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CASHEL UNION HOSPITAL.
738 was soon found to vary a good deal from day, and to be irregular in its distribution. Within a few days of admission she began to be troubled with severe muscular spasms, by which the legs were flexed upon the abdomen. The urine soon presented an alkaline reaction with abundance of ropy mucus-the usual indications, indeed, of a pronounced cystitis. Withoat going into particulars with regard to the treatment adopted, it may be said that all efforts, general and local, directed to the relief of the spinal trouble, the cystitis, and the bedsores, were unavailing, and a downward progression marked the course of the disease,
over
day
it was thought not impossible that there might be some connexion between the two; and when the second lung was seized it followed immediately on the opening of a small abscess, which formed at the point of injection. Dr. Laffan would prefer to select the arm or leg for the seat of injection on another occasion.
the abdomen
to
STRANGULATED FEMORAL HERNIA;
ASPIRATION, FOLLOWED FISTULA;
BY TEMPORARY RELIEF; OPERATION; F2ECAL DEATH FROM PHTHISIS ; REMARKS.
M. L—--, a female, married, aged fifty, was admitted on July 30th, under the care of Dr. Laffan, with strangulated patient died on Jan. 4th. Remarks by Dr. BANHAM.-The circumstances were un- right femoral hernia. The history was that she had had a favourable to a complete and thorough post-mortem examina- rupture for twelve months, and that this had doubled in tion, and the spinal cord unhappily was not examined. It size and become very painful about two days prior to her will, however, be conceded that paraplegia, with absolute admission. Taxis had been tried by the previous surgeon,, anaesthesia, loss of control over the bladder and rectum, and and was consequently now only slightly attempted. There bedsores over the sacrum, form a group of symptoms that, was severe pain, but no great constitutional disturbance. taken collectively, render the existence of myelitis not pro- She declined to allow a cutt;ng operation, and Dr. Laffan, bable only, but certain; and it may be said that such a then resolved to give tapping with the aspirator a trial. condition was present. In addition to the myelitis, there A small trocar and cannula were employed. Some fluid bowel contents came away; the bowel became was an impacted calculus in the ureter, which above was distended and thinned, while the pelvis and kidney were in readily flaccid, and slight pressure caused it to disappear the morbid condition that constitutes what is known as altogether; this it did, however, without gurgle. Next the tumour reappeared to the extent of half its former "surgical kidney." We have, therefore, in this case the day coincidence of two diseases of sufficient rarity to justify size. It was much softer, and some fluid matter exuded the suspicion of a causative relation existing between them. on pressure. On Aug. 1st she was attacked with severe The calculus and the alterations that the kidney and ureter pain in the part. On the 2nd she consented to be operated had undergone indicate clearly that disease in these parts on. This was accordingly done about 6 P.M. A portion of’ had preceded the spinal symptoms, which, indeed, only came the anterior wall of one of the coils, about the size of a on within three months of the final issue. It seems probable florin, was found to be gangrenous, and in it there was a that there was a subacute transverse myelitis, which, com- small opening, produced by the aspiration needle. Some of mencing in the lower part of the spinal cord, ascended and the adjacent portions of bowel presented marked signs of became converted into a meningo-myelitis, all secondary, inflammation. Constant vomiting followed. This was. and due to an impacted calculus in the ureter. From a com- checked after some hours by drop doses of aromatic ammonia. parison with other similar cases that have been recorded, There was some abdominal swelling, with a pulse of 112 and, and the
a temperature of 998°. There was some local tenderness" but it scarcely amounted to pain, and no general peritonitis at any time set in. A fsecal tistula ultimately formed. The discharges from the fistula were frequent during the day, and as it was high up in the small intestine, these weakened her very much. An effort was made to compensate for CASHEL UNION HOSPITAL. these by injections into the distal end, but these would not LARYNGOTOMY; RECOVERY. be tolerated by the part. An attempt to close the fistula the care of Dr. by pressure, and another to restore the continuity of LAFFAN.) (Under the bowel for temporary digestive purposes by means THE following case of successful laryngotomy may prove of a flexible tube, likewise proved failures. Pancreatic interesting from the encouragement which it holds out to enemata were administered per rectum, and these helped prompt action in like emergency. Dr. Laffan knows of cases to sustain the system to a certain extent. Dr. Laffan where life has apparently been lost from want of operative was arranging for an attempted cure of the fistula withmeasures in similar circumstances. Dupuytren’s enteretome, when the recrudescence of a Al. N-, farm labourer, aged fifty-three, was admitted chronic phthisis set in, and finally disposed of the patient at 4 P.M. on July 30th, 1885. He complained of sore-throat on Sept. l6th. and had some slight difficulty of breathing. On examinaRemarks by Dr. LA-FFA.N.-There are two points in this casetion signs of an ordinary attack of pharyngitis presented worthy of note. The first is the unreliability of the treatment themselves. The uvula was more swollen than usual; but by the aspirator, since by the seeming return of the tumour to this much significance was not attached. Therefore which followed from it, it tended to mask the real state of some routine treatment was ordered, and he was sent to one things. Absenceof gurglein the case of an unemptied gut would of the wards. An hour had scarcely elapsed when Dr. Laffan be significant enough, but in that of an emptied one might mean nothing, and could not therefore afford the help which was hurriedly sent for, with the announcement that the In found about ten minutes he was it would in the case of an untapped bowel. The second’ was patient dying. suffering from such extreme dyspnoea as ta promise speedy point is the hint afforded by the continued, though very asphyxia. The imminence of his danger was explained to small, discharge of intestinal contents. This in itself I shall him, and his permission obtained for operation. The larynx in future regard as an almost certain sign of gangrene, as I know of no instance where structures not gangrenous have was at once opened through the crico-thyroid membrane; there was scarcely any bleeding, and a dilating tube was failed to close up after the use of a small trocar, No. 3 of the easily inserted. At the moment of operation he fell back: most improved form of aspirator. apparently dead, but the entrance of air into the chest, a subcutaneous injection of ether over the sternal region, and ST. JOHN AMBULANCE ASSOCIATION. ammonia to the nostril quickly revived him. NotwithThe third{ standing that every possible precaution was taken, such as! annual meeting of the Gibraltar Centre was held on the regulated temperature, hot steaming, the patient was; 31st ult., at the new Assembly Rooms. The Governor, his seized with pleuro-pneumonia of the right base twenty-four Excellency General Sir John Adye, G.C.B., presided, and’ hours after the operation. Fourteen days after this he was! Lady Adye presented certificates and medallions, among the attacked with pleuro-pneumonia of the left side, and it was! recipients of the latter being the Chief Justice, Sir H. J. not till after the lapse of five months that he recoveredl Burford Hancock. Brigade Surgeon A. Clarke has reported perfectly. He was detained in the hospital some time3 to St. John’s Gate an excellent case of first aid rendered by longer, as his family circumstances were poor, and Dr. LaffanL Gentleman Cadet H. R. Beddoes, now attending his lectures at the Royal Military College. A poor woman was knocked was anxious to avoid exposing him to the hardship incidental to a damp house and scant living. The tube was9 down by a train at Farnborough Station and had her foot maintained in for eight days only, and the wound healed a1 and leg smashed. There was profuse arterial bleedingand much shock. No surgeon was available, but llr. Beddoes few days afterwards. The pain which ushered in the inflammation of the rightt applied temporary tourniquets and took such other measures. situated so near where the ether was injected thatt as undoubtedly saved the woman’s life.
and that have been the
subject of careful examination, there doubt that the spinal cord lesion in this case was consecutive to a neuritis which travelled upwards from the irritation in the kidney and ureter. can
be
no
,
-
-
lung was
over
day
it was thought not impossible that there might be some connexion between the two; and when the second lung was seized it followed immediately on the opening of a small abscess, which formed at the point of injection. Dr. Laffan would prefer to select the arm or leg for the seat of injection on another occasion.
the abdomen
to
STRANGULATED FEMORAL HERNIA;
ASPIRATION, FOLLOWED FISTULA;
BY TEMPORARY RELIEF; OPERATION; F2ECAL DEATH FROM PHTHISIS ; REMARKS.
M. L—--, a female, married, aged fifty, was admitted on July 30th, under the care of Dr. Laffan, with strangulated patient died on Jan. 4th. Remarks by Dr. BANHAM.-The circumstances were un- right femoral hernia. The history was that she had had a favourable to a complete and thorough post-mortem examina- rupture for twelve months, and that this had doubled in tion, and the spinal cord unhappily was not examined. It size and become very painful about two days prior to her will, however, be conceded that paraplegia, with absolute admission. Taxis had been tried by the previous surgeon,, anaesthesia, loss of control over the bladder and rectum, and and was consequently now only slightly attempted. There bedsores over the sacrum, form a group of symptoms that, was severe pain, but no great constitutional disturbance. taken collectively, render the existence of myelitis not pro- She declined to allow a cutt;ng operation, and Dr. Laffan, bable only, but certain; and it may be said that such a then resolved to give tapping with the aspirator a trial. condition was present. In addition to the myelitis, there A small trocar and cannula were employed. Some fluid bowel contents came away; the bowel became was an impacted calculus in the ureter, which above was distended and thinned, while the pelvis and kidney were in readily flaccid, and slight pressure caused it to disappear the morbid condition that constitutes what is known as altogether; this it did, however, without gurgle. Next the tumour reappeared to the extent of half its former "surgical kidney." We have, therefore, in this case the day coincidence of two diseases of sufficient rarity to justify size. It was much softer, and some fluid matter exuded the suspicion of a causative relation existing between them. on pressure. On Aug. 1st she was attacked with severe The calculus and the alterations that the kidney and ureter pain in the part. On the 2nd she consented to be operated had undergone indicate clearly that disease in these parts on. This was accordingly done about 6 P.M. A portion of’ had preceded the spinal symptoms, which, indeed, only came the anterior wall of one of the coils, about the size of a on within three months of the final issue. It seems probable florin, was found to be gangrenous, and in it there was a that there was a subacute transverse myelitis, which, com- small opening, produced by the aspiration needle. Some of mencing in the lower part of the spinal cord, ascended and the adjacent portions of bowel presented marked signs of became converted into a meningo-myelitis, all secondary, inflammation. Constant vomiting followed. This was. and due to an impacted calculus in the ureter. From a com- checked after some hours by drop doses of aromatic ammonia. parison with other similar cases that have been recorded, There was some abdominal swelling, with a pulse of 112 and, and the
a temperature of 998°. There was some local tenderness" but it scarcely amounted to pain, and no general peritonitis at any time set in. A fsecal tistula ultimately formed. The discharges from the fistula were frequent during the day, and as it was high up in the small intestine, these weakened her very much. An effort was made to compensate for CASHEL UNION HOSPITAL. these by injections into the distal end, but these would not LARYNGOTOMY; RECOVERY. be tolerated by the part. An attempt to close the fistula the care of Dr. by pressure, and another to restore the continuity of LAFFAN.) (Under the bowel for temporary digestive purposes by means THE following case of successful laryngotomy may prove of a flexible tube, likewise proved failures. Pancreatic interesting from the encouragement which it holds out to enemata were administered per rectum, and these helped prompt action in like emergency. Dr. Laffan knows of cases to sustain the system to a certain extent. Dr. Laffan where life has apparently been lost from want of operative was arranging for an attempted cure of the fistula withmeasures in similar circumstances. Dupuytren’s enteretome, when the recrudescence of a Al. N-, farm labourer, aged fifty-three, was admitted chronic phthisis set in, and finally disposed of the patient at 4 P.M. on July 30th, 1885. He complained of sore-throat on Sept. l6th. and had some slight difficulty of breathing. On examinaRemarks by Dr. LA-FFA.N.-There are two points in this casetion signs of an ordinary attack of pharyngitis presented worthy of note. The first is the unreliability of the treatment themselves. The uvula was more swollen than usual; but by the aspirator, since by the seeming return of the tumour to this much significance was not attached. Therefore which followed from it, it tended to mask the real state of some routine treatment was ordered, and he was sent to one things. Absenceof gurglein the case of an unemptied gut would of the wards. An hour had scarcely elapsed when Dr. Laffan be significant enough, but in that of an emptied one might mean nothing, and could not therefore afford the help which was hurriedly sent for, with the announcement that the In found about ten minutes he was it would in the case of an untapped bowel. The second’ was patient dying. suffering from such extreme dyspnoea as ta promise speedy point is the hint afforded by the continued, though very asphyxia. The imminence of his danger was explained to small, discharge of intestinal contents. This in itself I shall him, and his permission obtained for operation. The larynx in future regard as an almost certain sign of gangrene, as I know of no instance where structures not gangrenous have was at once opened through the crico-thyroid membrane; there was scarcely any bleeding, and a dilating tube was failed to close up after the use of a small trocar, No. 3 of the easily inserted. At the moment of operation he fell back: most improved form of aspirator. apparently dead, but the entrance of air into the chest, a subcutaneous injection of ether over the sternal region, and ST. JOHN AMBULANCE ASSOCIATION. ammonia to the nostril quickly revived him. NotwithThe third{ standing that every possible precaution was taken, such as! annual meeting of the Gibraltar Centre was held on the regulated temperature, hot steaming, the patient was; 31st ult., at the new Assembly Rooms. The Governor, his seized with pleuro-pneumonia of the right base twenty-four Excellency General Sir John Adye, G.C.B., presided, and’ hours after the operation. Fourteen days after this he was! Lady Adye presented certificates and medallions, among the attacked with pleuro-pneumonia of the left side, and it was! recipients of the latter being the Chief Justice, Sir H. J. not till after the lapse of five months that he recoveredl Burford Hancock. Brigade Surgeon A. Clarke has reported perfectly. He was detained in the hospital some time3 to St. John’s Gate an excellent case of first aid rendered by longer, as his family circumstances were poor, and Dr. LaffanL Gentleman Cadet H. R. Beddoes, now attending his lectures at the Royal Military College. A poor woman was knocked was anxious to avoid exposing him to the hardship incidental to a damp house and scant living. The tube was9 down by a train at Farnborough Station and had her foot maintained in for eight days only, and the wound healed a1 and leg smashed. There was profuse arterial bleedingand much shock. No surgeon was available, but llr. Beddoes few days afterwards. The pain which ushered in the inflammation of the rightt applied temporary tourniquets and took such other measures. situated so near where the ether was injected thatt as undoubtedly saved the woman’s life.
and that have been the
subject of careful examination, there doubt that the spinal cord lesion in this case was consecutive to a neuritis which travelled upwards from the irritation in the kidney and ureter. can
be
no
,
-
-
lung was