August 1,
A MIRROR OP HOSPITAL PRACTICE.
1872.]
A MIRROR OF HOSPITAL
PRACTICE.
CHANDNLE HOSPITAL, CALCUTTA.
.
AMPUTATION OF THIGH; RECOVERY. TWO OASES OP ENTERIC FEVER; RECOVERY.
Ilepoi'ted by Gopee, aged
Sub-Assistant
Surgeon
Mokiioda Churn Sen.
25 years, was admitted into hospital on the 15*h of December, 1871, with extensive disease of the lower end of the femur and the middle of the tibia of the right side, suppuration into the right knee joint, and numerous sinuses running in every direction, from the lower part of the thigh down to the ankle joint; the muscles of the posterior aspect of the leg were disorganised in large patches, and saturated with unhealthylooking and extremely offensive pus. The patient was very weak and emaciated, and at the time of the operation was rapidly going from bad to worse. After ineffectual treatment for upwards of a month, the limb was, on the 17th of January, 1872, amputated at the junction of the middle with the lower third of the thigh, by the ordinary flap operation. The operation was performed under the carbolic acid spray, and the stump subsequently covered with lint soaked in carbolic oil, and this surrounded with cotton wool. The first dressings were removed on the sixth day after operation, when the stump was found to be in a very favorable condition, the flaps having almost united. The ligature of the main artery separated on the eleventh day after operation. The operation relieved the patient of all constitutional symptoms, and he progressed slowly and steadily, and was discharged from the hospital on the 6th of April, 1872. Remarks.?The mortality after amputation of the thigh, among the native inmates of our Calcutta hospitals, lias for This case was a most some years past been very great indeed. unpromising one, and I attribute the man's recovery very much to the mode cf dressing the stump?a method which I described in the Indian Medical Gaztte, 1872, p. 63, in the instance of. several other amputations under my care.?0, Macnamara. ENTERIC FEVER. No. I. Jummoo, aged 28 years, was admitted into hospital on the 6th of March, 1872, with an attack of fever. The temperature of his body was 104?; pulse 130, weak and fluttering; respiration 48 ; articulation indistinct; mind roving ; tongue dry and brown ; muscular system generally tremulous; there was pain on pressure over the ccecum. No rash on the body or soinles on the teeth : this latter symptom made its appearance on the morning of the 7th, and within the next three days gurgling in the bowels, diarrhoea?the stools being the ochrey watery stools of enteric fever?congestion of the eyes, and some indistinct lenticular rose-spots oil the body appeared in succession. Typhoid symptoms continued severe up to tho fifth day after admission. During this time the temperature of the patient's body in the morning ranged from 101? to 102,? and in the evening from 103? to 101?. Pulse was very weak, and fluttering all along ; at times it could not be counted, and when this could be done, it was never below 120, or above 148. Respiration ranged from 36 to 46 in the minute. The patient made a good recovery, and was discharged on the 27th of March.
Treatment:?? Tinct: cinchona 5?8 Yin : rubrum ?93 Acid nitric dil: nix Inf: serpentaria ?i every four hours when the patient was very low. Quinine, in 20-grain doses, was administered whenever the temperature of the body rose to 103 5?. Diet:?Milk and soup every four hours; subsequently sago and milk. ...
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Seitroo, aged 16 years, was admitted into hospital on May, 1872, with an attack of enteric fever, attended pain in the left hypochondrium. On admission, his spleen was found to be enlarged ; temperature 103?; pulse 126, small and very weak; respiration 24; mind wandering; bowels irregular; there was pain on pressure over the coecum, but no gurgling sensation could be felt in it; no sordes on teeth or rash On the 4th of June the patient got an attack of on the body. diarrhoea, and on the 5th his teeth became covered with sordes. No. II. the 31st of with a dull
181
Tlie stools assumed the characteristic appearance of enteric fever. On the 6th there were a few rose-spots seen over the abdomen. The typhoid symptoms remained up to the 10th of June; during this time the temperature of the body in the morning ranged from 100 to 1024, and in the evening from 103 to 101, pulse from 96 to 120, and respiration from 26 to 40. Treatment: ... grs. xx Quinine sulph: every morning. Mist: cretaj, to check the purging. Diet:?Milk every four hours; four eggs during the day: arrowroot, soup, and port wine, as required. Brandy gvi. during the day, when the patient was very low. Bread and milk latterly : milk was omitted when the purging was profuse. Under this plan of treatment the patient recovered, and he was discharged, although still weak, on the 16th of June, 1872. Remarks.?I have no reasonable doubt that quinine is useful in cases of enteric fever among the natives of this country; the drug tends to keep down the temperature of the patient's body, and the dose must be regulated accordingly. I do not think quinine hastens the cure of this form of fever, but, in my opinion, it tends to lessen the danger of the various complications which render enteric fever so formidable a disease among the ill-fed populations of Lower Bengal.?0. Macnamara. ?
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/
A MIRROR OP HOSPITAL PRACTICE.
1872.]
A MIRROR OF HOSPITAL
PRACTICE.
CHANDNLE HOSPITAL, CALCUTTA.
.
AMPUTATION OF THIGH; RECOVERY. TWO OASES OP ENTERIC FEVER; RECOVERY.
Ilepoi'ted by Gopee, aged
Sub-Assistant
Surgeon
Mokiioda Churn Sen.
25 years, was admitted into hospital on the 15*h of December, 1871, with extensive disease of the lower end of the femur and the middle of the tibia of the right side, suppuration into the right knee joint, and numerous sinuses running in every direction, from the lower part of the thigh down to the ankle joint; the muscles of the posterior aspect of the leg were disorganised in large patches, and saturated with unhealthylooking and extremely offensive pus. The patient was very weak and emaciated, and at the time of the operation was rapidly going from bad to worse. After ineffectual treatment for upwards of a month, the limb was, on the 17th of January, 1872, amputated at the junction of the middle with the lower third of the thigh, by the ordinary flap operation. The operation was performed under the carbolic acid spray, and the stump subsequently covered with lint soaked in carbolic oil, and this surrounded with cotton wool. The first dressings were removed on the sixth day after operation, when the stump was found to be in a very favorable condition, the flaps having almost united. The ligature of the main artery separated on the eleventh day after operation. The operation relieved the patient of all constitutional symptoms, and he progressed slowly and steadily, and was discharged from the hospital on the 6th of April, 1872. Remarks.?The mortality after amputation of the thigh, among the native inmates of our Calcutta hospitals, lias for This case was a most some years past been very great indeed. unpromising one, and I attribute the man's recovery very much to the mode cf dressing the stump?a method which I described in the Indian Medical Gaztte, 1872, p. 63, in the instance of. several other amputations under my care.?0, Macnamara. ENTERIC FEVER. No. I. Jummoo, aged 28 years, was admitted into hospital on the 6th of March, 1872, with an attack of fever. The temperature of his body was 104?; pulse 130, weak and fluttering; respiration 48 ; articulation indistinct; mind roving ; tongue dry and brown ; muscular system generally tremulous; there was pain on pressure over the ccecum. No rash on the body or soinles on the teeth : this latter symptom made its appearance on the morning of the 7th, and within the next three days gurgling in the bowels, diarrhoea?the stools being the ochrey watery stools of enteric fever?congestion of the eyes, and some indistinct lenticular rose-spots oil the body appeared in succession. Typhoid symptoms continued severe up to tho fifth day after admission. During this time the temperature of the patient's body in the morning ranged from 101? to 102,? and in the evening from 103? to 101?. Pulse was very weak, and fluttering all along ; at times it could not be counted, and when this could be done, it was never below 120, or above 148. Respiration ranged from 36 to 46 in the minute. The patient made a good recovery, and was discharged on the 27th of March.
Treatment:?? Tinct: cinchona 5?8 Yin : rubrum ?93 Acid nitric dil: nix Inf: serpentaria ?i every four hours when the patient was very low. Quinine, in 20-grain doses, was administered whenever the temperature of the body rose to 103 5?. Diet:?Milk and soup every four hours; subsequently sago and milk. ...
...
...
...
...
...
...
...
Seitroo, aged 16 years, was admitted into hospital on May, 1872, with an attack of enteric fever, attended pain in the left hypochondrium. On admission, his spleen was found to be enlarged ; temperature 103?; pulse 126, small and very weak; respiration 24; mind wandering; bowels irregular; there was pain on pressure over the coecum, but no gurgling sensation could be felt in it; no sordes on teeth or rash On the 4th of June the patient got an attack of on the body. diarrhoea, and on the 5th his teeth became covered with sordes. No. II. the 31st of with a dull
181
Tlie stools assumed the characteristic appearance of enteric fever. On the 6th there were a few rose-spots seen over the abdomen. The typhoid symptoms remained up to the 10th of June; during this time the temperature of the body in the morning ranged from 100 to 1024, and in the evening from 103 to 101, pulse from 96 to 120, and respiration from 26 to 40. Treatment: ... grs. xx Quinine sulph: every morning. Mist: cretaj, to check the purging. Diet:?Milk every four hours; four eggs during the day: arrowroot, soup, and port wine, as required. Brandy gvi. during the day, when the patient was very low. Bread and milk latterly : milk was omitted when the purging was profuse. Under this plan of treatment the patient recovered, and he was discharged, although still weak, on the 16th of June, 1872. Remarks.?I have no reasonable doubt that quinine is useful in cases of enteric fever among the natives of this country; the drug tends to keep down the temperature of the patient's body, and the dose must be regulated accordingly. I do not think quinine hastens the cure of this form of fever, but, in my opinion, it tends to lessen the danger of the various complications which render enteric fever so formidable a disease among the ill-fed populations of Lower Bengal.?0. Macnamara. ?
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/
