exhausting discharge.
This measure
promptly produced
a
change for the better, and the patient is
now almost well. The knee-joint was found full of pus; its cartilages extensively the in existed tuberosities of the tibia, eroded, and cavities and condyles of the femur containing nodules of dead cancellous bone. These cavities communicated with the joint cavity, and were lined by a kind of pyogenic membrane. This condition was one of necrosis rather than of caries : inasmuch as a complete separation of the dead from the living bone had taken place, the former constituting in fact a cancellous sequestrum. Dr. Rate remarked that the specimen appeared to him to be a remarkably good one of the kind. He had seen a similar condition in the interior of an abscess in the head of the tibia. Raboo Avinas Chunder Bannerjee exhibited a patient with enormous enlargement of the spleen. He was a young man, a European, :et. 19. Had suffered from fever otf and on for two years. The heart was displaced upwards, the apex beating behind the left nipple. The arch of the aorta was perceptible in the inter-clavicular notch. There was a systolic bruit over the pulmonary cartilage. The spleen descended into the right iliac fossa and occupied almost the entire area of the front wall of the abdomen. He had been 20 days in hospital. His health had improved, and there was a slight reduction of the size of the spleen. He had been treated with iron and aloes. There was no anaemia, anasarca or palpitation of the heart. The liver was slightly enlarged. Dr. Bowser had seen a great many enlarged spleens in the malarious districts?Rungpore, Dinagepore, &c., in which he had served as civil medical officer. He had remarked that burning of the palms and soles was a common symptom in such cases. Dr. Rate thought that this symptom was present in most It yielded readily to quinine. cases of malarious fever. Baboo Avinas Chunder Bannerjee also exhibited the
following preparations :? 1. A portion of jejunum showing an abrupt stricture of the gut. The constricted part has the appearance of a healed
ulcer. The valvuloe conniventes are absent over the cicatriced The chronicity is evidenced by the marked hypertrophy and dilatation of the muscular coat above the site of stricture. No other constriction or ulceration was found in any part. From a native male, aged 36, who (lied within 24 hours of admission from acute pericarditis and pneumonia. 2. A portion of the lower end of the jejunum showing two transversely placed broad ulcers with much constriction of the gut, and a perforation admitting a crow-quill through the base of the upper one through which the contents were extravasated into the peritoneal cavity producing fatal peritonitis : the rest of the gut as also the stomach was free from ulceration of any kind. The preparation was taken, from a native male, aged about 40 years, who had been suffering from dyspepsia, vomiting after meals and colicky pains in the abdomen for six months, and died of peritonitis soon .after admission. 3. A Heart, from the same case, showing patches of subendocardial eccliymosis at the upper part of the septum ventriculorum (left side). 4. A Heart showing? (a.) Acute valvular endocarditis, one of the aortic semilunar valves being perforated in two places. (b.) Ulcerative myocarditis. From a native male, aged 26, who was admitted into the hospital for remittent fever, and showed symptoms of shortness of breath and tumultuous action of the heart 24 hour* previous to death. Baboo Avinas Chunder Bannerjee then read the following notes of two cases of Hepatic Abscess which TREATED IN Dr. ChUNDRA'S HAD BEEN SUCCESSFULLY area.
THE CALCUTTA MEDICAL SOCIETY. The fourth meeting of this Society was held at the Medical College on Wednesday, the 4th April 1880, Dr. Cayley presiding. Dr. K. McLeod exhibited a preparation of a knee-joint showing CIRCUMSCRIBED NECROSIS OF CANCELLOUS BONE. The patient, from whom the preparation had been obtained, was an elderly Hindu with a syphilitic history, who came to hospital with an acutely bent knee-joint. An abscess was
The operon the outside of it which was opened. ation was followed by sloughing cellulitis which spread up and down the limb, extending upwards beneath the quadriceps extensor and downwards between the gastrocnemius and soleus. The back of the head of the fibula was found tr> be bare, and subsequently the front of the shaft of the tibia. Free counter-openings were made. The constitutional symptoms were very severe, consisting of high fever of a hectic type. Fluid was detected in the knee-joint, which was found' on exploration by means of a capillary trocar to be purulent. Amputation was resorted to to save life which was rapidly ebbing under the continual pyrexia and
detected
WARDS TIONS
No.
BY
FREE
DRAINAGE
WITH
ANTISEPTIC PRECAU-
:?
1.?Hepatic
abscess:
history of intemperance: pointaspiration: free drainage: recovery. Goburdhon, a Hindu male, ret. 35, of Barrackpore, admitted to tin 2nd Physician's ward on the 13th September 1879, and discharge.! cured on the 23rd November same year. Previous history.?The patient stated that from a month and half previous to his admission, he had been noticing a swelling on the right side of his chest which was gradually increasing in bulk. About 12 days after the cominencame.it ing
between the ribs:
140
THE INDIAN MEDICAL GAZETTE.
the swollen part became painful, and ho began to get fever daily during the afternoon. Some native rcmedials were had reco.irsj to without any good effect. No history of jaundice, or ascites, or rigors. No history of dysentery or malarious fever. But he was addicted to drinking for about 5 months before his admission. Condition on admission.?He was pretty well nourished. Used to get fever every night. The right dorsal and lower axillary regions were swollen and prominent: the area being about (5 inches long and as many inches broad. The transverso girth of the right chest at the most prominent part was l(i inches; that of the left sidj at the same level being 14. The skin over the part was slightly (Edematous and tender The intercostal spaces were widened and to th j touch. The swelling extended the costal prominences effaced. from the 7tli rib downwards. No pain on pressure below the right costal arch. No thoracic or splenic complications. Bowels constipated : pulse regular : temperature 100-6" F. Treatment a nd subsequent progress.?Poultices were applied and cathartic enema given on admission. On the 15tli September (2 days after admission) the swelling was aspirated between the 8th and the 9th ribs on a line with the angle of th; right scapula and about 30 ounces of reddish brown pus with i-ome sloughs removed to the relief of the patient. On the 17th September both the fever and pain increased, and, consequently, an exit for the pus was made by means of a large trocar and canula, and afterwards a drainage tube of about 5 inches in length was introduced into the cavity. This time another 30 ounces of pus came out. The rib! were found necrosed. The whole was, however, dressed antiseptically. the cavity being syringed while the patient lay on his back. During the next two days the discharge of pus was not free in consequence of the drainage tube that was left in the cavity having been compressed by the intercostal muscles, so a large metallic canula was substituted, and the cavity then began to contract with great diminution of fever and discharge. Again, after some days, the drainage tube was employed ; and this time it met with no compression in consequence of inflammatory lymph being thrown out all round the opening, making it patent. From the 29th of September the cavity became a great deal reduced and filled up, as could be made out by the quantity of lotion that could be thrown in. Next only a sinus remained which took such a long time as 50 days to heal up.
Remarks.?The following points ought to be noted in this
case:?
1. Intemperance as the apparent cause of the abscess. 2. The tendency to point between the ribs caused their necrosis. 3. The tendency of the intercostal muscles to compress the soft India rubber tube. In such case the spiral wire tubes are best suited. 4. Aspiration was inadmissible in this case. 5. The great length of time taken by the sinus to heal up.
This measure
promptly produced
a
change for the better, and the patient is
now almost well. The knee-joint was found full of pus; its cartilages extensively the in existed tuberosities of the tibia, eroded, and cavities and condyles of the femur containing nodules of dead cancellous bone. These cavities communicated with the joint cavity, and were lined by a kind of pyogenic membrane. This condition was one of necrosis rather than of caries : inasmuch as a complete separation of the dead from the living bone had taken place, the former constituting in fact a cancellous sequestrum. Dr. Rate remarked that the specimen appeared to him to be a remarkably good one of the kind. He had seen a similar condition in the interior of an abscess in the head of the tibia. Raboo Avinas Chunder Bannerjee exhibited a patient with enormous enlargement of the spleen. He was a young man, a European, :et. 19. Had suffered from fever otf and on for two years. The heart was displaced upwards, the apex beating behind the left nipple. The arch of the aorta was perceptible in the inter-clavicular notch. There was a systolic bruit over the pulmonary cartilage. The spleen descended into the right iliac fossa and occupied almost the entire area of the front wall of the abdomen. He had been 20 days in hospital. His health had improved, and there was a slight reduction of the size of the spleen. He had been treated with iron and aloes. There was no anaemia, anasarca or palpitation of the heart. The liver was slightly enlarged. Dr. Bowser had seen a great many enlarged spleens in the malarious districts?Rungpore, Dinagepore, &c., in which he had served as civil medical officer. He had remarked that burning of the palms and soles was a common symptom in such cases. Dr. Rate thought that this symptom was present in most It yielded readily to quinine. cases of malarious fever. Baboo Avinas Chunder Bannerjee also exhibited the
following preparations :? 1. A portion of jejunum showing an abrupt stricture of the gut. The constricted part has the appearance of a healed
ulcer. The valvuloe conniventes are absent over the cicatriced The chronicity is evidenced by the marked hypertrophy and dilatation of the muscular coat above the site of stricture. No other constriction or ulceration was found in any part. From a native male, aged 36, who (lied within 24 hours of admission from acute pericarditis and pneumonia. 2. A portion of the lower end of the jejunum showing two transversely placed broad ulcers with much constriction of the gut, and a perforation admitting a crow-quill through the base of the upper one through which the contents were extravasated into the peritoneal cavity producing fatal peritonitis : the rest of the gut as also the stomach was free from ulceration of any kind. The preparation was taken, from a native male, aged about 40 years, who had been suffering from dyspepsia, vomiting after meals and colicky pains in the abdomen for six months, and died of peritonitis soon .after admission. 3. A Heart, from the same case, showing patches of subendocardial eccliymosis at the upper part of the septum ventriculorum (left side). 4. A Heart showing? (a.) Acute valvular endocarditis, one of the aortic semilunar valves being perforated in two places. (b.) Ulcerative myocarditis. From a native male, aged 26, who was admitted into the hospital for remittent fever, and showed symptoms of shortness of breath and tumultuous action of the heart 24 hour* previous to death. Baboo Avinas Chunder Bannerjee then read the following notes of two cases of Hepatic Abscess which TREATED IN Dr. ChUNDRA'S HAD BEEN SUCCESSFULLY area.
THE CALCUTTA MEDICAL SOCIETY. The fourth meeting of this Society was held at the Medical College on Wednesday, the 4th April 1880, Dr. Cayley presiding. Dr. K. McLeod exhibited a preparation of a knee-joint showing CIRCUMSCRIBED NECROSIS OF CANCELLOUS BONE. The patient, from whom the preparation had been obtained, was an elderly Hindu with a syphilitic history, who came to hospital with an acutely bent knee-joint. An abscess was
The operon the outside of it which was opened. ation was followed by sloughing cellulitis which spread up and down the limb, extending upwards beneath the quadriceps extensor and downwards between the gastrocnemius and soleus. The back of the head of the fibula was found tr> be bare, and subsequently the front of the shaft of the tibia. Free counter-openings were made. The constitutional symptoms were very severe, consisting of high fever of a hectic type. Fluid was detected in the knee-joint, which was found' on exploration by means of a capillary trocar to be purulent. Amputation was resorted to to save life which was rapidly ebbing under the continual pyrexia and
detected
WARDS TIONS
No.
BY
FREE
DRAINAGE
WITH
ANTISEPTIC PRECAU-
:?
1.?Hepatic
abscess:
history of intemperance: pointaspiration: free drainage: recovery. Goburdhon, a Hindu male, ret. 35, of Barrackpore, admitted to tin 2nd Physician's ward on the 13th September 1879, and discharge.! cured on the 23rd November same year. Previous history.?The patient stated that from a month and half previous to his admission, he had been noticing a swelling on the right side of his chest which was gradually increasing in bulk. About 12 days after the cominencame.it ing
between the ribs:
140
THE INDIAN MEDICAL GAZETTE.
the swollen part became painful, and ho began to get fever daily during the afternoon. Some native rcmedials were had reco.irsj to without any good effect. No history of jaundice, or ascites, or rigors. No history of dysentery or malarious fever. But he was addicted to drinking for about 5 months before his admission. Condition on admission.?He was pretty well nourished. Used to get fever every night. The right dorsal and lower axillary regions were swollen and prominent: the area being about (5 inches long and as many inches broad. The transverso girth of the right chest at the most prominent part was l(i inches; that of the left sidj at the same level being 14. The skin over the part was slightly (Edematous and tender The intercostal spaces were widened and to th j touch. The swelling extended the costal prominences effaced. from the 7tli rib downwards. No pain on pressure below the right costal arch. No thoracic or splenic complications. Bowels constipated : pulse regular : temperature 100-6" F. Treatment a nd subsequent progress.?Poultices were applied and cathartic enema given on admission. On the 15tli September (2 days after admission) the swelling was aspirated between the 8th and the 9th ribs on a line with the angle of th; right scapula and about 30 ounces of reddish brown pus with i-ome sloughs removed to the relief of the patient. On the 17th September both the fever and pain increased, and, consequently, an exit for the pus was made by means of a large trocar and canula, and afterwards a drainage tube of about 5 inches in length was introduced into the cavity. This time another 30 ounces of pus came out. The rib! were found necrosed. The whole was, however, dressed antiseptically. the cavity being syringed while the patient lay on his back. During the next two days the discharge of pus was not free in consequence of the drainage tube that was left in the cavity having been compressed by the intercostal muscles, so a large metallic canula was substituted, and the cavity then began to contract with great diminution of fever and discharge. Again, after some days, the drainage tube was employed ; and this time it met with no compression in consequence of inflammatory lymph being thrown out all round the opening, making it patent. From the 29th of September the cavity became a great deal reduced and filled up, as could be made out by the quantity of lotion that could be thrown in. Next only a sinus remained which took such a long time as 50 days to heal up.
Remarks.?The following points ought to be noted in this
case:?
1. Intemperance as the apparent cause of the abscess. 2. The tendency to point between the ribs caused their necrosis. 3. The tendency of the intercostal muscles to compress the soft India rubber tube. In such case the spiral wire tubes are best suited. 4. Aspiration was inadmissible in this case. 5. The great length of time taken by the sinus to heal up.
