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ON A CASE OF COMPOUND COMMINUTED FRACTURE OF BOTH LEGS.
709
I
the head, and an illness of only five days. The certifying surgeon described him as 11 a melancholic, having a tendency to suicide," but when admitted he was in a state of restless delirium, and had, during the first few days, attacks of H slight unconsciousness, with syncope. He was stoutish and aged. After a few days he had a succession of convulsions, like ordinary epileptic fits, and got rapidly into a comatose state, from which there seemed little chance of recovery; but five days later he rallied somewhat, and took nourishment, though he had numerous" fits," which chiefly affected the left side of the face. Nov. lst.-He was partly hemiplegic on the left side of the body and face, but conscious, and the fits did not recur so frequently. He was much weaker, and had a bed-sore The remained much in the same state patient forming. till Nov. 9th, when he died suddenly, a few minutes after the night-watch had left him. ease. Post-mortem M’a.MtMt
formation is the result of confinement. In the College of Surgeons there are nine specimens of hydatids in the sheep, situated in the lungs, brain, bones, liver, mesentery, and kidney. It is the presence of the Cysticercus tenuicollis in the brain that makes sleep giddy"-giddy it may well be with such " a bee in its bonnet." Of the diseases of pachyderms I need say little, as their great representative, the horse, has met with ample justice at the hands of Youatt and Stonehenge. The hog is very liable to the mumps and the mange, and is more frequently the subject of tubercle than any other pachyderm. A female Asiatic elephant that I dissected last year at Bellevue, died apparently from cystitis. Rodentia.-Rabbits, when kept in ill-ventilated hutches, are subject to a contagious and very fatal disease called the "sniffles." Its name is sufficiently characteristic of the dis-
on
710 30th:---Took the starch bandages off the right leg, which is now quite well and strong ; but the left leg, though equally strong, and now as long as the other, presents the appearance as if some small pieces of bone must come away. Ordered poultices to be applied. Dec. 26th, 1868.-Seven or eight small fragments of bone have come away (since our last report) from the left leg; but none since July last, since which time he has been constantly at work. He is now quite well, and has no shortening, deformity, or pain in either leg. Radstock, May, 1869.
by its
presence in
an
adult, who is able to explain the cir.
greatly sympathy, and a strong desire the part of the operator to render immediate relief if possible. But the difficulties of the situation are proportionably increased when the patient is a very young child, and when little assistance, perhaps none, can be obtained by reason of its tender age and inability to express itself. Then the surgeon has indeed a difficult task. There are cumstances,
excites
on
in surgery which demand more decision, promptitude, and dexterity in their treatment; few in which the no cases
removal of the exciting cause is followed by more successCASE OF PARTIAL PLACENTA PRÆVIA ful results. The irritating body once removed, the injury inflicted by the operator is rapidly repaired. AND SHOULDER PRESENTATION. The first case forcibly demonstrates the value of the BY DR. W. J. KENNEDY. principle of making an opening into the trachea for the ready admission of air into the lungs whilst the passage ON Sunday, 13th December, 1868, at 10. o’clock A.M., I was through the larynx is partially blocked; forgetting, as it cause of the dyspnoea, whilst were, for a time the hastily summoned to visit Mrs. H-, a farmer’s wife, re- placing the patient exciting in the most favourable condition for siding about four miles from my residence. On my arrival, carrying on the important function of respiration with the I found her quite unconscious, pale, and almost pulseless. least inconvenience. It also shows that it is by no means After she was restored to consciousness, the woman in absolutely necessary to abstract the foreign body at once. attendance informed me that on the day previous she was On the contrary, perhaps, as a rule, should any difficulties arise in connexion with tracheotomy, it is advisable to seized with labour pains, each pain being followed by a desist from further proceedings, as was done in this ingush of blood, which continued worse up till my arrival; stance, and with the happiest results. the haemorrhage being so profuse that the bed was wet CASE 1. Pebble in the larynx; tracheotomy; cure.-Caroline through. I endeavoured to ascertain the presentation by aged two years, was admitted at 3 P.M. on March 6th, digital examination, but could not reach the os. I then in- P-, troduced my whole hand into the vagina, when I at once 1869. She had been found by her mother, an hour before felt a portion of the placenta overlying the anterior lip of admission, apparently suffering from partial obstruction of the os. The os being largely dilated, I introduced my two the air-passages. The child was supposed to have some body in the windpipe, but as to its nature there was forefingers through it, and with slight force separated foreign the placenta from the cervix to the extent of about two no clue. On admission there was difficulty of breathing, but it was inches, when the hsemorrhage almost ceased. I obtained not excessive. The assistant-surgeon examined the fauces some cotton wool, with which I made a plug, and introduced into the vagina. In a short time I was happy to see with his finger, and thought he felt the sharp edge of a my patient very greatly improved, her colour and pulse foreign body; but, after several attempts to seize it with &c., it became dislodged, and was no longer percepbeing nearlv natural, and she was able to answer any ques- forceps tions put to her. After waiting for about an hour, she said tible. The child after the examination breathedmore she felt a very strong bearing-down pain. I removed the freely. At about 5.30 P.m., three hours and a half after the first plug, which showed little or no haemorrhage had taken were noticed, dyspnoea increased, the respirations and introduced hand as into the before. symptoms place, my vagina I found the membranes protruding through the os, and being characterised by a peculiar catch," which conveyed fancied I felt the shoulder presenting. I proceeded to rup- the impression that there was some solid body freely moving ture the membranes, when I found the right shoulder was in the trachea, drawn downwards during inspiration, and driven back against the presenting. As the os uteri was still well dilated and flexible, then by the force of expiration I introduced my hand through it, and laid hold of the left vocal cords, thus acting in a valvular manner. There were spasmodic attacks of coughing, threatening suffoleg of the child, which came down quite easily. I then seized frequent the right leg, and brought both outside the vagina. I ad- cation. The house-surgeon, Mr. Cortis, now performed tracheoministered one drachm of powdered ergot, which had the effect of producing strong pains, and in a short time my tomy, with the view of endeavouring to extract the foreign patient was delivered of a fine healthy child. The placenta body by instruments introduced through the wound in the trachea. However, a considerable flow of venous blood came away quite easily. Both mother and child are doing well. occurring at the operation rendered exploratory measures at the moment unadvisable. A tube was introduced into Sanquhar, January, 1809. the tracheal incision and secured there, after which breathing was performed with tolerable ease. Immediately after the operation, the child was placed beneath a tent of screens placed before the fire, and the air about it was kept moist and warm with steam. Respiration continued tolerably OF THE PRACTICE OF good throughout the day and two nights following the C(
Mirror
A
MEDICINE
AND IN
SURGERY
THE
HOSPITALS OF LONDON. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, tum aliorum, tum proprias collectas habere, et inter se eompajate.—MoRaAajri De Sed. et CaM. 3foft., lib. iv. ProcBmium.
GUY’S HOSPITAL. CASES OF FOREIGN BODIES IN THE AIR-PASSAGES. (Under the care of Mr. JOHN BIRKETT.) THE interest of the surgeon is invariably excited by any case of injury depending upon a foreign body in the airpassages. The distressing and alarming symptoms caused
operation. On the morning of the
8th the tube was removed from the wound in the trachea, and a bent probe was passed up’ wards to the rima glottidis. A fit of coughing ensued, and an elongated, irregularly-shaped, smooth pebble escaped through the wound. It would appear that the probe, when passed up to the rima, dislodged the stone, which, descending into the trachea, fell out. The tube was not replaced ; but, as the child did not breathe comfortably when the wound was closed, its edges were not brought together. On March 9th there was slight difficulty of breathing and
febrile
symptoms. The left side of the chest was dull, on percussion; and there were sibilant and
posteriorly,
moist sounds. After this time convalescence proceeded without interruption, though there wereoccasional violent fits of coughing. The wound granulated and cicatrised; and the child left the hospital, well, on the 31st of March. She was able
I
the head, and an illness of only five days. The certifying surgeon described him as 11 a melancholic, having a tendency to suicide," but when admitted he was in a state of restless delirium, and had, during the first few days, attacks of H slight unconsciousness, with syncope. He was stoutish and aged. After a few days he had a succession of convulsions, like ordinary epileptic fits, and got rapidly into a comatose state, from which there seemed little chance of recovery; but five days later he rallied somewhat, and took nourishment, though he had numerous" fits," which chiefly affected the left side of the face. Nov. lst.-He was partly hemiplegic on the left side of the body and face, but conscious, and the fits did not recur so frequently. He was much weaker, and had a bed-sore The remained much in the same state patient forming. till Nov. 9th, when he died suddenly, a few minutes after the night-watch had left him. ease. Post-mortem M’a.MtMt
formation is the result of confinement. In the College of Surgeons there are nine specimens of hydatids in the sheep, situated in the lungs, brain, bones, liver, mesentery, and kidney. It is the presence of the Cysticercus tenuicollis in the brain that makes sleep giddy"-giddy it may well be with such " a bee in its bonnet." Of the diseases of pachyderms I need say little, as their great representative, the horse, has met with ample justice at the hands of Youatt and Stonehenge. The hog is very liable to the mumps and the mange, and is more frequently the subject of tubercle than any other pachyderm. A female Asiatic elephant that I dissected last year at Bellevue, died apparently from cystitis. Rodentia.-Rabbits, when kept in ill-ventilated hutches, are subject to a contagious and very fatal disease called the "sniffles." Its name is sufficiently characteristic of the dis-
on
710 30th:---Took the starch bandages off the right leg, which is now quite well and strong ; but the left leg, though equally strong, and now as long as the other, presents the appearance as if some small pieces of bone must come away. Ordered poultices to be applied. Dec. 26th, 1868.-Seven or eight small fragments of bone have come away (since our last report) from the left leg; but none since July last, since which time he has been constantly at work. He is now quite well, and has no shortening, deformity, or pain in either leg. Radstock, May, 1869.
by its
presence in
an
adult, who is able to explain the cir.
greatly sympathy, and a strong desire the part of the operator to render immediate relief if possible. But the difficulties of the situation are proportionably increased when the patient is a very young child, and when little assistance, perhaps none, can be obtained by reason of its tender age and inability to express itself. Then the surgeon has indeed a difficult task. There are cumstances,
excites
on
in surgery which demand more decision, promptitude, and dexterity in their treatment; few in which the no cases
removal of the exciting cause is followed by more successCASE OF PARTIAL PLACENTA PRÆVIA ful results. The irritating body once removed, the injury inflicted by the operator is rapidly repaired. AND SHOULDER PRESENTATION. The first case forcibly demonstrates the value of the BY DR. W. J. KENNEDY. principle of making an opening into the trachea for the ready admission of air into the lungs whilst the passage ON Sunday, 13th December, 1868, at 10. o’clock A.M., I was through the larynx is partially blocked; forgetting, as it cause of the dyspnoea, whilst were, for a time the hastily summoned to visit Mrs. H-, a farmer’s wife, re- placing the patient exciting in the most favourable condition for siding about four miles from my residence. On my arrival, carrying on the important function of respiration with the I found her quite unconscious, pale, and almost pulseless. least inconvenience. It also shows that it is by no means After she was restored to consciousness, the woman in absolutely necessary to abstract the foreign body at once. attendance informed me that on the day previous she was On the contrary, perhaps, as a rule, should any difficulties arise in connexion with tracheotomy, it is advisable to seized with labour pains, each pain being followed by a desist from further proceedings, as was done in this ingush of blood, which continued worse up till my arrival; stance, and with the happiest results. the haemorrhage being so profuse that the bed was wet CASE 1. Pebble in the larynx; tracheotomy; cure.-Caroline through. I endeavoured to ascertain the presentation by aged two years, was admitted at 3 P.M. on March 6th, digital examination, but could not reach the os. I then in- P-, troduced my whole hand into the vagina, when I at once 1869. She had been found by her mother, an hour before felt a portion of the placenta overlying the anterior lip of admission, apparently suffering from partial obstruction of the os. The os being largely dilated, I introduced my two the air-passages. The child was supposed to have some body in the windpipe, but as to its nature there was forefingers through it, and with slight force separated foreign the placenta from the cervix to the extent of about two no clue. On admission there was difficulty of breathing, but it was inches, when the hsemorrhage almost ceased. I obtained not excessive. The assistant-surgeon examined the fauces some cotton wool, with which I made a plug, and introduced into the vagina. In a short time I was happy to see with his finger, and thought he felt the sharp edge of a my patient very greatly improved, her colour and pulse foreign body; but, after several attempts to seize it with &c., it became dislodged, and was no longer percepbeing nearlv natural, and she was able to answer any ques- forceps tions put to her. After waiting for about an hour, she said tible. The child after the examination breathedmore she felt a very strong bearing-down pain. I removed the freely. At about 5.30 P.m., three hours and a half after the first plug, which showed little or no haemorrhage had taken were noticed, dyspnoea increased, the respirations and introduced hand as into the before. symptoms place, my vagina I found the membranes protruding through the os, and being characterised by a peculiar catch," which conveyed fancied I felt the shoulder presenting. I proceeded to rup- the impression that there was some solid body freely moving ture the membranes, when I found the right shoulder was in the trachea, drawn downwards during inspiration, and driven back against the presenting. As the os uteri was still well dilated and flexible, then by the force of expiration I introduced my hand through it, and laid hold of the left vocal cords, thus acting in a valvular manner. There were spasmodic attacks of coughing, threatening suffoleg of the child, which came down quite easily. I then seized frequent the right leg, and brought both outside the vagina. I ad- cation. The house-surgeon, Mr. Cortis, now performed tracheoministered one drachm of powdered ergot, which had the effect of producing strong pains, and in a short time my tomy, with the view of endeavouring to extract the foreign patient was delivered of a fine healthy child. The placenta body by instruments introduced through the wound in the trachea. However, a considerable flow of venous blood came away quite easily. Both mother and child are doing well. occurring at the operation rendered exploratory measures at the moment unadvisable. A tube was introduced into Sanquhar, January, 1809. the tracheal incision and secured there, after which breathing was performed with tolerable ease. Immediately after the operation, the child was placed beneath a tent of screens placed before the fire, and the air about it was kept moist and warm with steam. Respiration continued tolerably OF THE PRACTICE OF good throughout the day and two nights following the C(
Mirror
A
MEDICINE
AND IN
SURGERY
THE
HOSPITALS OF LONDON. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, tum aliorum, tum proprias collectas habere, et inter se eompajate.—MoRaAajri De Sed. et CaM. 3foft., lib. iv. ProcBmium.
GUY’S HOSPITAL. CASES OF FOREIGN BODIES IN THE AIR-PASSAGES. (Under the care of Mr. JOHN BIRKETT.) THE interest of the surgeon is invariably excited by any case of injury depending upon a foreign body in the airpassages. The distressing and alarming symptoms caused
operation. On the morning of the
8th the tube was removed from the wound in the trachea, and a bent probe was passed up’ wards to the rima glottidis. A fit of coughing ensued, and an elongated, irregularly-shaped, smooth pebble escaped through the wound. It would appear that the probe, when passed up to the rima, dislodged the stone, which, descending into the trachea, fell out. The tube was not replaced ; but, as the child did not breathe comfortably when the wound was closed, its edges were not brought together. On March 9th there was slight difficulty of breathing and
febrile
symptoms. The left side of the chest was dull, on percussion; and there were sibilant and
posteriorly,
moist sounds. After this time convalescence proceeded without interruption, though there wereoccasional violent fits of coughing. The wound granulated and cicatrised; and the child left the hospital, well, on the 31st of March. She was able