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HYSTERICAL PAIN OF THE KNEE.
triangular and projecting masses beneath the skin. Mr. Coulson pointed out that the involvement of the glands in the disease precluded the adoption of operative procedure, and con-
fined himself to the use of tonic and anodyne remedies, with local palliatives. As the case progressed, fulness was noticed about the left lumbar region; the muscles were tense, and beneath them could be discerned a hard mass, which ultimately extended from the false ribs to the upper margin of the ilium. The fulness of the veins of the chest and abdomen indicated internal pressure. The bowels were constipated. A few days before death convulsions became frequent. The child died on the 27th of November. The post-mortem examination, which we had the opportunity of witnessing, showed that the encephaloid mass had almost wholly destroyed the left testicle, from which it sprang; the inguinal glands and spermatic cord were infiltrated; and the left kidney was occupied by a large encephaloid mass, of the size of a child’s head. It is rare for both testicles to be attacked, and in this case only the left was affected. The youth of the patient gives considerable interest to the case. Infancy and old age are usually free from this disease, which is favoured by the middle period of life ; but no Mr. Coulson remarked that the age is altogether exempt. rapid progress of the disease after irritation by tapping ought to be noted, since in the intermediate stages between the deposit of the cancerous matter in the testicle and the destruction of the tunica albuginea, which is followed by the protrusion of the morbid growth, the cavity of the tunica vaginalis is not unfrequently more or less distended with serum, the product of inflammation, which might lead to an error in diagnosis. Tapping can, of course, only serve to hasten the progress of the disease, and from the presence of the vascular network which is usually interweaved amidst the morbid deposit, the occurrence of troublesome, or even, as in this case, exhausting bleeding, is always to be apprehended.
FRACTURE OF THE
HUMERUS,
THE ELBOW BEING EXCISED SOME YEARS BEFORE BY THE
LATE MR. LISTON.
THE brief account which we give of this case will be found very interesting. The patient had excision of the elbow performed by Mr. Liston many years ago, and had a most useful arm. By an accident the humerus was broken in October last, and he became an out-patient at University College Hospital. The particulars of the case do not mention the ultimate result, but we have learnt that union of the fracture subse-
quently occurred. John H-, aged forty-nine, a cab-proprietor, presented himself at Mr. Erichsen’s out-patient room, on the 22nd of October last. Six days ago, whilst inebriated, he fell down, since which he has felt great pain in the right elbow-joint. On examination, a fracture was distinguished -piece of bone being chipped off-at the lower and outer part of the humerus.
From the altered appearance of the part, it was manifest that excision of the articular ends of the bones forming the elbowjoint had been performed. On questioning him, the following was gathered:—" A few weeks before Mr. Liston’s death, he was admitted into University College Hospital on account of After a residence of some an injury the limb had sustained. time in the hospital, the joint became disorganized, and his health impaired. Resection of the diseased bones was proposed, acceded to, and performed by Mr. Liston. The result The operation was favourable, and he soon left the hospital. The limb for all purwas performed by aT-shaped incision." poses is equal to its fellow. Any weight can be lifted by it. There is not full extension or flexion, but still both actions exist to a sufficient extent. Pronation and supination of the forearm slight. A PRACTICAL POINT IN AMPUTATION OF THE LEG.
LATELY a man, whose left leg had been amputated, was admitted into the Royal Free Hospital. The foot, having been AT St. Bartholomew’s Hospital, Mr. Skey has under his care crushed some twelve years previously, was then removed at the a curious and instructive case of hysterical pain in the knee. ankle, and subsequently amputation was performed in the The patient is a girl of seventeen, who was admitted on lower third of the leg. When admitted, owing to retraction of the 30th of December, with a most agonizing pain situated in the posterior flap, the tibia was protruding, and the sharp the left knee-joint, which had existed for five weeks. The margin of the truncated bone projected forward through the slightest touch caused her to cry out, and she evinced great skin. Mr. Gant amputated the leg high up through the fleshy anxiety and fear even before the limb was actually examined. belly of the gastrocnemius, and sawed off the bone obliquely With this dreadiul pain, there were no symptoms whatever of from before backwards, so as to allow the anterior flap of skin £ She had to rest upon a flat surface of bone. The vessels having been any real mischief going on in the articulation itself. not menstruated for three months, but was otherwise healthy, divided near their origin from the popliteal, many ligatures though of delicate complexion and nervous temperament. Mr. were required to suppress the hsemorrhage. After the operaSkey had the girl well supported with wine and good nourish- tion it was remarked that the tibia was the only bone in the ing diet, and an opium lotion was ordered. This treatment body which, being subcutaneous, was involved in an amputaseems to have greatly mitigated the pain. Every surgeon is tion, and that therefore it would be a good rule always to saw aware that in women the hysterical condition gives rise to an that bone obliquely from before backwards, and thus avoid the amount of pain which is never present as the actual result of probable occasion of a second amputation. In due time the organic disease itself. In this girl, who was under the impres- man left the hospital with a sound and well-covered stump. sion that something very active was being done for her, the pain has subsided, and the joint still retains the natural and healthy condition which it had on her admission. A cradle was at first used to protect the joint; it is now dispensed with, and the weight of the clothes upon it is borne without inconvenience. M edico-Chi1’u1’gical Transactions. Second Series, Vol. XXIII, London : Longman and Co. 185S. MORBUS BRIGHTII, WITH DISEASE OF BLOODProceedings of the Royal ivedico- C7tirurgical Society of London. VESSELS, AND THREATENED GANGRENE. Vol. II. London, 185S. IN one of the medical wards of Guy’s Hospital, on Jan. 4th, TAKEN altogether, we are inclined to consider the present Dr. Wilks (who was going round for Dr. Owen Rees) showed volume of the " Transactions" as the most important which the us the case of a man, aged thirty-five, who has had granular Society has published during the past three kidney for years, the urine being now pale and watery. The Medico-Chirurgical or four years; for it not only contains papers by some of the best patient has long afforded a good example of Bright’s disease, with the association of disease of the bloodvessels, many of observers in the profession, but many of the communications are which can be felt quite hard under the finger. This feature is of great value. On comparing the 11 Transactions" with the by no means uncommon in this affection, as most pathologists "Proceedings,"it appears that during the last session thirty-one know. The condition of the bloodvessels in this patient was, papers were read before the Fellows, of which number twentyno doubt, the cause of an attack a few months back of threatened gangrene of the toes of the right foot, for which he was one have been deemed worthy of publication in full. Before under Mr. Birkett’s care in the surgical wards, but fortunately noticing the most important of these, we would make a few actual mortification and sloughing did not ensue. At the pre. observations on the essays which appear only in abstract in the sent time the foot, although it has resumed vitality, does not that the printing of the latter still look very healthy. He has had a discharge from his left ear, "Proceedings;" premising seems to us an unpardonable waste of money. As, however, with deafness, for the past eight or nine weeks, and is taking iron wine, with the julep of the acetate of ammonia, combined this was pointed out last year in these pages, and as the sugwith tincture of hyoscyamus. It may be said that here are no gestions then made have received no consideration, it would less than four serious maladies in the same patient. only be a thankless task to insist further upon this matter.
HYSTERICAL PAIN OF THE KNEE.
Reviews and
Notices of Books.
__
57
fined himself to the use of tonic and anodyne remedies, with local palliatives. As the case progressed, fulness was noticed about the left lumbar region; the muscles were tense, and beneath them could be discerned a hard mass, which ultimately extended from the false ribs to the upper margin of the ilium. The fulness of the veins of the chest and abdomen indicated internal pressure. The bowels were constipated. A few days before death convulsions became frequent. The child died on the 27th of November. The post-mortem examination, which we had the opportunity of witnessing, showed that the encephaloid mass had almost wholly destroyed the left testicle, from which it sprang; the inguinal glands and spermatic cord were infiltrated; and the left kidney was occupied by a large encephaloid mass, of the size of a child’s head. It is rare for both testicles to be attacked, and in this case only the left was affected. The youth of the patient gives considerable interest to the case. Infancy and old age are usually free from this disease, which is favoured by the middle period of life ; but no Mr. Coulson remarked that the age is altogether exempt. rapid progress of the disease after irritation by tapping ought to be noted, since in the intermediate stages between the deposit of the cancerous matter in the testicle and the destruction of the tunica albuginea, which is followed by the protrusion of the morbid growth, the cavity of the tunica vaginalis is not unfrequently more or less distended with serum, the product of inflammation, which might lead to an error in diagnosis. Tapping can, of course, only serve to hasten the progress of the disease, and from the presence of the vascular network which is usually interweaved amidst the morbid deposit, the occurrence of troublesome, or even, as in this case, exhausting bleeding, is always to be apprehended.
FRACTURE OF THE
HUMERUS,
THE ELBOW BEING EXCISED SOME YEARS BEFORE BY THE
LATE MR. LISTON.
THE brief account which we give of this case will be found very interesting. The patient had excision of the elbow performed by Mr. Liston many years ago, and had a most useful arm. By an accident the humerus was broken in October last, and he became an out-patient at University College Hospital. The particulars of the case do not mention the ultimate result, but we have learnt that union of the fracture subse-
quently occurred. John H-, aged forty-nine, a cab-proprietor, presented himself at Mr. Erichsen’s out-patient room, on the 22nd of October last. Six days ago, whilst inebriated, he fell down, since which he has felt great pain in the right elbow-joint. On examination, a fracture was distinguished -piece of bone being chipped off-at the lower and outer part of the humerus.
From the altered appearance of the part, it was manifest that excision of the articular ends of the bones forming the elbowjoint had been performed. On questioning him, the following was gathered:—" A few weeks before Mr. Liston’s death, he was admitted into University College Hospital on account of After a residence of some an injury the limb had sustained. time in the hospital, the joint became disorganized, and his health impaired. Resection of the diseased bones was proposed, acceded to, and performed by Mr. Liston. The result The operation was favourable, and he soon left the hospital. The limb for all purwas performed by aT-shaped incision." poses is equal to its fellow. Any weight can be lifted by it. There is not full extension or flexion, but still both actions exist to a sufficient extent. Pronation and supination of the forearm slight. A PRACTICAL POINT IN AMPUTATION OF THE LEG.
LATELY a man, whose left leg had been amputated, was admitted into the Royal Free Hospital. The foot, having been AT St. Bartholomew’s Hospital, Mr. Skey has under his care crushed some twelve years previously, was then removed at the a curious and instructive case of hysterical pain in the knee. ankle, and subsequently amputation was performed in the The patient is a girl of seventeen, who was admitted on lower third of the leg. When admitted, owing to retraction of the 30th of December, with a most agonizing pain situated in the posterior flap, the tibia was protruding, and the sharp the left knee-joint, which had existed for five weeks. The margin of the truncated bone projected forward through the slightest touch caused her to cry out, and she evinced great skin. Mr. Gant amputated the leg high up through the fleshy anxiety and fear even before the limb was actually examined. belly of the gastrocnemius, and sawed off the bone obliquely With this dreadiul pain, there were no symptoms whatever of from before backwards, so as to allow the anterior flap of skin £ She had to rest upon a flat surface of bone. The vessels having been any real mischief going on in the articulation itself. not menstruated for three months, but was otherwise healthy, divided near their origin from the popliteal, many ligatures though of delicate complexion and nervous temperament. Mr. were required to suppress the hsemorrhage. After the operaSkey had the girl well supported with wine and good nourish- tion it was remarked that the tibia was the only bone in the ing diet, and an opium lotion was ordered. This treatment body which, being subcutaneous, was involved in an amputaseems to have greatly mitigated the pain. Every surgeon is tion, and that therefore it would be a good rule always to saw aware that in women the hysterical condition gives rise to an that bone obliquely from before backwards, and thus avoid the amount of pain which is never present as the actual result of probable occasion of a second amputation. In due time the organic disease itself. In this girl, who was under the impres- man left the hospital with a sound and well-covered stump. sion that something very active was being done for her, the pain has subsided, and the joint still retains the natural and healthy condition which it had on her admission. A cradle was at first used to protect the joint; it is now dispensed with, and the weight of the clothes upon it is borne without inconvenience. M edico-Chi1’u1’gical Transactions. Second Series, Vol. XXIII, London : Longman and Co. 185S. MORBUS BRIGHTII, WITH DISEASE OF BLOODProceedings of the Royal ivedico- C7tirurgical Society of London. VESSELS, AND THREATENED GANGRENE. Vol. II. London, 185S. IN one of the medical wards of Guy’s Hospital, on Jan. 4th, TAKEN altogether, we are inclined to consider the present Dr. Wilks (who was going round for Dr. Owen Rees) showed volume of the " Transactions" as the most important which the us the case of a man, aged thirty-five, who has had granular Society has published during the past three kidney for years, the urine being now pale and watery. The Medico-Chirurgical or four years; for it not only contains papers by some of the best patient has long afforded a good example of Bright’s disease, with the association of disease of the bloodvessels, many of observers in the profession, but many of the communications are which can be felt quite hard under the finger. This feature is of great value. On comparing the 11 Transactions" with the by no means uncommon in this affection, as most pathologists "Proceedings,"it appears that during the last session thirty-one know. The condition of the bloodvessels in this patient was, papers were read before the Fellows, of which number twentyno doubt, the cause of an attack a few months back of threatened gangrene of the toes of the right foot, for which he was one have been deemed worthy of publication in full. Before under Mr. Birkett’s care in the surgical wards, but fortunately noticing the most important of these, we would make a few actual mortification and sloughing did not ensue. At the pre. observations on the essays which appear only in abstract in the sent time the foot, although it has resumed vitality, does not that the printing of the latter still look very healthy. He has had a discharge from his left ear, "Proceedings;" premising seems to us an unpardonable waste of money. As, however, with deafness, for the past eight or nine weeks, and is taking iron wine, with the julep of the acetate of ammonia, combined this was pointed out last year in these pages, and as the sugwith tincture of hyoscyamus. It may be said that here are no gestions then made have received no consideration, it would less than four serious maladies in the same patient. only be a thankless task to insist further upon this matter.
HYSTERICAL PAIN OF THE KNEE.
Reviews and
Notices of Books.
__
57