housemaid's knee: removal of the bursa
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integument and healthy adipose tissue, before entering it.Much flatus escaped, -with fostid matter, which occupied a cir-cumscribed space, the centre being filled with a large slough,which was removed. After this, the bowels became constipated ; aperients and enemata were of no avail; the abscessbecame distended with flatus, but none passed from the rectum.In this condition she remained for a fortnight, being at thesame time frequently sick and rejecting everything. The con-stitutional symptoms were less than might have been expected,nor did the patient look as if she possessed any malignant dis-ease. Long tubes, bougies, the tinger, &c., were passed perrectum, but no opening could be found in the colon. Mr. Laneobserved, there was probably a stricture of the colon; butwhat had caused it he could not say. The patient couldnot live without an opening into the canal, and he wouldmake an artificial anus. Amussat’s operation is generallypreferred, as about half the cases recover. Those performedon the left side had been most successful in the lumbar region.He selected the inguinal region in the present case, because theabscess had been there. He considered that the disease of theintestine was the cause of the abscess, and would cut down tothe bowel in this region, so as to form a sort of hernia beforecutting into it.The patient was accordingly fully placed under the influence
of chloroform, when Mr. Lane cut down through the integu-ments and came at once upon the floor of the abscess, appa-rently formed by the external oblique muscle. He then con-tinued his incisions till the peritoneum was reached, which healso divided. On careful examination, the stricture was dis-covered a finger’s depth in the wound, about a foot from theanus. The bowel above it was drawn into the wound, opened,and carefully stitched to its margins, so that no feculentmatter could enter the abdominal cavity; when this was com-pleted, some fseees came away, thus showing the integrity of thecanal upwards. Mr. Lane remarked that an attack of perito-nitis might be expected, and if the patient got over it therewas a possibility of her life being saved.We learned, subsequently, that the patient died from the
shock of the operation.
NÆVI MATERNI ON THE NOSE AND FOREHEAD.
MOTHERS’ marks are not only commonly noticed upon thehead of newly-born infants, but they often evince a remark-able disposition to appear on some of the prominent fea-tures of the face. We recollect an infant, at St. George’sHospital, who came under Mr. Pollock’s care, with a nevusas large as a walnut, situated at the end of the nose. Another
infant, at University College Hospital, under the care of Mr.Erichsen, had one over the bridge of the nose, which wasstrangulated by a quadrupled ligature; and one, in the samesituation, in another child, at St. Bartholomew’s Hospital,was removed by Mr. Lloyd; only here it was supposed to be asolid nsevus undergoing the process of cure, but enlarging tothe size of a small plam, being at birth not half so large; and,on taking it away, it was found to be adherent to the peri-osteum.
HOUSEMAID’S KNEE: REMOVAL OF THE BURSA.
A FEMALE, about twenty-six years of age, had been the sub-ject of housemaid’s knee for some years, but the tumour (whichwas situated over the left patella) had been increasing duringthe past two years, and was productive of much incon-venience ; she, therefore, became an inmate of St. George’sHospital. The tumour felt somewhat soft, with deep-seated,indistinct fluctuation. It was quite movable, but it was easyto perceive that the walls forming the bursal cyst were of con-siderable thickness. To treat such a case by counter-irritants,setons, or any other method short of complete removal, wouldhave been utterly useless, involving much loss of time, and, per-haps, greater inconvenience to the patient herself. Mr. John-son, therefore, dissected the tumour away on the 28th of Oct.,doing so with care on account of its proximity to the articu-lation. It was the size of an orange, but flattened; and, onmaking a section, the walls were found to be exceedinglytough and resistant, and remarkably thick, with a comparatively small cavity, containing shreds apparently of nbrinousmaterials, and a little fluid.The practice of removing bursal cysts, situated over th
patella, is becoming general in such cases as the present, and,with ordinary precautions in dissecting them out, their termination is favourable enough. We have already noticed severaexamples in our " Mirror," wherein successful extirpation wa:accomplished.
FUNGUS HÆMATODES OF THE GROIN.
A VERY bad case of this form of medullary cancer is at pre-sent under treatment in University College Hospital. Thepatient is a man, aged forty-eight years, who was admitted on.the 27th October, under Mr. Erichsen’s care, with a tumour inthe groin, the size of an apple, which had been two yearsgrowing. On the first day of his admission, half a pint of bloodwas lost from this tumour, and it commenced to increase veryrapidly, with a continuation of frequent attacks of haemorrhage-
. To stop this, it has been injected with the perchloride of ironin several places, with partial benefit. (Edema of the leg is.
present, and the glands in the neighbourhood of the tumourare enlarged, and thus run up into the iliac region, betweenwhich and the tumour itself the femoral artery, on the dayafter admission, could be felt pulsating; but in two or threedays this pulsation had ceased. He is being supportedwith wine, and occasionally taking in it fifteen minims of lau-danum. It is one of those unfortunate cases which now and
. then show themselves, and terminate in but one way, and that,
the most unfavourable. When we saw the patient on the lOtlLNovember, a sort of cap was formed around the body of the
tumour by means of a bandage, and when this is taken off it is. intended to apply the deliquescent chloride of zinc to various
parts of the tumour.Mr. Wardrop has pointed out, in his work on this disease,
that, before it advances to a fatal termination, the swelling of.
the glands, and the number which are affected, are often pro.digious, particularly those which run upwards from the groin.into the abdomen, forming large masses surrounding the iliacvessels and aorta.
ROYAL SOCIETY.
THURSDAY, Nov. 18TH, 1858.PROFESSOR OWEN IN THE CHAIR.
DR. THEOPHILUS THOMPSON read a paperON CHANGES PRODUCED IN THE AMOUNT OF BLOOD-COR-
PUSCLES BY THE ADMINISTRATION OF COD-LIVER OIL.
The author had presented to the Royal Society on the 27th ofApril, 1854, a communication descriptive of the chemical.changes produced in the blood by the administration of cod-liver oil and of cocoa-nut oil, and advanced the conclusion, de-duced from chemical analysis, that any favourable result de-rived from the use of these oils is associated with an increase inthe proportion of red corpuscles. The present communicationwas an extension of the inquiry, but was confined to experi-ments on the influence of cod-liver oil on the blood. It com-
prehended the principal details regarding fourteen patientsaffected with pulmonary consumption in various stages of pro-gress, and the result of analyses of their blood. In two in-stances no oil had been given ; in the remaining twelve thatmedicine had been more or less freely administered, and anobvious contrast was noted in the condition of the blood, theproportion of red corpuscles to a thousand parts of blood in thetwo cases where no oil had been given being respectively 98’20and 119’64, and in ten of the other patients varying from142’32 to 174’76. In these ten cases the use of the oil had beenattended with marked gain in weight and other evidences ofamelioration. In another instance, in which the disease ad-vanced, and a loss of seven pounds in weight occurred, not-withstanding four months’ administration of oil, the proportionwas 114’39. In one example only was a favourable effect ofthe oil accompanied with a low proportion of corpuscles-viz.,84’83; but in this patient, haemoptysis, so profuse as to en-danger life by increasing the poverty of the blood, had appa-rently modified to some extent the ordinary influence of theremedy. The analysis was conducted by Mr. Dugald Campbellin the following manner :-The whole quantity of blood ab-stracted having been weighed, the coagulum was drained onbibulous paper for four or five hours, weighed, and divided intotwo portions. One portion was weighed, and then dried in awater-oven to determine the water. The other was maceratedin cold water until it became colourless, then moderately dried,and digested with ether and alcohol to remove fat, and finallydried completely and weighed as fibrin. From the respectiveweights of the fibrin and the dry clot that of the corpuscles wascalculated.
Dr. COPLAXD observed that consumption is a disease whichtends to produce a continual waste of blood-corpuscles, and thatwhatever promotes nutrition and excites the vital forces must