CASE OF POISONING BY HYDROCHLORIC ACID.

875 -his hand behind him. He was sent to me on July 18tb, by practitioner to whom he applied for relief. The signs of dislocation at the shoulder were well marked, the head of the humerus resting below the coracoid process. After taking off the man’s shirt, I laid him on his back upon a table, close to the edge, and attempted to make extension with my foot in the axilla as I sat on a chair at his side. Finding the position inconvenient, I gave up the attempt. Then, standing at the end of the table, behind the man’s shoulder as he lay on his back, I drew the arm away from -his side, with the forearm flexed at a right angle and the wrist raised perpendicularly upwards, the hand rather inclining to fall downwards. I kept the limb in that ,position by hooking my finger in the bend of his elbow, and diverted the man’s attention by talking upon indifferent subjects. Forcible extension was not wanted. The muscles soon relaxed, and I then let the hand fall over, thus rotating the head of the humerus inwards, and the bone slipped at The man ultimately re.once into the glenoid cavity. covered the perfect use of the limb. a

Oxford.

acid about his lips. Very fortunately for the patient, he had taken his dinner shortly before he swallowed the poison. I prescribed the usual remedies, such as milk, The following day he complained of magnesia, eggs, &c. pain in the throat as well as in the stomach, and spat up constantly a quantity of thick mucus. Small doses of laudanum were given at short intervals to lessen the irritation of the stomach, but he was able to take without difficulty beef-tea and egg flip. After a few days the pain in the throat and stomach disappeared, and since then he has never complained of any difficulty in swallowing. I was told he had swallowed a quantity equal to two tablespoonfuls of the acid, but as tne throat was affected in only a trifling degree I fancy the amount taken must have been considerably less. Dublin. ______________

AMPUTATION OF PENIS; COCAINE AS A LOCAL ANÆSTHETIC. BY DUGALD CHRISTIE, L.R.C.S., L.R.C.P. ED.

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BILHARZIA HÆMATOBIA. BY W. K. HATCH, M.B., M.R.C.S., SECOND

SURGEON,

JAMSETJEE JEJEEBHOY

HOSPITAL,

BOMBAY.

observing closely twelve cases of bilharzia haemaBombay, where the disease appears to be more common than formerly, especially amongst Mussulmans who have made a pilgrimage to Mecca, I venture to send the following point in diagnosis, which may be of use to army surgeons, now that invalids are constantly returning from Egypt. 1. Pain during micturition, with stoppages of short duration. The pain is said to be of a pricking character, generally felt at the root of the penis, or sometimes in the glans. It is caused, I suppose, by the passage of the sharp-pointed ova, while the stoppage may be due to spasm set up by ’them or to clots. The character of this pain becomes imporAFTER

tobia in

tant when no clots

THE following case may be interesting as illustrating the value of cocaine as a local anæsthetic in minor surgery. The patient, a Chinese merchant in this city, suffered from epithelioma of the penis. For over two years he had been going the round of the native practitioners, consulting them in vain, and only suffering severe torture from their often heroic but barbarous treatment. He came to me in a state of despair-weak, emaciated, with his nervous system, from prolonged pain and sleeplessness, in a state of extreme irritability. Although a year previously he had refused to submit to amputation as I recommended, he now readily agreed to our proposed method of treatment. Chloroform was carefully administered, but after a few inhalations, proving a bad subject for a general anæsthetic, it was decided to try cocaine. Twenty minims of a 5 per cent. solution of the hydrochlorate were injected, in five-minim doses, at short intervals, round the seat of incision, and into the urethra. A quarter of an hour after the firat injection the part was amputated without the patient experiencing the slightest pain; indeed, he would not believe me when informed that the operation was over. Another point of interest is that, except from the large bloodvessels, there was hardly any heamorrhage, doubtless due to the constricting effect of the drug on the capillaries. As to the aftertreatment, there is nothing worthy of note, only that the anaesthesia produced seemed to last over a day, and that the patient complained of no pain after the operation. He recovered without a bad symptom, and now enjoys excellent health. I constantly use cocaine in eye operations, cataract, iridectomy, pterygium, and also in cases of fistula in ano, abscesses, &c., with most satisfactory results.

can be found in the urine. 2. The passage of a few clots of blood at the end of micturition. The urine is seldom seen discoloured, but a few small clots and shreddy fragments of fibrin will be seen, especially on standing. If the latter are examined, ova in quantity will usually at once be found; not so often in the blood clots. Should there, however, be no such fragments, a catheter may be passed, and the eye examined on withdrawal; shreds and ova will usually be brought away. It saves much trouble to do this, as the urine may be searched in vain; and the symptoms, even though ova are not found at first, will give rise to strong suspicion. In hæmaturia due to filaria sanguinis the urine is much discoloured, and jelly-like yellow clots are often present in Houkden, North China. large quantities, while there is no pain and rarely stoppages ,during micturition. I may add that the patient with CASE OF PLACENTA PRÆVIA. bilharzia is often a strong robust man, and not the least BY M. H. TAYLOR, L.R.C.P., L.R.C.S. EDIN., anaemic, unless the disease has lasted for years. The time between the contraction of the disease and the passage of ON March 9th, at 6.30 A.M., I was called to a woman who blood and other symptoms may be very short; one patient, who stayed at an hotel at Suez for fourteen days, suffering was being attended by a midwife. The patient is a very from them a month after his return to Bombay. stout woman, forty-three years of age, and was seven Bombay. months advanced in her fourteenth pregnancy. I found her almost in a state of collapse, her lips bloodless, and I CASE OF POISONING BY HYDROCHLORIC ACID. could scarcely feel her pulse at the wrist. I heard she had been bleeding since 4 A.M. On examination, I found, as I BY C. H. ROBINSON, F.R.C.S.I., suspected, it was a case of placenta prævia. When I saw MEMBER OF THE COURT OF EXAMINERS, R.C.S.I.; FELLOW OF THE her the haemorrhage had stopped, but on the least moveACADEMY OF MEDICINE. ment it came on again. Not thinking it judicious to do till she had rallied from the state in which she anything THE following short notes of a case of attempted suicide then was, I gave her brandy and milk, and waited for about may be of interest, inasmuch as hydrochloric acid is not half an hour, when she felt better. I then examined her often used for this purpose. more fully. The os was very soft and dilated, sufficiently to On June 16th last a gentleman aged fifty, who for some admit two fingers. 1 found the placenta immediately inside time previously had lost his employment in a firm where he the os; it was detached and felt slightly ragged on the had been engaged for many years, during a fit of drinking right side, the head presenting. I swept my fingers round swallowed an ounce of hydrochloric acid which he had and detached as much placenta as was within reach, and as obtained from a neighbouring chemist. Within a few I did this the os dilated so that I was able to pass my hand minutes afterwards his wife gave him a mustard emetic, into the uterus, when by the bipolar method I turned the which acted several times, and I was sent for and saw him child and brought down the first leg I could seize (the within an hour of the attempt on his life. He was much right), till the foot protruded from the vagina. This I ,depressed, in a cold sweat, and complained greatly of pain found stopped the haemorrhage effectually, so I did nothing in the stomach. There were a couple of stains from the more for two hours, except to put on a binder, when the