?t JPirror of luspila! fractke. PURULIA DISPENSARY, MANBHOOM. CLINICAL NOTES ON SOME SURGICAL CASES. By
Surgeon-Major H. W. Hill, M.B.
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Case I. Hepatic abscess.?Nogendra Nath V Sen, of village Moubazar, a boy of 9 years of age, admitted as an out-door patient on the 18th April 1886, for hepatic abscess. On the above date the patient was brought before Civil Hospital Assistant Bhola Nath Gangooly, in charge of the dispensary, who kept the case till I visited the dispensary that day. The following are the symptoms :? The boy was weak and emaciated, and there was a previous history of repeated attacks of malarious fever. Suddenly he got severe pain on the right side in the hepatic region, attended with fever. The relatives of the boy tried various native medicines before bringing him On examination, there was to the dispensary. distinct bulging in the right hypochondriac region, dulness on percussion extending from below the right nipple to the left hypochondriac region ; below the lower border of the 10th rib where there was a prominence, there was distinct fluctuation. The rise of temperature in the evening removed all doubts as to suppuration having taken place, and I made a free incision into the abscess, which gave exit to nearly half a pint of greenish pus. A piece of lint soaked in carbolic oil was inserted daily into the wound, which was first washed out carefully with carbolic lotion and corrosive sublimate lotion (1 gr. in 16 oz.). Under this treatment the wound gradually healed, and in about a fortnight after the operation, the boy returned to his home in Moubazar, taking with him the dressings used. Information was received that the boy made a perfect recovery. Remarks.?Dr. Tomes, in a late number of the " Lancet, stated that Hepatic abscess has never met with in any person, Native or Eurobeen yet pean, below fifteen." Yet this case was in a boy of 9 years of age. There can be but little doubt that the abscess was of malarious origin, as the boy had suffered from repeated attacks of fever. Cancer of the mamma.? Toolsie Case II. Koolani, female, aged 38 years, was admitted as an in-patient from Burr a Bazar, on the 11th February 1887. She had a large ulcerated cancerous tumour of the left mamma. Says that the tumour first appeared about a year ago. Complains of stabbing pain of great severity, which prevents her from sleeping at night; has an anxious, care-worn look, is emaciated, and The also suffers from chronic bronchitis. axillary glands are not affected. On the 12th February, the patient was put under chloroform,
A MIRROR OF HOSPITAL
May, 1887.]
ami I removed the breast by two semi-elliptical incisions above and below the nipple, and dissected out the gland. There was a good deal of haemorrhage during the operation, but the vessels were quickly secured by ligatures, and the wound was sutured after washing it thoroughly with corrosive sublimate lotion (I gr. in 16 oz.) The tumour weighed 2 lbs. After the operation the cough became very troublesome, and she vomited incessantly. She iii was ordered effervescing draughts with m. acid, hydrocyan. dil. On the 14th February, the vomiting stopped, and she gradually improved. Some of the sutures gave way, but more than half of the wound healed by first intention, the rest by granulation. The wound was first washed with corrosive sublimate lotion, and then dressed with carbolic oil. She was on the 24th March 1887. cured discharged Case III. Wound of ankle-joint.?Nilmouey Singh, male, aged 21 years, was admitted as an in-patient, on the 12th March 1887, with an It incised wound of the right ankle-joint. appears he was sleeping on his left side, and was struck with an axe, which had penetrated the joint; the axe passed through from below one malleolus to the other, dividing the os calcis and astragalus, and severing branches of the dorsalis pedis artery. The lad was blanched from the excessive haemorrhage. The question now arose whether to amputate at the anklejoint or not. I decided on the latter. The two wounds were well washed and dressed with carbolic oil. On the 15th March there was excessive haemorrhage, when a pad and bandage were applied, and the wound dressed with Ruspini's styptic. Haemorrhage again occurred on the 16th and 18th March, but since then there has b^en no recurrence of haemorrhage. The patient is still in hospital ; both wounds have healed, but the ankle-joint is stiff, and he will be discharged in a few days. Remarks.?This was a case with wound of the tarsal bones, and there had been excessive hemorrhage conditions which might have necessitated amputation at the ankle-joint, but conservative surgery was adopted and the foot saved. ?
PRACTICE.
147
Surgeon-Major H. W. Hill, M.B.
/
.
Case I. Hepatic abscess.?Nogendra Nath V Sen, of village Moubazar, a boy of 9 years of age, admitted as an out-door patient on the 18th April 1886, for hepatic abscess. On the above date the patient was brought before Civil Hospital Assistant Bhola Nath Gangooly, in charge of the dispensary, who kept the case till I visited the dispensary that day. The following are the symptoms :? The boy was weak and emaciated, and there was a previous history of repeated attacks of malarious fever. Suddenly he got severe pain on the right side in the hepatic region, attended with fever. The relatives of the boy tried various native medicines before bringing him On examination, there was to the dispensary. distinct bulging in the right hypochondriac region, dulness on percussion extending from below the right nipple to the left hypochondriac region ; below the lower border of the 10th rib where there was a prominence, there was distinct fluctuation. The rise of temperature in the evening removed all doubts as to suppuration having taken place, and I made a free incision into the abscess, which gave exit to nearly half a pint of greenish pus. A piece of lint soaked in carbolic oil was inserted daily into the wound, which was first washed out carefully with carbolic lotion and corrosive sublimate lotion (1 gr. in 16 oz.). Under this treatment the wound gradually healed, and in about a fortnight after the operation, the boy returned to his home in Moubazar, taking with him the dressings used. Information was received that the boy made a perfect recovery. Remarks.?Dr. Tomes, in a late number of the " Lancet, stated that Hepatic abscess has never met with in any person, Native or Eurobeen yet pean, below fifteen." Yet this case was in a boy of 9 years of age. There can be but little doubt that the abscess was of malarious origin, as the boy had suffered from repeated attacks of fever. Cancer of the mamma.? Toolsie Case II. Koolani, female, aged 38 years, was admitted as an in-patient from Burr a Bazar, on the 11th February 1887. She had a large ulcerated cancerous tumour of the left mamma. Says that the tumour first appeared about a year ago. Complains of stabbing pain of great severity, which prevents her from sleeping at night; has an anxious, care-worn look, is emaciated, and The also suffers from chronic bronchitis. axillary glands are not affected. On the 12th February, the patient was put under chloroform,
A MIRROR OF HOSPITAL
May, 1887.]
ami I removed the breast by two semi-elliptical incisions above and below the nipple, and dissected out the gland. There was a good deal of haemorrhage during the operation, but the vessels were quickly secured by ligatures, and the wound was sutured after washing it thoroughly with corrosive sublimate lotion (I gr. in 16 oz.) The tumour weighed 2 lbs. After the operation the cough became very troublesome, and she vomited incessantly. She iii was ordered effervescing draughts with m. acid, hydrocyan. dil. On the 14th February, the vomiting stopped, and she gradually improved. Some of the sutures gave way, but more than half of the wound healed by first intention, the rest by granulation. The wound was first washed with corrosive sublimate lotion, and then dressed with carbolic oil. She was on the 24th March 1887. cured discharged Case III. Wound of ankle-joint.?Nilmouey Singh, male, aged 21 years, was admitted as an in-patient, on the 12th March 1887, with an It incised wound of the right ankle-joint. appears he was sleeping on his left side, and was struck with an axe, which had penetrated the joint; the axe passed through from below one malleolus to the other, dividing the os calcis and astragalus, and severing branches of the dorsalis pedis artery. The lad was blanched from the excessive haemorrhage. The question now arose whether to amputate at the anklejoint or not. I decided on the latter. The two wounds were well washed and dressed with carbolic oil. On the 15th March there was excessive haemorrhage, when a pad and bandage were applied, and the wound dressed with Ruspini's styptic. Haemorrhage again occurred on the 16th and 18th March, but since then there has b^en no recurrence of haemorrhage. The patient is still in hospital ; both wounds have healed, but the ankle-joint is stiff, and he will be discharged in a few days. Remarks.?This was a case with wound of the tarsal bones, and there had been excessive hemorrhage conditions which might have necessitated amputation at the ankle-joint, but conservative surgery was adopted and the foot saved. ?
PRACTICE.
147
