The value of diminished electrical resistance of the human body as a symptom in Graves' disease / by H.W.D. Cardew.

  • Cardew, H.W.D.
Date:
1891
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Licence: Public Domain Mark

Credit: The value of diminished electrical resistance of the human body as a symptom in Graves' disease / by H.W.D. Cardew. 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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    harpoon penetrated the right lobe of the liver, and on pass- ing the hand backwards along the under surface of the liver the point of the harpoon could be felt projecting through its posterior border. The difficulty of removing the harpoon now presented itself, as it was armed with two sharp, flattened barbs, about three-quarters of an inch long and two inches apart. With considerable difficulty a grooved director was passed down along the shaft of the harpoon, and upon this an incision was made forwards through the liver substance with a bistoury ; the harpoon was now pushed backwards in order to disengage its barbs from the liver substance in which they were embedded, and was then easily removed. The peritoneum was washed out with a 1 in 4000 warm perchloride of mercury solution, and nearly half a pint of dark blood-clot removed. The hEemorrhage from the wound in the liver proved troublesome and was not checked for nearly half an hour. The abdominal wound was closed with flve deep sutures, and a large indiarubber drainage-tube was inserted along the track of the harpoon. The wound was dressed with iodoform and carbolic gauze. The drainage- tube was removed on the fifth day, and, with the exception of a rise of temperature to 104° F. on the evening of the third day, the patient had no bad symptom and was discharged with the wound firmly healed on the twenty-first day after admission. Coraz.al, British Honduras. THE VALUE OF OXYGEN IN OPIUM POISONING. By \V. J. C. Meket, M.B., B.Ch. Oxon. The practice of the inhalation of oxygen in cases with em- barrassed respiration has been an established fact for some time past, and its use has been attended with varying success. It has been given in asphyxia from coal gas and other causes, and in many acute diseases attended with dyspnoea and cardiac failure. Its value, however, in opium poisoning with intense cyanosis, dyspnoea, and a flagging pulse, does not seem to have been yet put to the test, and the following case may throw some light on the subject. A man thirty-two years of age was brought to St. Thomas’s Hospital by the police. He had been found lying insensible on the Albert Embankment about half an hour previously, and, all attempts to rouse him proving ineffectual, he was conveyed to the hospital. When I first saw him he was some- what, though not greatly, cyanosed, and breathing stertor- ously about fifteen times per minute. He was quite uncon- scious, bis corneal reflex abolished, his pupils contracted and inactive, his pulse rapid and weak, and his limbs flaccid. His breath smelt of chlorodyne, and a quantity of brownish fluid with a similar smell was removed from the stomach by the stomach-pump. After this efforts were made to louse the man from his stupor, and, with this inten- tion, enforced exertions being out of the question, the in- terrupted current, flagellation, cold affusion, and strong ammonia to the nostrils were successively tried. The ammonia made him cough slightly, but he responded to this combined treatment only to the extent of indifferent protesta- tions when pressure was applied over the supra-orbital notch. The pulse having shown signs of failure at intervals during this time, hypodermic injections of ether were occasionally administered. At the end of about three hours the patient was very little, if at all, better, and as soon as the battery and other restoratives were discontinued he relapsed into profound coma. The united efforts of three policemen failing to make the patient walk, and his condition at the end of four hours’ continuous stimulating treatment being serious, he was sent up to the ward. When seen there shortly afterwards his face was intensely blue, and his lips and fingers livid ; respiration was very slow (about eight per minute) and laboured. The pulse was scarcely per- ceptible and unconsciousness was complete. It was then determined to try the effect of the administration of oxygen. This was given in such a way that only the pure gas, un- diluted with air, was breathed, and the inhalation was con- tinued without interruption for twenty minutes. At the end of this time the face had regained a nearly normal colour, the respirations were fuller, easier, and slightly quicker, and the pulse was now perceptible at the wrist, beating regularly about 100 to the minute. The patient was, however, still in a state of stupor, though the eyelids now responded slightly to a touch on the cornea. After an interval of about half an hour the inhalation was repeated with marked effect. Shortly after its commencement the man, for the first time, moved in bed and presently opened hi» eyes. The whole condition improved so rapidly from this time that before a quarter of an hour had elapsed the patient could tell his name and answer, though irti a somewhat rambling fashion, any reasonable question. The inhalations were repeated twice after this for twenty minutes, at intervals of three-quarters of an hour, at the end of which time the patient’s condition was so satisfactory that they were discontinued. The man remained in a somewhat- drowsy state during the day, but never relapsed into coma, and made a perfect recovery. Th^^patient, on his recovery, alleged that he had drunk two ounce bottles of chlorodyne (a preparation containing, I believe, somewhere about four grains of morphia to the ounce) at midnight—that is, about- three hours before the police discovered him. The use of oxygen was suggested by the lividity of the patient and by recent observations upon the destructive effect, apparently by oxidation, of potassium permanganate on morphia. That the oxygen was the turning-point in the case seems to be beyond doubt ; but of the exact way in which it acted it is- difficult to speak without further experience of its use in. similar cases. I am indebted to Dr. Payne for permission to publish the case-. St. Thomas’s Hospital, S.E. % glirmr OF HOSPITAL PEACTICE, BRITISH AND FOREIGN. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et mor> borum et dissectionum historias, turn aliorum turn proprias coUectas habere, et inter se comparare.—Morgagni De Sed. et Cans. Morb., lib. iv. Procemium. ST. THOMAS’S HOSPITAL. A CASE OF EUPTUBE OF UBETHEA TEEATBD BY IMMEDIATE. SUTUEE OF THE DIVIDED ENDS OF THE CANAL ; BE- COVEEY. (Under the care of Mr. William Andbeson.) Any method of treatment which is likely to save the subject of a ruptured urethra from the serious results of a- traumatic stricture is deserving of attention, and the method described in Mr. Anderson’s case is the one which is best- calculated to do so. It is most likely to succeed when employed early, but it is not infallible, for when the injury has- been severe some sloughing of the urethra, where contused, may follow, and this, combined with the effects of decom- posing urine in the tissues, may lead to failure in the most carefully sutured wound. A stricture may follow when there is partial rupture only if the case is treated by the- cathether without incision. With regard to these cases of ruptured m-ethra Mr. Harrison writes ; “Asa matter of fact, I have observed from a considerable number of cases that rupture of the deep urethra treated by perineal section and' bladder drainage, whether a catheter can in the fipt instance be passed or not, is seldom followed by stricture. A man thirty-two years of age was admitted into St. Thomas’s Hospital on Sept. 15th, 1893. The patient, while jumping backwards off a bicycle, alighted straddlewise on- the hinder wheel. On admission he was in much pain ; the perineum was greatly swollen and dark from extravasation of blood into the tissues. There was no bleeding from the urethra, and no attempt had been made to pass urine. An attempt was made to pass a catheter, but without success. Ether was then administered, and an incision was made into- the” swollen perineum in the median line, exposing a large- cavity fiUed with blood clot. After clearing away the extravasation the urethra was found to be completely divided a short distance in front of the triangular ligament, the two ends being separated by a distance of about an inch. An effort was then made to pass a catheter in the ordinary manner, but this was found impracticable owing to the difficulty of fixing the vesical end of the torn canal. A soft No. 10 olivary catheter was then introduced through the wound into the upper opening and pressed on for some distance into the bladder. The other end of the instrument^