Now! Then! 2024! - Yorkshire On This Day

Excerpt

C. S., aged 25, gas-pipe layer, was admitted on September 18, 1866. On admission he was suffering from very acute rheumatism, both muscular and arthritic, and there was considerable dyspnoea and oppression. On examination the pericardium was found to be much distended with fluid, and there was acute pain in the region of the heart. A blister over the heart was ordered, and full alkaline and opiate treatment. On September 19 Dr Allbutt was hastily summoned to see the patient, who was found sitting up in bed, with his elbows on his knees, struggling for breath. He was covered with a cold copious sweat. The area of pericardial dullness was found to be considerably increased, occupying nearly the whole of the left chest in front. There was perfect resonance all over the left lung behind. The patient was clearly at the point of death, and Dr Allbutt determined at once to ask Mr Wheelhouse to tap the pericardium. The extent of the pericardial dullness was now accurately defined, and the probable position of the apex of the left ventricle and of the auricle was as far as possible ascertained. Mr Wheelhouse determined to open the sac half an inch from the sternum on the left side and opposite the upper margin of the costal cartilage of the fifth rib. He passed in a fine trocar, inclining it slightly upwards and inwards, so as to enter, if possible, opposite the centre of the left ventricle. He pushed it onwards until he could distinctly feel the movements of the heart with the instrument; and then, sheathing the point, he pushed the canula well up to the heart until he could both feel and see the impulse. The trocar was then wholly withdrawn, and the fluid allowed to escape. This it did in a steady stream at first, which soon subsided into a saltatory flow coincident with the heart’s contractions. During the operation the patient gradually obtained relief, and after the canula was withdrawn, the bed rest was removed, and he was able to lie down. Dr Allbutt pointed out how strong an instance was to be seen in this case of the unity of the medical art in all its aspects. He said that no case could show more clearly how necessary it is for the physician to have a useful knowledge of the resources of the surgeon, and for the surgeon to be able at once to perceive the wants of the physician. Nothing, in his opinion, was more to be regretted than the unfortunate division of these two great departments of the healing art, by which a mere arrangement of convenience has been placed on the level of a real distinction, thereby encouraging at the very outset of a student’s career a narrowness of thought and an incompleteness of education, which is most mischievous to the best interests of the profession.

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To facilitate reading, the spelling and punctuation of elderly excerpts have generally been modernised, and distracting excision scars concealed. My selections, translations, and editions are copyright.

Abbreviations:

• ER: East Riding
• GM: Greater Manchester
• NR: North Riding
• NY: North Yorkshire
• SY: South Yorkshire
• WR: West Riding
• WY: West Yorkshire

Comment

Comment

This theme remained with him: “Physic,” he said in 1904 “is sterile in proportion to its divorce from surgery” (Rolleston 1929).

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Original

This rare operation was lately performed at the Leeds Infirmary in a case of acute rheumatic pericarditis, and with perfect success.
Dr. Allbutt, in his remarks upon this case, compared the operation as performed with a canula by Mr. Wheelhouse to that with a bistoury as recommended by Trousseau and others. He expressed a very decided opinion in favour of the canula. He also pointed out that in the present case one tapping was found to be sufficient, and that irritant injections were not required. He added that, had it been found necessary to repeat the operation, he should have advised the injection of an iodised solution.
Dr. Allbutt, in concluding his remarks, pointed out how strong an instance was to be seen in this case of the unity of the Medical Art in all its aspects. He said that no case could show more clearly how necessary it is for the Physician to have a useful knowledge of the resources of the Surgeon, and for the Surgeon to be able at once to perceive the wants of the Physician. Nothing, in his opinion, was more to be regretted than the unfortunate division of these two great departments of the healing art, by which a mere arrangement of convenience has been placed on the level of a real distinction, thereby encouraging at the very outset of a student’s career a narrowness of thought and an incompleteness of education, which is most mischievous to the best interests of the Profession.
For the notes of the following case we are indebted to Mr. George Thompson, Clinical Clerk:-
C. S., aged 25, gaspipe layer, was admitted into No. 4 ward, under the care of Dr. Allbutt, on September 18, 1866. On admission he was suffering from very acute rheumatism, both muscular and arthritic, and there was considerable dyspnoea and oppression. On examination the pericardium was found to be much distended with fluid, and there was acute pain in the region of the heart. A blister over the heart was ordered, and full alkaline and opiate treatment.
On September 19, about 11.36 p.m., Dr. Allbutt was hastily summoned to see the patient, who was found sitting up in bed, with his elbows on his knees, struggling for breath. He was covered with a cold copious sweat. The area of pericardial dulness was found to be considerably increased, occupying nearly the whole of the left chest in front. There was perfect resonance all over the left lung behind. The patient was clearly at the point of death, and Dr. Allbutt determined at once to ask Mr. Wheelhouse to tap the pericardium. Mr. Wheelhouse was, therefore, called in to see the patient.
The extent of the pericardial dulness was now accurately defined, and the probable position of the apex of the left ventricle and of the auricle was as far as possible ascertained. Mr. Wheelhouse determined to open the sac half an inch from the sternum on the left side and opposite the upper margin of the costal cartilage of the fifth rib. He passed in a fine trocar, inclining it slightly upwards and inwards, so as to enter, if possible, opposite the centre of the left ventricle. He pushed it onwards until he could distinctly feel the movements of the heart with the instrument; and then, sheathing the point, he pushed the canula well up to the heart until he could both feel and see the impulse. The trocar was then wholly withdrawn, and the fluid allowed to escape. This it did in a steady stream at first, which soon subsided into a saltatory flow coincident with the heart’s contractions. The fluid consisted of a pale-pink coagulable serum. On the whole, about two and a half or three ounces escaped. During the operation the patient gradually obtained relief, and after the canula was withdrawn, the bed rest was removed, and he was able to lie down. The breathing was now only 36 per minute, and he was able to speak a few words and express that he felt relieved. The pulse had lost its rapid and struggling character, and could easily be counted, its number being about 110. The area of dulness was very decidedly lessened, but it was not thought well to tease the patient again with a minute examination. Mr. Coleman was good enough to sit up all night with the patient, who passed it in tolerable comfort, though there were several threatenings of syncope, which were warded off by large and repeated doses of brandy; all other medicines were omitted.
Next day the cardiac dulness had not increased. On the evening of this day (September 20) the breathing again became more laboured, and considerable delirium came on. Another large blister was placed over the region of the heart, and half a drachm of liquor morphiae was given; ten drops were ordered to be repeated every six hours. A comfortable night was thus passed.
On the whole, the patient may be said to have steadily improved from this time, and on October 13 he was discharged cured. The pericardial dulness on his discharge was little, if any, beyond the normal extent. There was a loud blowing systolic murmur heard over the apex.

873 words.

Tags

Tags are assigned inclusively on the basis of an entry’s original text and any comment. You may find this confusing if you only read an entry excerpt.

• Allbutt, Clifford (1836-1925) (22), Dewsbury-born physician (Leeds Infirmary 1861-89), inventor of the clinical thermometer, Regius Professor of Physic at the University of Cambridge 1892-his death ·
• Armand Trousseau (2) ·
• Arthritis (1) ·
• Cannula (1) ·
• General practitioner (2) ·
• Heart (1) ·
• Leeds General Infirmary (13) ·
• 📌Leeds (235) ·
• Medical education (1) ·
• Medicine (8) ·
• Pericarditis (1) ·
• Pericardium (1) ·
• Rheumatism (3) ·
• Rheumatoid arthritis (1) ·
• Scalpel (1) ·
• Surgery (5) ·
• Trocar (1) ·
• Wheelhouse, Claudius Galen (1826-1909) (1), Leeds-based general practitioner, surgeon and photographer ·

All tags.

Similar

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• 14 January 1867: Clifford Allbutt of the Leeds Infirmary writes to the Medical Times praising his five-minute Celsius pocket clinical thermometer
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• 16 February 1886: Clifford Allbutt explains to James Crichton-Browne why three years later he was to trade a lucrative medical consulting career in Leeds for a less well paid Commissionership in Lunacy in London
• 9 July 1903: Clifford Allbutt, late of Leeds, tells a Bradford sanitary congress to reject the view that (preventive) medicine is antagonistic to the survival of the fittest
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• 17 March 1854: Samuel Jackson of Green Hammerton (Harrogate) writes to his 18-year-old son, John Hughlings Jackson, a student at York Medical and Surgical School
• 25 June 1808: Dr Campbell, lodging above a chandler’s on Leeds Kirkgate, advertises the results of his treatment of anorexia, Napoleonic wounds, and all other known illnesses