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THE LATE DR. EVAN THOMAS.
385 battalion orders that cigarettes should never be smoked by any officers or men of his regiment when on any duty whatThe examples quoted are, we believe, more or less soever. but isolated, they are valuable. Over-indulgence in smoking is harmful, and the ready-made cigarette, being cheap to buy and convenient to smoke, is an inducement to such overindulgence. To smoke it entails but little sacrifice in money or trouble.
The chronically which actpd as a predisposing cause. inflamed condition of the left appendages and the adhesions the conclusion probable that a similar condition had existed on the right side before infection with the typhoid bacillus. On admission the patient denied any previous illness, but when the question of operation was discussed at her bedside she feared that her uterine appendages might haveto be removed.
Irendered
____
INTESTINAL PERFORATION IN ENTERIC FEVER SIMULATED BY PERFORATION OF A PYOSALPINX.
____
THE
LATE
DR.
EVAN
THOMAS.
ONCE
again the risks to which the profession is exposed in the carrying on of its work are exemplified in the death of -’ Evan Thomas of Newbridge. He contracted septicsemia AT a meeting of the Societe Medicale des Hôpitaux of Dr. Paris M. L. Galliard and M. Chaput have reported re-‘while doing a post-mortem examination on Jan. 8th, and < on Jan. 15th. He was educated at University College, cently a case of enteric fever in which intestinal perfora- died tion was simulated by a rare complication-perforation of aAberystwith, and University College, London, and held the pyosalpinx due to the typhoid bacillus. A woman, agedM.D., B.S. Lond. as well as the diplomas of the Conjoint 30 years, was admitted into hospital on May 28th, 1909. Board. He was formerly obstetric assistant to Dr. Herbert For three weeks she had complained of pain in the back andSpencer at University College and also held resident posts lassitude, but had taken to bed only for four days. Forat Highgate Infirmary and Hanwell Asylum. He was a - some days there had been diarrhœa. On admission theretypical example of what the surgeon should be-thorough were headache, stupor, furred tongue, a temperature ofin his work and keen on it, very conscientious, and kind 101.8° F., and a rapid pulse. The spleen was slightlyand sympathetic to his patients. He was a justice of the enlarged. The abdomen was tympanitic and there waspeace for the county of Monmouth. His remains were laid .gurgling in the right iliac fossa. Lenticular rose spots to rest at his birthplace, the village of St. Dogmaels, near were present. Typhoid fever at the eighth day wasCardigan. We offer our sympathy to his widow and two
diagnosed. The evening temperature was 103°. On the children. 29th the temperature ranged from 104° to 104.7°, and the A FRENCH NAVAL SANATORIUM. The case ran an ordinary course, serum test was positive. and on June 12th the temperature had fallen to 990 and conWHILE we are still hesitating how to deal with the tubervalescence seemed to be imminent. But on the 13th the culous cases discharged from the Army and Navy the French patient complained of abdominal pains and there was slight Navy has opened a sanatorium at Brest for sailors and dockmeteorism. On the night of the 15th there were great yard workmen. In that large harbour there is an island, abdominal pain, nausea, and vomiting. When she was seen Treberon, which for some 200 years has been alternately a on the following morning the respiration was rapid, the eyes hospital and a quarantine station. It has a warm sunny The pulse was exposure, sloping gently from its northern cliffs to its were sunken, and the features were drawn. In May, 1909, Admiral Boue de 160 and small and the temperature was 104.3°. No urine southern sandy shore. had been passed. The abdomen was not tympanitic and Lapeyrere, the French Minister of Marine, then maritime showed no region specially tender to palpation, no swelling, prefect at Brest, was struck, when inspecting it, with the and no resistance even in the right iliac fossa. Vaginal promise it gave of usefulness as a sanatorium, and directed examination revealed nothing abnormal. Intestinal perfora- that cases should be sent there from the naval hospital at tion was suspected and laparotomy was performed under Brest by way of experiment. Accordingly, in June, 23 cases, spinal anaesthesia induced by novocaine, as chloroform would all with tubercle bacilli in their sputa, landed there under the not have been well borne. A little turbid fluid was found in care of Dr. Cazimian of the French Navy, who reports his The small intestine was examined experiences in the Archives de Médecine Navale for December, the peritoneal cavity. He spent three throughout its whole length but no perforation could be dis- 1909, in a very interesting paper. covered. There was only congestion of the lower part of the months on the island ; his staff was a steward, a ileum. The cascum and appendix were normal. On exploring good cook, and ten male nurses. The patients at most the pelvis pus and a greatly enlarged right Fallopian tube numbered 40 (64 passed through the sanatorium) and the were found. The left uterine appendages were sclerosed and principles of their treatment were fresh air, rest, and slight surrounded by adhesions. The uterus and right appendages overfeeding. In the barrack-rooms of the old quarantine were removed. Lavage of the peritoneum was not performed, station each patient had at night 2500 cubic feet of air space, but only dry wiping. No arrangement for drainage was and all the windows were kept open on the side away from made as the large communication between the vagina and the wind. Then by day each man took the stretcher given the peritoneal cavity ensured this. The patient’s condi- him on his arrival and put it in a sheltered place, under a tion after the operation was good, the evening tem- shed in wet weather or out among the trees when it was fine, On the 23rd the sutures were and thereon lay down and rested for hours. These men had perature being 101 - 60. removed from the abdominal wound. It had suppurated all come from treatment in the naval hospital, yet the and its edges were gangrenous at the level of the muscular added therapeutic influence of sanatorium treatment on the The evening temperature was 102°. 6bres. The wound island produced marked improvement. Their weight generally cicatrised without further incident and the patient left went up steadily during the first fortnight; they lost their hospital in good general health at the end of July. Exami- fever, sweats, and sleeplessness ; they gained appetite and nation of the specimen removed showed a much enlarged strength, and the pulmonary signs improved. Of 23 men Fallopian tube full of pus. On its posterior wall was a who had left the island when the reporter was relieved, only circular perforation with violaceous edges. There was no four had gained no benefit, but they, when they had arrived, lesion of the uterus. The pus contained the typhoid had each two or more lobes attacked ; all the rest (19) were The sanaM. Galliard and M. Chaput improved, and four are even reported cured. bacillus in pure culture. it seems likely to be but was torium the this unusual localisation of that only experimental, typhoid - suggested Dr. Cazimian >bacillus was due to previous lesions of the Fallopian tube, kept open at any rate through the winter. __
The chronically which actpd as a predisposing cause. inflamed condition of the left appendages and the adhesions the conclusion probable that a similar condition had existed on the right side before infection with the typhoid bacillus. On admission the patient denied any previous illness, but when the question of operation was discussed at her bedside she feared that her uterine appendages might haveto be removed.
Irendered
____
INTESTINAL PERFORATION IN ENTERIC FEVER SIMULATED BY PERFORATION OF A PYOSALPINX.
____
THE
LATE
DR.
EVAN
THOMAS.
ONCE
again the risks to which the profession is exposed in the carrying on of its work are exemplified in the death of -’ Evan Thomas of Newbridge. He contracted septicsemia AT a meeting of the Societe Medicale des Hôpitaux of Dr. Paris M. L. Galliard and M. Chaput have reported re-‘while doing a post-mortem examination on Jan. 8th, and < on Jan. 15th. He was educated at University College, cently a case of enteric fever in which intestinal perfora- died tion was simulated by a rare complication-perforation of aAberystwith, and University College, London, and held the pyosalpinx due to the typhoid bacillus. A woman, agedM.D., B.S. Lond. as well as the diplomas of the Conjoint 30 years, was admitted into hospital on May 28th, 1909. Board. He was formerly obstetric assistant to Dr. Herbert For three weeks she had complained of pain in the back andSpencer at University College and also held resident posts lassitude, but had taken to bed only for four days. Forat Highgate Infirmary and Hanwell Asylum. He was a - some days there had been diarrhœa. On admission theretypical example of what the surgeon should be-thorough were headache, stupor, furred tongue, a temperature ofin his work and keen on it, very conscientious, and kind 101.8° F., and a rapid pulse. The spleen was slightlyand sympathetic to his patients. He was a justice of the enlarged. The abdomen was tympanitic and there waspeace for the county of Monmouth. His remains were laid .gurgling in the right iliac fossa. Lenticular rose spots to rest at his birthplace, the village of St. Dogmaels, near were present. Typhoid fever at the eighth day wasCardigan. We offer our sympathy to his widow and two
diagnosed. The evening temperature was 103°. On the children. 29th the temperature ranged from 104° to 104.7°, and the A FRENCH NAVAL SANATORIUM. The case ran an ordinary course, serum test was positive. and on June 12th the temperature had fallen to 990 and conWHILE we are still hesitating how to deal with the tubervalescence seemed to be imminent. But on the 13th the culous cases discharged from the Army and Navy the French patient complained of abdominal pains and there was slight Navy has opened a sanatorium at Brest for sailors and dockmeteorism. On the night of the 15th there were great yard workmen. In that large harbour there is an island, abdominal pain, nausea, and vomiting. When she was seen Treberon, which for some 200 years has been alternately a on the following morning the respiration was rapid, the eyes hospital and a quarantine station. It has a warm sunny The pulse was exposure, sloping gently from its northern cliffs to its were sunken, and the features were drawn. In May, 1909, Admiral Boue de 160 and small and the temperature was 104.3°. No urine southern sandy shore. had been passed. The abdomen was not tympanitic and Lapeyrere, the French Minister of Marine, then maritime showed no region specially tender to palpation, no swelling, prefect at Brest, was struck, when inspecting it, with the and no resistance even in the right iliac fossa. Vaginal promise it gave of usefulness as a sanatorium, and directed examination revealed nothing abnormal. Intestinal perfora- that cases should be sent there from the naval hospital at tion was suspected and laparotomy was performed under Brest by way of experiment. Accordingly, in June, 23 cases, spinal anaesthesia induced by novocaine, as chloroform would all with tubercle bacilli in their sputa, landed there under the not have been well borne. A little turbid fluid was found in care of Dr. Cazimian of the French Navy, who reports his The small intestine was examined experiences in the Archives de Médecine Navale for December, the peritoneal cavity. He spent three throughout its whole length but no perforation could be dis- 1909, in a very interesting paper. covered. There was only congestion of the lower part of the months on the island ; his staff was a steward, a ileum. The cascum and appendix were normal. On exploring good cook, and ten male nurses. The patients at most the pelvis pus and a greatly enlarged right Fallopian tube numbered 40 (64 passed through the sanatorium) and the were found. The left uterine appendages were sclerosed and principles of their treatment were fresh air, rest, and slight surrounded by adhesions. The uterus and right appendages overfeeding. In the barrack-rooms of the old quarantine were removed. Lavage of the peritoneum was not performed, station each patient had at night 2500 cubic feet of air space, but only dry wiping. No arrangement for drainage was and all the windows were kept open on the side away from made as the large communication between the vagina and the wind. Then by day each man took the stretcher given the peritoneal cavity ensured this. The patient’s condi- him on his arrival and put it in a sheltered place, under a tion after the operation was good, the evening tem- shed in wet weather or out among the trees when it was fine, On the 23rd the sutures were and thereon lay down and rested for hours. These men had perature being 101 - 60. removed from the abdominal wound. It had suppurated all come from treatment in the naval hospital, yet the and its edges were gangrenous at the level of the muscular added therapeutic influence of sanatorium treatment on the The evening temperature was 102°. 6bres. The wound island produced marked improvement. Their weight generally cicatrised without further incident and the patient left went up steadily during the first fortnight; they lost their hospital in good general health at the end of July. Exami- fever, sweats, and sleeplessness ; they gained appetite and nation of the specimen removed showed a much enlarged strength, and the pulmonary signs improved. Of 23 men Fallopian tube full of pus. On its posterior wall was a who had left the island when the reporter was relieved, only circular perforation with violaceous edges. There was no four had gained no benefit, but they, when they had arrived, lesion of the uterus. The pus contained the typhoid had each two or more lobes attacked ; all the rest (19) were The sanaM. Galliard and M. Chaput improved, and four are even reported cured. bacillus in pure culture. it seems likely to be but was torium the this unusual localisation of that only experimental, typhoid - suggested Dr. Cazimian >bacillus was due to previous lesions of the Fallopian tube, kept open at any rate through the winter. __