On obstruction of the inferior vena cava, with cases / by William Henry Battle.

  • William Henry Battle
Date:
[1888]
Catalogue details

Licence: Public Domain Mark

Credit: On obstruction of the inferior vena cava, with cases / by William Henry Battle. 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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    charge, of small quantity, was extremely offensive. He com- plained of great pain, and was in a very irritable condition, sleeping badly. The left foot had been removed at the ankle by Perogoff's operation, and beyond a slightly cedematous condition, the stump appeared healthy. Examination of the thighs and trunk showed greatly dilated and tortuous veins passing from the thighs up to the chest, larger on the right than on the left side, some of them being as large as a finger, gradually diminishing in size until they reached the level of the third rib, when they could no longer be distinctly traced, and it appeared probable that they gradually emptied their contents into the intercostal veins. The veins in each lower extremity were much larger than normal. No tumour could be detected in the abdomen, and the liver and spleen appeared normal; there was no evidence of ascites. The chest was well developed, the lungs apparently normal but emphysema- tous. The heart was enlarged, but the sounds were normal. Pulse feeble. There was no albuminuria. Skin and hair dry. Temperature normal. Charcoal and linseed poultice was ordered; changed on May 20th to carbolic oil dressing. Stimulants and opium were also ordered on that date. It was not until July 11th that the toes had separated, leaving the four outer metatarsal bones bare and projecting, with ligaments still adherent but in a sloughing condition; the granulating surface was commencing to skin over, and was extremely sensitive to touch. On August 14th the projecting pieces of bone were removed with forceps; this operation caused extension of gangrene on the outer side of the foot, the small slough not separating completely until September 2nd. By October 19th the condition of the right foot had not improved to any great extent; although the sloughs had separated on the dorsum of the foot, gangrene appeared to be extending very slowly along the sole. Up to this date the temperature had been almost normal both morning and evening, excepting on the evening of May 31st, when it rose to 100'6°. Mr. Sydney Jones decided to remove the foot, and per- formed Syme's amputation (October 19th) with antiseptic