ST. GEORGE'S HOSPITAL.
1
605 Riggs, of New York,* resembling in general appearance an or- dinary trocar, of a curvilinear form, at the end of which is a bulb. This bulb is passed up an invaginated piece of skin, to the extremity of the inguinal canal, and a sty let with an eye is pushed through the intervening tissue; this is withdrawn with a thread in the eye, which subsequently pulls up a plug or foreign body, consisting of a fold of thick, twisted silk, or piece of sponge, and tied externally over the seat of puncture. Lately, at St. Bartholomew’s, two cases have been success- fully treated by Wützer’s operation, only with Rothmand’s modification of his instrument, which consists in the addition of lateral pieces to the main-plug used by Wützer, thus making it more flat than round in form, and capable of being enlarged to any extent. The first case was that of a lad sixteen years of age, Arthur P-, who had been ruptured for fifteen years with an oblique inguinal hernia, and who had worn a truss all that time. The internal ring was approximating somewhat towards the external opening. The operation was performed two weeks ago by Mr. Coote, when we saw the case, and a cure was completely effected. We may mention that the perforating rod of Roth- mand’s modification is made of silver, with a steel point, and is thus not so liable to rust. The second instance is one under Mr. Lawrence’s care, of a turner, fifty-four years of age, who suddenly ruptured himself eight years ago, from a slip on the pavement. He had never worn a truss. The hernia was a left inguinal one, of the left side, and was treated by the introduction of a medium-sized instrument of Rothmand’s, by Mr. Lawrence, on the 25th of May. This has been removed, and so far as can be judged during the short time that has elapsed since the operation, we should say a good cure had been effected. ST. GEORGE’S HOSPITAL. CONGENITAL HYDROCELE OF THE NECK. (Under the care of Mr. PRESCOTT HEWETT.) AT this hospital two examples of this very rare affectior were presented to the notice of the pupils on the 27th of May. The first was in an infant a month old, who was born with s cyst on the right side of the neck. It was the size of a rathei large orange, was punctured by Mr. Prescott Hewett, and several ounces of fluid withdrawn, a little discoloured. These tumours may be either multilocular or unilocular, (in the pre- sent instance it was the latter,) and are commonly known as hydrocele of the neck, and are treated as such a disease is- namely, by drawing off the fluid, and afterwards injecting some fluid to produce irritation and its resulting cure; iodine will probably be used in this case. In 1839 Mr. Hewett dis- sected a specimen of this disease for Mr. Cæsar Hawkins. In that instance, the cyst, which extended up to the jaws, was multilocular. The other example was in a somewhat older child, and had been already treated at the Children’s Hospital, by Mr. Athol Johnson. This was treated by puncture, and a quantity of fluid drawn off, as in Mr. Hewett’s case. It remained col- lapsed for several days, and then began to increase; it is now quite tense and more solid than in the infant, because it is so ’very full, and is about the size of an orange. Such cases as these are sometimes dangerous, as inflammation and sloughing may be produced; and as they lay over the - course of the carotid artery, sloughing might be attended with haemorrhage. n Mr. Hewett took this opportunity of referring to a case of the kind which first came under his notice some years ago, of a young lady with a cyst in this situation. Mr. Keate dis- sected the tumour out, but left a small bit of the cyst adherent to the subclavian artery. The wound healed up, and the patient remained well for several years. When fourteen or fifteen years of age, a tumour occupied the same situation, and she was taken to Edinburgh to a surgeon, who refused to meddle with it. He (Mr. Hewett) saw it a little later, and he also refused to do anything to it. He thought, however, it might be obliterated, and Mr. Keate saw the case wi:h him. The tumour was punctured, and a quantity of rock-water was drawn off. It was evidently a remnant of the old cyst, which he treated by passing two threads through it, to act as setons. Four days after, extensive suppuration of the whole cavity * New York Journal of Medicine took place; she had shivering and irritative fever. He opened the entire cyst, right down to the collar-bone, cutting through the great mass of the tumour. A good deal of pus was evacuated. She got up and went about, and a cough com- menced. One day, on her return home after a ride, she became faint, and vomited up a quantity of foetid matter, which must have come either from the lung itself, or was a, separate deposit. At any rate, Mr. Hewett stated, she has remained perfectly well ever since, and has quite recovered. This gives a good idea of what may sometimes be encountered in the treatment of this uncommon affection, which sometimes may attain to so large a size as to interfere with deglutition and respiration. Its general seat, as has been accurately de- scribed by Monnoir and Philips is the posterior inferior tri- angle of the neck, where it forms a somewhat bladder-like tumour, filled with various kinds of fluid, of a yellow or choco- late colour and serous character, but mostly resembling rock- water as pointed out by Mr. Hewett. Some surgeons prefer to treat these cases by a seton after prematurely tapping the cyst. CLINICAL RECORDS. BILIOUS REMITTENT FEVER. ’ THAT well-marked examples of this form of fever are occa- sionally met with, even in the metropolis, we think there can- not be any reasonable doubt. Of course, in tropical countries, this disease is not only severe in its general character, but becomes extremely fatal. In temperate latitudes, however, the same fever will be comparatively mild, but will at the same time possess most of the leading features. The essential cause of bilious remittent fever is probably the miasma which usually proceeds from a marshy district. This is clearly seen sometimes in its attacking a whole ship’s crew when the vessel approaches a miasmatic coast. Dr. Willshire lately attracted. our attention to the case of a young man in the Charing-cross Hospital, who was evidently labouring under this fever. It appeared that he had been previously admitted as a patient with an ephemeral fever, from which he had quite recovered and left the hospital. He went down to Sheerness, and during, we believe, some irregularities, was exposed to miasmatic in- fluence, and returned to the hospital with a bilious gastric remittent fever. There was a distinct remission in the character of the fever, and when admitted he had hæmorrhage from the nose ; there was also a yellowish tinge of the skin. The disease was certainly present in its mildest form, and could not be confounded with gastro-duodenitis connected with functional disturbance of the liver, as it sometimes is, because of the distinct paroxysmal form of the remission. There was, besides, uneasiness in the epigastrium, and slight headache. Under treatment, recovery was ensuing, as is generally the case in the mild forms of the complaint, although the severest will yield to prompt and proper treatment. On this point, Dr. Wood of Philadelphia has remarked : " There is, perhaps, no disease in which the resources of our profession are more happily displayed than in the worst forms of bilious fever. Fearfully fatal under neglect or mismanagement, they may, in the great majority of cases, be conducted by proper treatment to a favourable issue." CONGENITAL ABSENCE OF THE RADIUS AND ITS MUSCLES. VERY curious cases come under notice occasionally, illustrat- ing the freaks of Nature in the deficiency of parts. When they are uncommon, we generally bring them under the notice of our readers. On the 2nd of June, a child of two years was brought to Mr. Erichsen, at University College, whose left hand was twisted inwards, and quite loose at the wrist as if paralysed. The apparent thumb was rudimentary, and hung by a piece of skin. On minute examination, however, it was discovered that the entire radius was absent, as well as, so far as could be made out, its proper muscles. There was a wrist-joint ; but the true radio-carpal joint was not perfect, nor was there any metacarpal bone of the thumb. The true thumb was, therefore, de6cient, and the rudimentary finger in its place was evidently not a thumb, but probably a second index-finger. This appendage, being in the way, was removed by Mr. Erichsen. What is peculiarly interesting in this case is, that there is not only an absence of a bone, such as the radius, of itself very
Transcript of ST. GEORGE'S HOSPITAL.
605
Riggs, of New York,* resembling in general appearance an or-dinary trocar, of a curvilinear form, at the end of which is abulb. This bulb is passed up an invaginated piece of skin, tothe extremity of the inguinal canal, and a sty let with an eye ispushed through the intervening tissue; this is withdrawn witha thread in the eye, which subsequently pulls up a plug orforeign body, consisting of a fold of thick, twisted silk, or pieceof sponge, and tied externally over the seat of puncture.
Lately, at St. Bartholomew’s, two cases have been success-fully treated by Wützer’s operation, only with Rothmand’smodification of his instrument, which consists in the additionof lateral pieces to the main-plug used by Wützer, thus makingit more flat than round in form, and capable of being enlargedto any extent.The first case was that of a lad sixteen years of age, Arthur
P-, who had been ruptured for fifteen years with an obliqueinguinal hernia, and who had worn a truss all that time. Theinternal ring was approximating somewhat towards the externalopening. The operation was performed two weeks ago by Mr.Coote, when we saw the case, and a cure was completelyeffected. We may mention that the perforating rod of Roth-mand’s modification is made of silver, with a steel point, andis thus not so liable to rust.The second instance is one under Mr. Lawrence’s care, of a
turner, fifty-four years of age, who suddenly ruptured himselfeight years ago, from a slip on the pavement. He had neverworn a truss. The hernia was a left inguinal one, of the leftside, and was treated by the introduction of a medium-sizedinstrument of Rothmand’s, by Mr. Lawrence, on the 25th ofMay. This has been removed, and so far as can be judgedduring the short time that has elapsed since the operation, weshould say a good cure had been effected.
ST. GEORGE’S HOSPITAL.CONGENITAL HYDROCELE OF THE NECK.
(Under the care of Mr. PRESCOTT HEWETT.)
AT this hospital two examples of this very rare affectiorwere presented to the notice of the pupils on the 27th of May.The first was in an infant a month old, who was born with s
cyst on the right side of the neck. It was the size of a rathei
large orange, was punctured by Mr. Prescott Hewett, andseveral ounces of fluid withdrawn, a little discoloured. Thesetumours may be either multilocular or unilocular, (in the pre-sent instance it was the latter,) and are commonly known ashydrocele of the neck, and are treated as such a disease is-namely, by drawing off the fluid, and afterwards injectingsome fluid to produce irritation and its resulting cure; iodinewill probably be used in this case. In 1839 Mr. Hewett dis-sected a specimen of this disease for Mr. Cæsar Hawkins. In
that instance, the cyst, which extended up to the jaws, wasmultilocular.The other example was in a somewhat older child, and had
been already treated at the Children’s Hospital, by Mr. AtholJohnson. This was treated by puncture, and a quantity offluid drawn off, as in Mr. Hewett’s case. It remained col-
lapsed for several days, and then began to increase; it is nowquite tense and more solid than in the infant, because it is so’very full, and is about the size of an orange.Such cases as these are sometimes dangerous, as inflammation
and sloughing may be produced; and as they lay over the- course of the carotid artery, sloughing might be attended withhaemorrhage.
n
Mr. Hewett took this opportunity of referring to a case ofthe kind which first came under his notice some years ago, ofa young lady with a cyst in this situation. Mr. Keate dis-sected the tumour out, but left a small bit of the cyst adherentto the subclavian artery. The wound healed up, and thepatient remained well for several years. When fourteen orfifteen years of age, a tumour occupied the same situation, andshe was taken to Edinburgh to a surgeon, who refused to meddlewith it. He (Mr. Hewett) saw it a little later, and he alsorefused to do anything to it. He thought, however, it mightbe obliterated, and Mr. Keate saw the case wi:h him. Thetumour was punctured, and a quantity of rock-water wasdrawn off. It was evidently a remnant of the old cyst, whichhe treated by passing two threads through it, to act as setons.Four days after, extensive suppuration of the whole cavity
* New York Journal of Medicine
took place; she had shivering and irritative fever. He openedthe entire cyst, right down to the collar-bone, cutting throughthe great mass of the tumour. A good deal of pus wasevacuated. She got up and went about, and a cough com-menced. One day, on her return home after a ride, she becamefaint, and vomited up a quantity of foetid matter, which musthave come either from the lung itself, or was a, separate deposit.At any rate, Mr. Hewett stated, she has remained perfectlywell ever since, and has quite recovered.
This gives a good idea of what may sometimes be encounteredin the treatment of this uncommon affection, which sometimesmay attain to so large a size as to interfere with deglutitionand respiration. Its general seat, as has been accurately de-scribed by Monnoir and Philips is the posterior inferior tri-angle of the neck, where it forms a somewhat bladder-liketumour, filled with various kinds of fluid, of a yellow or choco-late colour and serous character, but mostly resembling rock-water as pointed out by Mr. Hewett. Some surgeons prefer totreat these cases by a seton after prematurely tapping thecyst.
CLINICAL RECORDS.
BILIOUS REMITTENT FEVER.
’ THAT well-marked examples of this form of fever are occa-sionally met with, even in the metropolis, we think there can-not be any reasonable doubt. Of course, in tropical countries,this disease is not only severe in its general character, butbecomes extremely fatal. In temperate latitudes, however,the same fever will be comparatively mild, but will at thesame time possess most of the leading features. The essentialcause of bilious remittent fever is probably the miasma whichusually proceeds from a marshy district. This is clearly seensometimes in its attacking a whole ship’s crew when the vesselapproaches a miasmatic coast. Dr. Willshire lately attracted.our attention to the case of a young man in the Charing-crossHospital, who was evidently labouring under this fever. Itappeared that he had been previously admitted as a patientwith an ephemeral fever, from which he had quite recoveredand left the hospital. He went down to Sheerness, and during,we believe, some irregularities, was exposed to miasmatic in-fluence, and returned to the hospital with a bilious gastricremittent fever. There was a distinct remission in the characterof the fever, and when admitted he had hæmorrhage from thenose ; there was also a yellowish tinge of the skin. The diseasewas certainly present in its mildest form, and could not beconfounded with gastro-duodenitis connected with functionaldisturbance of the liver, as it sometimes is, because of thedistinct paroxysmal form of the remission. There was, besides,uneasiness in the epigastrium, and slight headache. Undertreatment, recovery was ensuing, as is generally the case in themild forms of the complaint, although the severest will yieldto prompt and proper treatment. On this point, Dr. Wood ofPhiladelphia has remarked : " There is, perhaps, no disease inwhich the resources of our profession are more happily displayedthan in the worst forms of bilious fever. Fearfully fatal underneglect or mismanagement, they may, in the great majority ofcases, be conducted by proper treatment to a favourable issue."
CONGENITAL ABSENCE OF THE RADIUS ANDITS MUSCLES.
VERY curious cases come under notice occasionally, illustrat-ing the freaks of Nature in the deficiency of parts. Whenthey are uncommon, we generally bring them under the noticeof our readers. On the 2nd of June, a child of two years wasbrought to Mr. Erichsen, at University College, whose lefthand was twisted inwards, and quite loose at the wrist as ifparalysed. The apparent thumb was rudimentary, and hungby a piece of skin. On minute examination, however, it wasdiscovered that the entire radius was absent, as well as, so faras could be made out, its proper muscles. There was a
wrist-joint ; but the true radio-carpal joint was not perfect,nor was there any metacarpal bone of the thumb. The truethumb was, therefore, de6cient, and the rudimentary finger inits place was evidently not a thumb, but probably a secondindex-finger. This appendage, being in the way, was removedby Mr. Erichsen.What is peculiarly interesting in this case is, that there is
not only an absence of a bone, such as the radius, of itself very
