Abrams' method of treatment in aneurysms / by Albert Abrams.

Albert Abrams

Date:: [1914?]

Credit: Abrams' method of treatment in aneurysms / by Albert Abrams. Source: Wellcome Collection.

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$7 MeEpicaL JOURNAL — Stlemorands : MEDICAL, SURGICAL, OBSTETRICAL. GASTRO-INTESTINAL HAEMORRHAGE IN A NEWBORN INFANT. I was much interested in reading in the Journat of April 29th the report of Dr. Mills’s case of gastro-intestinal haemorrhage (melaena neonatorum), having seen a similar case two days before, though, I am happy to say, the result was more fortunate. The symptoms were almost identical, the haemorrhage coming on thirty-six hours after birth; the labour was normal (second confinement), and not unduly delayed—there was no interference. The parents were healthy. After birth the child took the breast well, but thirty-six hours afterwards began to vomit bright blood, and also pass blood and clots very frequently from the bowel. It became very blanched with very cold extremities, and appeared to be dying of collapse. Brandy was rubbed on the gums. She was kept quiet and warm, and gradually revived. In twelve hours she was sleeping comfortably, her colour was better, and she began to take the breast again; the motions after twenty-four hours were again normal, and without any trace of blood, and vomiting had not recurred. The interest of this case is chiefly in the rarity of the disease, and in the recovery of the child, the mortality in these cases being about 60 per per cent. What was particularly remarkable was the enormous quantity of blood passed (fifteen cloths saturated) and the quick recovery after such a loss. There were no symptoms of ulcer of stomach, or duodenum, before or after the haemorrhage, and it was too sudden for capillary oozing. One must attribute the cause to embolism of the umbilical vein near the liver, extending into its branches for some distance (Landau). There was no evidence that the blood came from the mother’s breast; there was no jaundice. Budleigh Salterton. Henry F. Sempre. SEVERE INJURY OF HAND: OPERATION: RESULT. Tur following case seems worth recording, both on account of the unusual nature of the injury and because of the result of treatment, in circumstances which at first did not appear very promising. : The patient, a farm labourer, aged 25, was admitted to the Leominster Cottage Hospital on December 28th, 1910, having had his right hand caught in a truss binder. Stateon Examination.—There was a lacerated transverse wound on the dorsum of the hand. A comminuted fracture of the index- metacarpal bone was also present. Hanging free out of the wound were the whole lengths of the extensor tendons of the index and middle fingers, a small portion of its muscular belly being attached to each tendon. The machinery had evidently gripped the tendons on the dorsum of the hand, and the ‘‘ drag’”’ had caused them to rupture high up in the forearm, and to be pulled downwards in their sheaths, and out at the wound. Treatment.—Under an anaesthetic the wound was thoroughly cleansed. A loose fragment of the index-metacarpal was removed. Reposition, am sztu, of the tendons was out of the question, owing to their lacerated and dirty condition. They were therefore cut off short, about the level of the wrist. An incision was then made upwards for about 4 inches from the middle of the wound, skin flaps were reflected, and the extensor of the ring: finger exposed. The distal cut end of the middle finger tendon was then stitched into a short longitudinal slit in the ring finger tendon. The communis tendon of the index was fixed to the ring tendon rather higher up. Lastly, the extensor indicis tendon was sutured into a slit. in the side of the middle finger extensor. Catgut sutures were used. The open sheath of the ring tendon was sutured, and the skin wounds closed, a small tube drain being inserted in the lower wound. A palmar splint was applied, fixing fingers and wrist in a position of hyperextension. gp Result.—Passive movement was begun in about a week, and active movements shortly afterwards. The splint was removed in three weeks. The hand wound had of necessity to heal partially by granulation. The patient left hospital on January 50th, 1911. In the middle of April there was almost perfect power of extension of the index and middle fingers, in spite of the scar being rather adherent. The fracture of the index- metacarpal was also firmly consolidated. In view of the septicity of the wound, and the possibility of adhesions it was thought unwise to suture the index tendons to the extensor longus pollicis tendon (and thus perhaps compromise the movements of the thumb), though this would have been a simpler procedure than was adopted. During a rather long experience of casualty work at the Leeds General Infirmary I do not recollect a similar case, and for this reason thought it of sufficient interest to record. Gorpon W. Tuomas, M.B., B.S.Lond., F.R.C.S.Eng., Hon. Surgeon to the Leominster Cottage Hospital; Late Casualty Officer, Leeds General Infirmary. PEPPERMINT OIL IN CORYZA. In the Errrome or Current Mepicau Literature of June 10th Dr. Laurens’s conclusions on the use of menthol im coryza, rhinitis, etc., are given, in which he says he con- siders that menthol is a valuable remedy in such diseases, but that it has fallen mto disrepute owing to its irritating effects on the mucous membrane. I was much interested in this, as I have been trying oleum menthae piperitae instead of menthol for coryza, and have had extremely good results from the treatment. The first case I used it in (two and a half years ago) was one of cold in the head with severe headache from pressure in the frontal sinuses, and my chief object was to try if possible to relieve the headache. Both nostrils were occluded by swelling of the mucous membrane, and a clear watery discharge was constantly running from the nose. I put a few drops of peppermint oil in a saucer, and heated it over a candle till the fumes rose, and got the patient to try to breathe this up her nose. This inhalation was kept up continuously till there was a clear passage through both nostrils, and shortly after this occurred she had a feeling. as if something broke in her head, a few drops of fluid came down her nose, and the headache disappeared. This result was so much better than I had expected that I made her continue inhaling the fumes for a couple of hours longer, and I also added a few drops of Jeyes’ fluid, as I thought it would be a useful antiseptic when volatilized. I told her when the saucer became nearly dry to add a few drops more of both, and continue the heating, so that fumes might be pretty continuously inhaled. The patient went to sleep that night with her nose free and headache I might mention that the treatment was started about 6 or 7 p.m., and stopped, I should think, between 10 and L1-p-m: i have not tried whether in other cases cure would be as quick, but have made patients continue the treatment longer, and in the early stages of colds with congested mucous membrane and watery discharge I have found it very successful. Unless too strong a sniff is taken after the passages are opened, peppermint oil volatilized in this way does not cause discomfort. The essential part of the treatment is to continue it after the nose has become clear, and not to allow the passage for air to become obstructed again for some — hours. : London, N. Ronautp T. Herpman, M.D. LATE CONCEALED POST-PARTUM HAEMORRHAGE. Mrs. A., aged 31, was confined of her eighth child on April 5th, 1911. She was attended by a midwife. Nothing abnormal noted during the puerperium or at labour. She got up on the tenth day, and went out for the first time on April 26th. She was taken suddenly ill in the street, and had to be brought home in a cab in a state of collapse. When first seen by me she was pallid and pulseless and the extremities were cold. She made no complaint of pain in the abdomen, and there was no external haemor- rhage. The uterus, enlarged and soft, reached to the level of the umbilicus. I was at a loss to account for this. Raising the legs, hot applications to the abdomen, and sipping hot water—the friends had given her about 3 oz. of brandy—revived her temporarily. I had to leave, but gave orders not to move her off the couch on which she was lying for at least an hour. She felt so much better, however, that she begged to be taken upstairs to bed; the friends did this about fifteen minutes after I had ‘left. When I saw her fifteen minutes later she was in bed in a moribund state. She died in about ten minutes. >a A limited post-mortem examination was made. ‘The distended uterus was full of dark blood clot. - . The case is one of a kind not mentioned in the text- books I have consulted. . Firm kneading of the uterus had y$

Abrams' method of treatment in aneurysms / by Albert Abrams.

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