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DISLOCATION OF THE RADIUS AND ULNA FORWARDS AT THE ELBOW WITHOUT FRACTURE
82 still dislocated, he reduced it by pressure its head was whilst good extension made by assistants. The
the pupils being moderately dilated, the patient had a copious feculent motion. This was the first action of the bowels for at least a week, and from that moment the pain and vomiting subsided. The pills were repeated twice daily, and the bowels continued to act regularly and copiously. On Jan. 8th the patient was discharged well. The most probable cause of the colic in this instance Dr. Murchison believed to be the accumulation of fæcal matter in the bowel, and for the following reasons. Before the bowels acted a doughy mass could be felt between the umbilicus and the left groin, which, on Dec. 30th, was the seat of considerable tenderness, and when the bowels began to act, large quantities of feculent matter were passed. It is well known that enormous accumulations of fasces may take place in the intestine, notwithstanding that the bowels act daily. A remarkable case of this sort is recorded by Frerichs, in which the accumulation was mistaken for pregnancy or an enormous tumour of the liver.*# Although the pain was referred to the back as well as the abdomen, the absence of blood or albumen from the urine, and the immediate cessation of the pain on the bowels acting, negatived the idea of nephritic colic. The situation of the pain, the age of the patient, and the complete absence of jaundice, were opposed to the notion that it was biliary colic. The fact that the patient had both attacks in the same house raised the suspicion that the symptoms might have been due to lead ; but opposed to this view were the following considerations :1. No other person in the same house had suffered from similar symptoms. 2. In the interval between the two attacks the patient herself had not suffered from colic. 3. The characteristic blue line of lead was absent from the margin of the gums. The edge of the gums was tumid and unusually red, but there was no blue tint.
on
arm was
was
then put on a straight splint and an evaporating lotion applied. A certain amount of heat and swelling ensued, but by the fourth day this subsided and the joint was quite movable.
li
CLINICAL RECORDS. NOVEL METHOD OF DEALING WITH LIGATURES APPLIED TO ARTERIES. MR. CAMPBELL DE MORGAN has been adopting of late, at the Middlesex Hospital, a plan of dealing with ligatures applied to vessels during a cutting operation, which merits notice. When the vessels have been tied, instead of following the usual custom and leaving the ligatures hanging out of the wound, Mr. De Morgan, by means of a needle, passes them through the skin close to where they are tied. They remain quite quie and come away without the slightest pain or trouble when their work is done. The wound consequently has
Medical Societies. ROYAL MEDICAL AND CHIRURGICAL SOCIETY. TUESDAY, JAN. 8TH, 1866. DR. JAMES ALDERSON, F.R.S., PRESIDENT. read with a peculiar title, and of such a that we only refer to it in order to say that it was admitted into the programme of the Society’s proceedings by mistake. It was not properly introduced to the Society, and had been read contrary to law. The consequence is an abstract of it will not appear in the Society’s " Transactions " nor in the journals. A
rAPER was
singular character,
TO A CASE OF COLOTOMY RECORDED IN THE LAST VOLUME OF THE " TRANSACTIONS," THE PATIENT HAVING DIED OF AN AFFECTION IN THE CECUM SIMILAR TO THAT IN THE SIGMOID FLEXURE OF THE COLON, FOR WHICH THE OPERATION WAS PERFORMED.
SEQUEL
BY T.
HOLMES,
ASSISTANT-SUEGEON TO ST.
GEORGE’S
HOSPITAL.
The patient remained in good general health, passed all the fasces through the artificial anus, and was in a state of comfort for several months. He still continued occasionally to pass urine from the anus, and complained occasionally of pains in the pelvis. About fifteen months after the operation the fæces again made their appearance in the water. Soon the faecal discharge from the artificial anus ceased, and he began to be in great distress from pain and difficulty in passing water, which In was as much loaded with fasces as before the operation. fact he fell again into the condition from which he had been relieved, and in this condition he died in the month of October, 1866. The parts were removed for exhibition to the Society. They show that the original opening was between the sigmoid flexure and the bladder; that it was not caused by malignant disease, but, as far as can be determined, by ordinary ulceration ; that the same action had taken plaoe in the cascum, by which it had become adherent to, and had been ulcerated into, the bladder, and thus the operation was from that time rendered nugatory. But for this fresh affection he might have enjoyed a long life, as the original diagnosis was correct, and the operation was calculated to afford complete relief from the
nothing to irritate it, and enjoys every opportunity of healing The paper is accompanied by the preparation, and a drawing by the first intention. The plan leaves the parts as quiet as if acupressure had been applied. There is now in the hospital a of the parts by Dr. Westmacott. Mr. CURLING agreed in the remarks which had been made case in which Mr. Moore tried the method at Mr. De Morgan’s Mr. Holmes in his paper, and which, though this case ended on a breast. after by suggestion, Wednesday week, removing badly, showed the correctness of the diagnosis, and justified the operation. In these cases, however completely the operaDISLOCATION OF THE RADIUS AND ULNA FOR- tion might be performed, it was not always possible to prevent some of the faecal matter from escaping into the intestine WARDS AT THE ELBOW WITHOUT FRACTURE. A CASE of this very rare dislocation occurred at University below. He related a case in point. It was curious in Mr. Holmes’s case that two adhesions existed in different parts, College Hos_pital the week before last, during the frost. A and ulcerated into the bladder in two places. In this respect of on of down age, slipped twenty years strong young man, the pavement, falling on his left elbow. On getting up he the case he believed was unique. Mr. JOHN WooD inquired whether any signs of an abscess found he could scarcely move the elbow, which was so painful existed in the peritoneal cavity between the peritoneum having that he applied immediately at the hospital. On examining him about twenty minutes after the fall, Mr. J. W. Langmore, the house-surgeon, found that there was some swelling and a slight bruise over the prominence of the elbow, with but little swelling elsewhere. The arm was bent at an angle of about 130°, but could be flexed to a right angle and straightened to about 160°, although all movement gave the patient great pain. The forearm was about three-quarters of an inch longer than its fellow. The condyles of the humerus were nearly on a level with the olecranon, which was displaced forwards, the tendon of the triceps muscle being very tightly stretched round the end of the humerus. The sigmoid notch could be felt. The head of the radius could also be felt in front of the lower end of the humerus. Mr. Langmore replaced the ulna by bending the elbow across his knee, and then, as the radius *
Diseases of the Liver, Sydenham Society’), Translation, vol. i. p. 69.
,
and bladder could be detected. Mr. CHARLES HAWKlNS said that cases of this kind were not necessarily malignant, and referred to the instance of a man who, without any previous illness or symptoms of disease, was startled at finding faecal matter mixed with his urine. A stone in the bladder was found, which was removed by lithotrity; after this the urine made its way into the rectum, but no fsecal matter passed with the urine. The opening had evidently contracted to such an extent that fsecal matter could not escape from the rectum. The man did not die from this disease, which was evidently not malignant. Mr. T. HOLMES regretted that the preparation of the parts had, by accident, not been brought before the Fellows. It was, however, in the museum of St. George’s Hospital, where any gentleman who took an interest in the case might inspect it. He had not been able to find any trace whatever of an
the pupils being moderately dilated, the patient had a copious feculent motion. This was the first action of the bowels for at least a week, and from that moment the pain and vomiting subsided. The pills were repeated twice daily, and the bowels continued to act regularly and copiously. On Jan. 8th the patient was discharged well. The most probable cause of the colic in this instance Dr. Murchison believed to be the accumulation of fæcal matter in the bowel, and for the following reasons. Before the bowels acted a doughy mass could be felt between the umbilicus and the left groin, which, on Dec. 30th, was the seat of considerable tenderness, and when the bowels began to act, large quantities of feculent matter were passed. It is well known that enormous accumulations of fasces may take place in the intestine, notwithstanding that the bowels act daily. A remarkable case of this sort is recorded by Frerichs, in which the accumulation was mistaken for pregnancy or an enormous tumour of the liver.*# Although the pain was referred to the back as well as the abdomen, the absence of blood or albumen from the urine, and the immediate cessation of the pain on the bowels acting, negatived the idea of nephritic colic. The situation of the pain, the age of the patient, and the complete absence of jaundice, were opposed to the notion that it was biliary colic. The fact that the patient had both attacks in the same house raised the suspicion that the symptoms might have been due to lead ; but opposed to this view were the following considerations :1. No other person in the same house had suffered from similar symptoms. 2. In the interval between the two attacks the patient herself had not suffered from colic. 3. The characteristic blue line of lead was absent from the margin of the gums. The edge of the gums was tumid and unusually red, but there was no blue tint.
on
arm was
was
then put on a straight splint and an evaporating lotion applied. A certain amount of heat and swelling ensued, but by the fourth day this subsided and the joint was quite movable.
li
CLINICAL RECORDS. NOVEL METHOD OF DEALING WITH LIGATURES APPLIED TO ARTERIES. MR. CAMPBELL DE MORGAN has been adopting of late, at the Middlesex Hospital, a plan of dealing with ligatures applied to vessels during a cutting operation, which merits notice. When the vessels have been tied, instead of following the usual custom and leaving the ligatures hanging out of the wound, Mr. De Morgan, by means of a needle, passes them through the skin close to where they are tied. They remain quite quie and come away without the slightest pain or trouble when their work is done. The wound consequently has
Medical Societies. ROYAL MEDICAL AND CHIRURGICAL SOCIETY. TUESDAY, JAN. 8TH, 1866. DR. JAMES ALDERSON, F.R.S., PRESIDENT. read with a peculiar title, and of such a that we only refer to it in order to say that it was admitted into the programme of the Society’s proceedings by mistake. It was not properly introduced to the Society, and had been read contrary to law. The consequence is an abstract of it will not appear in the Society’s " Transactions " nor in the journals. A
rAPER was
singular character,
TO A CASE OF COLOTOMY RECORDED IN THE LAST VOLUME OF THE " TRANSACTIONS," THE PATIENT HAVING DIED OF AN AFFECTION IN THE CECUM SIMILAR TO THAT IN THE SIGMOID FLEXURE OF THE COLON, FOR WHICH THE OPERATION WAS PERFORMED.
SEQUEL
BY T.
HOLMES,
ASSISTANT-SUEGEON TO ST.
GEORGE’S
HOSPITAL.
The patient remained in good general health, passed all the fasces through the artificial anus, and was in a state of comfort for several months. He still continued occasionally to pass urine from the anus, and complained occasionally of pains in the pelvis. About fifteen months after the operation the fæces again made their appearance in the water. Soon the faecal discharge from the artificial anus ceased, and he began to be in great distress from pain and difficulty in passing water, which In was as much loaded with fasces as before the operation. fact he fell again into the condition from which he had been relieved, and in this condition he died in the month of October, 1866. The parts were removed for exhibition to the Society. They show that the original opening was between the sigmoid flexure and the bladder; that it was not caused by malignant disease, but, as far as can be determined, by ordinary ulceration ; that the same action had taken plaoe in the cascum, by which it had become adherent to, and had been ulcerated into, the bladder, and thus the operation was from that time rendered nugatory. But for this fresh affection he might have enjoyed a long life, as the original diagnosis was correct, and the operation was calculated to afford complete relief from the
nothing to irritate it, and enjoys every opportunity of healing The paper is accompanied by the preparation, and a drawing by the first intention. The plan leaves the parts as quiet as if acupressure had been applied. There is now in the hospital a of the parts by Dr. Westmacott. Mr. CURLING agreed in the remarks which had been made case in which Mr. Moore tried the method at Mr. De Morgan’s Mr. Holmes in his paper, and which, though this case ended on a breast. after by suggestion, Wednesday week, removing badly, showed the correctness of the diagnosis, and justified the operation. In these cases, however completely the operaDISLOCATION OF THE RADIUS AND ULNA FOR- tion might be performed, it was not always possible to prevent some of the faecal matter from escaping into the intestine WARDS AT THE ELBOW WITHOUT FRACTURE. A CASE of this very rare dislocation occurred at University below. He related a case in point. It was curious in Mr. Holmes’s case that two adhesions existed in different parts, College Hos_pital the week before last, during the frost. A and ulcerated into the bladder in two places. In this respect of on of down age, slipped twenty years strong young man, the pavement, falling on his left elbow. On getting up he the case he believed was unique. Mr. JOHN WooD inquired whether any signs of an abscess found he could scarcely move the elbow, which was so painful existed in the peritoneal cavity between the peritoneum having that he applied immediately at the hospital. On examining him about twenty minutes after the fall, Mr. J. W. Langmore, the house-surgeon, found that there was some swelling and a slight bruise over the prominence of the elbow, with but little swelling elsewhere. The arm was bent at an angle of about 130°, but could be flexed to a right angle and straightened to about 160°, although all movement gave the patient great pain. The forearm was about three-quarters of an inch longer than its fellow. The condyles of the humerus were nearly on a level with the olecranon, which was displaced forwards, the tendon of the triceps muscle being very tightly stretched round the end of the humerus. The sigmoid notch could be felt. The head of the radius could also be felt in front of the lower end of the humerus. Mr. Langmore replaced the ulna by bending the elbow across his knee, and then, as the radius *
Diseases of the Liver, Sydenham Society’), Translation, vol. i. p. 69.
,
and bladder could be detected. Mr. CHARLES HAWKlNS said that cases of this kind were not necessarily malignant, and referred to the instance of a man who, without any previous illness or symptoms of disease, was startled at finding faecal matter mixed with his urine. A stone in the bladder was found, which was removed by lithotrity; after this the urine made its way into the rectum, but no fsecal matter passed with the urine. The opening had evidently contracted to such an extent that fsecal matter could not escape from the rectum. The man did not die from this disease, which was evidently not malignant. Mr. T. HOLMES regretted that the preparation of the parts had, by accident, not been brought before the Fellows. It was, however, in the museum of St. George’s Hospital, where any gentleman who took an interest in the case might inspect it. He had not been able to find any trace whatever of an