Selected cases from the surgical clinic of Frederic S. Dennis / reported by Thos. M'Cann.

  • Dennis, Frederic S. (Frederic Shepard), 1850-1934.
Date:
[1886?]
Catalogue details

Licence: Public Domain Mark

Credit: Selected cases from the surgical clinic of Frederic S. Dennis / reported by Thos. M'Cann. 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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    seriously to affect the patient. Tliese suffer- ers have become almost insane. The regular profession should discountenance as a char- latan any physician who practices such at- tempts to prey upon the minds of young men. Atrophy of the testicle, although it is rarely produced by varicocele, must however be thought of in connection with the dis- ease ; and where there is any evidence of such a condition, an operation can be per- foi-med with propriety. Case I. The first case this afternoon is one of necrosis of the tibia; the patient, A. S., set. 8, has a good family history. He has always ■ enjoyed good health, until one year ago, ■when he struck his leg while playing. Shortly after, a painful swelling appeared over the crest of the tibia, accompanied by constitu- tional symptoms. An exploratory incision was made then, and about a pint of pus evacuated; this operation was followed by closure of the wound, with the exception of a small sinus which continued to discharge pus and pieces of bone at regular intervals. Now, making an incision about four inches long, just over the anterior surface of the tibia, I incise the periosteum and strip it up i laterally. I see a sequestrum, surrounded Iby new bone. At the lower angle of the : incision there is a jnece of detached bone, ^and about the middle a collection of gela- t tinous material, filling in a small cavity which ! appears to lead to the epiphj-sis. Now, care- I fully gouging out all the necrosed bone, I jpack the wound with iodoform gauze and I allow it to heal from the bottom. Case II. The next patient (J. S., set. 27, ibrakeman), while coupling cars, got his hand I caught and received the injury which j'ounow >see. The whole hand is pulpified, circulation lhas been cut off from the fingers, and decom- 1 position has set in already, as is manifested by t the emphysematous crackling. I will amputate i just above the wrist joint. I make a circular iincision, and now two lateral ones and dissect liup anterior and posterior skin flaps about Itwo inches long; now I divide everything idown to the bone, |ust a little below the (limits of the flaps, dissect up the periosteum, divide the interosseous membrane, and saw the bones across under continuous irrigation to prevent any circular necrosis, which Volk- mann has shown may follow by rapid sawing, which acts like a cautery to the bone. The ends of the bones are now made smooth. I introduce a drainage tube and close the wound with a continuous suture. It will be dressed antiseptically and the stump placed ' on a palmar splint. Case III. We now have a case of condy- lomata of the penis. This patient (C. S., set. 20, book-keeper) states that three months ago a small sore appeared on his foreskin. It spread slowl}^ at first, but later on rapidly until the whole prepuce became involved in the warty growth. You can see the great in- crease in size, also the distinct warty appear- ance, and the foul-smelling discharge. Now, passing a bistourj- I slit up the foreskin and with a pair of curved scissors I remove all of the prepuce which is the seat of the vegetation. Here is some of the disease on the glans which I will also snip off with scissors. I cover the whole with loose gauze and a bandage. Case IV. The next patient I will show yovt is P. r.,a?i. 13,wlio gives the following history: About seven years ago he was thrown down and received a fracture of the left scapula. Five years ago the arm began to shorten and a surgeon re-frtictured the scapula. Shortly after, an abscess formed and discharged, leaving two sinuses, one near the coracoid process, the other on the upper portion of the arm posteriorly. Now, enlarging one of the sinuses and passing in m}' finger, I find it passes directly into the shoulder joint, in which I feel roughened bone. Excision of the joint is indicated certainl}', but as the parent objects I will content myself, at least for the present, with enlargingthe other sinus, passing a drainage tube through the joint, and applying the antiseptic dressing. Case V. This patient (V. S.,a;<. 38,a steam- boat man by occupation) contracted gonorr- hoea twenty years ago, and he has had repeated attacks since. He has had symptoms of stricture for fifteen years. He has used sounds at irregular intervals. Two weeks ago he had pain in the perineum and scrotum,