Description
of
Operations.
i
?
S3
n
a
o
x
q
B.?For Disease.
7.' 8.
9. 10.
Syme's?for
caries
.?
Leg?Epithelioma of foot Thigh?disease of knee-joint
...
220 o I 1
...
I
I
o
...
I
I
o
...
I
I
o
...
1
I
o
...
2
2
...
I
I
o
4
3
1
of femur
Hip-joint?sarcoma
Total
SURGICAL OPERATIONS PERFORMED THE MAYO HOSPITAL,
LAHORE,
AT
DURING
THE WINTER SESSION, 1883-84. By Surgeon-Major E. Lawrie, Professor of Surgery, Lahore Medical School.
Lahore, follows
Mayo Hospital October 1883 till April 1884, were as
operations performed
The
from
V.?Excision of Tumours.
A.?Malignant.
1. 2.
Scirrhus?mamma
3. 4.
5.
Sarcoma?parotid ?thigh ? ,, ?naso-pharyngeal
1.
Fibroma...
220
2.
Fatty Angioma Lymphoma Cystic Hydatid cyst Polypus nasi
220
B.?Non-malignant.
at the
3. 4.
:?
5.
Description
of
Operations.
2
xt
D
CJ
Epithelioma?face
6. 7.
...
a-v
Total
1
1
o
5
5
0 o
12
12
1
1
o
2
2
O
34
33
38
36
VI?Removal of Calculi. 1
I.?Operations 1. 2.
the
on
Eye
and
Appendages.
Extraction of cataract Other major operations
I.
151 151
Total
30
30
181
181
0 o
1. 2.
3. 4. 5. 6.
on
2.
?
Incision of knee-joint Excision of wrist of elbow ? of knee ,,
III.?Operations 1. 2.
3. 4. 5.
2
2
O
IO
IO
O
4.
2
2
0
1
I
O
6.
...
2
2
0
2
2
7.
5.
8. 9.
19
19
10. 11.
on Bones.
12.
Excision for necrosis... Fractures set Resection of ununited fracture Suturing of patella for simple fracture of olecranon for com...
Suturing pound
3.
...
Total
fracture
880
13. 14.
990
15.
220
I
Total
Tracheotomy CEsophagotomy
Abdominal section?obstruction of bowels Strangulated hernia?sac opened Radical cure of inguinal hernia Radical cure of umbilical hernia Fistula in ano Perineal section Internal urethrotomy (Holt's) External urethrotomy (Syme's) For hematocele Liver abscess Psoas and lumbar abscess For imperforate vagina ...
._
...
Ovariotomy
Total 1
I I
o
o
VIII A.?Reparative 1.
21
21
2.
3. 4.
5, 6.
1
1
o
1
1
o
I
O
I
220
990 I
I
o
770 3
2
1
660 I
I
o
I
I
o
220 o 1
I
o
2
I
I
46
43
Hare-lip
Circumcision
2
2
440
Total
A.?For Injury.
2.
3?
Operations.
I V.?A mputations.
1.
3
2
VIII. ?Incisions.
Joints.
Dislocation reduced... Extension of stiff joints
...
VII.?Removal of Foreign Bodies
1.
II.?Operations
Vesical?lithotomy
o
IX?Operations not classified\
Primary of fore-arm... of thigh ? Secondary of elbow-joint of knee-joint ? of hip-joint ,, of thigh ,, Total
I
O
1.
Excision of Tonsil
I
O
2.
I
O
0
I
3. 4*
1
O
Hydrocele Ovarian cyst?tapped Nerve stretching, sciatic
4
o
...
Total Grand Total
1
0
3
o
1
1
o
1
1
o
600 369
362
7
THE INDIAN MEDICAL GAZETTE.
256 There
were
man
operations. The amputation through the
of
case
a
patient
The
knee-joint.
deaths after
seven
first occurred in
who had sustained
was
compound comminuted the leg six months before
a
fracture of both bones of into
admission
supervened,
and
hospital. Extensive necrosis had suppuration had reduced him to
the last stage of exhaustion. due to shock the removal of
and loss
two
The second death
was
of blood fifteen hours after
large naso-pharyngeal polypus. The followed the operation of lithotomy
a
third and fourth in
emaciated old
an
worn-out old men.
The fifth took
in
place
a
patient complete obstruction of the bowels for sixteen days. An artificial anus who'had suffered from
by median abdominal incision, but afforded, though immense quantities
was made
relief
was
solid and died next which
no
day. performed
as
palliative
a
measure
in
a
with extravasation of urine* gangrene of the scrotum, and septic poisoning. The seventh death that
of
an
old woman, set. 50, who had under-
operation
of
ovariotomy.
day she did fairly well. refused food.
on
and died,
the sixteenth
none were
and
in, but she
set
of
exhaustion,
due
to
operations
preventible
poisoning, arising mortality would have
in the
was
1*9;
causes, such
hospital.
been lower if the
as
I believe
patients
nursing. In an instiMayo Hospital, connected as it is with a medical school, students no less than patients would derive incalculable advantage from the work of a thoroughly efficient staff of nurses; and it is a reproach to the wealthy natives of the Punjab, that
tution like the
forthcoming to supply this want in the principal hospital of the province. A few of the operations performed during the session require special mention. Among the operations The wrist-joint on joints there were five excisions. funds should be
excised by a flap cut from its dorsal aspect, in excision of the knee-joint, invery like the flap stead of, in the usual way, by longitudinal incisions along the radial and ulnar borders, which is both
was
difficult and tedious.
There
were
two
cases
of
of the
excision of the knee, and elbow-joint. All these were carried out antiseptically and healed two
by
young
4th
Novem-
precautions
After the flap was placed in posiand secured, without sutures, by three boracic of lint, the joint was laid on, and
in
a
of
an
covered
sheet.
with,
over
Rigidity
old chick cut
as
so
limb from the trochanter
sawdust,
eucalyptus
maintained
was
by
piece
a
encircle the whole
to
to the
and fastened
ankle,
of
bandage. This arrangement was never or interfered with till the end of the eighth changed when it was opened out for the first time and week, loops
found
was
healed, and patient was now
The
and move about the
on
limb,
with
from
chick
a
the bones
and
splint
the middle
firmly
allowed to get up
of the
bandage
thigh
to the
middle of the leg, to give it support. This was discontinued at the end of 15 weeks and she set out next
walk to her home?a distance of 30 miles. cases of fracture were treated by suturing of
day to
Two
the broken
The first
fragments.
was a
the patella, with
ture of
simple
frac-
effusion into
and
bruising impossible
to keep the fragknee-joint. It was other in way than by suturapposition any The friends unfortunately removed ing. patient's her from the hospital by night, twelve days after the
the
ments in
had had the benefit of skilled
no
strips thickly
eighth
day.
blood the
Up
literally
The percentage of deaths to
and
to the
Then she got diarrhoea
No acute symptoms
gradually sank,
tion
with
excisions a
on
employed.
were
ankylosed.
came
performed
was
of five and twenty on the The spray and all Lister's
ber 1883.
may be
dressing in these cases description of one of the
woman
the wound
was
gone the
Punjabi
of
faeces
of
illustrated by a of the knee which
away; and the woman The sixth followed perineal section
liquid
patient was
The method
[September, 1884-
the first intention
without
any
inflammation.
operation. Up to this time there inflammation, and the wound, which sawdust, had not required dressing. The second
Khan, a
aet.
case
30, who
thick stick
on
was was
Punjabi,
a
over
Hospital
on
no
put up in
was
Dulla
the elbow with
the 15th of January 1884,
mitted into the Mayo The
that of
struck
had been
the 1st
and ad-
February.
much inflamed, the arm and forearm swollen and brawny, and the olecranon was
elbow-joint
fractured and was a
was
widely separated
sloughy suppurating communicating with
the elbow
the joint. was
from the ulna.
wound
not
over
the fracture and with
The relation of the broken
improved by
There
the back of
position
any the inflammation did not subside.
of the
fragments arm, and
Accordingly,
on
the 4th February, the wound was enlarged and swabbed out with strong chloride of zinc solution ; the was then drawn down, drilled, and sutured the ulna with thick silver wire. The elbow was laid in sawdust, and the inflammation rapidly subsided.
olecranon
to
Passive motion
was
commenced
at
the end of
a.
SURGICAL OPERATIONS BY LAWRIE.
September, 1884.]
fortnight;
the wire
eighth day,
and
of
April with
by
firm
a
the
There
were
left the
man
useful
the
hospital
twentythe ist
on was
of
cases
formed by temporary in
amputation
at
the
One of these
(vide Lancet, 24th cases was operated
my absence.
during
of the upper
displacement by
rare
under observation
of
November 1883). on
Both recovered.
able that four of these
jaw,
Mr. Hardie
recommended
manner
Manchester
united
the ulna, and the elbow-joint
successful
two
on
The olecranon
arm.
bony union to freely moveable.
was
removed
was
257
by
Dr.
Perry
It is remark-
tumours should have come
during session, and Mr. Harhip-joint,?one for disease, and the other for osteothat their successful treatment myelitis following a fracture of the femur into the die truly remarks, taxes the resources of the surgeon to such an extent case first the there was a large sarknee-joint. In that they must always be of interest. coma of the femur involving the soft parts nearly The incisions included a successful case of tracheoThe limb was removed by two up to the trochanter. for oedema of the short skin flaps in the usual method, and the patient tomy in a young adult Cabuli was also a successful There after small-pox. left hospital cured at the end of five weeks. In the glottis In the third week of second case Furneaux Jordan's operation (vide the case of cesophagotomy. two patients, with foreign bodies Lancet, 22nd February 1879) was performed, and December 1883 the lad, who was nearly dead from pyemia, made an firmly impacted in the gullet, came into hospiIn the first case the foreign body, a large excellent recovery. The advantages of Furneaux tal. gristly piece of kid, was forced downwards into the Jordan's method are as follow:? The second stomach after very great difficulty. (1) None of the important structures of the the
thigh
its inner aspect touched.
which lie
the pelvis
are
on
near
(2)
The femoral artery is cut low down and the large muscles and vessels of the buttock
(3)
The wound drains naturally, heals
are
avoided.
and leaves
The sole drawback
impracticable
in
cases
a
shapely stump. to Jordan's plan
where,
readily,
is that it is
in the first of those
as
noted, the soft parts have to be extensively removed. Otherwise it is as perfect an operation in its way as Syme1s amputation
thigh, called mata
impossible
and it is
Among
of the foot,
Carden's of the
to say more
the tumours there
were
in its were
from the base of the skull.
growing
by reflecting
praise.
four cases of so-
These
nasopharyngeal polypus.
was removed
or
all
sarco-
The first
the cheek of the left
side,
the aperture of the anterior nares by In the the antrum with bone pliers.
and
enlarging cutting through second
case
the attachments of the tumour
extensive that it
was
decided,
after consultation with
18, and did not appear dangerously exhausted by the operation, which was most severe ; but during the following night he became comatose and died. No post-mot tern examination was allowed, but knowing how
absorption of the not of the skull, it is improbable that the boy's was due to haemorrhage within the cranium.
frequently
bones
these tumours
death In the third and fourth
cases
cause
the
operation
was
per-
Sikh female,
patient,
a
She
was
admitted
the
13th
she had
ret. 35,
not so fortunate.
was
14th December 1883. On accidentally swallowed a large gallthe
on
nut, which stuck in her throat. Before admission various unavailing attempts had been made to dislodge It could be felt from
it.
without,
below and behind
not be
moved up or down. cricoid, but could By midday on the 15th the woman was nearly collapsed, and in such distress that cesophagotomy beThis was carried out in the usual came imperative. was removed, and the patient was disnut the way, the
charged
cured in three weeks.
There
nia,
were
twelve
operations
these
one
were
of
cases
performed
herniotomy. Two of for strangulated her-
for incarcerated umbilical the radical
rest for
cure
of
hernia,
inguinal
and the
hernia.
They
conducted with Lister's precautions. The with dressed wounds were dry sponge, previously purified with corrosive sublimate, which was generally were
left undisturbed
were so
my colleagues, to remove the left upper jaw completely to gain access to them. The patient was a lad of
one
All the
days. one,
were
retarded
after the
operations
operation
In one case, where recovery was violent attack of dysentery, there was re-descent of the rupture, and the patient
of intestinal obstruction.
along
mass
The
with intestine in
and unconstricted ment of
ten
a
In the two cases of
is still
tum
or
successful.
by
partial obliged to wear a truss. strangulated hernia there were a
for nine
for the radical cure, except
the usual symptoms sac
contained
omen-
one; omentum
in the other.
alone
In both the treat-
the omentum consisted in transfixion of the
with catgut at the outer abdominal
ring,
and
?=?
I' THE INDIAN MEDICAL GAZETTE.
258
igature
in
two
toms of
and the
stump reduced.
obstruction of the bowels
and the
lieved,
The part below the
portions.
extirpated
was
patients
made
umbilical hernia occurred in
emale,
set.
rapid a
at once re-
were
recoveries.
very stout
The rupture had been
48.
cible for many years, but became
ligatures
The sympThe
European
easily
irreducible
redusome
time before
admission, and she suffered from constant and increasing dragging pain in the belly, frequent attacks of sickness and vomiting, and constipation. During the last four months the skin over the tumour had ulcerated extensively, and the patient was utterly unfit for any occupation, and was willing to undergo The sac conany risk on the chance of being cured. tained nothing but omentum, adherent throughout The omentum was treated in to its inner surface. the
same
the
edges of
way
as
in the
cases
described above, and
the umbilical
opening were brought together with thick catgat. The patient left the hospital cured, and entirely free from her previous symptoms, a month after the operation. As herniotomy is now, thanks to Listerism, a safe operation, and the strictest ligature of masses of omentum is -no longer a questionable procedure, there can be no doubt about the propriety of operating in all cases of incarcerated omental hernia withPercival Pott out waiting till urgent symptoms arise. long ago pointed out the dangers of incarcerated omental ruptures. These are briefly : (1) the omentum may become diseased ; (2) it may become constricted and occasion
a
collection of fluid in the
sac ; (3) it may cause symptoms of intestinal obstruction by reason of its connection with the abdominal vis-
cera ;
(4)
patient portion
as
long
cannot be
as
an
secure
omental rupture exists the against the descent of a
of intestine, and is therefore always liable
to
every kind and degree of danger attending an intestinal one. It used to be thought that the symptoms of bowel obstruction, so often associated with
till
they
urinary organs, and is at best but a palliative measure. I have therefore for some years been in the habit of section in cases of this kind whenever they present themselves. A tube is left in the bladder for a week afterwards, and the wound is then allowed to heal. The result is uniformly
performing perineal
favorable.
It cannot be said
the session.
during
Holt's method has fallen some-
what into disuse of late years, but in my experience it is incomparably the best plan of curing all ->trictures which
are
Three
and the
not
cases
impermeable. of
hydrocele
injection
into the
were
sac
tion of the bowels in these
cases.
of obstruc-
treated
of from
a
by tapping, drachm to
carbolic acid. Carbolic acid is certain in its effects than tincture of iodine,
two drachms of pure more
and its
injection
is
perfectly painless.
Whatever
substance is used it is better to make the puncture with the trocar at the top of the sac, than, as is usually
done,
If the puncture is made
at or near the bottom.
of the injection fluid dependent position canula when this is the of may trickle along the track withdrawn, and set up more or less cellulitis. This accident cannot possibly happen if it is made from in
some
a
above. other
Many but
not
operations in the list might be detailed, unduly lengthening this report. The
without
especially
cause
hypertrophy
the relief of the retention of urine is permanent. Holt's operation was performed in all the cases of stricture of the urethra which came under treatment
reduction
principal
that the
of the prostate is cured, but its encroachment on the urethra appears to be arrested by the operation, and
due to constriction
which is the
obliged by complete
are
retention of urine, and when once this stage has been reached the urine has to be drawn off with a catheter every six or eight hours. This irritates the
But Rushton Parker has shown
constriction of the incarcerated omentum, but its connexion with, and causing a drag on, the abdo-
viscera,
hospital
of the cost of
that, with proper safeguards against septic complications, masses of omentum may be constricted by ligature without giving rise to any symptoms whatever: and he has conclusively proved {vide La?icet, 17th May 1884) that it is not the
minal
come to
work of the session
were
1884.
Perineal section was performed twice for the relief of retention of urine in senile hypertrophy of the prostate. In this condition patients seldom
principal
irreducible omental ruptures, of the omentum.
[September,
as
to be
of
Listerism,
was
surgical
which is
now
directed
to
the and
dressings, inexpensive
so
within the reach of any surgeon in any
station in India.
antiseptics employed in my department of the hospital at present are :? (1) Carbolic acid?for Lister's spray. (2) Iodoform and powdered boracic acid (1 part in 10) for dusting wounds. sublimate and chloride of zinc for Corrosive (3) purifying dressings, spongesand instruments. The
1
THE ACTIVE PRINCIPLE OF INDIAN HEMP.
September, 1884.] *
(4)
Eucalyptus oil?when
The
dressings
volatile antiseptic is
a
necessary.
consist almost
sponges, and rags, purified tion of corrosive sublimate
of
entirely
sawdust,
saturation with
by (1?1,000)
a
solu-
and dried.
Lastly, splints cut out of chicks were introduced hospital at the beginning of the session by my colleague Dr. Perry. They cost nothing, ran be adapted to any limb, and increased rigidity can be obtained doubling or trebling their folds. It might be objected that some of the antiseptics I have mentioned are too expensive for ordinary use. But if pure Listerism is carried out, the dressings are seldom or never changed, and the first cost is spread into the
over
the whole treatment of the
of the
above
knee-joint dressing was required,
In the excision
case.
recorded,
the total
where
cost
only
one
of
everything including carbolic acid and spray, iodoform, dressings, splints and bandages, was exactly two rupees and three pie. On employed in spirit for the
the case,
the other hand, in cases where putrefaction has taken place before the patient comes under treatment, expensive antiseptics are not often required. For
instance, extremity
a
case
was
r884. There incisions were
charged limb
was
of diffuse
cellulitis of the lower
admitted into my wards in was
a
septic
made all
pus and
sloughs
laid in
common
wound
in
the
January leg,
and
the limb, which disnearly a month. The sawdust, which was changed over
for
it caked with the discharges, and the total cost of the dressings from first to last did not exceed four as
annas.
of
Operations.
i
?
S3
n
a
o
x
q
B.?For Disease.
7.' 8.
9. 10.
Syme's?for
caries
.?
Leg?Epithelioma of foot Thigh?disease of knee-joint
...
220 o I 1
...
I
I
o
...
I
I
o
...
I
I
o
...
1
I
o
...
2
2
...
I
I
o
4
3
1
of femur
Hip-joint?sarcoma
Total
SURGICAL OPERATIONS PERFORMED THE MAYO HOSPITAL,
LAHORE,
AT
DURING
THE WINTER SESSION, 1883-84. By Surgeon-Major E. Lawrie, Professor of Surgery, Lahore Medical School.
Lahore, follows
Mayo Hospital October 1883 till April 1884, were as
operations performed
The
from
V.?Excision of Tumours.
A.?Malignant.
1. 2.
Scirrhus?mamma
3. 4.
5.
Sarcoma?parotid ?thigh ? ,, ?naso-pharyngeal
1.
Fibroma...
220
2.
Fatty Angioma Lymphoma Cystic Hydatid cyst Polypus nasi
220
B.?Non-malignant.
at the
3. 4.
:?
5.
Description
of
Operations.
2
xt
D
CJ
Epithelioma?face
6. 7.
...
a-v
Total
1
1
o
5
5
0 o
12
12
1
1
o
2
2
O
34
33
38
36
VI?Removal of Calculi. 1
I.?Operations 1. 2.
the
on
Eye
and
Appendages.
Extraction of cataract Other major operations
I.
151 151
Total
30
30
181
181
0 o
1. 2.
3. 4. 5. 6.
on
2.
?
Incision of knee-joint Excision of wrist of elbow ? of knee ,,
III.?Operations 1. 2.
3. 4. 5.
2
2
O
IO
IO
O
4.
2
2
0
1
I
O
6.
...
2
2
0
2
2
7.
5.
8. 9.
19
19
10. 11.
on Bones.
12.
Excision for necrosis... Fractures set Resection of ununited fracture Suturing of patella for simple fracture of olecranon for com...
Suturing pound
3.
...
Total
fracture
880
13. 14.
990
15.
220
I
Total
Tracheotomy CEsophagotomy
Abdominal section?obstruction of bowels Strangulated hernia?sac opened Radical cure of inguinal hernia Radical cure of umbilical hernia Fistula in ano Perineal section Internal urethrotomy (Holt's) External urethrotomy (Syme's) For hematocele Liver abscess Psoas and lumbar abscess For imperforate vagina ...
._
...
Ovariotomy
Total 1
I I
o
o
VIII A.?Reparative 1.
21
21
2.
3. 4.
5, 6.
1
1
o
1
1
o
I
O
I
220
990 I
I
o
770 3
2
1
660 I
I
o
I
I
o
220 o 1
I
o
2
I
I
46
43
Hare-lip
Circumcision
2
2
440
Total
A.?For Injury.
2.
3?
Operations.
I V.?A mputations.
1.
3
2
VIII. ?Incisions.
Joints.
Dislocation reduced... Extension of stiff joints
...
VII.?Removal of Foreign Bodies
1.
II.?Operations
Vesical?lithotomy
o
IX?Operations not classified\
Primary of fore-arm... of thigh ? Secondary of elbow-joint of knee-joint ? of hip-joint ,, of thigh ,, Total
I
O
1.
Excision of Tonsil
I
O
2.
I
O
0
I
3. 4*
1
O
Hydrocele Ovarian cyst?tapped Nerve stretching, sciatic
4
o
...
Total Grand Total
1
0
3
o
1
1
o
1
1
o
600 369
362
7
THE INDIAN MEDICAL GAZETTE.
256 There
were
man
operations. The amputation through the
of
case
a
patient
The
knee-joint.
deaths after
seven
first occurred in
who had sustained
was
compound comminuted the leg six months before
a
fracture of both bones of into
admission
supervened,
and
hospital. Extensive necrosis had suppuration had reduced him to
the last stage of exhaustion. due to shock the removal of
and loss
two
The second death
was
of blood fifteen hours after
large naso-pharyngeal polypus. The followed the operation of lithotomy
a
third and fourth in
emaciated old
an
worn-out old men.
The fifth took
in
place
a
patient complete obstruction of the bowels for sixteen days. An artificial anus who'had suffered from
by median abdominal incision, but afforded, though immense quantities
was made
relief
was
solid and died next which
no
day. performed
as
palliative
a
measure
in
a
with extravasation of urine* gangrene of the scrotum, and septic poisoning. The seventh death that
of
an
old woman, set. 50, who had under-
operation
of
ovariotomy.
day she did fairly well. refused food.
on
and died,
the sixteenth
none were
and
in, but she
set
of
exhaustion,
due
to
operations
preventible
poisoning, arising mortality would have
in the
was
1*9;
causes, such
hospital.
been lower if the
as
I believe
patients
nursing. In an instiMayo Hospital, connected as it is with a medical school, students no less than patients would derive incalculable advantage from the work of a thoroughly efficient staff of nurses; and it is a reproach to the wealthy natives of the Punjab, that
tution like the
forthcoming to supply this want in the principal hospital of the province. A few of the operations performed during the session require special mention. Among the operations The wrist-joint on joints there were five excisions. funds should be
excised by a flap cut from its dorsal aspect, in excision of the knee-joint, invery like the flap stead of, in the usual way, by longitudinal incisions along the radial and ulnar borders, which is both
was
difficult and tedious.
There
were
two
cases
of
of the
excision of the knee, and elbow-joint. All these were carried out antiseptically and healed two
by
young
4th
Novem-
precautions
After the flap was placed in posiand secured, without sutures, by three boracic of lint, the joint was laid on, and
in
a
of
an
covered
sheet.
with,
over
Rigidity
old chick cut
as
so
limb from the trochanter
sawdust,
eucalyptus
maintained
was
by
piece
a
encircle the whole
to
to the
and fastened
ankle,
of
bandage. This arrangement was never or interfered with till the end of the eighth changed when it was opened out for the first time and week, loops
found
was
healed, and patient was now
The
and move about the
on
limb,
with
from
chick
a
the bones
and
splint
the middle
firmly
allowed to get up
of the
bandage
thigh
to the
middle of the leg, to give it support. This was discontinued at the end of 15 weeks and she set out next
walk to her home?a distance of 30 miles. cases of fracture were treated by suturing of
day to
Two
the broken
The first
fragments.
was a
the patella, with
ture of
simple
frac-
effusion into
and
bruising impossible
to keep the fragknee-joint. It was other in way than by suturapposition any The friends unfortunately removed ing. patient's her from the hospital by night, twelve days after the
the
ments in
had had the benefit of skilled
no
strips thickly
eighth
day.
blood the
Up
literally
The percentage of deaths to
and
to the
Then she got diarrhoea
No acute symptoms
gradually sank,
tion
with
excisions a
on
employed.
were
ankylosed.
came
performed
was
of five and twenty on the The spray and all Lister's
ber 1883.
may be
dressing in these cases description of one of the
woman
the wound
was
gone the
Punjabi
of
faeces
of
illustrated by a of the knee which
away; and the woman The sixth followed perineal section
liquid
patient was
The method
[September, 1884-
the first intention
without
any
inflammation.
operation. Up to this time there inflammation, and the wound, which sawdust, had not required dressing. The second
Khan, a
aet.
case
30, who
thick stick
on
was was
Punjabi,
a
over
Hospital
on
no
put up in
was
Dulla
the elbow with
the 15th of January 1884,
mitted into the Mayo The
that of
struck
had been
the 1st
and ad-
February.
much inflamed, the arm and forearm swollen and brawny, and the olecranon was
elbow-joint
fractured and was a
was
widely separated
sloughy suppurating communicating with
the elbow
the joint. was
from the ulna.
wound
not
over
the fracture and with
The relation of the broken
improved by
There
the back of
position
any the inflammation did not subside.
of the
fragments arm, and
Accordingly,
on
the 4th February, the wound was enlarged and swabbed out with strong chloride of zinc solution ; the was then drawn down, drilled, and sutured the ulna with thick silver wire. The elbow was laid in sawdust, and the inflammation rapidly subsided.
olecranon
to
Passive motion
was
commenced
at
the end of
a.
SURGICAL OPERATIONS BY LAWRIE.
September, 1884.]
fortnight;
the wire
eighth day,
and
of
April with
by
firm
a
the
There
were
left the
man
useful
the
hospital
twentythe ist
on was
of
cases
formed by temporary in
amputation
at
the
One of these
(vide Lancet, 24th cases was operated
my absence.
during
of the upper
displacement by
rare
under observation
of
November 1883). on
Both recovered.
able that four of these
jaw,
Mr. Hardie
recommended
manner
Manchester
united
the ulna, and the elbow-joint
successful
two
on
The olecranon
arm.
bony union to freely moveable.
was
removed
was
257
by
Dr.
Perry
It is remark-
tumours should have come
during session, and Mr. Harhip-joint,?one for disease, and the other for osteothat their successful treatment myelitis following a fracture of the femur into the die truly remarks, taxes the resources of the surgeon to such an extent case first the there was a large sarknee-joint. In that they must always be of interest. coma of the femur involving the soft parts nearly The incisions included a successful case of tracheoThe limb was removed by two up to the trochanter. for oedema of the short skin flaps in the usual method, and the patient tomy in a young adult Cabuli was also a successful There after small-pox. left hospital cured at the end of five weeks. In the glottis In the third week of second case Furneaux Jordan's operation (vide the case of cesophagotomy. two patients, with foreign bodies Lancet, 22nd February 1879) was performed, and December 1883 the lad, who was nearly dead from pyemia, made an firmly impacted in the gullet, came into hospiIn the first case the foreign body, a large excellent recovery. The advantages of Furneaux tal. gristly piece of kid, was forced downwards into the Jordan's method are as follow:? The second stomach after very great difficulty. (1) None of the important structures of the the
thigh
its inner aspect touched.
which lie
the pelvis
are
on
near
(2)
The femoral artery is cut low down and the large muscles and vessels of the buttock
(3)
The wound drains naturally, heals
are
avoided.
and leaves
The sole drawback
impracticable
in
cases
a
shapely stump. to Jordan's plan
where,
readily,
is that it is
in the first of those
as
noted, the soft parts have to be extensively removed. Otherwise it is as perfect an operation in its way as Syme1s amputation
thigh, called mata
impossible
and it is
Among
of the foot,
Carden's of the
to say more
the tumours there
were
in its were
from the base of the skull.
growing
by reflecting
praise.
four cases of so-
These
nasopharyngeal polypus.
was removed
or
all
sarco-
The first
the cheek of the left
side,
the aperture of the anterior nares by In the the antrum with bone pliers.
and
enlarging cutting through second
case
the attachments of the tumour
extensive that it
was
decided,
after consultation with
18, and did not appear dangerously exhausted by the operation, which was most severe ; but during the following night he became comatose and died. No post-mot tern examination was allowed, but knowing how
absorption of the not of the skull, it is improbable that the boy's was due to haemorrhage within the cranium.
frequently
bones
these tumours
death In the third and fourth
cases
cause
the
operation
was
per-
Sikh female,
patient,
a
She
was
admitted
the
13th
she had
ret. 35,
not so fortunate.
was
14th December 1883. On accidentally swallowed a large gallthe
on
nut, which stuck in her throat. Before admission various unavailing attempts had been made to dislodge It could be felt from
it.
without,
below and behind
not be
moved up or down. cricoid, but could By midday on the 15th the woman was nearly collapsed, and in such distress that cesophagotomy beThis was carried out in the usual came imperative. was removed, and the patient was disnut the way, the
charged
cured in three weeks.
There
nia,
were
twelve
operations
these
one
were
of
cases
performed
herniotomy. Two of for strangulated her-
for incarcerated umbilical the radical
rest for
cure
of
hernia,
inguinal
and the
hernia.
They
conducted with Lister's precautions. The with dressed wounds were dry sponge, previously purified with corrosive sublimate, which was generally were
left undisturbed
were so
my colleagues, to remove the left upper jaw completely to gain access to them. The patient was a lad of
one
All the
days. one,
were
retarded
after the
operations
operation
In one case, where recovery was violent attack of dysentery, there was re-descent of the rupture, and the patient
of intestinal obstruction.
along
mass
The
with intestine in
and unconstricted ment of
ten
a
In the two cases of
is still
tum
or
successful.
by
partial obliged to wear a truss. strangulated hernia there were a
for nine
for the radical cure, except
the usual symptoms sac
contained
omen-
one; omentum
in the other.
alone
In both the treat-
the omentum consisted in transfixion of the
with catgut at the outer abdominal
ring,
and
?=?
I' THE INDIAN MEDICAL GAZETTE.
258
igature
in
two
toms of
and the
stump reduced.
obstruction of the bowels
and the
lieved,
The part below the
portions.
extirpated
was
patients
made
umbilical hernia occurred in
emale,
set.
rapid a
at once re-
were
recoveries.
very stout
The rupture had been
48.
cible for many years, but became
ligatures
The sympThe
European
easily
irreducible
redusome
time before
admission, and she suffered from constant and increasing dragging pain in the belly, frequent attacks of sickness and vomiting, and constipation. During the last four months the skin over the tumour had ulcerated extensively, and the patient was utterly unfit for any occupation, and was willing to undergo The sac conany risk on the chance of being cured. tained nothing but omentum, adherent throughout The omentum was treated in to its inner surface. the
same
the
edges of
way
as
in the
cases
described above, and
the umbilical
opening were brought together with thick catgat. The patient left the hospital cured, and entirely free from her previous symptoms, a month after the operation. As herniotomy is now, thanks to Listerism, a safe operation, and the strictest ligature of masses of omentum is -no longer a questionable procedure, there can be no doubt about the propriety of operating in all cases of incarcerated omental hernia withPercival Pott out waiting till urgent symptoms arise. long ago pointed out the dangers of incarcerated omental ruptures. These are briefly : (1) the omentum may become diseased ; (2) it may become constricted and occasion
a
collection of fluid in the
sac ; (3) it may cause symptoms of intestinal obstruction by reason of its connection with the abdominal vis-
cera ;
(4)
patient portion
as
long
cannot be
as
an
secure
omental rupture exists the against the descent of a
of intestine, and is therefore always liable
to
every kind and degree of danger attending an intestinal one. It used to be thought that the symptoms of bowel obstruction, so often associated with
till
they
urinary organs, and is at best but a palliative measure. I have therefore for some years been in the habit of section in cases of this kind whenever they present themselves. A tube is left in the bladder for a week afterwards, and the wound is then allowed to heal. The result is uniformly
performing perineal
favorable.
It cannot be said
the session.
during
Holt's method has fallen some-
what into disuse of late years, but in my experience it is incomparably the best plan of curing all ->trictures which
are
Three
and the
not
cases
impermeable. of
hydrocele
injection
into the
were
sac
tion of the bowels in these
cases.
of obstruc-
treated
of from
a
by tapping, drachm to
carbolic acid. Carbolic acid is certain in its effects than tincture of iodine,
two drachms of pure more
and its
injection
is
perfectly painless.
Whatever
substance is used it is better to make the puncture with the trocar at the top of the sac, than, as is usually
done,
If the puncture is made
at or near the bottom.
of the injection fluid dependent position canula when this is the of may trickle along the track withdrawn, and set up more or less cellulitis. This accident cannot possibly happen if it is made from in
some
a
above. other
Many but
not
operations in the list might be detailed, unduly lengthening this report. The
without
especially
cause
hypertrophy
the relief of the retention of urine is permanent. Holt's operation was performed in all the cases of stricture of the urethra which came under treatment
reduction
principal
that the
of the prostate is cured, but its encroachment on the urethra appears to be arrested by the operation, and
due to constriction
which is the
obliged by complete
are
retention of urine, and when once this stage has been reached the urine has to be drawn off with a catheter every six or eight hours. This irritates the
But Rushton Parker has shown
constriction of the incarcerated omentum, but its connexion with, and causing a drag on, the abdo-
viscera,
hospital
of the cost of
that, with proper safeguards against septic complications, masses of omentum may be constricted by ligature without giving rise to any symptoms whatever: and he has conclusively proved {vide La?icet, 17th May 1884) that it is not the
minal
come to
work of the session
were
1884.
Perineal section was performed twice for the relief of retention of urine in senile hypertrophy of the prostate. In this condition patients seldom
principal
irreducible omental ruptures, of the omentum.
[September,
as
to be
of
Listerism,
was
surgical
which is
now
directed
to
the and
dressings, inexpensive
so
within the reach of any surgeon in any
station in India.
antiseptics employed in my department of the hospital at present are :? (1) Carbolic acid?for Lister's spray. (2) Iodoform and powdered boracic acid (1 part in 10) for dusting wounds. sublimate and chloride of zinc for Corrosive (3) purifying dressings, spongesand instruments. The
1
THE ACTIVE PRINCIPLE OF INDIAN HEMP.
September, 1884.] *
(4)
Eucalyptus oil?when
The
dressings
volatile antiseptic is
a
necessary.
consist almost
sponges, and rags, purified tion of corrosive sublimate
of
entirely
sawdust,
saturation with
by (1?1,000)
a
solu-
and dried.
Lastly, splints cut out of chicks were introduced hospital at the beginning of the session by my colleague Dr. Perry. They cost nothing, ran be adapted to any limb, and increased rigidity can be obtained doubling or trebling their folds. It might be objected that some of the antiseptics I have mentioned are too expensive for ordinary use. But if pure Listerism is carried out, the dressings are seldom or never changed, and the first cost is spread into the
over
the whole treatment of the
of the
above
knee-joint dressing was required,
In the excision
case.
recorded,
the total
where
cost
only
one
of
everything including carbolic acid and spray, iodoform, dressings, splints and bandages, was exactly two rupees and three pie. On employed in spirit for the
the case,
the other hand, in cases where putrefaction has taken place before the patient comes under treatment, expensive antiseptics are not often required. For
instance, extremity
a
case
was
r884. There incisions were
charged limb
was
of diffuse
cellulitis of the lower
admitted into my wards in was
a
septic
made all
pus and
sloughs
laid in
common
wound
in
the
January leg,
and
the limb, which disnearly a month. The sawdust, which was changed over
for
it caked with the discharges, and the total cost of the dressings from first to last did not exceed four as
annas.
