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ARTERIAL OBSTRUCTION IN AN OLD MAN; EMBOLISM; ENDOCARDITIS; RECOVERY.
CLINICAL NOTES.
1315
suggestion of Mr. Howlett, of Hull, damped wool was some stiffness. There was no spasm of the back, and the muscles of the face and forehead were in the same condition ; successfully used on the vacuum tubes to prevent sparking. On May 23rd, 1897, the seventeen test-tubes containing the 10 c.c. of antitoxin were injected. On the 17th I was told he cultivations of tubercle bacilli were exposed to the x rays. bad had a quiet night, but that the spasms had come on again .
The series of cultivations received exposures varying froml half’an-hour to eleven hours. Two tubes were withdrawnI from the area of the x rays at intervals of half an hour, one, two, four, six, eight, and ten hours, the remaining threeI tubes receiving the full exposure of eleven hours. During; these eleven hours the control cultivations were taken out of, the incubator and placed in a protected place at ordinary, room temperature similar to that in which the experiments, were carried out. At the conclusion of the experiments thei whole number of cultivations was returned to the incubator. During the first week of September, 1897, the cultivationsI were examined, a period of over three months having elapsedI since they were exposed to the x rays. All the colonies of, tubercle bacillus were found to be thriving. Differences inL the rate of growth of the colonies were perceptible, both in those which had been exposed to the x rays and those which had been used as controls. These differences were only such as are usual in a series of agar cultivations of tubercle bacillus. In tube No. 16, which had been exposed to the rays for eight hours, the activity of the growth was remarkable, the colony of tubercle bacillus taking the shape of an acuminated corrugated mound with a base area somewhat larger than a threepenny piece. From this largest growth the colonies graduated downwards in size to that of a pin’s head. The development of the colonies during the three months between the exposures and the final examinations was in accord with that of any large series of tubercle bacillus cultivations. A comparison of the colonies exposed to the x rays with those used as controls showed no variation in colour, size, or manner of development which could be attributed to the different treatments which the colonies had undergone. These experiments point to the conclusion that x rays do not affect the tubercle bacillus, and lead us to believe that the improved condition of tuberculous patients who have been submitted to the influence of x rays was due to causes other than the action of the rays. ,
Bournemouth.
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL.
The finger was dressed with chlorinated soda of antitoxin were injected, and five grains of calomel were administered; the mixture to be taken as before. At 9 P,M. the patient was better, but the jaw was stiff. The spasms commenced when I came, perhaps owing to On the nervousness ; 10 c c. of antitoxin were injected. l9th he complained that be could not micturate except when out of bed, while he had pain in the right side and leg. I made him straighten and draw up the leg, which caused much trembling, but the spasms were evidently much less, and so be was reassured. On the 20th he felt better ; he could open the jaws wider, and could lie with the legs stretched out. On the 26th the mouth could be opened wide ; the legs were weak and inclined to get hard in the calves, but were otherwise much better. This day a carbuncle was found to be developing in the neck ; this ran its normal course and the patient made a complete recovery. In all, 50 c.c. of antitoxin were injected ; and though the sedatives may have assisted in the successful treatment (the bromide was continued almost until the man went to his work), I think that the symptoms were much alleviated after each dose of the at 10 30 A.M.
lotion, 10
serum was
c.c.
injected.
Polesworth,
near
Tamworth.
NOTE ON AN UNUSUAL ATTACHMENT OF THE FUNIS. BY W. F. GARDENER, M.R.C S. ENG., L.R.C.P. LOND. ON Oct. 25th last I attended a primipara who was within fortnight of her full time. The labour was normal and she The cord was then seen to was delivered of a small foetus. be expanded at its fcetal attachment into a keel-shaped mass, with long diameter running from above downwards in the fcetus. The "fault" in the abdomen measured 34 in. in length, 24’ in. in breadth, and stocd up from the abdominal surface 1$in. The mass consisted entirely of Wharton’s jelly. The fcetus lived thirty-six hours. I was unable to obtain permission to make a full postmortem examination, but an incision into the tumour revealed beneath a layer of Wharton’s jelly an inch and a quarter in depth the liver and transverse colon, so that a very large umbilical hernia would have resulted if the child had lived. I believe this to be a very uncommon condition. a
Sydenham. A CASE OF TETANUS SUCCESSFULLY TREATED BY TETANUS ANTITOXIN.
ARTERIAL OBSTRUCTION IN AN OLD MAN; EMBOLISM; ENDOCARDITIS; RECOVERY.
BY W. H. SMART, M.A., M.B. CANTAB., M.R.C S. ENG.
BY ERNEST A MAN, aged about forty years, came to me on July 4th, with the last phalanx of one finger crushed ; the nail was removed, but the bone was uninjured. The wound was cleansed and dressed with cold water applications. All went well until July 13th, when his jaw felt stiff. During the night of the 14th he had pain in the legs, and the next day he sent for me in the afternoon, when I found him suffering from tetanic spasms of the legs occurring, I was told, about every half-hour. The jaws would open about an inch with pain, the corners of the mouth were drawn up, the eyebrows were raised, and the forehead was wrinkled transversely. There were no spasms of the arms or opisthotonos. The bowels had not been opened for four days. He was given five grains of calomel and a mixture containing two drachms of bromide of potassium and one drachm of chloral hydrate, an eighth part of which was taken every three hours. He slept during the night, avoiding spasm of the legs by keeping them drawn up, but the spasm came on again immediately any attempt was made to straighten the legs. On the 16th the jaw appeared to be a little less stiff, but the spasms were still very severe. I amputated the injured joint under chloroform and injected 10 c.c. of antitoxin at 12 midday, At 6 P.M. the spasms were less frequent, the jaw was !till stiff, and the finger was painful. He could put the legs down and draw them up again, but it caused trembling and
1897,
I
MABERLY, M.R.C.S. ENG.
seventy years of age, who, with attack of influerza, had as far as he always enjoyed the best of health, came under my care on April 9th, 1897. Just two months pre viously he had received a severe bite from a dog on the left leg. No medical man was at first called in to the case, the patient treating the wound himself with an ointment of soap and honey and eventually applying sticking plaster. The wound appears to have partially scabbed over under this treatment, but it became very offensive and there was great congestion and swelling around it. When seen by his medical man nine days later a Goulard lotion was applied four times a day for a week. On Feb. 25th the wound was dressed with zinc ointment and bathed with warm water four times a day for a week and the leg was bandaged ; the patient remained in bed most of the time. Before he left home on April 5th On April 9th I was he began to walk about a little. called in for the first time. He complained then of great constipation and flatulence and of considerable pain over the hepatic region. On examination I found the liver very congested ; the tongue was white and thickly furred; the motions were clay-coloured; hardly any action of the bowels had taken place for a week. One tablespoonful of castor oil was given, and a mustard leaf was applied over the hepatic regicn. No action of the bowels was obtained until five grain THE
patient,
a man over
the exception of could remember
an
1316
HOSPITAL MEDICINE AND SURGERY.
of calomel were administered at bedtime and half-ounce doses of sulphate of magnesium in the morning. After continuing this treatment for four days, the bowels began to act well. The motions were still hard and clay-coloured. On OF the 14th the patient’s general condition was very little improved. He still complained of flatulence and pain in the HOSPITAL hepatic region. The tongue was white and thickly coated, and he still had a bitter taste in the mouth. The heart BRITISH AND FOREIGN. and lungs were normal. There was no albumin in the urine. On the 15th the patient was confined to bed and Nulla autem est alia pro certo noscendi via, nisi quamplurimas et he had a restless night. On listening to the heart a morborum et dissectionum historias, tum aliorum tum proprias De Sed. et Cam. distinct soft systolic murmur could be heard at the apex. eot!ect!t9 habere, et inter se comparare.—MON&AQNI lib. iv. Prooemium. There was no thrill. The respirations were 26, the pulse was 100, and the temperature was 99 4°. There was no ST. MARY’S HOSPITAL. albumin. Large doses of quinine and iron were given with sulphate of magnesia every four hours. As to diet, milk, A CASE OF ANEURYSM OF THE ABDOMINAL AORTA, WITH eggs, and beaf tea were ordered. At 6 P.M. the respirations SYMPTOMS OF RENAL COLIC; NECROPSY. were 28, the pulse was 96, and the temperature was 99 8°. (Under the care of Dr. CHEADLE.) There was no trouble with the urine, which was free from albumin. THE following case derives its interest from the great At 2 A.M. no pulse could be felt in the left wrist. Hot fomentations were applied to similarity of the symptoms in the early stages to those of the forearm. The nails were very blue. On the renal calculus, and later to those of perinephritic abscess. 16th, at 11 A.M, the respirations were 18, the pulse of the abdominal aorta attain no incon. Aneurysms may Was 84, and the temperature was 9$5°. The radial left size without rise to siderable any painful On to the giving symptom, heart a listening pulse was scarcely perceptible. when from the but this is the arises murmur could be heard. The whole of the loud only aneurysm possible systolic very left forearm was painful; it was very blue and congested. anterior aspect of the vessel, for when the aneurysm grows The hot fomentations were still continued and at 2 P.M. the backwards from the artery and presses on and erodes the pulse of the left radial artery was stronger. On the 17th, at vertebras pain, violent and lancinating, is generally present. 10 P.M., the pulse of the same vessel was very thready. The respirations were 28. The mitral murmur had gone. On the For the notes of the case we are indebted to Dr. F. John 19th the forearm was resuming its natural colour. There had Poynton, Medical Registrar, and Dr. Arnold F. Bill, been a great deal of pain in the left leg all night. Hot Demonstrator of Pathology. fomentations were ordered. On the 20th, at 12 noon, the The patient, a man aged forty years, was admitted to pulse was 78 and the respirations were 24. The patient still St. Mary’s Hospital on June 2nd, 1897, on account of complained of great pain in the left knee-joint. There paroxysmal pain in the abdomen shooting down to the left were no cardiac murmurs. No pulse could be felt in the testicle. This had occurred in paroxysms sometimes oncea foot. The hot fomentations were continued. On the 21st, week and sometimes once a month for the last four years, at 10 A.M., the pulse was 72, the respirations were 18, and the but during the last six weeks they had become more frequent was The in the foot. returned 98’40. temperature pulse and more severe ; he had, in addition, suffered from headThere was no pain. The fomentations were discontinued. ache, hsematuria, and haemoptysis. He was of middle height From this date up to April 29th the patient made an uninter- and emaciated, and his face was pale and worn with pain. rupted recovery. The temperature was 101° F., the pulse was 84, and the Throughout the illness, although there was great con- respiration was 20. He said that the pain was situated on the stipation, the patient perspired freely, and this no doubt left side of the abdomen and in the left lumbar region, and accounted for the comparatively low temperature. Stimulants that when a paroxysm came on it shot down to the left testicle were freely given during the illness. When convalescent and was so severe that he was compelled to hold his scrotum the patient went to the seaside for a couple of months. with his hand. He had never vomited with the pain nor was Swelling of the foot and leg continued for some time, but it increased on movement. Examination of the abdomen this was reduced by careful bandaging and massage and at showed slight retraction of the parietes with marked hyperthe end of two months he wrote to me saying that he was sesthesia over the left kidney, both in front and behind, but well enough to return to his ordinary duties. revealed nothing further. The bowels were constipated. The Eversley, Hants. urine contained a trace of albumin but no blood. The cardiac impulse was forcible and was felt in the fifth space the nipple. No adventitious sounds were heard. just MANCHESTER CHILDREN’S HOSPITAL.-On The outside lungs were apparently normal. On June4th, at 2A.M., after Nov. 13th Sir William Agnew formally opened a new cona severe paroxysm of pain occurred, commencing valescent home which he has built and equipped and micturition, in the left testicle and passing up the left side of the abdoto Children’s the Manchester The home Hospital. presented without vomiting or blood in the urine. A dull, aching will accommodate twenty-five patients, and it is expected men, the attack. Several more severe attacks that the resident officials will be a matron, two nurses, and pain remained after of occurred the week, but on June llth the symduring pain two servants. It stands about a mile from St. Anne’s was violent heaving over the left side ptoms changed. There station on the road to and has fine view a Blackpool railway the of was present in the epigastrium, and chest, pulsation of the sea. Mr. J. Francis Richardson, chairman of the board of governors, presided at the ceremony and received a loud systolic bruit was heard over the upper part of the the deed of gift from Sir William Agnew who said that there abdominal aorta. The twelfth rib was moved by pulsation in the left flank and over it the heart-sounds could be was no incident in his career that he would refer to with counted. There was an impaired note in the left lateral greater pleasure than the transaction of that day. region of the chest reaching to the tenth rib. On the 25th LUXOR HOSPITAL FOR THE NATIVES OF UPPER the patient felt pain down the front of the left leg to the EGYPT.-An appeal is being made by Mr. Thomas Cook for foot and the pulsation in the epigastrium had extended to the contributions towards the support of this hospital which was right of the middle line. On July 5th he was blanched. The opened by His Excellency the late Khedive at the commence- dulness in the left side of the thorax had reached to midway ment of the year 1891. In order to show the necessity for between the spine and angle of the scapula. At the upper such an institution it is stated that on the day of opening fifty limit there was segopbony and over the dull area the breath natives were waiting for the medical officer’s attention and up sounds were faint. There was fulness in the left renal to the spring of the present year medical and surgical treat- region, which was very tender on pressure and gave a ment was afforded to 25,820 cases, for whom about 493 dull note on percussion. Since June 25th the temperature operations were performed, and no less than 28,781 out- had varied between 990 and 100°. On July 8th the patient patients had been relieved, of whom about 5178 were became unconscious and died. During the last few days the females. During last year 327 in-patients were treated, the bruit in the epigastrium had disappeared. - VecMpsy.—A post-mortem examination was made by daily average of in-patients being seventeen. 6240 diets were issued and 107 operations performed. Each ward is Dr. Poynton, and a detailed dissection by Dr. Bill after isolated from the others, and there are twenty-six beds removal of the aneurysm and surrounding structures from the available for in-patients. body. The body was found to be much emaciated. In
A Mirror
PRACTICE,
Afof.,
-
1315
suggestion of Mr. Howlett, of Hull, damped wool was some stiffness. There was no spasm of the back, and the muscles of the face and forehead were in the same condition ; successfully used on the vacuum tubes to prevent sparking. On May 23rd, 1897, the seventeen test-tubes containing the 10 c.c. of antitoxin were injected. On the 17th I was told he cultivations of tubercle bacilli were exposed to the x rays. bad had a quiet night, but that the spasms had come on again .
The series of cultivations received exposures varying froml half’an-hour to eleven hours. Two tubes were withdrawnI from the area of the x rays at intervals of half an hour, one, two, four, six, eight, and ten hours, the remaining threeI tubes receiving the full exposure of eleven hours. During; these eleven hours the control cultivations were taken out of, the incubator and placed in a protected place at ordinary, room temperature similar to that in which the experiments, were carried out. At the conclusion of the experiments thei whole number of cultivations was returned to the incubator. During the first week of September, 1897, the cultivationsI were examined, a period of over three months having elapsedI since they were exposed to the x rays. All the colonies of, tubercle bacillus were found to be thriving. Differences inL the rate of growth of the colonies were perceptible, both in those which had been exposed to the x rays and those which had been used as controls. These differences were only such as are usual in a series of agar cultivations of tubercle bacillus. In tube No. 16, which had been exposed to the rays for eight hours, the activity of the growth was remarkable, the colony of tubercle bacillus taking the shape of an acuminated corrugated mound with a base area somewhat larger than a threepenny piece. From this largest growth the colonies graduated downwards in size to that of a pin’s head. The development of the colonies during the three months between the exposures and the final examinations was in accord with that of any large series of tubercle bacillus cultivations. A comparison of the colonies exposed to the x rays with those used as controls showed no variation in colour, size, or manner of development which could be attributed to the different treatments which the colonies had undergone. These experiments point to the conclusion that x rays do not affect the tubercle bacillus, and lead us to believe that the improved condition of tuberculous patients who have been submitted to the influence of x rays was due to causes other than the action of the rays. ,
Bournemouth.
Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL.
The finger was dressed with chlorinated soda of antitoxin were injected, and five grains of calomel were administered; the mixture to be taken as before. At 9 P,M. the patient was better, but the jaw was stiff. The spasms commenced when I came, perhaps owing to On the nervousness ; 10 c c. of antitoxin were injected. l9th he complained that be could not micturate except when out of bed, while he had pain in the right side and leg. I made him straighten and draw up the leg, which caused much trembling, but the spasms were evidently much less, and so be was reassured. On the 20th he felt better ; he could open the jaws wider, and could lie with the legs stretched out. On the 26th the mouth could be opened wide ; the legs were weak and inclined to get hard in the calves, but were otherwise much better. This day a carbuncle was found to be developing in the neck ; this ran its normal course and the patient made a complete recovery. In all, 50 c.c. of antitoxin were injected ; and though the sedatives may have assisted in the successful treatment (the bromide was continued almost until the man went to his work), I think that the symptoms were much alleviated after each dose of the at 10 30 A.M.
lotion, 10
serum was
c.c.
injected.
Polesworth,
near
Tamworth.
NOTE ON AN UNUSUAL ATTACHMENT OF THE FUNIS. BY W. F. GARDENER, M.R.C S. ENG., L.R.C.P. LOND. ON Oct. 25th last I attended a primipara who was within fortnight of her full time. The labour was normal and she The cord was then seen to was delivered of a small foetus. be expanded at its fcetal attachment into a keel-shaped mass, with long diameter running from above downwards in the fcetus. The "fault" in the abdomen measured 34 in. in length, 24’ in. in breadth, and stocd up from the abdominal surface 1$in. The mass consisted entirely of Wharton’s jelly. The fcetus lived thirty-six hours. I was unable to obtain permission to make a full postmortem examination, but an incision into the tumour revealed beneath a layer of Wharton’s jelly an inch and a quarter in depth the liver and transverse colon, so that a very large umbilical hernia would have resulted if the child had lived. I believe this to be a very uncommon condition. a
Sydenham. A CASE OF TETANUS SUCCESSFULLY TREATED BY TETANUS ANTITOXIN.
ARTERIAL OBSTRUCTION IN AN OLD MAN; EMBOLISM; ENDOCARDITIS; RECOVERY.
BY W. H. SMART, M.A., M.B. CANTAB., M.R.C S. ENG.
BY ERNEST A MAN, aged about forty years, came to me on July 4th, with the last phalanx of one finger crushed ; the nail was removed, but the bone was uninjured. The wound was cleansed and dressed with cold water applications. All went well until July 13th, when his jaw felt stiff. During the night of the 14th he had pain in the legs, and the next day he sent for me in the afternoon, when I found him suffering from tetanic spasms of the legs occurring, I was told, about every half-hour. The jaws would open about an inch with pain, the corners of the mouth were drawn up, the eyebrows were raised, and the forehead was wrinkled transversely. There were no spasms of the arms or opisthotonos. The bowels had not been opened for four days. He was given five grains of calomel and a mixture containing two drachms of bromide of potassium and one drachm of chloral hydrate, an eighth part of which was taken every three hours. He slept during the night, avoiding spasm of the legs by keeping them drawn up, but the spasm came on again immediately any attempt was made to straighten the legs. On the 16th the jaw appeared to be a little less stiff, but the spasms were still very severe. I amputated the injured joint under chloroform and injected 10 c.c. of antitoxin at 12 midday, At 6 P.M. the spasms were less frequent, the jaw was !till stiff, and the finger was painful. He could put the legs down and draw them up again, but it caused trembling and
1897,
I
MABERLY, M.R.C.S. ENG.
seventy years of age, who, with attack of influerza, had as far as he always enjoyed the best of health, came under my care on April 9th, 1897. Just two months pre viously he had received a severe bite from a dog on the left leg. No medical man was at first called in to the case, the patient treating the wound himself with an ointment of soap and honey and eventually applying sticking plaster. The wound appears to have partially scabbed over under this treatment, but it became very offensive and there was great congestion and swelling around it. When seen by his medical man nine days later a Goulard lotion was applied four times a day for a week. On Feb. 25th the wound was dressed with zinc ointment and bathed with warm water four times a day for a week and the leg was bandaged ; the patient remained in bed most of the time. Before he left home on April 5th On April 9th I was he began to walk about a little. called in for the first time. He complained then of great constipation and flatulence and of considerable pain over the hepatic region. On examination I found the liver very congested ; the tongue was white and thickly furred; the motions were clay-coloured; hardly any action of the bowels had taken place for a week. One tablespoonful of castor oil was given, and a mustard leaf was applied over the hepatic regicn. No action of the bowels was obtained until five grain THE
patient,
a man over
the exception of could remember
an
1316
HOSPITAL MEDICINE AND SURGERY.
of calomel were administered at bedtime and half-ounce doses of sulphate of magnesium in the morning. After continuing this treatment for four days, the bowels began to act well. The motions were still hard and clay-coloured. On OF the 14th the patient’s general condition was very little improved. He still complained of flatulence and pain in the HOSPITAL hepatic region. The tongue was white and thickly coated, and he still had a bitter taste in the mouth. The heart BRITISH AND FOREIGN. and lungs were normal. There was no albumin in the urine. On the 15th the patient was confined to bed and Nulla autem est alia pro certo noscendi via, nisi quamplurimas et he had a restless night. On listening to the heart a morborum et dissectionum historias, tum aliorum tum proprias De Sed. et Cam. distinct soft systolic murmur could be heard at the apex. eot!ect!t9 habere, et inter se comparare.—MON&AQNI lib. iv. Prooemium. There was no thrill. The respirations were 26, the pulse was 100, and the temperature was 99 4°. There was no ST. MARY’S HOSPITAL. albumin. Large doses of quinine and iron were given with sulphate of magnesia every four hours. As to diet, milk, A CASE OF ANEURYSM OF THE ABDOMINAL AORTA, WITH eggs, and beaf tea were ordered. At 6 P.M. the respirations SYMPTOMS OF RENAL COLIC; NECROPSY. were 28, the pulse was 96, and the temperature was 99 8°. (Under the care of Dr. CHEADLE.) There was no trouble with the urine, which was free from albumin. THE following case derives its interest from the great At 2 A.M. no pulse could be felt in the left wrist. Hot fomentations were applied to similarity of the symptoms in the early stages to those of the forearm. The nails were very blue. On the renal calculus, and later to those of perinephritic abscess. 16th, at 11 A.M, the respirations were 18, the pulse of the abdominal aorta attain no incon. Aneurysms may Was 84, and the temperature was 9$5°. The radial left size without rise to siderable any painful On to the giving symptom, heart a listening pulse was scarcely perceptible. when from the but this is the arises murmur could be heard. The whole of the loud only aneurysm possible systolic very left forearm was painful; it was very blue and congested. anterior aspect of the vessel, for when the aneurysm grows The hot fomentations were still continued and at 2 P.M. the backwards from the artery and presses on and erodes the pulse of the left radial artery was stronger. On the 17th, at vertebras pain, violent and lancinating, is generally present. 10 P.M., the pulse of the same vessel was very thready. The respirations were 28. The mitral murmur had gone. On the For the notes of the case we are indebted to Dr. F. John 19th the forearm was resuming its natural colour. There had Poynton, Medical Registrar, and Dr. Arnold F. Bill, been a great deal of pain in the left leg all night. Hot Demonstrator of Pathology. fomentations were ordered. On the 20th, at 12 noon, the The patient, a man aged forty years, was admitted to pulse was 78 and the respirations were 24. The patient still St. Mary’s Hospital on June 2nd, 1897, on account of complained of great pain in the left knee-joint. There paroxysmal pain in the abdomen shooting down to the left were no cardiac murmurs. No pulse could be felt in the testicle. This had occurred in paroxysms sometimes oncea foot. The hot fomentations were continued. On the 21st, week and sometimes once a month for the last four years, at 10 A.M., the pulse was 72, the respirations were 18, and the but during the last six weeks they had become more frequent was The in the foot. returned 98’40. temperature pulse and more severe ; he had, in addition, suffered from headThere was no pain. The fomentations were discontinued. ache, hsematuria, and haemoptysis. He was of middle height From this date up to April 29th the patient made an uninter- and emaciated, and his face was pale and worn with pain. rupted recovery. The temperature was 101° F., the pulse was 84, and the Throughout the illness, although there was great con- respiration was 20. He said that the pain was situated on the stipation, the patient perspired freely, and this no doubt left side of the abdomen and in the left lumbar region, and accounted for the comparatively low temperature. Stimulants that when a paroxysm came on it shot down to the left testicle were freely given during the illness. When convalescent and was so severe that he was compelled to hold his scrotum the patient went to the seaside for a couple of months. with his hand. He had never vomited with the pain nor was Swelling of the foot and leg continued for some time, but it increased on movement. Examination of the abdomen this was reduced by careful bandaging and massage and at showed slight retraction of the parietes with marked hyperthe end of two months he wrote to me saying that he was sesthesia over the left kidney, both in front and behind, but well enough to return to his ordinary duties. revealed nothing further. The bowels were constipated. The Eversley, Hants. urine contained a trace of albumin but no blood. The cardiac impulse was forcible and was felt in the fifth space the nipple. No adventitious sounds were heard. just MANCHESTER CHILDREN’S HOSPITAL.-On The outside lungs were apparently normal. On June4th, at 2A.M., after Nov. 13th Sir William Agnew formally opened a new cona severe paroxysm of pain occurred, commencing valescent home which he has built and equipped and micturition, in the left testicle and passing up the left side of the abdoto Children’s the Manchester The home Hospital. presented without vomiting or blood in the urine. A dull, aching will accommodate twenty-five patients, and it is expected men, the attack. Several more severe attacks that the resident officials will be a matron, two nurses, and pain remained after of occurred the week, but on June llth the symduring pain two servants. It stands about a mile from St. Anne’s was violent heaving over the left side ptoms changed. There station on the road to and has fine view a Blackpool railway the of was present in the epigastrium, and chest, pulsation of the sea. Mr. J. Francis Richardson, chairman of the board of governors, presided at the ceremony and received a loud systolic bruit was heard over the upper part of the the deed of gift from Sir William Agnew who said that there abdominal aorta. The twelfth rib was moved by pulsation in the left flank and over it the heart-sounds could be was no incident in his career that he would refer to with counted. There was an impaired note in the left lateral greater pleasure than the transaction of that day. region of the chest reaching to the tenth rib. On the 25th LUXOR HOSPITAL FOR THE NATIVES OF UPPER the patient felt pain down the front of the left leg to the EGYPT.-An appeal is being made by Mr. Thomas Cook for foot and the pulsation in the epigastrium had extended to the contributions towards the support of this hospital which was right of the middle line. On July 5th he was blanched. The opened by His Excellency the late Khedive at the commence- dulness in the left side of the thorax had reached to midway ment of the year 1891. In order to show the necessity for between the spine and angle of the scapula. At the upper such an institution it is stated that on the day of opening fifty limit there was segopbony and over the dull area the breath natives were waiting for the medical officer’s attention and up sounds were faint. There was fulness in the left renal to the spring of the present year medical and surgical treat- region, which was very tender on pressure and gave a ment was afforded to 25,820 cases, for whom about 493 dull note on percussion. Since June 25th the temperature operations were performed, and no less than 28,781 out- had varied between 990 and 100°. On July 8th the patient patients had been relieved, of whom about 5178 were became unconscious and died. During the last few days the females. During last year 327 in-patients were treated, the bruit in the epigastrium had disappeared. - VecMpsy.—A post-mortem examination was made by daily average of in-patients being seventeen. 6240 diets were issued and 107 operations performed. Each ward is Dr. Poynton, and a detailed dissection by Dr. Bill after isolated from the others, and there are twenty-six beds removal of the aneurysm and surrounding structures from the available for in-patients. body. The body was found to be much emaciated. In
A Mirror
PRACTICE,
Afof.,
-