CASES FROM HOSPITAL PRACTICE. By A. POWELL, M.B.,
M.Ch.,
Kalain, Cachar.
(i).?Accidents following Hysterectomy. Case
I.?Phlegmasia
60, suffering from
Dolens.?Hindu
female,
due to carcinoma of the cervix. Examination shewed a large cauliflower excrescence and considerable enlargement of the glands in both groins. Patient was very anaemic, and complained of a continuous boring pain in the region of the left
sacro-iliac
joint.
severe
haemorrhage
Local styptics failed to arrest the haemorrhage, and plugging caused high septic fever by obstructing the discharge. The cauliflower growth and the cervix were then removed piecemeal with scissors and sharp spoon, but bleeding still continued if plugging were not employed, and the use of the plug invariably caused high fever. September 11 th, 1894.?The uterus was removed through the vagina,?-not with any hope of cure, but to stop the haemorrhage. The tubes and broad ligaments were divided between three double ligatures on each side. Temperature in the evening was 100'2? F. ; on the second evening was 100-8?, but there-
THE INDIAN MEDICAL GAZETTE.
408
after quite afebrile. Pain continued about the left sacro-iliac joint, but there was no further haemorrhage. Patient gained in weight and went home on the 1st October. On the 4th October the left leg was found in a condition resembling phlegmasia, evidently due to thrombosis of the iliac veins. There was practically no pain, only a feeling of heaviness and tightness of the skin. This condition continued till the death of the patient from internal recurrence of the cancer in August 1895. The term "phlegmasia alba dolens" is to me a charming one, perhaps as accurate as the historic definition of a crab. (1) "Phlegmasia" is an unwarranted assumption in pathology, simple thrombus, without any inflammation sometimes causing the affection. " (2) Alba is clearly out of place among our black and brown patients in India. (3) "Dolens." In many cases the pain is slight and in some absent. Case II.?Epileptiform Convulsions.?Hindu, aged 28, said she had never suffered from fits of any kind. A uterine myoma, the size of a nine months' pregnant uterus, was removed by laparotomy. The tumour extended very low down and into the broad ligaments, necessitating a very thick stump which was surrounded by a serre-noeud. Three hours after the operation the patient had a fit, the muscles of the upper extremities and face being thrown into clonic spasms. The pupils became widely dilated, and unconsciousness lasting two or three minutes ensued. The pulse during the attack was barely per"
ceptible.
Six similar fits took place in the three days following. A seventh took place as I was tightening the serre-noeud. It seemed possible that the wire was pressing some ovarian tissue or nerve, so I slackened it considerably. There was only one more fit which was slighter, and took place four hours later. Subsequent tightening of the serre-noeud
caused
no
recurrence.
Case III.?Intestinal Obstruction.?Hindu, 30. A large myoma was removed by abdominal incision. The pedicle was thick and was treated with the serre-noeud. Patient did well till the fourth day, when there was considerable distention of the abdoAn enema caused a slight motion and men. There was neither some relief to the distention. tenderness nor vomiting, so I ordered a seidlitz
[Nov.
1899.
(ii).?Cholera Antitoxin. I have received a number of enquiries cona cholera serum I was using two or three years ago. I may say the serum proved a complete failure. It was tried in 14 cases with 10 deaths and 4 recoveries which seemed in no way influenced by the serum. The serum was prepared from a horse at the farm of the Jenner Institute under Professor Macfadyen, and from a pony and a goat at Kalain. All three sera had the power of quickly precipitating comma bacilli in fluid media, but in none of the three animals could any very marked degree of tolerance be induced; in fact the goat was killed by 20 c.c. of an emulsion, 16 c.c. of a similar one having produced little reaction twelve days previously.
cerning
(in).?Satyriasis
and Prostatic
Enlargement.
Enlargement of the prostate is popularly associated, either as cause or effect, with an erotic disposition. The following is a case in point. I am inclined to consider the hypertrophy at such an early age as the cause rather than the effect of the
patient's disposition.
A European, aged 25, who bore the reputation of a veritable satyr in a district where the standard of sexual morality is by no means bigoted, consulted me for constipation. He was directed to use an enema, but complained that he could not insert it. In shewing him how to use it, I found, owing to some obstruction, I had to pass the nozzle almost directly backwards. Examination showed this was a uniformly enlarged prostate, smooth, firm and measuring 2? inches along its vertical curve. It was quite free from pain, tenderness or inflammation, and had never interfered with micturition. He had never suffered from gonorrhoea or
prostatitis.
His erotic propensities had fellows several soubriquets more to his virility than his morality.
won
from
his
complimentary
aged
powder.
I had to leave home and did not return for two days when I found the patient had died just before my arrival. A knuckle of intestine had slipped in between the pubes and the stump. Persistent vomiting had set in immediately after the purgative was
given.
(iv).?Cure of Hydrocele by Injection of Comma Bacilli. In two cases I have found tapping the hydrocele and injecting an emulsion of comma bacillus set up a mild inflammation which soon subsided, aud has apparently radically cured the disease, as there has been no recurrence at intervals of nine and twenty months respectively. The emulsion and dose were the same as in Haffkine's inoculation. It was intended to "kill two birds with one stone,"?to cure the hydrocele aud add to the numbers for testing the protective value of the inoculation.
M.Ch.,
Kalain, Cachar.
(i).?Accidents following Hysterectomy. Case
I.?Phlegmasia
60, suffering from
Dolens.?Hindu
female,
due to carcinoma of the cervix. Examination shewed a large cauliflower excrescence and considerable enlargement of the glands in both groins. Patient was very anaemic, and complained of a continuous boring pain in the region of the left
sacro-iliac
joint.
severe
haemorrhage
Local styptics failed to arrest the haemorrhage, and plugging caused high septic fever by obstructing the discharge. The cauliflower growth and the cervix were then removed piecemeal with scissors and sharp spoon, but bleeding still continued if plugging were not employed, and the use of the plug invariably caused high fever. September 11 th, 1894.?The uterus was removed through the vagina,?-not with any hope of cure, but to stop the haemorrhage. The tubes and broad ligaments were divided between three double ligatures on each side. Temperature in the evening was 100'2? F. ; on the second evening was 100-8?, but there-
THE INDIAN MEDICAL GAZETTE.
408
after quite afebrile. Pain continued about the left sacro-iliac joint, but there was no further haemorrhage. Patient gained in weight and went home on the 1st October. On the 4th October the left leg was found in a condition resembling phlegmasia, evidently due to thrombosis of the iliac veins. There was practically no pain, only a feeling of heaviness and tightness of the skin. This condition continued till the death of the patient from internal recurrence of the cancer in August 1895. The term "phlegmasia alba dolens" is to me a charming one, perhaps as accurate as the historic definition of a crab. (1) "Phlegmasia" is an unwarranted assumption in pathology, simple thrombus, without any inflammation sometimes causing the affection. " (2) Alba is clearly out of place among our black and brown patients in India. (3) "Dolens." In many cases the pain is slight and in some absent. Case II.?Epileptiform Convulsions.?Hindu, aged 28, said she had never suffered from fits of any kind. A uterine myoma, the size of a nine months' pregnant uterus, was removed by laparotomy. The tumour extended very low down and into the broad ligaments, necessitating a very thick stump which was surrounded by a serre-noeud. Three hours after the operation the patient had a fit, the muscles of the upper extremities and face being thrown into clonic spasms. The pupils became widely dilated, and unconsciousness lasting two or three minutes ensued. The pulse during the attack was barely per"
ceptible.
Six similar fits took place in the three days following. A seventh took place as I was tightening the serre-noeud. It seemed possible that the wire was pressing some ovarian tissue or nerve, so I slackened it considerably. There was only one more fit which was slighter, and took place four hours later. Subsequent tightening of the serre-noeud
caused
no
recurrence.
Case III.?Intestinal Obstruction.?Hindu, 30. A large myoma was removed by abdominal incision. The pedicle was thick and was treated with the serre-noeud. Patient did well till the fourth day, when there was considerable distention of the abdoAn enema caused a slight motion and men. There was neither some relief to the distention. tenderness nor vomiting, so I ordered a seidlitz
[Nov.
1899.
(ii).?Cholera Antitoxin. I have received a number of enquiries cona cholera serum I was using two or three years ago. I may say the serum proved a complete failure. It was tried in 14 cases with 10 deaths and 4 recoveries which seemed in no way influenced by the serum. The serum was prepared from a horse at the farm of the Jenner Institute under Professor Macfadyen, and from a pony and a goat at Kalain. All three sera had the power of quickly precipitating comma bacilli in fluid media, but in none of the three animals could any very marked degree of tolerance be induced; in fact the goat was killed by 20 c.c. of an emulsion, 16 c.c. of a similar one having produced little reaction twelve days previously.
cerning
(in).?Satyriasis
and Prostatic
Enlargement.
Enlargement of the prostate is popularly associated, either as cause or effect, with an erotic disposition. The following is a case in point. I am inclined to consider the hypertrophy at such an early age as the cause rather than the effect of the
patient's disposition.
A European, aged 25, who bore the reputation of a veritable satyr in a district where the standard of sexual morality is by no means bigoted, consulted me for constipation. He was directed to use an enema, but complained that he could not insert it. In shewing him how to use it, I found, owing to some obstruction, I had to pass the nozzle almost directly backwards. Examination showed this was a uniformly enlarged prostate, smooth, firm and measuring 2? inches along its vertical curve. It was quite free from pain, tenderness or inflammation, and had never interfered with micturition. He had never suffered from gonorrhoea or
prostatitis.
His erotic propensities had fellows several soubriquets more to his virility than his morality.
won
from
his
complimentary
aged
powder.
I had to leave home and did not return for two days when I found the patient had died just before my arrival. A knuckle of intestine had slipped in between the pubes and the stump. Persistent vomiting had set in immediately after the purgative was
given.
(iv).?Cure of Hydrocele by Injection of Comma Bacilli. In two cases I have found tapping the hydrocele and injecting an emulsion of comma bacillus set up a mild inflammation which soon subsided, aud has apparently radically cured the disease, as there has been no recurrence at intervals of nine and twenty months respectively. The emulsion and dose were the same as in Haffkine's inoculation. It was intended to "kill two birds with one stone,"?to cure the hydrocele aud add to the numbers for testing the protective value of the inoculation.
