CLAYTON HOSPITAL, WAKEFIELD.

HOSPITAL MEDICINE AND SURGERY.

654

stiffness of the joints but this was gradually overmassage and the patient was able to leave hospital on March 31st. Owing to the difficulty in obtaining supplies three brands of serum were used, the respective makers being Parke, Davis and Co., Burroughs, Wellcome and Co., and the Lister Institute. The temperature and general condition always seemed to respond to the serum and no unpleasant effects were manifested at the sites of injection. During the greater part of the febrile portion of the illness small doses of quinine were given in an effervescing mixture. was some

come

A Mirror OF

HOSPITAL

PRACTICE,

BRITISH AND

FOREIGN.

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, tum aliorum tum proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Caus. Morb., lib. iv., Proœmium.

CLAYTON A

CASE

OF

BUDLEIGH-SALTERTON COTTAGE HOSPITAL.

HOSPITAL, WAKEFIELD.

PUERPERAL FEVER SUCCESSFULLY WITH ANTISTREPTOCOCCIC SERUM.

TREATED

(Under the care of Mr. WILLIAM STANGER.) FOR the notes of this case we are indebted to Dr. C. Dyson Holdsworth, house surgeon to the hospital. The patient, who was aged 23 years and had already given birth to one child, was delivered of a male child on Oct. 19th, 1905. The midwife in attendance was unable to deliver the placenta. After the lapse of nearly two hours, during which time there had been considerable hoemorrhage, Mr. L. T. Wells was called in. He had to strip off the placenta manually but it came away whole. The first week of the puerperium was normal but on the night of the 26th the patient’s temperature ran up to 1050 F. and the lochia became foul. Vaginal douches containing perchloride of mercury were given, cold sponging was practised, and quinine was administered in an effervescing mixture. On the next night the patient’s temperature again rose to 105°, but after this there was a slight improvement which, however, proved to be only temporary, so she was removed to the Clayton Hospital on Nov. 6th. As her temperature remained irregular and the discharge began to increase the uterus was explored under an anmsthetic on the 8th and some fragments of membrane were removed with a blunt curette. Intra-uterine douches were given daily for the next week, the discharge decreasing rapidly. On the 9th a pyasmic abscess was opened in the left deltoid region and numerous streptococci were That found on microscopical examination of the pus. evening 20 cubic centimetres of antistreptococcic serum were injected into the abdominal muscles. At midnight the temperature had risen to 105° and the pulse-rate to 150, so ten more cubic centimetres of serum were given. On the following morning the temperature had fallen to 100° but about 7 P.M. the patient had a rigor and her temperature ran up to 105’60, with a pulse-rate of 138 ; ten cubic centimetres of serum were administered and as her condition was apparently becoming worse 20 more cubic centimetres were injected and liquor strychnine hydrochloridi was given every four hours in five-minim doses hypodermically. During the next two days 30 cubic centimetres of serum were given per diem but the patient seemed to be sinking. Several pyasmie abscesses were openednamely, one in the lumbar region posteriorly, another in the right arm, and another in one of the fingers of the left hand. She then rallied slightly and on the 15th her temperature was down to 99°, so the serum, which had been used in 20 cubic centimetre doses for the last three days, was discontinued. The improvement lasted until the night of the 20th, when the temperature rose to 103° and the serum treatment was accordingly resumed, 20 cubic centimetres being given per diem. On the 23rd the temperature rose to 1C4’ 4° and the pulse-rate to 144, so the serum was increased to 30 cubic centimetres per 24 hours for the next three days. On the 25th a large amount of pus was evacuated from the back. The patient seemed to be becoming feebler and her pulse weaker, so digitalis was administered instead of strychnine for a few days with apparent benefit. On the z’ 26th, as the temperature was lower and the patient seemed a little better, the serum was discontinued; on Dec. 3rd, however, the temperature rose to 103°, so ten cubic centimetres of serum were given on this and the succeeding day, after which no more serum was used. For the next three weeks the patient’s temperature remained irregular and several new abscesses had to be opened. The temperature then became steadier, the abscesses gradually dried up, and with the help of tonics the patient made a very good recovery. For a time there

by

A

CASE OF

RUPTURED PYOSALPINX COMPLICATED LARGE OVARIAN CYST.

BY A

Mr. THOMAS G. C. EVANS and Mr. RUSSELL COOMBE.)

(Under the care of

THE patient was 39 years of age and had been married for ten years but had never been pregnant. Eight weeks after marriage she had an attack of pelvic pain which kept her in bed for six weeks. During the last few years she had had frequent attacks of abdominal pain which had kept her in bed for a few days at a time. One of these lasted from Feb. 13th to 16th, 1905, and about midnight between Feb. 16th and 17th she had an attack of very acute pelvic pain with vomiting and repeated shivering fits. She was seen by Mr. Evans on the morning of the 17th. Her pulse-rate was then from 150 to 160 and her temperature was 105° F. Her abdomen was distended and very tender just above the pubes. She was removed to the

hospital. Mr. Russell Coombe saw her with Mr. Evans at 3 P.M. Her abdomen was distended and moving fairly freely; both flanks were resonant ; the central part of the abdomen from the pubes to above the umbilicus was dull ; there was exquisite tenderness on the left side above the middle of Poupart’s ligament ; the pulse-rate was 160 and the temperature was 103°. Chloroform having been administered by Dr. A. Walker, and Mr. Evans assisting, Mr. Coombe made an incision through the left rectus when a large ovarian cyst, not congested, presented. The excision was extended and this was delivered. It was found to be incorporated with the right side of the womb and the right tube, splitting the broad ligament and lifting the peritoneum up to the pubes anteriorly and up to the cascum on the right side, so that the bladder showed in a groove on its left side below and the appendix in a groove on its right side above. All attempts to clear it from its connexion with the peritoneum and broad ligament failed and it was therefore drawn over against the right side of the abdominal wound. The pelvis was then explored and the left tube was found to be much enlarged and surrounded by pus which was escaping from a hole in the tube ; the pus was sponged up, the tube The tube was then was emptied, and the tear was clamped. dissected off three or four inches of bowel to which it was adherent, the raw surface was covered, and the tube was ligatured off close to the uterus and removed. The remainder of the ovarian cyst was narrowed by a purse-string suture and cut off fiush with the abdominal wound, its cavity was packed with gauze, and it was fastened in the lower end of the wound. A large drainage-tube with a gauze wick was then passed down to the stump of the left tube and the abdominal wound was closed with silkworm-gut sutures. The patient made an uninterrupted recovery and is now (August, 1906) in excellent health.

THE WINSLEY SANATORIUM.-The trustees of£ the Winsley Sanatorium have convened a meeting to consider the financial position of the institution and a proposition which has been made to enable them to raise q7500 on

mortgage.

INTERNATIONAL CONFERENCE

ON

TUBERCULOSIS.-

The International Central Bureau for the Prevention of Consumption is meeting at the Hague this week, the deliberations commencing on Sept. 5th. The National Association of England is represented by Dr. C. Theodore Williams and

Dr. Nathan Raw.