SURGICAL CASES IN THE MAYO HOSPITAL, ,
Br Suegeon-Majob
LAHORE.
T. E. B. Brown, Medical College.
CASE
Principal,
Lahore
I.?ABSCESS IX AXILLA.
student of the Medical School, Lahore, was admitted on the 29fch of December 1873, suffering from an extensive swelling in the right axilla ; there was obscure fluctuation and evidence of the presence of an abscess, but it was evidently deeply seated. It was, therefore, determined that the abscess should be opened by Hilton's method. Chloroform was administered, and an incision made opposite the lower border of the pectoralis major muscle in the fold of the axilla; the skin superficial and deep fascias were divided, but no large vessel was injured. Then a director was forcibly pushed iuto the axilla for about an inch and a half, before the abscess was opened. After using a little force pus appeared ; a common dressing forceps was then passed along the director into the abscess and forcibly opened, when an abundant flow of pus occurred, and has since continued for several days without causing any pain or uneasiness. The lower border of the pectoralis mnjor muscle can be seen in the incision; it moves up when the arm is raised, and permits the pus to flow out. No blood was lost in this operation.
Bolundkhan,
a
CASE II.?STRANGULATED INGUINAL HERNIA. Thakoor Sing, a Hindoo male, by occupation a goldsmith, had been subject to a hernia on the right side of the scrotum for many years, which used to come down whenever he passed a motion, but was usually easily returned by himself. One day, however, in January, he was disturbed while relieving the hernia, and went downstairs without reducing it. He found that lie could not push it back, when he subsequently tried, and the remedies ordered by native hakims proved of no service, but the pain increased and hiccup and vomiting occurred with obstinate constipation ; so that the next morning, 16 hours after the descent of the hernia, he was admitted into the Mayo Hospital, and was found to have a very tense tumour in the right side of the scrotum which could not be forced back As he was greatly distressed with hiccup into the abdomen. and vomiting, and his tongue was dry and pulse quick, it was determined to operate without delay. Chloroform was given, and an incision made over the neck of the sac. The skin, superficial fascia and three layers of fibrous tissue were divided, and then the sac was seen nearly transparent with the intestine visible through it. A finger was then passed along the sac towards the abdomen, and the fibrous stricture detected, evidently formed by the intercoluinnar fibres; these were divided by a hernia-knife, and then a little pressure served to press up the intestine, which could be seen through that sac moving upwards. One artery, the superficial epigastric, was tied with a catgut ligature cut short and the wound closed by cat-gut sutures. Three grains of opium were given daily. On the next day there was slight fever and tenderness, but no discharge from the wound, and the feverish symptoms continued for a week, but the pain gradually subsided; the bowels were moved of themselves on the third day, causing a litle increase of pain and fever, but the patient continued to improve ; on the sixth day the lower part of the incision had united by the first intention; but a little sloughing occurred at the upper part of the wound, which
THE INDIAN MEDICAL GAZETTE.
98 separated by ulceration. state, and lie
the natural
CASE
The was
temperature gradually discharged.
fell to
III.?DISLOCATION OF THE FEMUR INTO THE OBTURATOR FORAJIEN.
Hulla, a Mahomedan coolie, aged 35, was admitted into hospital on the 12th of January, suffering from a dislocation of the thigh. It appeared that on the previous day he was working at the Railway bridge over the Ravee, when a piece of wood, weighing about three maunds, fell and struck him on the back of the left thigh, while he was in a stooping posture. He fell to the ground insensible, and on coining to his senses he found that he was not able to move his left leg, and that he had great pain in the hip joint. Attempts were made to reduce the dislocation at the Railway hospital, but these did not succeed ; and the patient was admitted into the Mayo Hospital. When seen, the left leg was found to be very much flexed on the pelvis, and the foot was much everted. The inner side of the thigh measured 1? .inch in length more than the sound side, and there was an obvious protrusion near the ramus of the pubis with a hollow space opposite the acetabuDislocation of the head of the femur into the thyroid lum. foramen was diagnosed by Dr. Scriren, and measures were taken to reduce it. The patient was put under chloroform, pulleys were attached to the wall and connected with hanks of native cotton thread passed in a loose loop round the upper part of the thigh at right angles to the axis of the limb, while a sheet was passed around the pelvis through the loop and held by the students. The extending force was maintained at right angles to the thigh, and at the same time the foot was drawn inwards, and direct manipulation was employed to force the head of the femur into its socket. The first attempt failed, but on making another a loud noise was heard, and the leg returned to its natural position and length. A splint and bandage was applied. This
case
illustrates
a
rather
rare
form of dislocation.
[April
1, 1874.
Br Suegeon-Majob
LAHORE.
T. E. B. Brown, Medical College.
CASE
Principal,
Lahore
I.?ABSCESS IX AXILLA.
student of the Medical School, Lahore, was admitted on the 29fch of December 1873, suffering from an extensive swelling in the right axilla ; there was obscure fluctuation and evidence of the presence of an abscess, but it was evidently deeply seated. It was, therefore, determined that the abscess should be opened by Hilton's method. Chloroform was administered, and an incision made opposite the lower border of the pectoralis major muscle in the fold of the axilla; the skin superficial and deep fascias were divided, but no large vessel was injured. Then a director was forcibly pushed iuto the axilla for about an inch and a half, before the abscess was opened. After using a little force pus appeared ; a common dressing forceps was then passed along the director into the abscess and forcibly opened, when an abundant flow of pus occurred, and has since continued for several days without causing any pain or uneasiness. The lower border of the pectoralis mnjor muscle can be seen in the incision; it moves up when the arm is raised, and permits the pus to flow out. No blood was lost in this operation.
Bolundkhan,
a
CASE II.?STRANGULATED INGUINAL HERNIA. Thakoor Sing, a Hindoo male, by occupation a goldsmith, had been subject to a hernia on the right side of the scrotum for many years, which used to come down whenever he passed a motion, but was usually easily returned by himself. One day, however, in January, he was disturbed while relieving the hernia, and went downstairs without reducing it. He found that lie could not push it back, when he subsequently tried, and the remedies ordered by native hakims proved of no service, but the pain increased and hiccup and vomiting occurred with obstinate constipation ; so that the next morning, 16 hours after the descent of the hernia, he was admitted into the Mayo Hospital, and was found to have a very tense tumour in the right side of the scrotum which could not be forced back As he was greatly distressed with hiccup into the abdomen. and vomiting, and his tongue was dry and pulse quick, it was determined to operate without delay. Chloroform was given, and an incision made over the neck of the sac. The skin, superficial fascia and three layers of fibrous tissue were divided, and then the sac was seen nearly transparent with the intestine visible through it. A finger was then passed along the sac towards the abdomen, and the fibrous stricture detected, evidently formed by the intercoluinnar fibres; these were divided by a hernia-knife, and then a little pressure served to press up the intestine, which could be seen through that sac moving upwards. One artery, the superficial epigastric, was tied with a catgut ligature cut short and the wound closed by cat-gut sutures. Three grains of opium were given daily. On the next day there was slight fever and tenderness, but no discharge from the wound, and the feverish symptoms continued for a week, but the pain gradually subsided; the bowels were moved of themselves on the third day, causing a litle increase of pain and fever, but the patient continued to improve ; on the sixth day the lower part of the incision had united by the first intention; but a little sloughing occurred at the upper part of the wound, which
THE INDIAN MEDICAL GAZETTE.
98 separated by ulceration. state, and lie
the natural
CASE
The was
temperature gradually discharged.
fell to
III.?DISLOCATION OF THE FEMUR INTO THE OBTURATOR FORAJIEN.
Hulla, a Mahomedan coolie, aged 35, was admitted into hospital on the 12th of January, suffering from a dislocation of the thigh. It appeared that on the previous day he was working at the Railway bridge over the Ravee, when a piece of wood, weighing about three maunds, fell and struck him on the back of the left thigh, while he was in a stooping posture. He fell to the ground insensible, and on coining to his senses he found that he was not able to move his left leg, and that he had great pain in the hip joint. Attempts were made to reduce the dislocation at the Railway hospital, but these did not succeed ; and the patient was admitted into the Mayo Hospital. When seen, the left leg was found to be very much flexed on the pelvis, and the foot was much everted. The inner side of the thigh measured 1? .inch in length more than the sound side, and there was an obvious protrusion near the ramus of the pubis with a hollow space opposite the acetabuDislocation of the head of the femur into the thyroid lum. foramen was diagnosed by Dr. Scriren, and measures were taken to reduce it. The patient was put under chloroform, pulleys were attached to the wall and connected with hanks of native cotton thread passed in a loose loop round the upper part of the thigh at right angles to the axis of the limb, while a sheet was passed around the pelvis through the loop and held by the students. The extending force was maintained at right angles to the thigh, and at the same time the foot was drawn inwards, and direct manipulation was employed to force the head of the femur into its socket. The first attempt failed, but on making another a loud noise was heard, and the leg returned to its natural position and length. A splint and bandage was applied. This
case
illustrates
a
rather
rare
form of dislocation.
[April
1, 1874.
