Cases of liver and gall-duct surgery / by John D. Malcolm.

  • Malcolm, John David.
Date:
[1895]
Catalogue details

Licence: Public Domain Mark

Credit: Cases of liver and gall-duct surgery / by John D. Malcolm. 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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    and the total bulk in fluid measure when they were dried and well shaken down was a little over an ounce. Besides those counted there were innumerable very small calculi which came freely through the aspirating needle and were seen as mere specks in the bile. Convalescence was very smooth. .The temperature rose to 101° F. before midnight of the day of operation, and it was never above 100° in the vagina after the second day. The highest pulse was 80. Thei’e was at first a copious discharge of bile, but after a fortnight it diminished greatly. The tube was removed on the twenty-fifth day. There was very little discharge after this, and the patient went home a month after the operation ; but it was about three weeks longer before the wound finally healed. The patient gradually regained her strength. I last saw her at the end of August, 1893, 13 months after the operation. ' She was then about to start for Canada, having been detained by the illness and death of a son, which had entailed on her much work and worry, but there had been no recurrence of gall- stone symptoms. [Since this paper was read 1 have heard from the patient that she continues well.] Case 7. Operation for gall-stones.—The next case was that of one of Mr. Alban Doran’s patients, but he has kindly permitted me to record it here, as I had charge of the case and performed an operation on the patient during his temporary absence. “ A woman, aged 42 years, a widow, came under my care at the Samaritan Free Hospital in October, 1893. She was a laundress, tall and once strong. On August 4th, 1893, she lifted an unusually heavy basket of linen. Three days later she was seized with abdominal pains, vomiting, and sweating. There was no jaundice. After resting three weeks in bed she went to work. Early in September another attack of pain came on, without sickness. Dr. Nias and Mr. Arathoon attended her at the Marylebone General Dispensary. She recovered from the pain, and I saw her on October 10th. There was a swelling in the region of the gall-bladder. On October 14tli a severe attack of pain occurred. On the 19th the patient was admitted. An attack occurred on October 22nd. The swelling grew larger, and the skin over it became reddened. In a few days the pain went away, but the redness increased, and the integuments were cedematous. I suspected obstruction of the gall-ducts. Mr. Kuowsley Thornton, who kindly examined the patient, was of a similar opinion, though he thought that possibly the swelling might be an inflamed hydatid cyst. On November 7th I, assisted by Mr. Malcolm, made an. exploratory incision along the outer border of the right rectus over the middle of the swelling. I found under the muscular layers an irregular cavity containing pus, clots, and shreds of broken-down tissue. There was hardness behind the cavity. A pocket trocar and cannula was thrust into the hard surface, but nothin0- oozed out nor did the trocar touch anything that felt like a calculus I then believed that the cavity migbt represent an abscess in the abdominal walls, developed early in August after a bruise from a heavy clothes-basket. I washed out the cavity with iodine water and drained it I did so, believing that if the disease was simple abscess it would thus be cured ; if it were more than abscess further operation could be more safely undertaken when the cavity was rendered aseptic. For a few days the patient seemed to be better. I then, on account of severe indisposition, left her in Mr. Malcolm’s charge.”* At this time the patient was not jaundiced. The abscess gradually contracted until * Mr. Doran has kindly written for me the portions in inverted commas.