On abdominal abscess : a clinical lecture delivered in the Royal Infirmary, Edinburgh / by T. Grainger Stewart.

Date:
[1875?]
Catalogue details

Licence: Public Domain Mark

Credit: On abdominal abscess : a clinical lecture delivered in the Royal Infirmary, Edinburgh / by T. Grainger Stewart. 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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    Many of you also watched with interest the case of a girl : who, during tlie last winter session, was under treatment iu Ward VIII. on account of al>dominal abscess. She is now quite well; but I wish to i-ecall to you the main features of lier case. She was twenty-three years of age, unmarried; and she told us tliat she had been a feeble child up to the age of seven, but that she afterwards liad become quite strong. We further ascertained that when about twenty-one she had had a child, and had been affected with sypliilis. She was confined in tlie Maternity Hospital, and her recovery was so slow that she remained there six weeks. On leaving liospital she com- plained of pain in the right side, where the swelling after- wards appeared. Although this pain was nearly constant, and interfered with comfort in walking, it did not cause her to take to bed. About the month of May last year she was obliged to remain in bed, the pain having extended and become more intense, while gradually a fulness and hardness had appeared. Tliese increased at first very slowly, but after the beginning of October with considerable rapidity. On admission, she was a pale, delicate-looking girl, somewhat emaciated, with a pink flush on each cheek. Her tempera- ture was 1014^, her tongue furred, her gums were painful and red, appetite was poor, thirst considerable, digestion im- paired, the bowels were constipated. The liver was of natural size. The abdomen was prominent, particularly on the right side; it was tender to the touch, especially at the swollen part. A tumour extended from the level of the crest of the right ilium to a point midway between the umbilicus and the ensi- form cartilage, and to a short distance to the left of the umbilicus. The mass was slightly nodulated, and was hard throughout most of its extent, but in the central part, where it ' was most prominent, careful palpation revealed deep-seated fluc- tuation. On placing the hand on the right lumbar region, and tilting forwards in the direction of the kidney, the tumour was not lifted up, and there was no marked tenderness. The urinary iid all the other systems presented no important abnor- Hiality. No pelvic tumour could be found on examination by ij the rectum or the vagina. The uterus was not fixed. The ■ bowels were readily moved by aperient medicine. Eegarding tlie '■^se as one requiring surgical interference, I asked Mr Annan- de to see the patient. We directed the house-physician to vplore with an aspirator. Pus being found, Mr Annandale proceeded on October 15 to operate as you saw him do in the [ recent case. The incision was made parallel with, and internal to, the crest of the ilium. Ten ounces of pus, with several solid mps, were evacuated. A drainage-tube was introduced, and iitiseptic dressing carefully applied. During the week fullow- i mg the operation the fever continued, but it gradually subsided,