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HOSPITAL FOR CONSUMPTION, BROMPTON.
HOSPITAL FOR CONSUMPTION, BROMPTON.
found right bronchus, regurgitation being prevented, it the expand the lung. No aperture of escape, howimpossible was
to
was visible in front. The right lung was now carefully removed from the thorax, and, on renewing the expansive efforts with the lung under water, the perforation was at once THE fatality of pneumothorax is by no means proportionate detected. It lay an inch and a half from the posterior apex, in to its frequency. Of six well-marked cases which have occurred size equal to a large pin’s head, well defined at the edges, which were gradually thinned towards the opening, and surrounded in the above hospital within the last three months, only oneby a very pale piece of pleura, about an inch and a quarter in that which we record to-day-proved directly fatal. In an- diameter, and which towards the perforation had an appearother, where tubercular disease was also very far advanced, the ance as of concentric arrangement, produced, as found afterby various degrees of thinning. The perforation compatient went about for some days, but died ten days after the wards, attack. In a third case, the immediate effects were very vio- municated with a tubercular cavity, the size of a large walnut, with shreddy, ragged wallr. The cavity, again, was in direct lent, but the ultimate result beneficial, inasmuch as the pul- connexion with a moderately large bronchus, which satisfacmonary disease was arrested. The other three cases are still torily accounted for the complete resistance presented to all under observation. The obvious cause of the non-fatal issue, efforts at expansion. The left lung contained a cavity occupyin most of such cases, is the amount of previous pleuritic ad- ing almost the whole upper lobe; while in the lower lobe were hesion, limiting the extent and amount of pressure. It is very some cheesy deposits, situated chiefly in lines immediately beneath the pleura. The liver was large, congested, and fatty. rare indeed that we meet with so very advanced pulmonary disease with so little attendant adhesion as in the following case; and it is the more remarkable, considering the tendency exhibited here for the tubercular deposit to show itself, in the CLINICAL RECORDS. first instance, immediately beneath the pleura. In ttte lung itself, moreover, there was little or no congestion of the tissue around the softening tubercles. THE LATE OPERATION FOR ARTIFICIAL ANUS. Perhaps this may be taken in connexion with a fact observed IN relation to this important case, of which we gave a brief during the course of treatment-viz., that counter-irritation instead of, as in most cases, giving positive relief, and tending record on the 27th of November, we may observe that the cirto arrest the disease, did, in this case, give no relief, but pro- cumscribed abscess situated above Poupart’s ligament did not duced only irritation and weakness. Was there any attendant communicate with the intestine or abdominal cavity, and it inflammation or congestion to subdue ? This subject is fully was external to the abdominal muscles. Six days after this treated of in Dr. Cotton’s work " On Consumption." We abscess was opened, a large slough came away, and the dis. avail ourselves of the notes taken by Dr. Maxwell at the charge lost its foetor and became healthy in character. When the bowels afterwards ceased to act, tubes passed per anum hospital :E. W , aged twenty-nine, single, lady’s-maid, was" ad- would not go up beyond seven or eight inches, being opposed mitted into the hospital on June 28th, 1858. Her illness dated by some hard obstruction, which when pressed upon produced from January of the present year, and its origin was ascribed excruciating pain. The bowels had now been constipated for to over-exertion in nursing a brother, who died about that time fourteen days, and on careful examination by Mr. Lane and of phthisis. The principal features of her complaint were, fre- Dr. Sibson, obstruction in the sigmoid flexure of the colon was quent harassing cough, copious frothy and purulent expectora- diagnosed. The next day (November 23rd) the operation for tion, occasional bilious vomiting, and great decline of general artificial anus was performed in the manner already described, health. The physical signs, on admission, indicated limited the edges of the wound in the gut being attached by six intersoftening at the posterior apex of the right lung, with much rupted sutures to the margin of the external wound. A short No time afterwards, the faeces began to flow from the new opening, more extensive softening at the anterior apex of the left. continued to do so in great quantities. Three hours after improvement took place at any time during her residence in and the evacuations were still much larger in quanhospital: the general health continued to decline; and at the the operation, last careful examination, on the 13th of October, the physical tity. The pulse at this time was 130, and very weak, and the was supported by beef-tea and brandy frequently given. signs indicated a small cavity with surrounding softening at patient the right apex, and on the left a cavity comprehending most of The pulse subsequently rose; she rejected everythingshe swalthe upper lobe, both cavities in a more or less active condition. lowed, and died twelve hours after the operation. At the autopsy, the peritoneum was found extensively inOn Oct. 19th, during the early morning, she complained of flamed, and its cavity contained an ounce of pus, with about some uneasiness and aching in the upper part of the right side of the back. About half-past nine A.M. this uneasiness sud- two ounces in the pelvis, between the uterus and rectum. The denly resolved itself into very acute pain; and this was fol- omentum was adherent to an old band close to the wound. its: lowed, on the instant, by great oppression of the respiration. The stricture of the colon was annular, firm, and dense,The When seen about two minutes afterwards by Dr. Cotton’s mucous coat being ulcerated at the most contracted part. firmly bound to the iliac fossa, close to Poupart’s house-physician, the dyspncea and anxiety were extreme. On intestine was that of ligament, the chest was part of the bowel above and that below the examination, bulging right quite perceptible to the hand, the percussion-tone all over it was distinctly tym- stricture forming an acute angle with each other. panitic, and respiratory sounds were heard, only very weak and distant, over the ’oack. Collapse followed so rapidly that MALIGNANT DISEASE OF THE TIBIA. no minuter examination was attempted; and the patient, layON the 28th of October, we saw three cases at St. George’s herself on her moved with the which scarcely ing right side, respiratory efforts, gradually sank, and died in six hours and a Hospital in which the right knee was either itself implicated half after the attack. by disease, or had disease very close to it. Thus, one was The diagnosis of pneumothorax was from the first but too an example of housemaid’s knee, in which a thick patellar the very exhausted previous condition bursa was dissected out by Mr. Charles Johnson (as described easy; of the patient, and the state of the left lung, no treatment in a previous number). A second was a case of most extensive disease of the articulation-complete disorganization-for which was considered advisable but the use of sinapisms, which were effectual in removing the pain, and stimulants, which she could the leg was taken off by the same surgeon, by means of the hardly swallow, and which did not perceptibly retard the fatal circular amputation above the joint. The patient, a man about issue. thirty, had been in the hospital three months before with Sectio cadaveris, twenty-:four laours after death.-Right side ofacute inflammation of the joint and symptoms of ulcerated chest obviously larger than left, and tympanitis all over on cartilages. He went out much relieved at that time, but unpercussion. On cutting through the anterior thoracic wall, the! fortunately injured the same knee, and was again admitted air gushed out on the right, and, on raising it, the cavity of the, three weeks ago, with a large abscess over the head of the right pleura was found quite distended. No fluid was present; tibia communicating with the joint. When the limb was in the cavity; but the lung was pushed backwards and up examined after removal, utter destruction of the entire articuwards, and reduced to the size of a man’s fist. No adhesions lation was found, implicating the soft structures below it, in were present, except three quite adjacent, narrow, inch-long immediate proximity to the abscess. bands. about two inches from the apex laterally. The left lung; The third patient was a lad aged eighteen years, admitted was of natural volume, and quite free from adhesions. On push under Mr. Tatum’s care, with pain below the knee, accompanied ing the bellows’ point through a hole in the trachea down int(> with swelling and an indistinct and doubtful fluctuation. The
ever,
PHTHISIS; PNEUMOTHORAX; FATAL RESULT. (Under the care of Dr. COTTON.)
but considering
.
-
; -
604
found right bronchus, regurgitation being prevented, it the expand the lung. No aperture of escape, howimpossible was
to
was visible in front. The right lung was now carefully removed from the thorax, and, on renewing the expansive efforts with the lung under water, the perforation was at once THE fatality of pneumothorax is by no means proportionate detected. It lay an inch and a half from the posterior apex, in to its frequency. Of six well-marked cases which have occurred size equal to a large pin’s head, well defined at the edges, which were gradually thinned towards the opening, and surrounded in the above hospital within the last three months, only oneby a very pale piece of pleura, about an inch and a quarter in that which we record to-day-proved directly fatal. In an- diameter, and which towards the perforation had an appearother, where tubercular disease was also very far advanced, the ance as of concentric arrangement, produced, as found afterby various degrees of thinning. The perforation compatient went about for some days, but died ten days after the wards, attack. In a third case, the immediate effects were very vio- municated with a tubercular cavity, the size of a large walnut, with shreddy, ragged wallr. The cavity, again, was in direct lent, but the ultimate result beneficial, inasmuch as the pul- connexion with a moderately large bronchus, which satisfacmonary disease was arrested. The other three cases are still torily accounted for the complete resistance presented to all under observation. The obvious cause of the non-fatal issue, efforts at expansion. The left lung contained a cavity occupyin most of such cases, is the amount of previous pleuritic ad- ing almost the whole upper lobe; while in the lower lobe were hesion, limiting the extent and amount of pressure. It is very some cheesy deposits, situated chiefly in lines immediately beneath the pleura. The liver was large, congested, and fatty. rare indeed that we meet with so very advanced pulmonary disease with so little attendant adhesion as in the following case; and it is the more remarkable, considering the tendency exhibited here for the tubercular deposit to show itself, in the CLINICAL RECORDS. first instance, immediately beneath the pleura. In ttte lung itself, moreover, there was little or no congestion of the tissue around the softening tubercles. THE LATE OPERATION FOR ARTIFICIAL ANUS. Perhaps this may be taken in connexion with a fact observed IN relation to this important case, of which we gave a brief during the course of treatment-viz., that counter-irritation instead of, as in most cases, giving positive relief, and tending record on the 27th of November, we may observe that the cirto arrest the disease, did, in this case, give no relief, but pro- cumscribed abscess situated above Poupart’s ligament did not duced only irritation and weakness. Was there any attendant communicate with the intestine or abdominal cavity, and it inflammation or congestion to subdue ? This subject is fully was external to the abdominal muscles. Six days after this treated of in Dr. Cotton’s work " On Consumption." We abscess was opened, a large slough came away, and the dis. avail ourselves of the notes taken by Dr. Maxwell at the charge lost its foetor and became healthy in character. When the bowels afterwards ceased to act, tubes passed per anum hospital :E. W , aged twenty-nine, single, lady’s-maid, was" ad- would not go up beyond seven or eight inches, being opposed mitted into the hospital on June 28th, 1858. Her illness dated by some hard obstruction, which when pressed upon produced from January of the present year, and its origin was ascribed excruciating pain. The bowels had now been constipated for to over-exertion in nursing a brother, who died about that time fourteen days, and on careful examination by Mr. Lane and of phthisis. The principal features of her complaint were, fre- Dr. Sibson, obstruction in the sigmoid flexure of the colon was quent harassing cough, copious frothy and purulent expectora- diagnosed. The next day (November 23rd) the operation for tion, occasional bilious vomiting, and great decline of general artificial anus was performed in the manner already described, health. The physical signs, on admission, indicated limited the edges of the wound in the gut being attached by six intersoftening at the posterior apex of the right lung, with much rupted sutures to the margin of the external wound. A short No time afterwards, the faeces began to flow from the new opening, more extensive softening at the anterior apex of the left. continued to do so in great quantities. Three hours after improvement took place at any time during her residence in and the evacuations were still much larger in quanhospital: the general health continued to decline; and at the the operation, last careful examination, on the 13th of October, the physical tity. The pulse at this time was 130, and very weak, and the was supported by beef-tea and brandy frequently given. signs indicated a small cavity with surrounding softening at patient the right apex, and on the left a cavity comprehending most of The pulse subsequently rose; she rejected everythingshe swalthe upper lobe, both cavities in a more or less active condition. lowed, and died twelve hours after the operation. At the autopsy, the peritoneum was found extensively inOn Oct. 19th, during the early morning, she complained of flamed, and its cavity contained an ounce of pus, with about some uneasiness and aching in the upper part of the right side of the back. About half-past nine A.M. this uneasiness sud- two ounces in the pelvis, between the uterus and rectum. The denly resolved itself into very acute pain; and this was fol- omentum was adherent to an old band close to the wound. its: lowed, on the instant, by great oppression of the respiration. The stricture of the colon was annular, firm, and dense,The When seen about two minutes afterwards by Dr. Cotton’s mucous coat being ulcerated at the most contracted part. firmly bound to the iliac fossa, close to Poupart’s house-physician, the dyspncea and anxiety were extreme. On intestine was that of ligament, the chest was part of the bowel above and that below the examination, bulging right quite perceptible to the hand, the percussion-tone all over it was distinctly tym- stricture forming an acute angle with each other. panitic, and respiratory sounds were heard, only very weak and distant, over the ’oack. Collapse followed so rapidly that MALIGNANT DISEASE OF THE TIBIA. no minuter examination was attempted; and the patient, layON the 28th of October, we saw three cases at St. George’s herself on her moved with the which scarcely ing right side, respiratory efforts, gradually sank, and died in six hours and a Hospital in which the right knee was either itself implicated half after the attack. by disease, or had disease very close to it. Thus, one was The diagnosis of pneumothorax was from the first but too an example of housemaid’s knee, in which a thick patellar the very exhausted previous condition bursa was dissected out by Mr. Charles Johnson (as described easy; of the patient, and the state of the left lung, no treatment in a previous number). A second was a case of most extensive disease of the articulation-complete disorganization-for which was considered advisable but the use of sinapisms, which were effectual in removing the pain, and stimulants, which she could the leg was taken off by the same surgeon, by means of the hardly swallow, and which did not perceptibly retard the fatal circular amputation above the joint. The patient, a man about issue. thirty, had been in the hospital three months before with Sectio cadaveris, twenty-:four laours after death.-Right side ofacute inflammation of the joint and symptoms of ulcerated chest obviously larger than left, and tympanitis all over on cartilages. He went out much relieved at that time, but unpercussion. On cutting through the anterior thoracic wall, the! fortunately injured the same knee, and was again admitted air gushed out on the right, and, on raising it, the cavity of the, three weeks ago, with a large abscess over the head of the right pleura was found quite distended. No fluid was present; tibia communicating with the joint. When the limb was in the cavity; but the lung was pushed backwards and up examined after removal, utter destruction of the entire articuwards, and reduced to the size of a man’s fist. No adhesions lation was found, implicating the soft structures below it, in were present, except three quite adjacent, narrow, inch-long immediate proximity to the abscess. bands. about two inches from the apex laterally. The left lung; The third patient was a lad aged eighteen years, admitted was of natural volume, and quite free from adhesions. On push under Mr. Tatum’s care, with pain below the knee, accompanied ing the bellows’ point through a hole in the trachea down int(> with swelling and an indistinct and doubtful fluctuation. The
ever,
PHTHISIS; PNEUMOTHORAX; FATAL RESULT. (Under the care of Dr. COTTON.)
but considering
.
-
; -
604