Historical notices on the occurance of inflammatory affections of the internal organs after external injuries and surgical operations / by William Thomson, M.D.

  • Thomson, William, 1802-1852.
Date:
1840
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Licence: Public Domain Mark

Credit: Historical notices on the occurance of inflammatory affections of the internal organs after external injuries and surgical operations / by William Thomson, M.D. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    still more distant from the original injury, diseased actions, appa- rently sympathizing with the state of the stump, have also been dis- covered. I know of no particular set of symptoms that peculiarly characterize these instances of metastasis. Great irritative fever has been present in some cases ; hectic and topical affections of the chest, as dyspnoea, cough, and sense of suffocation, have been found in those where metastasis to the thorax has taken place; and the usual symptom of deranged biliary functions have appeared before death, where the liver has been its seat. Of the cure of cases of this nature I can say nothing satisfactory. Dr. Hennen has added some cases illustrative of these observa- tions, p. 271, &c. The following case fell under my own observation. Lyons, 25th October, 1823. This morning Mr. Janson per- formed amputation on a woman about 30 years of age, about halt way up the left thigh, on account of a scrofulous knee-joint. The thigh and leg were both greatly emaciated ; the knee-joint was in a state of demiflexion ; the inferior end of the thigh formed a similar projection outwards. In performing this operation, M. Janson carried his knife through the integuments and muscles down to the bone, without drawing, or dissecting, back the skin, or waiting for the retraction of the external muscles. The bone consequently was sawn through very nearly at a level with the external incision. The integuments were then pulled down over the bone as far as could be done, and a roller applied from above downwards, to keep them in this situation. The cavity formed by the two lips of the wound was stuffed with charpie and compresses ; and over the whole more charpie and another roller were applied. Febrile symptoms manifested themselves on the second or third day after the operation, and became gradually more severe. The bone was seen to project beyond the level of the flesh at thefirst dressing, and this projection continued to increase. The secretion of purulent matter was small in quantity, and there was no appear- ance of the formation of granulations. The surface of the wound was pale and flabby-looking. 8th November. M. Mortier remarked to-day, that, though there is very little appearance of inflammation on the surface of the stump, as manifested by the trifling suppuration, &c, the patient is labouring under a high degree of inflammatory fever; that this must arise from the existence of inflammation in some of the internal organs; and that in cases of external injury inflammation often goes on to a very great extent in internal viscera, without occasioning any symptom that leads to a suspicion of its existence. With regard to the present case, M. Mortier remarked, that there is no reason to suppose the inflammation to be situated in the head or in the abdo- men The patient has slight cough, and complains of some degree of pain in the chest, and we may therefore suspect the existence of pleurisy. She is evidently sinking fast; has the facies hippo-