Annual report of the Medical and Sanitary Department / Sierra Leone.

Sierra Leone. Medical and Sanitary Department.

Date:: [1934]

Catalogue details

Licence: Public Domain Mark

Credit: Annual report of the Medical and Sanitary Department / Sierra Leone. Source: Wellcome Collection.

76/90 (page 64)

Although the patient’s general condition was far from 'good and he was not responding well to treatment it was decided that immediate Operation would give him his only chance. Nephrectomy was therefore performed. The lumbar route was used and the kidney was found to be much enlarged and bound by dense adhesions; the ureter too was considei- ably thickened and fixed. threat difficulty was experienced and the kidney burst during the removal and flooded the wound with pus. Haemorrhage was also very troublesome. The kidney was found to have distended calyces with little kidney tissue remaining and the cavity was almost full of branched oxalate stones lying in pus. Immediately after the operation was concluded the patient’s condition became bad and in spite of remedial measures he succumbed to the prolonged procedure. The second case was that of a Syrian male aged 47. He came complaining of pain and swelling in the left side of the abdomen with frequency of micturition. The pain had commenced several years ago and was intermittent in character—a dull ache in the loin; lately he had been able to feel a swelling in the same area. He said that be had been X-rayed in Beirut a year previously, and that he had been told that a stone was present. On admission to hospital the patient was thin and anaemic-looking. A large fixed swelling could be palpated bimanually in the left lumbar region—it was tender. The temperature varied between 98 and 100 degrees F. Examination of the urine revealed pus in fair amount. Cystoscopy showed a slight amount of chronic cystitis and thick yellow pus slowly exuding from the left ureter. Indigo carmine injected intravenously appeared in 5 minutes from the right ureter and came strongly at 6 minutes, it was never observed at the left ureteric orifice. The right kidney having been demonstrated to be acting efficiently operation was decided on. Under spinal stovaine nephrectomy was done by the lumbar route. Pus was encountered in the muscles posterior to the kidney and surrounding the kidney itself. Removal was exceedingly difficult as the kidney was buried in a dense mass of fibrous tissue and was really just a fibrous bag of pus containing several branched calculi. The bed was packed and a large tube left m. The wound continued to discharge for some time but ultimately soundly healed. I saw the patient one year later and he was very fit. Q. STEWART, Surgical Specialist. B—MATERNITY WARD. The maternity work of the Connaught Hospital is all done in one ward of twelve beds with a labour ward of two beds. Lack of accommodation this year made it necessary to erect a further two beds in the ward, but still the work was cramped and cases had to be sent out early to make room for more urgent ones; there was also no possibility of separating septic cases from the others and ante-natal cases often had to be refused through insufficiency of beds. There is great need for a larger establishment. Dr. E. J. Wright was in charge of the work during the year and whilst he was away on leave from May to October Dr. E. Taylor-Cummings took over the work of the ward an 1 the clinics. The work of the latter will be described separately. The total number of admissions was 501, of which number 331 gave birth in the ward. There were 214 multiparse and 117 primiparse. Of the 331 women who gave birth, 207 had normal, and 124 abnormal, labours. For the purpose of this report a normal labour is considered one in which the pelvis is of normal size, the pregnancy is single, the child living and delivered without aid, vertex presents with the back in front, membranes do not j upt.ure prematurely^ there is no bleeding before or excessive bleeding during labour and the mother is apparently healthy and suffers no injury during the birth. The 124 labours that did not fall within this category Avere : — 18 twin labours, 46 torn perinaeums requiring suture, and 60 various abnormalities to be detailed presently.