A MIRROR OF HOSPITAL PRACTICE. CHAKDNEY
HOSPITAL, CALCUTTA.
Operation for division of a cicatrix, the result of a burn. It is needless to remark how difficult these cases are to manage, especially among children, the more so, if the patients happen and the surgeon has not the advantage of an to be sickly, experienced instrument-maker,
to
adapt
a
screw
apparatus
to
the circumstances of the case. Sowdamoney, a poor weakly little girl, was admitted into the Chandney Hospital, the right arm and part of the forearm being closely bound down to the side of the thorax by a cicatrix, the result of a burn. The connecting band was triangular in shape and about five inches long, an inch and a half broad at its base, being lost above in the fold of the axilla. Under these conditions the following proceeding was adopted by Dr. Macnamara on the lGth October 1870. The child having been placed under the influence of chloroform, a long triangular needle threaded with whip-cord was passed through the portion of the cicatrix attached to the The ligature was arranged precisely in the manner dethorax. scribed and depicted by Mr. Erichsen for the strangulation of noevi. (The Science and Art of Surgery, by J. E. Erichsen, 4th Edition, p. 685.) The whip-cord in this way passed in a succession of loops along the thorax, and then crossing the apex of the constricting band, down the side of the cicatrix attached to the arm. The loops of whip-cord having been tied, the whole of the triangular cicatrix was thus isolated from the rest of the body, strangulated in fact. Of course, by this means loss of blood was saved, a matter of no small importance in a patient of this kind, and the operation induced no shock to the system. Carbolic acid dressing was used. The whole of the cicatrix fell away from its attachments eight days after the ligatures were applied ; the wound along the side of the thorax and arm gradually healed, and on the 24th of December the child was discharged from the hospital, having perfect use of the nrm and forearm, and with no vestige of the cicatrix, except the marks left along the thorax and arm, indicating its former
position.
Hypertrophy of the Scrotum.?There are at present two cases of this form of disease under treatment in tlie Chandney Hospital ; in both instances the hypertrophied structure has been removed, and the patients are doing remarkably well. The evidence of the beneficial action of carbolic acid dressing is remarkably strong in this class of cases, so far as the experience gained in the Chandney Hospital is concerned. Mr. Watson, who has been connected with the institution for so many years, bears strong testimony in favour of this dressing. During the operation for the removal of an hypertrophied scrotum, no water is used which does not contain carbolic acid:?the surface of the wound is painted over with the pure acid, and subsequently dressed with lint soaked in oil containing one part of carbolic acid to twelve of linseed oil. The parts heal with remarkable rapidity, and the result under this plau of treatment has up to the present time been very successful. Abscess of the Liver. The case of Jaggeshur, set. 40, recently discharged from the hospital, offers a good instance of the treatment of abscesses of the liver, which has, as a general rule, been adopted iu the Chandney Hospital for many years past?in fact, since Dr. John Jackson's time; and which from the experience of the Medical Officer in charge of the hospital affords the best hope of recovery from this formidable disease. The abscess was of considerable size, projecting from beneath the ribs into the epigastric region : the patient was terribly emaciated; P. 120 ; morning temperature 100?, evening 102?. Three days after admission into hospital a valvular opening was made into the abscess, and about 20 ounces of reddish-looking pus drained away ; the wound was then carefully closed, and re-opened in five days : this proceeding was repeated from time to time until the contents of the abscess was considerably diminished, when the cavity was syringed out twice a day with a weak solution of carbolic acid, until it had entirely contracted and healed. The patient's diet throughout the treatment was almost entirely composed of bread and milk, the latter being given him ad libitum.
Tumour of the Upper Jaw. In a successful case of removal of the upper jaw affected with myeloid disease, a very considerable portion of the lint employed to fill the cavity caused by the removal of the tumour was allowed to remain in situ until the whole of the external incisions had healed ; the dressings, in fact, being forced out into the mouth by the granulations springing up within the wound. The dressings employed consisted of lint soaked in oil and carbolic acid, which was thus allowed to remain in the cavity previovisly occupied by the tumour for twenty-four days, without creating the slightest irritation, and saving the patient much pain and inconvenience from constantly changing the dressings. On the 10th of September Dr Macnamara removed a large proliferous cystic tumour from the inner side of the left thigh. The case was worthy of note as being an instance of a proliferous cyst containing vascular growths. The patient had noticed pain in the upper part of the thigh three years and gradually the tumour ago ; this was followed by swelling, developed itself. When she came under treatment the tumour It was found to extend was about the size of a child's head. between the adductor longus and pectineus muscles, being firmly attached to the anterior surface of the os pubis. The cyst contained four cavities, the septa and its walls were remarkably tough and formed of connective tissue. Each cavity contained, besides a serous fluid, masses of fibrillated material attached to its walls, in which were numerous corpuscles. In one of the cavities this intra-cystic growth exactly resembled a large vascular polypus. The woman made a rapid recovery after the removal of the tumour.
HOSPITAL, CALCUTTA.
Operation for division of a cicatrix, the result of a burn. It is needless to remark how difficult these cases are to manage, especially among children, the more so, if the patients happen and the surgeon has not the advantage of an to be sickly, experienced instrument-maker,
to
adapt
a
screw
apparatus
to
the circumstances of the case. Sowdamoney, a poor weakly little girl, was admitted into the Chandney Hospital, the right arm and part of the forearm being closely bound down to the side of the thorax by a cicatrix, the result of a burn. The connecting band was triangular in shape and about five inches long, an inch and a half broad at its base, being lost above in the fold of the axilla. Under these conditions the following proceeding was adopted by Dr. Macnamara on the lGth October 1870. The child having been placed under the influence of chloroform, a long triangular needle threaded with whip-cord was passed through the portion of the cicatrix attached to the The ligature was arranged precisely in the manner dethorax. scribed and depicted by Mr. Erichsen for the strangulation of noevi. (The Science and Art of Surgery, by J. E. Erichsen, 4th Edition, p. 685.) The whip-cord in this way passed in a succession of loops along the thorax, and then crossing the apex of the constricting band, down the side of the cicatrix attached to the arm. The loops of whip-cord having been tied, the whole of the triangular cicatrix was thus isolated from the rest of the body, strangulated in fact. Of course, by this means loss of blood was saved, a matter of no small importance in a patient of this kind, and the operation induced no shock to the system. Carbolic acid dressing was used. The whole of the cicatrix fell away from its attachments eight days after the ligatures were applied ; the wound along the side of the thorax and arm gradually healed, and on the 24th of December the child was discharged from the hospital, having perfect use of the nrm and forearm, and with no vestige of the cicatrix, except the marks left along the thorax and arm, indicating its former
position.
Hypertrophy of the Scrotum.?There are at present two cases of this form of disease under treatment in tlie Chandney Hospital ; in both instances the hypertrophied structure has been removed, and the patients are doing remarkably well. The evidence of the beneficial action of carbolic acid dressing is remarkably strong in this class of cases, so far as the experience gained in the Chandney Hospital is concerned. Mr. Watson, who has been connected with the institution for so many years, bears strong testimony in favour of this dressing. During the operation for the removal of an hypertrophied scrotum, no water is used which does not contain carbolic acid:?the surface of the wound is painted over with the pure acid, and subsequently dressed with lint soaked in oil containing one part of carbolic acid to twelve of linseed oil. The parts heal with remarkable rapidity, and the result under this plau of treatment has up to the present time been very successful. Abscess of the Liver. The case of Jaggeshur, set. 40, recently discharged from the hospital, offers a good instance of the treatment of abscesses of the liver, which has, as a general rule, been adopted iu the Chandney Hospital for many years past?in fact, since Dr. John Jackson's time; and which from the experience of the Medical Officer in charge of the hospital affords the best hope of recovery from this formidable disease. The abscess was of considerable size, projecting from beneath the ribs into the epigastric region : the patient was terribly emaciated; P. 120 ; morning temperature 100?, evening 102?. Three days after admission into hospital a valvular opening was made into the abscess, and about 20 ounces of reddish-looking pus drained away ; the wound was then carefully closed, and re-opened in five days : this proceeding was repeated from time to time until the contents of the abscess was considerably diminished, when the cavity was syringed out twice a day with a weak solution of carbolic acid, until it had entirely contracted and healed. The patient's diet throughout the treatment was almost entirely composed of bread and milk, the latter being given him ad libitum.
Tumour of the Upper Jaw. In a successful case of removal of the upper jaw affected with myeloid disease, a very considerable portion of the lint employed to fill the cavity caused by the removal of the tumour was allowed to remain in situ until the whole of the external incisions had healed ; the dressings, in fact, being forced out into the mouth by the granulations springing up within the wound. The dressings employed consisted of lint soaked in oil and carbolic acid, which was thus allowed to remain in the cavity previovisly occupied by the tumour for twenty-four days, without creating the slightest irritation, and saving the patient much pain and inconvenience from constantly changing the dressings. On the 10th of September Dr Macnamara removed a large proliferous cystic tumour from the inner side of the left thigh. The case was worthy of note as being an instance of a proliferous cyst containing vascular growths. The patient had noticed pain in the upper part of the thigh three years and gradually the tumour ago ; this was followed by swelling, developed itself. When she came under treatment the tumour It was found to extend was about the size of a child's head. between the adductor longus and pectineus muscles, being firmly attached to the anterior surface of the os pubis. The cyst contained four cavities, the septa and its walls were remarkably tough and formed of connective tissue. Each cavity contained, besides a serous fluid, masses of fibrillated material attached to its walls, in which were numerous corpuscles. In one of the cavities this intra-cystic growth exactly resembled a large vascular polypus. The woman made a rapid recovery after the removal of the tumour.
