Cheever, D. W.

Gunter, L. D.

English

ZENODO

with complete relief. Owing, however, tothe fear of tingcing the skin by the nitrate,I have, in later years, substituted the sul-phate of zinc in doses of a half-grain, gradu-ually increased to two grains, three timesa day, in pill or solution, combined withopium, or extract of hyoscyamus, with happyeffects. My experience with this remedyhas been quite extensive for several years,and I think it as safe and sure asquinine inintermittents. My explanation of its modusoperandi is, that it acts on the inflamed andengorged mucous coat of the stomach in thesame way that it does in ophthalmia. I havealso used the sulphate of zinc in epilepsywithbenefit, and think it serviceable in all casesin which nilras argenti relieves. The actionof both is probably owing to their improv-ing the condition of the stomach.MASSACHUSETTS GENERAL HOSPITAL.Surgical Operations for the week ending March 28th.Reported by Messrs. Thomas Waterman, Jr.,and H. H. A. Beach.(Continued from page 199.)8. Tenolomy. Dr. H. G. Clark.9. Tumor of Abdominal Parietes ; Excis-ed. Dr. R. M. Hodges.—Male, aged 46.Patient attributed his trouble to a blow re-ceived at that point six years ago. Oneyear later he discovered a tumor the sizeof a silver dollar, slightly prominent andsituated in the median line half way betweenthe ensiform cartilage and the umbilicus.It had grown gradually since, till it meas-ured over its apex four inches. It waselastic to the touch, adherent to the integu-ment, but movable on the surface beneath.A semilunar incision, three .and one-halfinches long with its concavity upward, wasmade through the integument at the limitsof the tumor, and the latter dissected out.Three ligatures were applied, two of whichwere passed through the flap, after themethod of Dr. Morgan, and the flap securedby silk sutures.The tumor was composed of fat.10. Excision of Breast; Scirrhus. Dr.H. G. Clark.—Patient first noticed the tu-mor six weeks ago, which was then aboutan inch in diameter. It has steadily in-creased in size until it is now about threeinches in diameter. There has been verylittle pain. The tumor is firm, hard, mova-ble and situated about two inches inwardsfrom the left nipple, which is retracted.One of the axillary glands is enlarged.Operation with ether. The mammary glandand tumor were included between two semi-lunar incisions and dissected out. Six liga-tures were applied, and the edges of thewound adjusted with sutures. Dry com-presses and swathe.11. Scrofulous Lymphatic Gland; Excis-ed. Dr. R. M. Hodges.—Female, aged 21.Four months ago a tumor appeared in thoright submaxillary region, which increasedsteadily until it became as large as a horse-chestnut. A semilunar incision, two and onehalf inches long with its concavity towardsthe jaw, was made through the integumentand the tumor easily dissected out.12. Opening of Sinuses. Dr. R. M.Hodges.—Female, aged 6. January 15th,the patient had both legs amputated abouttwo inches below the knees for an accidentreceived at that time. The outside of herleft thigh sustained at the same time asevere bruise which was followed by an ab-scess ; and this communicated with the endof the stump and refused to heal. A direc-tor introduced into the opening on thethigh followed a sinus to the end of thostump, and communicated with another atthat part. The integument was slit openthroughout this course and the woundpacked with lint.13. Polypus Nasi; Removed. Dr. H. J.Bigelow.BOSTON CITY HOSPITAL.Some of the principal Operations in March, 1868, byD. W. Cheever, M.D. Reported by L. D.Gunter, House Surgeon.Case I.— Compound, Comminuted Frac-tures ofFingers, with extensive Laceration.—James McD., aged 52. Patient's hand wascaught between two cog-wheels, producingcompound, comminuted fractures, with ex-tensive laceration of the right index, mid-dle and ring fingers. The two first wereamputated at the metacarpo-phalangeal ar-ticulations. The third at the middle of thefirst phalanx, by circular flap. The flapswere kept in apposition by strips of adhe-sive plaster. Dilute carbolic-acid dressing.A speedy recovery ensued, without slough-ing of the more or less contused flaps, andthough attacked with erysipelas in the face,it did not appear about the wound.Case II.—The application of Nitric Acidto Internal Haemorrhoids.—No haemorrhage,and but little pain when the bowels weremoved the first time after the application.Case III.—Evulsion of an In-growing Toe-nail of two years' standing.—The raw sur-face was dressed with dilute carbolic acid, The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at UNIVERSITY COLLEGE LONDON on June 27, 2016.  For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society.and cicatrization was most undoubtedlyretarded by the dressing. During the thirdday, the wound became inflamed, swollenand extremely sensitive, but this all passedoff within the next twenty-four hours, andgranulations appeared on the fifth day. Itis interesting to note that there was no sup-puration.Case IV.— Vascular Tumor of the MeatusUrinarius.—Catherine A., aged 51, mar-ried, entered hospital March 2th, with thestatement that, for five years, she had ex-perienced constant pain in the lumbar andhypogastric regions and vulva ; that fortwo years past she had been troubled moreor less with dysuria, and a severe pain, af-ter the act of micturition, in vulva andbladder. Examination disclosed an eleva-ted raspberry growth upon the floor of theurethra, extending from the meatus half aninch inward. It was very sensitive andvascular, the slightest touch causing it tobleed. Her sleep had been broken by thefrequent desire to urinate and the conse-quent pain, and her health somewhat im-paired.March 6th.—Since previous date, painand irritation severe after micturition ; re-lieved by opiates. Etherize, dilate theurethra with dressing forceps, and applynitric acid to the vascular growth.tth.—Slept well all night without an opi-ate. Comfortable No retention of urineor pain after micturition.8th.—Completely relieved of dysuria andpain in hypogastrium and irritation invulva. Rests well at night. Up and walk-ing about.9th.—A very slight irritation in urethraafter urinating.10th.—The slough produced by the caus-tic has come away, and irritation and painincreased ; not so severe, however, as be-fore the application.12th.—Pain and frequent micturition.Obliged to pass water several times duringthe night.13th.—Re-apply the acid. The formerapplication reduced the growth more thanone half, also rendering it less vascular and^sensitive.14th.—Completely relieved from all painand irritation.15th.—Comfortable.17th.—Discharged, well.Case V.— Congenital Hernia.—Joseph D.,aged 2 years and 10 months, was broughtto the hospital March 10th, with the reportthat for three months he had been troubledwith diarrhoea and loss of appetite ; that,seven weeks previous, first noticed a smalltumor in right groin, which, till of late, haddisappeared when in the horizontal posi-tion ; that, ten days since, it came downand had not returned, since which he hadbeen constipated, and at times had notpassed his water for a day or more. Uponexamination, it was found to be an obliqueinguinal hernia, with a large neck, and haddescended to the bottom of the scrotum,which was swollen, red and quite sensitive.The hernia was about the size of a hen'segg, and required pretty firm pressure toreduce it. Seen by Dr. Cheever, and pro-nounced a " congenital hernia." Orderedhot bath, hot fomentations to hypogastrium,and an enema of soap-suds.March 11th.—Bowels moved freely soonafter the enema, and passed a large amountof water. Restless during the night. Her-nia easily reduced. Scrotum less swollen.12th.—Hernia returns as soon as pres-sure is removed. Tenderness and inflam-mation disappeared from scrotum. Slightdiarrhoea ; controlled by paregoric.13th.—Etherize, and operate for radicalcure, by Wood's second method. Whenthe needle passed out through the integu-ment of the abdomen, '%. considerableamount of serum escaped a"t the side of it,the sac having been transfixed by the nee-dle. The wound was dressed with dilutecarbolic acid, and the patient ordered to bekept quiet in the horizontal .position.14th.—Very comfortable. Scrotum slight-ly swollen. No diarrhoea. Milk diet.15th.—Doing well. Swelling of scrotummoderate.17th.—Swelling and redness about seatof operation gradually subsiding. No mo-tion of bowels since operation. R. Oleiricini 5n'j-20th.—Slight purulent discharge fromwound. No tenderness in abdomen. Do-ing well.23d.—Remove the wire and apply spicabandage and compress. A firm mass oflymph the whole length of the canal. Dis-charge slight. Swelling subsiding.26th.—No impulse. The mass of lymphis firm, and the wound clean and granulat-ing.30th.—Walking about the ward.April 10th.—Wounds healed. No im-pulse can be detected. The mass of lymphalong the canal somewhat absorbed, butpermanent. Is much improved in healthand strength, and almost completely re-lieved from diarrhoea, which had troubledhim for three months.Case VI.—Epithelial Cancer of Clitoris ;Removal.—Mary C, aged 39, married, en- The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at UNIVERSITY COLLEGE LONDON on June 27, 2016.  For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society.tered the Hospital March 12th, with a tumorgrowing from the clitoris and contiguousportion of nymphaa. Soon after her lastconfinement, three years ago, her attentionwas drawn to the part by excessive itchingand an occasional darting pain. At thattime, it was about the size of a bean. Ithas gradually increased, with but littlepain, till recently. Now, it is about thesize of a hen's egg, conical, indurated andmovable upon the deep tissues. The vagi-na and lower portion of the nymphaa arenot involved. Its surface is inflamed andits apex occupied by a deep sloughing ulcer,the odor of which is very offensive.•Theglands in the groins are enlarged and pain-ful. For the last two weeks, the left labiumhas been much inflamed and very painful,and deep seated in its tissues can be felt asmall, hard nodule the size of an Englishwalnut. Examination with the microscopeshows that the tumor is composed of epi-thelial cells and granular matter,March 20th.—The parts are less inflamedand labium less swollen, but pain very se-vere at night, requiring opiates. Etherized,and, a catheter having been passed into thebladder, the tumor was removed by an ovalincision. The tissues were involved downto the wall of the urethra and very vascular.Hemorrhage profuse. Three ligatures re-quired. The tumor was removed from thelabium.21st.—No haemorrhage. Passes waterwithout trouble. Labium very painful.Charcoal poultice. Wound dressed withdilute carbolic acid.23d.—Comfortable. Rests well at night.27th.—Doing well. No pain. Woundshealthy and granulating. Continue poul-tice to labium.April 4th.—The glands in groins growingless. Wounds healing very rapidly.6th.—Labium healed and of natural size.The wound of clitoris nearly well. Theglands in groins considerably reduced insize and hardness. No pain. General con-dition much improved. Catamcnia present.Discharged.Case VII. — Pislol-slwl Wound of Eye.Enuclealion of Eye-ball.—March 25th. JohnMcD., aged 7, wounded in left eye by anaccidental discharge of a small sized re-volver, loaded with patent cartridge. Hewas brought to tho Hospital about an hourafter the accident, conscious and free frompain. His father said, that though some-what stunned at first, he was not uncon-scious, and that he had vomited cousiderarble "blood" soon after the injury,Upon examination, it was found that thecornea and sclerotica were lacerated, andthe contents of the globe had escaped. Theright pupil was slightly dilated and respond-ed sluggishly to light. Pulse feoble. Ether-ized, and examined by Drs. Williams andChecver. It was found that the bullet hadpenetrated the roof of the orbit, about aquarter of an inch from its apex, and hadpassed on in a backward and outward direc-tion, towards the left temporal bone. Theopening was sufficiently large to admit thetip of the little finger, with serrated edges,and inclined to the outer wall. A probewas inserted a short distance into thewound, but the ball could not be felt. Or-dered to be kept perfectly quiet. Coldwater dressing to the eye and both eyescovered. Liquid farinaceous diet. Eve-ning—Comfortable. No cerebral symptoms.March 26th.—Slept well all night. Nopain or headache. Pulse quick, feeble andirregular. Some swelling about the eyeand side of face. 12, M. Sleeps most ofthe time. Pulse intermittent.27th.—Right pupil dilated; contractsslowly to light. Pulse intermittent everyfifth beat. Swelling increased about eyeand in left temple. Bowels moved by ene-ma. Perfectly free from pain, and bright.38th.—Consultation held. The eye-ballremoved. It was found that the ball hadpenetrated the orbit nearer the outer wallthan was evident at first examination, andprobably might have gone outside of theskull, into the temporal fossa. There wasconsiderable tenderness and swelling overtemporal region. No further search wasmade. Pulse feeble and intermittent. R.Vini Xerici pro re nata. Wound dressedwith dilute carbolic acid, 5'ss-'—Qj.29th.—Slept very well, but somewhatrestless. Slight subsultustendinurn. Rightpupil contracts slowly. Swelling increased,especially in left temple. No pain.30th.—Pupil contracts readily. Pulsestronger and regular. Wound healthy. Ap-petite good. Bowels regular. Comfortable.April 2d.—Free purulent discharge frombeneath the lids, increased by pressure uponthe temple. Doing well.6th.—Wound healthy and granulating.Nearly an ounce of pus at each dressing,most of which seems to come from the tem-poral fossa. Much improved. Sits up inbed. Diet, tea and toast. Subsequently acounter-opening made for drainage throughthe temple, and a seton passed.May 8th.—Continues well. Intelligenceperfect. Wounds healing. Convalescent. The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at UNIVERSITY COLLEGE LONDON on June 27, 2016.  For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society.

Boston City Hospital

https://zenodo.org/record/1722294/files/article.pdf

Boston City Hospital

Abstract

Similar works

Full text

Available Versions

ZENODO