A FEW SURGICAL NOTES. By Surgeon-Captain W. J.

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BUCHANAN, m.b., Officiating Civil Surgeon of Miclnapore, Case No. 1.? Cancer of Penis : amputation, ?H. B., aet. 24, Hindu, was admitted to hospital on account of a tumour of the penis in August last. This was a large cauliflower-like growth involving the entire length of the penis up (o The body of the the skin of the pubes. organ was infiltrated with the tumour. The urine passed in a thin stream with soms difficulty; The inguinal glands were hard and slightly enlarged. According to patient's statement the growth commenced in a chancre on the prepuce. It was determined to remove it; as, though not very painful, it was a source of great inconvenience and annoyance to the patient. A stout elnslic ligature round root of penis and round the groins controlled the

haemorrhage.

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J

372

INDIAN MEDICAL GAZETTE.

A No. 6 catheter was passed into bladder to mark the urethera. The tumour was easily removed ; but as it involved the skin up to the pubes, no attempt could be made to provide a flap for the urethral orifice, as insisted upon by Hilton. Deep ligatures were kept in stump to prevent retraction. A catheter being kept in the bladder prevented infiltration of urine into the scrotum. Patient recovered rapidly without a bad symptom and learnt to pass a catheter himself, which he was advised to do daily to prevent contraction of the urethral orifice. When seen two mouths later there was no sign of a return, and the urethera remained patent. Case No, 2.?Penetrating wound of abdomen. ?C. M., a Hindu male, was brought to hospital at 1 A.M. on night of 23rd August. He had been in some 1 row in the bazaar, and was stabbed in the abdomen with a knife. Wound one inch long, protrusion of omentum, which was tightly constricted by lips of wound. The tumour was red, swollen, and very dirty ; it formed a hard irregular lump about the size of an orange. It was in such a dirty and strangulated state that the Assistant Surgeon (Durga Nand Sen) considered it better to cut it off and to return it to the abdomen by enlarging the wound. It was ligatured with catgut, cut off, and the stump returned. Little or no bleeding. The abdominal wound was sutured with catgut, and a broad pad and bandage applied. On first evening the temperature was 101? F., but after judicious use of castor oil it never rose again. Patient made an uninterrupted recovery. He was allowed ordinary diet on 9th day, and discharged cured on 12th day. The wonderful feature of the case is how the intestines escaped. Case No. 3.?Diffuse Traumatic Aneurism of Brachial Artery, Ligature in wound. Recovery.? A Hindu boy, tet. 16, came to hospital, on 30th August, with a pulsating tumour above left elbow. On examination there was found to be a subcutaneous, soft, semi-fluctuating tumour about the size of a small orange. The skin was stretched, and blue. The whole arm below was (edematous. There was a distinct pulsation to be felt by hand synchronous with the heart, and a very loud bruit. It was on the line of the brachial artery. The history is curious. Two months before while helping to shoe a horse, the animal let out and kicked him on the arm. He states that there was much blood lost then. There was only a very, small scar. It may have been that the external wouud communicated with the ruptured artery, but was closed by native drugs (as described in Erichsen, vol i., ch. xv.) There was a very feeble radial pulse, and no ulnar It is probable that collateral one to be felt. circulation had set in, as the arm was fairly warm, though less so than the uninjured limb. The case being recognised as a so-called " ,f aneurism or traumatic rupture of an artery, ?

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[Dec

1892.

the operation was commenced immediately. The limb was made bloodless by an Esmarch's bandThe tumour age and a tourniquet applied* was laid completely open by one stroke of the, knife, the clots scooped out with finger, and the cavity, consisting of bloodclots, ragged and disorganised tissue, was flushed out with perchloride lotion. Then began the search for the ruptured artery. The expression " tedious and difficult" applied to this part of the operation by Erichsen is well deserved. However, iu time, the glistening white sheath of the artery was found, and the upper end of the ruptured vessel secured by stout catgut ligature. After further search the lower end of the artery was also secured. Both having been tested by relaxing the tourniquet, the cavity was well cleaned out with chloride of zinc lotion, and the edges of the wound brought together by ligatures, drainage being provided for at lower end. The limb was wrapped in cotton wool and put on a straight splint. That evening temperature was 100? F., and patient complained of pain. Opium was given, aud a dose of castor oil next morning.

On the 2nd day pulse was felt more distinctly in radial artery. On 3rd day suppuration set in wound, and two sutures were removed from lower end of wound. From this date till 10th day, when he was allowed to go home, nothing worth record occurred. The granulations formed rapidly. There was no secondary hjcmorrhage. On 6th day an angular splint was used aud a sling, aud patient allowed to walk about. Now* five weeks after, the only sign of the tumour is a red scar a couple of inches long, the radial and ulnar pulses remain feeble ; but nevertheless circulaThe collateral circulation is good in the arm. tion must have been through the inferior! profunda and an anastomotic arteries communicating with the ulnar recurrents. CASE No. 4.?Large carbuncle on abdomen treated by hypodermic injections of pure carbolic acid.? An old man, Bengali, attended hospital He had a large carbuncle on for treatment. It measured abdomen just above the umbilicus. four inches any way?was irregularly circular, broad and flat, and of a deep dusky red colour. It contained a large slough in its centre. Patient was old; constitutional disturbance was not so ns be great might expected. There was no diabetes. Like many Bengalis, his abdominal wall was thin ; so it was thought better not to; make a crucial incision. '

The Assistant Surgeon, Durganand Sen, injected at five different poiuts five minims of pure Carbolic acid, and applied a thick antiseptic poultice of lint soaked in a strong solution^ boric acid. Generous diet and stirnulants were given. In two days the slough was separating and soon came away, leaving a large ulcer*

which granulated

over.rapidly.

Pec. 1892.]

ELLIOT'S NOTE ON EXTIRPATION OF PENTS FOR CANCER.

A useful modification of the above treatment is to dilute the carbolic acid according to following formula and inject in half a dozen places about 10 m. (3j in all) :? R Acid Carbol. Pur. >

.

Glycerin. Aqua distillata ad

...

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...

...

...

...

3j. 5j. jj.

Case No.

5.?Secondary Cataract.?By this closure of the opening in the anterior capsule left after the removal of arcafaractous lens, with a thickening of the capsule, by which an impediment is offered to the rays of light in passing through the pupil. It may be due to a

I

mean a

previously thickened capsule of cells

on

the

inner

or

to

surface

proliferation

of the torn

capsule. In 17 cases of cataract done here lately this occurred once, about 10 days after extraction of lens by the " 3 millimetre flap" opera-

only

tion.

Patient complained that fiis sight wag as dim before. Examination with a lens showed a fine cobweb-like membrane closing the pupil Sir W. Bowman's operation was done. A area. discission needle was passed through the inner quadrant of the cornea and into the centre of the opacity; then, with the other hand, a second needle through the outer quadrant and into the membrane close beside the first needle. By approximating the handles the points are separated, and a sufficient opening is made in the The membrane, and the needles withdrawn. value of the two needles is that it prevents traction on the iris and ciliary processes. This is simpler and as effective as any other method as

proposed.

A Few Surgical Cases.

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