SRINAGAR
HOSPITAL?GURHWAL.
Cases reported by Assist ant-Surgeon
Mohendra
Nath Ohdedar. I.?A case
of
Vesical Calculus coma
complicated with Myxo-Sar-
in the lladder.
Bamku, a Hindu male, aged 59, resident of Kangra, was admitted into the Srinagar Hospital on the 4th of June 1882. About 4 years ago he first felt pain during micturition, and the symptoms rapidly developed. On admission, all the symptoms of vesical calculus?pain during micturition, &c. were well marked, but no stone could be felt although the Native Doctor and myself explored the bladder very carefully. The symptoms, however, were so prominent as to leave no doubt in my mind that the case was one of vesical calculus. The next day I again sounded the bladder with the intention that, if no stone were to be felt, I would explore the bladder by means of perineal section a3 recommended by Sir Henry Thompson. This time on turning the point of the sound towards the right it happily struck against the stone. On the 7tli of June, after bringing him under chloroform, I performed the operation of Lateral Lithotomy. On introducing my finger into the bladder I found that the whole of its interior was covered with polypoid growths, one oi which was larger than the rest. Introducing the forceps I extracted the stone?an uric acid calculus weighing 310 grains. I now introduced a small lithotomy forceps, and adjusting it well twisted out the largest growth. Haemorrhage which, up to the removal of the calculus, was trivial,,
)
August
NOTICES TO CORRESPONDENTS.
1, 1882.]
came on so furiously that I had to give up the attempt removing the other polypoid growths ; but even if the haemorrhage were not of an alarming kind, I do not think it were possible to remove all of them. The bladder was washed out with cold water, but the bleeding not diminishing, a weak solution of alum was thrown in. The legs of the patient were then tied together and he was put into bed. The subsequent history is of the ordinary kind. On the 12th of June he passed some urine through vias naturales, and the whole of it on the 23rd. The wound rapidly healed and he was discharged cured on the 8th of July 1882. I sent the tumour to Dr. Gr. D. McReddie, M. D., Civil Surgeon of Pratapgurli (Oudh), who very kindly examined it and sent me the following notes :? Examined a polypoid growth, said to have been removed from the interior of the bladder. Superficially it was l"xf" with a peduncle about in length and diameter. Several large papillae on surface discretely scattered; no mucous membrane covered the polypus. A section placed under a objective and magnified 375 diameters shewed the structure to be composed of closely interwoven fibrillas, enclosing rounded cells, indicating origin from mucous membrane. Growth?a myxo-sarcoma." II.?Ancestlietic Leprosy Stretching of ulnar nerve: cure. In April last, when the Extra Assistant Commissioner's camp was at Srinagar, a strong, well-built Hindu male, by name Ram Singh, aged 40, came to me and asked for some liniment for the cure of anaesthesia of certain portions of his body. I found it to be a case of anaesthetic leprosy, and told him that a surgical operation was the only thing which held out any hope of cure. The residents of these hills, as a rule, are very much afraid of surgical operations, and Ram Singh not being an exception to this, said that, having
now
of
"
"
"
?
in the E. A. Commissioner's Court, he could not the operation then but that he would come later on. As his case was not to come off till about a fortnight, I succeeded in inducing him to undergo the operation, and the next day (10th April 1882) he was admitted into the hospital. In the bed-head ticket I entered the following note :? a
case
undergo
"
Loss of sensation on the inner side of the fore-arms and hands, over the area of distribution of the ulnar nerves ; both the ulnar nerves are very distinct and have a cordlike feel?the right more so ; pain along the ulnar nerves ; a papular eruption over the area of distribution of the right ulnar nerve, below the elbow. Loss of sensation in the left leg and foot and pain shooting down the sciatic nerve." The same day, I exposed the right ulnar nerve, by means of an incision on the inner side a little above the inner condyle of the humerus, and hooking it up with my finger stretched it well. It was very much thickened and was nearly four times its natural size in circumference. A few strands of catgut were put in for drainage and the wound was
closed.
On the 12th, two days after operation, he was free from the pain which he felt along the ulnar nerve, and by the 17th the sensation was almost completely restored, so that he felt the prick of a pin as much on the inner as on the outer side. The papular eruption had also disappeared. He left the hospital well satisfied with the result of the operation, and promised to come back to be operated on the left side after his case was decided in the court. the operation of "nerveRemarks?I have stretching"?ulnar and sciatic?seven times, but Ram Singh's case was the most successful one as regards the result. In this one, was the restoration of none of the cases, except sensation so rapid and complete. In one case (of sciatic nerved there was no appreciable improvement ; but in the remaining five, there was improvement more or less, and the unhealthy ulcers on the fingers and toes healed very rapidly. The operation of " nerve-stretching" is easy and devoid of any danger, if performed with ordinary care, and one has to be convinced of its good only to perform it a few times effect. The result depends a great deal on the duration of the disease.
performed
^
Srinagar, July 11th,
1882.
213
HOSPITAL?GURHWAL.
Cases reported by Assist ant-Surgeon
Mohendra
Nath Ohdedar. I.?A case
of
Vesical Calculus coma
complicated with Myxo-Sar-
in the lladder.
Bamku, a Hindu male, aged 59, resident of Kangra, was admitted into the Srinagar Hospital on the 4th of June 1882. About 4 years ago he first felt pain during micturition, and the symptoms rapidly developed. On admission, all the symptoms of vesical calculus?pain during micturition, &c. were well marked, but no stone could be felt although the Native Doctor and myself explored the bladder very carefully. The symptoms, however, were so prominent as to leave no doubt in my mind that the case was one of vesical calculus. The next day I again sounded the bladder with the intention that, if no stone were to be felt, I would explore the bladder by means of perineal section a3 recommended by Sir Henry Thompson. This time on turning the point of the sound towards the right it happily struck against the stone. On the 7tli of June, after bringing him under chloroform, I performed the operation of Lateral Lithotomy. On introducing my finger into the bladder I found that the whole of its interior was covered with polypoid growths, one oi which was larger than the rest. Introducing the forceps I extracted the stone?an uric acid calculus weighing 310 grains. I now introduced a small lithotomy forceps, and adjusting it well twisted out the largest growth. Haemorrhage which, up to the removal of the calculus, was trivial,,
)
August
NOTICES TO CORRESPONDENTS.
1, 1882.]
came on so furiously that I had to give up the attempt removing the other polypoid growths ; but even if the haemorrhage were not of an alarming kind, I do not think it were possible to remove all of them. The bladder was washed out with cold water, but the bleeding not diminishing, a weak solution of alum was thrown in. The legs of the patient were then tied together and he was put into bed. The subsequent history is of the ordinary kind. On the 12th of June he passed some urine through vias naturales, and the whole of it on the 23rd. The wound rapidly healed and he was discharged cured on the 8th of July 1882. I sent the tumour to Dr. Gr. D. McReddie, M. D., Civil Surgeon of Pratapgurli (Oudh), who very kindly examined it and sent me the following notes :? Examined a polypoid growth, said to have been removed from the interior of the bladder. Superficially it was l"xf" with a peduncle about in length and diameter. Several large papillae on surface discretely scattered; no mucous membrane covered the polypus. A section placed under a objective and magnified 375 diameters shewed the structure to be composed of closely interwoven fibrillas, enclosing rounded cells, indicating origin from mucous membrane. Growth?a myxo-sarcoma." II.?Ancestlietic Leprosy Stretching of ulnar nerve: cure. In April last, when the Extra Assistant Commissioner's camp was at Srinagar, a strong, well-built Hindu male, by name Ram Singh, aged 40, came to me and asked for some liniment for the cure of anaesthesia of certain portions of his body. I found it to be a case of anaesthetic leprosy, and told him that a surgical operation was the only thing which held out any hope of cure. The residents of these hills, as a rule, are very much afraid of surgical operations, and Ram Singh not being an exception to this, said that, having
now
of
"
"
"
?
in the E. A. Commissioner's Court, he could not the operation then but that he would come later on. As his case was not to come off till about a fortnight, I succeeded in inducing him to undergo the operation, and the next day (10th April 1882) he was admitted into the hospital. In the bed-head ticket I entered the following note :? a
case
undergo
"
Loss of sensation on the inner side of the fore-arms and hands, over the area of distribution of the ulnar nerves ; both the ulnar nerves are very distinct and have a cordlike feel?the right more so ; pain along the ulnar nerves ; a papular eruption over the area of distribution of the right ulnar nerve, below the elbow. Loss of sensation in the left leg and foot and pain shooting down the sciatic nerve." The same day, I exposed the right ulnar nerve, by means of an incision on the inner side a little above the inner condyle of the humerus, and hooking it up with my finger stretched it well. It was very much thickened and was nearly four times its natural size in circumference. A few strands of catgut were put in for drainage and the wound was
closed.
On the 12th, two days after operation, he was free from the pain which he felt along the ulnar nerve, and by the 17th the sensation was almost completely restored, so that he felt the prick of a pin as much on the inner as on the outer side. The papular eruption had also disappeared. He left the hospital well satisfied with the result of the operation, and promised to come back to be operated on the left side after his case was decided in the court. the operation of "nerveRemarks?I have stretching"?ulnar and sciatic?seven times, but Ram Singh's case was the most successful one as regards the result. In this one, was the restoration of none of the cases, except sensation so rapid and complete. In one case (of sciatic nerved there was no appreciable improvement ; but in the remaining five, there was improvement more or less, and the unhealthy ulcers on the fingers and toes healed very rapidly. The operation of " nerve-stretching" is easy and devoid of any danger, if performed with ordinary care, and one has to be convinced of its good only to perform it a few times effect. The result depends a great deal on the duration of the disease.
performed
^
Srinagar, July 11th,
1882.
213
