A
OF MENINGOCELE (CONGENITAL) CASE COMPLICATED HYDROWITH CHRONIC CE PRALUS.
By
Assistant
Surgeon Mohim Chundeb Roy,
L. M. S., JBeawur
A FEMALE child, aged 2 months, was brought to the Beawur Charitable Dispensary on the morning of Tuesday, the 7th April 1874, suffering from a tumour about the size of a small foetal head on the occipital bone just at its centre. The mother told me that the tumour was noticed at the time the child Since was born, but then it was much smaller than at present. then it has steadily been increasing in size. There has never been any indication of cerebral disturbance in the child since its birth. As the case seemed to me to be one of peculiar interest, I sent word to Dr. Somerville, of the Beawur Mission Hospital,
182 to
to
kindly come and see it with me, and immediately comply with my desire.
THE INDIAN MEDICAL GAZETTE. he
had the goodness
The child looked rather weak and emaciated ; the head apparently large in proportion to the face, measuring nearly 14 inches in circumference, and was to all appearance hydrocephalic ; the forehead was very prominent; the fontanelles, both anterior and posterior, were pretty large and tense; the sutures, particularly the sagittal, were well marked. On the occiput, about an inch below posterior fontanelle, there was a cyst, measuring 11| inohes in circuma pedicle nearly an inch ference, attached to the bone by thick. The cyst was formed by a membrane quite different in appearance from the skin, with which it had formed a firm adhesion around the pedicle. To us this membrane seemed brain through an to be a protrusion of the meninges of the opening in the occipital bone, though no such opening could be felt at the time even under careful examination. The contents appeared to be quite fluid, and in this we were confirmed by the appearance the tumour presented under transmitted light. The tumour had commenced to ulcerate around the pedicle. Whether to leave the tumour alone or remove it by surgical operation was now the question to settle. There was danger To leave it alone would be leaving the child on either side. in positive danger, while in the event of surgical operation being had recourse to the child would have a chance to live, feeble though indeed in the extreme. What however we most feared would look very awkward should the child die was that it during operation. After much deliberation however we decided in favor of the operation. The next question that occurred was as to the nature of the operation, i.e.., whether to remove the tumour by knife or by ligature, and we thought of deciding this question, after having ascertained, by letting the contents out, whether there was direct communication between the cyst and the interior of the head, that, should such a communication be found to exist to put the cyst under ligature, but have recourse to knife should none such be found in existence. Having thus set all questions at rest, our next step was to perform the operation, which we did about 5 o'clock p.m. that same day. was
the^
Just as we had anticipated, when the fluid contents of the cyst were all drawn off by puncturing it with a fine trocar, there was found a tolerably big opening, about the size of an
eight anna piece in the occipital bone through which the meninges of the brain had made their exit. The head also became smaller by about an inch with the fontanelles much depressed. Having thus no further doubt about the communication above referred to, we put the sack under three ligatures, our object in doing so being that should the child survive
it would have the benefit of a firm cicatrix and thus become less liable to a recurrence of the disease. When I saw the child next morning, the morning of the 8th, it was lying in its mother's lap sucking. The mother said it ?was very restless in the night. The fontanelles and sutures had all filled up. Head measured 13-25 inches in circumference; temperature at axilla 100u; pulse 123 ; respirations 47. I saw the child again this day at 5 p.m. The native doctor reported that it had strong fever after 11 forenoon, which lasted till 3 p.m. Temperature takeii in the axilla 102?; pulse weak 142 ; respirations 51; looked drowsy. On the morning of the 9th the child was found to be getting collapsed. Temperature 94?; pulse too weak to be counted; had ceased to suck; head 13*75 inches in circumference; no marked head symptoms present. Ordered, Spirit, ammonia) aromatic. 10 ni. with some mother s milk to be injected hour rectum and hot every per water bottles to be kept constantly applied to the body and limbs. -Death took place about 5 o'clock p.m. Ko post-mor* tem examination was allowed. Remarks.?This case is peculiarly interesting from the circumstance of the entire absenoe of head symptoms, (even after the cyst was put under ligature) which, we are told bv eminent authorities, are almost invariably present in cases of this nature. 2. Though the operation that was had recourse to may be considered dangerous and most likely to prove fatal, there was not the less that and not at a danger, perhaps very distant date had the tumour been left alone, since ulceration hud the around commenced already pedicle. In conclusion, I beg to tender my best thanks to Dr. Somerville, of the Beawur Mission, for the very great assistance he rendered me during my examination of and operation on the tumour.
[July 1,
1874.
OF MENINGOCELE (CONGENITAL) CASE COMPLICATED HYDROWITH CHRONIC CE PRALUS.
By
Assistant
Surgeon Mohim Chundeb Roy,
L. M. S., JBeawur
A FEMALE child, aged 2 months, was brought to the Beawur Charitable Dispensary on the morning of Tuesday, the 7th April 1874, suffering from a tumour about the size of a small foetal head on the occipital bone just at its centre. The mother told me that the tumour was noticed at the time the child Since was born, but then it was much smaller than at present. then it has steadily been increasing in size. There has never been any indication of cerebral disturbance in the child since its birth. As the case seemed to me to be one of peculiar interest, I sent word to Dr. Somerville, of the Beawur Mission Hospital,
182 to
to
kindly come and see it with me, and immediately comply with my desire.
THE INDIAN MEDICAL GAZETTE. he
had the goodness
The child looked rather weak and emaciated ; the head apparently large in proportion to the face, measuring nearly 14 inches in circumference, and was to all appearance hydrocephalic ; the forehead was very prominent; the fontanelles, both anterior and posterior, were pretty large and tense; the sutures, particularly the sagittal, were well marked. On the occiput, about an inch below posterior fontanelle, there was a cyst, measuring 11| inohes in circuma pedicle nearly an inch ference, attached to the bone by thick. The cyst was formed by a membrane quite different in appearance from the skin, with which it had formed a firm adhesion around the pedicle. To us this membrane seemed brain through an to be a protrusion of the meninges of the opening in the occipital bone, though no such opening could be felt at the time even under careful examination. The contents appeared to be quite fluid, and in this we were confirmed by the appearance the tumour presented under transmitted light. The tumour had commenced to ulcerate around the pedicle. Whether to leave the tumour alone or remove it by surgical operation was now the question to settle. There was danger To leave it alone would be leaving the child on either side. in positive danger, while in the event of surgical operation being had recourse to the child would have a chance to live, feeble though indeed in the extreme. What however we most feared would look very awkward should the child die was that it during operation. After much deliberation however we decided in favor of the operation. The next question that occurred was as to the nature of the operation, i.e.., whether to remove the tumour by knife or by ligature, and we thought of deciding this question, after having ascertained, by letting the contents out, whether there was direct communication between the cyst and the interior of the head, that, should such a communication be found to exist to put the cyst under ligature, but have recourse to knife should none such be found in existence. Having thus set all questions at rest, our next step was to perform the operation, which we did about 5 o'clock p.m. that same day. was
the^
Just as we had anticipated, when the fluid contents of the cyst were all drawn off by puncturing it with a fine trocar, there was found a tolerably big opening, about the size of an
eight anna piece in the occipital bone through which the meninges of the brain had made their exit. The head also became smaller by about an inch with the fontanelles much depressed. Having thus no further doubt about the communication above referred to, we put the sack under three ligatures, our object in doing so being that should the child survive
it would have the benefit of a firm cicatrix and thus become less liable to a recurrence of the disease. When I saw the child next morning, the morning of the 8th, it was lying in its mother's lap sucking. The mother said it ?was very restless in the night. The fontanelles and sutures had all filled up. Head measured 13-25 inches in circumference; temperature at axilla 100u; pulse 123 ; respirations 47. I saw the child again this day at 5 p.m. The native doctor reported that it had strong fever after 11 forenoon, which lasted till 3 p.m. Temperature takeii in the axilla 102?; pulse weak 142 ; respirations 51; looked drowsy. On the morning of the 9th the child was found to be getting collapsed. Temperature 94?; pulse too weak to be counted; had ceased to suck; head 13*75 inches in circumference; no marked head symptoms present. Ordered, Spirit, ammonia) aromatic. 10 ni. with some mother s milk to be injected hour rectum and hot every per water bottles to be kept constantly applied to the body and limbs. -Death took place about 5 o'clock p.m. Ko post-mor* tem examination was allowed. Remarks.?This case is peculiarly interesting from the circumstance of the entire absenoe of head symptoms, (even after the cyst was put under ligature) which, we are told bv eminent authorities, are almost invariably present in cases of this nature. 2. Though the operation that was had recourse to may be considered dangerous and most likely to prove fatal, there was not the less that and not at a danger, perhaps very distant date had the tumour been left alone, since ulceration hud the around commenced already pedicle. In conclusion, I beg to tender my best thanks to Dr. Somerville, of the Beawur Mission, for the very great assistance he rendered me during my examination of and operation on the tumour.
[July 1,
1874.
