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CASE OF COMPLETE LATERAL DISLOCATION OF THE ELBOW-JOINT.
CLINICAL NOTES.
382
was worked by the patient himself. The diet was restricted to peptonised preparations with white of egg, stale bread, and green vegetables, and as little liquid nourishment as possible. When any signs of putrefactive changes showed themselves I immediately washed out the stomach, and to procure complete antisepticity I ordered the following mixture : four grains of hydronaphthol, fifteen grains of salicylate of bismuth, and ten grains of bicarbonate of soda; to be taken in cachet form three times daily one hour after meals, and a tumblerful of hot water (temperature from 110° to 120° F.) to be sipped before mealtimes. After twelve days of this treatment a slight improvement showed itself, and at the end of the thirteenth week my patient no longer required the stomach to be washed out ; he took nourishment well. The pyrosis was completely checked, and he talked of returning to work after an enforced period of idleness extending over nearly two years. My principal object in mentioning this case is to show the remarkable properties of hydronaphthol as an alkaline antiseptic when used in combination with salicylate of bismuth and bicarbonate of soda.
arrangement which
Broadgate,
that beyond the obstruction being quite empty. The stone was removed through an incision which was closed with a horsehair suture. The amount of distension was so considerable that very great difficulty was experienced in bringing the aponeurotic edges into apposition. Under the constant care of the resident medical officer, Mr. Freeland, she gradually regained her strength. I am putting this case on record as it is the first instance of intestinal obstruction due to gall- stone in which I have had an opportunity of operating. Such cases must be relatively very rare as compared to other causes of obstruction. The conditions presented at the operation were such as to render it probable that she could hardly survive the inflammatory changes consequent on the great It seemed that distension of her obstructed intestine. recovery was largely due to the absence of decomposable material in the bowel, the distension being almost entirely I would point out that the symptoms presented gaseons. by this case differed in no manner from those usually seen in obstruction of this part of the bowel by band or by the strangulation of a knuckle in a hernial sac. St. Thomas’s-street, S.E.
Lincoln. ___
CASE OF COMPLETE LATERAL DISLOCATION OF THE ELBOW-JOINT. BY C. S. SIMPSON, L.R.C.P. LOND., M.R.C.S. ENG., SENIOR HOUSE
SURGEON,
BRIGHTON AND HOVE DISPENSARY.
A PORTER at the Brighton railway station was brought to the Brighton and Hove Dispensary on May 19th, having fallen a distance of 6 ft. from a ladder upon the platform, falling directly upon the left elbow. On examination both bones of the forearm were found to be completely dislocated outwards, the olecranon lying external to the outer condyle of the humerus. The head of the radius lay in front of the olecranon, occupying the position of the coronoid process, for which, in fact, I at first mistook it. A bony prominence below the internal condyle was probably the fractured coronoid process. The bones of the forearm were pronated. The dislocation was reduced under chloroform without difficulty ; but the case deserves to be recorded on account of its extreme rarity. Brighton.
GALL-STONE
PRODUCING
ACUTE
THE INGESTION AND PASSAGE OF A POCKET-KNIFE. BY G. B.
THE following case is interesting as showing the toleration of the intestinal tract, even in the very young. At half-past eight on the evening of June 21st A. B-,a child two years
and eleven months of age, swallowed a pocket-knife just unde] three inches long, of the familiar shape-two blades, mother of-pearl sides, and brass tips. On the evening of Monday June 25th, the knife was passed by the rectum, and at n< time did the child experience pain or even inconvenience. Greenwich.
_________________
A Mirror
INTESTINAL
OBSTRUCTION ; OPERATION; RECOVERY. BY W. ARBUTHNOT GUY’S CHILDREN,
ASSISTANT SURGEON TO
SICK
A PATIENT
OF
LANE, M.S.,
HOSPITAL AND TO THE HOSPITAL FOR GREAT ORMOND-STREET.
fifty-four years
of age
was
admitted into
Guy’s
from symptoms of acute intestinal obstruction, which had commenced at 3 A.M. on Friday, the 20th, more than four and a half days previously. From the commencement of the attack up to the time I saw her she had suffered from very severe griping pain at frequent intervals, from vomiting, and from constipation. She had been treated with opium, belladonna, and nutrient enemata. The material vomited was never faecal. On her admission the abdomen was distended, very tender on pressure, and a distinct thrill could be felt on percussion. There was no evidence of any distension of the large intestine, and the character of the vomited material suggested that the distension was probably limited to the upper part of the small intestine. She had never been troubled by constipation. During the last three years she bad suffered off and on from attacks of indigestion, during which she experienced much distension of the abdomen, with some tenderness on pressure. Two or three months after the appearance of the indigestion she was jaundiced for several days. There had never been any particular pain or tenderness in the region of the gallbladder. Immediately on her admission I opened the abdomen by means of a long median incision, when a quantity of fluid more or less turbid in character and tinged with blood escaped. The upper part of the jejunum was very much distended, the walls being deeply injected and covered with lymph where the ceils approximated. A gall-stone was found at the lower limit of the distended intestine, which involved about the upper eight feet of the small bowel
Hospital
on
Tuesday night, April 24th, suffering
GOODALL, M.B., C.M.EDIN.
HOSPITAL PRACTICE, FOREIGN. BRITISH AND
Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, turn aliorum tum proprias collectas habere, et inter se comparare.—MoReAGNl De Sed. et Caus. Morb., lib. iv. Prooemium. —————
WESTMINSTER HOSPITAL. NOTES ON TWO
CASES OF ENTERIC FEVER WITH TIONAL NERVOUS SYMPTOMS.
EXCEP-
(Under the care of Dr. STURGES.) NERVOUS symptoms of the pronounced character described in the two following cases are by no means commonly present in enteric fever. True meningitis occurs sometimes, though at an rarely, early period of the fever, and is then attended with the symptoms displayed by the patient in the first case. Recovery from such a condition is very unusual. For the
reports of these cases we Winckworth, house physician. The
are
indebted to Mr. W. B.
notes refer to two patients, lads of sevenyears of age, both friends and from Westminster, but not living in the same house or having their meals together. The fathers of the lads are also friends, and it is possible that the two boys may have been infected from the same source and at the same time, as, for example, from a common food-supply. The cases have many points of resemblance, the striking feature in both being the marked nervous phenomena of a kind very rarely met with in connexion with enteric fever and hardly mentioned in textbooks. In the younger patient, who had had a discharge from his right ear intermittently for years, these consisted
following
teen and
twenty
382
was worked by the patient himself. The diet was restricted to peptonised preparations with white of egg, stale bread, and green vegetables, and as little liquid nourishment as possible. When any signs of putrefactive changes showed themselves I immediately washed out the stomach, and to procure complete antisepticity I ordered the following mixture : four grains of hydronaphthol, fifteen grains of salicylate of bismuth, and ten grains of bicarbonate of soda; to be taken in cachet form three times daily one hour after meals, and a tumblerful of hot water (temperature from 110° to 120° F.) to be sipped before mealtimes. After twelve days of this treatment a slight improvement showed itself, and at the end of the thirteenth week my patient no longer required the stomach to be washed out ; he took nourishment well. The pyrosis was completely checked, and he talked of returning to work after an enforced period of idleness extending over nearly two years. My principal object in mentioning this case is to show the remarkable properties of hydronaphthol as an alkaline antiseptic when used in combination with salicylate of bismuth and bicarbonate of soda.
arrangement which
Broadgate,
that beyond the obstruction being quite empty. The stone was removed through an incision which was closed with a horsehair suture. The amount of distension was so considerable that very great difficulty was experienced in bringing the aponeurotic edges into apposition. Under the constant care of the resident medical officer, Mr. Freeland, she gradually regained her strength. I am putting this case on record as it is the first instance of intestinal obstruction due to gall- stone in which I have had an opportunity of operating. Such cases must be relatively very rare as compared to other causes of obstruction. The conditions presented at the operation were such as to render it probable that she could hardly survive the inflammatory changes consequent on the great It seemed that distension of her obstructed intestine. recovery was largely due to the absence of decomposable material in the bowel, the distension being almost entirely I would point out that the symptoms presented gaseons. by this case differed in no manner from those usually seen in obstruction of this part of the bowel by band or by the strangulation of a knuckle in a hernial sac. St. Thomas’s-street, S.E.
Lincoln. ___
CASE OF COMPLETE LATERAL DISLOCATION OF THE ELBOW-JOINT. BY C. S. SIMPSON, L.R.C.P. LOND., M.R.C.S. ENG., SENIOR HOUSE
SURGEON,
BRIGHTON AND HOVE DISPENSARY.
A PORTER at the Brighton railway station was brought to the Brighton and Hove Dispensary on May 19th, having fallen a distance of 6 ft. from a ladder upon the platform, falling directly upon the left elbow. On examination both bones of the forearm were found to be completely dislocated outwards, the olecranon lying external to the outer condyle of the humerus. The head of the radius lay in front of the olecranon, occupying the position of the coronoid process, for which, in fact, I at first mistook it. A bony prominence below the internal condyle was probably the fractured coronoid process. The bones of the forearm were pronated. The dislocation was reduced under chloroform without difficulty ; but the case deserves to be recorded on account of its extreme rarity. Brighton.
GALL-STONE
PRODUCING
ACUTE
THE INGESTION AND PASSAGE OF A POCKET-KNIFE. BY G. B.
THE following case is interesting as showing the toleration of the intestinal tract, even in the very young. At half-past eight on the evening of June 21st A. B-,a child two years
and eleven months of age, swallowed a pocket-knife just unde] three inches long, of the familiar shape-two blades, mother of-pearl sides, and brass tips. On the evening of Monday June 25th, the knife was passed by the rectum, and at n< time did the child experience pain or even inconvenience. Greenwich.
_________________
A Mirror
INTESTINAL
OBSTRUCTION ; OPERATION; RECOVERY. BY W. ARBUTHNOT GUY’S CHILDREN,
ASSISTANT SURGEON TO
SICK
A PATIENT
OF
LANE, M.S.,
HOSPITAL AND TO THE HOSPITAL FOR GREAT ORMOND-STREET.
fifty-four years
of age
was
admitted into
Guy’s
from symptoms of acute intestinal obstruction, which had commenced at 3 A.M. on Friday, the 20th, more than four and a half days previously. From the commencement of the attack up to the time I saw her she had suffered from very severe griping pain at frequent intervals, from vomiting, and from constipation. She had been treated with opium, belladonna, and nutrient enemata. The material vomited was never faecal. On her admission the abdomen was distended, very tender on pressure, and a distinct thrill could be felt on percussion. There was no evidence of any distension of the large intestine, and the character of the vomited material suggested that the distension was probably limited to the upper part of the small intestine. She had never been troubled by constipation. During the last three years she bad suffered off and on from attacks of indigestion, during which she experienced much distension of the abdomen, with some tenderness on pressure. Two or three months after the appearance of the indigestion she was jaundiced for several days. There had never been any particular pain or tenderness in the region of the gallbladder. Immediately on her admission I opened the abdomen by means of a long median incision, when a quantity of fluid more or less turbid in character and tinged with blood escaped. The upper part of the jejunum was very much distended, the walls being deeply injected and covered with lymph where the ceils approximated. A gall-stone was found at the lower limit of the distended intestine, which involved about the upper eight feet of the small bowel
Hospital
on
Tuesday night, April 24th, suffering
GOODALL, M.B., C.M.EDIN.
HOSPITAL PRACTICE, FOREIGN. BRITISH AND
Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, turn aliorum tum proprias collectas habere, et inter se comparare.—MoReAGNl De Sed. et Caus. Morb., lib. iv. Prooemium. —————
WESTMINSTER HOSPITAL. NOTES ON TWO
CASES OF ENTERIC FEVER WITH TIONAL NERVOUS SYMPTOMS.
EXCEP-
(Under the care of Dr. STURGES.) NERVOUS symptoms of the pronounced character described in the two following cases are by no means commonly present in enteric fever. True meningitis occurs sometimes, though at an rarely, early period of the fever, and is then attended with the symptoms displayed by the patient in the first case. Recovery from such a condition is very unusual. For the
reports of these cases we Winckworth, house physician. The
are
indebted to Mr. W. B.
notes refer to two patients, lads of sevenyears of age, both friends and from Westminster, but not living in the same house or having their meals together. The fathers of the lads are also friends, and it is possible that the two boys may have been infected from the same source and at the same time, as, for example, from a common food-supply. The cases have many points of resemblance, the striking feature in both being the marked nervous phenomena of a kind very rarely met with in connexion with enteric fever and hardly mentioned in textbooks. In the younger patient, who had had a discharge from his right ear intermittently for years, these consisted
following
teen and
twenty