St George's Bristol, Go Green Business Breakfast - Happy & Healthy, St George's, 21st May 2015
ST. GEORGE'S HOSPITAL
1
136 at first some little difficulty in retaining the funis above the I head, but by the careful management of Mr. Ninnis, the senior obstetric clerk, it was kept up till the head fairly entered the os, after which there was no further trouble. The advantage of the above plan over the older one of seizing the head from within the uterus, and drawing it into its na- tural position, was very obvious in this case. The ease with I which the whole was effected was surprising. At first the power exercised was from the exterior, afterwards the head could be held between the hand outside and that inside, so that it could have been placed wherever required. The advan- tages of cephalic over pelvic and podalic version have always I been recognised, and it should be preferred in all cases where option is given us. Should, however, it be found for some reason impracticable, it is easy to make pressure externally on the opposite end of the fœtus, and thus convert it into a breech case. Wellington-street, London-bridge, Jan. 1861. A Mirror OF THE PRACTICE OF MEDICINE AND SURGERY IN THE HOSPITALS OF LONDON. Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum et dissectionum historias, tam aliornm ptoprias, collectas habere et inter se com- parare.—MORGAGNI. De Sed. et Caus, Morb., lib. 14. Proœmium. ST. GEORGE’S HOSPITAL. EXCISION OF SEBACEOUS TUMOURS FROM THE SCALP, FOLLOWED BY DIFFUSE CELLULAR INFLAMMATION, ERYSIPELAS OF THE FACE, AND DIPHTHERITIC IN- FLAMMATION OF THE PHARYNX ; FATAL RESULT. (Under the care of Mr. PRESCOTT HEWETT.) THE removal of sebaceous tumours from the scalp is an ope- ration by no means uncommon; we have seen a large number of them taken away at one sitting without any inconvenience. It is recommended by surgical writers not to operate if the pa- I tient’s health is out of order or the season unfavourable, from the risk of erysipelas-an affection very liable to occur in elderly and stout people whose complexion is florid. We to- day place upon record an instance in which erysipelas set in two days after the removal of several of these tumours, in a comparatively young man, whose habits of life, however, had been somewhat irregular. The erysipelas subsequently involved the entire scalp and face, the patient became delirious at night, had dyspnoea, and complained of pain in his throat; this was followed by death from exhaustion. As is not unusual in such cases, the erysipelas had spread inwards to the pharyngeal mucous membrane and that of the larynx, producing œdema of the glottis and diphtheritic exuda- tion, which were the main causes of the fatal result. The danger of this affection when it has once spread to the throat is clearly pointed out in Dr. Gibb’s work on " Diseases of the Throat and Windpipe." The erysipelatous inflammation is so violent that it runs through its stages with remarkable rapidity, and is not unfrequently followed by extensive purulent infiltration throughout the whole of the submucous tissues of the structures entering into the formation of the larynx. The muriated tincture of iron, in full doses, possesses remark- able curative powers in this affection, and should not be for- gotten in the hour of danger. We have known patients in several of the hospitals complain of sore-throat when the scalp and face were affected with erysipelas, and the disease has yielded to the use of this medicine, conjoined with an abun dance of stimulants. The notes of the following case were furnished by Mr. Jas. Rouse, surgical registrar to the hospital:- Edward H—, agea tlurty-two, aamittect January, 1860, under the care of Mr. Hewett, with three small sebaceous. tumours of the scalp which had existed for some years; latterly they had been increasing in size, and he was anxious to have- them removed. He was a footman, and, although not a drunkard, he had been in the habit of drinking a considerable amount of beer and spirits. On the llth the tumours were removed; he remained quite well until the 13th, when the- scalp in the neighbourhood of the incisions became puffy and tender, the tongue coated, and the system disordered. He was given bark and ammonia, and a purgative. On the 14th’ the inflammation had spread, and involved nearly the whole- scalp ; he was ordered wine, porter, and eggs. He continued to get worse until the 17th, when the entire scalp and face- were involved. He was delirious at night, and tremulous. The tongue was actually loaded; he complained of pain in the- throat ; and there was difficulty of breathing. No new symp- toms presented themselves; he became weaker and lower, and, appeared to die from exhaustion. Autopsy twenty-six 7toui-s after, death.—On cutting through, the scalp it was found much thickened, and the space between the pericranium and tendon of the occipito-frontalis was infil- trated with serous fluid to so great an extent as to have ac- quired, in most places, the thickness of an inch. There were two small wounds, made in the removal of sebaceous tumours’ over the occipital bone. They did not present any morbid appearances, and had not apparently injured the occipito-fron- talis muscle. The veins of the diploe were noticed to be large- in several places, but, on rasping away the skull so as to expose- their cavity, it seemed healthy. There was a good deal of sub. arachnoid fluid, but the membranes were healthy and the sub- stance of the brain firm. The upper part of the pharynx was-. coated with a layer of effused lymph, which extended down the opening of the larynx as far as the root of the epiglottis. It was easily peeled off the mucous membrane. There was some cedema, of the left vocal cord, so that the corresponding ventricle of the larynx was nearly obliterated. The upper part of the larynx, especially above the vocal cords, was very vascular. Both cavities of the heart were filled with decolorized clot. The liver was large, weighed five pounds ten ounces, and appeared fatty. The spleen was large and soft. The kid- neys were of very large size, and together weighed one pound ten ounces; their cortical tissue was much hypertrophied, and. their substance somewhat congested. UNIVERSITY COLLEGE HOSPITAL. SANGUINEOUS EXTRAVASATION IN PATCHES OVER THE HEAD, FACE, NECK, AND LEFT ARM, FROM SEVERE CONTUSION; RECOVERY. (Under the care of Mr. H. THOMPSON.) FoR the notes of the following very interesting case we are indebted to Mr. Henry C. Bastian, late house-surgeon to the- hospital. Considering the nature of the accident, it is remark-- able that greater injuries than those described were not sus- tained :- Thomas B-, aged eight, admitted into the above hospital on September 19th, 1860, at half’past seven P.M. Nothing positive could be ascertained as to the nature of the accident which he had sustained, except that he was struck by, & Hansom cab, and got his neck and left arm so tightly jammed between one of its wheels and the spring that several minutes elapsed before he could be extricated, and then only by taking off the wheel. On admission half an hour after the accident, he was apparently insensible, but could stand a little when supported. Pulse rather slow and full ; surface of body warm, but extremities cold. The head, face, and neck were much,, swollen and congested, and the whole surface of these parts,- as well as of the left upp-er extremity as far as the wrist, and corresponding upper half of the back over the scapula, was studded with minute points of extravasated blood. These- hæmorrhagic spots were also seen, on separating the hair, over the whole of the scalp, and also on both sides of the pinna of the ear. There was, moreover, a large spot of extravasated blood beneath the outer side of the right conjunctiva. One hour after admission the congestion and swelling about the head and neck had not diminished. The surface of the body was warm; he moved his limbs freely; was sensitive and feverish when touched; but did not take the slightest notice when
Transcript of ST. GEORGE'S HOSPITAL
136
at first some little difficulty in retaining the funis above the Ihead, but by the careful management of Mr. Ninnis, the seniorobstetric clerk, it was kept up till the head fairly entered theos, after which there was no further trouble.The advantage of the above plan over the older one of seizing
the head from within the uterus, and drawing it into its na- tural position, was very obvious in this case. The ease with Iwhich the whole was effected was surprising. At first thepower exercised was from the exterior, afterwards the headcould be held between the hand outside and that inside, sothat it could have been placed wherever required. The advan-
tages of cephalic over pelvic and podalic version have always Ibeen recognised, and it should be preferred in all cases where
option is given us. Should, however, it be found for somereason impracticable, it is easy to make pressure externally onthe opposite end of the fœtus, and thus convert it into a breechcase.
Wellington-street, London-bridge, Jan. 1861.
A MirrorOF THE PRACTICE OF
MEDICINE AND SURGERYIN THE
HOSPITALS OF LONDON.
Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum etdissectionum historias, tam aliornm ptoprias, collectas habere et inter se com-parare.—MORGAGNI. De Sed. et Caus, Morb., lib. 14. Proœmium.
ST. GEORGE’S HOSPITAL.
EXCISION OF SEBACEOUS TUMOURS FROM THE SCALP,FOLLOWED BY DIFFUSE CELLULAR INFLAMMATION,ERYSIPELAS OF THE FACE, AND DIPHTHERITIC IN-
FLAMMATION OF THE PHARYNX ; FATAL RESULT.
(Under the care of Mr. PRESCOTT HEWETT.)THE removal of sebaceous tumours from the scalp is an ope-
ration by no means uncommon; we have seen a large numberof them taken away at one sitting without any inconvenience.It is recommended by surgical writers not to operate if the pa- Itient’s health is out of order or the season unfavourable, fromthe risk of erysipelas-an affection very liable to occur inelderly and stout people whose complexion is florid. We to-
day place upon record an instance in which erysipelas set intwo days after the removal of several of these tumours, in acomparatively young man, whose habits of life, however, hadbeen somewhat irregular. The erysipelas subsequently involvedthe entire scalp and face, the patient became delirious at night,had dyspnoea, and complained of pain in his throat; this wasfollowed by death from exhaustion.As is not unusual in such cases, the erysipelas had spread
inwards to the pharyngeal mucous membrane and that of thelarynx, producing œdema of the glottis and diphtheritic exuda-tion, which were the main causes of the fatal result. The dangerof this affection when it has once spread to the throat is clearlypointed out in Dr. Gibb’s work on " Diseases of the Throatand Windpipe." The erysipelatous inflammation is so violentthat it runs through its stages with remarkable rapidity, andis not unfrequently followed by extensive purulent infiltrationthroughout the whole of the submucous tissues of the structuresentering into the formation of the larynx.The muriated tincture of iron, in full doses, possesses remark-
able curative powers in this affection, and should not be for-gotten in the hour of danger. We have known patients inseveral of the hospitals complain of sore-throat when the scalpand face were affected with erysipelas, and the disease hasyielded to the use of this medicine, conjoined with an abundance of stimulants.The notes of the following case were furnished by Mr. Jas.
Rouse, surgical registrar to the hospital:-
Edward H—, agea tlurty-two, aamittect January, 1860,under the care of Mr. Hewett, with three small sebaceous.tumours of the scalp which had existed for some years; latterlythey had been increasing in size, and he was anxious to have-them removed. He was a footman, and, although not adrunkard, he had been in the habit of drinking a considerableamount of beer and spirits. On the llth the tumours wereremoved; he remained quite well until the 13th, when the-scalp in the neighbourhood of the incisions became puffy andtender, the tongue coated, and the system disordered. Hewas given bark and ammonia, and a purgative. On the 14th’the inflammation had spread, and involved nearly the whole-scalp ; he was ordered wine, porter, and eggs. He continuedto get worse until the 17th, when the entire scalp and face-were involved. He was delirious at night, and tremulous. Thetongue was actually loaded; he complained of pain in the-throat ; and there was difficulty of breathing. No new symp-toms presented themselves; he became weaker and lower, and,appeared to die from exhaustion.
Autopsy twenty-six 7toui-s after, death.—On cutting through,the scalp it was found much thickened, and the space betweenthe pericranium and tendon of the occipito-frontalis was infil-trated with serous fluid to so great an extent as to have ac-quired, in most places, the thickness of an inch. There weretwo small wounds, made in the removal of sebaceous tumours’over the occipital bone. They did not present any morbidappearances, and had not apparently injured the occipito-fron-talis muscle. The veins of the diploe were noticed to be large-in several places, but, on rasping away the skull so as to expose-their cavity, it seemed healthy. There was a good deal of sub.arachnoid fluid, but the membranes were healthy and the sub-stance of the brain firm. The upper part of the pharynx was-.coated with a layer of effused lymph, which extended downthe opening of the larynx as far as the root of the epiglottis.It was easily peeled off the mucous membrane. There wassome cedema, of the left vocal cord, so that the correspondingventricle of the larynx was nearly obliterated. The upper partof the larynx, especially above the vocal cords, was veryvascular. Both cavities of the heart were filled with decolorizedclot. The liver was large, weighed five pounds ten ounces,and appeared fatty. The spleen was large and soft. The kid-neys were of very large size, and together weighed one poundten ounces; their cortical tissue was much hypertrophied, and.their substance somewhat congested.
UNIVERSITY COLLEGE HOSPITAL.
SANGUINEOUS EXTRAVASATION IN PATCHES OVER THE
HEAD, FACE, NECK, AND LEFT ARM, FROM SEVERE
CONTUSION; RECOVERY.
(Under the care of Mr. H. THOMPSON.)FoR the notes of the following very interesting case we are
indebted to Mr. Henry C. Bastian, late house-surgeon to the-hospital. Considering the nature of the accident, it is remark--able that greater injuries than those described were not sus-tained :-Thomas B-, aged eight, admitted into the above hospital
on September 19th, 1860, at half’past seven P.M. Nothingpositive could be ascertained as to the nature of the accidentwhich he had sustained, except that he was struck by, &
Hansom cab, and got his neck and left arm so tightly jammedbetween one of its wheels and the spring that several minuteselapsed before he could be extricated, and then only by takingoff the wheel. On admission half an hour after the accident,he was apparently insensible, but could stand a little whensupported. Pulse rather slow and full ; surface of body warm,but extremities cold. The head, face, and neck were much,,swollen and congested, and the whole surface of these parts,-as well as of the left upp-er extremity as far as the wrist, andcorresponding upper half of the back over the scapula, wasstudded with minute points of extravasated blood. These-hæmorrhagic spots were also seen, on separating the hair, overthe whole of the scalp, and also on both sides of the pinna ofthe ear. There was, moreover, a large spot of extravasatedblood beneath the outer side of the right conjunctiva. Onehour after admission the congestion and swelling about thehead and neck had not diminished. The surface of the bodywas warm; he moved his limbs freely; was sensitive and feverishwhen touched; but did not take the slightest notice when
