THE CALCUTTA MEDICAL SOCIETY. The Fourth
Meeting of 1882 was held at the Medical on "Wednesday, 12th April ; Dr. Harvey presding. Mr. Wallace showed a case of Congenital absence op the Vagina in a child 8 months old. The external portions of the generative organs are well formed ; the urethral orifice is a little lower than natural, and between the well developed labia majora is a sulcus but no vaginal orifice. In a child so young no evidence of any value regarding the existence of a uterus can be made out by a combined rectal examination, but an idea as the thickness of the septum between the rectum and bladder might be obtained by passing a catheter into the bladder and feeling it through the rectum. The question is at what age would it be safest and best to operate on a young child like the one shown to the Society. Dr. McLeod thought that interference ought to be delayed till puberty. It would then become apparent whether this was a case of imperforate hymen or undeveloped vagina, and measures could be taken accordingly. Dr. Harvey agreed that this would be the wisest course. DR. Harvey exhibited two polypous fibro-myomata of the uterus which he had removed recently by means of the ecraseur. One case was that of an elderly woman who had borne children. The tumour was found hanging outside of the cervix. The growth had been first noticed 5 years ago. Great constitutional debility with profound anemia had been caused by frequent floodings aggravated at menstrual periods. The removal of the mass had been accomplished with great ease by means of the ecraseur. Bleeding had ceased since the lump was taken away. The other was the case of a married European woman who had also borne children. The growth had been noticed 2 years ago, and sprang from the cervix. There had also been monorrhagia and great constitutional depression. Removal was effected in the same way without difficulty. Dr. McLeod exhibited a case of transverse fracture of the patella, which he had treated by cutting down on the fragments and bringing them together with silver wire. The particulars of the case, as drawn up by AssistantSurgeon Devendra Nath DEY, M. B., are as follows :? G-. P., an European Engineer aged 50 years, was admitted into the 1st Surgeon's ward with simple fracture of the right patella on the 9th February 1882. Previous history.?The patient was walking along the footpath of Bowbazar Street at about 8 p. M. on the 9th February, when a man struck him from behind with a lathi over his right ham and he immediately fell on his to rise up but failed, and right knee. He soon attempted he was carried home in a palkec, when he examined his knee and found his right knee cap broken. He came to about 2 hours after the accident, and his right leg College
/
hospital was
put
upon a
splint.
admission.?The right patella was found transversely fractured, the line of fracture instead of being there was separation of the quite horizontal was oblique, and Condition
on
fragments to the extent of about an inch. The soft parts over the seat of fracture were a good deal bruised, and there was a patch of ecchymosis of the size of an eight anna bit over the knee. Strappings were put on, bringing the fragments as closely together as possible, the limb put straight on a posterior splint and the foot raised. The next day there was oedema of the leg and foot and much swelling of the knee ; the strappings being too tight were removed and vesiunderneath cations were found ; they healed in 2 or 3 days, and the strappings were renewed but the fragments could not be brought closer together. Operation.?On the 23rd the operation of stitching the fragments together with silver wire was performed under chloroform and strict antiseptic precautions, t\ro parallel incisions, each about 2 inches long and about an inch apart from each other, were made over the knee down to the patella longitudinally from above downwards and tie joint was opened. The articular surface of the patella could be felt by the finger through the wound, and the fragments were drilled with a brad awl above and below on each side ; a large thrombus was found interposed between the fragments and was removed. A hernia needle was passed through the liole and threaded with silver wire which was drawn out throigh each hole of one side and thus a double silver wire was pass;d through both the fragments on both sides and then twisted bringing the fragments closely together. The parallel wounte were then stitched with two wire sutures and a few hoisehair sutures and dressed antiseptically ; the two wire loops vere made to emerge through the middle of the wounds and tlen cut short: the
leg put on a posterior splint. Progress.?There was slight rise of temptrature for two days after the operation. At first some fluxion of the wound was noticed and the discharge was sanguineoui; the swelling subsided and the discharge became lymphy aid sweet; the wire stitches pressed tightly on the parts, anl were cut across on the 27th February and removed on th( 2nd March. There was no swelling of the joint, nor of the leg nor foot; the wound was aseptic throughout, and healec by the first intention except in the track of the wire loops Some of the horse-
hair stitches were removed on the 8th andthe rest on the 11th. The patella was found to move in a mass ireely and smoothly On the 15th the over the articular surface of the femu; fragments united, but the callus was not irm ; the wire loops became encysted, the patella was movedfreely without any grating sensation being felt. The Mclntye's splint was taken off and the knee secured in a gutta perha trough. On the 4th April the silver wire loops were uitwisted and drawn out, the fragments found united ; the \t)und healed except in the tracks of the wire. The patelli moved freely over the trochlear surface of the femur wihout the least sensation of grating. Two cases, in which an operation for tie radical cube op hernia according to the method describd at previous meetings, were also shown. The details of these cases are furnshed by AssistantSurgeon Devendra Nath Dey, M. B. No. 1.?A. Jackman, a European saior, aged 48 years, was admitted into the 1st Surgeon's wait with a reducible inguinal hernia of the right side on the 'th January 1882. Previous history.?The patient had been suffering from hernia for the last 18 years ; it first caie on suddenly after an impulse of coughing with a peculiar sesation of something having given way. For about a montl the tumour was of the size of a pigeon's egg, and he too; do notice of it for 12 months, after which it became large and more painful, when he was obliged to wear a trus which proved to be useful in keeping back the protrudin gut and removing the pain. He had been continually faring the truss for the last 17 years, after which from Ion exercise or sudden impulse of coughing the hernia became very painful and he took his admission into the 1st Surgen's ward on the 27th December 1880, and underwent Wood'operation for radical The wund suppurated in cure on the 2nd January 1881. the track of the wires, which were taen out 11 days after the operation and two drainage tubes ;ach one inch long inserted. The wound healed in 22 day ; the inguinal canal was found to be contracted, hardly amitting the tip of the forefinger, and a new truss was gven to the patient for additional safety, but in spite of ithe had a descent of the hernia again on the 1st April. Heleft hospital on the 14th May, and was advised to come bat in the next winter for another operation.
3 38
THE INDIAN MEDICAL GAZETTE.
Condition on admission.?The inguinal ring of the right side admitted the tips of 3 fingers ; there was no thickening of the cord ; the scrotum of natural size ; the hernial tumour was of the size of a duck's egg, it did not come down when the patient lay on his back but only when he stood up or sat. Operation.?On the 11th a modified Wood's operation was performed under chloroform and strict antiseptics. An incision 2 inches long was made over the external ring along the cord and the subjacent fasciae divided and the sac exposed, it was tied close to the ling and cut off. The pillars were brought together by 2 catgut stitches and the ends left long for drainage. The wound was stitched and dressed. Progress.?The vound was aseptic throughout, and healed by the first intention, the wire stitches were removed on the 16th, and the honehairs on the 19th : a small sinus was left in the track of tie drain which came away on the 21st; fungous granulatbns sprouted through the sinus, and were snipped three times and kept down by application of caustics. The wound is now completely healed and a linear depressed cicatrix left. There is consolidation of tissue around, and the ring is closed and united to the cord. No impulse on coughing below the cicitrix, the canal is practically closed up. No. 2.?Tinconry Mandal, aged 40 years, a Hindoo cultivator and an inhabitant of Hooglily, was admitted into the 1st Sui>eon's ward with strangulated hernia (epiplocele) of the rigit side on the 9th March 1882. Previous histovj.?Four years before admission he noticed in his right gron a hernial protrusion which came on suddenly while vorking in the fields ; it remained for two hours, after whicl it went up by itself. Since then he had been subject to tfis hernial descent 10 or 12 times, but the tumour was on eaih occasion easily reduced, and was never strangulated, till [ days before admission when the hernia came down with an intense cutting pain, and could not be reduced by taxis >hich was tried both at home and abroad as well as in the hospital under chloroform. The hernial descent was follo\\jd by incessant vomiting, and his bowels had been confinedfor 4 days. The pain gradually became excruciating, intei'ering with free respiration and preventing sleep, and the tur,our increased in size and became tender to the touch. Condition on amission.?Body well nourished ; countenance anxious ; extremities warm ; pulse good and regular ; tongue coated bui moist; no symptoms of sti-angulation except vomiting $id constipation. The right side of the scrotum 4 times lrger than the left, the tumour being of the size of a larfc gourd, quite dull on percussion and divided into two mequal segments by a slight constriction. It extende* up along the right spermatic cord into the inguinal ritg, by which it was tightly embraced. The upper or the sialler tumour was of the size of an orange, dull on percussion nd solid to the feel, and when punctured by the capillary trcar gave out 5 or 6oz. of thick sanguineous The loweror the larger tumour, also dull on percusserum. sion, was softer anc fluctuating, it was explored and a large quantity of high-olored serous fluid came out through the canula. There waialso a small hydrocele on the left side. The contents of th upper tumour were at once diagnosed to be strangulate omentum, which was exactly verified by the subsequent peration : the lower tumour being a pure
hydrocele.
Operation.?Theumour was well washed with strong Carbolic lotion and the iatient put under chloroform ; an incision about 3 inches lon
Meeting of 1882 was held at the Medical on "Wednesday, 12th April ; Dr. Harvey presding. Mr. Wallace showed a case of Congenital absence op the Vagina in a child 8 months old. The external portions of the generative organs are well formed ; the urethral orifice is a little lower than natural, and between the well developed labia majora is a sulcus but no vaginal orifice. In a child so young no evidence of any value regarding the existence of a uterus can be made out by a combined rectal examination, but an idea as the thickness of the septum between the rectum and bladder might be obtained by passing a catheter into the bladder and feeling it through the rectum. The question is at what age would it be safest and best to operate on a young child like the one shown to the Society. Dr. McLeod thought that interference ought to be delayed till puberty. It would then become apparent whether this was a case of imperforate hymen or undeveloped vagina, and measures could be taken accordingly. Dr. Harvey agreed that this would be the wisest course. DR. Harvey exhibited two polypous fibro-myomata of the uterus which he had removed recently by means of the ecraseur. One case was that of an elderly woman who had borne children. The tumour was found hanging outside of the cervix. The growth had been first noticed 5 years ago. Great constitutional debility with profound anemia had been caused by frequent floodings aggravated at menstrual periods. The removal of the mass had been accomplished with great ease by means of the ecraseur. Bleeding had ceased since the lump was taken away. The other was the case of a married European woman who had also borne children. The growth had been noticed 2 years ago, and sprang from the cervix. There had also been monorrhagia and great constitutional depression. Removal was effected in the same way without difficulty. Dr. McLeod exhibited a case of transverse fracture of the patella, which he had treated by cutting down on the fragments and bringing them together with silver wire. The particulars of the case, as drawn up by AssistantSurgeon Devendra Nath DEY, M. B., are as follows :? G-. P., an European Engineer aged 50 years, was admitted into the 1st Surgeon's ward with simple fracture of the right patella on the 9th February 1882. Previous history.?The patient was walking along the footpath of Bowbazar Street at about 8 p. M. on the 9th February, when a man struck him from behind with a lathi over his right ham and he immediately fell on his to rise up but failed, and right knee. He soon attempted he was carried home in a palkec, when he examined his knee and found his right knee cap broken. He came to about 2 hours after the accident, and his right leg College
/
hospital was
put
upon a
splint.
admission.?The right patella was found transversely fractured, the line of fracture instead of being there was separation of the quite horizontal was oblique, and Condition
on
fragments to the extent of about an inch. The soft parts over the seat of fracture were a good deal bruised, and there was a patch of ecchymosis of the size of an eight anna bit over the knee. Strappings were put on, bringing the fragments as closely together as possible, the limb put straight on a posterior splint and the foot raised. The next day there was oedema of the leg and foot and much swelling of the knee ; the strappings being too tight were removed and vesiunderneath cations were found ; they healed in 2 or 3 days, and the strappings were renewed but the fragments could not be brought closer together. Operation.?On the 23rd the operation of stitching the fragments together with silver wire was performed under chloroform and strict antiseptic precautions, t\ro parallel incisions, each about 2 inches long and about an inch apart from each other, were made over the knee down to the patella longitudinally from above downwards and tie joint was opened. The articular surface of the patella could be felt by the finger through the wound, and the fragments were drilled with a brad awl above and below on each side ; a large thrombus was found interposed between the fragments and was removed. A hernia needle was passed through the liole and threaded with silver wire which was drawn out throigh each hole of one side and thus a double silver wire was pass;d through both the fragments on both sides and then twisted bringing the fragments closely together. The parallel wounte were then stitched with two wire sutures and a few hoisehair sutures and dressed antiseptically ; the two wire loops vere made to emerge through the middle of the wounds and tlen cut short: the
leg put on a posterior splint. Progress.?There was slight rise of temptrature for two days after the operation. At first some fluxion of the wound was noticed and the discharge was sanguineoui; the swelling subsided and the discharge became lymphy aid sweet; the wire stitches pressed tightly on the parts, anl were cut across on the 27th February and removed on th( 2nd March. There was no swelling of the joint, nor of the leg nor foot; the wound was aseptic throughout, and healec by the first intention except in the track of the wire loops Some of the horse-
hair stitches were removed on the 8th andthe rest on the 11th. The patella was found to move in a mass ireely and smoothly On the 15th the over the articular surface of the femu; fragments united, but the callus was not irm ; the wire loops became encysted, the patella was movedfreely without any grating sensation being felt. The Mclntye's splint was taken off and the knee secured in a gutta perha trough. On the 4th April the silver wire loops were uitwisted and drawn out, the fragments found united ; the \t)und healed except in the tracks of the wire. The patelli moved freely over the trochlear surface of the femur wihout the least sensation of grating. Two cases, in which an operation for tie radical cube op hernia according to the method describd at previous meetings, were also shown. The details of these cases are furnshed by AssistantSurgeon Devendra Nath Dey, M. B. No. 1.?A. Jackman, a European saior, aged 48 years, was admitted into the 1st Surgeon's wait with a reducible inguinal hernia of the right side on the 'th January 1882. Previous history.?The patient had been suffering from hernia for the last 18 years ; it first caie on suddenly after an impulse of coughing with a peculiar sesation of something having given way. For about a montl the tumour was of the size of a pigeon's egg, and he too; do notice of it for 12 months, after which it became large and more painful, when he was obliged to wear a trus which proved to be useful in keeping back the protrudin gut and removing the pain. He had been continually faring the truss for the last 17 years, after which from Ion exercise or sudden impulse of coughing the hernia became very painful and he took his admission into the 1st Surgen's ward on the 27th December 1880, and underwent Wood'operation for radical The wund suppurated in cure on the 2nd January 1881. the track of the wires, which were taen out 11 days after the operation and two drainage tubes ;ach one inch long inserted. The wound healed in 22 day ; the inguinal canal was found to be contracted, hardly amitting the tip of the forefinger, and a new truss was gven to the patient for additional safety, but in spite of ithe had a descent of the hernia again on the 1st April. Heleft hospital on the 14th May, and was advised to come bat in the next winter for another operation.
3 38
THE INDIAN MEDICAL GAZETTE.
Condition on admission.?The inguinal ring of the right side admitted the tips of 3 fingers ; there was no thickening of the cord ; the scrotum of natural size ; the hernial tumour was of the size of a duck's egg, it did not come down when the patient lay on his back but only when he stood up or sat. Operation.?On the 11th a modified Wood's operation was performed under chloroform and strict antiseptics. An incision 2 inches long was made over the external ring along the cord and the subjacent fasciae divided and the sac exposed, it was tied close to the ling and cut off. The pillars were brought together by 2 catgut stitches and the ends left long for drainage. The wound was stitched and dressed. Progress.?The vound was aseptic throughout, and healed by the first intention, the wire stitches were removed on the 16th, and the honehairs on the 19th : a small sinus was left in the track of tie drain which came away on the 21st; fungous granulatbns sprouted through the sinus, and were snipped three times and kept down by application of caustics. The wound is now completely healed and a linear depressed cicatrix left. There is consolidation of tissue around, and the ring is closed and united to the cord. No impulse on coughing below the cicitrix, the canal is practically closed up. No. 2.?Tinconry Mandal, aged 40 years, a Hindoo cultivator and an inhabitant of Hooglily, was admitted into the 1st Sui>eon's ward with strangulated hernia (epiplocele) of the rigit side on the 9th March 1882. Previous histovj.?Four years before admission he noticed in his right gron a hernial protrusion which came on suddenly while vorking in the fields ; it remained for two hours, after whicl it went up by itself. Since then he had been subject to tfis hernial descent 10 or 12 times, but the tumour was on eaih occasion easily reduced, and was never strangulated, till [ days before admission when the hernia came down with an intense cutting pain, and could not be reduced by taxis >hich was tried both at home and abroad as well as in the hospital under chloroform. The hernial descent was follo\\jd by incessant vomiting, and his bowels had been confinedfor 4 days. The pain gradually became excruciating, intei'ering with free respiration and preventing sleep, and the tur,our increased in size and became tender to the touch. Condition on amission.?Body well nourished ; countenance anxious ; extremities warm ; pulse good and regular ; tongue coated bui moist; no symptoms of sti-angulation except vomiting $id constipation. The right side of the scrotum 4 times lrger than the left, the tumour being of the size of a larfc gourd, quite dull on percussion and divided into two mequal segments by a slight constriction. It extende* up along the right spermatic cord into the inguinal ritg, by which it was tightly embraced. The upper or the sialler tumour was of the size of an orange, dull on percussion nd solid to the feel, and when punctured by the capillary trcar gave out 5 or 6oz. of thick sanguineous The loweror the larger tumour, also dull on percusserum. sion, was softer anc fluctuating, it was explored and a large quantity of high-olored serous fluid came out through the canula. There waialso a small hydrocele on the left side. The contents of th upper tumour were at once diagnosed to be strangulate omentum, which was exactly verified by the subsequent peration : the lower tumour being a pure
hydrocele.
Operation.?Theumour was well washed with strong Carbolic lotion and the iatient put under chloroform ; an incision about 3 inches lon
