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A NEW SYRINGE CASE.
585
NEW INVENTIONS.
the medial side of the tendo Achillis near the ankle was another tender swelling. Left Thigh.-The internal saphenous vein was thickened and tender for about one inch on the medial aspect of the thigh. This area of thrombo-phlebitis subsided during the patient’s three weeks’ stay in hospital.
in weight during 14 months, and the thyroid To some extent she was dieted but, as she
greatly handicapped ,
Left Foot.-A superficial vein on the outer side of the of the left foot was painful and thickened. Right Upper Arm.-The basilic vein along the middle
dorsum
of the upper arm became swollen and tender while in hospital. A portion of this was excised under local anaesthesia and on pathological examination showed a chronic inflammatory, organising thrombus, with phlebitis and periphlebitis ; there was no evidence of Qlarise or Bacillus leprce. CASE 2.-A Malayan seaman, aged 26 years, was admitted to the hospital on Jan. 23rd, 1930, complaining of pain in his right leg and of occasional fleeting pains in various parts of his body. He had first noticed the pain in his right leg during a night watch in October, 1929 ; two weeks later the leg had begun to swell and it had remained swollen since. He gave a history of a fever, probably malaria, in 1914, dysentery in 1921, and gonorrhcoa in 1924. There was no illness immediately antecedent to the onset of the
thrombo-phlebitis.
On examination his
were some
and
spleen
very were
general condition
was
was
so
regards physical activity’
with consequent metabolic inhibition and a tendency over many months’ illness to be given sweets, stress was not laid upon diet. Weight reduction, however, was imperative as she has to wield an artificial lower limb with the support only of a lower limb which is largely hors de combat. At no time did the patient show any intolerance to the drug. During October, 1928, Mr. Rock Carling performed laminectomy at my request. During April, 1929, the artificial limb required considerable adjustment in view of the decrease in body-weight and in the size of the stump.
good ; there
septic stumps in his mouth ; the liver not enlarged ; the sigmoid colon was just
and was tender ; palpable urine was normal and the
the reflexes were normal ; the blood picture was as follows : red cells, 5,200,000 ; white cells, 14,000 ; haemoglobin, 90 per cent. There were no microfflarim present in night or day blood and no malarial parasites. Ankylostome ova were present in the feaces. The Wassermann reaction was negative. Radiological examination of the abdomen, pelvis, and thigh for calcified filarial remains was negative, veins were affected as follows :Left Leg.-Superficial vein at the back of the calf was thickened but not tender. There was slight swelling of the left leg which subsided with rest.
On the three occasions the patient was in hospital the thyroid was given as fresh gland combined with adrenal and pituitary glands (Burroughs Wellcome Three Gland Tabloids). Each tabloid contains grs. 6 fresh gland (grs. 5 fresh gland is the equivalent of gr. 1 dried gland).
The
Right Leg.-The right leg
was
NEW INVENTIONS
definitely swollen, especially
A NEW SYRINGE CASE.
the thigh, with distension of the superficial veins of the leg and also of the lower abdominal veins, suggesting a thrombosis affecting the external iliac vein. There was in addition a superficial thrombo-phlebitis affecting the internal saphenous vein in front of the right ankle, where it was thrombosed for several inches and very tender. The patient had two attacks of generalised abdominal pain with a feeling of distension in the stomach and right side of the chest. In the second attack there was a temperature of 995° F. for 24 hours, and diarrhoea with mucus but no blood ; there was tenderness in both iliac fossee and in the epigastrium, but no rigidity of the abdominal wall. Such symptoms suggest the possibility of involvement of the mesenteric veins by the thrombo-phlebitis, but in the light of the history of dysentery nine years previously it is not possible to be certain.
The two
as
dosage.
THE case here illustrated is of metal, nickel-plated, and is intended to be filled with rectified spirits to sterilise the contents. The new cone fitting cap ensures absolute freedom from spirit leakage without the use of washers, while the hexagonal top facilitates opening and closing of the cap. The barrel, piston,
illustrate the simplest variety of in which only the veins
cases
thrombo-phlebitis migrans,
of the extremities are affected, without implication of the viscera. Ankylostomiasis and a history of gonorrhoea are features common to both cases, but
these
can have no causal relationship. is characteristic of thrombo-phlebitis setiological factor could be elucidated.
as
Otherwise,
migrans,
no
THYROID TOLERANCE AND BENEFIT IN OBESITY. BY HILDRED CARLILL, M.D. CAMB., PHYSICIAN
A
TO
WESTMINSTER HOSPITAL.
at the age of 6 showed evidence of syringe- and needles are mounted separately, so that there is the age of 11she developed ulcers on the no of the piston getting stuck in the possibility left sole. When aged 17 consecutive amputations barrel if the syringe is not used frequently. In use were performed on the left leg which at this date the cap is unscrewed and placed on the table upside was spastic and deficient in thermal sense. At 23 down, when it will act as a stand on which the comthe left lower limb was amputated above the knee. of the syringe are mounted. The pillar of When admitted to Westminster Hospital on ponents the stand is attached to the cap, so that the withAugust 14th, 1928 (aged 26), she had progressive: drawal of the cap removes the components of the spasticity of the right lower limb. The upper limbs: syringe at the same time. also were affected. The height was 5 ft. 6 in. The’ Messrs. Allen and Hanburys, of Wigmore-street, weight in night clothes, without the artificial limb W.1, are the makers of the svrinse case. which weighed 7 lb. 2 oz., was 14 st. 10 lb. 12 oz. MILROY PAUL, M.R.C.P. Lond., The Table shows the total reduction (5 st. 7 lb. 4 oz.) Ceylon Medical Service. GIRL
myelia. At
,
,
F.R.C.S. Eng.,
NEW INVENTIONS.
the medial side of the tendo Achillis near the ankle was another tender swelling. Left Thigh.-The internal saphenous vein was thickened and tender for about one inch on the medial aspect of the thigh. This area of thrombo-phlebitis subsided during the patient’s three weeks’ stay in hospital.
in weight during 14 months, and the thyroid To some extent she was dieted but, as she
greatly handicapped ,
Left Foot.-A superficial vein on the outer side of the of the left foot was painful and thickened. Right Upper Arm.-The basilic vein along the middle
dorsum
of the upper arm became swollen and tender while in hospital. A portion of this was excised under local anaesthesia and on pathological examination showed a chronic inflammatory, organising thrombus, with phlebitis and periphlebitis ; there was no evidence of Qlarise or Bacillus leprce. CASE 2.-A Malayan seaman, aged 26 years, was admitted to the hospital on Jan. 23rd, 1930, complaining of pain in his right leg and of occasional fleeting pains in various parts of his body. He had first noticed the pain in his right leg during a night watch in October, 1929 ; two weeks later the leg had begun to swell and it had remained swollen since. He gave a history of a fever, probably malaria, in 1914, dysentery in 1921, and gonorrhcoa in 1924. There was no illness immediately antecedent to the onset of the
thrombo-phlebitis.
On examination his
were some
and
spleen
very were
general condition
was
was
so
regards physical activity’
with consequent metabolic inhibition and a tendency over many months’ illness to be given sweets, stress was not laid upon diet. Weight reduction, however, was imperative as she has to wield an artificial lower limb with the support only of a lower limb which is largely hors de combat. At no time did the patient show any intolerance to the drug. During October, 1928, Mr. Rock Carling performed laminectomy at my request. During April, 1929, the artificial limb required considerable adjustment in view of the decrease in body-weight and in the size of the stump.
good ; there
septic stumps in his mouth ; the liver not enlarged ; the sigmoid colon was just
and was tender ; palpable urine was normal and the
the reflexes were normal ; the blood picture was as follows : red cells, 5,200,000 ; white cells, 14,000 ; haemoglobin, 90 per cent. There were no microfflarim present in night or day blood and no malarial parasites. Ankylostome ova were present in the feaces. The Wassermann reaction was negative. Radiological examination of the abdomen, pelvis, and thigh for calcified filarial remains was negative, veins were affected as follows :Left Leg.-Superficial vein at the back of the calf was thickened but not tender. There was slight swelling of the left leg which subsided with rest.
On the three occasions the patient was in hospital the thyroid was given as fresh gland combined with adrenal and pituitary glands (Burroughs Wellcome Three Gland Tabloids). Each tabloid contains grs. 6 fresh gland (grs. 5 fresh gland is the equivalent of gr. 1 dried gland).
The
Right Leg.-The right leg
was
NEW INVENTIONS
definitely swollen, especially
A NEW SYRINGE CASE.
the thigh, with distension of the superficial veins of the leg and also of the lower abdominal veins, suggesting a thrombosis affecting the external iliac vein. There was in addition a superficial thrombo-phlebitis affecting the internal saphenous vein in front of the right ankle, where it was thrombosed for several inches and very tender. The patient had two attacks of generalised abdominal pain with a feeling of distension in the stomach and right side of the chest. In the second attack there was a temperature of 995° F. for 24 hours, and diarrhoea with mucus but no blood ; there was tenderness in both iliac fossee and in the epigastrium, but no rigidity of the abdominal wall. Such symptoms suggest the possibility of involvement of the mesenteric veins by the thrombo-phlebitis, but in the light of the history of dysentery nine years previously it is not possible to be certain.
The two
as
dosage.
THE case here illustrated is of metal, nickel-plated, and is intended to be filled with rectified spirits to sterilise the contents. The new cone fitting cap ensures absolute freedom from spirit leakage without the use of washers, while the hexagonal top facilitates opening and closing of the cap. The barrel, piston,
illustrate the simplest variety of in which only the veins
cases
thrombo-phlebitis migrans,
of the extremities are affected, without implication of the viscera. Ankylostomiasis and a history of gonorrhoea are features common to both cases, but
these
can have no causal relationship. is characteristic of thrombo-phlebitis setiological factor could be elucidated.
as
Otherwise,
migrans,
no
THYROID TOLERANCE AND BENEFIT IN OBESITY. BY HILDRED CARLILL, M.D. CAMB., PHYSICIAN
A
TO
WESTMINSTER HOSPITAL.
at the age of 6 showed evidence of syringe- and needles are mounted separately, so that there is the age of 11she developed ulcers on the no of the piston getting stuck in the possibility left sole. When aged 17 consecutive amputations barrel if the syringe is not used frequently. In use were performed on the left leg which at this date the cap is unscrewed and placed on the table upside was spastic and deficient in thermal sense. At 23 down, when it will act as a stand on which the comthe left lower limb was amputated above the knee. of the syringe are mounted. The pillar of When admitted to Westminster Hospital on ponents the stand is attached to the cap, so that the withAugust 14th, 1928 (aged 26), she had progressive: drawal of the cap removes the components of the spasticity of the right lower limb. The upper limbs: syringe at the same time. also were affected. The height was 5 ft. 6 in. The’ Messrs. Allen and Hanburys, of Wigmore-street, weight in night clothes, without the artificial limb W.1, are the makers of the svrinse case. which weighed 7 lb. 2 oz., was 14 st. 10 lb. 12 oz. MILROY PAUL, M.R.C.P. Lond., The Table shows the total reduction (5 st. 7 lb. 4 oz.) Ceylon Medical Service. GIRL
myelia. At
,
,
F.R.C.S. Eng.,