- Email: [email protected]
THE ROYAL HOSPITAL FOR CHILDREN AND WOMEN.
890
nourished ; the heart palpitated, and there was dulness over the cardiac region. There was a mitral bruit, and possibly aortic also; subcrepitant rfi,les were audible at both sides behind; no anasarca; the lips were blue; the urine did not show any reaction from the usual tests, no albumen being present, and it was rather darker than natural. Ordered ammonia and senega mixture, with five minims of tincture of digitalis every four hours, and a blister to be applied over the bases of both lungs. ’Diet to consist of milk and
fruit stone is in its fruit. The large vessels the mass and were diminished in size from, pressure. The tumour was yellowish, of a firm consistence, and although it ran some distance down the spine its origin It was below the situation of the was difficult to trace. thymus gland, but probably originated in that organ. Nobony structures were involved. The left lung was pushed into the post-mediastinum. The right lung was not so compressed, as that side of the chest contained considerably beef-tea. less of the tumour. The microscope has since shown the Oct. 20th: General appearance about the same ; the tem- structure to be of the round-celled sarcoma. The tumour ; pulse weak. Ordered three ounces of was about the size of a small child’s head. All the other perature falling brandy. In the evening decidedly worse. Another ounce organs appeared healthy. The stomach was larger than of brandy to be given. The patient is’ sick.-21st : Crying usual, and there was a good deal of fluid in the organ. The out with angina. One capsule of nitrite of amyl imme- rugose condition was well marked. diately gave relief.-22nd : The patient died early this
morning. Necropsy.-There was complete obliteration of the pericardial cavity; the parietal and visceral layers of the pericardium were fused together. Heart hypertrophied ; delicate vegeta-
bedded in it ran
as a
through
ROYAL ARSENAL HOSPITAL, WOOLWICH OPERATION FOR SUTURE OF TENDON.
care of Surgeon-Major W. F. STEVENSON.) (Under tionswere attached to the three nodules of theaortic valves, and W. W-, aged thirty-eight, received a wound across The chordæ a fringe of similar growths round mitral valve. of left hand, opposite the metacarpo-phalangeal the the palm tendineae and muscular bands were not enlarged. The lungs were carnified. A good deal of claret-coloured blood oozed joints, on July 1st, 1883. On July 6th, when the wound, from the vessels in the thorax and neck. The lungs had which on admission seemed to be superficial, was nearly a liver-like feel, and floated in water. Sandiness over pleura healed, it was found that the power of flexion of the fourth on left side, and a few adhesions. Liver, nutmeg-like. no of the of the was in
the
lost, consequence, doubt, slip Spleen, leather-like, not enlarged. Kidneys enlarged, the finger flexor sublimis to the second phalanx of that finger passing of fluid An excess structures apparently healthy. pyramidal in the peritoneal cavity. All the other organs appeared having been severed. As the finger in this condition would have been worse than useless to him at his work as a fitter, healthy to the unaided eye. the man was desirous that an attempt should be made to LARGE TI:MOUR ENVELOPING THE HEART. restore the finger to its normal condition. Accordingly, (Under the care of Dr. PARK.) ether having been administered, the limb rendered bloodless Ada B-, aged seven, was admitted on Oct. 27th, 1883. by elevation, and an Esmarch’s tube applied above the The child’s illness began seventeen weeks before admission ; elbow, an incision at right angles to the original wound was respiration became’ gradually more laboured, and latterly made, with all antiseptic precautions ; the ends of the tendon was attended with much distress. She had had some were found and united with a carbolised catgut suture, and paroxysmal attacks, during which she had sat up gasping the operation wound closed by means of wire sutures; a for breath and screaming out. Perspiration had been profuse, and gauze dressing was applied, and the hand and she was muchwasted. She had had some of the ordinary protective a the fingers being somewhat flexed. placed upon children’s complaints. Her family was said to be healthy, The ends of thesplint, tendon were found about an inch anda and there were seven other children. apart, and they were not refreshed. Two months On examination, she appeared emaciated. The respiration quarter afterwards he was seen, and he could then flex the finger was noisy, with rattling sounds audible at some distance almost on to the palm of the hand. from the cot. She preferred the sitting posture, with her COMPOUND FRACTURE OF TIBIA. arms supported, as in cases of asthma. Pulse 150, respiration 40, temperature 988°. The chest was divested of flesh, W. 0-, aged thirty-seven, was admitted on August and bulged forward on the left side. The protuberance 28th, 1883, with a compound fracture of the left tibia, the looked like an aneurismal swelling, but there was no bruit. fibula also being broken. The fracture occurred at the On palpation, it was evident that there was a large tumour of junction of the middle and lower thirds, and there was great some kind within the thorax. The protuberance was conThe bones having been got into position, and varicose veins ran from it to the the was small and which had been caused by which externally, wound, gested xiphoid cartilage. The epigastric took a very tortuous the point of the upper fragment coming through the skin, course thence to the navel. The chest was dull on the left was enlarged to make certain of free drainage, the clots side, and the breath sounds were deficient both above pressed out and a 1 in 20 carbolic lotion freely syringed be and behind, but there was increased resonance at the tween the ends of the bones by means of a rubber catheter; base behind. The second sound of the heart was in- a drainage-tube was put in and a full dressing applied. audible, and the first was feeble, and heard outside the The limb was put up in splints and slung. On the second nipple-line. ’ The right side of the chest and the other and third days it was found necessary to renew the dressorgans appeared healthy. The appetite was good consider- ings in consequence of blood having oozed through them,.,. ing the child1s condition. The urine gave no reaction with this was done under the spray. Temperature 99’0°F. the usual.tests. Ordered three ounces of brandy daily, and Swelling not great; bones in good position. The wound a belladonna plaster. was again dressed on the tenth day; no discharge of any Oct. 29th: The child had a better night. Takes liquid woundquite aseptic. Temperature 984°. Tube diet well, with eggs.—30th: Several attacks to-day; much removed. On the seventeenth day wound redressed; no dyspnaea and noisy respiration. Ordered three drachms of discharge. Temperature 98’4°. On the twenty-ninth day a mixture of ammonia with senega and four minims of the wound was quite healed, and the bones firm. Plastertincture of digitalis every four hours.—31st: Sitting up in of-Paris apparatus was applied on the thirtieth day, and on bed, having rallied from yesterday’s attacks. the next day he was discharged to his own home.
displacement.
kind;
Nov. 5th: The child has been much better since she
began taking the last symptoms have recurred
mixture.-12th: The distressing with severe angina pectoris, which caused the child to scream out. One capsule of nitrite 29th : There has been nothing of amyl gave relief. the 12th, and the child seems record since to special improving. This afternoon the mother gave her a bag full of all of which she ate. In the evening another asthmatic attack came on, and the child died completely -
lujubes,
exhausted.
Necropsy. Body much emaciated. On removing the sternum a large tumour presented itself. A vertical incision into its substance for two inches brought the heart into view, and it was completely encased by this growth-em-
SEVERE INJURY CAUSED BY MACHINERY.
J. F-, aged eighteen, was admitted on November 30th, 1883. His been caught by some engine shafting, and he had been carried round with great violence. The shaft revolves at about the rate of 120 revolutions per minute, and it was stated that he had been on it for over two minutes. On examination it was found that he had sustained a simple, but greatly comminuted, fracture of the right femur, a compound comminuted fracture of the left femur, a simple comminuted fracture of the left humerus, a compound fracture of both bones of the left forearm, and a severe contusion of the head, causing a large extravasation of blood unde?
clothes had
nourished ; the heart palpitated, and there was dulness over the cardiac region. There was a mitral bruit, and possibly aortic also; subcrepitant rfi,les were audible at both sides behind; no anasarca; the lips were blue; the urine did not show any reaction from the usual tests, no albumen being present, and it was rather darker than natural. Ordered ammonia and senega mixture, with five minims of tincture of digitalis every four hours, and a blister to be applied over the bases of both lungs. ’Diet to consist of milk and
fruit stone is in its fruit. The large vessels the mass and were diminished in size from, pressure. The tumour was yellowish, of a firm consistence, and although it ran some distance down the spine its origin It was below the situation of the was difficult to trace. thymus gland, but probably originated in that organ. Nobony structures were involved. The left lung was pushed into the post-mediastinum. The right lung was not so compressed, as that side of the chest contained considerably beef-tea. less of the tumour. The microscope has since shown the Oct. 20th: General appearance about the same ; the tem- structure to be of the round-celled sarcoma. The tumour ; pulse weak. Ordered three ounces of was about the size of a small child’s head. All the other perature falling brandy. In the evening decidedly worse. Another ounce organs appeared healthy. The stomach was larger than of brandy to be given. The patient is’ sick.-21st : Crying usual, and there was a good deal of fluid in the organ. The out with angina. One capsule of nitrite of amyl imme- rugose condition was well marked. diately gave relief.-22nd : The patient died early this
morning. Necropsy.-There was complete obliteration of the pericardial cavity; the parietal and visceral layers of the pericardium were fused together. Heart hypertrophied ; delicate vegeta-
bedded in it ran
as a
through
ROYAL ARSENAL HOSPITAL, WOOLWICH OPERATION FOR SUTURE OF TENDON.
care of Surgeon-Major W. F. STEVENSON.) (Under tionswere attached to the three nodules of theaortic valves, and W. W-, aged thirty-eight, received a wound across The chordæ a fringe of similar growths round mitral valve. of left hand, opposite the metacarpo-phalangeal the the palm tendineae and muscular bands were not enlarged. The lungs were carnified. A good deal of claret-coloured blood oozed joints, on July 1st, 1883. On July 6th, when the wound, from the vessels in the thorax and neck. The lungs had which on admission seemed to be superficial, was nearly a liver-like feel, and floated in water. Sandiness over pleura healed, it was found that the power of flexion of the fourth on left side, and a few adhesions. Liver, nutmeg-like. no of the of the was in
the
lost, consequence, doubt, slip Spleen, leather-like, not enlarged. Kidneys enlarged, the finger flexor sublimis to the second phalanx of that finger passing of fluid An excess structures apparently healthy. pyramidal in the peritoneal cavity. All the other organs appeared having been severed. As the finger in this condition would have been worse than useless to him at his work as a fitter, healthy to the unaided eye. the man was desirous that an attempt should be made to LARGE TI:MOUR ENVELOPING THE HEART. restore the finger to its normal condition. Accordingly, (Under the care of Dr. PARK.) ether having been administered, the limb rendered bloodless Ada B-, aged seven, was admitted on Oct. 27th, 1883. by elevation, and an Esmarch’s tube applied above the The child’s illness began seventeen weeks before admission ; elbow, an incision at right angles to the original wound was respiration became’ gradually more laboured, and latterly made, with all antiseptic precautions ; the ends of the tendon was attended with much distress. She had had some were found and united with a carbolised catgut suture, and paroxysmal attacks, during which she had sat up gasping the operation wound closed by means of wire sutures; a for breath and screaming out. Perspiration had been profuse, and gauze dressing was applied, and the hand and she was muchwasted. She had had some of the ordinary protective a the fingers being somewhat flexed. placed upon children’s complaints. Her family was said to be healthy, The ends of thesplint, tendon were found about an inch anda and there were seven other children. apart, and they were not refreshed. Two months On examination, she appeared emaciated. The respiration quarter afterwards he was seen, and he could then flex the finger was noisy, with rattling sounds audible at some distance almost on to the palm of the hand. from the cot. She preferred the sitting posture, with her COMPOUND FRACTURE OF TIBIA. arms supported, as in cases of asthma. Pulse 150, respiration 40, temperature 988°. The chest was divested of flesh, W. 0-, aged thirty-seven, was admitted on August and bulged forward on the left side. The protuberance 28th, 1883, with a compound fracture of the left tibia, the looked like an aneurismal swelling, but there was no bruit. fibula also being broken. The fracture occurred at the On palpation, it was evident that there was a large tumour of junction of the middle and lower thirds, and there was great some kind within the thorax. The protuberance was conThe bones having been got into position, and varicose veins ran from it to the the was small and which had been caused by which externally, wound, gested xiphoid cartilage. The epigastric took a very tortuous the point of the upper fragment coming through the skin, course thence to the navel. The chest was dull on the left was enlarged to make certain of free drainage, the clots side, and the breath sounds were deficient both above pressed out and a 1 in 20 carbolic lotion freely syringed be and behind, but there was increased resonance at the tween the ends of the bones by means of a rubber catheter; base behind. The second sound of the heart was in- a drainage-tube was put in and a full dressing applied. audible, and the first was feeble, and heard outside the The limb was put up in splints and slung. On the second nipple-line. ’ The right side of the chest and the other and third days it was found necessary to renew the dressorgans appeared healthy. The appetite was good consider- ings in consequence of blood having oozed through them,.,. ing the child1s condition. The urine gave no reaction with this was done under the spray. Temperature 99’0°F. the usual.tests. Ordered three ounces of brandy daily, and Swelling not great; bones in good position. The wound a belladonna plaster. was again dressed on the tenth day; no discharge of any Oct. 29th: The child had a better night. Takes liquid woundquite aseptic. Temperature 984°. Tube diet well, with eggs.—30th: Several attacks to-day; much removed. On the seventeenth day wound redressed; no dyspnaea and noisy respiration. Ordered three drachms of discharge. Temperature 98’4°. On the twenty-ninth day a mixture of ammonia with senega and four minims of the wound was quite healed, and the bones firm. Plastertincture of digitalis every four hours.—31st: Sitting up in of-Paris apparatus was applied on the thirtieth day, and on bed, having rallied from yesterday’s attacks. the next day he was discharged to his own home.
displacement.
kind;
Nov. 5th: The child has been much better since she
began taking the last symptoms have recurred
mixture.-12th: The distressing with severe angina pectoris, which caused the child to scream out. One capsule of nitrite 29th : There has been nothing of amyl gave relief. the 12th, and the child seems record since to special improving. This afternoon the mother gave her a bag full of all of which she ate. In the evening another asthmatic attack came on, and the child died completely -
lujubes,
exhausted.
Necropsy. Body much emaciated. On removing the sternum a large tumour presented itself. A vertical incision into its substance for two inches brought the heart into view, and it was completely encased by this growth-em-
SEVERE INJURY CAUSED BY MACHINERY.
J. F-, aged eighteen, was admitted on November 30th, 1883. His been caught by some engine shafting, and he had been carried round with great violence. The shaft revolves at about the rate of 120 revolutions per minute, and it was stated that he had been on it for over two minutes. On examination it was found that he had sustained a simple, but greatly comminuted, fracture of the right femur, a compound comminuted fracture of the left femur, a simple comminuted fracture of the left humerus, a compound fracture of both bones of the left forearm, and a severe contusion of the head, causing a large extravasation of blood unde?
clothes had