Billeder på siden
PDF
ePub

pulse rate fell to 112, and increased in volume. At eight p. m. it had risen again to 120, and the temperature, which at the time of transfusion was 100 4-5 degrees F., rose to 102 at 8 p. m. The transfusion was discontinued at the end of fifty minutes, as the donor began to show some signs of depletion and the face of the patient was considerably flushed, in contrast to it's previous palor.

The vaginal discharge, which had been bright red before the transfusion, became watery in character, later changing to a dark brown color and of greater consistency.

There was a brief improvement in the symptoms, the patient resting for a while, but the gas eructations, distension and vomiting continued in spite of the fact that the bowels moved freely several times and the stomach was emptied by lacage.

Marked restlessness ensued, the pulse gradually became weak and rapid and the patient died January 25 at 1 a. m. three days after the transfusion and on the eight day following the operation.

The character of the late vaginal discharge and of the vomitus, which became a dark brown in color and evidently contained disintegrated corpuscles, furnished some grounds for the belief that hemolysis had occurred.

Case 3.-Mr. G. L., age 65. Farmer. I was called to see this case December 11, 1911, by Dr. George Perry. The patient gave a history of having attended the apple exhibit in Wilkes-Barre the previous week and on his way home Saturday evening he was taken with sharp abdominal pains, which lasted through the night. Sunday morning he had one or two bowel movements, consisting largely of blood streaked mucous. A dose of castor oil failed to produce further evacuations but was followed by vomiting and intense intermittent cramp-like pains. Dr. Perry saw him Sunday and again on Monday, when he made the diagnosis of obstruction of the bowel.

When I saw the case there was considerable abdominal distention, a very distinct peristaltic wave in the distended loops of intestines and a history of fecal vomiting.

The patient was taken at once to the hospital and operated upon that evening. We found that eight inches of the ileum.

48

had passed through the ileo-cecal valve into the ascending colon. By gently milking the colon and with slight traction on the ileum the intussusceptum was gradually disengaged, and although considerably thickened, the blood supply was still so good that a resection was considered unnecessary.

The only possible cause that we could discover was a veillike band of adhesions, extending across the angle between the ileum and the colon, in such a manner that it may have guided the lower portion of the ileum under the effort of an intense peristaltic contraction, directly into the ileo-cecal opening. This band was divided and carefully stitched to the colon, to prevent further adhesions.

The patient made an uinterrupted recovery.

Intussusception in the adult is rather a rare occurrence, especially in one so old.

Dr. Perry deserves to be congratulated for his early diagnosis in this case, which thereby avoided a resection of a portion of the bowel.

Case 4-Mrs. M. S., age 34. Operated upon by Dr. Brooks for vesical calculus. The usual symptoms of vesical irritation were present, a diagnosis having been made by means of the sound, and just previous to the operation I made a cystoscopic examination, confirming the presence of the calculus.

The bladder was opened through a suprapublic incision, and the stone was found to be attached to the base of the bladder by a pedicle, which had to be cut through before the calculus could be removed. Careful examination of the specimen revealed the fact that the stone had been formed upon a presumably benign papilloma and was attached to the bladder wall by the pedicle of the tumor which was free from any incrustation.

The case made a good recovery.

Case 5-Mr. C. D., age 65. This case gave a history of some urinary trouble for several winters past, though in the summer time he was quite comfortable.

For several weeks previous to his admission to the hospital he had suffered with marked vesical irritability, frequent

49

urination, tenesmus and some retention, and had been treated by irrigation. When admitted he was passing urine every fifteen or twenty minutes and the pain was so great that a cystoscopic examination, unless under general anesthetic, was impossible. A rectal examination revealed the presence of a large prostate. He was operated upon January 18, 1912.

A medium perineal incision was made and the prostate and bladder explored with the finger. A large encysted vesical calculus was found behind the prostate. After the removal of the prostate an attempt was made to extract the stone through the perineal incision, but this being impossible, on account of its size, a suprapublic incison was made and its removal effected in that manner.

The kidneys functionated fairly well for about twelve hours following the operation, then a condition of anuria ensued, accompanied by a stupor that quickly became coma, and the patient died about thirty-six hours after the operation from kidney insufficiency.

Case 6. Mrs. M. W., age 44. Patient was seized suddenly while at work with a severe pain in the side and fainted. Dr. Tobias was called and when he reached the house he found the patient conscious but quite weak and suffering with severe pain. A hypodermatic injection of morphine was administered and laxatives ordered.

The following day she was no better, the bowels had not moved and some vomiting occurred. Further laxatives produced no results and the vomiting continued.

On the third day a rectal examination was made, with the idea that the obstruction might be due to fecal impaction. Several hard rounded masses could be felt but a vaginal examination proved them to be multiple fibroid tumors of the uterus, very low down, almost preventing the introduction of the examining finger into the vagina.

On the fourth day, as the vomiting was becoming fecal and the patient's condition serious, Dr. Tobias, by using considerable force, was able to push the incarcerated uterus up into the abdominal cavity. This relieved the obstruction to the bowels

and was followed almost immediately by several bowel movements. The symptoms subsided at once.

The next week normal menstruation occurred (there was no history of irregular or increased menstruation) and the following week she entered the hospital, where an abdominal hysterectomy was performed.

On opening the abdomen we found the shape of the uterus reversed, being much longer at the cervical portion than at the fundus, where several fibrous knobs about the size of an English walnut extended between the layers of the broad ligament on a level with the cervix, making it exceedingly difficult to determine which was the real cervix. It was this peculiar shape which no doubt explained the obstruction to the rectum during its incarceration in the pelvis.

By working down one side and up the other, the tumor was removed without much difficulty and an uneventful recovery followed.

M

Abdominal hysterectomy was

Case 7.-Mrs. P. B performed for cap or the cervi

Previous to thoperation, following the suggestion of Howard Kelley, ureteral Meintroduced into both ureters to aid in their recognition, thus allowing a more complete excision of the broad ligaments in the cervical region, without injury to these structuBRARY

In other respects this case presented no unusual circumstances and made a good recovery.

Case 8.-G. K., age 38. Seven years ago had an attack of typhoid fever, and since that time has had some trouble with his stomach. For the past year has had a great deal of pain immediately after eating and vomits large amounts of sour, partly digested food. Lately the pain has become almost continuous. He has marked tenderness over the epigastrium and has lost twenty-five to thirty pounds in weight and has been unable to work for the last year.

The results from a test meal and lavage showed the presence of an obstruction, preventing the stomach from emptying itself in the usual time, and also the presence of acid in the gastric contents.

A diagnosis of ulcer of the stomach was made and the patient was operated upon June 12, 1911.

A thickened mass, about the size of a silver dollar, was found on the posterior wall of the stomach, near the pyloris. As the position of the ulcer did not permit of easy removal and there had been no hemorrhage from it, we allowed it to remain and a posterior gastro-enterostomy was done.

The patient gradually developed a great amount of distention, in spite of active treatment, until on the fourth day; there was some gaping of the wound and I feared that the sutures would break. That evening the stomach was washed again, and following a suggestion of Howard Kelly, a paquelin cautery, heated to a cherry red, was passed around over the abdomen, just far enough away from the skin to prevent burning. Whether or not it was a coincidence, within half an hour the patient had a bowel movement and passed large quantities of flatus, relieving the distention, which disappeared entirely within the following forty-eight hours.

The patient's recovery was rapid from that time on, and a recent report from him is to the effect that he has gained thirty-five pounds, is working steadily in the mines, and is enjoying the best of health.

A SIMPLE METHOD FOR MAKING CARBON
DIOXID SNOW.

BY DR. MAURICE B. AHLBORN, WILKES-BARRE, PA.

READ MARCH 27, 1912.

I have found all the methods for the production of carbon dioxid snow to be extremely unsatisfactory, as with a piece of chamois skin over the vent of the tank nothing could be produced at best but soft snow, which was almost melted by the time one kneaded it into a mold or crayon. Filter-paper tubes and other porous materials gave little satisfaction because of the frequent bursting of the paper, to say nothing of the necessity of swaddling the cone of paper with towels or other insulating materials during the flow of gas from the vent. I found that in the first place tilting of the gas tank to an angle of

« ForrigeFortsæt »