A clinical lecture on seven cases of perforated gastric ulcer treated by operation, with three recoveries : delivered at University College Hospital on Oct. 20th, 1896 / by Arthur E. Barker.

  • Barker, Arthur E. J. (Arthur Edward James), 1850-1916.
Date:
[1896]
Catalogue details

Licence: Public Domain Mark

Credit: A clinical lecture on seven cases of perforated gastric ulcer treated by operation, with three recoveries : delivered at University College Hospital on Oct. 20th, 1896 / by Arthur E. Barker. 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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    side and base of the right lung with deficient resonance on percussion and absence of vocal fremitus as high as the fourth rib in the nipple line. Some of my colleagues referred this to dry pleuritic rub; to me it was rather more like a fine bubbling crepitation. On the eighteenth day I felt that there must be some matter in the sub-phrenic space ; and at 10 p.m. I punctured with an aspirator needle in the eighth space in the posterior axillary line, and at a depth of two inches from the skin surface reached pus and drew off thirteen ounces of thin, pale fluid, quite sweet, and not blood-stained. This gave relief and lowered the temperature. It also caused total and immediate disappearance of the fine crepitation previously heard. The next morning the patient was better, and I thought it well to resect one and a half inches of the ninth rib opposite my puncture, stitch the phrenic and parietal pleura together, and puncture again. But though I did this in various directions I found no matter The wound was packed with iodoform gauze. The patient remained much better for the next couple of days, and on the twenty-second day I punctured again opposite the proximal end of the excised rib and at a distance of half an inch from the rib reached pus. A narrow-bladed knife was thrust along the needle and the opening was enlarged and with forceps I inserted a drain tube which slid in some three inches. About five ounces of odourless pus were thus evacuated containing white clots of lymph. I confess I am uncertain as to whether this was a sub-phrenic collection or a localised empyema lying under the base of the lung upon the diaphragm. It certainly was reached at no more than half an inch from the outer surface of the ninth rib Nor do I know any way of settling the difficulty. On removing the first thirteen ounces of pus the fine crepitation completely disappeared, which seems to me to negative a parietal friction rub and to favour the view I personally held from the first, that it was a fine mucous crepitation in compressed lung. This sound, however, reappeared the next morning over a diminished area and not so loud. The patient’s present con- dition (thirtieth day) is as follows. She takes nourishment well by the mouth ; the bowels act without enemata; the abdomen is painless, and the wound in the abdomen is clean and closing steadily ; the pulse is from 90 to 104, the respira- tion about 20, and the temperature from 100 6° at night to 99'2° in the day ; the rib wound is draining well; the patient is feeling well and is cheerful; and although it is too soon to pronounce her out of danger I think I am justified in calling