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SUCCESSFUL CASE OF BLOODLESS LIGATURE OF THE FEMORAL ARTERY FOR TRAUMATIC ANEURISM.
345 in reducing temperature, even in doses of half an every quarter of an hour (though not given for that object), is worthy of remark, as the temperature rose to 107 4° after the patient had taken thirty ounces of brandy in fifteen hours. This case also shows conclusively (if further proof were needed) the immediate effoot that the ice pack has in reducing temperature, and also the inutility of trusting to the simple wet pack in severe cases. It is not impossible, though scarcely probable, that the result might have been different if the physician’s assistant bad, immediately on the rise of temperature, plungpd the patient into a cold bath, following the example of Dr. Wilson Fox, who successfully resorted to this treatment in a case in which the temperature rose to 107°, and which was further complicated by the presence of a double pneumonia, and a double pleuritic, as well as a large pericardial, effusion. In the present c-tse, however, the ice-pack was resorted to through fear lest the moving of the patient should bring
inutility ounce
on
immediate and fatal
collapse.
SUCCESSFUL CASE OF
healthy; there was no pain; pulse 120; temperature 984°. He was seen on the 18th-and 25th of September and on the 9th of October, and never had a bad symptom. The wound being nearly healed, and the appetite and spirits being good, the patient was left to the care of his own medical attendant. Mr. Crates remarked :—" Esmarch’s apparatus converted in this cse an operation that, without its aid, would have been difficult, bloodv, and dangerous, into a comparatively easy, safe, and bloodless one. It is applicable to a wounded artery of any limb, and renders an operation which was formerly characterised by baste and confusion one of deliberation and certainty. Had I not been able to discover the wound in the artery I should have had the elastic cord momentarily loosened to allow a small jet of arterial blood to take place, enabling me to detect the small wound of the vessel, and I should then have had it tightened and proceeded to ligature the vessel." Mr. Marshall’s formidable description of this operation, in his book, enables one to realise its terrible nature. A friend of Mr. Coates’s saw a patient bleed to death on the operating-table of a metropolitan hospital from baemorrhage. Every hospital surgeon must have frequently witnessed the uncertainty of the finger and old tourniquets for compressing the main arteries during a protracted operation : a certain tourniquet presents itself in Esmarch’s looked
BLOODLESS LIGATURE OF THE FEMORAL ARTERY FOR TRAUMATIC ANEURISM. apparatus. BY MARTIN COATES, M.R.C.S, &c., SURGEON TO THE SALISBURY INFIRMARY; FORMERLY LECTURER IN ANATOMY AND MIDWIFERT AT
L’ÉCOLE
DE
MÉDECINE,
PARIS.
A Mirror
(Reported by Mr. HARCOURT COATES, M.R.C.S.)
OF
T. A-, a farmer’s son, aged sixteen, was cutting a stick, when the knife slipped, and penetrated deeply the inside of the thigh, about an inch and a half on the inside of the femoral artery, just before its entry into Hunter’s canal. The wound in the integument was nearly parallel to the course of the artery, and about half an inch in length. Profuse arterial haemorrhage occurred, soaking through the trousers and filling the boot. An old soldier who was present tied a handkerchief tightly over the wound, and the lad was carried home on a hurdle. Mr. Tarzewell, of Sturminster Newton, was immediately in attendance, and applied a pad of lint and a bandage, which at once arrested the
HOSPITAL PRACTICE, BRITISH
AND
FOREIGN.
Nalla antem est alia pro certo noscendi via, nisi quamplurimas et morborum dissectionum historias, tum aliorum, turn proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Cau8. Morb., lib. iv. Procemium.
et
KING’S COLLEGE HOSPITAL. RECURRING CHANCRE OF THE PENIS, FOLLOWED BY EPITHELIOMA.
of Mr. HENRY SMITH.) (Under THE following case (for the notes of which we are indebted to Mr. Duncan, late surgical registrar) is of clinical haemorrhage. Sept 5t,b, 1876.—Mr. Coates was called in consultation, interest, inasmuch as it not only proves that a morbid and observed a tumour, which pulsated obscurely, occupy- growth presenting all the external physical characters of ing the middle and part of the lower third of the thigh, and the primary syphilitic lesion may recur several times in having over its surface an evident aneurismal bruit. The the site of the original inoculation, but shows also that the wound of the integument was almost healed. The patient recurring growth may ultimately present the characters of was pale, but free from pain. Digital compression was tried for a short period of time, but was discontinued on account epithelioma. A man, aged sixty-five, was admitted on Dec. 13th with of the excessive pain produced by it. 8th.-Mr. Coates again visited the patient, who was much epithelioma of the penis. Seven years before he contracted a chancre, which was followed in a month by a secondary worse. The pain was excruciating; the tumour had increased in size, and now extended into the upper and lower rash on the skin, sore-throat, and "cramps" in the legs, thirds of the thigh; there was also some 03dema, of the leg which were especially severe at night. He was treated by andthigh. Methylene having been administered, Mr. Coates. a chemist; the medicine taken did not make the gums sore being assisted by Mr. Biggs, Dr. Coates, Mr. Tarzewell, and or cause salivation. The chancre gradually healed. Twelve myself, proceeded to operate as fotlows :-Esmarch’s band- months afterwards the chancre reappeared in its old site, age having been applied, the wound was enlarged upwards after a drinking bout. It healed up wit bin three weeks. and downwards for about three inches each way. The knife was carried fairly into the aneurism, and about three doublehandfuls of clots were removed and the cavity carefully sponged clean. Immediately the main artery was clearly seea, with a slit on its inner side about half an inch in length. The vein was behind the artery, and had escaped injury. The artery was secured above and below the wound with catgut ligatures. When the band was removed there was a little haemorrhage from a small branch of the vein, which was at once secured with a Chinese-silk ligature. The wound was sponged out with carbolic solution, and loosely plugged with lint. Next day the dressings were removed and the plug withdrawn from the wound. There had been no pain or bmmorrhage, and the appetite had to a certain extent returned. The cavity ot the wound was syringed out daily with a carbolic solution (1 to 40). Pulse 120; temperature 98.4°. On the llth the patient was progressing favourably; the wound
the
care
After that date the chancre recurred about f"ur or five times. The patient stated distinctly that the reappearance had always been preceded by drinking bouts, and that it had never been due to any fresh sexual connexion. The chancre always disappeared again within a month. Sometimes he had been treated by chemists; at other times he had no treatment whatever. The secondary rash also reappeared four or five times, but not necessarily coincidently with the reappearance ofthe chancre. It may he noted that the patient’s foreskin had always covered the glans
No family history of cancer was obtainable. This attack commenced six weeks before admission with a sore in the usual site. It did not evince any tendency to heal up within the usual period, but, on the contrary, had spread, and had also bzen the seat of very severe pain, a symptom which had not been present previously. Soon after the sore appeared a sharp attack of haemorrhage occurred from the part, but he did not lose any flesh.
penis.
inutility ounce
on
immediate and fatal
collapse.
SUCCESSFUL CASE OF
healthy; there was no pain; pulse 120; temperature 984°. He was seen on the 18th-and 25th of September and on the 9th of October, and never had a bad symptom. The wound being nearly healed, and the appetite and spirits being good, the patient was left to the care of his own medical attendant. Mr. Crates remarked :—" Esmarch’s apparatus converted in this cse an operation that, without its aid, would have been difficult, bloodv, and dangerous, into a comparatively easy, safe, and bloodless one. It is applicable to a wounded artery of any limb, and renders an operation which was formerly characterised by baste and confusion one of deliberation and certainty. Had I not been able to discover the wound in the artery I should have had the elastic cord momentarily loosened to allow a small jet of arterial blood to take place, enabling me to detect the small wound of the vessel, and I should then have had it tightened and proceeded to ligature the vessel." Mr. Marshall’s formidable description of this operation, in his book, enables one to realise its terrible nature. A friend of Mr. Coates’s saw a patient bleed to death on the operating-table of a metropolitan hospital from baemorrhage. Every hospital surgeon must have frequently witnessed the uncertainty of the finger and old tourniquets for compressing the main arteries during a protracted operation : a certain tourniquet presents itself in Esmarch’s looked
BLOODLESS LIGATURE OF THE FEMORAL ARTERY FOR TRAUMATIC ANEURISM. apparatus. BY MARTIN COATES, M.R.C.S, &c., SURGEON TO THE SALISBURY INFIRMARY; FORMERLY LECTURER IN ANATOMY AND MIDWIFERT AT
L’ÉCOLE
DE
MÉDECINE,
PARIS.
A Mirror
(Reported by Mr. HARCOURT COATES, M.R.C.S.)
OF
T. A-, a farmer’s son, aged sixteen, was cutting a stick, when the knife slipped, and penetrated deeply the inside of the thigh, about an inch and a half on the inside of the femoral artery, just before its entry into Hunter’s canal. The wound in the integument was nearly parallel to the course of the artery, and about half an inch in length. Profuse arterial haemorrhage occurred, soaking through the trousers and filling the boot. An old soldier who was present tied a handkerchief tightly over the wound, and the lad was carried home on a hurdle. Mr. Tarzewell, of Sturminster Newton, was immediately in attendance, and applied a pad of lint and a bandage, which at once arrested the
HOSPITAL PRACTICE, BRITISH
AND
FOREIGN.
Nalla antem est alia pro certo noscendi via, nisi quamplurimas et morborum dissectionum historias, tum aliorum, turn proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Cau8. Morb., lib. iv. Procemium.
et
KING’S COLLEGE HOSPITAL. RECURRING CHANCRE OF THE PENIS, FOLLOWED BY EPITHELIOMA.
of Mr. HENRY SMITH.) (Under THE following case (for the notes of which we are indebted to Mr. Duncan, late surgical registrar) is of clinical haemorrhage. Sept 5t,b, 1876.—Mr. Coates was called in consultation, interest, inasmuch as it not only proves that a morbid and observed a tumour, which pulsated obscurely, occupy- growth presenting all the external physical characters of ing the middle and part of the lower third of the thigh, and the primary syphilitic lesion may recur several times in having over its surface an evident aneurismal bruit. The the site of the original inoculation, but shows also that the wound of the integument was almost healed. The patient recurring growth may ultimately present the characters of was pale, but free from pain. Digital compression was tried for a short period of time, but was discontinued on account epithelioma. A man, aged sixty-five, was admitted on Dec. 13th with of the excessive pain produced by it. 8th.-Mr. Coates again visited the patient, who was much epithelioma of the penis. Seven years before he contracted a chancre, which was followed in a month by a secondary worse. The pain was excruciating; the tumour had increased in size, and now extended into the upper and lower rash on the skin, sore-throat, and "cramps" in the legs, thirds of the thigh; there was also some 03dema, of the leg which were especially severe at night. He was treated by andthigh. Methylene having been administered, Mr. Coates. a chemist; the medicine taken did not make the gums sore being assisted by Mr. Biggs, Dr. Coates, Mr. Tarzewell, and or cause salivation. The chancre gradually healed. Twelve myself, proceeded to operate as fotlows :-Esmarch’s band- months afterwards the chancre reappeared in its old site, age having been applied, the wound was enlarged upwards after a drinking bout. It healed up wit bin three weeks. and downwards for about three inches each way. The knife was carried fairly into the aneurism, and about three doublehandfuls of clots were removed and the cavity carefully sponged clean. Immediately the main artery was clearly seea, with a slit on its inner side about half an inch in length. The vein was behind the artery, and had escaped injury. The artery was secured above and below the wound with catgut ligatures. When the band was removed there was a little haemorrhage from a small branch of the vein, which was at once secured with a Chinese-silk ligature. The wound was sponged out with carbolic solution, and loosely plugged with lint. Next day the dressings were removed and the plug withdrawn from the wound. There had been no pain or bmmorrhage, and the appetite had to a certain extent returned. The cavity ot the wound was syringed out daily with a carbolic solution (1 to 40). Pulse 120; temperature 98.4°. On the llth the patient was progressing favourably; the wound
the
care
After that date the chancre recurred about f"ur or five times. The patient stated distinctly that the reappearance had always been preceded by drinking bouts, and that it had never been due to any fresh sexual connexion. The chancre always disappeared again within a month. Sometimes he had been treated by chemists; at other times he had no treatment whatever. The secondary rash also reappeared four or five times, but not necessarily coincidently with the reappearance ofthe chancre. It may he noted that the patient’s foreskin had always covered the glans
No family history of cancer was obtainable. This attack commenced six weeks before admission with a sore in the usual site. It did not evince any tendency to heal up within the usual period, but, on the contrary, had spread, and had also bzen the seat of very severe pain, a symptom which had not been present previously. Soon after the sore appeared a sharp attack of haemorrhage occurred from the part, but he did not lose any flesh.
penis.