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ON A CASE OF OBSTRUCTIVE JAUNDICE OF AN UNUSUAL NATURE.1
1123
flaps, by which easily approximated,
bases of the
means the edges of the wound and the subsequent passing of the stitches was thus rendered comparatively easy.7 Two decalcified drainage-tubes, threaded with horsehair, were inserted and secured at the lower opening, and the whole dressed with protective plasterand gauze in the usual way, care being taken to bandage the right arm firmly to the side, with the view of keeping the parts at absolute rest and relieving tension. I did not touch the dressings till the third day, when the horsehair was withdrawn from the tubes, and everything found to be looking remarkably well. Union by first intention had taken place along nearly the whole line of incision. The wound was dressed once a week in the usual antiseptic fashion, and it is needless to give further particulars of the progress of the case, as the patient made an excellent recovery, and was dismissed well on Nov. 18th. She is now (March, 1883) in the best of health, and attending to her ordinary avocation. The temperatures (rectal) were taken twice daily, and the accompanying chart will be found to give an accurate repre-
were
FIG. 3.
that the amount of nourishment taken was extremely small. Three weeks after the full development of jaundice, yellow vision and intense irritation of the skin, particularly that of the lower extremities, were complained of. No enlargement of the liver could be made out; very slight tenderness on pressure over the region of the gall-bladder was the only local indication. On Dec. 4th the emaciation due no doubt to the want of sufficient nourishment, had. become so marked that, acting on the counsel of his medical advisers, he returned to India to try the effect of a change to a hill climate. After a month’s residence at one of the hill stations, there being no amelioration whatever in his condition, he applied for and obtained furlough to Europe. Several days’ delay occurred at Bombay prior to his embarkation. The second day after his arrival at that city, Jan. 18th, he had occasion to go to the closet, and while inspecting the excreta, as had been his wont since the commencement of the attack, discovered, to his great surprise, a large ascaris lumbricoides, apparently dead, one end. of its body, to the extent of half an inch, being of a deep The very next day the stools began to green colour. exhibit a slight amount of the normal bilious hue. Ten davs afterembarkation their colour was quite natural, and. Defore landing in England convalescence was satisfac-
torily established.
Remarks. —The subject of this record had undergone privations of the campaign of the previous year, including those of the terrible march back in June, historically known as "the march of death." It is more than probable that in quenching his thirst with roadside water of doubtful quality he swallowed the ovum of the parasite with which he subsequently oecame infested. The immediate reappearance of bile in the stools which followed its expulsion, and the deep staining of one end of the parasite, render it very probable that in its migrations it entered the ductus communis, thus effectually plugging it and preventing the flow of bile. THe mechanical nature of the oball the
some
sentation of these during nearly the first three weeks of residence in hospital. Figures 1 and 2 represent the dition of affairs before and after operating, and in connexion with these my best thanks are due to Horace Paterson, of this city, for the excellent photographs of the case which he has produced, as well as for the extreme pains which he took in order to show the growth to the best possible ’ advantage, and which Mr. Miller has turned to good account in the execution of . the woodcuts. The tumour when removed weighed eight and a half pounds, and those of my readers who may happen to be interested in its histological characteristics will find these fully commented on in the Glasgow Medical Journal for the present month (March, 1883), under the heading of an article which appears there, "On the Photography of Microscopic Sections." A very fair photo-micrograph of the tumour sections is appended.
Mr.
con-
I
Glasgow. ON
A
CASE
struction
readily explains
the tailure ot every
remedy
that
The was tried. deducible from the that when a case of case would seem to three months-is met in -this case lasted which no disease of the liver can be made out, and where there is no constitutional which would
practical point be, exactly organic
foregoing persistent jaundice with,
dyscrasia
account for the symptom, the possibility of the plugging of the common bile-duct by a round worm should not be overlooked. There can be but little doubt that a few doses of santonine would have materially abridged the
duration of the
case
above recorded.
Watton.
FRACTURE OF THE LARYNX BY DIRECT VIOLENCE. BY JAMES OLIVER, M.B., HOUSE-PHYSICIAN TO THE HOSPITAL FOR WOMEN, LONDON.
OF
OBSTRUCTIVE JAUNDICE OF AN UNUSUAL
FRACTURE of the larynx by direct violence is an accident of infrequent occurrence, and one which from a medico-legal point of view is of so great interest, that I deem it worth while to mention a case which recently came under my notice. The thyroid cartilage in its normal state is of such M-, an officer in the Indian army, who had served a structure that interference with its continuity can only during the Afghan campaign of 1878-79, proceeded, on the result under very untoward circumstances. Like other strucrenewal of the war on Sept. 13tb, 1879, to Dhaka, a fort tures of a similar nature in the human frame, however, the situated at the Afghan end of the Khyber Pass. While are liable in advanced life to become the laryngeal cartilages stationed there he enjoyed good health until Oct. 13th, when seat of ossific deposit, and then to be more easily fractured. he was attacked with intermittent fever of a very mild type. The in my case had evidently resulted from the free injury The attack, however, an unusual event in his case, was use of a piece of wooden rail. The post-mortem appearances attended with a good deal of nausea and vomiting. Two were in every respect those of death by suffocation, and need days subsequently a decidedly yellow tinge of the conjunc- no mention. The larynx, with the pharynx, tongue, &c., tivae was noticed, and a week later well-marked jaundice were removed en masse, and examined. The thyroid carwas developed, with its usual accompaniments of whitish tilage, more especially the right half of it, was broken up The appetite was not much into many pieces, one of which hung free in the lumen of the stools, dark-brown urine, &c. impaired, but the ingestion of nearly every kind of food tube, evidencing great violence. Ossific change was very procurable was attended with so much subsequent nausea extensive. Corresponding with the inferior border of the of the lower maxilla was a wound, incised in appear7 A capital illustration of the method which was adopted by me in body this particular instance is given in the Glasgow Medical Journal for ance, running from the middle line outwards to the left, and extending for about three inches. The wound was gaping, January, 1883, p. 13. 1 Read before the Norwich and exposed the bone for about an inch and a half. The left Medico-Chirurgical Society.
NATURE.1 BY H. MALLINS, A.B., M.B., M.CH., T.C.D,
so
flaps, by which easily approximated,
bases of the
means the edges of the wound and the subsequent passing of the stitches was thus rendered comparatively easy.7 Two decalcified drainage-tubes, threaded with horsehair, were inserted and secured at the lower opening, and the whole dressed with protective plasterand gauze in the usual way, care being taken to bandage the right arm firmly to the side, with the view of keeping the parts at absolute rest and relieving tension. I did not touch the dressings till the third day, when the horsehair was withdrawn from the tubes, and everything found to be looking remarkably well. Union by first intention had taken place along nearly the whole line of incision. The wound was dressed once a week in the usual antiseptic fashion, and it is needless to give further particulars of the progress of the case, as the patient made an excellent recovery, and was dismissed well on Nov. 18th. She is now (March, 1883) in the best of health, and attending to her ordinary avocation. The temperatures (rectal) were taken twice daily, and the accompanying chart will be found to give an accurate repre-
were
FIG. 3.
that the amount of nourishment taken was extremely small. Three weeks after the full development of jaundice, yellow vision and intense irritation of the skin, particularly that of the lower extremities, were complained of. No enlargement of the liver could be made out; very slight tenderness on pressure over the region of the gall-bladder was the only local indication. On Dec. 4th the emaciation due no doubt to the want of sufficient nourishment, had. become so marked that, acting on the counsel of his medical advisers, he returned to India to try the effect of a change to a hill climate. After a month’s residence at one of the hill stations, there being no amelioration whatever in his condition, he applied for and obtained furlough to Europe. Several days’ delay occurred at Bombay prior to his embarkation. The second day after his arrival at that city, Jan. 18th, he had occasion to go to the closet, and while inspecting the excreta, as had been his wont since the commencement of the attack, discovered, to his great surprise, a large ascaris lumbricoides, apparently dead, one end. of its body, to the extent of half an inch, being of a deep The very next day the stools began to green colour. exhibit a slight amount of the normal bilious hue. Ten davs afterembarkation their colour was quite natural, and. Defore landing in England convalescence was satisfac-
torily established.
Remarks. —The subject of this record had undergone privations of the campaign of the previous year, including those of the terrible march back in June, historically known as "the march of death." It is more than probable that in quenching his thirst with roadside water of doubtful quality he swallowed the ovum of the parasite with which he subsequently oecame infested. The immediate reappearance of bile in the stools which followed its expulsion, and the deep staining of one end of the parasite, render it very probable that in its migrations it entered the ductus communis, thus effectually plugging it and preventing the flow of bile. THe mechanical nature of the oball the
some
sentation of these during nearly the first three weeks of residence in hospital. Figures 1 and 2 represent the dition of affairs before and after operating, and in connexion with these my best thanks are due to Horace Paterson, of this city, for the excellent photographs of the case which he has produced, as well as for the extreme pains which he took in order to show the growth to the best possible ’ advantage, and which Mr. Miller has turned to good account in the execution of . the woodcuts. The tumour when removed weighed eight and a half pounds, and those of my readers who may happen to be interested in its histological characteristics will find these fully commented on in the Glasgow Medical Journal for the present month (March, 1883), under the heading of an article which appears there, "On the Photography of Microscopic Sections." A very fair photo-micrograph of the tumour sections is appended.
Mr.
con-
I
Glasgow. ON
A
CASE
struction
readily explains
the tailure ot every
remedy
that
The was tried. deducible from the that when a case of case would seem to three months-is met in -this case lasted which no disease of the liver can be made out, and where there is no constitutional which would
practical point be, exactly organic
foregoing persistent jaundice with,
dyscrasia
account for the symptom, the possibility of the plugging of the common bile-duct by a round worm should not be overlooked. There can be but little doubt that a few doses of santonine would have materially abridged the
duration of the
case
above recorded.
Watton.
FRACTURE OF THE LARYNX BY DIRECT VIOLENCE. BY JAMES OLIVER, M.B., HOUSE-PHYSICIAN TO THE HOSPITAL FOR WOMEN, LONDON.
OF
OBSTRUCTIVE JAUNDICE OF AN UNUSUAL
FRACTURE of the larynx by direct violence is an accident of infrequent occurrence, and one which from a medico-legal point of view is of so great interest, that I deem it worth while to mention a case which recently came under my notice. The thyroid cartilage in its normal state is of such M-, an officer in the Indian army, who had served a structure that interference with its continuity can only during the Afghan campaign of 1878-79, proceeded, on the result under very untoward circumstances. Like other strucrenewal of the war on Sept. 13tb, 1879, to Dhaka, a fort tures of a similar nature in the human frame, however, the situated at the Afghan end of the Khyber Pass. While are liable in advanced life to become the laryngeal cartilages stationed there he enjoyed good health until Oct. 13th, when seat of ossific deposit, and then to be more easily fractured. he was attacked with intermittent fever of a very mild type. The in my case had evidently resulted from the free injury The attack, however, an unusual event in his case, was use of a piece of wooden rail. The post-mortem appearances attended with a good deal of nausea and vomiting. Two were in every respect those of death by suffocation, and need days subsequently a decidedly yellow tinge of the conjunc- no mention. The larynx, with the pharynx, tongue, &c., tivae was noticed, and a week later well-marked jaundice were removed en masse, and examined. The thyroid carwas developed, with its usual accompaniments of whitish tilage, more especially the right half of it, was broken up The appetite was not much into many pieces, one of which hung free in the lumen of the stools, dark-brown urine, &c. impaired, but the ingestion of nearly every kind of food tube, evidencing great violence. Ossific change was very procurable was attended with so much subsequent nausea extensive. Corresponding with the inferior border of the of the lower maxilla was a wound, incised in appear7 A capital illustration of the method which was adopted by me in body this particular instance is given in the Glasgow Medical Journal for ance, running from the middle line outwards to the left, and extending for about three inches. The wound was gaping, January, 1883, p. 13. 1 Read before the Norwich and exposed the bone for about an inch and a half. The left Medico-Chirurgical Society.
NATURE.1 BY H. MALLINS, A.B., M.B., M.CH., T.C.D,
so