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FUNGOID ULCERATIONS OF THE LEG.
But one inconvenience sometimes arising in these arrested cases is, that the puncture in the bladder may become permaby Mr. Macgregor, house-surgeon to the hospital, (to whom we nently patulous. The result of the experience of Mr. Cock is, are indebted for the notes of the case,) and a good recovery that the improvement in the condition of the urethra, is so was made, under the use of tonics and a liberal allowance of great, that the btricture very readily submits to careful treat. timulants. ment, because the urine (from having a new channel whereby F. B-, aged sixty-four, labourer, was admitted into the escape) has ceased to prove a source of irritation. A. ward of this hospital, on the 24th of July, 1858. He stated that about a week before admission he perceived a small pimple FUNGOID ULCERATIONS OF THE LEG. upon his face, which he cut while shaving, and almost immediately after this, symptoms of erysipelatous inflammation OCCASIONALLY ulcers about the legs, after resisting treatment supervened. On admission, he was in a delirious condition, the right side of his face much swollen, of a dusky-red colour, for a time, suddenlytake on a peculiar action, with the growth accompanied with great pain of a tingling character. Pulse of fungus-looking masses, not unlike carcinoma, and called by 120; tongue furred and dry. He was ordered a grain of quinine, some pathologists, from the histological elements entering into with twenty minims of the muriated tincture of iron, in an ounce their composition, epithelioma. Such a case came under notice of water, every four hours; with milk, arrowroot, and beef-tea, at King’s College Hospital on the 30th of October, in an elderly man who had sustained some injury to the right leg three years and six ounces of wine daily. ending in ulceration, which became chronic. Upon this treatment he continued to improve up to the 2nd of and a halftheago, surface of the ulcer became fungous, much eleAugust, when an abscess, about the size of a five-shilling piece, Latterly above the surrounding skin, and, so far as could be seen, began to form over the horizontal ramus of the lower jaw of vated the side affected. A large slough gradually formed, which was assumed an appearance of malignancy. Mr. Fergusson removed treated with linseed-meal poultices. On the night of the 10th these masses down to the bone, which had formed ridges proof August, the house-surgeon was called up by the nurse, who jecting into the disease. These were taken away with the curved stated that the patient was bleeding to death. He accordingly cutting forceps, and the wound dressed with cold wetted lint. hurried over, and found him very faint from loss of blood. On Since the operation, which was accomplished under chloroform examination, the hemorrhage was seen to proceed from the administered by Dr. Anstey, the patient has gone on pretty well, facial artery, which had been laid open by the extendingslough. and is likely to recover. We have seen cases like this on three or four occasions: one Some difficulty was experienced in arresting the bleeding, but this was accomplished, after a time, by the application of we can call to mind under Mr. Lawrence’s care at St. Barthopounded alum and ice, and a compress, supporting the patient lomew’s Hospital, in the person of a female; only that the The bandages were not fungoid masses were more indurated, although equally promiat the same time with brandy, &c. removed for two days, lest fresh bleeding should ensue. Linseed- nent. It was considered doubtful at the time whether ampumeal poultices were now continued until the slough came away. tation should be had recuurse to or not, but Mr. Lawrence After this the patient progressed rapidly, granulations were removed the diseased masses with a knife, and scraped, or freely thrown out, the wound filled up, and the man became con- rather sawed, away the surface of bone affected in a similar valescent, and shortly after was discharged from the hospital manner to that of Mr. Fergusson’s patient. The woman was carefully watched, the ulcer completely healed up, and she leit quite well.
artery, and was followed by a very large rhage, nearly proving fatal to the patient.
amount of hemor- hours.
This
was
’
I to
CLINICAL
RECORDS.
the hospital quite well. These cases are very instructive, and clearly show us how much may be done to enect cures without resorting to themajor operations. Mr. Fergusson spoke of another hospital patient who had done well under such treatment, which induced him to repeat it on the present occasion.
PUNCTURE OF THE BLADDER THROUGH THE RECTUM. of THE operation puncturing the bladder through the rectum is generally resorted to by the surgeon for retention of urine. EXTENSIVE RHINOCEROS NÆVUS. We, however, had the opportunity of seeing it performed at the Westminster Hospital, on the 7th of December last, in a bad OF all the exaggerated forms of nsevus which havebeen observed by pathologists, none are so remarkable or so extencase of impermeable stricture, which had resisted every attempt to introduce an instrument, and in which a perineal section sive as that which comes under the above designation, from had failed. The patient was a man of about sixty years of age, the fact that both in colour and general appearance it strikingly the subject of stricture for fifteen years, and who has been an resembles the skin of the rhinoceros. When an example of inmate of the hospital for the last four months, under Mr. this form of nsevus is once observed, it can never be forgotten. Holt’s care, having been sent up from the country. During On the 4th of December, a little child was brought into the the four months, several attempts had been made to introduce theatre of King’s College Hospital to have strangulated two or three erectile tumours on the back, which had recently become even the smallest-sized instruments, but in vain. The scrotum and perinasum are riddled with sinuses and fistulas, which enlarged in the centre of a very large nsevus. The following originated in numerous small abscesses, after previous attacks will give an idea of its appearance-Over the whole anterior of infiltration of urine. This fluid passes through a number of part of the right side of the chest, commencing about the meopenings, a little of it escaping also by the urethra in a small sian line of the sternum, a blackish-brown skin was present, stream. The urethra is extremely tortuous, and said to be spreading around the side to the back, covering the shoulder and almost rotten. Mr. Holt thought it advisable, a fortnight part of the neck, and the greater part of the arm. It encroached previously, to try the effects of an incision in the perinaeum, somewhat upon the lower part of the back, and passed to the but failed to find the canal, which seemed almost wholly left of the spine. Some interrupted patches covered the butobliterated in this situation, and consequently he had no guide tocks also. The skin seemed to hang slightly in folds, and to cut upon to perfect perineal section. As the urine, there- presented knobs or tuberosities here and there, from which fore, escaped from so many outlets, and had set up so much sprung several loose hairs, a description corresponding to what general irritation, Mr. Holt resolved to puncture the bladder is met with in the animal already referred to. These knobs through the rectum, and thus form a new outlet for the urine, constituted small tumours of an erectile character, which would in order that the diseased parts in the perinasum, as well as the now and then increase in size and require removal by stranguurethra, might have time to regain a healthy condition to some lation, to which treatment Mr. Fergusson had resorted on two extent, and hereafter permit the passage of a bougie. The or three occasions. If these were allowed to grow, they might operation was performed in the usual manner behind the pros- destroy life, although at present there is nothing of the chatate gland: introducing the canula first, then hooking up the racter of malignancy about them. The child is healthy, and end of it with the finger, and finally introducing the trocar, so is its mother; and the explanation which the latter gives pushing it into the viscus and withdrawing its contents. In- of this remarkable cutaneous malformation is, that when she stead of leaving the canula in the bladder, as we have seen was pregnant with this child, one day a large black dog jumped Mr. Cock do at Guy’s Hospital, a gum-elastic catheter was upon her back, which frightened her very much, and left an introduced through the canula, and this latter tube withdrawn impression upon her mind not to be effaced. We have referred to this case on a previous occasion; but over it. It was believed that less irritation would be excited by the catheter than by the canula. If everything goes on the appearances which we described at that time have become favourably, the urine after awhile will be collected in the more pronounced, as the child has increased both in age and, tctum, and periodically got rid of during the twenty-four stature.
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artery, and was followed by a very large rhage, nearly proving fatal to the patient.
amount of hemor- hours.
This
was
’
I to
CLINICAL
RECORDS.
the hospital quite well. These cases are very instructive, and clearly show us how much may be done to enect cures without resorting to themajor operations. Mr. Fergusson spoke of another hospital patient who had done well under such treatment, which induced him to repeat it on the present occasion.
PUNCTURE OF THE BLADDER THROUGH THE RECTUM. of THE operation puncturing the bladder through the rectum is generally resorted to by the surgeon for retention of urine. EXTENSIVE RHINOCEROS NÆVUS. We, however, had the opportunity of seeing it performed at the Westminster Hospital, on the 7th of December last, in a bad OF all the exaggerated forms of nsevus which havebeen observed by pathologists, none are so remarkable or so extencase of impermeable stricture, which had resisted every attempt to introduce an instrument, and in which a perineal section sive as that which comes under the above designation, from had failed. The patient was a man of about sixty years of age, the fact that both in colour and general appearance it strikingly the subject of stricture for fifteen years, and who has been an resembles the skin of the rhinoceros. When an example of inmate of the hospital for the last four months, under Mr. this form of nsevus is once observed, it can never be forgotten. Holt’s care, having been sent up from the country. During On the 4th of December, a little child was brought into the the four months, several attempts had been made to introduce theatre of King’s College Hospital to have strangulated two or three erectile tumours on the back, which had recently become even the smallest-sized instruments, but in vain. The scrotum and perinasum are riddled with sinuses and fistulas, which enlarged in the centre of a very large nsevus. The following originated in numerous small abscesses, after previous attacks will give an idea of its appearance-Over the whole anterior of infiltration of urine. This fluid passes through a number of part of the right side of the chest, commencing about the meopenings, a little of it escaping also by the urethra in a small sian line of the sternum, a blackish-brown skin was present, stream. The urethra is extremely tortuous, and said to be spreading around the side to the back, covering the shoulder and almost rotten. Mr. Holt thought it advisable, a fortnight part of the neck, and the greater part of the arm. It encroached previously, to try the effects of an incision in the perinaeum, somewhat upon the lower part of the back, and passed to the but failed to find the canal, which seemed almost wholly left of the spine. Some interrupted patches covered the butobliterated in this situation, and consequently he had no guide tocks also. The skin seemed to hang slightly in folds, and to cut upon to perfect perineal section. As the urine, there- presented knobs or tuberosities here and there, from which fore, escaped from so many outlets, and had set up so much sprung several loose hairs, a description corresponding to what general irritation, Mr. Holt resolved to puncture the bladder is met with in the animal already referred to. These knobs through the rectum, and thus form a new outlet for the urine, constituted small tumours of an erectile character, which would in order that the diseased parts in the perinasum, as well as the now and then increase in size and require removal by stranguurethra, might have time to regain a healthy condition to some lation, to which treatment Mr. Fergusson had resorted on two extent, and hereafter permit the passage of a bougie. The or three occasions. If these were allowed to grow, they might operation was performed in the usual manner behind the pros- destroy life, although at present there is nothing of the chatate gland: introducing the canula first, then hooking up the racter of malignancy about them. The child is healthy, and end of it with the finger, and finally introducing the trocar, so is its mother; and the explanation which the latter gives pushing it into the viscus and withdrawing its contents. In- of this remarkable cutaneous malformation is, that when she stead of leaving the canula in the bladder, as we have seen was pregnant with this child, one day a large black dog jumped Mr. Cock do at Guy’s Hospital, a gum-elastic catheter was upon her back, which frightened her very much, and left an introduced through the canula, and this latter tube withdrawn impression upon her mind not to be effaced. We have referred to this case on a previous occasion; but over it. It was believed that less irritation would be excited by the catheter than by the canula. If everything goes on the appearances which we described at that time have become favourably, the urine after awhile will be collected in the more pronounced, as the child has increased both in age and, tctum, and periodically got rid of during the twenty-four stature.
32