BROWN ON SURGICAL DISEASES

CLINICS.

Statistical Report of the Principal Operations performed in the London Hospitals during the month of September, 1854.

Lithotomy-Number of cases, 4; recovered, 3; under treatment, 1.

OF WOMEN,

Case

had some little bleeding a few hours after the operation; but it ceased spontaneously, and he subsequently recovered well. 3. A boy, aged 3, in good health, under the care of Mr. Ward, in the London Hospital. Recovered without a bad symptom. It is worthy of note, that this boy's sister had also suffered from calculus, and had three years ago had the stone extracted after lithotrity, by Mr. Luke, in the same Hos{pital. Case 4. A man, in fair general health, but rather emaciated, and with some symptoms of phthisis, aged 25, under the care of Mr. Cock, in Guy's Hospital. A large stone was easily removed. On the

Case 1. A boy, aged 12, in good health, under the care of Mr. Cock, in Guy's Hospital. No bad symptoms followed the operation, and he was quite well in a fortnight. Case 2. A boy, aged 4, under the care of Mr. Paget, in St. Bartholomew's Hospital. The bladder was very large; and, on the operating table, some difficulty was found in forming a positive opinion as to the pre-fifth day after the operation, hemorrhage sence of a stone. Those present were, however, at length convinced, and the operation was performed. The stone proved a small one, and very light; its exterior was coated with minute crystals, which made it resem. ble sand-paper, and had prevented it from yielding, when struck by the sound, the usual chink of a smooth stone. The boy

from the wound occurred. A flexible catheter was passed by the urethra, and the wound then plugged with sponge. The sponge effectually arrested the bleeding; it was retained in situ for three days, and then removed, after which no further hemorrhage took place. The urine at this period contained much mucus and phosphatic deposit,

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VOL. XIII.-1

and the man had sunk into a very feeble Case 2. A man, aged 45, under the care of condition. By the cautious employment of Mr. Ure, in St. Mary's Hospital. Hernia good diet, and the exhibition of an efferves-direct inguinal; strangulated eighteen cent draught, containing in each dose five grains of the ammonio-tartrate of iron, he has since improved satisfactorily, and is now recovering.

Lithotrity. A man, aged about 60, of large make, and very stout, has just been discharged from the London Hospital, where he had been treated by Mr. Adams. After five or six operations, the stone appeared to have been all got rid of. The man was in good health, and had not suffered materially. He was the subject of a very large prostate. Mr. Adams believed the stone to have been of small size.

hours; sac opened. The man did well for two days after the operation, when he was attacked by an acute carbuncular inflammation of the upper lip, which spread over the cheeks, and, in spite of treatment by free incisions, and the use of stimulants, caused death on the fifth day. At the autopsy, very slight evidences of peritonitis were found. Case 3. A man, aged 56, under the care of Mr. Thompson, in the Marylebone Infirmary. Some difficulties attended the diagnosis of this case; only one testicle existed in the scrotum, that of the right side being undescended. In the right inguinal canal was a painful swelling, which might have easily been taken for an inflamed testicle only. As the symptoms of strangulated bowel were present, however, it was determined to operate. The sac having been laid bare, it was found to be tightly constricted at its neck; and, having next been opened, was seen to contain a coil of bowel, which had been prevented from

The

Lithotomy in the Female.-A girl, aged 6, in good health, was admitted into Guy's Hospital, under the care of Mr. Cock, suffering from a large vesical calculus. The operation for its removal was conducted under chloroform. Mr. Cock dilated the urethra until it would admit a small pair of forceps. The stone was then seized; and, while held forwards firmly, the urethra was divided on each side in a direction down-passing through the external ring by the wards and outwards, to the extent requisite testis, which in an atrophied condition was to allow of the extraction. The stone was there situated, and served as a plug. of peculiar shape, having a body about the hernia was of the congenital inguinal form, size of a damson-plum, and a long curved and had been strangulated thirty-six hours. neck, which had seemingly been moulded The bowels acted spontaneously on the se. in the urethra. It broke during the opera-cond and third days after the operation, but tion, and was extracted in two parts. After subsequently the patient had symptoms of the operation a catheter was passed into the urethra, and the vagina plugged with sponge, so as to support the incised parts in contact. Union by the first intention resulted, and the child recovered perfectly, without the least incontinence of urine. [The mode of operating in this case was similar to that we recorded in detail at page 111 of the Med. Times and Gaz. for July 29, 1854.] Herniotomy -In Mr. Cock's case, No. 7, of last report, the patient has since covered. Number of cases, 11; recovered, 7; although not painful, Mr. Birkett selected died, 4.

low peritonitis, and died on the fifth day. The bowel was found, at the autopsy, almost gangrenous at the part where it had been constricted. Case 4. A lad, aged 17, under the care of Mr. Birkett, in Guy's Hospital, hernia congenital, and strangulated about thirty-two hours. In the scrotum there was but one testicle, that of the right side being undescended. Both inguinal canals appeared full, and in neither could the swellre-ing be diminished by pressure. The left side appearing rather the fuller of the two,

it for the operation. The sac having been Case 1. A man, aged 23, under the care opened, a knuckle of intestine, not much of Mr. Wormald, in St. Bartholomew's congested, was exposed, and was, after a Hospital. Hernia of the congenital form, little manipulation, returned without dividbut never down before; of large size, and ing the internal ring. The symptoms, which strangulated twenty-four hours. The stric- had been rather sharp, ceased immediately ture was the neck of the sack itself, and was after the operation, and on the next day very tight. The sac was opened, and the the patient might have been pronounced bowel was found much congested. Death well. The swelling on the right side was from peritonitis followed on the second day.of course the testis. Case 5. A woman,

aged 55, under the care of Mr. Prescott feces. There was hiccough, and it was said Hewett, in St. George's Hospital, hernia that she had passed no urine for five days. femoral, strangulated sixteen hours; sac opened, recovered. Case 6. A woman, aged 53, under the care of Mr. Thompson, in the Marylebone Infirmary, hernia femoral, strangulated seventy hours; sac opened. Recovered without a bad symptom. Case 7. A woman, aged 70, under the care of Mr. Ure, in St. Mary's Hospital, hernia oblique inguinal, strangulated eighteen hours; sac opened; recovered. Case 8. An infant, aged 5 months, under the care of Mr. Lane, in St. Mary's Hospital, hernia congenital, strangulated twelve hours, sac opened. A hydrocele on the same side complicated the case. Many attempts at taxis had been made before its admission. The testicle, when exposed, was found acutely inflamed, as if from bruising. After the operation, the child had convulsions, and subsequently an attack of scarlet fever. As it was recovering from the latter, the wound became affected by sloughing; ultion mately, however, a perfect recovery ensued. Case 9. A man, aged 40, under the care of Mr. Ure, in St. Mary's Hospital, hernia scrotal. The protrusion had been down for some months, and had not recently increased in size. Slight but increasing symptoms of strangulated bowel had existed for several days; reduction could not be effected, and, in obedience to the surgical rule for doubt ful cases, the operation was performed. The vomiting had not been severe, but the bow. els were constipated. The sac having been opened, no bowel was found, but a mass of consolidated omentum only. This mass, about the size of a pigeon's egg, was cut away, and the bleeding vessels tied. Excepting some sloughing of the wound, the man made an unimpeded recovery. Case 10. A man, aged about 40, under the care of Mr. Pollock, in St. George's Hospital, hernia femoral, strangulated twenty-four hours; sac opened. Cholera came on after the operation, and was fatal. Case 11. A woman, aged 34, under the care of Mr. Le Gros Clarke, in St. Thomas's Hospital. She was in the third month of pregnancy. She had been the subject of an easily reducible femoral hernia for six years, and had suffered from symptoms of acute strangulation for five days. Her aspect on admission was extremely anxious, pulse very frequent, and so small as to be almost imperceptible; tongue foul and covered with

Mr. Clarke opened the sac, and found that it contained bowel and omentum. The gut, which was of a chocolate colour, was returned, and part of the omentum cut away. Vomiting and hiccough persisted for three days after the operation, when miscarriage took place. After the latter event, recovery gradually supervened, the exposed omentum sloughed away, and the wound healed. The woman was discharged well three weeks after admission.

Ligature of Arteries.-A boy, aged 5, was admitted, under the care of Mr. Ward, into the London Hospital, having just previously been stabbed by a knife in the middle of his left thigh. He had bled very profusely, and was pale and faint. From the amount of hemorrhage, and the position of the wound, it was rendered very probable that the femoral itself had been wounded, and Mr. Pouldon, the House-Surgeon

duty, without delay, at once enlarged the wound, and exposed that vessel. An oblique wound, about the eighth of an inch long, from which the blood issued, was seen. An armed aneurism needle having been passed under the artery, its threads were separated, and one tied above and the other below the injured spot; the lower one, however, having a little slipped, did not quite get beyond the wound, and it was necessary to introduce a third still lower. All bleeding ceased, and the wound having been dressed, the patient was removed to a bed.

On the fifth day after the operation pulsation in the posterior tibial was perceptible. The child did remarkably well throughout, and the ligatures came away without inconvenience.

Treatment of Aneurism by Compression.Mr. De Morgan's case in the Middlesex Hospital continues under treatment.

Amputations. The patient (Case 16 of the report for May), on whom M. Pirogoff's modification of the amputation at the anklejoint had been performed, died suddenly about two months after the operation. The cause of death being a large mass of tubercle in the brain, was not connected with the amputation. The condition of the stump was, however, not satisfactory. The portion of os calcis which had been left had been dragged by the muscles of the calf up behind the tibia, and a considerable part of it had necrosed, and would, if the man had

lived, have required removal subsequent-dent. The man's state at the time was not ly.

Number of cases, 10; recovered, 5; un. der treatment, 1; died, 4.

of the worst, and he had good spirits, and was himself hopeful. For a week after the operation he did well, but, at the end of {that period, severe rigors began to occur. It was at first hoped that, as the tongue continued clean and the appetite good, these might be dependent on some intermittent disease; but, ultimately, the symptoms of pyæmia developed themselves, and death, at the end of three weeks, took place. At the autopsy, secondary deposits of pus were found in the lungs and liver.

Of the Thigh.-Case 1. A man, aged 63, under the care of Mr. James Lane, in St. Mary's Hospital, on account of compound fracture above, and extending into the anklejoint. The tibia only protruded, and, after sawing off a portion, was easily reduced. The wound took on a sloughy condition, the leg was affected by erysipelas, and the condition of the limb was so threatening that it was deemed necessary to amputate on the sixth day. The man, who had been of very intemperate habits, had already become de lirious, and much sunken. Very little blood indeed was lost at the amputation. Death followed on the second day, apparently from exhaustion. Case 2. A girl, aged 17, performed. Is doing well. Case 9. A man, under the care of Mr. Tatum, in St. George's Hospital, on account of diseased knee-joint. She was in tolerable health, and recovered well. Case 3. A man, aged 19, under the care of Mr. Birkett, in Guy's Hospital, on account of diseased knee-joint, of nine months' duration. The joint was disorganized, and the patient's health very much reduced. Recovered. Case 4. A man, aged 49, admitted into Hospital at 7 P. M., having, in a railway accident, sustained compound comminuted fractures of both thighs. Amputation of the left thigh was performed about eleven the same evening, the patient having then somewhat rallied. Death took place immediately after the operation, and before the flaps had been adapted. Case 5. A man, under the care of Mr. Pollock, in St. George's Hospital, on account of disease of the tibia, involving the knee-joint. He was the subject of Bright's disease, but he, notwithstanding, recovered well from the operation, and the stump healed kindly.

Of the Upper Extremity.-Case 8. A man, aged 55, under the care of Mr. Walton, in St. Mary's Hospital, on account of compound fracture of the humerus, extending into the elbow-joint. Primary amputation in the middle of the upper arm was

(aged 22, admitted, under the care of Mr. Wormald, into St. Bartholomew's Hospital, for a crushed wrist. Primary amputation through the forearm was performed. Some erysipelas followed, but he ultimately recovered well. Case 10. A man, aged 31, under the care of Mr. Wardsworth, in the London Hospital, for compound fracture. Secondary amputation was performed three weeks after the accident. Death from pyæmia followed. Secondary deposits were found in some of the internal viscera.

Excision of Bones and Joints.-The three cases of excision of the knee-joint, under the care of Messrs. Fergusson, Statham, and Holt, in King's College, University College, and the Westminster Hospitals respectively, are doing well. In each case the patient may be deemed out of danger from the operation, and in the first and last the parts are nearly healed. Mr. Erichsen's case, in which the head of the femur had been excised, has been sent to Margate. The lad is in improved health, but an open Of the Leg.-Case 6. A man, aged 35, sinus still exists. In Case 6 of last month's under the care of Mr. Paget, in St. Bar-report, the patient, a woman, aged 74, tholomew's Hospital, on account of com- whose elbow-joint had been excised by Mr. pound fracture of the leg. Primary ampu-Statham, in University College Hospital, tation was performed. The man was in is doing well. In Case 8, in which excision good health, and recovered well. Case 7. of the carpal bones had been performed, A man, aged 35, admitted with a compound amputation through the forearm has since fracture of the leg, under the care of Mr. {been necessary: The patient in Case 3 of our Curling, in the London Hospital. An at- report for July, a girl, aged 11, under the tempt was made to save the limb, but, on care of Mr. Ure, in St. Mary's Hospital, on account of the profuse suppuration, and the whom excision of part of the os calcis, on exhaustion induced, secondary amputation account of abscess with carious disease, was became needful one month after the acci- performed, has recovered. The wound is