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A CASE OF EMPYEMA OF THE ANTRUM OF HIGHMORE OF SEVEN YEARS' DURATION.
CLINICAL NOTES.-HOSPITAL MEDICINE AND SURGERY.
inches,
was
a
small, annular, hard, and fixed swelling,
which was tender to the touch. The cervix uteri was central and the body of the uterus was felt in front lying on the floor. There was occurred five months after
pelvic
V
Gordon-square, W.C. W
deposit in parturition. no
the
pelvis.
aged thirty-four
pain referred to the left
OF
HOSPITAL
LATE ASSISTANT HOUSE PHYSICIAN, GENERAL HOSPITAL, NOTTINGHAM.
MAN
A Mirror
Death
A CASE OF EMPYEMA OF THE ANTRUM OF HIGHMORE OF SEVEN YEARS’ DURATION. BY GEORGE PINDER, M.D., B.C. CANTAB.,
A
979
sought advice for constant temporal, mastoid, and occipital
he complained also of more or less constant and of palpitation of the heart. A careful physical ’examination failed to elicit any positive evidence of .organic disease, and inquiry was then directed towards a purulent discharge from the left nostril disregarded by the patient, since he had had it for quite seven years ’and " had got used to it." He explained that the discharge was due to an attack of influenza seven years previously, and that his club attendant had told him that " there was a piece of dead bone in his nose." On rhinoscopic examination the anterior portions of the septum and of the left inferior turbinal bone were seen to be studded with numerous small sessile vascular polypi, and pus was observed oozing from the situation of the middle meatus. ’The purulent discharge was constant and offensive ; it varied much in amount and was not affected by the position of the head, save that at bedtime it ’,ran down the back of the throat." The left upper molars were carious but not painful. There was tenderness on pressure over the situation of the left infra-orbital nerve. Under ether the decayed teeth were extracted, and, in view of the long-standing nature of the case, two holes were drilled into the antrum, one in the situation of the second molar and the other through the canine fossa. A pyogenic membrane, forming a very complete cast of the antral cavity, was removed by syringing with an antiseptic solution, together with a quantity of pus and caseous The polypi were removed and their bases material. ’cauterised. The troublesome symptoms ceased almost immediately, and the patient is now, after some ten The only remarkable weeks’ treatment, perfectly well. ’feature of the case, and its best apology for publication, is the extraordinary length of time the disease had existed - nausea
FOREIGN.
Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, tum aliorum tum proprias collectae habere, et inter se comparare.-MORGAGNI De Sed. et Oaus. Morb., lib. iv. Prooemium.
MIDDLESEX HOSPITAL.
years
’i.’egions;
PRACTICE,
BRITISH AND
TWO
CASES OF INGUINAL HERNIA PRESENTING CHARACTERS.
(Under the
UNUSUAL
of Mr. HENRY MORRIS.) THE rarity of the first of these cases is shown by the fact the condition is not described in our text-books or in the special treatises on hernia to which we have been able to refer. Mr. William Anderson has described1 a similar condition met with by him in three cases where he operated for left inguinal hernia. He speaks of it as "an anatomical variation which has not hitherto been recognised (except as a possibility by Joseph Maclure in his Surgical Anatomy) the absence of a sigmoid meso-colon in the iliac segment of the large intestine." He apparently apprehended some loss of vitality in the portion of bowel which he dissected up and returned, owing to the movement from its attachments, but all three cases recovered satisfactorily. The second case is also an unusual one, for although it is not uncommon to meet with ulceration of the bowel in a case of strangulated hernia, the destruction of tissue occurs at the care
that
FIG. 1.
the patient having been under almost constant medical care since the first appearance of the nasal discharge. It emphasises once more the importance of thorough intranasal examination in all cases of purulent nasal discharge.
unrecognised,
Ramsey,
Isle of Man.
ST. MARY’S
HOSPITAL
MEDICAL
SCHOOL -
REVISED LIST.- University Scholarships : R. R. Wade, B.A., of Exeter College, Oxon., £52 10s.G. S. Keeling, B.A., - Cams College, Cambridge, £52 10s. ;A. Ferguson MacCallan, B.A., Christ’s College, Cambridge, Exhibition of E26 5s. Natural Science Scholarships : W. H. Willcox, B.Sc., £105; E. W. Holyoak, £52 10s.; A. F. Hayden, E52 10s. .J. Tattersall, E52 10s.
THE NEW ASYLUM FOR WEST SUSSEX.-The violent opposition to the county council’s scheme for erecting point a new lunatic for the administrative district of West
asylum
Sussex has not been heard of lately, and meanwhile the new on apace. It stands about a mile from .Chichester, and is built from the design of Sir Arthur Blomfield. The executive buildings stand in a block in the centre ’of a series of six blocks for the reception of the patients ; the - latter blocks are to be connected by underground corridors. The chapel is to cost £4000 out of £114,669, the amount of the
building is getting
contract.
The total expenses will
£200,000, but the original estimate
probably
was
far in
be
nearer
excess even
of this figure. Water has been found at a depth of 400 ft., and a huge water tower some 100 ft. in height will serve the buildings. The asylum will accommodate 450 patients, and is capable of being extended to receive another 150. Up to the present time the asylum at Hayward’s Heath, in East Sussex, has been the only one in the district, but for years patients have had to be drafted thence to Berrywood, Salisbury, and establishments at other places.
Diagram showing sac open and bowel behind posterior wall of sac-indeed, forming posterior wall of sac.
of strangulation, usually the neck of the sac. Here the ulceration occurred at the fundus of the sac ; and the escape of the contents of the intestine was limited by adhesions before the perforation was complete. The resection of the bowel was undertaken under favourable circumstances compared with most cases of operation for ulceration with perforation, the patient being in a condition to permit a prolonged operation and therefore of all necessary care in the suturing. It will be noticed that Mr. Morris resorted to the method of uniting the ends as the most reliable when he had the choice, and did not resort to the use of any of the artificial aids which are recommended by some surgeons. For the notes of the cases we are indebted to Mr. John
Murray, surgical registrar. CASE 1. Bernia of the sigmoid flexure into the scrotuma; part of the sac used to give a complete covering of peritoneum to the bowel, the rest excised ;; inguinal canal closed 1
Medical Press and Circular,
1894, vol. ii.,
p. 621.
inches,
was
a
small, annular, hard, and fixed swelling,
which was tender to the touch. The cervix uteri was central and the body of the uterus was felt in front lying on the floor. There was occurred five months after
pelvic
V
Gordon-square, W.C. W
deposit in parturition. no
the
pelvis.
aged thirty-four
pain referred to the left
OF
HOSPITAL
LATE ASSISTANT HOUSE PHYSICIAN, GENERAL HOSPITAL, NOTTINGHAM.
MAN
A Mirror
Death
A CASE OF EMPYEMA OF THE ANTRUM OF HIGHMORE OF SEVEN YEARS’ DURATION. BY GEORGE PINDER, M.D., B.C. CANTAB.,
A
979
sought advice for constant temporal, mastoid, and occipital
he complained also of more or less constant and of palpitation of the heart. A careful physical ’examination failed to elicit any positive evidence of .organic disease, and inquiry was then directed towards a purulent discharge from the left nostril disregarded by the patient, since he had had it for quite seven years ’and " had got used to it." He explained that the discharge was due to an attack of influenza seven years previously, and that his club attendant had told him that " there was a piece of dead bone in his nose." On rhinoscopic examination the anterior portions of the septum and of the left inferior turbinal bone were seen to be studded with numerous small sessile vascular polypi, and pus was observed oozing from the situation of the middle meatus. ’The purulent discharge was constant and offensive ; it varied much in amount and was not affected by the position of the head, save that at bedtime it ’,ran down the back of the throat." The left upper molars were carious but not painful. There was tenderness on pressure over the situation of the left infra-orbital nerve. Under ether the decayed teeth were extracted, and, in view of the long-standing nature of the case, two holes were drilled into the antrum, one in the situation of the second molar and the other through the canine fossa. A pyogenic membrane, forming a very complete cast of the antral cavity, was removed by syringing with an antiseptic solution, together with a quantity of pus and caseous The polypi were removed and their bases material. ’cauterised. The troublesome symptoms ceased almost immediately, and the patient is now, after some ten The only remarkable weeks’ treatment, perfectly well. ’feature of the case, and its best apology for publication, is the extraordinary length of time the disease had existed - nausea
FOREIGN.
Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, tum aliorum tum proprias collectae habere, et inter se comparare.-MORGAGNI De Sed. et Oaus. Morb., lib. iv. Prooemium.
MIDDLESEX HOSPITAL.
years
’i.’egions;
PRACTICE,
BRITISH AND
TWO
CASES OF INGUINAL HERNIA PRESENTING CHARACTERS.
(Under the
UNUSUAL
of Mr. HENRY MORRIS.) THE rarity of the first of these cases is shown by the fact the condition is not described in our text-books or in the special treatises on hernia to which we have been able to refer. Mr. William Anderson has described1 a similar condition met with by him in three cases where he operated for left inguinal hernia. He speaks of it as "an anatomical variation which has not hitherto been recognised (except as a possibility by Joseph Maclure in his Surgical Anatomy) the absence of a sigmoid meso-colon in the iliac segment of the large intestine." He apparently apprehended some loss of vitality in the portion of bowel which he dissected up and returned, owing to the movement from its attachments, but all three cases recovered satisfactorily. The second case is also an unusual one, for although it is not uncommon to meet with ulceration of the bowel in a case of strangulated hernia, the destruction of tissue occurs at the care
that
FIG. 1.
the patient having been under almost constant medical care since the first appearance of the nasal discharge. It emphasises once more the importance of thorough intranasal examination in all cases of purulent nasal discharge.
unrecognised,
Ramsey,
Isle of Man.
ST. MARY’S
HOSPITAL
MEDICAL
SCHOOL -
REVISED LIST.- University Scholarships : R. R. Wade, B.A., of Exeter College, Oxon., £52 10s.G. S. Keeling, B.A., - Cams College, Cambridge, £52 10s. ;A. Ferguson MacCallan, B.A., Christ’s College, Cambridge, Exhibition of E26 5s. Natural Science Scholarships : W. H. Willcox, B.Sc., £105; E. W. Holyoak, £52 10s.; A. F. Hayden, E52 10s. .J. Tattersall, E52 10s.
THE NEW ASYLUM FOR WEST SUSSEX.-The violent opposition to the county council’s scheme for erecting point a new lunatic for the administrative district of West
asylum
Sussex has not been heard of lately, and meanwhile the new on apace. It stands about a mile from .Chichester, and is built from the design of Sir Arthur Blomfield. The executive buildings stand in a block in the centre ’of a series of six blocks for the reception of the patients ; the - latter blocks are to be connected by underground corridors. The chapel is to cost £4000 out of £114,669, the amount of the
building is getting
contract.
The total expenses will
£200,000, but the original estimate
probably
was
far in
be
nearer
excess even
of this figure. Water has been found at a depth of 400 ft., and a huge water tower some 100 ft. in height will serve the buildings. The asylum will accommodate 450 patients, and is capable of being extended to receive another 150. Up to the present time the asylum at Hayward’s Heath, in East Sussex, has been the only one in the district, but for years patients have had to be drafted thence to Berrywood, Salisbury, and establishments at other places.
Diagram showing sac open and bowel behind posterior wall of sac-indeed, forming posterior wall of sac.
of strangulation, usually the neck of the sac. Here the ulceration occurred at the fundus of the sac ; and the escape of the contents of the intestine was limited by adhesions before the perforation was complete. The resection of the bowel was undertaken under favourable circumstances compared with most cases of operation for ulceration with perforation, the patient being in a condition to permit a prolonged operation and therefore of all necessary care in the suturing. It will be noticed that Mr. Morris resorted to the method of uniting the ends as the most reliable when he had the choice, and did not resort to the use of any of the artificial aids which are recommended by some surgeons. For the notes of the cases we are indebted to Mr. John
Murray, surgical registrar. CASE 1. Bernia of the sigmoid flexure into the scrotuma; part of the sac used to give a complete covering of peritoneum to the bowel, the rest excised ;; inguinal canal closed 1
Medical Press and Circular,
1894, vol. ii.,
p. 621.