Further report on aseptic and septic surgical cases : with special reference to the infection from the skin / by C.B. Lockwood.

  • Lockwood, Charles Barrett, 1856-1914.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Further report on aseptic and septic surgical cases : with special reference to the infection from the skin / by C.B. Lockwood. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    whore the skin had not been quite accurately adjusted. Gela- tine and agar-agar tubes were inoculated from this and other points, but remained quite sterile. The synovial membrane was tuberculous, and occasional tubercle bacilli were seen near the free surface. Six months after the operation the patient seemed exceed- ingly well and fat. The knee was excellent, although the patient had not used it, having been laid up with influenza. There seemed no reason why she should not begin to get about upon it, in spite of the absence of the head of the other femur. Case n. Carcinoma of the Breast; Amputation; Clearing of Axilla.—The patient is a single woman, aged 41, and was sent in under my care by Dr. Stokes. She had a scirrhous cancer of the left breast, which had been growing for four years ; the axillary glands were also affected. The whole breast and mammary gland, together with the pectoral fascia and several axillary glands, were removed. The wound was brought together with button and interrupted sutures, and dressed in the usual way without drainage. The skin was rubbed with a little iodoform. On the following day she complained of the pressure of the Martin's bandage, and this seemed a source of annoyance for the next week, and was afterwards found to have caused some eczema of the back and side of chest, but otherwise there was nothing to note. The dressings and sutures were removed on the tenth day, and culture tubes of gelatine and agar-agar were inoculated from the scar, but remained quite sterile. She left the hospital on the four- teenth day after the operation. The only point that calls for remark in this case is the trouble caused by the Martin's bandage. I have now begun to omit this part of the dressing, or apply it much more lightly and to remove it earlier—on the third or fourth day. Of course, care has always been taken not to let the Martin's bandage be in actual contact with the skin. Case hi. Senile Gangrene; Amputation of Thigh.—The patient was aged 77. He was admitted with senile gangrene of the toes of the right foot, which had come on during the cold weather. He was kept under observation for several days, during which the gangrene extended into the sole of the foot. There was also some inflammatory oedema of the lower part of the leg, and septic poisoning seemed to be in progress. There was a very feeble pulse in the popliteal artery, but none in the tibials. He suffered greatly from pain, and was delirious at night, and was rapidly losing ground. After consultation amputation was done through the lower third of the thigh. The wound was dressed in the usual way, and a small drainage tube inserted towards the inner side. No iodoform was used. The operation caused very little shock, and the wound was dressed on the fifth day, and gelatine and agar-agar tubes inoculated from the drainage tube and from the wound, but they remained sterile. Before the opera- tion his temperature ranged between 99° F. and 100° F.; after- wards it was 99.4° for some days, and then fluctuated slightly between 98° and 99.8°. On the eighth day it reached 100.2° owing to some bladder trouble, which continued troublesome until he got up. He kicked his second dressing off on the twelfth day, but the wound was healed. It is only necessary to add that there was rather more serous discharge from this wound than is usual in aseptic cases; indeed, there was enough on the fifth day just to show through the dressings.