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CARLISLE INFIRMARY.
733
Provincial Hospital Reports. CARLISLE INFIRMARY. CHRONIC
ENLARGEMENT
(Under the THE notes of the
care
OF
PREPUCE.
of Mr. R. BROWN.)
following
case are
by
Mr. J. Troutbeck,
house-surgeon. J. C-, aged thirty-six, tailor, was admitted in January, 1870. Ten years ago a chancre commenced at the meatus urethrse, and, spreading over the glans, caused the prepuce in a few months to become adherent to the ulcerated surface. Gradual enlargement of the skin covering the dorsum of the penis, and more especially of the prepuce, then ensued for the next few years, and caused diminution in the size of the stream. During 1865-66-67, a series of abscesses formed in the posterior and lateral aspects of the enlarged prepuce, some of which discharged pus through sinuses opening on its integumental surface, while others afforded exit to some of the urine during micturition. These conditions remained the same till a year ago (1869), when the prepuce was enlarged to such an extent as to prevent the normal exit of urine, and divert it through four sinuses, which were placed two on each lateral aspect of the prepuce. Retention of urine took place three days prior to admission, but was relieved by the plugged orifices of sinuses becoming
again patent.
No. 16 Jaeger. Patient has slight circum orbital pain. Two leeches were applied to the right temple, and drops of atropine (two grains to the ounce) applied every four hours. March 2nd.-The patient being seated in a chair to prevent the foreign body falling back into the posterior chamber, Mr. Townsend made an incision with a Sichel knife in the lower sclero-corneal junction, grasped with a pair of fine forceps the foreign body and a portion of iris to which it was attached, and removed it with great facility. A wet pad with a bandage was applied; atropine dropped in night and morning. The foreign body was found to be a fragment of flint, and was almost identical in size and shape to a grain of wheat. 4th.-No irritation; wound nearly healed. 12th.-Wound united. There is still some conjunctival injection, and the media are slightly hazy. Patient went home to-day at his own request. May 3rd.-The patient presented himself for examination to-day. Coloboma clear, and so completely hidden by the lower lid as to cause not the slightest disfigurement. Reads without difficulty No. 2 Jaeger.
Medical Societies. ROYAL MEDICAL AND CHIRURGICAL SOCIETY. TUESDAY, APRIL 20TH, 1870. DR. BURROWS, F.R.S., PRESIDENT, IN THE CHAIR.
The patient being chloroformed, Mr. Brown pushed a director from one sinus to the other on the left side, and on it slit up the soft textures; in doing so he opened into an ADJOURNED DEBATE ON MR. GANT’S PAPER ON EXCISION OF THE JOINTS FOR DISEASE. abscess-sac containing two calculi, each the size of a pea, - which he removed. The sinuses on the other side being THE PRESIDENT said the Fellows were aware that it was laid open in a similar manner, he pushed a director from the wish of the Society to adjourn the debate on Mr. Gant’s one incision to the other through the centre of the soft paper read at the last meeting. They were now met to parts, joined them by a transverse cut, and removed the resume its discussion, but, to give those who were before whole of the prepuce in front by dissecting downwards and absent an idea of the paper, it was advisable to have an forwards. Two orifices were by these means brought into abstract read, and he would call upon the Secretary to do so. view; but as they were merely sinuses leading from the Mr. T. SMITH then read an abstract of the paper. meatus to the abscess-sacs, Mr. Brown removed more of Mr. CALLENDER, as mover of the adjournment, was then the soft textures by a transverse cut, and exposed the called upon to resume the discussion. He said he wished urethra, capable of admitting a No. 8 catheter. A large to refer to some remarks by Mr. Holmes as to the comparaportion of external thickened tissue at the circumference tive death-rates in excision of the knee-joint and amputawas left, under the impression that it would disappear by tion at the thigh. The latter, if performed early in life, ’contraction. Haemorrhage was arrested by pressure, and was nearly free from danger; all under ten years of age did finally by a few ligatures and styptics. In the evening well; so also for the most part of those under twenty. This after operation he passed water in a full stream, and was was at St. Bartholomew’s Hospital. Age was therefore a free from pain. Subsequently, by the use of lotions, &c., most important factor in estimating the value and risk of the the wound healed kindly, and he was discharged cured. two operations. In the paper reference was made to three Remarks.-It is well to recapitulate that, during 1869, the joints, in two of which movement had been secured; but urine passed along the entire urethra, then by sinuses to not so with the knee. He trusted we might yet hope to the sacs in which the calculi lay, and lastly through the secure this. He could not help thinking of Neudorpfen, four openings. The penis is now of normal dimensions, who told him that he constantly had some movement. In and presents a small prepuce covering the glans for a few one instance at St. Bartholomew’s movement had accidentlines. ally been retained. Considerable modifications were required in the operation to secure motion. The extensor tendons would have to be left, the articular surfaces of the BIRMINGHAM AND MIDLAND EYE HOSPITAL. bone alone removed, and the femur not cut straight across FRAGMENT OF STONE IMPACTED IN THE IRIS. as now, but after the contour of the joint. They wanted clear evidence as to the growth of the limb after excision. the of C. care Mr. (Under TOWNSEND.) In three cases under his own observation there was no THE following case, for notes of which we are indebted shortening beyond that consequent on the portion originally to Mr. Frank Hodges, house-surgeon, is interesting from removed. He thought it better to have the limb slightly the very slight irritation which followed so serious an flexed than quite straight. HENRY LEE said he would first allude to the question injury as a rough fragment of flint being forcibly driven of Mr. If all were taken, instead of one death-rate. through the cornea into the iris, where it remained upwards only, the results wouldhospitals be very different. Some years ago of. three days, and the almost unimpaired vision which re- he belonged to a Clinical Society of Observation, and their sulted from its removal. Transactions" showed that the results, after amputation, in George W-, a healthy-looking man of thirty-three, persons under sixteen, were not nearly so favourable as was breaking stone on Feb. 26th, 1870, when a piece struck those given by Mr. Callender. Next, as to motion, he had his right eye. He was judiciously treated by a surgeon, been unfortunate enough to have motion of the knee-joint who saw him a few minutes after the accident. On the after excision, but it was in any direction; hence it was 1st of March he came to the hospital. Upon examining not so good as anchylosis. In the elbow it was different. the right eye, a foreign body was plainly seen fixed in the Mr. Gant’s preparation suggested certain notes ; in one lower segment of the iris, and projecting forwards into the instance the head of the bone did not appear to be diseased anterior chamber. In the centre of the cornea was a cica- at all, or only slightly so. In this respect it resembled two trix, showing where the foreign body had entered. There ofhis own cases, where he had operated by Wood’s method; was some ciliary injection; but no plastic effusion from the the diseased bone was gouged out, and the joint not opened. iris, and the aqueous humour was perfectly clear. Reads In one case, that of a young woman with symptoms of hip ’’
Provincial Hospital Reports. CARLISLE INFIRMARY. CHRONIC
ENLARGEMENT
(Under the THE notes of the
care
OF
PREPUCE.
of Mr. R. BROWN.)
following
case are
by
Mr. J. Troutbeck,
house-surgeon. J. C-, aged thirty-six, tailor, was admitted in January, 1870. Ten years ago a chancre commenced at the meatus urethrse, and, spreading over the glans, caused the prepuce in a few months to become adherent to the ulcerated surface. Gradual enlargement of the skin covering the dorsum of the penis, and more especially of the prepuce, then ensued for the next few years, and caused diminution in the size of the stream. During 1865-66-67, a series of abscesses formed in the posterior and lateral aspects of the enlarged prepuce, some of which discharged pus through sinuses opening on its integumental surface, while others afforded exit to some of the urine during micturition. These conditions remained the same till a year ago (1869), when the prepuce was enlarged to such an extent as to prevent the normal exit of urine, and divert it through four sinuses, which were placed two on each lateral aspect of the prepuce. Retention of urine took place three days prior to admission, but was relieved by the plugged orifices of sinuses becoming
again patent.
No. 16 Jaeger. Patient has slight circum orbital pain. Two leeches were applied to the right temple, and drops of atropine (two grains to the ounce) applied every four hours. March 2nd.-The patient being seated in a chair to prevent the foreign body falling back into the posterior chamber, Mr. Townsend made an incision with a Sichel knife in the lower sclero-corneal junction, grasped with a pair of fine forceps the foreign body and a portion of iris to which it was attached, and removed it with great facility. A wet pad with a bandage was applied; atropine dropped in night and morning. The foreign body was found to be a fragment of flint, and was almost identical in size and shape to a grain of wheat. 4th.-No irritation; wound nearly healed. 12th.-Wound united. There is still some conjunctival injection, and the media are slightly hazy. Patient went home to-day at his own request. May 3rd.-The patient presented himself for examination to-day. Coloboma clear, and so completely hidden by the lower lid as to cause not the slightest disfigurement. Reads without difficulty No. 2 Jaeger.
Medical Societies. ROYAL MEDICAL AND CHIRURGICAL SOCIETY. TUESDAY, APRIL 20TH, 1870. DR. BURROWS, F.R.S., PRESIDENT, IN THE CHAIR.
The patient being chloroformed, Mr. Brown pushed a director from one sinus to the other on the left side, and on it slit up the soft textures; in doing so he opened into an ADJOURNED DEBATE ON MR. GANT’S PAPER ON EXCISION OF THE JOINTS FOR DISEASE. abscess-sac containing two calculi, each the size of a pea, - which he removed. The sinuses on the other side being THE PRESIDENT said the Fellows were aware that it was laid open in a similar manner, he pushed a director from the wish of the Society to adjourn the debate on Mr. Gant’s one incision to the other through the centre of the soft paper read at the last meeting. They were now met to parts, joined them by a transverse cut, and removed the resume its discussion, but, to give those who were before whole of the prepuce in front by dissecting downwards and absent an idea of the paper, it was advisable to have an forwards. Two orifices were by these means brought into abstract read, and he would call upon the Secretary to do so. view; but as they were merely sinuses leading from the Mr. T. SMITH then read an abstract of the paper. meatus to the abscess-sacs, Mr. Brown removed more of Mr. CALLENDER, as mover of the adjournment, was then the soft textures by a transverse cut, and exposed the called upon to resume the discussion. He said he wished urethra, capable of admitting a No. 8 catheter. A large to refer to some remarks by Mr. Holmes as to the comparaportion of external thickened tissue at the circumference tive death-rates in excision of the knee-joint and amputawas left, under the impression that it would disappear by tion at the thigh. The latter, if performed early in life, ’contraction. Haemorrhage was arrested by pressure, and was nearly free from danger; all under ten years of age did finally by a few ligatures and styptics. In the evening well; so also for the most part of those under twenty. This after operation he passed water in a full stream, and was was at St. Bartholomew’s Hospital. Age was therefore a free from pain. Subsequently, by the use of lotions, &c., most important factor in estimating the value and risk of the the wound healed kindly, and he was discharged cured. two operations. In the paper reference was made to three Remarks.-It is well to recapitulate that, during 1869, the joints, in two of which movement had been secured; but urine passed along the entire urethra, then by sinuses to not so with the knee. He trusted we might yet hope to the sacs in which the calculi lay, and lastly through the secure this. He could not help thinking of Neudorpfen, four openings. The penis is now of normal dimensions, who told him that he constantly had some movement. In and presents a small prepuce covering the glans for a few one instance at St. Bartholomew’s movement had accidentlines. ally been retained. Considerable modifications were required in the operation to secure motion. The extensor tendons would have to be left, the articular surfaces of the BIRMINGHAM AND MIDLAND EYE HOSPITAL. bone alone removed, and the femur not cut straight across FRAGMENT OF STONE IMPACTED IN THE IRIS. as now, but after the contour of the joint. They wanted clear evidence as to the growth of the limb after excision. the of C. care Mr. (Under TOWNSEND.) In three cases under his own observation there was no THE following case, for notes of which we are indebted shortening beyond that consequent on the portion originally to Mr. Frank Hodges, house-surgeon, is interesting from removed. He thought it better to have the limb slightly the very slight irritation which followed so serious an flexed than quite straight. HENRY LEE said he would first allude to the question injury as a rough fragment of flint being forcibly driven of Mr. If all were taken, instead of one death-rate. through the cornea into the iris, where it remained upwards only, the results wouldhospitals be very different. Some years ago of. three days, and the almost unimpaired vision which re- he belonged to a Clinical Society of Observation, and their sulted from its removal. Transactions" showed that the results, after amputation, in George W-, a healthy-looking man of thirty-three, persons under sixteen, were not nearly so favourable as was breaking stone on Feb. 26th, 1870, when a piece struck those given by Mr. Callender. Next, as to motion, he had his right eye. He was judiciously treated by a surgeon, been unfortunate enough to have motion of the knee-joint who saw him a few minutes after the accident. On the after excision, but it was in any direction; hence it was 1st of March he came to the hospital. Upon examining not so good as anchylosis. In the elbow it was different. the right eye, a foreign body was plainly seen fixed in the Mr. Gant’s preparation suggested certain notes ; in one lower segment of the iris, and projecting forwards into the instance the head of the bone did not appear to be diseased anterior chamber. In the centre of the cornea was a cica- at all, or only slightly so. In this respect it resembled two trix, showing where the foreign body had entered. There ofhis own cases, where he had operated by Wood’s method; was some ciliary injection; but no plastic effusion from the the diseased bone was gouged out, and the joint not opened. iris, and the aqueous humour was perfectly clear. Reads In one case, that of a young woman with symptoms of hip ’’