Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL.

368 March. On April 21st she consulted her doctor, complaining of pain and weight in the womb," which had been going on since the 16th, and on the 20th there had been just a few drops of blood -only a few spots one and five years, or 1 death in 35 cases, 2 between the On Saturday night, April 23rd, she was ages of six and ten years, or 1 death in 23 cases; and 1 on the linen. between the ages of eleven and fifteen years, or 1 death in seized with a severe attack of pain in the region of 13 cases. Of the whole number, the death-rate is 1 in a the womb, which lasted about an hour, and then entirely little over 26 cases, the mortality being between 3 and 4 ceased. On the following day she had another similar per cent. The authenticity and correctness of this record attack in the same place. This also passed off in about the are undoubted. In our hospital the house-surgeon acts as same time as the other. The slight red discharge had con. the surgical registrar, and the duty devolves upon him of tinued from the 20th, and still went on. On Monday, the entering in the operation-book every operation performed, 25 th, the pain returned, and continued until 3 P.M.,when the with its result; and as this book is inspected and signed at doctor was called in ; there was then great pain at the lower each monthly meeting of the Medical Committee, there is part of the abdomen, in the middle, just over the pubes; no chance of any error or misstatement being undetected pulse was good, and nothing abnormal could be felt on or not corrected. Although to a considerable extent I am palpating the region complained of. This pain lasted conresponsible for the performance of the majority of the tinuously from the 25th to the 27th, when, at about 8 P.M., operations, yet it must not be forgotten that the present it became suddenly much more intense ; in fact, so much so series is not a personal one, but includes t he operations of that her friends thought she was dying, and I was called ia every member of the surgical staff since the year 1864, and and saw her about an hour later. She was then in a state as such it is a remarkable and an almost unique record, of profound collapse (with extreme pallor, small pulse, cold and it nearly beats the "barely 5 per cent. of deaths" of extremities, &c.), had been sick, and had vomited twice. Cheselden, who cut 213 patients and lost 10. I On palpating the abdomen, it was found to be too tender to I do not think it is desirable to lengthen this short paper make out anything definite, or even perform a satisfactory by copying the lithotomy tables and the conclusions which examination. The usual restoratives were administered, to are to be drawn from them, which are to be found in various tide her over the collapse, and she was seen again next day, published papers, monographs, text-books, and surgical when a tumour was discovered above the pubes, extending treatises, as I wish these observations to be considered a from a point just to the left of the middle line right across contribution to the very important subject of perineal the iliac region of the right side. The pain abated, and the lithotomy in male children and boys, especially as at tenderness diminished daily until April 30th, when she present the employment of other operative methods of passed a decidua of considerable thickness, which formeda dealing with this particular surgical disease is being complete cast of the interior of the uterus. Up to this strongly recommended to be adopted, as it were, to the time the slight-very slight-discharge continued, but effacement of that time-honoured operation for the removal after passing the decidua it entirely ceased. On May 13th of stone from the male bladder-viz., the great English a very slight discharge appeared again, continued for three days, and then stopped completely. After this surgeon’s improvement of Frere Jacques’ method. the haematocele disappeared very rapidly, and the patient Wolverhampton. made a good and uninterrupted recovery.

performed in the Wolverhampton and Staffordshire General Hospital, and that 5 of the patients died from causes sequential to the operation, 2 of these between the ages of

"bearing-down

her

Leicester. ___________

Clinical Notes: MEDICAL, SURGICAL, OBSTETRICAL,

AND

POISONING BY SICHERHEIT (A NEW EXPLOSIVE). BY JOHN STOKES, M.B., B.S., M.R.C.S.

THERAPEUTICAL. A CASE OF

EXTRA-UTERINE GESTATION FOLLOWED BY RUPTURE; RECOVERY. BY T. N. THOMAS, L.R.C.P., M.R.C.S. AFTER what appeared in THE LANCET of the 13th ult. on Extra-uterine Gestation, the following brief notes of a case may be of some interest. M. K-, baker’s wife, married in September, 1885. After marriage she only menstruated once before becoming pregnant. She aborted in December following without any assignable cause unless it was due to hard work, as she had to stand at the counter many hours in the day. After the abortion she continued at her work as usual, having a rather clear discharge tinged with blood, off and on, for a time afterwards. The discharge then stopped and she menstruated normally, once in the beginning of February, 1886. She then came pregnant again and carried the child very well until she had gone eight months, when on Oct. 6th she was confined prematurely. The labour was a very tedious one, and the" waters broke" the day before delivery. She was in labour altogether about two days and one night; and, according to her statement, her then medical attendant tried to apply the forceps to expedite the delivery, but for some reason the instrument slipped, and so the delivery was left to nature. Chloroform was not given, though she wished it. The patient got on well after that, and made a good recovery ; but the child was very puny, and never appeared to thrive, and on Dec. 2nd it succumbed, owing, as the mother thinks, to the cold weather which then prevailed. The lochia stopped in about a fortnight, and she menstruated about a month subsequently. After this the catamenia lasted a long time at each period, though she did not lose a large quantity, and usually went a month between. She was last poorly at the end of February, 1887; considered herself pregnant, and did not menstruate in

long

SICHERHEIT ("security") is a new explosive manufactured by the Flameless Explosive Company, and is used for blasting in confined spaces and in mines. The chief component is dinitro-benzene, probably. The details of its manufacture are as follows. (These particulars were given me by the patient whose case is described below.) The " dinitro" is placed in a pan heated bv means of a steam jacket until liquefied; then to this is added a quantity ofa white crystalline substance called "oxalate"in the works, and sometimes there is also added another white crystalline substance called by the men "potash" (what these are I cannot discover) ; the whole mass is then mixed mechanically by means of stirrers, during which process a large amount of bluish smoke is given off. After complete mixture the pan is covered with a lid, and the whole mass is heated for twenty minutes, and then allowed to cool down to the consistency of dough, when it is scraped out by means of brass knives. During this process blue fumes are given off largely; these fumes smell strongly of almonds. The substance is then ground down into a fine powder by machinery, and is sieved by the men; during this large quantities of the material are inhaled by the men, causing great sneezing. The powder is then packed into suitable cases for blasting purposes. It will be noticed that the occasions in which the poisonous materials are taken into the system are (1) when the substance is being heated, (2) when it is being scraped out of the pan, and (3) when it is being sieved. Details of the case.-On July 30th, 1889, I was called at night to see G. R-, aged twenty-three years. He was sitting on a chair, with his head thrown back. His face, lips, finger-tips, and nails were blue, and his face had a pinched, anxious look. Pulse weak, rather irregular, 90 per minute; breathing weak and hurried, 30 per minute ; temperature normal. He was very nervous and trembling; he had just fainted, and had been very sick. The patient informed me that a week previously (July 22nd) he had started working at the Sicherheit manufactory at Denaby. After the first day’s work he noticed that his face and hands were blue,

work