AMPUTATION THROUGH THE LOWER THIRD OF THE THIGH ; DEATH FROM SECONDARY HÆMORRHAGE FIVE DAYS...
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868 pale and the extremities cold. The pulse was feeble. On the in ier side of the left limb there was a deep wound com- mencing about the junction of the middle and lower thirds of the leg which ran along the posterior border of the tibia round the external malleolus and across the ankle to the outer side of the foot. The ankle-joint was opened into ; the tarsal bones were comminuted ; the vessels were torn across, and the tendons dragged out of their sheaths. The patient having been placed under chloroform, Dr. Foss amputated through the upper third of the leg. The posterior flap was made by transfixion, and the anterior by cutting from without inwards, and consisted chiefly of skin. The limb having been removed, it was noticed that there was no bleeding from the flaps. The pulse could not be felt either in the femoral or radial artery. The breathing was regular. The surface of the body was cold. In a little time the pulse returned at the wrist, and a few seconds later could be felt in the groin. But still there was no hæmorrhage from the stump, so the flaps were brought together with silver sutures and the patient removed to bed. She made a steady recovery, somewhat delayed by two granulating patches, which relused to heal until skin grafts were placed on them. AMPUTATION THROUGH THE LOWER THIRD OF THE THIGH ; DEATH FROM SECONDARY HÆMORRHAGE FIVE DAYS AFTERWARDS. (Under the care of Dr. Foss.) J. T-, aged forty-six years, was admitted to the hospital on March 24th, 1881, at 3 A.M. The patient’s right leg bad been caught in some machinery and severely crushed. The tibia and fibula were comminuted from the upper third downwards. The vessels were torn across, and these, together with the skin, were torn and con- tused. Chloroform having been administered, Dr. Foss amputated the thigh at a little above the condyles. The flaps being formed according to Teale’s method, only the femoral artery required a ligature. The flaps were brought together by silver wire sutures. Not much blood was lost during the operation, but apparently before being brought in he had lost some, and at this time was suffering from this and a good amount of shock. The same morning, at nine o’clock, the temperature was 98.2°. In the evening the temperature was the same ; the pulse was 116. A sedative draught was prescribed. He slept during the night and next morning. Pulse 120 ; temperature 100 4°. The dressings were stained with blood. Complained of pain in the stump, also in the other leg. ’ On the 27th the wound was dressed for the first time. The wound looked well ; there was no tension or sloughing of flaps ; no hæmorrhaee. About 10 A.lV!:. next day the nurse noticed that he had fainted, and it was discovered that there was bleeding from the stump. Notwithstanding stimulants, he went into a state of collapse, and died in about half an hour. The quantity of blood lost was not large, but considering his condition, it was sufficient to cause death. A hurried examination of the stump was made after death, but no point from which the haemorrhage could have come was observed. The ligature was firmly fixed in the femoral artery, and there was an organised clot inside it. THE LEVEE. -The following members of the medical profession were present at the levée held at St. James’s Palace on Monday last :-Surgeon R. F. Adams, Surgeon T. Archer, Surgeon J. Battersby, Surgeon E. Butt, Surgeon L. H. Carter. Surgeon G. J. Coates, Surgeon S. A. Crick, Surgeon-MajorJ. S. Comyn, M.B., Surgeon-Major A. F. Churchill, Surgeon J. G. Crofts, Surgeon G. W. H. Cook, Surgeon A. B. Cottell, Surgeon F. A. B. Daly, Surgeon J. R. Dodd, Dr. Peter Eade (Sheriff of Norwich), Surgeon- Major B. Franklin, Surgeon-General S. H. Fasson, Surgeon R. W. Ford, Surgeon W. Deane-Freeman, Surgeon S. G. Hamilton, Surgeon-Major H. F. Hensrnan, Surgeon-Major E. Hoile, Deputy Surgeon-General F. Holton, Surgeon A. G. Kay, Surgeon R. C. K. Laffan, Surgeon G. S. Lewis, Surgeon C. A. P. Mittchell, Surgeon R. E. R. Morse, Surgeon H. J. R. Moberly, Surgeon-Major S. Moore, Surgeon-Major E. M’Crystal, Surgeon T. Mayne, Surgeon T. C. Nugeut, Dr. Ord, Surgeon George Turner Phillips, Surgeon - Major William H. Pickford, M.B , Surgeon A. S. Rose, Surgeon S. Salaman, Surgeon A. T. Sloggett, Surgeon G. E. Twiss, Surgeon T. B. A. Tuckey, and Surgeon T. P. Woodhouse. Medical Societies. ROYAL MEDICAL & CHIRURGICAL SOCIETY. Hepatotomy.—Removal of the Uterine Appendages. THE ordinary meeting of the Medical and Chirurgical Society was held on Tuesday, May 24th, Dr. Barclay, President, in the chair. Two papers, by Mr. Lawson Tait, on subjects of considerable interest in connexion with ah. dominal surgery, were read. Mr. Morrant Baker exhibited a case of bromide of potassium rash. " On Three Cases of Hepatotomy," by Mr. LAWSON TAIT (Birmingham). This paper contains the narration of three cases in which the author performed operations on the liver similar to those in two cases already received by the Society. Abdominal section was performed in all three. The liver was found not to be adherent to the parietes in any of them; the contents of the tumours were removed, and the edges of the wounds in the liver were stitched by continuous suture to the edges of the wounds in the abdominal wall, and drainage-tubes were fastened in. Two of the cases wele operated upon for hydatids of the liver, and the other for a large cystic abscess enclosing a loose piece of liver tissue, weighing about an ounce, and which had apparently been a slough. All three patients made good recoveries. —Mr. H. MORRIS was surprised to hear that Mr. Lawson Tait preferred abdominal section to aspiration for unilocular hydatid cyst. During the last few months he had had two cases in which two aspirations had been successful. In one case eighteen and twenty ounces respectively were drawn off; in the other, under Dr. Powell’s care, three or four ounces were drawn off by him on the second occasion, anll both were, up to the present, cured. He should certainly hesitate to resort to abdominal section at first in such cases. There are no doubt other cases in which aspiration is quite hopeless.-Dr. HEYWOOD SMITH asked if there was any troublesome haemorrhage from the incision through the liver, and whether pressure was sufficient to control it, or whether the vessels could be taken up. He wished to know if sinuses followed the use of drainage-tubes in such cases.—Mr. HULKE thought the great risk was the escape of the contents of the cyst into the peritoneal cavity, and he asked how Mr. Tait quite prevented this. He thought all surgeons must at times have regretted not making freer incisions into hydatids of the liver, especially when suppurating.—Mr. LAWSON TAIT replied that the haemorrhage was stopped by pressure. He had had no trouble in now six cases of operation on the liver. He would never again aspirate liver hydatids ; he had no fear of abdominal section, but he had fear of aspiration, and he had heard that aspiration rarely cured hydatid cysts. Styrian surgeons especially had this experience. The tapfing does not affect the cyst at all, which may at any time reall. In his monocystic case he believed the patient was cured. His assistant seized the cyst with forceps on each side, and placed a sponge on each side, and so prevented any escape into the peritoneum. On Removal of Uterine Appendages for the Arrest of Uterine Hæmorrhages," by Mr. LAWSON TAIT. The author commenced his paper by referring to the use of the statis- tical method in testing the real value of operations, and especially instanced ovariotomy as one which would not have obtained the complete acceptance it has received had not the careful statistical method of Mr. Spencer Wells shown that its results could be favourably compared with those ot every other major operation in surgery. Mr. Lawson Tait wished to lay his experience in another portion of the department of abdominal surgery before the Society, in order to obtain its decision as a guide for the future for himself and others. After protracted trials of drugs for the arrest of uterine haemorrhage, he had come to the conclusion that all were absolutely without effect, save ergot and two salts of potash, the chlorate and the bromide, and these were by no means uniformly successful in giving permanent relief. In all the cases he had to relate these drugs had been fallytried before the question of operating was discussed. He had entitled his paper "The Removal of the Uterine Appendages," be- cause his experience seemed to show that the removal of the ovaries was not a certain method of arresting
Transcript of AMPUTATION THROUGH THE LOWER THIRD OF THE THIGH ; DEATH FROM SECONDARY HÆMORRHAGE FIVE DAYS...
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pale and the extremities cold. The pulse was feeble. Onthe in ier side of the left limb there was a deep wound com-mencing about the junction of the middle and lower thirdsof the leg which ran along the posterior border of the tibiaround the external malleolus and across the ankle to theouter side of the foot. The ankle-joint was opened into ;the tarsal bones were comminuted ; the vessels were tornacross, and the tendons dragged out of their sheaths.
The patient having been placed under chloroform, Dr. Fossamputated through the upper third of the leg. The posteriorflap was made by transfixion, and the anterior by cuttingfrom without inwards, and consisted chiefly of skin. Thelimb having been removed, it was noticed that there was nobleeding from the flaps. The pulse could not be felt eitherin the femoral or radial artery. The breathing was regular.The surface of the body was cold. In a little time the pulsereturned at the wrist, and a few seconds later could be felt inthe groin. But still there was no hæmorrhage from thestump, so the flaps were brought together with silver suturesand the patient removed to bed.
She made a steady recovery, somewhat delayed by twogranulating patches, which relused to heal until skin graftswere placed on them.
AMPUTATION THROUGH THE LOWER THIRD OF THE
THIGH ; DEATH FROM SECONDARY HÆMORRHAGEFIVE DAYS AFTERWARDS.
(Under the care of Dr. Foss.)J. T-, aged forty-six years, was admitted to the
hospital on March 24th, 1881, at 3 A.M. The patient’sright leg bad been caught in some machinery and severelycrushed. The tibia and fibula were comminuted fromthe upper third downwards. The vessels were torn across,and these, together with the skin, were torn and con-
tused. Chloroform having been administered, Dr. Fossamputated the thigh at a little above the condyles. Theflaps being formed according to Teale’s method, only thefemoral artery required a ligature. The flaps were broughttogether by silver wire sutures. Not much blood was lostduring the operation, but apparently before being broughtin he had lost some, and at this time was suffering from thisand a good amount of shock. The same morning, at nineo’clock, the temperature was 98.2°. In the evening thetemperature was the same ; the pulse was 116. A sedativedraught was prescribed. He slept during the night and nextmorning. Pulse 120 ; temperature 100 4°. The dressingswere stained with blood. Complained of pain in the stump,also in the other leg. ’
On the 27th the wound was dressed for the first time.The wound looked well ; there was no tension or sloughingof flaps ; no hæmorrhaee.About 10 A.lV!:. next day the nurse noticed that he had
fainted, and it was discovered that there was bleeding fromthe stump. Notwithstanding stimulants, he went into astate of collapse, and died in about half an hour. Thequantity of blood lost was not large, but considering hiscondition, it was sufficient to cause death. A hurriedexamination of the stump was made after death, but nopoint from which the haemorrhage could have come wasobserved. The ligature was firmly fixed in the femoralartery, and there was an organised clot inside it.
THE LEVEE. -The following members of themedical profession were present at the levée held atSt. James’s Palace on Monday last :-Surgeon R. F. Adams,Surgeon T. Archer, Surgeon J. Battersby, Surgeon E. Butt,Surgeon L. H. Carter. Surgeon G. J. Coates, Surgeon S. A.Crick, Surgeon-MajorJ. S. Comyn, M.B., Surgeon-Major A. F.Churchill, Surgeon J. G. Crofts, Surgeon G. W. H. Cook,Surgeon A. B. Cottell, Surgeon F. A. B. Daly, Surgeon J.R. Dodd, Dr. Peter Eade (Sheriff of Norwich), Surgeon-Major B. Franklin, Surgeon-General S. H. Fasson, SurgeonR. W. Ford, Surgeon W. Deane-Freeman, Surgeon S. G.Hamilton, Surgeon-Major H. F. Hensrnan, Surgeon-MajorE. Hoile, Deputy Surgeon-General F. Holton, Surgeon A. G.Kay, Surgeon R. C. K. Laffan, Surgeon G. S. Lewis, SurgeonC. A. P. Mittchell, Surgeon R. E. R. Morse, Surgeon H. J.R. Moberly, Surgeon-Major S. Moore, Surgeon-Major E.M’Crystal, Surgeon T. Mayne, Surgeon T. C. Nugeut, Dr.Ord, Surgeon George Turner Phillips, Surgeon - MajorWilliam H. Pickford, M.B , Surgeon A. S. Rose, SurgeonS. Salaman, Surgeon A. T. Sloggett, Surgeon G. E. Twiss,Surgeon T. B. A. Tuckey, and Surgeon T. P. Woodhouse.
Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.
Hepatotomy.—Removal of the Uterine Appendages.THE ordinary meeting of the Medical and Chirurgical
Society was held on Tuesday, May 24th, Dr. Barclay,President, in the chair. Two papers, by Mr. Lawson Tait,on subjects of considerable interest in connexion with ah.dominal surgery, were read. Mr. Morrant Baker exhibiteda case of bromide of potassium rash.
" On Three Cases of Hepatotomy," by Mr. LAWSON TAIT(Birmingham). This paper contains the narration of threecases in which the author performed operations on the liversimilar to those in two cases already received by the Society.Abdominal section was performed in all three. The liverwas found not to be adherent to the parietes in any of them;the contents of the tumours were removed, and the edges ofthe wounds in the liver were stitched by continuous sutureto the edges of the wounds in the abdominal wall, anddrainage-tubes were fastened in. Two of the cases weleoperated upon for hydatids of the liver, and the otherfor a large cystic abscess enclosing a loose piece of livertissue, weighing about an ounce, and which had apparentlybeen a slough. All three patients made good recoveries.
—Mr. H. MORRIS was surprised to hear that Mr. LawsonTait preferred abdominal section to aspiration for unilocularhydatid cyst. During the last few months he had had twocases in which two aspirations had been successful. In onecase eighteen and twenty ounces respectively were drawnoff; in the other, under Dr. Powell’s care, three or fourounces were drawn off by him on the second occasion, anllboth were, up to the present, cured. He should certainlyhesitate to resort to abdominal section at first in such cases.There are no doubt other cases in which aspiration is quitehopeless.-Dr. HEYWOOD SMITH asked if there was anytroublesome haemorrhage from the incision through theliver, and whether pressure was sufficient to control it,or whether the vessels could be taken up. He wished toknow if sinuses followed the use of drainage-tubes insuch cases.—Mr. HULKE thought the great risk was theescape of the contents of the cyst into the peritonealcavity, and he asked how Mr. Tait quite prevented this. Hethought all surgeons must at times have regretted notmaking freer incisions into hydatids of the liver, especiallywhen suppurating.—Mr. LAWSON TAIT replied that the
haemorrhage was stopped by pressure. He had had notrouble in now six cases of operation on the liver. Hewould never again aspirate liver hydatids ; he had no fearof abdominal section, but he had fear of aspiration, and hehad heard that aspiration rarely cured hydatid cysts. Styriansurgeons especially had this experience. The tapfing does notaffect the cyst at all, which may at any time reall. In hismonocystic case he believed the patient was cured. Hisassistant seized the cyst with forceps on each side, andplaced a sponge on each side, and so prevented any escapeinto the peritoneum.On Removal of Uterine Appendages for the Arrest of
Uterine Hæmorrhages," by Mr. LAWSON TAIT. The authorcommenced his paper by referring to the use of the statis-tical method in testing the real value of operations, andespecially instanced ovariotomy as one which would not haveobtained the complete acceptance it has received had not thecareful statistical method of Mr. Spencer Wells shown thatits results could be favourably compared with those ot everyother major operation in surgery. Mr. Lawson Tait wishedto lay his experience in another portion of the department ofabdominal surgery before the Society, in order to obtain itsdecision as a guide for the future for himself and others.After protracted trials of drugs for the arrest of uterinehaemorrhage, he had come to the conclusion that all wereabsolutely without effect, save ergot and two salts of potash,the chlorate and the bromide, and these were by no meansuniformly successful in giving permanent relief. In all thecases he had to relate these drugs had been fallytried beforethe question of operating was discussed. He had entitledhis paper "The Removal of the Uterine Appendages," be-cause his experience seemed to show that the removalof the ovaries was not a certain method of arresting
