Report of clinical cases treated during the session 1859-60 in the surgical wards of the Royal Infirmary under the care of James Spence.

Date:
1861
Catalogue details

Licence: Public Domain Mark

Credit: Report of clinical cases treated during the session 1859-60 in the surgical wards of the Royal Infirmary under the care of James Spence. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    30 usual way, and everything seemed to promise fair for a successful issue ; but she was restless and depressed from the first. Symptoms of acute pyaemia set in, and the patient died eight days after the operation. It appears difficult to account for the unfortunate result in a case where the disease seemed so local, and where the general health had only suffered for a short time, except on the view that the peculiar affection of the synovial membrane is one where opera- tions are unusually dangerous; and certainly, when we consider how frequently disastrous results follow even the slightest and most carefully conducted operations in cases of loose cartilages, there does seem reason to think that there must be some peculiarity connected with it which leads to the development of unfavourable results. The principal operations on the urinary organs were two for lithotomy, and two of perineal section for stricture of the urethra. In both the cases of lithotomy the lateral operation was per- formed under chloroform with success. In the case of the man K , two calculi were removed. In the boy C ’s case the stone was very large in proportion to the space through which it had to be extracted, yet he never had a bad symptom after the operation. Of the two cases of perineal section, one had a fatal termination. The patient had a very bad, irritable stricture, which had been re- peatedly dilated and had again returned, and he now suffered great irritation whenever an instrument was passed. He was of dissipated habits, and had long suffered from varicose veins. The operation was easily performed, with almost no bleeding; and a No. 9 silver catheter was introduced, which was changed for a gum catheter at the end of twenty-tour hours, the latter instrument being withdrawn at the end of forty-eight hours. The urine flowed freely, princi- pally by the wound, but partly by the urethra; and he never had any pain or uneasiness there, nor in the abdomen; but on the eighth day he had a rigor, and the next day complained of pain :n his leg, which was found to be erythematous, the varicose veins being extremely painful to the touch. The inflammation of the veins ex- tended, and he ultimately died with all the symptoms of pyaemia. How far this condition was the result of the perineal section I leave others to judge ; I can only say that, as regards the irritation of the parts operated on, he never suffered more, if so much, as he had often done after the introduction of a catheter. The successful case stands in strong contrast to the one just related, whether considered in reference to the unfavourable conditions under which it was per- formed, or the advanced age and previous exhaustion of the patient. I was summoned to see him at the house where he lodged ; and, from the statement made to me, I supposed it was a case of reten- tion from enlarged prostate. I found him straining violently to pass water, which he voided drop by drop. On examining the pros- tate per anum, I felt it greatly enlarged; but when he saw the