« PředchozíPokračovat »
was again etherized, the sinus still remaining open, and the whole thoroughly curetted, bringing away considerable cheesy material. The cavity thus made was packed with iodoform gauze, which packing was changed daily. It progressed favorably from this time, and she was discharged Aug. 21st, with the wound all healed, although there was still much thickening and induration of that side of the neck.
CASE II. N. B—; age, 16. Admitted Sept. 8th. Diagnosis, tubercular abscess of the neck.
Family history a bad one; mother died of tuberculosis, father died of cancer. A year ago a broken down gland in the right side of the neck was opened. Since November last, three others have formed abscesses and spontaneously ruptured, but have never healed. They were not painful, and the general health has been good, but the neck continued to discharge a yellowish, bloody pus.
Sept. gth. The patient was etherized. The old sinus was opened, thoroughly curetted, and the edges trimmed, after which the cavity was packed with iodoform gauze.
It progressed favorably, was entirely healed on the thirteenth day, and she was discharged on the sixteenth.
CASE III. L. M
Admitted Aug. 29th Diagnosis, enlarged cervical glands; tubercular.
The glands of the right side of the neck began to enlarge about a year ago, and have continued to do so, until at the present time there are apparently two large glands beneath the anterior portion of the sterno-cleido-mastoid muscle. These are readily movable, are not now and never have been painful. Respiration and deglution are not disturbed. The family history is one of tuberculosis.
Sept. 2nd. Patient was etherized. An incision was made over and parallel to the anterior margin of the sterno-mastoid muscle, extending down to the prominent gland beneath. This was easily enucleated and removed ; its removal brought to view a second lying higher in the neck, deep down beside the carotid at its bifurcation. By extending the incision upward this also was removed intact. Below and posteriorly at the base of the neck was still another, so an opening was made over the posterior border of the sterno-mastoid, beneath which muscle the gland lay. This, too, was readily removed, when still another one was discovered, so deeply placed as to have been unnoticed. With patience, this one, with several smaller glands, ranging in size from a pea to a small bean, were successfully enucleated, only to find one more, as large as a pullet's egg, lying deep
down behind the subclavian and carotid arteries. It was decided best not to disturb this one, since its low position was doubtless due to pressure from those above, and now that that pressure was removed, it would ascend into the neck, so that it could easily and without danger, be removed at some subsequent operation. The hemorrhage was trifling. The wounds were carefully closed without drainage, healed throughout by first intention, and at no time did he experience any pain and discomfort. He sat up on the third day and was discharged on the eleventh.
The gland which had been left had already so ascended into the neck that it could easily have been removed, but it was decided to leave it in the hope that it would retrograde and disappear.
A CASE OF ENLARGED INGUINAL GLAND. Miss i age, 21.
Admitted Sept. ist. Diagnosis, enlarged inguinal gland.
This patient was admitted as having a strangulated hernia. Two weeks ago, noticed a pain in the right groin over the internal ring, which rapidly increased, became exquisitely sensitive, was accompanied by nausea, vomiting and constipation, and finally a small lump appeared which has gradually increased until it was the size of a hen's egg. Efforts were made to reduce it, upon the supposition that it was a hernia, but were unavailing.
Sept 2nd. Patient was etherized. The swelling simulated exactly a strangulated hernia, and all the subjective symptoms supported this theory. Careful examination showed, however, that the tumor was closely adherent to the integument by the surrounding inflammation, and was harder, and more resilient than a hernia could be. Upon incising down to it, it was found to be an inflamed inguinal gland, which was removed. The next day she suffered much pain in the wound, with severe headache, but upon the following day, she markedly improved, and continued to do so, until she was discharged, cured, Sept. 19th.
A CASE OF VENTRAL HERNIA. Mrs.
; age 50. Admitted. Diagnosis, ventral hernia. She has had eleven children, the first when she was twenty years old ; the last one, still-born at full time, eight years ago. Twenty-four years ago, when about four months pregnant, she took a long ride in a country stage over a very rough road, immediately following which a small lump, about as large as one's thumb, appeared at the umbilicus. This has increased in size, especially in the last three years, during which time she
has grown very fleshy. At times there has been anasarca. The hernia is a pendulous tumor hanging quite to the knees when in an upright position, and reaching to the knees and resting upon the thighs when the patient is sitting. By the thinning and distention of the abdominal walls, what was origiually an umbilical hernia, has now become a ventral hernia.
The measurements are as follows :
Around the hips, over the greatest prominence of the tumor, 73 inches; circumference of the tumor, 30 inches; from pubes to ensiform cartilage, 37 inches ; bust measure, 40 inches; circumference of thigh, 33 inches; height, 5 feet, 3 inches; weight, 3194 pounds.
Sept. 2nd. The attempt was made to etherize the patient, in order to perform an operation for the reduction of the hernia.
She took the ether badly, however, and long before a stage of anästhesia sufficient to operate was obtained, she became seriously asphyxiated, and it was the unanimous opinion of those present that it would be unsafe to continue the ether. Very reluctantly, therefore, the operation was given up. She had suffered so much, was so brave and patient, and so eager to obtain even a measure of relief, that it was with the greatest regret that the operation was abandoned.
CASE I. Mr. ; age, 66. Admitted July 2nd. Diagnosis, rheumatic iritis.
When he came to the hospital, the sight of the right eye was entirely gone, and he suffered excruciating pain through the right eye and orbit, extending to the back of the head. The eye was undergoing a rapid degenerative process, with constant and increasing pain.
July 13th. Patient was etherized, and the eye was removed. The operation completely relieved the pain, the wound healed without incident, and he was discharged on July 23rd.
CASE II. Mrs. -; age 40. Admitted July 21st. Diagnosis, glaucoma.
Last March had a severe attack of neuralgia over the left eye and through to the back of the head. This continued for several weeks, when there was some remission, followed by another attack, and then she discovered that the sight of the left eye was entirely gone. The pupil was widely dilated, and the ball was very tense. There had been some pain over the right eye, the pupil was somewhat dilated, and there was a cresent of opacity over the upper and nasal portions of the cornea. She could see only with the outer half of the eye.
Dr. L. H. Kimball was invited to see the case. He advised an operation, and on July 31st, under ether, performed iridectomy on the right eye, removing a section from the upper portion of the iris.
It required much care and patience to administer the ether, as both lungs were in a state of phthisis, considerably advanced.
Aug. 3rd. Bandages were removed, and she could see better with the right eye; the left still continued to pain her. The right made an uninterrupted recovery.
Aug. 28th. Under ether, Dr. Kimball removed the left eye. She made a rapid recovery after this operation, although the ether caused considerable irritation of the lungs. The pain was
relieved, and the extent of vision very markedly increased. Discharged Sept. 9th.
CASE III. Miss ; age, 62. Admitted Aug. 21st. Diagnosis, movable bodies in the knee joint.
Twenty-five years ago, the right knee first troubled her by reason of rheumatism. Gradually small bodies formed in the joint and protruded beside the patella, causing acute pain. Sometimes one or more would slip into the joint between the bones, but had always been able by manipulation to move them into such a position that she was not incapacitated by them, until the day before coming to the hospital, when one persisted in remaining in the deeper portion of the joint. Besides rendering her helpless, this caused her such severe pain that she came to the hospital for relief.
Aug. 26th. Patient was etherized. Several movable bodies could be found within the joint at the outer side, and above the patella. An incision was made over these, and down to the capsule; by pressure the movable bodies were fixed, and the joint opened directly above them. Three bones varying from i of an inch, to it inches in diameter, somewhat flat, oval, lobulated in appearance, and having no attachments whatever, were removed. Also several pieces of bony growths, attached to the margins of the patella and tibia, were removed forcibly. The whole margin of the patella was covered with smaller growths, most of which, however, were so firmly attached, that it was not deemed wise to keep the joint open long enough, nor to use sufficient force, to remove them, as they were evidently permanently incorporated with the patella.
The wound in the capsule was carefully closed with a fine catgut suture, after which the external wound was closed and the limb put upon a straight posterior splint. There was very little pain following the operation. The splint was removed upon the fifth day, and there was no impairment of the movements of the joint. The knee recovered without incident.
The following summary includes only the hospital cases and private cases of the attending surgeon, and does not note the private cases of other members of the staff.