Notes of practice among the out-patients of St. Bartholomew's Hospital / by James Paget.

  • Paget, James, Sir, 1814-1899.
Date:
[between 1850 and 1859?]
Catalogue details

Licence: Public Domain Mark

Credit: Notes of practice among the out-patients of St. Bartholomew's Hospital / by James Paget. 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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    NOTKS OP PEACTICE AMONG THE OUT-PATIENTS OF ST. BAETHOLOMEW’S HOSPITAL. By JAMES PAGET, F.R.S. Assistant-Surgeon to the Hospital. The out-patients’ rooms of large hospitals are not places for the minute study of surgical science ; but they may provide a kind of useful knowledge which can be got nowhere else, unless in an extensive private or parochial practice. Some of this knowledge (or what seems to be so) I propose to publish in this and a few following papers. It may be they ^vill contain nothing that is not familiar to the majority of those who have much surgical experience ; nevertheless, they may be useful to the larger number, whether practitioners or students, who have fewer opportunities of study; and, al- though tjie statements made in them may have been chiefly founded on observations among Hospital-patients, yet I have, in nearly every instance, satisfied myself that they will prove true in private practice. If it be objected that the papers are desultory, disorderly, and fragmentary, the answer may be, that these were, unavoidably, the characters of the studies in which they had their origin, and which, if they were in these respects less faulty, they would less truly represent. No. I.—ON SOME AFFECTIONS OF LYMPHATIC GLANDS. A form of Acute Inflammation of Lymphatic Glands often occurs, in which all the glands of a cluster appear to coalesce in one swelling, involving both themselves and the tissues be- tween and about them, and accompanied ^vith uniform indura- tion, heat, and pain. The local cause of the disease is seldom evident: it is most frequent in those who are enfeebled by previous illness, or by defective food: its most usual seat is in the glands below the angle and base of the jaw, or in those behind and beneath the upper part of the mastoid muscle. In the former situation, the glands swell out to the level of the jaw, or beyond it, and may feel as if adherent to it; in the latter, being bound down by the tough fascia, they are less prominent; but, in both places, they make swellings of remarkable hardness, with a nearly uniform flattish pre- senting surface. The integiunents over them are usually somewhat cedematous, but not reddened in proportion to the severity of the deeper inflammation. In the progress of this disease, which is usually accompa- nied by sharp inflammatory fever, it is common to find one or two small suppurations, as if one gland in the cluster had 8upp\irated, while the rest remained swollen and hard. The finger passing over the diseased part sinks in as it passes on some small yielding spot; there is no distinct fluctuation, but a circumscribed softness.