- Email: [email protected]
INVOLUNTARY REDUCTION OF DISLOCATION OF THE SHOULDER.
1733
along the intestine till it reached the ileo-cmeal valve, given on account of some pain which was speedily relieved. in which position it was found ; and it is almost incredible The patient took by the mouth a little iced water and occato believe that a sharp pin four and a half inches long sional drops of milk up to the 10th, being fed up to this date could pass the tortuous and in places acutely bent track by nutrient enemata and on this date the bowels acted of the small intestine without laceration or some other slightly normally. From the llth the patient was given a In my own case, on the other hand, the more solid diet, consisting largely of fish and suet dumplings, serious damage. pin never passed beyond the stomach ; in fact, when found to ensure the passage of the pin-head over the appendix. it was lying in that viscus as though it had never turned or The first suture was removed on the 16th. An oil enema been disturbed in any way. was given on the 18th which brought away the head of the On Dec. 3rd, 1897, the patient, a woman, 60 years of age, pin. The patient was up wearing an abdominal belt with It stuck in her throat and she the wound quite healed on the 23rd. There was no fever was eating a crust of bread. unsuccessfully attempted to push it down with her finger, throughout the cafe. and then feeling herself aaffocating she passed a bonnet-pin Winchcombe. do vn head first, hoping to dislodge it. In doing this the pjiat of the pin stuck fast in her palate and only with difficulty did she manage to disengage it. In doing so she loosed her hold of the pin and _it slipped down her throat. She thought very little of the accident, believing that the pin would soon pass from her, and to accomplish this end MEDICAL, SURGICAL, OBSTETRICAL, AND she took strong purgatives. She experienced little inconTHERAPEUTICAL. venience till the 5tb, when she felt a pricking pain in the abdomen high up in the epigastric region. She was admitted On examination to the Winchcombe Cottage Hospital. INVOLUNTARY REDUCTION OF DISLOCATION OF on the 7th nothing could be felt by external maniTHE SHOULDER. pulation, but on deep pressure over the left iliac BY E. IRVING DAY, L.R.C.P. LOND. fossa she complained of sharp pricking pains and of similar pains in this locality when she moved, coughed, or stooped. The pain had completely moved from the epigastric region ; I WAS called to see a woman who was reported to have ___
Clinical Notes:
there was no sickness, the motions were normal in colour, and the patient was quite free from pain when still. Her temperature before the operation was 9940 F. On the 7th, the patient having been prepared for operation by all solids i being withheld for 24 hours and a good enema having been given so that the bowel was fairly empty, she was put under chloroform by my colleague, Mr. Cox. The abdominal walls were rendered aseptic by a carbolic pad which was worn for four hours previously to the operation. An incision three inches long was made downwards in the middle line from one and a half inches below the umbilicus. The bowel, being much distended with flatus, immediately protruded. I passed my hand down to the left iliac region where the sensation of pricking had been experienced but could find no trace of the pin. Believing that she might have exaggerated the size of the body swallowed I carefully examined inch by inch the coils of intestine in this locality, but again with negative result. I next enlarged the incision upwards to the extent of one inch and passed my hand towards the stomach and after much difficulty I detected the shaft of the pin lying in that organ. The head lay upwards and to the right and the point downwards and to the left. The point was embedded in the posterior wall of the stomach and I found it impossible to extricate it by manipulation owing to its being so far from the abdominal incision. From the position of the pin I concluded that the best course to adopt was to draw it through the hole which was already partially made by its point, and consequently, with a finger guiding its point, I made steady pressure on the head over the anterior stomach wall and ultimately succeeded in bringing the shaft of the pin (see illustration) through the posterior wall of the stomach
Illustration
(diagrammatic) of pin reduced one-half.
fallen and injured herself. On examination I found that she had dislocated her right shoulder by the fall, the symptoms being quite typical and unmistakable. I made a somewhat mild attempt to reduce the dislocation, but she complained so much of the pain that I thought it advisable to use an anaesthetic for the purpose-indeed, she would not hear of my doing anything further without its aid. Having omitted to bring any with me and the hour being rather late I decided to call in the morning, which I accordingly did, armed with the necessaries I required. On uncovering the shoulder I at once noticed a difference and soon I found that the dislocation had been reduced. asked her what had happened and she told me that she had fallen asleep with her injured arm her lap, as I had left it, within a sling. on She was sitting in a chair, as sbe had too much pa’n in hEr shoulder to with to go to bed. Having been asleep about half an hour she woke up with a start; she felt herself slip slightly downwards and at the same time felt a violent pain in her injured shoulder wh;ch almost made her faint. On recovering herself the pain was all gore and she ffl6 so much better that sbe got into bed and slept the remainder of the night. She felt that "something had happ-ned," but hardly dared to think that her shoulder was all right again. However, it was so, and the case is a good illustra1ion of how easily a dislocation can be reductd when the muscles are relaxed, if only in sleep. I may say that the woman was of stout bu’ld and that she had never previously dislocated the joint. The dislocation was the normal sub-coracoid variety. Henley-on-Thames. A CASE OF INFANTILE HEMIPLEGIA ASSOCIATED WITH APHASIA.
BY F. W. ERNEST HUTCHISON,
M.S. GLASG.
M.B., descending layer of omentum. Abandoning my intention of and the stomach wall extriincising original THE patient, a male, aged two years, on Oct. 3rd, 1899, cating the head of the pin, I made gentle traction on the shaft and carefully passing a pair of bone forceps whilst playing, fell off a doorstep and when picked up was along it I nipped the shaft through close to the stomach found "to be paralysed and unable to speak." I saw the wall, leaving the head free in that viscus. I experienced about two hours afterwards. The right arm, leg, very great difficulty in replacing the highly inflated patient and lower part of the face and tongue were paralysed, espebowel. This was eventually done by means of pressure with warm sponges and the abdominal incision was closed cially the leg and arm. The angle of the mouth was drawn with silkworm-gut. I employed four deep interrupted upwards and to the sound side. There was complete absence sutures, including all the thickness of the parietes except of speech. The little patient did not appear to comprehend the parietal peritoneum, and six smaller superficial sutures anything that was said to him. Articles which he had were distributed amongst these. The wound was dusted been very fond of playing with and previously knew with iodoform and boric powder and a dressing of wet well by name now appeared quite incomprehensible to mercury and zinc cyanide gauze and a thick pad of Gamgee him when he was asked if he would like so-and-so, tissue included in a many-tailed bandage were applied. A but directly they were exhibited to him he changed nutrient enema of beef tea containing one ounce of whisky his expression to one of comprehension, smiled with was given. On the evening of the day of operation a hypo- delight, and wished for the same. The previous health dermic injection of one quarter of a grain of morphia was had been good, and he had never suffered from scarlet and the
along the intestine till it reached the ileo-cmeal valve, given on account of some pain which was speedily relieved. in which position it was found ; and it is almost incredible The patient took by the mouth a little iced water and occato believe that a sharp pin four and a half inches long sional drops of milk up to the 10th, being fed up to this date could pass the tortuous and in places acutely bent track by nutrient enemata and on this date the bowels acted of the small intestine without laceration or some other slightly normally. From the llth the patient was given a In my own case, on the other hand, the more solid diet, consisting largely of fish and suet dumplings, serious damage. pin never passed beyond the stomach ; in fact, when found to ensure the passage of the pin-head over the appendix. it was lying in that viscus as though it had never turned or The first suture was removed on the 16th. An oil enema been disturbed in any way. was given on the 18th which brought away the head of the On Dec. 3rd, 1897, the patient, a woman, 60 years of age, pin. The patient was up wearing an abdominal belt with It stuck in her throat and she the wound quite healed on the 23rd. There was no fever was eating a crust of bread. unsuccessfully attempted to push it down with her finger, throughout the cafe. and then feeling herself aaffocating she passed a bonnet-pin Winchcombe. do vn head first, hoping to dislodge it. In doing this the pjiat of the pin stuck fast in her palate and only with difficulty did she manage to disengage it. In doing so she loosed her hold of the pin and _it slipped down her throat. She thought very little of the accident, believing that the pin would soon pass from her, and to accomplish this end MEDICAL, SURGICAL, OBSTETRICAL, AND she took strong purgatives. She experienced little inconTHERAPEUTICAL. venience till the 5tb, when she felt a pricking pain in the abdomen high up in the epigastric region. She was admitted On examination to the Winchcombe Cottage Hospital. INVOLUNTARY REDUCTION OF DISLOCATION OF on the 7th nothing could be felt by external maniTHE SHOULDER. pulation, but on deep pressure over the left iliac BY E. IRVING DAY, L.R.C.P. LOND. fossa she complained of sharp pricking pains and of similar pains in this locality when she moved, coughed, or stooped. The pain had completely moved from the epigastric region ; I WAS called to see a woman who was reported to have ___
Clinical Notes:
there was no sickness, the motions were normal in colour, and the patient was quite free from pain when still. Her temperature before the operation was 9940 F. On the 7th, the patient having been prepared for operation by all solids i being withheld for 24 hours and a good enema having been given so that the bowel was fairly empty, she was put under chloroform by my colleague, Mr. Cox. The abdominal walls were rendered aseptic by a carbolic pad which was worn for four hours previously to the operation. An incision three inches long was made downwards in the middle line from one and a half inches below the umbilicus. The bowel, being much distended with flatus, immediately protruded. I passed my hand down to the left iliac region where the sensation of pricking had been experienced but could find no trace of the pin. Believing that she might have exaggerated the size of the body swallowed I carefully examined inch by inch the coils of intestine in this locality, but again with negative result. I next enlarged the incision upwards to the extent of one inch and passed my hand towards the stomach and after much difficulty I detected the shaft of the pin lying in that organ. The head lay upwards and to the right and the point downwards and to the left. The point was embedded in the posterior wall of the stomach and I found it impossible to extricate it by manipulation owing to its being so far from the abdominal incision. From the position of the pin I concluded that the best course to adopt was to draw it through the hole which was already partially made by its point, and consequently, with a finger guiding its point, I made steady pressure on the head over the anterior stomach wall and ultimately succeeded in bringing the shaft of the pin (see illustration) through the posterior wall of the stomach
Illustration
(diagrammatic) of pin reduced one-half.
fallen and injured herself. On examination I found that she had dislocated her right shoulder by the fall, the symptoms being quite typical and unmistakable. I made a somewhat mild attempt to reduce the dislocation, but she complained so much of the pain that I thought it advisable to use an anaesthetic for the purpose-indeed, she would not hear of my doing anything further without its aid. Having omitted to bring any with me and the hour being rather late I decided to call in the morning, which I accordingly did, armed with the necessaries I required. On uncovering the shoulder I at once noticed a difference and soon I found that the dislocation had been reduced. asked her what had happened and she told me that she had fallen asleep with her injured arm her lap, as I had left it, within a sling. on She was sitting in a chair, as sbe had too much pa’n in hEr shoulder to with to go to bed. Having been asleep about half an hour she woke up with a start; she felt herself slip slightly downwards and at the same time felt a violent pain in her injured shoulder wh;ch almost made her faint. On recovering herself the pain was all gore and she ffl6 so much better that sbe got into bed and slept the remainder of the night. She felt that "something had happ-ned," but hardly dared to think that her shoulder was all right again. However, it was so, and the case is a good illustra1ion of how easily a dislocation can be reductd when the muscles are relaxed, if only in sleep. I may say that the woman was of stout bu’ld and that she had never previously dislocated the joint. The dislocation was the normal sub-coracoid variety. Henley-on-Thames. A CASE OF INFANTILE HEMIPLEGIA ASSOCIATED WITH APHASIA.
BY F. W. ERNEST HUTCHISON,
M.S. GLASG.
M.B., descending layer of omentum. Abandoning my intention of and the stomach wall extriincising original THE patient, a male, aged two years, on Oct. 3rd, 1899, cating the head of the pin, I made gentle traction on the shaft and carefully passing a pair of bone forceps whilst playing, fell off a doorstep and when picked up was along it I nipped the shaft through close to the stomach found "to be paralysed and unable to speak." I saw the wall, leaving the head free in that viscus. I experienced about two hours afterwards. The right arm, leg, very great difficulty in replacing the highly inflated patient and lower part of the face and tongue were paralysed, espebowel. This was eventually done by means of pressure with warm sponges and the abdominal incision was closed cially the leg and arm. The angle of the mouth was drawn with silkworm-gut. I employed four deep interrupted upwards and to the sound side. There was complete absence sutures, including all the thickness of the parietes except of speech. The little patient did not appear to comprehend the parietal peritoneum, and six smaller superficial sutures anything that was said to him. Articles which he had were distributed amongst these. The wound was dusted been very fond of playing with and previously knew with iodoform and boric powder and a dressing of wet well by name now appeared quite incomprehensible to mercury and zinc cyanide gauze and a thick pad of Gamgee him when he was asked if he would like so-and-so, tissue included in a many-tailed bandage were applied. A but directly they were exhibited to him he changed nutrient enema of beef tea containing one ounce of whisky his expression to one of comprehension, smiled with was given. On the evening of the day of operation a hypo- delight, and wished for the same. The previous health dermic injection of one quarter of a grain of morphia was had been good, and he had never suffered from scarlet and the