPLETE OBSTRUCTION OF LEFT URETER, WITH PARTIAL CLOSURE OF LEFT ILIAC VESSELS. (Under the care of Dr. J. WILSON-STEELE.) THE points worthy of notice in the following case are: first, the obscure nature of the disease, the patient never complaining of any abdominal pain till within a few days of death; secondly, that although the left ureter was occluded, the depuration of the blood was continued for some time by means of the right kidney alone; and thirdly, that the pain which extended down the back of the left thigh was no doubt caused by pressure of the tumour on the sciatic nerve. Margaret Fwas admitted into hospital Sept. 23rd, 1872. The patient was forty years of age, the mother of three children, the youngest aged fourteen years; husband dead nine years. She had been ailing since March last, but was able to follow her usual avocations until a few days previous to her admission into hospital. The patient said that about twenty-five years ago she was knocked down by a vehicle, the wheel of which passed over her left leg. The catamenia had ceased to appear during the last three years, and had been very irregular for several years previous to that time. At the time of admission the patient complained only of weakness; pulse 110, regular, but rather weak; temperature normal. Was ordered a tonic mixture. Sept. 24th.-The patient has passed a very restless night; complains of extreme pain down the back of the left thigh. On pressing with a pencil along the course of the sciatic nerve, there was great tenderness. Three small blisters were ordered to be applied along the course of the nerve, then the endermic application of morphia. 25th.-Slept well during the night, and expresses herself as feeling much better. 27th.-Very painful node on left tibia. Ordered iodide of potassium in five-grain doses; painful part to be painted with tincture of iodine. 28th.-Feels better. 29th.-Complains to-day of a difficulty in passing water, and of a general feeling of numbness in the left limb. Was ordered a warm bath and a diuretic mixture. 30th.-Passes more urine, but the feeling of numbness still continues. Oct. 2nd.—Genera oedema of left limb, which is also very painful. Pulsation in left femoral artery much less forcible than in right. Difficulty in passing urine still continues. On the catheter being passed, the bladder was found to be empty. 4th.-Limb still cedematous. Passes urine in very small quantities. 5th.-Slept little during the night; complains of great pain in left iliac region to-day. Patient very weak. : 6th.-There is a very thick fetid discharge from the, vagina; limb much swollen; urine almost suppressed. 7th.-Great tenderness over abdomen; bowels consti-pated ; ordered an enema; turpentine stupes to be applied to abdomen. 8th.-Tenderness over abdomen increased; peritonitis well marked; mind quite clear; died at 2.35 P.M. Autopsy, thirty hours after death. -On opening the chest, the heart and lungs were found to be quite healthy. The abdomen having been opened, there was evidence of extensive peritonitis, the abdominal cavity being full of peritoneal effusion. On examining the viscera more minutely, a small tumour was found situated on the left side of the pelvis, extending slightly above the true brim and downwards towards the spine of the ischium ; to the latter bone the tumour was attached. The tumour was very closely adherent to the anterior wall of the vagina, close to the neck of the uterus; it was also intimately connected with the bladder. The left iliac vessels and left ureter were seen to enter the tumour; and, on removing the fascia from the ureter, it was found to be enormously distended, from the place where it entered the tumour up to the kidnpy. The ureter was about eight lines in diameter. The tumour, kidneys, bladder, uterus and vagina were removed en masse and carefully dissected. The iliac vessels passed through the tumour, becoming greatly diminished in diameter. Whilst the left ureter was completely closed, the right ureter was also enlarged, its entrance into the bladder being marked by a prominent papilla, admitting a large-sized knitting-needle. At the place where the tumour came in contact with the vagina an abscess had formed and burst into that canal, at the same time producing a vesico-vaginal fistula, which accounted for the fetid discharge that occurred two days previous to death. On examining the kidneys, the left was found to be pale and much smaller than the right. On laying open the left kidney, its interior was seen to be totally disorganised, the pelvis and calyces being quite distended with urine. The pressure from the urine was so great as to cause some of the uriniferous tubes to project, the capsule having been pushed before them in the form of small bulloo on the surface. The tumour itself weighed ten ounces. A section under the microscope showed abundance of cancer cells. The ovaries were quite healthy. (Communicated by WILLIAM OGLE, M.D., of Derby.) ExACT numerical records of the movements of the several parts of the chest-wall are needed, both as physiological data and in the study of disease. All the methods of mensuration of these movements hitherto in use, when passed in review, are found to be faulty for many purposes, in that they record either the simple gross enlargement of the circumference of the chest, or merely the resultant of the true dimensions of the motion. Most of the movements on either side of the sternum take place in three planes at right angles to one another; and, owing to the variations in even healthy breathing, it is important to measure all the dimensions of the motion during one act of breathing. An instrument for doing this had been devised by the author. [Its construction and the mode of its application having been demonstrated, the possible sources of error in its use were pointed out, and graphical representations of the several motions were shown.] The small extent of costal motion in ordinary breathing remarked by Haller, Hutchinson, and Sibson, rendered it necessary to observe chiefly forced respiration. In this action, in points near the ends of the sternal ribs the chief motions were forward and upward, the forward movement being most equable and starting much more rapidly at first than the upward rise, which took place chiefly at the latter portion of the act of breathing. The ordinary action of the
doi:10.1016/s0140-6736(02)56686-1 fatcat:erll7ug6ljb5bpvpshozdkgt3u