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BRISTOL GENERAL HOSPITAL.
628
primary cancer of the vagina is rare. cough, and also attacks of haemoptysis and epistaxis; sheposterior wall of the vagina is its usual had not been unwell since February, 1885. In July an abseat-not the anterior, as in this case. It is also rare for scess was noticed to be forming on the outer side of the hip. cancerous growth to so block the urethra as to cause retenThis remained stationary in size till January, 1886, when it tion of urine ; in the case now reported this complication increased rapidly. She was also getting weaker, and the, to the
vagina,
When it
occurs
but the
occurred. There was mechanical obstruction to the flow of urine and the entry of the catheter, and the passage of the instrument caused such extreme suffering that the estab-
was of a very hectic character. On Jan. 19th the abscess was opened, under strict antiseptic precautions, by an incision three inches long, to the inner edge of thelishment of an artificial vesico-vaginal fistula proved an tensor vaginae femoris: no diseased bone was felt; a alternative preferable to repeated catheterisation. drainage-tube was inserted, but was never shortened. She was very sick after the chloroform. After this the temperature fell to normal for twenty-eight days. From this period BRISTOL GENERAL HOSPITAL. up to the end of May her condition became gradually worse, EXCISION OF THE ELBOW-JOINT, WITH SUTURE OF THE temperature varying from 1008° to 1042°, pulse about 130, OLECRANON TO THE SAWN END OF THE and respirations 20. Discharge increasing; wound dressed ULNA; REMARKS. antiseptically twice daily. There was slight puffiness of the (Under the care of Mr. C. F. PICKERING.) eyelids in the morning, but no evidence of albumen in the. A. F——, aged fifteen, a strumous girl, had suffered from urine. Lungs and liver normal; appetite very bad; conpain over the joint. disease of the elbow-joint since June, 1885. In February, siderable On June llth, the patient being under chloroform, Mr.. was and erasion of the she admitted into the 1886, hospital, Taylor removed the head of the femur by the usual operajoint was performed. The joint was at that time found to tion. The bone was found to be unusually soft and pulpy be in an advanced state of pulpy degeneration, but the in the upper three inches of the femur. Acetabulum healthy.. cartilages were healthy. This operation was only partially A considerable amount of blood was lost. A large drainagesuccessful in stopping the progress of the disease, and in thei tube was inserted, and one suture to keep the edges of the following July, as the arm was becoming stiff, it was thought wound in closer approximation. Wound dressed antiseptiadvisable to excise the joint. This was done on July 8th, cally. She was under chloroform an hour and a half, and in the following manner. A longitudinal incision about was in a most exhausted state. A drachm of ether was given three inches in length was made over the back of the joint, whilst she was on the table. One hour after hypodermically exposing the olecranon. The tip of this was then divided the operation she was in great pain, for which half a grain with a sharp chisel, and the joint was thus opened. The of morphia was administered. She vomited most percartilages were found to have completely disappeared by sistently for forty-eight hours afterwards, and took only ulceration, and the articulating surfaces of the bone were small quantities of ice and brandy. An extension apparatus. bare and in a carious state. The olecranon, with the triceps of four was pounds applied. Evening temperature 100’60. attached, was now turned up out of the way and the operaJune l2th.-Temperature 97°. Still very sick. Wound tion proceeded with in the usual manner. After the diseased and tube removed. ends of the bones had been removed, the tip of the olecranon dressed, improvement; able to take light solids, two l5th.-Slight was united by a strong wire suture to the sawn surface of ounces of brandy, and four ounces of wine. Wound dressed the ulna. Drainage-tubes were inserted, and the wound with solution of corrosive sublimate (1 in 2000). Tem-sewn up. The operation was done under strict antiseptic daily 98’4°; pulse 104; respiration 22. perature precautions. The patient made a good recovery, the temThe femur having been found so extensively diseased, it normal perature remaining throughout. was considered that the patient’s only chance of ultimate remarks by Alr. PrCKERING.-I hoped, by the union of recovery lay in removing the limb at the hip-joint. Accordthe olecranon to the ulna, to greatly improve the movement on June 18th, chloroform having been administered,. ingly, of extension in the false joint, as the triceps in this way the limb was made bloodless by Esm arch’s bandage, a reserve would be acting to greater advantage than in the usual of blood being kept in the healthy limb, which was supply mode of performing the operation, in which the principal liberated at the end of the operation. The aorta was conattachment is cut away and the power of extension only trolled by Mr. Hamilton by Lister’s compressor. The anterior on muscular fibres’inserted into the fibrous the depends flap was partially dissected and partially transfixed, and theaponeurosis of the forearm. This case has so far been posterior transfixed. Very little blood was lost, but the successful, as, though the time has not yet come for the arm patient showing symptoms of collapse, thirty minims of to acquire perfect movement, the power of extension is ether were given hypodermically. No drainage-tube was good, and better than that of flexion; the latter has been inserted, and the flaps were accurately brought together for delayed by the greatly wasted condition of the biceps. The the inner two-thirds, whilst a large opening was left at the. tip of the olecranon has firmly united to the ulna below, outer angle for drainage, as a considerable amount of tissue and the wire has not been removed, as it is causing no infiltrated with inflammatory products, and riddled with irritation. Only the tip of the olecranon should be cut off, sinuses, was left in the posterior flap. After operation the and it should be united subsequently to the ulna by very had a light sleep, and then was in great pain for an patient strong and thick wire, so as to hold it firmly. hour, which was relieved by the injection of half a grain of morphia. Dosed till 3 P.M, and then had an enema of CHESTER GENERAL INFIRMARY. brandy (one ounce) and two drachms of Liebig’s extract. No CASE OF HIP-JOINT DISEASE ; RESECTION ; AMPUTATION vomiting till 5 P.M. At 5.30 respiration only 11; pulse 132t z6 P.M.: Enema repeated.-9 P.M. Temperature 101’2° AT THE HIP-JOINT; RECOVERY. pulse 132; respiration 16. (Under the care of Mr. J. TAYLOR.) June 19th.-Passed a good night; vomited once; passed THE following notes are by Mr. W. Lees, house-surgeon. urine in the night naturally. Took ice, barley-water, and Mary B--, aged eighteen, residing at Acrefair, Ruabon, cream. Complains of being very hungry. Temperature was admitted on May 20th, 1885. The patient had never 98’40; pulse 136; respiration 20. Wound dressed. Slept. been strong, was of strumous appearance, and had suffered soundly all day. No pain. Took brandy, cream, and from repeated attacks of hemoptysis. One sister died at Liebig’s extract. Vomited slightly once.-9 P.M.: Tempenineteen years of age from hip-joint disease, and another sister rature 100°; pulse 128 ; respiration 24. suffers from chronic abscesses in the neck ; the rest ofth e famíly From this time the patient made a rapid recovery. The Her present illness began in February, 1885, stump was dressed daily with lint soaked in solution of are healthy. when there was acute pain in the right knee, which was corrosive sublimate (1 in 2000). She took solid food on the swollen and very tender to the touch. For this the joint 21st. On July 10th the wound had healed, except a small In March following sinus at its outer angle. The patient was able to sit up in was painted with tincture of iodine. she was in bed for three weeks under medical treatment at bed, and partake of middle diet. home. In May, being much worse, she came to the Chester On an examination of the femur, the whole of it was found to be in a most disorganised state, the medulla Infirmary. On admission the knee and foot were considerably swollen ; breaking down under the slightest pressure. The kneetemperature 101° ; pulse 100. The limb was put up on a joint was diseased, the cartilages being eroded and thinned, back splint for four weeks. The patient now for the first and the synovial membrane everywhere thickened. There time complained of pain in the right hip-joint, and for this was also a small collection of pus about half an inch above She had a severe the epiphysial line. an extension apparatus was applied.
temperature
primary cancer of the vagina is rare. cough, and also attacks of haemoptysis and epistaxis; sheposterior wall of the vagina is its usual had not been unwell since February, 1885. In July an abseat-not the anterior, as in this case. It is also rare for scess was noticed to be forming on the outer side of the hip. cancerous growth to so block the urethra as to cause retenThis remained stationary in size till January, 1886, when it tion of urine ; in the case now reported this complication increased rapidly. She was also getting weaker, and the, to the
vagina,
When it
occurs
but the
occurred. There was mechanical obstruction to the flow of urine and the entry of the catheter, and the passage of the instrument caused such extreme suffering that the estab-
was of a very hectic character. On Jan. 19th the abscess was opened, under strict antiseptic precautions, by an incision three inches long, to the inner edge of thelishment of an artificial vesico-vaginal fistula proved an tensor vaginae femoris: no diseased bone was felt; a alternative preferable to repeated catheterisation. drainage-tube was inserted, but was never shortened. She was very sick after the chloroform. After this the temperature fell to normal for twenty-eight days. From this period BRISTOL GENERAL HOSPITAL. up to the end of May her condition became gradually worse, EXCISION OF THE ELBOW-JOINT, WITH SUTURE OF THE temperature varying from 1008° to 1042°, pulse about 130, OLECRANON TO THE SAWN END OF THE and respirations 20. Discharge increasing; wound dressed ULNA; REMARKS. antiseptically twice daily. There was slight puffiness of the (Under the care of Mr. C. F. PICKERING.) eyelids in the morning, but no evidence of albumen in the. A. F——, aged fifteen, a strumous girl, had suffered from urine. Lungs and liver normal; appetite very bad; conpain over the joint. disease of the elbow-joint since June, 1885. In February, siderable On June llth, the patient being under chloroform, Mr.. was and erasion of the she admitted into the 1886, hospital, Taylor removed the head of the femur by the usual operajoint was performed. The joint was at that time found to tion. The bone was found to be unusually soft and pulpy be in an advanced state of pulpy degeneration, but the in the upper three inches of the femur. Acetabulum healthy.. cartilages were healthy. This operation was only partially A considerable amount of blood was lost. A large drainagesuccessful in stopping the progress of the disease, and in thei tube was inserted, and one suture to keep the edges of the following July, as the arm was becoming stiff, it was thought wound in closer approximation. Wound dressed antiseptiadvisable to excise the joint. This was done on July 8th, cally. She was under chloroform an hour and a half, and in the following manner. A longitudinal incision about was in a most exhausted state. A drachm of ether was given three inches in length was made over the back of the joint, whilst she was on the table. One hour after hypodermically exposing the olecranon. The tip of this was then divided the operation she was in great pain, for which half a grain with a sharp chisel, and the joint was thus opened. The of morphia was administered. She vomited most percartilages were found to have completely disappeared by sistently for forty-eight hours afterwards, and took only ulceration, and the articulating surfaces of the bone were small quantities of ice and brandy. An extension apparatus. bare and in a carious state. The olecranon, with the triceps of four was pounds applied. Evening temperature 100’60. attached, was now turned up out of the way and the operaJune l2th.-Temperature 97°. Still very sick. Wound tion proceeded with in the usual manner. After the diseased and tube removed. ends of the bones had been removed, the tip of the olecranon dressed, improvement; able to take light solids, two l5th.-Slight was united by a strong wire suture to the sawn surface of ounces of brandy, and four ounces of wine. Wound dressed the ulna. Drainage-tubes were inserted, and the wound with solution of corrosive sublimate (1 in 2000). Tem-sewn up. The operation was done under strict antiseptic daily 98’4°; pulse 104; respiration 22. perature precautions. The patient made a good recovery, the temThe femur having been found so extensively diseased, it normal perature remaining throughout. was considered that the patient’s only chance of ultimate remarks by Alr. PrCKERING.-I hoped, by the union of recovery lay in removing the limb at the hip-joint. Accordthe olecranon to the ulna, to greatly improve the movement on June 18th, chloroform having been administered,. ingly, of extension in the false joint, as the triceps in this way the limb was made bloodless by Esm arch’s bandage, a reserve would be acting to greater advantage than in the usual of blood being kept in the healthy limb, which was supply mode of performing the operation, in which the principal liberated at the end of the operation. The aorta was conattachment is cut away and the power of extension only trolled by Mr. Hamilton by Lister’s compressor. The anterior on muscular fibres’inserted into the fibrous the depends flap was partially dissected and partially transfixed, and theaponeurosis of the forearm. This case has so far been posterior transfixed. Very little blood was lost, but the successful, as, though the time has not yet come for the arm patient showing symptoms of collapse, thirty minims of to acquire perfect movement, the power of extension is ether were given hypodermically. No drainage-tube was good, and better than that of flexion; the latter has been inserted, and the flaps were accurately brought together for delayed by the greatly wasted condition of the biceps. The the inner two-thirds, whilst a large opening was left at the. tip of the olecranon has firmly united to the ulna below, outer angle for drainage, as a considerable amount of tissue and the wire has not been removed, as it is causing no infiltrated with inflammatory products, and riddled with irritation. Only the tip of the olecranon should be cut off, sinuses, was left in the posterior flap. After operation the and it should be united subsequently to the ulna by very had a light sleep, and then was in great pain for an patient strong and thick wire, so as to hold it firmly. hour, which was relieved by the injection of half a grain of morphia. Dosed till 3 P.M, and then had an enema of CHESTER GENERAL INFIRMARY. brandy (one ounce) and two drachms of Liebig’s extract. No CASE OF HIP-JOINT DISEASE ; RESECTION ; AMPUTATION vomiting till 5 P.M. At 5.30 respiration only 11; pulse 132t z6 P.M.: Enema repeated.-9 P.M. Temperature 101’2° AT THE HIP-JOINT; RECOVERY. pulse 132; respiration 16. (Under the care of Mr. J. TAYLOR.) June 19th.-Passed a good night; vomited once; passed THE following notes are by Mr. W. Lees, house-surgeon. urine in the night naturally. Took ice, barley-water, and Mary B--, aged eighteen, residing at Acrefair, Ruabon, cream. Complains of being very hungry. Temperature was admitted on May 20th, 1885. The patient had never 98’40; pulse 136; respiration 20. Wound dressed. Slept. been strong, was of strumous appearance, and had suffered soundly all day. No pain. Took brandy, cream, and from repeated attacks of hemoptysis. One sister died at Liebig’s extract. Vomited slightly once.-9 P.M.: Tempenineteen years of age from hip-joint disease, and another sister rature 100°; pulse 128 ; respiration 24. suffers from chronic abscesses in the neck ; the rest ofth e famíly From this time the patient made a rapid recovery. The Her present illness began in February, 1885, stump was dressed daily with lint soaked in solution of are healthy. when there was acute pain in the right knee, which was corrosive sublimate (1 in 2000). She took solid food on the swollen and very tender to the touch. For this the joint 21st. On July 10th the wound had healed, except a small In March following sinus at its outer angle. The patient was able to sit up in was painted with tincture of iodine. she was in bed for three weeks under medical treatment at bed, and partake of middle diet. home. In May, being much worse, she came to the Chester On an examination of the femur, the whole of it was found to be in a most disorganised state, the medulla Infirmary. On admission the knee and foot were considerably swollen ; breaking down under the slightest pressure. The kneetemperature 101° ; pulse 100. The limb was put up on a joint was diseased, the cartilages being eroded and thinned, back splint for four weeks. The patient now for the first and the synovial membrane everywhere thickened. There time complained of pain in the right hip-joint, and for this was also a small collection of pus about half an inch above She had a severe the epiphysial line. an extension apparatus was applied.
temperature