Some cases illustrating the surgery of the spleen / by D'Arcy Power.

  • Power, D'Arcy, 1855-1941.
Date:
[1908?]
Catalogue details

Licence: In copyright

Credit: Some cases illustrating the surgery of the spleen / by D'Arcy Power. 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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    her pulse being 96 and of good volume after she had been put to bed. From the time of the operation until the fifth day the patient presented evidence of some irritation of the sympa- thetic nervous system in a curiously agonised expression, of which she was quite unaware, reminding one of those who suffer from abdominal cancer or of commencing tetanus. The facies seemed to be due to a slight tonic contraction of the platysma and its connections, but in no other way was there evidence of sympathetic disturbance, and the patient was quite cheerful. She remained comfortable for many days, with a normal temperature and a pulse of 64. The stitches were removed on the seventh day, when the wound was healed, except for a small stitch abscess at the lower part, which had disappeared on the ninth day. The patient progressed satisfactorily until September 28— the twenty-second day after the operation—when her tempera- ture began to rise. Two days later she was suddenly seized with intense pain in her left side, the action of her heart and diaphragm were impeded, and she was thought to be dying. The symptoms, which were alarming for a time, passed off spontaneously and were succeeded by a similar attack two days later. They proved to be the heralds of a subdiaphragmatic abscess v?hich was opened by an incision carried parallel to the scar of the original wound and 2 inches to its outer side. There was free bleeding for several days afterwards, apparently from an artery at the bottom of the abscess cavity; pus was discharged by the bowel, and a faecal fistula formed. The fistula soon closed, leaving only a small sinus through which silk ligatures came away from time to time. The general con- dition of the patient remained good; she increased in weight, her temperature became normal, and she went home on October 18—the forty-second day after the operation. The patient came under my care again during the month of November 1901—more than two years after her spleen had been removed—for the cure of an ulcer of the leg. The sore was situated over the upper part of the tibia. It healed whilst she took iodide of potassium, and ceased to heal when this drug was discontinued. She appeared at this time to be well nourished, of a ruddy complexion, quite cheerful and able, in every way, to follow her usual occupation and enjoy her life. The original line of incision through which the spleen was removed was almost imperceptible, but there was a depressed scar at the point where the faecal fistula had discharged itself, and to this point VOL. XLIV. a
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