Surgical Memoranda
1883
BMJ (Clinical Research Edition)
%rz~~.H BRTS .Fbl fisohargestiom the urethra. Organic stricture is also accompanied by profuse oozing. The cases which we call gleet, go oater many year, ate most difficult to cure, and are sometimes incurable:i The discharge in these instances, especially after much physical btkeition, unusual sexual indulgence, or alcoholic excesses, becomes distinctly purulent, even years after the original infection. There arei some men who, aftet any sexual intercourse, have discharge from the. urethra,
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... ch passes away in a few days without any treatment. It would appear to us that these facts indicate there are some mucous membranes which become so congested when stimulated, that they produce a mtuco-punrlent discharge, under sources of irritation which are not gonorrhceal in character, and this is what we find with other mucous surfaces. The conjunctiva in some instinces becomes congested, and pours out a copious secretion in a few hours, after being irritated by an external agent. The same ruile applies to the nose, the pharynx, and the bronchial tubes. If -we apply the same line of thought to the skin, we shall find some cuticles so susceptible to external influences, that the east wind, the sun, soap, and, in one instance I have met with, even daylight, produce an acute eczematous condition. ShaU we doubt, then, that muco-purulent discharges, not distinguishable from gonorrhcea, do occurininstances where the irritation is not set up by specific pus-cells? It has often occurred to my mind, that the many remedies advocated for curing clap, have had their reputation based upon the treatment of cases which have been non-specific discharges; discharges which would recover under any line of therapeutics. Ear and Aural S3urgery. B. H., AGED 27, came to the dispensary complaining of frequent headache and giddiness. According to my custom in these cases, the ears were examined, and, a black mass of cerumen being visible in the right ear, she was referred to my clinic for diseases of that organ. Some difficulty being experienced in clearing the canal, a probe was employed, which at once came into contact with a hard body; and its impaction required the further use of forieps for removal. This body, upon emiation, was found to be metallic, in-shipe like a grape-stone with very sharp apex, and weighed twelve grains. It was kindly tested for me by Mr. Leopold Dean; analytical chemist at Sir William Armstrong and Co.'s, and proved to be a globule of iron. The patient had lived in the neighbourhood of ironworks from the age of three until ten years, and as a child played and rolled in the sand. During the latter part of this time she suffered from'pain in the right ear, for which the workmen puffed in tobacco smoke. At the age of ten years she was removed from the locality, and since then has resided in such places where no opportunity has afforded for the introduction of such a body, besides having no recollection of anythiag of the kind happening during the seventeen years. The globule of iron must, therefore, have been in the ear nearly twenty years. It was imbedded in dense ceramen, occupyig the deep part of the canal, the circumference of which I observed to be irritated, the membrana tympani was somewhat depresed and thickened, with alteration of the "cone of light."' Hearing has not diminished, and since the removal of the foreign body the giddiness and headache have ceased. After the age of ten years the earache subsided as the calibre of the canal increased. This case may be regarded as a most remarkabl instance of a dangerous foreign body remaining for years in the ear without serious and alarming consequences. SURGICAL MEMORANDA. EXCISION OF CLAVICLE FOR NECROSIS. P. C., pged 14, a doffer, living in a cellar, was seen for the .rt time oanOctober 22nd, 1882. Some three weeks before this, :wibi)t en-*ged. in carrying a basketful of umbrellas on his head, theabaket slipped and fell on his shoulder. He felt something giwr%way at .thAshoulder, and afterwards experienced pain t.here. .e. noutiaued at his work for four days, when the increased pain compeiled*him to desist. Subsequently the arm was maintained at rest, nd pouices were applied. On October 22nd the lad was greatly emaitd and the right shoulder was excessively tender. Over the outer half of the right clavicle, by candle-light, was seen a red and swollen Iluct. tuating abscess, evidently on the point of bursting, which, on the following day, was opened at a point two and a half inches eiternal to and on a level with the sterno-olavioular articulatiqn. A large quantity of yellow pus (not feetid) flowed out, and the absce cavity admitted a probe for a couple of inches in all directionxi, but no bare bone was felt. The cavity was stuffe with lint, and the limb put up as for fracture, the lad thereafter expressing a sense of comfort and gratitude. November 2nd. Bare bone was felt on probing. November 5th. It was decided to excise the clavicle. November 6th. Chloroform was administered at 8.35 P.M., and an examination made. There were two openings; one, the incision made into the abscess, and the other an inch nearer the sternal articulation, where the skin had given way since the abscess was opened. Pus flowed very freely through both these openings on pressure, and.a dir6ctor, pushed in for about two inches, came against bare bone. On the director being pushed through the artificial opening, an incision was made upwards to th.clavicle. From the end of this incision, the knife was carried outwards to the acromial end of the bone, and, with some difficulty, the ligaments attachling the clavicle to the scapula were divided. The acromial end was then raised, the horizontal incision continued inwards to the sterno-clavicular joint, some callus, which had formed round the inner half of the bone, cut thidugh, and the bone easily removed, there being no muscular attachments. No ligatures or sutures were used, but a general oozing was stopped by stuffing the wound with dry lint, over which a pad was placed, the whole being kept in position bystrips of plaster and a bandage. The temperature, after the operation, did not exceed 1020. For the first two or three days, during-which much pus oozed from the wounds and sinuses round the shoulder-joint and in front of the chest, the wound was washed with carbolic lotion. Afterwards, up to December 18th, it was dressed with zinc lotion, then with dry lint till January 2nd, when the wound was quite healed. The bone came away without the interarticulat fibro-cartilage, and was denuded of periosteum, except where-the clavioulo-scapular ligaments were attached, and a portion of the inner half of the shaft, where the bone was almost surrounded by callus. There was no evidence of fraoture. Rochdale. HEHNR BLAND. SILVER v. ELASTIC CATHETER IN HYPERTROPHY OF THE PROSTATE. IN this age so ripe with new inveitions in which both large and small things bear a part, one is repeatedly reminded in the daily routine of work how advisable it is not to place too much reliance on this or that form of instrument, or on any particular drug, but sttictlj to take each case on its own merits. In reportWg to the JO NAL, we cannot be accused of egotism, but rather in its weeldy peruisal gladly accept hints of any successful treatment, therein described by our colleagues, occurring in private or hospital pta6tice. I was sent for to meet in consultation a medical man in charge of a case which comes under the above heading. W. J., aged about eighty, comfortably off, strong and active for his years, who was suddenly taken with retention of urine. His usual medical attendantasd his assistant had been with their patient all night; but, as no relief could be obtained even by the aid of various sizes of the silver catheter, I was called in. I found the exciting cause of retention probably due to over physical exkertion, culminiating in smodic stricture combined with enlargement of the prostate; and as the bladder was very distended, it required speedy emptying. The medical man again used a silver Icatheter without any result, then handed the case to me. As it was decidedly urgent, Iimmediately well oiled a mediumn-sized gum-elastic catheter, and with firm pressure and a turn of the wrist in about two minutes easily passed the instrument into the bladder. If this had not occurred, for the sake of life we must have forced a silver catheter through the prostatic urethra, or else punctured the bladder by the rectum or above the pubes. The instant and happy relief procured in this case' shows that it is not the-surgedn'a hand rse, but the means used, that accomplishes the end. Bromley. T. WELLS HUBBAn R, l:.R.C.S.Eng., L.M;, LS.A.
doi:10.1136/bmj.1.1153.204-a
fatcat:cutjaqgk3jcdtlbci6wcy75exy