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OBSTRUCTIVE ANURIA FOR FIVE DAYS; COPIOUS DIURESIS; RECOVERY.
972
record, but 1 have not heard of one in which there was such copious diuresis. In that respect I think this case beats record. The patient is now (April 15th) in his usual health.
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND STRANGULATED INGUINAL HERNIA WITHOUT LOCAL PAIN. BY JULIUS CÆSAR, L.R.C.P. & S. ED.
THERAPEUTICAL. OBSTRUCTIVE ANURIA FOR FIVE DAYS; COPIOUS DIURESIS; RECOVERY. BY H. E. COUNSELL, M.R.C.S., L.R.C.P.LOND. THE following case will, I think, be read with a considerable amount of interest. S. C---, aged fifty-five, a very stout, big-made agricultural labourer, has passed renal calculi at various times during the last ten years. He has also been the subject of a large omental hernia in the left scrotum. His last attack of renal colic in the right side was a year ago, since which time the attacks have always been confined to the left side. On Jan. 15th a severe attack of pain came on in the left side, shooting down into the scrotum, and the rupture, which had been increasing in size since the previous Friday, became much more swollen. His bowels, usually open every day, had not been moved since the Friday night, and he had not passed flatus since that time. On the 16th he commenced vomiting bilious matter, and had only passed an ounce of urine during the previous twenty-four hours. At 4 P.M. he passed flatus, but I gave him some chloroform and thoroughly examined the rupture, which was quite irreducible. As soon as he had recovered from the chloroform he passed half a pint of urine, and during the next four hours passed two pints. All went well until the 18th at midnight, when severe pain came on in the left side soon after micturition, and from that time until 2 PM. on the 23rd he never passed a drop of urine. On the 20bb, after forty-eight hours’ suppression, he was rather drowsy, but in no pain; there was no urine in the bladder, and he did not want to micturate. He was quite sensible and cheerful. He perspired slightly, had slight headache, the pupils were very contracted, and the tongue was dry and brown. Temperature 98’4°; pulse 70; respiration 25. On the 21st, whenever he fell asleep his face twitched and his limb jumped so much that he was constantly aroused. The bowels were open. Severe itching came on. As he had passed urine after chloroform during the first slight attack, I gave him some more, but without any good result. On the 22nd he was in the same state and very cheerful. Pulse 80; respiration 20. On the 23rd, at 11 A.M., the twitching was rather more pronounced, and occurred now when awake. He also complained of temporary defects in vision, which I attributed to spasm of his ciliary muscles. I could not see any retinal heamorrhages, and the discs looked normal. At 2 P,M. he passed half a pint of clear urine without blood, and had no previous pain. Ten minutes later he passed another half-pint, and in ten minutes more a third. He then returned to bed, but in half an hour got up and passed about half a pint, and this went on all through the night and following morning. There was generally half an hour between each act, and usually half a pint was voided at a time. All the urine was quite clear, except that passed at 8 P,M., which contained bright blood. On the 24th, at 3.30 P.M., when I saw him, the half-hourly process was still going on, and he had up to that time passed twenty-three pints-i.e., three gallons all but a pint in twenty-six hours. He was quite comfortable, had no headache, no twitching, the itching was almost gone, and the pupils were not so contracted. Urine: sp. gr. 1012; acid; no sugar; distinct ring of albumen with HN03. At 4 P.M. on the 25th he had passed one gallon of urine since the previous afternoon ; during the next twenty-four hours he passed three quarts. On the 30th, at 6 A.M., he passed a stone per urethram. It measured seven millimetres in length, its greatest circumference being three millimetres. It weighed just over one grain, and was composed of uric acid and phosphates. Remarks are needless, as the case tells its own story. The right ureter was evidently plugged a year ago, and the kidney in consequence disorganised, so that he had only the left one to depend upon ; but fortunately this one seems to have been quite equal to the occasion, and secreted such a volume of urine that the stone was bound to move on, and Similar cases are on was finally swept into the bladder.
case narrated below will, I think, illustrate in a forcible manner the lesson inculcated by Dr. Shaw’s very in connexion with the above communication opportune THE in LANCET of March 17th. subject In July, 1885,received a letter from a man living some miles from my house asking me to send some opening medicine, as his bowels had not acted for four days, and were causing him pain. He omitted any reference to his being ruptured. On visiting him he made the following statement in reply to my queries: He had a rupture of ten years’ standing, which had hitherto given him no trouble. He did not attribute his present state to the fact of his rupture having been down and irreducible for the previous four days, though such a thing had not occurred before. His bowels had not acted for four days, and he had a dragging pain about the umbilicus. On examining him I found a left inguinal hernia about the size of a duck’s It was not affected in any way by coughing or egg. forced expiration or inspiration. My efforts at reduction, which were patient and prolonged, were not successful, and were not attended by the least pain at the seat of constriction. Seeing that the case was not urgent, I ordered him belladonna and opium internally, and spirit and lead lotion externally. Next day 1 found that the dragging pain at the umbilicus still continued, and that hiccough had developed during the night. Looking upon this as the first step towards the vomiting stage, I determined to give chloroform (with which I had not been provided on the previous day), and, if unable to reduce the hernia under its influence, to operate at once. Taxis not proving successful, I performed herniotomy. The sac and its contents were quite healthy. The wound was treated with lint soaked in lead and spirit lotion, and simply laid on it. The man never had a bad symptom, and resumed work in three weeks. My sole help was a labourer fetched from an adjoining field.
Tirh
ACUTE YELLOW ATROPHY OF THE LIVER. BY J. CARNE-ROSS, M.D.
yellow atrophy of the liver is so rarely met with practice, and its incidence amongst children is relatively so infrequent, that the following instance of what was probably a case of that disease in a child of five years of age may perhaps not be without interest. ACUTE
in
At 7 P.M. on Nov. 6th, 1887,was asked to see a child who was said to be very ill. At my visit I found him lying in his mother’s arms. He was restless, throwing himself about and muttering deliriously. He was at once undressed and put to bed. On examination the temperature was 97° and the pulse 80 per minute. On auscultation the breath sounds were found to be normal, the heart’s rhythm regular, but the first sound very soft. There was nothing to note in the abdomen. The liver dulness in the right mammary line was found on percussion to be contracted to a space limited by the breadth of the sixth rib; above and below the bone the percussion note was resonant. The left side was examined, and it was evident that the case was not one of misplaced viscera. Tongue moist, not much coated with brownish fur; sordes on the lips. The pupils were dilated, but reacted sluggishly to light; they did not, however, contract fully; no shrinking from light. The bowels had acted twice by the use of magnesia; the motions were said to have been the colour of white clay. Urine had been passed, and was said by the mother to have been saffron-coloured. The child was also said to be yellow, but the colour could not be recognised by candle-light. The boy appeared to take no notice of his surroundings, yet after repeated requests put out his tongue, but it was necessary to shout before he could be induced to draw it back again. With difficulty he was roused sufficiently to tell his name. At my morning visit on Nov. 7th the child was said to have
record, but 1 have not heard of one in which there was such copious diuresis. In that respect I think this case beats record. The patient is now (April 15th) in his usual health.
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND STRANGULATED INGUINAL HERNIA WITHOUT LOCAL PAIN. BY JULIUS CÆSAR, L.R.C.P. & S. ED.
THERAPEUTICAL. OBSTRUCTIVE ANURIA FOR FIVE DAYS; COPIOUS DIURESIS; RECOVERY. BY H. E. COUNSELL, M.R.C.S., L.R.C.P.LOND. THE following case will, I think, be read with a considerable amount of interest. S. C---, aged fifty-five, a very stout, big-made agricultural labourer, has passed renal calculi at various times during the last ten years. He has also been the subject of a large omental hernia in the left scrotum. His last attack of renal colic in the right side was a year ago, since which time the attacks have always been confined to the left side. On Jan. 15th a severe attack of pain came on in the left side, shooting down into the scrotum, and the rupture, which had been increasing in size since the previous Friday, became much more swollen. His bowels, usually open every day, had not been moved since the Friday night, and he had not passed flatus since that time. On the 16th he commenced vomiting bilious matter, and had only passed an ounce of urine during the previous twenty-four hours. At 4 P.M. he passed flatus, but I gave him some chloroform and thoroughly examined the rupture, which was quite irreducible. As soon as he had recovered from the chloroform he passed half a pint of urine, and during the next four hours passed two pints. All went well until the 18th at midnight, when severe pain came on in the left side soon after micturition, and from that time until 2 PM. on the 23rd he never passed a drop of urine. On the 20bb, after forty-eight hours’ suppression, he was rather drowsy, but in no pain; there was no urine in the bladder, and he did not want to micturate. He was quite sensible and cheerful. He perspired slightly, had slight headache, the pupils were very contracted, and the tongue was dry and brown. Temperature 98’4°; pulse 70; respiration 25. On the 21st, whenever he fell asleep his face twitched and his limb jumped so much that he was constantly aroused. The bowels were open. Severe itching came on. As he had passed urine after chloroform during the first slight attack, I gave him some more, but without any good result. On the 22nd he was in the same state and very cheerful. Pulse 80; respiration 20. On the 23rd, at 11 A.M., the twitching was rather more pronounced, and occurred now when awake. He also complained of temporary defects in vision, which I attributed to spasm of his ciliary muscles. I could not see any retinal heamorrhages, and the discs looked normal. At 2 P,M. he passed half a pint of clear urine without blood, and had no previous pain. Ten minutes later he passed another half-pint, and in ten minutes more a third. He then returned to bed, but in half an hour got up and passed about half a pint, and this went on all through the night and following morning. There was generally half an hour between each act, and usually half a pint was voided at a time. All the urine was quite clear, except that passed at 8 P,M., which contained bright blood. On the 24th, at 3.30 P.M., when I saw him, the half-hourly process was still going on, and he had up to that time passed twenty-three pints-i.e., three gallons all but a pint in twenty-six hours. He was quite comfortable, had no headache, no twitching, the itching was almost gone, and the pupils were not so contracted. Urine: sp. gr. 1012; acid; no sugar; distinct ring of albumen with HN03. At 4 P.M. on the 25th he had passed one gallon of urine since the previous afternoon ; during the next twenty-four hours he passed three quarts. On the 30th, at 6 A.M., he passed a stone per urethram. It measured seven millimetres in length, its greatest circumference being three millimetres. It weighed just over one grain, and was composed of uric acid and phosphates. Remarks are needless, as the case tells its own story. The right ureter was evidently plugged a year ago, and the kidney in consequence disorganised, so that he had only the left one to depend upon ; but fortunately this one seems to have been quite equal to the occasion, and secreted such a volume of urine that the stone was bound to move on, and Similar cases are on was finally swept into the bladder.
case narrated below will, I think, illustrate in a forcible manner the lesson inculcated by Dr. Shaw’s very in connexion with the above communication opportune THE in LANCET of March 17th. subject In July, 1885,received a letter from a man living some miles from my house asking me to send some opening medicine, as his bowels had not acted for four days, and were causing him pain. He omitted any reference to his being ruptured. On visiting him he made the following statement in reply to my queries: He had a rupture of ten years’ standing, which had hitherto given him no trouble. He did not attribute his present state to the fact of his rupture having been down and irreducible for the previous four days, though such a thing had not occurred before. His bowels had not acted for four days, and he had a dragging pain about the umbilicus. On examining him I found a left inguinal hernia about the size of a duck’s It was not affected in any way by coughing or egg. forced expiration or inspiration. My efforts at reduction, which were patient and prolonged, were not successful, and were not attended by the least pain at the seat of constriction. Seeing that the case was not urgent, I ordered him belladonna and opium internally, and spirit and lead lotion externally. Next day 1 found that the dragging pain at the umbilicus still continued, and that hiccough had developed during the night. Looking upon this as the first step towards the vomiting stage, I determined to give chloroform (with which I had not been provided on the previous day), and, if unable to reduce the hernia under its influence, to operate at once. Taxis not proving successful, I performed herniotomy. The sac and its contents were quite healthy. The wound was treated with lint soaked in lead and spirit lotion, and simply laid on it. The man never had a bad symptom, and resumed work in three weeks. My sole help was a labourer fetched from an adjoining field.
Tirh
ACUTE YELLOW ATROPHY OF THE LIVER. BY J. CARNE-ROSS, M.D.
yellow atrophy of the liver is so rarely met with practice, and its incidence amongst children is relatively so infrequent, that the following instance of what was probably a case of that disease in a child of five years of age may perhaps not be without interest. ACUTE
in
At 7 P.M. on Nov. 6th, 1887,was asked to see a child who was said to be very ill. At my visit I found him lying in his mother’s arms. He was restless, throwing himself about and muttering deliriously. He was at once undressed and put to bed. On examination the temperature was 97° and the pulse 80 per minute. On auscultation the breath sounds were found to be normal, the heart’s rhythm regular, but the first sound very soft. There was nothing to note in the abdomen. The liver dulness in the right mammary line was found on percussion to be contracted to a space limited by the breadth of the sixth rib; above and below the bone the percussion note was resonant. The left side was examined, and it was evident that the case was not one of misplaced viscera. Tongue moist, not much coated with brownish fur; sordes on the lips. The pupils were dilated, but reacted sluggishly to light; they did not, however, contract fully; no shrinking from light. The bowels had acted twice by the use of magnesia; the motions were said to have been the colour of white clay. Urine had been passed, and was said by the mother to have been saffron-coloured. The child was also said to be yellow, but the colour could not be recognised by candle-light. The boy appeared to take no notice of his surroundings, yet after repeated requests put out his tongue, but it was necessary to shout before he could be induced to draw it back again. With difficulty he was roused sufficiently to tell his name. At my morning visit on Nov. 7th the child was said to have