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DEVON AND EXETER HOSPITAL
418 CASE 7.
with surrounding cedema;; from the right side; it was tied in two parts with thick silk, excision..cure. (From notes by Messrs. W. F. Clarke and and returned. There was one long thin omental adhesion, W. C. Swayne.)-F. T--, aged twenty-three, a worker in ’which was easily separated. The intestines did not come a dye-house of a leather merchant, was admitted on into i view. The left ovary appeared healthy. The abdominal Dec. 23rd, 1886. On Dec. 20th a small pimple came at the -wound was brought together by silk sutures, which were root of the nose. On the 21st, whilst at work amongremoved at the end of the week, when the wound was found leather, he picked the top off the pimple, and he says a lhealed. Gamgee tissue was used as a dressing. The girl hard morsel like a crystal of brown sugar came awaymade an uninterruptedly good recovery. Remarks by Mr. BELL.-The points of interest in the case (possibly hardened serous effusion); after this his eyes began to ache, and were swollen under the lower lids.seem to be the age of the girl, her small size for her age, th& On the 22nd the pimple became more painful, and thesize of the cyst, and its somewhat rapid growth. swelling under the eyelids increased. There is a small sore at the root of the nose in the median line, about the size of an ordinary shirt-button in circumference, and for a small area around the part affected it is indurated and swollen. Underneath the eyes it is much puffed, and the parts are very painful. No enlarged glands. ROYAL MEDICAL & CHIRURGICAL SOCIETY. No vesicles to be seen around the sore. Some of the fluid from the sore was examined, but no bacteria could be found. Urine acid; sp. gr. 1015; no albumen or blood. Rupture of the Urinary Bladder. Temperature 994°. AN ordinary meeting of this Society took place on After admission, chloroform having been administered, a circular incision three-fourths of an inch in diameter was Tuesday last; Dr. J. W. Ogle, F.R.C.P., Vice-President, in made round the sore, and the whole of the tissues excised the chair. down to the bone. Very little bleeding occurred. The Mr. HENRY MORRIS read a case in which the Urinary wound was washed with iodine lotion, and iodine dressings Bladder was twice Ruptured, the first time by an injury,, applied. the second time-seven years after the first-by the giving Dec. 25th.-Wound looking well; no pain. The swelling way of the cicatrix. A man aged thirty-six, had been under the eyelids is almost gone. Temperature normal. and remains about the ward drinking at a public-house on the evening of June 4th,. 29th.-The patient gets up all day. No sign of inflammation around the part. The 1879, when a struggle ensued, and his opponent threw him and knelt with violence upon his abdomen. All the oedema of the face has entirely disappeared. Jan. 4th, 1887.-The patient has been going on very well. symptoms of peritonitis and rupture of the bladder wereWound looking healthy and filling up ; but at 7 o’clock this excited, and the patient was admitted into the Middlesex morning he had a rigor, and was put to bed, with hot-water Hospital on June 6th, 1879. The treatment consisted of bottles to his feet. 11 A.M.: Still has a fit of shivering come hot fomentations to the abdomen, half a grain of opium in over him now and then. Temperature 99’2°; skin feels hot a pill every six hours, and the retention just within the and moist. neck of the bladder of a gum-elastic catheter. He recovered 7th.-Patient discharged well. perfectly, and left the hospital on July 10th, 1879. lie applied at the hospital again on August 4th, 1886, and gavethe following account :-On August 2nd he had been at a. DEVON AND EXETER HOSPITAL. "beanfeast." On the following morning his bowels acted UNILOCULAR OVARIAN CYST IN A GIRL AGED THIRTEEN; and he passed some urine, but the latter act was attended with some pain. From this time pain increased, and in the OVARIOTOMY; REMARKS. evening he was unable to micturate. He vomited frequently" (Under the care of Mr. BELL.) and had had since the onset of pain, until the Foli, the notes of the following case we are indebted to afternoon of hiccough 4th, 1886, when a catheter was passed August Dr. A. Blomfield. and nearly three ounces of bloody urine were withEdith G- was admitted on Aug. 19th, 1886, with a drawn. He was then admitted as a case of peritonitis. fluctuating abdominal tumour. The girl was very small and and suppression of urine. On the 5th about one pint undeveloped for her age, and had never menstruated. About of thick, purulent, and slightly blood-stained urine wasfour months before her admission she complained of pain in drawn off. At 7 A.M. on August 6th he passed a little the left iliac fossa, which she describes as "like stomach- flatus and a large quantity of urine, and suddenly became ache." The pain was afterwards felt higher up and on the very sick. Soon afterwards he was quite collapsed; his. opposite side of the abdomen. She is certain that there was abdomen became very distended; he never rallied, and At the necropsy recent no enlargement at this time, but that shortly afterwards the died at 11.5 A,M. on the same day. abdomen began to enlarge and increased somewhat rapidly general peritonitis was found, and in the pelvis there were to its present size. There has been no jaundice, vomiting, fifteen ounces of purulent urine and a quantity of lymph.. A band an inch and a quarter long united the fundus of the or cedema of the legs. State on admission.-The abdomen is much enlarged, bladder with the rectum. The vesical end of this band was presenting a somewhat barrel-shape appearance. The hollowed out into a slender funnel, and through a rupture in superficial veins are not prominent, nor is there any oedema it close to the bladder a string of mucus was projecting.. of the walls. The circumference of the abdomen, one inch Slight pressure caused purulent urine to ooze from the above the umbilicus, is thirty-two inches; the left side bladder through the rent into the peritoneal cavity. The measuring three-quarters of an inch more than the right, rectum, bladder, and penis were removed en masse, and and the measurement from the left anterior superior iliac were submitted to a committee consisting of Mr. Savory, spine to the lower border of the sternum is half an inch Mr. Bryant, and Drs. Goodhart and Kingston Fowler, There is complete who reported that in their opinion " the specimen ex-more than from the opposite spine. dulness over the part of the abdomen to the level of the hibits all the features which might be expected at alower border of the sternum; the left flank is quite remote period after a rupture of the bladder." This resonant, the right somewhat less so. There is resonance case, in the first instance, was reported in 1879 as one over the left iliac region, but the right fossa is absoof recovery from rupture of the bladder. It is now brought lutely dull. There is a distinct free wave of fluid from before the Royal Medical and Chirurgical Society because side to side through the swelling. On placing the hand in its completed form it affords conclusive proof that on the abdomen, a sensation of crepitus can sometimes an intra-peritoneal rupture of the bladder is not necesbe felt. sarily fatal, but may be recovered from under the simple The case was sent into the hospital as probably ascites, treatment employed in this case, provided the urine at but from the examination it was evident that the fluid was the time of the rupture is of normal composition. The encysted, and the opinion given was that the case was one case is believed to be unique in that it furnishes us with of ovarian dropsy. the post-mortem appearances of the bladder some years On Aug. 28th, under chloroform, Mr. Bell, through a small after recovery from an intra-peritoneal rupture of the coats incision (three inches), removed a unilocular ovarian cyst. of that organ. Mr. W. H. BENNETT read a case of Extra-peritoneal RupThe cyst weighed twelve ounces, and contained eight pints and a half of fluid. The pedicle was broad, and sprang ture of the Urinary Bladder, the direct result of aspiration
Charbon
of face,
-
Medical Societies.
with surrounding cedema;; from the right side; it was tied in two parts with thick silk, excision..cure. (From notes by Messrs. W. F. Clarke and and returned. There was one long thin omental adhesion, W. C. Swayne.)-F. T--, aged twenty-three, a worker in ’which was easily separated. The intestines did not come a dye-house of a leather merchant, was admitted on into i view. The left ovary appeared healthy. The abdominal Dec. 23rd, 1886. On Dec. 20th a small pimple came at the -wound was brought together by silk sutures, which were root of the nose. On the 21st, whilst at work amongremoved at the end of the week, when the wound was found leather, he picked the top off the pimple, and he says a lhealed. Gamgee tissue was used as a dressing. The girl hard morsel like a crystal of brown sugar came awaymade an uninterruptedly good recovery. Remarks by Mr. BELL.-The points of interest in the case (possibly hardened serous effusion); after this his eyes began to ache, and were swollen under the lower lids.seem to be the age of the girl, her small size for her age, th& On the 22nd the pimple became more painful, and thesize of the cyst, and its somewhat rapid growth. swelling under the eyelids increased. There is a small sore at the root of the nose in the median line, about the size of an ordinary shirt-button in circumference, and for a small area around the part affected it is indurated and swollen. Underneath the eyes it is much puffed, and the parts are very painful. No enlarged glands. ROYAL MEDICAL & CHIRURGICAL SOCIETY. No vesicles to be seen around the sore. Some of the fluid from the sore was examined, but no bacteria could be found. Urine acid; sp. gr. 1015; no albumen or blood. Rupture of the Urinary Bladder. Temperature 994°. AN ordinary meeting of this Society took place on After admission, chloroform having been administered, a circular incision three-fourths of an inch in diameter was Tuesday last; Dr. J. W. Ogle, F.R.C.P., Vice-President, in made round the sore, and the whole of the tissues excised the chair. down to the bone. Very little bleeding occurred. The Mr. HENRY MORRIS read a case in which the Urinary wound was washed with iodine lotion, and iodine dressings Bladder was twice Ruptured, the first time by an injury,, applied. the second time-seven years after the first-by the giving Dec. 25th.-Wound looking well; no pain. The swelling way of the cicatrix. A man aged thirty-six, had been under the eyelids is almost gone. Temperature normal. and remains about the ward drinking at a public-house on the evening of June 4th,. 29th.-The patient gets up all day. No sign of inflammation around the part. The 1879, when a struggle ensued, and his opponent threw him and knelt with violence upon his abdomen. All the oedema of the face has entirely disappeared. Jan. 4th, 1887.-The patient has been going on very well. symptoms of peritonitis and rupture of the bladder wereWound looking healthy and filling up ; but at 7 o’clock this excited, and the patient was admitted into the Middlesex morning he had a rigor, and was put to bed, with hot-water Hospital on June 6th, 1879. The treatment consisted of bottles to his feet. 11 A.M.: Still has a fit of shivering come hot fomentations to the abdomen, half a grain of opium in over him now and then. Temperature 99’2°; skin feels hot a pill every six hours, and the retention just within the and moist. neck of the bladder of a gum-elastic catheter. He recovered 7th.-Patient discharged well. perfectly, and left the hospital on July 10th, 1879. lie applied at the hospital again on August 4th, 1886, and gavethe following account :-On August 2nd he had been at a. DEVON AND EXETER HOSPITAL. "beanfeast." On the following morning his bowels acted UNILOCULAR OVARIAN CYST IN A GIRL AGED THIRTEEN; and he passed some urine, but the latter act was attended with some pain. From this time pain increased, and in the OVARIOTOMY; REMARKS. evening he was unable to micturate. He vomited frequently" (Under the care of Mr. BELL.) and had had since the onset of pain, until the Foli, the notes of the following case we are indebted to afternoon of hiccough 4th, 1886, when a catheter was passed August Dr. A. Blomfield. and nearly three ounces of bloody urine were withEdith G- was admitted on Aug. 19th, 1886, with a drawn. He was then admitted as a case of peritonitis. fluctuating abdominal tumour. The girl was very small and and suppression of urine. On the 5th about one pint undeveloped for her age, and had never menstruated. About of thick, purulent, and slightly blood-stained urine wasfour months before her admission she complained of pain in drawn off. At 7 A.M. on August 6th he passed a little the left iliac fossa, which she describes as "like stomach- flatus and a large quantity of urine, and suddenly became ache." The pain was afterwards felt higher up and on the very sick. Soon afterwards he was quite collapsed; his. opposite side of the abdomen. She is certain that there was abdomen became very distended; he never rallied, and At the necropsy recent no enlargement at this time, but that shortly afterwards the died at 11.5 A,M. on the same day. abdomen began to enlarge and increased somewhat rapidly general peritonitis was found, and in the pelvis there were to its present size. There has been no jaundice, vomiting, fifteen ounces of purulent urine and a quantity of lymph.. A band an inch and a quarter long united the fundus of the or cedema of the legs. State on admission.-The abdomen is much enlarged, bladder with the rectum. The vesical end of this band was presenting a somewhat barrel-shape appearance. The hollowed out into a slender funnel, and through a rupture in superficial veins are not prominent, nor is there any oedema it close to the bladder a string of mucus was projecting.. of the walls. The circumference of the abdomen, one inch Slight pressure caused purulent urine to ooze from the above the umbilicus, is thirty-two inches; the left side bladder through the rent into the peritoneal cavity. The measuring three-quarters of an inch more than the right, rectum, bladder, and penis were removed en masse, and and the measurement from the left anterior superior iliac were submitted to a committee consisting of Mr. Savory, spine to the lower border of the sternum is half an inch Mr. Bryant, and Drs. Goodhart and Kingston Fowler, There is complete who reported that in their opinion " the specimen ex-more than from the opposite spine. dulness over the part of the abdomen to the level of the hibits all the features which might be expected at alower border of the sternum; the left flank is quite remote period after a rupture of the bladder." This resonant, the right somewhat less so. There is resonance case, in the first instance, was reported in 1879 as one over the left iliac region, but the right fossa is absoof recovery from rupture of the bladder. It is now brought lutely dull. There is a distinct free wave of fluid from before the Royal Medical and Chirurgical Society because side to side through the swelling. On placing the hand in its completed form it affords conclusive proof that on the abdomen, a sensation of crepitus can sometimes an intra-peritoneal rupture of the bladder is not necesbe felt. sarily fatal, but may be recovered from under the simple The case was sent into the hospital as probably ascites, treatment employed in this case, provided the urine at but from the examination it was evident that the fluid was the time of the rupture is of normal composition. The encysted, and the opinion given was that the case was one case is believed to be unique in that it furnishes us with of ovarian dropsy. the post-mortem appearances of the bladder some years On Aug. 28th, under chloroform, Mr. Bell, through a small after recovery from an intra-peritoneal rupture of the coats incision (three inches), removed a unilocular ovarian cyst. of that organ. Mr. W. H. BENNETT read a case of Extra-peritoneal RupThe cyst weighed twelve ounces, and contained eight pints and a half of fluid. The pedicle was broad, and sprang ture of the Urinary Bladder, the direct result of aspiration
Charbon
of face,
-
Medical Societies.