Now! Then! 2024! - Yorkshire On This Day

Excerpt

May I now say a few words on thrombosis of the limbs in infections and septic conditions? In ordinary practice nowadays we see little of the infectious fevers, but I am thinking of days, not very long ago, when typhoid fever was frequent, and further back to a time when I had entire charge of the Leeds Fever Hospital. Thrombosis of the veins of the legs was no rare accident, less frequently of an arm; sometimes we had to deal with the far more grievous event of thrombosis in the popliteal or femoral artery. These accidents were events of convalescence, especially of the early stage of it. Now one of the first reliefs to which such a patient looks forward is to turn, or be turned, to lie upon his side, or at least to lift one leg over the other, or to turn so as to lie upon an arm. Thereupon pressure falls on a blood-vessel, slows its current, and a clot may ensue. Then and since I have given strict orders to nurses to shift such patients, or to let them shift themselves only with very careful precautions, such as the insertion of a soft pillow between the legs, and the like. By these means thrombosis of the limbs could always be prevented. As I have never seen this point of practice mentioned in any book or essay, I have ventured to quote my own experience.

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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

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Comment

Via Rolleston (Rolleston 1929).

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Original

THROMBOSIS, PULMONARY AND ELSEWHERE.
To the Editor of THE LANCET.
SIR,-We must all have read with much interest the full discussion on pulmonary thrombosis, embolism. and allied conditions, held at Liverpool on March 14th and reported by you on April 12th.
Concerning the clinical distinction between pulmonary thrombosis and embolism, I think there is rarely, if ever, any difficulty. An embolism always (?) causes instant distress, panting, dyspnoea, and often haemoptysis. Thrombosis, rapid as it may be, is gradual. A case which I witnessed a few years ago may be worth recording.
I was asked by a colleague to see with him a case of acute pneumonia in a man of middle age. It was a case of some severity, and we met two or three times until crisis having occurred normally I took my leave with words of congratulation to the patient and his friend. It was in a humorous spirit that, on bidding my medical friend good-bye, I said you will have no more need of me unless the patient gets a clot in his pulmonary artery. A day or two later (I have no notes, unfortunately) my colleague telephoned to me that all seemed well but that the patient “felt bad.” On further inquiry I was told that the pulse was 82, the respirations easy, and the temperatures normal. This seemed so reassuring that I replied that I hoped no more was the matter than a reaction from severe illness. However, in a day or two again my friend telephoned that the symptoms were still as before, but that the patient still said that he “felt bad.” I was not definitely requested to visit the patient again (he lived some distance away), and on the record given I hoped he would soon recover his strength and spirits. In another day or two the telephone gave the same message. The patient still “feels bad,” please come over at once.
On my arrival one saw at once he was ” bad.” He was sitting up in bed, not panting, but distressed. a little ashen in colour, and he had the appealing look of a man in dread. Still temperature normal, respirations not obviously hurried – say 18 to 20 – pulse of excellent quality – 82 – and heart-sounds normal. Nothing definitely abnormal to be heard in the lungs. An invalid diet was taken as usual. There was no doubt about the diagnosis of thrombosis. Carbonate of ammonia was pressed in doses as large as possible, but no hope of recovery could be given. For about two days more the patient remained much the same – no worse; then as the nurse was counting the pulse – it was still 80 and quite regular – he turned suddenly over and died, the pulse stopping on the instant under her finger. The autopsy went no farther than to reveal a dense pale clot in the pulmonary artery. During its formation the patient must have lived at least seven or eight days; while the only tell-tale was his aspect, which was unmistakable. It was something like that of angina, but there was no pain.
May I now say a few words on thrombosis of the limbs in infections and septic conditions? In ordinary practice nowadays we see little of the infectious fevers, but I am thinking of days, not very long ago, when typhoid fever was frequent, and further back to a time when I had entire charge of the Leeds Fever Hospital. Thrombosis of the veins of the legs was no rare accident, less frequently of an arm; sometimes we had to deal with the far more grievous event of thrombosis in the popliteal or femoral artery. These accidents were events of convalescence, especially of the early stage of it. Now one of the first reliefs to which such a patient looks forward is to turn, or be turned, to lie upon his side, or at least to lift one leg over the other, or to turn so as to lie upon an arm. Thereupon pressure falls on a blood-vessel, slows its current, and a clot may ensue. Then and since I have given strict orders to nurses to shift such patients, or to let them shift themselves only with very careful precautions, such as the insertion of a soft pillow between the legs, and the like. By these means thrombosis of the limbs could always be prevented. As I have never seen this point of practice mentioned in any book or essay, I have ventured to quote my own experience.
We used to read of thrombosis of the cerebral sinuses in chlorosis; I say “used to,” because for some unexplained reason chlorosis is a disappearing malady. I remember one case only of this thrombosis. I was called by a medical friend to a large Yorkshire house in consultation on a young woman in chlorosis – a “classical” case. Our opinion, both as to prognosis and cure, was hopeful and confident. Two days later the patient died, almost suddenly, of encephalic thrombosis – a mishap which was not placed to the credit either of my colleague or of myself. I think these cases were very rarely seen at any period of history.
I am, Sir, yours faithfully,
CLIFFORD ALLBUTT.
Cambridge, April 15th. 1924.

881 words.

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• 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 ·
• Leeds House of Recovery (3) ·
• 📌Leeds (235) ·
• Nursing (2) ·
• The Lancet (2) ·
• Thrombosis (1) ·
• Typhoid fever (5) ·

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Similar

• 19 October 1909: Opening a nurses’ home in Dewsbury, Clifford Allbutt describes their predecessors in the Leeds fever hospital in the 1860s
• 13 April 1915: During the wartime Serbian typhus epidemic, Clifford Allbutt recalls the open-air treatment he used in the 1865-66 outbreak in Leeds
• 19 September 1866: Consciously breaking with medical tradition, Clifford Allbutt, physician, and Claudius Galen Wheelhouse, surgeon, cooperate at Leeds Infirmary to cure a pericarditis
• 16 February 1909: Clifford Allbutt, supporting George Bernard Shaw’s proposal that medicine be socialised, gives a Yorkshire example of a physician drawn by vocation, not money
• 13 August 1877: For want of a bathroom, T. Clifford Allbutt almost loses a feverish patient
• 3 January 1915: Ex-prime minister Asquith on the Yorkshireness of his then chief whip, Percy Illingworth (Bradford), who died this day of typhoid
• 8 January 1925: Writing to Berkeley Moynihan, Clifford Allbutt recalls surgery at Leeds Infirmary in the 1860s
• 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
• 18 August 1889: Eight survivors of prostate surgery present themselves to a meeting of the BMA in Leeds
• 27 April 1924: In a letter to Edmund Gosse, Clifford Allbutt recalls the Brontës