At the end of a month, no trace of the tumour was discoverable. The young lady had carefully increased her nutriment and exercise without inconvenience, and all remedial measures were now omitted.
During the months of December and January last, she remained free from any inconvenience from the tumour, and the union of the parietes of the artery was therefore regarded as complete.
In the above account, we have only to regret that the state of the artery above the tumour, before and after the treatment, had not been noticed. Perhaps this may be supplied by Dr. Souchier, in the commentary, which he proposes publishing on the above case.
48. Protrusion and Wound of the Stomach.—Mr. Travers, in the Edin. Journ. of the Med. Sciences, for Jan. 1826, relates, that a female, aged 53, and the mother of nineteen children, inflicted on herself a wound in the abdomen, three inches in length, and in a transverse direction. When admitted into St. Thomas' Hospital, at the expiration of six hours, the greater part of the large curvature of the stomach, the arch of the colon, and the entire large omentum, were protruded and strangulated in the wound. The omentum was partially detached from the stomach, which organ was wounded in two places; one, half an inch long through the peritoneal coat; the other, a perforation of all the coats, admitting the head of a large probe, and giving issue to a considerable quantity of mucus. Patient faint; pain slight; pulse 102, and irregular; some hiccup. A silk ligature was placed round the small puncture in the stomach, and the displaced viscera returned, after enlarging the external wound. This last was closed by the quill suture. Warm fomentations and abstinence from food and drink enjoined. 2nd day, some re-action; had been sick in the night from some drink given; is free from pain; pulse 120; pain on pressure; an enema ordered. Evening, a dose of castor oil, and twenty leeches to the abdomen. 3d, much fever; V.S. ℥xviij. and 20 leeches to the abdomen; bowels not opened. 4th day, two stools; pulse 98; tension of the abdomen; three more stools during the day. 5th, sutures removed; wound united, except at its right extremity, where a serous fluid is discharged in considerable quantities. On the 6th day, was allowed food, and on the 23d of Dec., about two months after the accident, was discharged cured.
49. Œsophagotomy.—This operation has been objected to, not only on account of the dangers attending its performance, but from the alleged difficulty of promoting the union of the wound in the œsophagus; as it is seldom at rest, the lips of the incision being often separated, and the mucous coat adhering with difficulty under any circumstances. Hence we are induced to notice the following case, in which the operation was successfully executed on an inferior animal, by M. Felix, a veterinary surgeon of Bergelac. The account is published in the Feb. No. of Le Propagateur des Sci. Med.
A Cow was threatened with immediate suffocation from the lodgment of a potato in the œsophagus. It had shortness of respiration, an incapacity of swallowing even its saliva, which flowed from the mouth, was in great distress, and covered with a cold sweat. Being properly secured in a horizontal posture, an external incision was made on the inside of the sterno-mastoid muscle, and a cautious dissection practised until the tumour was completely exposed. The œsophagus was divided by "an incision extending the whole length of the foreign body, which was extracted without any force, which is almost always fatal. I immediately made two close sutures; and also two others in the skin, on each side, adapting to them two pieces of packthread, more easily to fix the dressings. I dressed the wound with brandy, filling the opening with hemp soaked with brandy." The animal was kept on very little food or drink. On the third day the wound was dressed for the first time, and a digestive ointment applied.
In the course of the 2nd week, the cicatrization of the œsophagus occurred; the part was dressed with lint; and by the 20th day after the operation, the animal was quite restored.
This case would have been more useful, if more precision had been employed in describing the dressing and subsequent treatment of the wound. It would seem that the sutures were passed through the parietes of the œsophagus only, and that the external wound was kept open by being filled with tow. Certainly, union by the adhesive inflammation ought to have been attempted in all parts of the wound; but whether sutures in the œsophagus are advantageous, or whether the uniting bandage be preferable, is not so easily determined. In the two cases described in 3d vol. of the Mem. de l'Acad. de Chirur. the uniting bandage was alone employed, and with success.
50. Retention of Urine, caused by a Stricture of the Urethra, relieved by a forcible but gradual Injection.—The editor of Le Propagateur des Sci. Med. in the No. for Feb. 1826, introduces the following case, by observing, that it reflects great honour on M. Amussat, and that his discovery merits the greatest praise. M. D... aged 70 years, of a plethoric constitution, had suffered about 30 years before from three attacks of gonorrhœa; since which period he has had a difficulty in urinating, and can never discharge more than one or two ounces of urine at a time.
At eight o'clock, P. M. of the 1st of Feb. he tried to urinate, but could not succeed. He suffered great pain. Pulse agitated; face flushed; belly swelled, and globular at its inferior part; the subcutaneous abdominal veins distended, and the penis in a state of semi-erection. All attempts to urinate were painful and ineffectual. At ten o'clock, A. M., on the 2nd, M. Amussat visited him, and passed a bougie. This was arrested by a contraction near the bulb of the urethra, and caused the discharge of some blood. No urine had been passed for 14 hours, while ordinarily he urinated 12 or 16 times through the night. The obstruction was so great, that none of the usual means of relief remained, except the forcible introduction of the catheter, or the puncture of the bladder. M. Amussat resorted to the following plan which he had devised, and which completely succeeded. He injected warm water forcibly, but gradually, into the urethra, which, dilating the orifice of the stricture, forced backwards the thickened mucus which had obstructed it. As soon as the liquid injection met the urine, the patient cried out that he was saved, and immediately was able to urinate as formerly. At two trials, he discharged nearly two pints of thick urine. There was no return of the retention, the patient continuing well.