Dr Steve Pereira Institute of Hepatology UCL Medical School & University College Hospital
UNIVERSITY COLLEGE HOSPITAL.
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149 of the recurrent fibroid variety, had been removed at St. Thomas’s Hospital two years before. It was remarked that after the operation there was a constant spasm of the muscles which were exposed in the wound. This was noticed daily when it was dressed. On New-year’s eve his face was observed to be affected, and on the following day a regular attack of convulsions ensued, which continued until death on Jan. 2nd. At the autopsy, several nerves of the anterior crural were found to pass into the circumference of the wound or to its surface. The body was that of a strong young man. RECURRENT FIBROID TUMOUR OF THE LEG ; REMOVAL; DEATE FROM PYÆMIA. (Under the care of Mr. BIRKETT.) Morris H-, aged sixty, admitted 31st December, 1862. A recurrent fibroid tumour was removed from the outer side of the leg on the 14th January. This operation was followed by all the symptoms of pyæmia, which ended fatally on the 24th. The liver, spleen, and kidneys were found very soft, but con- tained no purulent deposits. The lungs were in a state of lobalar congestion, without any inflammatory products. The skin was yellowish, especially on the face. UNIVERSITY COLLEGE HOSPITAL. AN UNUNITED COMPOUND FRACTURE OF THE LEG, OF THREE MONTHS’ DURATION, EXTENDING INTO THE ANKLE-JOINT ; AMPUTATION ; CLINICAL REMARKS. (Under the care of Mr. ERICHSEN.) A. W. R -, aged fifty-two, a baker, was admitted Oct. 17th, 1862. On coming down stairs with some bread on his head, he had made a false step, fallen backwards, and broken his right leg. When brought to the hospital, the lower part of the leg was found to be broken, and a portion of the tibia projected considerably through an open wound. The limb was carefully set, but union of the bones did not ensue; and as his condition was somewhat precarious, it was considered prudent to ampu- tate the leg through its upper fourth. This was done on the 28th January, 1863, under chloroform, on which occasion Mr. Erichsen made a few practical remarks. He said the man was in a precarious condition, and the limb in a less satisfactory state than it was some weeks ago; a por- tion of the tibia still protruded and was in a state of necrosis, and the leg was undermined with abscesses. Even if he did not remove the limb now, it would be an inconvenience rather than a source of usefulness to him. His constitution would not bear up against any further delay; he would be likely to go off from erysipelas or pyæmia; the former he had had twice already. Under all the circumstances, there seemed nothing to be done but secondary amputation. The injury at first was not sufficiently severe to amputate, and he then had hopes of saving the limb, but latterly these had been abandoned. The patient had been artificially maintained by three pints of stout daily, brandy, animal food, &c. The hectic symptoms he had had at one time had subsided, and there was now present the low anaemic exhaustion rather than any special disease. His condition was not so favourable to recovery as it would have been if he had consented to part with the limb some six weeks ago. The leg was now removed at its upper fourth by antero- posterior flaps. The tissues were much infiltrated, from the general condition of the body. The flaps had to be dissected back, and did not retract ; they were cut sufficiently long, and but three or four teaspoonfuls of blood were lost. On examining the amputated limb, the fracture was found to be immediately above the ankle-joint, and the lower end of the tibia was in a state of considerable necrosis, with a projection outwards of the upper fragment, causing the leg to be much deformed. The ankle-joint was involved; the injury had splintered the malleolar arch; the upper surface of the astra- galus was deprived of its cartilage, and the bone was rough and bare. There was no hope of saving such a limb, the causes of the deep suppuration of which were now fully explained. There is now a reasonable hope that the man will make a good recovery. ROYAL INSTITUTION.-The executors of the late James Walker, Esq., F.P..S., have presented to the Royal Institution of Great Britain a marble bust of Professor Faraday, by Noble. ROYAL INFIRMARY. EDINBURGH. OPERATIONS PERFORMED BY MR. SPENCE DURING THE MONTH OF JANUARY. THE following list has been furnished by Dr. Arthur G. Reid, resident surgeon at the infirmary :- Operations. -1. Amputation of the thigh (upper third). 2. Amputation of the leg below the knee. 3. Excision of the elbow-joint. 4. Tracheotomy (croup). 5. Hernia (femoral). 6. Removal of several depressed pieces of cranial bones. 7. Large bronchocele, consisting of several cysts, tapped and injected. Minor operations.-1. Operations for the cure of hydrocele (two). 2. Removal of fibro-cystic tumours of the mammse (two). 3. Radical cure of haemorrhoids. 4 and 5. Ununited fractures of the ulna and of the tibia and fibula, stirred up by a strong needle. 6. Amputation of the forefinger. 7. Ampu- tation of the ring and half the middle fingers. 8. Removal of enlarged tonsils. 9. Removal of erectile tumour. 10. Removal of necrosed bone (tibia). 11. Removal of the greater part of the body and of the nasal and palatine plates of the superior maxilla. for necrosis following fever. ROYAL MEDICAL & CHIRURGICAL SOCIETY. TUESDAY, JANUARY 27TH, 1863. SAMUEL SOLLY, ESQ., F.R.S., IN THE CHAIR. CASE OF WHITE FIBRO-SEROUS DISCHARGE FROM THE THIGH. BY A. B. BUCHANAN, M.D., PHYSICIAN TO THE DISPENSARY FOR SKIN DISEASES, GLASGOW. (Communicated by E. H. SIEVEKING, M.D.) THE author recorded the history of a remarkable case of dis charge of white fibro-serons fluid from the posterior cutaneous surface of the thigh, at present under his care in Glasgow. The patient was a woman, in other respects in fair health, aged forty-six, and mother of six healthy children. The discharge was white, like milk, and flowed from excoriations produced by the rupture of small vesicles scattered over the back of the thigh; and particularly from an infiltrated patch, of the size of the palm of the hand, on which the vesicles and excoriations were most abundant. The milky fluid coagulated a few minutes after being passed. It contained a fatty molecular base similar to that of chyle, and a few nucleated cells. The results of a chemical analysis closely corresponded with those yielded by " chylous urine." The patient dated the commencement of her malady from a shivering fit twenty-one years ago, shortly after which she noticed a "lump" " in the situation of the affected surface. Fifteen years ago vesicles appeared, from which a brownish fluid exuded on scratching. For the last six years the discharge has been milk-white, and is always worst in wet weather, and while the patient is walking about, when its amount may be half a pint per hour. At night it ceases to run, recommencing about an hour after the patient rises in the morning; but in dry or frosty weather it may occasionally be absent for a week or two. The veins of the affected limb are varicose, but no enlargement of the lymphatic glands could be detected. The author succeeded in controlling the discharge for two months by a long elastic stocking ; the use of which, however, had to be discontinued, owing to severe lancinating pains in the thigh. The breasts also swelled, and began to secrete small quantities of cholestrum. Immediately on ceasing to use the stocking the uneasy sensations subsided, and the discharge commenced anew. After remarking that cases of this affection were extremely rare in temperate latitudes, Dr. Buchanan pointed out, by re- ferring to several recent examples, that they were probably more frequent in warm climates. He cited, however, and gave an account of, two unequivocal cases of the same affection, both dating from the seventeenth century; one of which, in a male subject, occurred in Germany, and the other, in a female, in France. While referring to various pathological theories, the author fully recognised the identity of the above disease with " chylons urine," or, as he would prefer to call it, " white fibro-serous urine." " He objected particularly to the theory which iden- F 2
Transcript of UNIVERSITY COLLEGE HOSPITAL.
149
of the recurrent fibroid variety, had been removed at St.Thomas’s Hospital two years before. It was remarked thatafter the operation there was a constant spasm of the muscleswhich were exposed in the wound. This was noticed dailywhen it was dressed. On New-year’s eve his face was observedto be affected, and on the following day a regular attack ofconvulsions ensued, which continued until death on Jan. 2nd.At the autopsy, several nerves of the anterior crural were
found to pass into the circumference of the wound or to itssurface. The body was that of a strong young man.
RECURRENT FIBROID TUMOUR OF THE LEG ; REMOVAL; DEATEFROM PYÆMIA.
(Under the care of Mr. BIRKETT.)Morris H-, aged sixty, admitted 31st December, 1862.
A recurrent fibroid tumour was removed from the outer side ofthe leg on the 14th January. This operation was followedby all the symptoms of pyæmia, which ended fatally on the24th.The liver, spleen, and kidneys were found very soft, but con-
tained no purulent deposits. The lungs were in a state oflobalar congestion, without any inflammatory products. Theskin was yellowish, especially on the face.
UNIVERSITY COLLEGE HOSPITAL.
AN UNUNITED COMPOUND FRACTURE OF THE LEG, OFTHREE MONTHS’ DURATION, EXTENDING INTO THE
ANKLE-JOINT ; AMPUTATION ; CLINICAL REMARKS.
(Under the care of Mr. ERICHSEN.)A. W. R -, aged fifty-two, a baker, was admitted Oct. 17th,
1862. On coming down stairs with some bread on his head, hehad made a false step, fallen backwards, and broken his rightleg. When brought to the hospital, the lower part of the legwas found to be broken, and a portion of the tibia projectedconsiderably through an open wound. The limb was carefullyset, but union of the bones did not ensue; and as his conditionwas somewhat precarious, it was considered prudent to ampu-tate the leg through its upper fourth. This was done on the28th January, 1863, under chloroform, on which occasion Mr.Erichsen made a few practical remarks.He said the man was in a precarious condition, and the limb
in a less satisfactory state than it was some weeks ago; a por-tion of the tibia still protruded and was in a state of necrosis,and the leg was undermined with abscesses. Even if he didnot remove the limb now, it would be an inconvenience ratherthan a source of usefulness to him. His constitution would notbear up against any further delay; he would be likely to gooff from erysipelas or pyæmia; the former he had had twicealready. Under all the circumstances, there seemed nothingto be done but secondary amputation. The injury at first wasnot sufficiently severe to amputate, and he then had hopes ofsaving the limb, but latterly these had been abandoned. The
patient had been artificially maintained by three pints of stoutdaily, brandy, animal food, &c. The hectic symptoms he hadhad at one time had subsided, and there was now present thelow anaemic exhaustion rather than any special disease. Hiscondition was not so favourable to recovery as it would havebeen if he had consented to part with the limb some six weeksago.The leg was now removed at its upper fourth by antero-
posterior flaps. The tissues were much infiltrated, from thegeneral condition of the body. The flaps had to be dissectedback, and did not retract ; they were cut sufficiently long, andbut three or four teaspoonfuls of blood were lost.On examining the amputated limb, the fracture was found
to be immediately above the ankle-joint, and the lower end ofthe tibia was in a state of considerable necrosis, with a projectionoutwards of the upper fragment, causing the leg to be muchdeformed. The ankle-joint was involved; the injury hadsplintered the malleolar arch; the upper surface of the astra-galus was deprived of its cartilage, and the bone was roughand bare. There was no hope of saving such a limb, the causesof the deep suppuration of which were now fully explained.There is now a reasonable hope that the man will make a good
recovery.
ROYAL INSTITUTION.-The executors of the late JamesWalker, Esq., F.P..S., have presented to the Royal Institutionof Great Britain a marble bust of Professor Faraday, by Noble.
ROYAL INFIRMARY. EDINBURGH.OPERATIONS PERFORMED BY MR. SPENCE DURING THE MONTH
OF JANUARY.
THE following list has been furnished by Dr. Arthur G. Reid,resident surgeon at the infirmary :-
Operations. -1. Amputation of the thigh (upper third).2. Amputation of the leg below the knee. 3. Excision of the
elbow-joint. 4. Tracheotomy (croup). 5. Hernia (femoral).6. Removal of several depressed pieces of cranial bones.
7. Large bronchocele, consisting of several cysts, tapped andinjected.
Minor operations.-1. Operations for the cure of hydrocele(two). 2. Removal of fibro-cystic tumours of the mammse(two). 3. Radical cure of haemorrhoids. 4 and 5. Ununited
fractures of the ulna and of the tibia and fibula, stirred up bya strong needle. 6. Amputation of the forefinger. 7. Ampu-tation of the ring and half the middle fingers. 8. Removal ofenlarged tonsils. 9. Removal of erectile tumour. 10. Removalof necrosed bone (tibia). 11. Removal of the greater part of thebody and of the nasal and palatine plates of the superior maxilla.for necrosis following fever.
ROYAL MEDICAL & CHIRURGICAL SOCIETY.
TUESDAY, JANUARY 27TH, 1863.
SAMUEL SOLLY, ESQ., F.R.S., IN THE CHAIR.
CASE OF WHITE FIBRO-SEROUS DISCHARGE FROM THE THIGH.
BY A. B. BUCHANAN, M.D.,PHYSICIAN TO THE DISPENSARY FOR SKIN DISEASES, GLASGOW.
(Communicated by E. H. SIEVEKING, M.D.)
THE author recorded the history of a remarkable case of discharge of white fibro-serons fluid from the posterior cutaneoussurface of the thigh, at present under his care in Glasgow. Thepatient was a woman, in other respects in fair health, agedforty-six, and mother of six healthy children. The dischargewas white, like milk, and flowed from excoriations producedby the rupture of small vesicles scattered over the back of thethigh; and particularly from an infiltrated patch, of the sizeof the palm of the hand, on which the vesicles and excoriationswere most abundant. The milky fluid coagulated a few minutesafter being passed. It contained a fatty molecular base similarto that of chyle, and a few nucleated cells. The results of achemical analysis closely corresponded with those yielded by" chylous urine."The patient dated the commencement of her malady from a
shivering fit twenty-one years ago, shortly after which shenoticed a "lump" " in the situation of the affected surface.Fifteen years ago vesicles appeared, from which a brownishfluid exuded on scratching. For the last six years the dischargehas been milk-white, and is always worst in wet weather, andwhile the patient is walking about, when its amount may behalf a pint per hour. At night it ceases to run, recommencingabout an hour after the patient rises in the morning; but indry or frosty weather it may occasionally be absent for a weekor two. The veins of the affected limb are varicose, but noenlargement of the lymphatic glands could be detected. Theauthor succeeded in controlling the discharge for two monthsby a long elastic stocking ; the use of which, however, had tobe discontinued, owing to severe lancinating pains in the thigh.The breasts also swelled, and began to secrete small quantitiesof cholestrum. Immediately on ceasing to use the stockingthe uneasy sensations subsided, and the discharge commencedanew.
After remarking that cases of this affection were extremelyrare in temperate latitudes, Dr. Buchanan pointed out, by re-ferring to several recent examples, that they were probablymore frequent in warm climates. He cited, however, and gavean account of, two unequivocal cases of the same affection, bothdating from the seventeenth century; one of which, in a malesubject, occurred in Germany, and the other, in a female, inFrance.While referring to various pathological theories, the author
fully recognised the identity of the above disease with " chylonsurine," or, as he would prefer to call it, " white fibro-serousurine." " He objected particularly to the theory which iden-
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