STANLEY HOSPITAL, LIVERPOOL. COMPOUND FRACTURE OF THE TEMPORAL BONE WITH HERNIA CEREBRI ; RECOVERY
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1126 varicose veins. The ligature cut mto the structure of the pedicle, allowing considerable haemorrhage, and another embracing the whole was applied below. There were i3o adhesions. The cyst was found to be multilocular, one of the compartments containing a large clot. The right ovary was healthy. The wound was closed by means of alternate catgut and silk sutures, and the whole operation, which was carried out with strict antiseptic precautions, was concluded within thirty- five minutes.—2nd : She vomited once at 9 1,. M. last night, and required an injection of morphia at G P.M. to relieve the pain. She has slept fairly well. Temperature 98.4.° to 101 40.-3rd: No sickness; slept well after morphia injection. Temperature 100° to 1002°. - 4th : Pain occa- sionally not enough to require morphia ; ice and one ounce soda water every hour. Some mucus in the urine, which is drawn off by catheter. Temperature 98.8°. —6th: Tem- perature normal yesterday and to-day in the morning, but going up to 100’8° in the evening. A good deal of flatu- lence and some pain, for which morphia was given. - 7the : Dressed, looking well; hardly any discharge. Temperature in the afternoon 103°. Vomited once. Chicken hroth and Brand’s eseence. -Sth : Wound redressed, all silk sutures removed ; much abdominal distension. Ordered enema sim- plex. Temperature 97.8° to 1002°. Stimulants ordered.- 9th : Bowels acted four times after enema, and the patient much more comfortable ; has less pain, and there is less dis- tension.—10th, P.M.: Considerable pain over the bladder and inability to pass urine, which is thick, sp. gr. 1022, and contains muco-pus. Temperaturenormal.—15th: Urine im- proving in appearance, but the patient still unable to pass it herself. Temperature 100’2° last night, 99° this morning. After this date the temperature was 100 2° at 2 A.M. on the 16th and 17th, but excepting that it continued normal till she left. She was up on the 19th and rapidly regained strength; there was slight suppuration about one of the punctures left by the silk sutures on the 22nd, but other- wise convalescence was not letarded. STANLEY HOSPITAL, LIVERPOOL. COMPOUND FRACTURE OF THE TEMPORAL BONE WITH HERNIA CEREBRI; RECOVERY. (Under the care of Mr. SHELDON.) FOR the following notes we are indebted to Mr. F. W. Pilkinton, house-surgeon. P. D-, aged twelve, was brought to the Stanley Hos- pital on April 6th last, having received a kick from a horse in the left temporal region. On admission two small punctured wounds were found, leading down to a fracture of the temporal bone, from which a portion of brain substance, the size of a small nut, pro- truded. The boy was completely collapsed, and the pulse scacely perceptible. Antiseptic dressings were used, the patient was kept in bed in a darkened room, ice bags were applied to the head, and two grains of calomel were given twice a day with milk diet. For the first four days his condition remained unchanged. On the fifth day the tem- perature rose to 108°, and he became delirious. This lasted until the tenth day after admission. From that time the temperature gradually fell to normal, the head symptoms rapidly disappeared, and the boy was discharged on May 1st perfectly well. There was very free discharge of pus from the wound after the elevation of the temperature, the pro- truded brain substance gradually sloughing. This continued until a few days before the boy left the hospital. Remarks.—Two interesting features in the case are that complete loss of speech occurred after the acme of tempera- ture was reached, gradually returning during convalescence; and, secondly, at no time were the sphincters or extremities affected. BEQUESTS AND DONATIONS TO MEDICAL CHARITIES. Mr. Francis Marcet, 1,,ite of Stratton-street, bequeathed £105 to University College Hospital, and 9100 to the Hospital at Geneva.—Bv the death of Miss Ann Bremner, Inverness, the Northern Infirmary becomes entitled to £ 2500, left by legacy hy the Misses 11,t,tle,,, and of which Miss Bremner enjoyed a life interest.—Mr. Samuel Morley has given :E100 to the National Hospital for Consumption, Ventnor.-The Duke of West minster has given £50 to the British Hospice and Ophtalmic Dispensary at Jerusalem. Medical Societies. ACADEMY OF MEDICINE IN IRELAND. Votes oit Bloodvessels of New Growths.—Congenital Defect of the Rectum.—Obstruction of the Inferior Vena Cava. THE Pathological Section met on March 2nd, the President )f the Section in the chair. Mr. P. S. ABRAHAM read notes on the Bloodvessels of New Growths, with especial reference to their origin in granulation tissue. The bloodvessels which are seen in sections of tumours may be considered under two heads- 1) those belonging to the proper tissue of the part into which the neoplasm has infiltrated ; and (2) those which have arisen anew and belong to the new growth itself. The former have become enveloped by the new invading tissue, which they afterwards in greater or less part supply. Thelatterare the vessels of circumscribed growth, and are either prolonga. tions or sproutings from the vessels of the neighbouring tissue, or, formed apart, have been subsequently connected with them. The small arteries and veins which come under the first category are often distinctly modified by what appear to be inflammatory changes, and the proliferation of the cells of the coats may go on to such an extent in the case of the intestine that the lumen may become occluded. An extreme case of the vascular wall, thick- ened and studded with an irregular cell growth, is seen in certain sections of leprous tumour. The young blood- vessels of neoplasmata in general do not always show any distinction of tunica; and sometimes in a quickly growing mass of cells the wall of the vascular chan- nels can scarcely be differentiated from the surrounding cell-tissues. From the consideration of the actions of granulation tissue, which had formed in sponges placed for various periods in wounds and on theoretical grounds, it seems unlikely that Professor Hamilton’s new and ingenious mechanical theory of the formation of granulation vessels will be altogether accepted. In the specimens shown the vessels branch freely and inoculate among the fibres of the sponge ; they give off-shoots of different sizes, and there is abundant evidence of a new formation of capillaries going on, much in the manner described by Arnold. Even if the capillary blood-pressure were sufficient to produce the mechanical effect of forcing out and elongating the capillary loops, it is difficult to understand how that pressure could cause the cell-multiplication which goes on in the wall of the elongating capillary. The cells of the wall, indeed, are not simply stretched ; they increase in number by division and the wall of the capillary grows. Several other argu- ments were brought forward, and in conclusion it was remarked that, as Professor Hamilton shows, a thrombus in a ligatured artery becomes vascular by the throwing in of granulation loops from the vasa vasorum near the point of ligature-in his own words, "it is nothing more than a granulating surface within a vessel." If this be the case, the pushing in of the loops must be against an intra-arterial pressure certainly greater than that of the blood in the vasa. Dr. E. H. BENNETT read a paper on Congenital Defects of the Rectum, based on the details of a case which he had treated during the winter by laparotomy, failing to reach the bowel by the perineum. The variety of deformity exhibited was that in which the anus and other pelvic organs, except the rectum, were normal, and there existed a cord of variable length connecting the anal cul-de-sac wih the extremity of the intestine. With the specimen recently acquired Dr. Bennett showed three examples of the same deformity con- tained in the museum of the Royal College of Surgeons, and contrasted these with an example of complete defect of the anus and urino-genitary outlet, contained in the museum of the School of Physic, Trinity College. Having directed attention to the views of Giraldes and of Curling, who have attributed this deformity to obliteration of the rectum by a pathological process, Dr. Bennett showed from the evidence presented by the specimens that this view was erroneous, and that the lesion is due to the arrest of development of the bowel, the hypoblastic pouch failing to reach the anal inflec- tion from the surface ot the embryo. He indicated the pro- bable analogy between the muscular cord connecting thee parts and such bodies as the gnbernaculum testis. H< further demonstrated that attention to the position and relation of the cord might enab’e the surgeon when opera-
Transcript of STANLEY HOSPITAL, LIVERPOOL. COMPOUND FRACTURE OF THE TEMPORAL BONE WITH HERNIA CEREBRI ; RECOVERY
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varicose veins. The ligature cut mto the structure of thepedicle, allowing considerable haemorrhage, and anotherembracing the whole was applied below. There were i3oadhesions. The cyst was found to be multilocular, one of thecompartments containing a large clot. The right ovary washealthy. The wound was closed by means of alternatecatgut and silk sutures, and the whole operation, which wascarried out with strict antiseptic precautions, was concludedwithin thirty- five minutes.—2nd : She vomited once at 9 1,. M.last night, and required an injection of morphia at G P.M. torelieve the pain. She has slept fairly well. Temperature98.4.° to 101 40.-3rd: No sickness; slept well after morphiainjection. Temperature 100° to 1002°. - 4th : Pain occa-sionally not enough to require morphia ; ice and one ouncesoda water every hour. Some mucus in the urine, which isdrawn off by catheter. Temperature 98.8°. —6th: Tem-perature normal yesterday and to-day in the morning, butgoing up to 100’8° in the evening. A good deal of flatu-lence and some pain, for which morphia was given. - 7the :Dressed, looking well; hardly any discharge. Temperaturein the afternoon 103°. Vomited once. Chicken hroth andBrand’s eseence. -Sth : Wound redressed, all silk suturesremoved ; much abdominal distension. Ordered enema sim-plex. Temperature 97.8° to 1002°. Stimulants ordered.-9th : Bowels acted four times after enema, and the patientmuch more comfortable ; has less pain, and there is less dis-tension.—10th, P.M.: Considerable pain over the bladderand inability to pass urine, which is thick, sp. gr. 1022, andcontains muco-pus. Temperaturenormal.—15th: Urine im-proving in appearance, but the patient still unable to pass itherself. Temperature 100’2° last night, 99° this morning.After this date the temperature was 100 2° at 2 A.M. on the16th and 17th, but excepting that it continued normal tillshe left. She was up on the 19th and rapidly regainedstrength; there was slight suppuration about one of thepunctures left by the silk sutures on the 22nd, but other-wise convalescence was not letarded.
STANLEY HOSPITAL, LIVERPOOL.COMPOUND FRACTURE OF THE TEMPORAL BONE WITH
HERNIA CEREBRI; RECOVERY.
(Under the care of Mr. SHELDON.)FOR the following notes we are indebted to Mr. F. W.
Pilkinton, house-surgeon.P. D-, aged twelve, was brought to the Stanley Hos-
pital on April 6th last, having received a kick from a horsein the left temporal region.On admission two small punctured wounds were found,
leading down to a fracture of the temporal bone, from whicha portion of brain substance, the size of a small nut, pro-truded. The boy was completely collapsed, and the pulsescacely perceptible. Antiseptic dressings were used, thepatient was kept in bed in a darkened room, ice bags wereapplied to the head, and two grains of calomel were giventwice a day with milk diet. For the first four days hiscondition remained unchanged. On the fifth day the tem-perature rose to 108°, and he became delirious. This lasteduntil the tenth day after admission. From that time thetemperature gradually fell to normal, the head symptomsrapidly disappeared, and the boy was discharged on May 1stperfectly well. There was very free discharge of pus fromthe wound after the elevation of the temperature, the pro-truded brain substance gradually sloughing. This continueduntil a few days before the boy left the hospital.
Remarks.—Two interesting features in the case are thatcomplete loss of speech occurred after the acme of tempera-ture was reached, gradually returning during convalescence;and, secondly, at no time were the sphincters or extremitiesaffected.
BEQUESTS AND DONATIONS TO MEDICAL CHARITIES.Mr. Francis Marcet, 1,,ite of Stratton-street, bequeathed £105to University College Hospital, and 9100 to the Hospital atGeneva.—Bv the death of Miss Ann Bremner, Inverness, theNorthern Infirmary becomes entitled to £ 2500, left by legacyhy the Misses 11,t,tle,,, and of which Miss Bremner enjoyed alife interest.—Mr. Samuel Morley has given :E100 to theNational Hospital for Consumption, Ventnor.-The Duke ofWest minster has given £50 to the British Hospice andOphtalmic Dispensary at Jerusalem.
Medical Societies.ACADEMY OF MEDICINE IN IRELAND.
Votes oit Bloodvessels of New Growths.—Congenital Defectof the Rectum.—Obstruction of the Inferior Vena Cava.THE Pathological Section met on March 2nd, the President
)f the Section in the chair.Mr. P. S. ABRAHAM read notes on the Bloodvessels of
New Growths, with especial reference to their origin ingranulation tissue. The bloodvessels which are seen insections of tumours may be considered under two heads-1) those belonging to the proper tissue of the part into whichthe neoplasm has infiltrated ; and (2) those which havearisen anew and belong to the new growth itself. The formerhave become enveloped by the new invading tissue, whichthey afterwards in greater or less part supply. Thelatterarethe vessels of circumscribed growth, and are either prolonga.tions or sproutings from the vessels of the neighbouringtissue, or, formed apart, have been subsequently connectedwith them. The small arteries and veins which come underthe first category are often distinctly modified by whatappear to be inflammatory changes, and the proliferationof the cells of the coats may go on to such an extentin the case of the intestine that the lumen may becomeoccluded. An extreme case of the vascular wall, thick-ened and studded with an irregular cell growth, is seenin certain sections of leprous tumour. The young blood-vessels of neoplasmata in general do not always showany distinction of tunica; and sometimes in a quicklygrowing mass of cells the wall of the vascular chan-nels can scarcely be differentiated from the surroundingcell-tissues. From the consideration of the actions ofgranulation tissue, which had formed in sponges placed forvarious periods in wounds and on theoretical grounds, itseems unlikely that Professor Hamilton’s new and ingeniousmechanical theory of the formation of granulation vesselswill be altogether accepted. In the specimens shown thevessels branch freely and inoculate among the fibres of thesponge ; they give off-shoots of different sizes, and there isabundant evidence of a new formation of capillaries goingon, much in the manner described by Arnold. Even if thecapillary blood-pressure were sufficient to produce themechanical effect of forcing out and elongating the capillaryloops, it is difficult to understand how that pressure couldcause the cell-multiplication which goes on in the wall ofthe elongating capillary. The cells of the wall, indeed, arenot simply stretched ; they increase in number by divisionand the wall of the capillary grows. Several other argu-ments were brought forward, and in conclusion it was
remarked that, as Professor Hamilton shows, a thrombusin a ligatured artery becomes vascular by the throwing inof granulation loops from the vasa vasorum near the point ofligature-in his own words, "it is nothing more than agranulating surface within a vessel." If this be the case,the pushing in of the loops must be against an intra-arterialpressure certainly greater than that of the blood in the vasa.
Dr. E. H. BENNETT read a paper on Congenital Defectsof the Rectum, based on the details of a case which he hadtreated during the winter by laparotomy, failing to reach thebowel by the perineum. The variety of deformity exhibitedwas that in which the anus and other pelvic organs, exceptthe rectum, were normal, and there existed a cord of variablelength connecting the anal cul-de-sac wih the extremity ofthe intestine. With the specimen recently acquired Dr.Bennett showed three examples of the same deformity con-tained in the museum of the Royal College of Surgeons,and contrasted these with an example of complete defect ofthe anus and urino-genitary outlet, contained in the museumof the School of Physic, Trinity College. Having directedattention to the views of Giraldes and of Curling, who haveattributed this deformity to obliteration of the rectum by apathological process, Dr. Bennett showed from the evidencepresented by the specimens that this view was erroneous,and that the lesion is due to the arrest of development of thebowel, the hypoblastic pouch failing to reach the anal inflec-tion from the surface ot the embryo. He indicated the pro-bable analogy between the muscular cord connecting theeparts and such bodies as the gnbernaculum testis. H<further demonstrated that attention to the position andrelation of the cord might enab’e the surgeon when opera-
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