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EYE INFIRMARY, GLASGOW.
819 The patient was put under the iniluence of ether, and as morphia. Temperature 97 4°; was without pain. Wound redressed; stitches removed; union not good; parts sup- soon as the quadriceps muscle relaxed, with a very little ported by strapping. On the 10th the tongue was still lateral pressure on the margins of the bone the dislocation furred and rather glazed ; she had vomited again ; there was easily reduced by Dr. Vachell. was a free discharge from the artificial anus, and the patient Itemccrhs.-This is about the twentieth case which has appeared fairly well. Temperature 9S’S°; pulse 120, stronger. been placed on record. As a rule, these dislocations are Enemata every three hours ; these were retained fairly. caused by muscular spasm; in this case there can be no On the 14th, though she had slept fairly well, she was doubt that it was caused by the pressure of the iron bar
of
weaker and unable to retain the nutrient enemata. A little claret by the mouth was tried, but it caused vomiting. Small quantities of fæcal matter passed from the wound. Pulse 120, weaker. Temperature 99.2°.—15th: Pulse 120 ;
directly upon the patella itself, the spasm of the quadriceps retaining it in its abnormal position. The redaction, which in many cases has been most difficult, was in this very easily
effected. After the reduction a back splint was put on, and temperature98°. Tongue dryandratherglazed. No vomiting. this on the following morning was replaced by a plaster case. Slept in snatches, and her mind was not so clear as usual.17th : Much weaker. Pulse 108, feeble. No pain. Nutrient enemata not retained longer than an hour. Temperature 96.2°. EYE INFIRMARY, GLASGOW. On the 18th the had slept well, and was somewhat better, REMOVAL OF EYELASH FROM ANTERIOR CHAMBER FOUR though the pulse was 120, and still feeble; had retained one WEEKS AFTER INJURY, RESULTING IN GOOD VISION. enema, but only takes a little brandy and soda-water by the (Under the care of Dr. CRAWFORD RENTON.) mouth. Temperature 96’4° to 98°.—19th: During the day there was increasing weakness, the evening temperature J. D-, aged thirty, gamekeeper, was admitted on Before Oct. rose to 102’4°, and she died soon after midnight. 18th, 1881. He was suffering from an injury to his the operation the temperature varied from 97’-1° to 99’2°. eye, caused by the splinteringof a percussion-cap two right after was 98’6°. The evening temperature Next operation weeks previously. On examination, a slight abrasion of the day it reached 100’8°; but did not again exceed 99’6° until the evening of the 19th, when, as before mentioned, it was cornea was observed ; the iris was irregular, and across the 1024°. The morning temperature was usually subnormal, lower and inner side of the pupil a minute foreign body and on one occasion was only 96°. seemed to be lying, but owing to the presence of iritis, it A postmortem examination was made a few hours after was difficult to be certain that it was not pigment or lymph. death. There were a few adhesions at the apex of the right Fomentations and atropine solutions were recommended to lung; thoracic organs otherwise healthy ; the kidneys and soothe the pain and subdue the iriti?. On Oct. 28th the eye spleen normal; the liver small, friable, and adherent to The was quiet, the pupil had yielded, and it was now more under surface of the diaphragm ; gall-bladder much distended. apparent that a fOleigu body was present, and that it was The coils of intestine were slightly glued together; there wa-< enher a very fine splinter of the cap, or, as the resident recent peritonit,s. The artificial anus had been established surgeon, Dr. Hunter, suggested, an eyelash. in the small intestine twenty-nine inches from the ileoOn Nov. 2nd Dr. Renton made an incision through the csecai valve ; the gut above was quite patent and filled wi’h lower and outer aspect of the cornea, and removed with a bilious fluid faeces as far as the orifice made. The lower fine pair of forceps the foreign body, which proved to be an part of the ileurn and the cascam were matted together by eyelash —18th: Pupil did not yield freely after the operaglandular and inflammatory infiltration. The rectum was tion, but it gradually improved, and the patieat was discompressed and adherent to the posterior wall of the uterus missed with good vision. and upper part of the vagina. On separating them a small Jan. 6th, 1883.—The patient is reported as having found abscess cavity containing about four ounces of pas was his eye as useful as formerly during the whole shooting found. In Douglas’s pouch were three or four papillary season, and no trace is left of the inflammatory attack or ill growths a’1out the size of hiberts. They were hard, nodular, effects from the injury. and seemel to spring from the region of the left ovary and broad ligament. The position of the left ovary was ABERDEEN GENERAL DISPENSARY. occupied by a firm mass of fibrous cicatricial tissue from EXTERNAL HÆMORRHOIDS IN A NEW-BORN CHILD. which grew one of the papillary growths. the care of Dr. FRANCIS OGSTON, junior, and Mr. (Under GEORGE VINCENT.) CARDIFF INFIRMARY. AT the beginning of February a child three days old was VERTICAL DISLOCATION OF PATELLA. taken to the dispensary by its mother, who stated that she (Under the care of Dr. VACHELL.) had noticed the child cried very much when its bowels were FOR the following notes we are indebted to Mr. P. Rhys moved, and that it had a red projecting tumour at the anus. Oa examination a btight-scarlet tongue-shaped tumour Griffiths, M.B., B.S. Lonrl., house-surgeon :— Michael E-, aged thirty-one, a labourer of strong build, was seen to spring from the point of union of the mucous membrane of the anus with the skin. It was situated at was admitted into the iufirmary on the night of Feb. 13th, 1883. He said that when as-isting some men to push a the left side. At the front part of the anal border a second flatter tumour of the size of a split pea was also found. trolley his legs were jammed between the trolley and a long After a few days’ treatment with boracic acid ointment iron bar called " The David." Tiie pain he experienced was the redness had in a great measure subinflammatory intense-he described it as "wrenching." After the acci- sided, and the larger tongae-like tumour had nnw changed
dent he was unable to move. Ou examination the left leg was found to be fully and forcibly extended, and the dislocation of the patella was evident. The patella had been rotated on its vertical axis, the
into
a
club-shaped unmistakable hemorrhoid with a
narrow
and the second flatter projection had greatly diminished. A day or two afrerwarda the larger tumour was removed by surrounding the pedicle with a loop of convex anterior surface was directed forwards, inwards, and thread. Note by Dr. OGSTON.—The earliest case of haemorrhoids slightly upwards. The outer slightly concave half of the posterior surface of the patella was plainly seen and ea-iiy felt, th- which I can find record of occurred in a child of four months skin being very tense. The right border of the patella rested of age, but this seems to have been existent at birth or a apparently in the small depression immerliately above the few hours after it. It is difficult to account, for such a mter-condyldr groove. To the inner side of this border phenomenon thus early in life, for the bowels had all along immediately there was a well-marked depression, in which been moved freely and the stools were of normal colour and the ridge to the inner side of the articular surface of the consistence, a fact which was verified by the howels being of the femur, as well as a part of the smooth moved while I was examining the child. The icterus neonacondylar surface, could be felt ; a portion of the external torum had never been present. The liver seemed on palcondylar surface was also felt. The tendon of the quadriceps pation of normal size ; and the umbilicus cicatrised in a extensor was very tense, and could be plainly seen as two healthy manner. Thus none of the usually given predisposing strong bands. The patella was slightly movable on the causes of hæmorrhoids—portal congestion, liver disease, and right border as axis. Attempted flexion of the limb was overloading the rectum with bard fæces,—were present. the sixth, had been a perfectly normal one, with accompanied by acute pain. The patient complained of pain nly over tde inner side uf the linee-joint. head presentation.
pedicle ;
internat condyle
The labour,
of
weaker and unable to retain the nutrient enemata. A little claret by the mouth was tried, but it caused vomiting. Small quantities of fæcal matter passed from the wound. Pulse 120, weaker. Temperature 99.2°.—15th: Pulse 120 ;
directly upon the patella itself, the spasm of the quadriceps retaining it in its abnormal position. The redaction, which in many cases has been most difficult, was in this very easily
effected. After the reduction a back splint was put on, and temperature98°. Tongue dryandratherglazed. No vomiting. this on the following morning was replaced by a plaster case. Slept in snatches, and her mind was not so clear as usual.17th : Much weaker. Pulse 108, feeble. No pain. Nutrient enemata not retained longer than an hour. Temperature 96.2°. EYE INFIRMARY, GLASGOW. On the 18th the had slept well, and was somewhat better, REMOVAL OF EYELASH FROM ANTERIOR CHAMBER FOUR though the pulse was 120, and still feeble; had retained one WEEKS AFTER INJURY, RESULTING IN GOOD VISION. enema, but only takes a little brandy and soda-water by the (Under the care of Dr. CRAWFORD RENTON.) mouth. Temperature 96’4° to 98°.—19th: During the day there was increasing weakness, the evening temperature J. D-, aged thirty, gamekeeper, was admitted on Before Oct. rose to 102’4°, and she died soon after midnight. 18th, 1881. He was suffering from an injury to his the operation the temperature varied from 97’-1° to 99’2°. eye, caused by the splinteringof a percussion-cap two right after was 98’6°. The evening temperature Next operation weeks previously. On examination, a slight abrasion of the day it reached 100’8°; but did not again exceed 99’6° until the evening of the 19th, when, as before mentioned, it was cornea was observed ; the iris was irregular, and across the 1024°. The morning temperature was usually subnormal, lower and inner side of the pupil a minute foreign body and on one occasion was only 96°. seemed to be lying, but owing to the presence of iritis, it A postmortem examination was made a few hours after was difficult to be certain that it was not pigment or lymph. death. There were a few adhesions at the apex of the right Fomentations and atropine solutions were recommended to lung; thoracic organs otherwise healthy ; the kidneys and soothe the pain and subdue the iriti?. On Oct. 28th the eye spleen normal; the liver small, friable, and adherent to The was quiet, the pupil had yielded, and it was now more under surface of the diaphragm ; gall-bladder much distended. apparent that a fOleigu body was present, and that it was The coils of intestine were slightly glued together; there wa-< enher a very fine splinter of the cap, or, as the resident recent peritonit,s. The artificial anus had been established surgeon, Dr. Hunter, suggested, an eyelash. in the small intestine twenty-nine inches from the ileoOn Nov. 2nd Dr. Renton made an incision through the csecai valve ; the gut above was quite patent and filled wi’h lower and outer aspect of the cornea, and removed with a bilious fluid faeces as far as the orifice made. The lower fine pair of forceps the foreign body, which proved to be an part of the ileurn and the cascam were matted together by eyelash —18th: Pupil did not yield freely after the operaglandular and inflammatory infiltration. The rectum was tion, but it gradually improved, and the patieat was discompressed and adherent to the posterior wall of the uterus missed with good vision. and upper part of the vagina. On separating them a small Jan. 6th, 1883.—The patient is reported as having found abscess cavity containing about four ounces of pas was his eye as useful as formerly during the whole shooting found. In Douglas’s pouch were three or four papillary season, and no trace is left of the inflammatory attack or ill growths a’1out the size of hiberts. They were hard, nodular, effects from the injury. and seemel to spring from the region of the left ovary and broad ligament. The position of the left ovary was ABERDEEN GENERAL DISPENSARY. occupied by a firm mass of fibrous cicatricial tissue from EXTERNAL HÆMORRHOIDS IN A NEW-BORN CHILD. which grew one of the papillary growths. the care of Dr. FRANCIS OGSTON, junior, and Mr. (Under GEORGE VINCENT.) CARDIFF INFIRMARY. AT the beginning of February a child three days old was VERTICAL DISLOCATION OF PATELLA. taken to the dispensary by its mother, who stated that she (Under the care of Dr. VACHELL.) had noticed the child cried very much when its bowels were FOR the following notes we are indebted to Mr. P. Rhys moved, and that it had a red projecting tumour at the anus. Oa examination a btight-scarlet tongue-shaped tumour Griffiths, M.B., B.S. Lonrl., house-surgeon :— Michael E-, aged thirty-one, a labourer of strong build, was seen to spring from the point of union of the mucous membrane of the anus with the skin. It was situated at was admitted into the iufirmary on the night of Feb. 13th, 1883. He said that when as-isting some men to push a the left side. At the front part of the anal border a second flatter tumour of the size of a split pea was also found. trolley his legs were jammed between the trolley and a long After a few days’ treatment with boracic acid ointment iron bar called " The David." Tiie pain he experienced was the redness had in a great measure subinflammatory intense-he described it as "wrenching." After the acci- sided, and the larger tongae-like tumour had nnw changed
dent he was unable to move. Ou examination the left leg was found to be fully and forcibly extended, and the dislocation of the patella was evident. The patella had been rotated on its vertical axis, the
into
a
club-shaped unmistakable hemorrhoid with a
narrow
and the second flatter projection had greatly diminished. A day or two afrerwarda the larger tumour was removed by surrounding the pedicle with a loop of convex anterior surface was directed forwards, inwards, and thread. Note by Dr. OGSTON.—The earliest case of haemorrhoids slightly upwards. The outer slightly concave half of the posterior surface of the patella was plainly seen and ea-iiy felt, th- which I can find record of occurred in a child of four months skin being very tense. The right border of the patella rested of age, but this seems to have been existent at birth or a apparently in the small depression immerliately above the few hours after it. It is difficult to account, for such a mter-condyldr groove. To the inner side of this border phenomenon thus early in life, for the bowels had all along immediately there was a well-marked depression, in which been moved freely and the stools were of normal colour and the ridge to the inner side of the articular surface of the consistence, a fact which was verified by the howels being of the femur, as well as a part of the smooth moved while I was examining the child. The icterus neonacondylar surface, could be felt ; a portion of the external torum had never been present. The liver seemed on palcondylar surface was also felt. The tendon of the quadriceps pation of normal size ; and the umbilicus cicatrised in a extensor was very tense, and could be plainly seen as two healthy manner. Thus none of the usually given predisposing strong bands. The patella was slightly movable on the causes of hæmorrhoids—portal congestion, liver disease, and right border as axis. Attempted flexion of the limb was overloading the rectum with bard fæces,—were present. the sixth, had been a perfectly normal one, with accompanied by acute pain. The patient complained of pain nly over tde inner side uf the linee-joint. head presentation.
pedicle ;
internat condyle
The labour,