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LEICESTER MEDICAL SOCIETY.
treated all such cases in Jervis-street Hospital antiseptically, hypochondrium ten not dream of
years ago.
Four years since
pain
and
amputating in an ordinary swelling began in the epigastrium, which became very severe case of compound luxation.-Mr. CROLY, in reply, thought three weeks before her admission to the Leicester Infirmary. injuries to the ankle-joint were not favourable to primary There was bilious vomiting, but no jaundice was noticed. amputation, and therefore students should be cautioned not The urine was high-coloured; the stools were never white. to rush for an amputation knife in cases of compound dis- On admission there was fulness over the liver, and below it a location of the ankle. In the cases which he had described pear-shaped swelling to the right of the rectus muscle. On he enlarged the wound to give room for drainage, and anti- Aug. 27th, 1889, an incision three inches and a half long septic surgery was carried out in its integrity. Tenotomy was made over the most prominent part of the tumour. The of the tendo Achillis was not necessary. It was a sugges- gall-bladder was seen in the wound, and the fluid, which tion by Campbell de Morgan, and was injurious, as weaken- was clear and limpid, was withdrawn by an aspirator, and ing the back of the leg by taking away needful support. the gall-bladder then opened. A loose gall-stone was reHe was glad the President had endorsed the opinion that moved, but another was felt firmly impacted in the cystic preservative surgery of the foot ought to be kept in view in duct. Fruitless efforts were made to dislodge or break up the stone, and the patient was sent back to bed. The gallcompound dislocations. bladder was stitched to the skin. Three days afterwards K. read a on J. BARTON Battey’s Operation.-Mr. paper this case. Mary M-, a maid-of-all-work, aged twenty- Mr. Marriott again operated. He enlarged the original six, had suffered for a year from severe pain in the abdomen, incision to one inch below the umbilicus, and made his way which was greatly swollen and tympanitic. Reflex vomiting to the outside of the cystic duct, when the stone could be felt. was so severe as to require nutrient enemata for six weeks. He tried to split it with a needle thrust through the duct, .The diagnosis was "inflammatory disease in left ovary." but failed. He then seized the stone with a pair of forceps its blades guarded with indiarubber, and using both Having failed to give relief after a protracted trial, Battey’s having in crushing the stone and operation was decided upon. Both ovaries and Fallopian tubes hands with much force, succeeded The abdominal wound was then were ligatured and removed; both were hard, white, and removing the fragments. about three times their normal size. The patient recovered stitched up, and a drainage-tube left in the gall-bladder. from the operation without a bad symptom. In a month she The temperature was 100° on the night of the operation, and did not rise higher; the wound healed rapidly, and the was up, and in two she had left hospital, healthy, vigorous, and cheerful, to earn her own living.-Mr. O’CALLAGHAN patient said she felt well. The stone and crushed fragments said the operation described by Mr. Barton was not Battey’s, were shown to the Society. but Mr. Lawson Tait’s. Battey had simply removed the Cholecystotomy—Mr. BOND related a case in which he ovaries, but Tait removed the ovaries and appendages. The had opened and drained the gall-bladder in March, 1889, for case seemed to him to be one of retroflexion and prolapsed urgent symptoms owing to obstruction in the common duct. A biliary fistula resulted, and although from twenty to As from of to chronic the the inflammation, ovary. history case there was not a symptom of it.-Dr. FREDERICK forty ounces of bile were discharged daily, the patient conKIDD did not gather from the paper that there had tinued in good health and gained in weight. As the fistula been any examination per vaginam. All the pain seemed did not close, a second exploratory operation was undertaken to be developed on the left side, and yet the right ovary in November, to ascertain the condition of the common and
they would
affected than the left. He asked how it was that there were no subjective symptoms on the right.Mr. MYLES asked, regarding the operation itself, if they were to assume that every young woman who suffered from hysterical symptoms was to be deprived of the power of reproducing her species. To destroy the highest physiological functions of a woman was an operation that should not be lightly undertaken.-Mr. THORNLEY STOKER said Mr. Barton had not impressed upon his mind that the case was one of such extreme gravity as would justify an operation warranted only when the condition was such that life was threatened or had become intolerable by suffering.Dr. PATTESON regarded the diagnosis as inadequate to indicate operative procedure-the leftovary being the seat of all the symptoms, though the rightproved to be more enlarged and more diseased. Microscopical appearances did not point to chronic inflammation of the ovary.The PRESIDENT said that, the woman being in great pain, and her life in imminent danger from that pain, the operation was simply done to save her life ; and under such circumstances, where the woman could not have lived, there were few hospital surgeons who would hesitate to remove both ovaries.-Mr. BARTON blamed himself to some extent for the adverse criticism in not having made clear that the patient was dying of long-continued disease. The serious character of the operation he did not at all blink, nor did he suggest or think that it should be lightly undertaken. In this case he had had the benefit of Dr. Purefoy’s opinion that there was no retroflexion of the uterus. He was gratified to say that the case was more successful than some of his critics seemed to think, and the girl was now capable of performing the functions of a domestic servant. was more
LEICESTER MEDICAL SOCIETY.
duct. No calculus was detected. As a result of this operation, bile began to flow into the duodenum more freely, and a month afterwards only from half an ounce to one ounce of bile in twenty-four hours escaped through the fistula. It was suggested that some stretching of the duct or rupture of adhesions had been the cause of the relief.-Dr. PRATT had estimated the urea passed by Mr. Bond’s patient, and found that when a small quantity of bile issued from the fistula the urine was of lighter colour than when a large quantity of bile was discharged, but that the amount of urea was unaffected by the biliary flow.-Dr. TOMKINS suggested, in explanation of the colour, that probably the total amount of urine was less when the escape of bile was
greatest.
Vital Force.—Dr. BENNETT in this paper pointed out the tendency which there had always been to account for the mysterious by the supernatural, a method which yielded everywhere before the steady advance of science. He thought that life must in the same way cease to be regarded as the action of an external principle on matter, and be regarded as the outcome of ordinary processes of nature, only in peculiar form. He showed that the processes which occur in living organisms are processes of which we gain fuller knowledge day by day, and which are always identical with other chemical changes. He maintained that vital processes were governed by ordinary chemical laws, which alone were sufficient to account for the complexity of life.-Dr. PRATT maintained that living bodies possessed some principle or force over and above those possessed by non-living bodies: such as adaptability to change of environment ; growth; reproduction, sexual and otherwise; repair of injury; also the impossibility of artificially producing living matter.-Several other members spoke.
THE DEVONSHIRE HOSPITAL
AND
BUXTON BATH
CHARITY.—The annual report for 1889, just circulated, DEC. 6TH, 1889. demonstrates the continued satisfactory utility of the institution. The medical statistics for the past year illusDR. COOPER, PRESIDENT, IN THE CHAIR. trate the remedial value of the Buxton mineral water, more DR. BENNETT showed a case of Morbus Cceruleus depen- especially in the relief of most cases of rheumatism, dent probably on patent Foramen Ovale. arthritic or gouty in character. Of the 2131 cases under Cholecystotomy and Crushing of Impacted Gall-stone in treatment in the hospital, 359 were complicated with some Cystic Duct.—Mr. MARRIOTT read notes of a case in which form or degree of rheumatic heart complication. The he had performed this operation. P. R-,female, aged report shows how far the hospital is removed from being a forty-two, had had eight children. She had " inflammation mere convalescent institution, and the efficiency of the work of bowels " twenty years ago and severe pain in the right done by the medical staff.
years ago.
Four years since
pain
and
amputating in an ordinary swelling began in the epigastrium, which became very severe case of compound luxation.-Mr. CROLY, in reply, thought three weeks before her admission to the Leicester Infirmary. injuries to the ankle-joint were not favourable to primary There was bilious vomiting, but no jaundice was noticed. amputation, and therefore students should be cautioned not The urine was high-coloured; the stools were never white. to rush for an amputation knife in cases of compound dis- On admission there was fulness over the liver, and below it a location of the ankle. In the cases which he had described pear-shaped swelling to the right of the rectus muscle. On he enlarged the wound to give room for drainage, and anti- Aug. 27th, 1889, an incision three inches and a half long septic surgery was carried out in its integrity. Tenotomy was made over the most prominent part of the tumour. The of the tendo Achillis was not necessary. It was a sugges- gall-bladder was seen in the wound, and the fluid, which tion by Campbell de Morgan, and was injurious, as weaken- was clear and limpid, was withdrawn by an aspirator, and ing the back of the leg by taking away needful support. the gall-bladder then opened. A loose gall-stone was reHe was glad the President had endorsed the opinion that moved, but another was felt firmly impacted in the cystic preservative surgery of the foot ought to be kept in view in duct. Fruitless efforts were made to dislodge or break up the stone, and the patient was sent back to bed. The gallcompound dislocations. bladder was stitched to the skin. Three days afterwards K. read a on J. BARTON Battey’s Operation.-Mr. paper this case. Mary M-, a maid-of-all-work, aged twenty- Mr. Marriott again operated. He enlarged the original six, had suffered for a year from severe pain in the abdomen, incision to one inch below the umbilicus, and made his way which was greatly swollen and tympanitic. Reflex vomiting to the outside of the cystic duct, when the stone could be felt. was so severe as to require nutrient enemata for six weeks. He tried to split it with a needle thrust through the duct, .The diagnosis was "inflammatory disease in left ovary." but failed. He then seized the stone with a pair of forceps its blades guarded with indiarubber, and using both Having failed to give relief after a protracted trial, Battey’s having in crushing the stone and operation was decided upon. Both ovaries and Fallopian tubes hands with much force, succeeded The abdominal wound was then were ligatured and removed; both were hard, white, and removing the fragments. about three times their normal size. The patient recovered stitched up, and a drainage-tube left in the gall-bladder. from the operation without a bad symptom. In a month she The temperature was 100° on the night of the operation, and did not rise higher; the wound healed rapidly, and the was up, and in two she had left hospital, healthy, vigorous, and cheerful, to earn her own living.-Mr. O’CALLAGHAN patient said she felt well. The stone and crushed fragments said the operation described by Mr. Barton was not Battey’s, were shown to the Society. but Mr. Lawson Tait’s. Battey had simply removed the Cholecystotomy—Mr. BOND related a case in which he ovaries, but Tait removed the ovaries and appendages. The had opened and drained the gall-bladder in March, 1889, for case seemed to him to be one of retroflexion and prolapsed urgent symptoms owing to obstruction in the common duct. A biliary fistula resulted, and although from twenty to As from of to chronic the the inflammation, ovary. history case there was not a symptom of it.-Dr. FREDERICK forty ounces of bile were discharged daily, the patient conKIDD did not gather from the paper that there had tinued in good health and gained in weight. As the fistula been any examination per vaginam. All the pain seemed did not close, a second exploratory operation was undertaken to be developed on the left side, and yet the right ovary in November, to ascertain the condition of the common and
they would
affected than the left. He asked how it was that there were no subjective symptoms on the right.Mr. MYLES asked, regarding the operation itself, if they were to assume that every young woman who suffered from hysterical symptoms was to be deprived of the power of reproducing her species. To destroy the highest physiological functions of a woman was an operation that should not be lightly undertaken.-Mr. THORNLEY STOKER said Mr. Barton had not impressed upon his mind that the case was one of such extreme gravity as would justify an operation warranted only when the condition was such that life was threatened or had become intolerable by suffering.Dr. PATTESON regarded the diagnosis as inadequate to indicate operative procedure-the leftovary being the seat of all the symptoms, though the rightproved to be more enlarged and more diseased. Microscopical appearances did not point to chronic inflammation of the ovary.The PRESIDENT said that, the woman being in great pain, and her life in imminent danger from that pain, the operation was simply done to save her life ; and under such circumstances, where the woman could not have lived, there were few hospital surgeons who would hesitate to remove both ovaries.-Mr. BARTON blamed himself to some extent for the adverse criticism in not having made clear that the patient was dying of long-continued disease. The serious character of the operation he did not at all blink, nor did he suggest or think that it should be lightly undertaken. In this case he had had the benefit of Dr. Purefoy’s opinion that there was no retroflexion of the uterus. He was gratified to say that the case was more successful than some of his critics seemed to think, and the girl was now capable of performing the functions of a domestic servant. was more
LEICESTER MEDICAL SOCIETY.
duct. No calculus was detected. As a result of this operation, bile began to flow into the duodenum more freely, and a month afterwards only from half an ounce to one ounce of bile in twenty-four hours escaped through the fistula. It was suggested that some stretching of the duct or rupture of adhesions had been the cause of the relief.-Dr. PRATT had estimated the urea passed by Mr. Bond’s patient, and found that when a small quantity of bile issued from the fistula the urine was of lighter colour than when a large quantity of bile was discharged, but that the amount of urea was unaffected by the biliary flow.-Dr. TOMKINS suggested, in explanation of the colour, that probably the total amount of urine was less when the escape of bile was
greatest.
Vital Force.—Dr. BENNETT in this paper pointed out the tendency which there had always been to account for the mysterious by the supernatural, a method which yielded everywhere before the steady advance of science. He thought that life must in the same way cease to be regarded as the action of an external principle on matter, and be regarded as the outcome of ordinary processes of nature, only in peculiar form. He showed that the processes which occur in living organisms are processes of which we gain fuller knowledge day by day, and which are always identical with other chemical changes. He maintained that vital processes were governed by ordinary chemical laws, which alone were sufficient to account for the complexity of life.-Dr. PRATT maintained that living bodies possessed some principle or force over and above those possessed by non-living bodies: such as adaptability to change of environment ; growth; reproduction, sexual and otherwise; repair of injury; also the impossibility of artificially producing living matter.-Several other members spoke.
THE DEVONSHIRE HOSPITAL
AND
BUXTON BATH
CHARITY.—The annual report for 1889, just circulated, DEC. 6TH, 1889. demonstrates the continued satisfactory utility of the institution. The medical statistics for the past year illusDR. COOPER, PRESIDENT, IN THE CHAIR. trate the remedial value of the Buxton mineral water, more DR. BENNETT showed a case of Morbus Cceruleus depen- especially in the relief of most cases of rheumatism, dent probably on patent Foramen Ovale. arthritic or gouty in character. Of the 2131 cases under Cholecystotomy and Crushing of Impacted Gall-stone in treatment in the hospital, 359 were complicated with some Cystic Duct.—Mr. MARRIOTT read notes of a case in which form or degree of rheumatic heart complication. The he had performed this operation. P. R-,female, aged report shows how far the hospital is removed from being a forty-two, had had eight children. She had " inflammation mere convalescent institution, and the efficiency of the work of bowels " twenty years ago and severe pain in the right done by the medical staff.