Excision of Larynx and Part of the OEsophagus

Abstract

Surgeon and Surgeon for Diseases of thle Tlhroat, St. Tlhomas's Hospital. THE cases of suppurative pericarditis treated by incision alnd drainage-are still, according to our medical records, very few and far between. This is no doubt due to the misfortune of only successful cases generally being published, and partly explains the favourable statistics to be drawn from tlhem, as shown in my paper in the Clinical Society's Transactions, vol. xxx. The following case, although unsuccessful, is another contribution towards this very limited list: J. W., aged 4, was admitted into the East London hlospital for Childreni, Shadwell, on January I3th, I898, under the care of my colleague, Dr. Coutts. He had been well up to three weeks before, when lie took cold and complained of pain in his chest, particularly on the right side. He had a very bad cough, and there was considerable difficulty in expectorating. One week before admission he became much worse, his breathing being very rapid, with profuse sweating at night. On admission, he was very aniemic and cyanotic at times; there was no vomiting, but constipation. The cardiac area was a little increased on percussion, and the heart sounds ratherfeeble. Pulse 124; temperature, 8 P.M., I01.60. Lungs were normal on percussion anteriorly, but there was some dulness at the right base, over whicil there was a patch of tubular breathing; over both lungs mucous rdles were heard. Respirations 44 per minute. Abdomen normal. January I4th, 8 A.M.-Pulse 120; respirations 4o. Local conditions about the same. 8 P.ms.-Temperature 100.60; pulse i8o; respirations I6o. Breathing more difficult, and heart sounds not so distinct. January I5th, 8 A.m.-Temperature, 96.80; pulse, 120; respirations, 48. Sick once. Heart sounds distant and feebly heard at apex; cardiac dulness increased. There is some extension of dulness at base of right lung, and tubular breathing especially hleard about the angle of the right scapula. At 8 P.mr. the temperature was 990; pulse, 120; respirations, 52.