1862 The Lancet  
700 The clamp was removed on the next day, forty-eight hours after the operation, and the stump was washed with a solution of carbolic acid. The wound was quite quiet, and appeared to have united throughout the deeper part. Shf ' jiow taking a little wine-and-water. Nov. lst.-The bowels not naving been relieved since the operation, and great griping pain being complained of, she had an enema of castor oil and turpentine, and turpentine tomentations were applied over the abdomen. No evacuation
more » ... llowed the enema. At night the pain was severe, and there was fulness and marked tenderness over the left iliac region. She was ordered a grain of calomel and a quarter of a grain of opium every four hours. On the 2nd, she was much easier; but the pulse was 112, and sharp. Half an ounce of castor oil was given, which towards evening caused a free action from the bowels twice, with great relief. The calomel was discontinued on the following day, as all the symptoms were so much more favourable. She went on in this way, occasionally suffering much from wind, which was generally relieved by opium, chloric ether, and sal volatile, with turpentine fomentations. There was always, however, some tenderness in the old situation, which on the 18th was so much more severe that she was again put on calomel and opium. ' Dr. Priestley now made a vaginal examination, and found a decided fulness in the left broad ligament and iliac fossa, and the posterior surface of the uterus was fixed by inflammatory adhesions, so as to interfere with its mobility. The calomel and opium were continued till the 24th, the tenderness and fulness diminishing day by day. At this time the gums were very slightly affected. From this period she went on improving, and soon began to sit up and to move about. At first she was very weak ; but she gained strength steadily, and left the hospital on the 16th December. The wound was perfectly cicatrized, and measured only four inches and a half. The tumour weighed ten pounds, and was made up of one large and pretty solid cyst and a number of small ones. MULTILOCULAR OVARIAN TUMOUR OF THREE YEARS' DURATION; OVARIOTOMY; DEATH. (Under the care of Dr. PRIESTLEY and Mr. HULKE.) A country woman aged fifty-six, admitted Oct.2lst, I862, with a large globular ovarian tumour, of the presence of which she had first become aware three years previously, soon after the cessation of menstruation. At that time it was movable in the right iliac region, and about the size of a teacup. The girth of the belly was 413/4 inches. The lower part of the front of the belly, and the lower extremities, were cedematous. The urine was not albuminous. Catamenia ceased when nearly fifty-three, and she had had two children at the ages of thirtythree and thirty six. Her complexion was sallow, and she was much emaciated. The ceclema of the legs and abdominal walls subsided. On Dec. 2nd ovariotomy was performed. An incision about three inches long was made below the umbilicus. On dividing the peritoneum, several translucent yellowish bladders presented themselves in the wound ; these were collections oj yellow ascitic serum in the extremely attenuated and t :ansparent omentum. Oa pushing them aside the white ovarian cyst came into view, and now a strong adhesion was found, oj deep-red colour. The cyst was next tapped, and pulled out through the wound ; the pedicle was enclosed in a clamp, anc then divided; and the wound was closed with iron-wire stitches, Death occurred from collapse sixty-five hours and fort3 minutes after the operation. At the post mortem examination, signs of recent peritoniti: were apparent. A tliich-walled abscess was found in the spleen The gall bladder contained nearly a hundred calculi. THE patient was a labouring man, aged about thirty-seve years, who was admitted in November, with a large and prc minent tumour of his left arm, for which he underwent opera tion on the 29th of the same month. Mr. Fergusson at the time made some clinical remarks. He said it was not an easy matter to form a decided opinion in this case; but he believed an attempt should be made to remove the growth and save the arm. Seven years ago the patient received a bite from a dog, the mark of which was to be seen to this day. He would not say it had anything to do with the tumour. Twelve months ago the patient noticed a swelling in the arm, and he watched its gradual development until it had attained the size then witnessed. On examination after his admission into the hospital, he (Mr. Fergusson) experienced some difficulty, first as to its character, and then its precise relations. A growth with so rapid a development has an appearance of malignity about it, and he believed it was malignant. Next as to locality, and whether it was attached to one of the nerves, or deposited in or around a gland or a muscle ? It was impossible to say; but there was one circumstance he could readily determine, and it was that the tumour lay under the aponeurosis of the arm; and although it seemed tolerably circumscribed, yet it was so associated with neighbouring parts that it was difficult to ascertain its relations, especially in respect to the biceps muscle. In his own mind it was quite clear that something should be done to save the arm and even life itself, and he resolved to dissect it, and be guided by circumstances in regard to any ulterior proceeding. In doing this, he selected a part farthest from the brachial artery, and came upon muscular fibres. Wherever the knife entered these were divided ; they appeared to be those of the biceps, and it therefore seemed that the tumour was developed within that muscle, and intimately incorporated with its fibres. Out of the body these muscular fibres might be dissected off the tumour, but it was impossible in the living person. It looked more as if the growth had actually commenced in the biceps muscle. He had succeeded in getting the whole of the tumour away, without involving any important structure, except the muscle itself. The operation, he further observed, was done as much for saving life as the arm. A section of the tumour gave an indication of early medullary disease, which in a more advanced stage would have been like fungus haematodes, with soft bloody funguslooking masses, rarely seen now-a dttys, because something is done before it is allowed to proceed to that extent. The patient subsequently went on well, so far as concerned the effects nf the nnaratinn UNIVERSITY COLLEGE HOSPITAL. THE EMPLOYMENT OF TELEGRAPH SUTURES IN CLOSING WOUNDS IN VARIOUS CASES. (Under the care of Mr. ERICHSEN.) MR. CLOVER has introduced a new form of suture, which appears to possess many advantages over those ordinarilyemployed, whether of silk, thread, or metal. It consists in the adoption of a very fine copper wire covered with gutta-percha -in fact, a minute telegraphic wire, and therefore receiving the name or " telegraph sutures." We have seen them used in a number of cases at University College Hospital, wherein Mr. Clover was himself allowed to apply them, because, as we heard Mr. Erichsen remark, it was but fair to allow the in. ventor to show the application of his own invention. One of the first cases which came under our notice was one in which Mr. Erichsen removed a tumour the size of an orange from the right parotid region of an elderly man on the 22nd of October last. The growth, although movable, was situated in a region requiring care to excise it, for it lay between the angle of the jaw and mastoid process, and did not dip behind the former. The tumour proved rather hard on making a section, and was fibro nucleated in character-a form that is considered to be somewhat rare. The incision used was ,-shaped, and this was closed with a fine telegraph wire, in the continuous or Glover's suture, by Mr. Clover; a small portion being left open to permit of the drain of secretion. On the 17th inst. the edges of a double hare-lip in an infant were pared by Mr. Erichsen, and evenly brought together by deep interrup ed telegraph sutures by Mr. Clover. These, the former gentleman remarked, leave no scar-nothing at all like the hare-lip pin. He further stated that he had used them on the face of a gentleman from whom he had removed a tumour ten days previously, and no cicatrix was visible. He had also employed them in other cases. The silver wire, he observed, has the disadvantage of being very rigid, and does not tie well.
doi:10.1016/s0140-6736(02)41700-x fatcat:y34umh462fbpbcrrperjir4doq