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Brownleefl, A. 0.
Burke, S. J.
Black, A. G.
Brovxiing, J. H.
CarBtairs, J. G.
Casey, G.G.
Cooke, J.
Cutts, W. H.
Dick, T. T.
Dowling, F. J.
Diirei,C.
FetherBton, G. H.

(2 years)
Ford, F. T. W.
Fisher, A.



Fletcher, £.
Francis, H.
Fyflfe, B.
Figff, E. G.
Graham, G.
Haig,W.
Harricks, F. M.
Heniy, L.
Hewlett, T.
Hora, Tador
He£Feman, E. B.
Jackson, James
Jakins, W. V.
Jamieson, J.
Jonasson, H.
Langford, W.
Le Fevre, G.
Lewellin, J. H.
Long, D. B.
Maclnemey, J. B.
McMillan, T. L.
M'Crea, W.
Meyer. F.
Moloney, P.
Neild, J. E.
Penfold, O.



Pincott, B.
Pinnock, B. D.
Bobertson, J.
Bobertson, B.
Bobinson, S. "R^
BodaU, J. T.
Banldn, W. B^
Byan, C. 8.
Schleooher, C»
Shields, A.
Smith, C.
Smith, L L.
SnowbaU, W.
Sparrow, B. H.
Talbot, T.
Tomer, D.
Walsh, W.B.
Webb, J. H.
Whitcombe, W. ]
Wigg, H. C.
Williams, D. J.
Williams, J.
Wilkie, D. B.
Wilson, H. B.
Workman, F.



jnspital lUpnrts*



Under the directum of R. A. Stirling, M.B., L.R.C.S.R,.
Departmental Editor,



MELBOURNE HOSPITAL.

Suppuratiffe Synovitis of Uft Knee-joint — Recovery,

Under the care of Mr. Stirling.

Reported by Dr. A. A. Flrtohbr.

Johanna H., et. ll, was admitted April 8th, 1884. Seven
weeks previooslj while kneeling on the floor a portion of a
darning-needle entered the inner side of the left knee-joint. It
was removed almost immediately. Shortly afterwards the joint
became excessively painful and swollen. A medical man who saw
her ordered rest, and the application of poultices to the inflamed
part; and some three weeks before admission made a small
pimcture in the skin in front of the patella. Finding that she '
getting no better she was sent to the hospital



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3bpt. 15, 1884 Australian Medical Journal, 405

State on Admission, — ^The girl is extremely thin and delicate-
looking, typkallj strumous, and in a highly feverish condition.
There is flexion of the left knee-joint — which is much swollen ; a
«mall mark an of a puncture can be detected on the inner side of
the joint, and a small wound with granulating edges in front of
the patella. A network of large veins is seen over the knee and
extending up the thigh; below, the limb is (edematous. The
inguinal glands on the left side are enlarged and prominent. The
muscles above are much wasted.

April 4, 1884. — ^Temp. 101 '4*. Under chloroform the precise
state of the joint can be made out; on movement a small quantity
of blood-stained sero-purulent fluid escaped from the incision in
fi:*ont ; absence of marked crepitus. It was decided to lay the
joint freely open, and to provide for efficient drainage by passing
a tube through the articulation. Antiseptic precautions were
used; and a retentive apparatus of back-splint, and two bracketed
side-splints applied — along with swinging of the Hmb.

May. — ^The cavity of the joint was syringed out daily with
ab antiseptic lotion ; at first we used the boro^lyoeride (five per
asat. solution) so highly recommended by Mr. Barwell. But
afterwards thought it best to continue with the ordinary carbolic
solution (1 in 20) of the Listerian method which was otherwise
strictly adhered to throughout. Her temperature now ranges
from lOO"" in the evening, to 99'* morning ; exacerbations of tem-
perature occurred during the formation of small abscesses in the
•cellular tissue internal to the joint. The granulations are pale,
large, bleeding readily. Discharge from joint copious and
purulent.

» June 29. — ^The temperature is now much more regular and
lower than it has been. Discharge from joint less; and the
secondary abscesses round the joint have disappeared. Drain
discontinued. Granulations healthy.

July 26. — ^The incisions on each side are now quite healed. The
Joint is stiff — somewhat larger than its fellow, from post-inflam-
matory thickening, but can be slightly flexed without much pain.
There is no lateral mobility of the tibia on the femur, and no
grating. Plaster of Paris splint applied to limb.

August 5. — ^The improvemcfnt in the child's general health is
now very marked. She has a good useful limb, with the prospect
4>f considerable motion in time. Discharged.

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406 Australian Medical Journal. Sbpt. 15, 1884

Intracapsular Fracture of the Thigh — Fragments held together with
Periosteum and Reflection of Capsular Ligament.

Under the care of Dr. Beaney.

Eeported by Mr. Florance, House Surgeon.

C. B., set. 39, a tent maker, was admitted into Ward 18, oa
June Tth, 1884. He stated that he had sustained the accident bjr
falling on the left hip from a ladder, which slipped ; he fell from-
a height of 12 feet. Was unable to walk afterwards, and waa^
brought to the Hospital immediately.

Previous History — Has suffered from rheumatic gout. Family
history — none traceable.

Examination on the day of admission. — Has pain in the left
thigh ; very slight swelling of the left trochanter, great pain on
moving the limb, no crepitus obtainable, cannot raise the heel from
the bed, can bend the knee, no shortening, eversion of the left foot.
Nelaton's line was perfect. It was at first thought that no fracture-
was present, and belladonna foments were applied.
, On the 13th June, as the eversion of the foot was so mari^ed^
Dr. Beaney had the patient put under chloroform, and crepitus
: was readily obtained by rotating the thigh ; it was felt beet in the^
. centre of the upper part of the thigh. There was no shortening ;.
, a yellow discoloration of a bruise over the outer and inner side of
the thigh. A long splint and perineal pad were applied.

On the 25th July the splint was removed and the patient
allowed up. He was sent out of the Hospital able to walk fairly
well on the 1st August ; no plaster of Paris being applied.

At a polyclinic Dr. Beaney made the following remarks : —
He said, "This case possesses several important points. (1.) The*
occurrence of intracapsular fracture in so young a man (39 years).
(2.) The eversion of the foot and crepitus without shortening o£
the limb. (3.) The rapid recovery made by the patient ; he being
allowed up without a plaster bandage immediately the splint was
removed. With r^;ard to the diagnosis," he continued, '< that the-
history, viz., the absence of shortening, the presence of crepitnSy.
the eversion of the foot, and the appearance of injury, pointed out
conclusively that the fracture was intracapsular, and that the
periosteum and reflection of the capsular ligament maintained the-
fragments in apposition, and aided the reparatory process."
{Vide Holmes and Hulke, YoL I. foL 1001.)

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SiPT. 15, 1884 AtMtrdlian Medical Journal, 407

Fracture of External Malleolus in a Child Jive and a half years old.

Under the care of Dr. Beaney.

Beported hj Mr. Flobance, House Surgeon.

M. K., aged 5^, was admitted into ward 22 on June 4tli, 1884.
She states that when running she slipped and fell, the foot bending
beneath her. She is a healthy looking child, and has not been ill
for two jears, when she suffei*ed from hooping cough.

On examination, there is a considerable effusion over the outer
malleolus of the right leg ; the foot was inverted ; was unable to
walk. Crepitus was distinctly obtainable over the outer malleolus
when moving the foot or the 1^. The injured leg was immediately
put up in a plaster of Paris bandage, strengthened with perforated
zinc. She was discharged and made an out>patient in a few days.

This case deserves consideration, in that fractures of the leg are
very rare in childhood. Malgaigne, in 515 cases, met with 12
between the ages of 5 and 15, and Morris states that, of 176 cases
of fracture of the fibula met with in the Middlesex Hospital, there
were 4 only between the ages of 4 and 12. This offers a remark,
able contrast to fractures of the femur.



LYING-IN HOSPITAL.

Ovariotomy,

Under the care of Dr. Fetherston.

Reported by Felix Meyer, Resident Medical Officer.

Case I.

The patient was admitted into the institution on the 20th Dec.

She was a dressmaker, 27, single, of regular and quiet habits, in

fair general condition. The skin and extremities were warm ;

the bodily temperature normal; no glandular swellings or

mammary areoke. The following measurements were taken :

Girth at the mnbilioal level • • . . 86 inohes

Ensifonn cartilage to mnbilicos • . . . 8 „

Umbilieos to pnbes .. •• 9i •,

Bight anterior superior iliao spine to mnbilioos 9 „

Left „ „ „ 11 „

The abdominal tumour is slightly moveable; there is no
evidence of adhesions; parietes thin; no lines albicantes or
dilated veins. Fluctuation well marked; impulse too; no
crepitus; no tenderness. Dulness (not affected by position)

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408 Australian Medical Journal, Sbfe. 15, 1884

everywhere on percussion; lumbar regions alightiy reaonaat.
Uterus slightly retroverted; os pin-hole, cervix shortened.
Catamenia regular, the flow lasting seven days, less if anything
lately, began at twelve, never ceased since; no dysmenorrhcaa,
dysuria, or incontinence. Urine acid, full of lithates ; some small
amount of albumen and mucus. All other functions normal. No
family history of ovarian disease.

She gave the following brief account of her illness. She ixwt
complained of feeling stout in October. The fulness began on the
right side, and gradually extended. There was no pain bat a
sense of dragging on that side. Three or four weeks ago she
experienced a " bearing down " of the uterus, but there were no
symptoms of pressure on the bladder, and the bowels did not
sufier. The enlargement was very rapid, without in any way
causing functional changes. Patient had a warm bath cm the
night of admission, and on the following day Dr. Fethraeton
performed ovariotomy, with antiseptic precautions. The inctsion
in the median line began two inches below the umbilicus, extmiding
downwards three inches. The cyst, very t^ise and thin, was
tapped with trochar, and about six quarts of dark red fluid drawn
off. The larger part of the cyst being helped out of the abdominal
cavity, a second sub-cyst was trochared and emptied of its lighter
coloured fluid contents. The removal of the cyst required a ftAr
amount of force to sever it from its connections to the omentum,
the only visible part adherent. A third sac of thick chocolate*
coloured fluid was evacuated, some of the cont^its escaping into
the abdominal cavity. The pedicle was seen running long^ thin,
and free to the right ovary. This was secured with clamp, cut
short at the distal end, touched with solid ferrL perchlor. The
opposite ovary was sound. There was no haemorrhage. The
abdomen was sponged internally with a 1 in 200 tepid carbolic
acid solution. The wound was closed with deep silk and
intermediate horsehair sutures ; lint in strips was wrapped round
the clamp; lint and cotton wool completed the dressing. The
cyst was multilocular, with a few hard bulgings ; its weight, free
of fluid, two pounds ; the total amount of fluid nine quarts.

At the end of the operation, which lasted half an hour, there
was no shock ; the pulse 132 ; suppos. opii gr. j given. Three
hours after there was an inclination to vomit, abdominal pain
with a hot skin. Pulse 132 ; temp. 102*2*; respirations 32. A
second suppository was given ; ice and champagne.. By nioming

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Bbpt. 15, 1864 AuttraUan Medical Journal. 409

the temperature was normal. Patient made an uninterrapted
feoovery. Three sutures were removed on the fourth day, there
being good union by first intention. The chunp was off on the
9th January; patient was up a day or two afterwards and
<tiflcharged well on the 29th January.

Case 11.

A. M. H., 46, married, was admitted into the institution on
9th June, 1884, with the following history. Has always eiyoyed
exceptional health. The catamenia came on at 16, recurring
regularly and painlessly at intervals of four weeks, and last ceased
three weeks ago. Is twenty-five years married, has had 11
children and no miscarriages. The last confinement 18 months
ago, and, like the rest, natural

Three years ago the abdomen began to enlarge, on which side she
cannot say. This enlargement went on steadily up to and during
pregnancy, causing her for the first time severe dragging pain
in the left side. Her health kept good. After delivery she still
remained large, and five months later Dr. Fetherston saw her and
'drew off 22 pints of thick dark fluid, telling her at the same time
'she had an ovarian tumour. She has increased ever since, the
abdominal enlargement being attended with pain in the back and
left side. She now chiefly complains of extreme fatigue and
languor, and occasionally of a little pain in the left iliac fossa.
She is a well nourished, healthy type of woman, with a pleasant
expression and good dark complexion. The skin is clear and cool,
'and there are no glandular swellings. The abdomen is distended
by an enormous freely fluctuating tumour, dull everywhere save at
the sides. The os uteri is very far up and drawn forwards under
the pubes. Urine add, 1026 ; no albumen. The following
measurements were taken two days after admission :

Girth at mnbilions level •• •• •• 46iDohei



Greatest girth

Ensiform cartilage to oinbilioiiB

UmbilioaB to pnbes

Bight anterior iliao spine to umbilieos

Left do do do do •



47

llj

lOJ

14

12



On the 19th June Dr. Fetherston performed ovariotomy with
antiseptic measures. The incision in the mid line was begun 2 inches
below the umbilicus and was 3 inches long. The cyst being met with
was trochared, and gave out dark, oily, chocolate-coloured fluid.
It was then drawn through the abdominal opening, the adhesions



410 Atuiralian Medical Journal, Sept. 15. 1884

to the omentum being few and easily broken through. A smaller
cjrst being trochared gave out dear white-of-egg fluid The cjrst
being drawn through the abdominal opening, the long pedicle to
the right ovary was clamped externally and the cyst snipped off.
Two or three small portions of broad ligament inclined to bleed
were ligatured with carbolised silk. The abdomen was sponged
with dry warm sponges. The wound was closed with silk and
horsehair sutures, and the dressing for it and the damp was the
same as for the previous case.

At the close of the operation which lasted something under half
an hour the patients' condition was good. A half-grain opium
suppository was given, and during the next 12 hours liq. opiL
sed., m. Ixxx in divided doses, was given to allay back pains*
There was a little vomiting within this period, which was quieted
with small sips of iced champagne.

The maximum temperature was 100°*6, 27 hours after operation,,
with slight abdominal pain, for which one grain of opium in pill
was given. After this patient went on well, the only trouble beings
flatus, for which a small pill of belladonna and nux vomica was.
found sedative. The diet was milk and Ume water, barley water ,.
cocoa, chicken broth. Three sutures were removed on the fifth day.
Union by first intention. The bowels were well relieved by enema
the day following. The clamp came off a week later. The patient
was up on the 19th day, and was discharged well on the 24th day^
after operation.

. Nine days later (22nd July) she came up to the Hospital
looking and feeling well, and stated that she had menstruated on
the 19th July, just a month after the operation. She had had a
little back pain at the time. This patient^ be it remembered, was
nearly 47.

The cyst was a single one with several smaller internal ones and
weighed 2\ lbs.

(1.) The first fluid amounted to 33 pints. Dark red, slightly
opaque, viscid fluid. Sp. gr. 1023, neutral. Contained a great
amount of albumen. Microscopically. — Large round darkly
granular oells (Drysdale). Free granular matter, a few granular
epithelial scales and some crystals of cholesterine ; also red blood
cells.

(2.) Clear visdd fluid, sp. gr. 1013, neutral, or very slightlj
alkaline. Albumen in abundance. No salt Microscopically —
A few fat globules and rhombic indented plates of cholesterine.

uiyiuztiu uy >_j v^ v_/pt i.^^



Sbpt. 15, 1884 Aiutralian Medical Journal. 411

GEELONG HOSPITAL.

Fracture of the Os Calm from MuKular Action,
Reported by Fosset J. Newman, M.B., Resident Surgeon.

A. F., let. 39, admitted May 11, 1883. Was thrown from his*
horse whilst out riding a few miles from Geelong. According to
his statement he came down on his back and buttocks alone, his.
feet not striking the ground at all. He, however, instinctively
jerked his legs whilst he was falling, and at once felt sharp pain in.
the back of his right heeL He was unable to rise, but was soon
afterwards picked up and brought into town.

On examination the parts below and behind the right ankle
were somewhat swollen, but there was no discoloration or bruising
whatever. There was a large detached piece of the posterior portion
of the OS calds drawn up and movable at some distance above the
heel, the space separating the fragments being nearly two inches in
extent. By forcible depression the upper portion could be brought
down to the body of the bone, but on withdrawing the pressure was
again retracted. The leg was flexed and adjusted to an outside
dine splint, fomentations being applied over the injured parts. In
a couple of days the swelling had gone down, but there was now
marked discoloration over the back of the foot and lower third of
the leg : this however, disappeared by the end of the week. The
detached fragment could now be easily brought down to the heel
and kept there by a turn of bandage. The leg was afterwarda
put up in plaster of Paris and dextrine, the foot being extended
and the leg flexed, in which position the patient was allowed to
get about on crutches. On the plaster being removed some twa
months afterwards the fracture was found to have firmly united.



^ixstrdian Plttrkal f 0n;rnaL



SEPTEMBEB 15th, 1884.



DISINFECTANTS.

In the " Instructions, &c., for the use of Local Boards of
Health and others," recently issued, there is contained the
following memorandum : —

The Central Board of Health is of opinion that the only
absolutely complete and perfect method of disinfection is.

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^12 Atutralian Medical Journal, Sift. 15, 1884

•destruction hjfire. When fire cannot be used, a selection may be
made from the following : —

FOR WOOLLEN CLOTHINO, BEDDING, LINEN, &C

Expose in a closed chamber to a dry heat, at a temperature
of 230* F., for an hour at least. Bundles or bales of goods should
be previously opened. The hair of infected mattresses should be
teased out, fumigated, and exposed to the air, if they cannot be
disinfected in a hot-air chamber. Hags and valueless linen should
be burnt.

Linen, <Scc., should be boiled in water, with the addition of
washing soda, " chloride of lime " or " chloride of soda," or soft
soap, or in a boiling solution of sulphate of zinc and common salt,
in the proportion of 8J^ oz. of the former and 4^ oz. of the latter
dissolved in about two gallons of water.

DISINFECTION OF CLOSETS, URINALS, SINKS, kc.

Solution of sulphate of iron (2 oz. to a pint of water), added
in a quantity sufficient to cover the matter to be disinfected.
When the above cannot be obtained, " chloride of lime " (4 oz. to
a pint of water), " chloride of soda solution," carbolic acid (two
tablespoonfuls to a pint of water, or a tesrcupfnl to a gallon), or
<;hroinio acid {\ oz. to a pint of water) may be used in the same
manner as the sulphate of iron.

FOR DRAINS.

Any of the above solutions, used in such quantity that they
may be readily detected at the drain outlet.

Small quantities or dilute solutions are of no value.

FOR ROOMS.

Graseous disinfectants, such as the vapour of carbolic acid,
•chlorine, sulphurous acid, cannot be usefully applied in inhabited
rooms. To act efficiently, they must be present in such quantity
as to render the air irrespirable. A sheets soaked with the strong
aolution of carbolic acid, should be hung before the door of any
room containing a person suffeiing from any infectious disease.

Chlorine is the most effective, but it will corrode most metallic
ware, and is very irritating, and must not be inhaled. Chlorine
-can be rapidly obtained by taking equal parts of common salt and
oxide of manganese, and adding two parts of water and the same
of sulphuric acid.

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Best, 15, 1884 Auslralum Medical J<mmal. 413

If solphoroiiB add is used, 16 oz. (or as much more as the
atmoiq)here in the room will consume) of sulphur must be burnt
on an iron dish, in a room 10 feet by 10 feet. All cracks and
air-openings should be pasted up, and left for twenty-four hours.

The walls of a room may be disinfected by a wash made with
/resh quicklime; paint>work by washing with a solution of
''chloride of soda'' or ''chloride of lime" — 1 lb. to a gallon of water.

All furniture should be washed with hot soap and water, and
exposed to the air and sunshine.

Carpets and curtains that cannot be treated as above should be^
saturated with benzine or rectified turpentine, and then expoeed to
air and sun.

The common plan of placing saucers containing some substance
supposed to be an effeotiye disinfectant is a delusion ; it is quite
unsafe to place reliance upon such.

DISINFECTION OF THE DEAD BODY.

When a patient dies of any infectious disease, the body should
be enveloped in a sheet saturated with a solution of carbolic acid
or chlorinated lime, and placed in the coffin as soon as possible^
and covered with quicklime or fresh charcoal.

N.6. — Carbolic acid is highly poisonoui.

These rules are on the whole both good and practical,
though it might be possible to point oat some that are
not quite equal to the others. The decided statement about
the uselessness of placing vessels containing disinfectants
about in a room, with the hope of purifying or disinfecting
the atmosphere, was a very necessary one. We doubt how-
ever if such prominence should have been given to sulphate
of iron, which has little claim to be anything better than a
deodorant, and when such an unmanageable agent as chromic
acid was mentioned, there seems to be no good reason for not
mentioning corrosive sublimate, which is both cheap and of
proved efficiency. Again, we doubt the practicability of
saturating carpets or curtains with benzine; the expense
would be excessive, and besides if sulphurous acid or chlorine
is dry it has little effect on colours, and so even such large
articlas may be subjected to the action of these agents, by
hanging them up in the room in which one of these gases is

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i



414 Australian Medical Jov/maL Sift. 15, 1884

evolved About the use of dry heat, too, it may be a
•question wliether exposure for even "an hour at least," to
a temperature of 230** F., can be absolutely depended on to
kill dried germs. While making these remarks by way
•of suggestion, we must add that the memorandum will
be found a useful guide to the practice of disinfection.



^jeijijefccr^



CLINICAL DEMONSTRATIONS ON OPHTHALMIC
SUBJECTS.

Bj J. R. WoLPB, M.D., F.R.aS.E.

This work consists of four essays, dealing with transplantation
of conjunctiva from the rabbit to the human subject, transplantation
of skin-flap from distant parts without pedicle, operation for the
cure of detachment of the retina, and tubercle of the iris and
ciliary body.

Dr. Wolfe, as is known to most of those interested in ophthalmic
surger]^, has long advocated making use of the conjunctiva of the
rabbit for transplantation in symblepharon, and judging from the
details of the three cases which he reports, he has heen rewarded
with remarkable success. He observes (p. 8), << All the contrivances
resorted to by surgeons to separate the lids from the globe have
proved a mere waste of ingenuity — ^have, in other words, ended in
disappointment." This is perhaps a little too forcibly stated, as
«ome favourable results have been at least occasionally obtained by
Mr. T. P. Teale's and analogous methods of transplanting conjunc-
tiva ; but experience has conclusively demonstrated the inutility of
merely separating the lids from the globe and inserting shields of
glass, metal, or other material ; there must also be a transplanta-
tion of conjunctiva, sometimes however it can be borrowed from
the affected eye itself. The mode of preparing and fixing the
rabbit's conjunctiva is described. The formation of new eyelids,



Online LibraryReale accademia delle scienze di TorinoThe Australian medical journal, Volume 6 → online text (page 41 of 58)