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THE THIRTEENTH INTERNATIONAL CONGRESS OF MEDICINE.
1821 Further, although the wound from access of air and the conFIELD FORCE.-SERVICE ABROAD, SOUTH AFRICA. sequent increased possibility of infection by organisms might teasonably be expected to become septic it seldom appears Table showing the Personnel of Medical Units on the Lines of Communication. to do so. The immediate shock is rarely great, nor is it often that the immediate haemorrhage is alarming. In several instances though blood the man officer.
was
was pouring from the mouth able to walk up and report himself to his
in any quantity is comamount is, in my experience, by the ordinary physical signs, but often needs careful auscultation and percussion to diagnose. The effused blood as a rule rapidly disappears and the wound in the lung as rapidly heals. In one only of the cases under my care has the intra-pleural heamorrhage been alarming, and from its comparative rarity the case
Haemorrhage
into the
pleura
rare, though a small paratively usual and is discoverable
worthy of record. days after being wounded at Paardeberg Private PHe was admitted to hospital late at came under my care. night in a very collapsed condition, having travelled a long distance. Beneath the left clavicle, at the junction of the middle and outer thirds, was the entrance wound of a Mauser seems
Ten
bullet, and the exit wound was found between the ninth and tenth ribs posteriorly on the same side about two inches external to the outer edge of the erector spinas. The left chest moved well on respiration and the percussion note was resonant except for obscure dulness at the base posteriorly. (The patient was too exhausted to try the effect of change of position.) There was absence of breath-sounds on the whole left chest except near the sternum. On the right side the breathing was harsh. On the left side with coin percussion the clanging sound was marked and audible without a stethoscope or application of the ear to the chest. Vocal resonance was in abeyance. The heart was pushed over to the right side till the apical impulse and point of greatest intensity of the first sound were one and a half inches to the right of the sternum. There were great loss of power and aching pain in the left arm and hand, but no loss of sensation and no swelling. Radial, brachial, and axillary pulses on the left side were imperceptible and the limb, though warm, was of lower temperature than its fellow. Apparently there was thrombosis of the subclavian artery in its third part, fair collateral circulation being established. It was decided to aspirate the left chest, and this was done by means of an ordinary trocar and cannula, the trocar being inserted through the wound of exit of the bullet, between the ninth and tenth ribs posteriorly. Two and a half pints of fluid blood of dark colour and some air were removed. Chloroform was given as pus had been anticipated, the temperature having varied from 100° to 102° F. The relief to the breathing and to the circulation was great. The following day faint breath-sounds were audible over the left chest anteriorly and posteriorly except below the ninth rib, and the cardiac impulse and point of greatest intensity of the first sound were just at the right edge of the sternum. Four days later the physical signs remained the same, and there were much proacordial pain and dyspnoea. Aspiration was again resorted to in the same region with a Potain’s aspirator, eight ounces of fluid blood and a large quantity of air being removed. The relief obtained was considerable, but the temperature remained febrile. Morphia was required nightly on account of prmeordial pain. 14 days later, the symptoms being aggravated, chloroform was given and a portion of the seventh rib was resected in the posterior axillary line. The pleural cavity was found to be full of fibrinous strings and about eight ounces of fluid blood. A large-sized drainage-tube was inserted. From this time improvement was steadily maintained, except for a temporary relapse which was induced by the patient having to be moved from one ward to another. He was sent down to Cape Town convalescent two months after being wounded. The conclusions to be drawn from the cases seen are :1. In the majority of cases relatively little immediate or remote damage results from Mauser bullet wounds of the
lung.
in
2. The immediate haemorrhage is usually small. 3. Intra-pleural hmmorrhage in small quantity is the rule ;
large quantity comparatively rare. intra-pleural haemorrhage of any large extent ultimate resection and drainage will in most cases be required. 5. The destruction of lung tissue is relatively small. 4. In
(a) Secretary and Registrar: to act as officer in charge of the unit till its arrival in Natal. 1. The Principal Medical Officer, Natal, will arrange for a LieutenantColonel of the Royal Army Medical Corps in South Africa to be detailed as officer in charge of this unit. 2. The quartermaster and two warrant officers will join the unit on its arrival in South Africa. 3. 20 nursing sisters, Army Nursing Service Reserve, will be ordered to embark as early as possible after June 16th. 4. A superintendent or acting superintendent, Army Nursing Service, to be selected from the Army Nursing Service in South Africa, an extra nursing sister being included in the detail referred to in (3) to allow of the adjustment. Medical Division, War Office, June 13th, 1900.
THE
THIRTEENTH INTERNATIONAL CONGRESS OF MEDICINE.
THE Executive Committee of the Thirteenth International Congress of Medicine announce the following entertainments offered to members attending the Congress. On the opening day of the Congress, August 2nd, Dr. Lannelongue, the President of the Council, will give an evening fête in the name of the Government of the Republic. On August 3rd members will be invited to an evening fête by the President of the Congress. On August 5th the President of the Republic will receive the members of the Congress in the Elysee. On August 8th an evening fete will be held in the Palais du Senat and the Gardens of the Luxembourg, where the members of the Congress will be entertained by the Bureau and the Organising Committees of the Congress. The Town Council of Paris is to be asked to give an entertainment.
Besides the above, sundry fetes will be organised in the various sections, and it should be noted that to all these entertainments the wives, daughters, and sisters of members attending the Congress are invited. A ladies’ committee has been organised for the reception of these ladies.
A NEW PUBLIC GARDEN
IN THE
BLACKFRIARS-
ROAD.-The Bishop of Rochester on June 15th formally opened to the public the churchyard and burial ground of Christchurch, Blackfriars, which have been adapted for a public garden. Several years since a similar adaptation was considered and the Metropolitan Public Gardens Association was consulted on the question, with the result that as soon as the St. Saviour’s District Board of Works had a vested interest in the churchyard and burial ground the association agreed that it would at its own cost layout the ground for public recreation purposes. This generous promise has now been fulfilled.
was
was pouring from the mouth able to walk up and report himself to his
in any quantity is comamount is, in my experience, by the ordinary physical signs, but often needs careful auscultation and percussion to diagnose. The effused blood as a rule rapidly disappears and the wound in the lung as rapidly heals. In one only of the cases under my care has the intra-pleural heamorrhage been alarming, and from its comparative rarity the case
Haemorrhage
into the
pleura
rare, though a small paratively usual and is discoverable
worthy of record. days after being wounded at Paardeberg Private PHe was admitted to hospital late at came under my care. night in a very collapsed condition, having travelled a long distance. Beneath the left clavicle, at the junction of the middle and outer thirds, was the entrance wound of a Mauser seems
Ten
bullet, and the exit wound was found between the ninth and tenth ribs posteriorly on the same side about two inches external to the outer edge of the erector spinas. The left chest moved well on respiration and the percussion note was resonant except for obscure dulness at the base posteriorly. (The patient was too exhausted to try the effect of change of position.) There was absence of breath-sounds on the whole left chest except near the sternum. On the right side the breathing was harsh. On the left side with coin percussion the clanging sound was marked and audible without a stethoscope or application of the ear to the chest. Vocal resonance was in abeyance. The heart was pushed over to the right side till the apical impulse and point of greatest intensity of the first sound were one and a half inches to the right of the sternum. There were great loss of power and aching pain in the left arm and hand, but no loss of sensation and no swelling. Radial, brachial, and axillary pulses on the left side were imperceptible and the limb, though warm, was of lower temperature than its fellow. Apparently there was thrombosis of the subclavian artery in its third part, fair collateral circulation being established. It was decided to aspirate the left chest, and this was done by means of an ordinary trocar and cannula, the trocar being inserted through the wound of exit of the bullet, between the ninth and tenth ribs posteriorly. Two and a half pints of fluid blood of dark colour and some air were removed. Chloroform was given as pus had been anticipated, the temperature having varied from 100° to 102° F. The relief to the breathing and to the circulation was great. The following day faint breath-sounds were audible over the left chest anteriorly and posteriorly except below the ninth rib, and the cardiac impulse and point of greatest intensity of the first sound were just at the right edge of the sternum. Four days later the physical signs remained the same, and there were much proacordial pain and dyspnoea. Aspiration was again resorted to in the same region with a Potain’s aspirator, eight ounces of fluid blood and a large quantity of air being removed. The relief obtained was considerable, but the temperature remained febrile. Morphia was required nightly on account of prmeordial pain. 14 days later, the symptoms being aggravated, chloroform was given and a portion of the seventh rib was resected in the posterior axillary line. The pleural cavity was found to be full of fibrinous strings and about eight ounces of fluid blood. A large-sized drainage-tube was inserted. From this time improvement was steadily maintained, except for a temporary relapse which was induced by the patient having to be moved from one ward to another. He was sent down to Cape Town convalescent two months after being wounded. The conclusions to be drawn from the cases seen are :1. In the majority of cases relatively little immediate or remote damage results from Mauser bullet wounds of the
lung.
in
2. The immediate haemorrhage is usually small. 3. Intra-pleural hmmorrhage in small quantity is the rule ;
large quantity comparatively rare. intra-pleural haemorrhage of any large extent ultimate resection and drainage will in most cases be required. 5. The destruction of lung tissue is relatively small. 4. In
(a) Secretary and Registrar: to act as officer in charge of the unit till its arrival in Natal. 1. The Principal Medical Officer, Natal, will arrange for a LieutenantColonel of the Royal Army Medical Corps in South Africa to be detailed as officer in charge of this unit. 2. The quartermaster and two warrant officers will join the unit on its arrival in South Africa. 3. 20 nursing sisters, Army Nursing Service Reserve, will be ordered to embark as early as possible after June 16th. 4. A superintendent or acting superintendent, Army Nursing Service, to be selected from the Army Nursing Service in South Africa, an extra nursing sister being included in the detail referred to in (3) to allow of the adjustment. Medical Division, War Office, June 13th, 1900.
THE
THIRTEENTH INTERNATIONAL CONGRESS OF MEDICINE.
THE Executive Committee of the Thirteenth International Congress of Medicine announce the following entertainments offered to members attending the Congress. On the opening day of the Congress, August 2nd, Dr. Lannelongue, the President of the Council, will give an evening fête in the name of the Government of the Republic. On August 3rd members will be invited to an evening fête by the President of the Congress. On August 5th the President of the Republic will receive the members of the Congress in the Elysee. On August 8th an evening fete will be held in the Palais du Senat and the Gardens of the Luxembourg, where the members of the Congress will be entertained by the Bureau and the Organising Committees of the Congress. The Town Council of Paris is to be asked to give an entertainment.
Besides the above, sundry fetes will be organised in the various sections, and it should be noted that to all these entertainments the wives, daughters, and sisters of members attending the Congress are invited. A ladies’ committee has been organised for the reception of these ladies.
A NEW PUBLIC GARDEN
IN THE
BLACKFRIARS-
ROAD.-The Bishop of Rochester on June 15th formally opened to the public the churchyard and burial ground of Christchurch, Blackfriars, which have been adapted for a public garden. Several years since a similar adaptation was considered and the Metropolitan Public Gardens Association was consulted on the question, with the result that as soon as the St. Saviour’s District Board of Works had a vested interest in the churchyard and burial ground the association agreed that it would at its own cost layout the ground for public recreation purposes. This generous promise has now been fulfilled.