Report of clinical cases treated during the session 1859-60 in the surgical wards of the Royal Infirmary under the care of James Spence.

Date:: 1861

Credit: Report of clinical cases treated during the session 1859-60 in the surgical wards of the Royal Infirmary under the care of James Spence. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$caused by the bursting of a pistol, part of which had gone through first and second metacarpal bones, fracturing these, and destroying soft parts entirely. Amputation of whole of thumb and forefinger, except head of metacarpal bone, which was uninjured. Cured. 4. Walter W n, mt. 35, while working in a pit, suffered a severely lacerated wound of thigh by the bursting of a large powder- flask which he held in his hand. The skin was stripped off the upper part of thigh, on its inner and anterior surfaces, for about 7 inches square; the muscles torn and charred; the common femoral was bared, and seen pulsating for several inches of its course. Mr Spence performed amputation at the hip-joint, first tying, however, the com- mon femoral where exposed, and taking one large flap from the outer and back aspects of the hip. Patient, besides having lost a good deal of blood, was much exhausted by a long journey by railway. Opiates and stimulants were administered, but he sank on the morning of the second day. No bleeding occurred after the stump was dressed. 5. Michael L n, set. 38, with enormously large spleen and the other signs and symptoms of leukaemia, had a small abscess in the leg opened. Wound continued to bleed for four days ; arrested by a compress ; afterwards sent to Medical wards. 6. Thomas M e, set. 21, by an unfortunate stroke of his sickle, nearly divided the left tendo achillis. He was afterwards sent to hospital, and had the foot retained in the slipper apparatus until union took place. 7. GeorgeN 1, set. 41, was stabbed in the lower part of abdomen with a clasp knife, producing a wound half an inch long, situated in the left lumbar region, close above the iliac crest, and two inches posterior to the anterior superior process. Bleeding per saltum, and very copiously. One artery ligatured; its other extremity, which could not be secured, was closed by pressure. Patient faint; anxious expression ; pulse 120, feeble. Ordered wine and opiates. No peritonitis ensued, and the patient made a good recovery. 8. James C x, aet. 38, received a penetrating wound of abdo- men, situated a little to the left of the mesial line, commencing just above pubes, and extending upwards for about two inches. From this opening a considerable portion (about 12 inches) of small intestine protruded. This could not be returned until Mr Spence enlarged the wound in the peritoneum, which, at first, would only admit of the point of little finger being introduced. The right epigastric artery, which lay close upon the track of the original cut, was tied above and below, and the lips of the wound being now secured by stitches, a pad and bandage were applied. There were other wounds besides this on various parts of patient’s person, all inflicted with a clasp knife. Patient was pale, faint, and anxious; pulse 88, feeble. Ordered wine and opiates. There was no injury to bladder. At the end of 24 hours peritonitis set in, and he died about 48 hours after admission. 9. Cunningham G 1, set. 17, fell from a ladder 40 feet high, n$