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A CASE OF PRIMARY SARCOMA OF THE LUNG.
902 bleeding rather tend to confirm, and yet, as in the first case, although Dr. A. Ptrkin and Dr. W. E. Hume at the necropsy A CASE OF PRIMARY SARCOMA OF THE examined the interior of the chest carefully, no sign of LUNG. injury was apparent either on the surface of the lung or in BY H. W. WEBBER, M.D. LOND, F.R.C.S. EDIN., the intercostal artery. As the haemorrhage always occurred ASSISTANT SURGEON TO THE SOUTH DEVON AND EAST CORNWALL in patients who-e temperature was high it may be that a HOSPITAL. poisoned state of the blood is responsible for the bleeding,
and that alone or combined with alteration of pressure. The blood-vessels would become unhealthy and if injured would probably not contract so well. They might rupture as a consequence of malnutrition and sepsis. It is difficult to explain the haemorrhage in such cases, especially when after death careful examination failed to reveal the presence of a
bleeding point. Newcastle-on-Tyne.
A CASE OF FRACTURE OF THE SURGICAL NECK OF THE HUMERUS. BY F. C. WALLIS, M.B. CANTAB., F.R.C.S. ENG., SURGEON TO CHARING CROSS HOSPITAL.
patient, a man aged 27 years, fell through a lift-hole striking the edge of the hole with his left shoulder. On admission to Charing Cross Hospital he was found to have THE
a
fracture of the
surgical
neck of the humerus with
shortening of one inch. Splints with extension failed to keep the fragments in good position, so operation was decided upon. Three weeks after the accident the following operation was performed. The fragments were reached by -eparating the fibres of the deltoid and pulling aside the tendon of the biceps. The upper fragment was found to be tilted outwards and backwards ; the lower was drawn upwards and inwards. (Fig. 1 ) Extension and manipulation failed to get FiG. 1.
FIG. 2.
the fractured surfaces together. The arm was then raised to full extension; this brought the lower fragment to the upper. (Fig. 2.) The two were then fixed together by two staples. (Fig. 3.) The arm was next brought down to the side, the two fragments moving together. (Fig. 4.) The wound was then closed and the stitches were removed on - the ninth day.
FIG. 3.
FIG. 4.
THE patient was a well-built man, aged 29 years, and above He had been under the care of the average physique. medical men in Chicago for three months for anaemia and loss of strength and was sent to Europe for a change of air and rest. While on the steamer he had pain in the left side and shortness of breath and was treated by the ship’s surgeon for pleurisy. On arrival of the ship at Plymouth on August 16th, 1904, he was landed and taken to a He was at once seen by hotel on a stretcher. Mr. H. H. Parsloe, who found him collapsed, breathing with difficulty, ansemic, complaining of great pain in the epigastrium, and with a weak pulse of 140 per minute. Morphine and strychnine were given hypodermically and it was found on examination that there was a considerable pleural effusion on the left side. This was aspirated in the eighth left interspace below the angle of the scapula, and one pint of claret-coloured fluid was drawn off. On standing, about one-fourth of this subsided to clot, leaving the remaining three-fourths as pinkish serum. After the aspiration there remained an area dull to percussion below the eighth rib extending forwards to the posterior axillary line and over this area tubular breathing could be heard. The patient’s respiration became easier and he could sit up in bed. On August 17th and following days the epigastric pain was constant and severe, requiring a hypodermic injection of one-quarter of a grain of morphine every four hours. The liver was found to be enlarged, the edge being felt three inches below the costal margin. The stomach was much dilated. The pleural effusion steadily re-accumulated and on the 23rd the left, cavity was aspirated again and one and a half pints of blood-stained fluid were removed. The patient’s pulse was now 140 per minute, very weak, and the anasmia was marked. On the 28th Mr. Parsloe and myself consulted as to the advisability of a third aspiration, as the fluid had again accumulated. We decided, in view of the evident approach of a fatal termination, not to aspirate again. The patient died on the 31st. At the post-mortem examination the stomach was found to be much dilated, the great curvature being half-way between the umbilicus and the iliac crest. The pylorus was normal and there was no pyloric obstruction. The liver was large, friable, and fatty. There was excess of pericardial fluid and of epicardial fat. The left pleural cavity contained three pints of blood-,-tained fluid. The lower three-fourths of the left lung were replaced by a fleshy, nodulated, hsemorrhagio growth, there being only part of the left apex remaining as lung tissue. Microscopically this was found to be a very bmmorrbagic mixed-celled sarcoma. Plymouth. ___________________
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL. A NEW "CHAUFFEUR’S FRACTURE." BY STANLEY RAW, M.D., B.S. DURH., F.R.C.S. EDIN.
The main reason for publishing this case is to show the method by which the ends of the bone were joined together with staples. The fracture in this case was really higher than the surgical neck and no form of manipulation had any good result until that shown in the diagram was adopted. The inability to bring the ends in apposition in fractures of this kind has usually resulted in excision of the head of the bone. If the plan adopted in this case is carried out I believe that excision of the head of the bone will practically never be necessary in fractures of this character.
Harlej7-street, W
I WAS recently consulted by the driver of a motor-car wl.o asked me to examine his hand as he had injured it whilst starting the car ten days before he came to see me. Since that time he had had a great deal of pain in the hand and it was now beginning to swell. The car was driven by a 10 to 12 horse-power two cylinder engine. On the day of tl.e accident it was proceeding along a busy thoroughfare at a speed of about k5ix miles an hour, the engine being well governed, but having the spark fully advanced. For some unexplained reason the car suddenly stopped and as there was a good deal of traffic in the road the driver quickly jumped from the car and went to the starting lever ; in his
and that alone or combined with alteration of pressure. The blood-vessels would become unhealthy and if injured would probably not contract so well. They might rupture as a consequence of malnutrition and sepsis. It is difficult to explain the haemorrhage in such cases, especially when after death careful examination failed to reveal the presence of a
bleeding point. Newcastle-on-Tyne.
A CASE OF FRACTURE OF THE SURGICAL NECK OF THE HUMERUS. BY F. C. WALLIS, M.B. CANTAB., F.R.C.S. ENG., SURGEON TO CHARING CROSS HOSPITAL.
patient, a man aged 27 years, fell through a lift-hole striking the edge of the hole with his left shoulder. On admission to Charing Cross Hospital he was found to have THE
a
fracture of the
surgical
neck of the humerus with
shortening of one inch. Splints with extension failed to keep the fragments in good position, so operation was decided upon. Three weeks after the accident the following operation was performed. The fragments were reached by -eparating the fibres of the deltoid and pulling aside the tendon of the biceps. The upper fragment was found to be tilted outwards and backwards ; the lower was drawn upwards and inwards. (Fig. 1 ) Extension and manipulation failed to get FiG. 1.
FIG. 2.
the fractured surfaces together. The arm was then raised to full extension; this brought the lower fragment to the upper. (Fig. 2.) The two were then fixed together by two staples. (Fig. 3.) The arm was next brought down to the side, the two fragments moving together. (Fig. 4.) The wound was then closed and the stitches were removed on - the ninth day.
FIG. 3.
FIG. 4.
THE patient was a well-built man, aged 29 years, and above He had been under the care of the average physique. medical men in Chicago for three months for anaemia and loss of strength and was sent to Europe for a change of air and rest. While on the steamer he had pain in the left side and shortness of breath and was treated by the ship’s surgeon for pleurisy. On arrival of the ship at Plymouth on August 16th, 1904, he was landed and taken to a He was at once seen by hotel on a stretcher. Mr. H. H. Parsloe, who found him collapsed, breathing with difficulty, ansemic, complaining of great pain in the epigastrium, and with a weak pulse of 140 per minute. Morphine and strychnine were given hypodermically and it was found on examination that there was a considerable pleural effusion on the left side. This was aspirated in the eighth left interspace below the angle of the scapula, and one pint of claret-coloured fluid was drawn off. On standing, about one-fourth of this subsided to clot, leaving the remaining three-fourths as pinkish serum. After the aspiration there remained an area dull to percussion below the eighth rib extending forwards to the posterior axillary line and over this area tubular breathing could be heard. The patient’s respiration became easier and he could sit up in bed. On August 17th and following days the epigastric pain was constant and severe, requiring a hypodermic injection of one-quarter of a grain of morphine every four hours. The liver was found to be enlarged, the edge being felt three inches below the costal margin. The stomach was much dilated. The pleural effusion steadily re-accumulated and on the 23rd the left, cavity was aspirated again and one and a half pints of blood-stained fluid were removed. The patient’s pulse was now 140 per minute, very weak, and the anasmia was marked. On the 28th Mr. Parsloe and myself consulted as to the advisability of a third aspiration, as the fluid had again accumulated. We decided, in view of the evident approach of a fatal termination, not to aspirate again. The patient died on the 31st. At the post-mortem examination the stomach was found to be much dilated, the great curvature being half-way between the umbilicus and the iliac crest. The pylorus was normal and there was no pyloric obstruction. The liver was large, friable, and fatty. There was excess of pericardial fluid and of epicardial fat. The left pleural cavity contained three pints of blood-,-tained fluid. The lower three-fourths of the left lung were replaced by a fleshy, nodulated, hsemorrhagio growth, there being only part of the left apex remaining as lung tissue. Microscopically this was found to be a very bmmorrbagic mixed-celled sarcoma. Plymouth. ___________________
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL. A NEW "CHAUFFEUR’S FRACTURE." BY STANLEY RAW, M.D., B.S. DURH., F.R.C.S. EDIN.
The main reason for publishing this case is to show the method by which the ends of the bone were joined together with staples. The fracture in this case was really higher than the surgical neck and no form of manipulation had any good result until that shown in the diagram was adopted. The inability to bring the ends in apposition in fractures of this kind has usually resulted in excision of the head of the bone. If the plan adopted in this case is carried out I believe that excision of the head of the bone will practically never be necessary in fractures of this character.
Harlej7-street, W
I WAS recently consulted by the driver of a motor-car wl.o asked me to examine his hand as he had injured it whilst starting the car ten days before he came to see me. Since that time he had had a great deal of pain in the hand and it was now beginning to swell. The car was driven by a 10 to 12 horse-power two cylinder engine. On the day of tl.e accident it was proceeding along a busy thoroughfare at a speed of about k5ix miles an hour, the engine being well governed, but having the spark fully advanced. For some unexplained reason the car suddenly stopped and as there was a good deal of traffic in the road the driver quickly jumped from the car and went to the starting lever ; in his