GOVERNMENT CIVIL HOSPITAL, HONG-KONG.

21 Mr. Battle made a median incision, four inches in length, to lengthen life by removal of the growth and make it much between the umbilicus and the pubes ; the recti were more comfortable by a lateral anastomosis and closure of the separated and the peritoneum was incised. The operator’s colotomy wound. The details of the case do not differ hand was then introduced and a hard mass was felt at the much from those given in the description of similar cases in this way by me, and I not refer to them. lower part of the sigmoid flexure, with some scattered hard The growth was brought outside the The apparatus made for getting rid of the spur is perhaps mesenteric glands. wound and as it was distinctly limited it was decided to of interest, as it has proved useful. It consists when comThe wound all round the exposed piece of bowel pleted of a T-shaped instrument which can be easily made remove it. Two pieces of was packed with gauze and clamps of rubber-tubing were in the wards without special apparatus. passed through holes in the mesentery and fastened with ordinary firewood are taken, a long one (about three inches in pressure forceps ; two of these clamps were placed on eachi length) and a short one (about two inches). The long one side of the growth and an inch apart. The bowel was thenL is drilled longitudinally through its centre by means of a red divided with scissors between each pair of clamps and the hot skewer; the short one is shaped like a bow. Both are growth with some of the corresponding portion of mesentery, covered with drainage tubing, a double piece of thread was removed. There was some amount of hoemorrhageB encircling the smaller is carried from its convex border up during the division of the mesentery, but it was soon stopped the centre of the longer one. The smaller piece is then placed with pressure forceps. The divided vessels were then tiedI astride the spur of the colotomy opening and the long arm is and the wound was packed afresh with gauze and the cutt fastened to it by pulling on the string which is secured so as These ends were theni to complete the T. Pressure is applied by means of the ends of the bowel were washed. inverted and sewn up with Lembert’s sutures. The pieces off dressings and body bandage. It is inexpensive, easily made, bowel were then placed side by side with the ends in opposite3 permits fascal matter to pass it, and effectively acts on the directions and so placed that the posterior aspect of one3 spur. I have tried other methods of getting rid of the spur piece lay against the anterior aspect of the other. Then thee after colotomy, but none have given me quite such satisfacr serous coats were united by continuous Lembert sutures for tory results. two inches in the long axis of the bowel, the ends of the silk being left long for future use. An incision of two inches in GOVERNMENT CIVIL HOSPITAL, HONGlength was made in each piece of bowel parallel to the seam The and passing through all the coats of the intestine. KONG. adjoining edges of the incisions were united by continuous A CASE OF PNEUMONIC PLAGUE TREATED BY LARGE DOSES sutures passing through the mucous and muscular coats. OF CARBOLIC ACID ; RECOVERY. Then a needle was threaded on to the long end of silk left the care of Mr. J. BELL, Assistant Superintendent.) from the first seam and the remaining portion of the (Under of the serous coat was Lembert’s suturing performed by As we have on some previous occasions pointed out, method. The bowel was washed and replaced in the carbolic acid is much less poisonous than it is usually conabdomen. The abdominal wall was then closed in successive layers and the wound was dressed with cyanide gauze. A sidered to be. The toxic symptoms which appear when tb& length of about six inches of the bowel was removed. On drug is taken in an undiluted form are almost entirely section it was found that the lumen was almost closed ; it referable to the local caustic action. When taken with free dilution phenol-gives rise to very few symptoms indeed ; in proved to be a columnar-celled carcinoma. The patient did well after the operation and free escape many cases even the darkening of the urine (" carboluria ") of fæcal matter occurred from the rectum through a tube may not be present. With regard to the question of its which had been placed there to prevent any accumulation. therapeutic value in plague, it is as yet impossible to from He steadily progressed and on April 23rd a curved piece of an opinion, and we await with much interest the result of wood covered by rubber tubing was introduced into the the extended trial of carbolic acid in the treatment of plague colotomy wound to press on the " spur." It caused a little which Mr. Bell tells us he is carrying out. A healthy Greek sailor, aged 24 years, was admitted into pain, but the spur became much less obvious. The bowel was washed out daily both through the anus and through the the Government Civil Hospital, Hong-Kong, on April 17th, colotomy wound. He was allowed to get up every day. with gonorrhoea. His temperature was 101° F. and save for On May 5th a different instrument was employed to exertthe local condition he seemed to be well and made no compressure on the spur and in a few days solid motions were plaint. His temperature for the next two days kept slowly passed through the rectum. On May 15th Mr. Battle rising and his tongue became more furred till the morning decided to close the colotomy opening. After the patient of the 20th when he was very apathetic, the temperature was anaesthetised and the skin around the wound had beenL being 105° and the tongue very dry and furred; there were no washed an oblique incision was made above and another buboes. The principal civil medical officer (Dr. J. A. Lowson) below the opening, and these were then joined so as to now saw the patient and agreed that there was a probability surround the artificial anus. By careful dissection the edges! that he was suffering from plague. His lungs were full of of the opening were dissected up without opening the; coarse rates all over, but there was no dulness. Shortly general peritoneal cavity. Then the openiog in the mucous3after the consultation he began to spit thick bloody sputum, membrane of the bowel was closed with 16 silk interrupted1 which on examination was found to be full of typical bacilli. sutures. The sub-peritoneal tissue was united over the As he was too ill to be moved to the Infectious Diseases stitches and the muscles and skin were sutured separately. Hospital he was at once isolated and put on a suitable diet with stimulants. Hypodermic injections of digitalis A drainage-tube was inserted. After the operation the patient progressed satisfactorily. and strychnia were made every four hours and 12 grains A small quantity of pus escaped for a few days from the3 of pure carbolic acid in solution were given every three tube and after the latter was removed a small collection off hours. He continued to be very ill all day, the pulse pus was found and opened, but later the wound healed1 was very quick and intermittent, he was delirious, and and on March 5th the patient left the hospital completelyy the temperature ranged between 105° and 1064°. On the recovered. He was seen at the hospital on June 29th, having next day there was a marked though slow change for the recently returned from a convalescent home. He lookedi better. His temperature slowly fell to 102° and only rose bronzed and well, having gained seven pounds in weightt to 1034° in the evening. The tongue was more moist, though during his stay at the home. The bowels acted regularlyy it was still very furred, and the breath was offensive. and without difficulty ; there was a small sinus in the site off Injections were not required so frequently as his pulse was the former colotomy opening from which there had been a a stronger and not so quick, varying from 94 to 102. Bacilli little faecal-smelling discharge. His were still in the sputum both morning and evening. Remarks by Mr. BATTLE.-On account of the distensiorn temperature slowly fell each day till the 24th, when it of the abdomen and general condition of the patient n(o became normal. The sputum soon ceased to contain blood, search was made for the cause of the obstruction whern though it was very free for 48 hours. His tongue remained colotomy was performed. It appeared probable that this caUSE,e moist and slowly cleaned and the patient expressed himwas a malignant stricture of the large bowel, probably thEe self as feeling much better in every way. On the 24th upper part of the rectum or sigmoid flexure, and it seemedaa there was no sputum and the lungs were quite clear. The pity to let a man with the possibilities for further usefulnes:;s carbolic acid was decreased after 48 hours to four hourly of this patient pass out of observation condemned to the lif,fe doses and was stopped on the 24th, from which date the of an invalid, with a prospect of death in a few months fronm patient convalesced rather rapidly. It was ascertained extension of growth to other parts, when it might be p’)ssiblle through his friends that he contracted the original trouble

treated

need

————————————————————————————————————

.

.

.

22 whereas all experiments made with species of culex, at least ten (in Italy, Africa, and India), had given negative results. Although it was quite possible that a species of culex might be found which was capable of serving as intermediary hosts to human parasites, the evidence hitherto gathered pointed solely to anopheles as fulfilling this function. The interesting fact that anopheles persisted in England whilst malaria had to all appearances disappeared was a subject for further investigation. The disappearance of the malarial parasites might very well be due to a progressive diminution in the number of anopheles, a plentiful supply of which was absolutely necessary for their continued existence. There might, however, be other factors concerned in their disappearance which still remained to be discovered. The treatment. suggestion that it might be due to the anopheles in England not sucking blood was untenable, for Dr. Nuttall had proved the contrary by experiments upon himself. Dr. Louis COBBETT (Cambridge) showed some Cultures of Bacillus Diphtherias which had been obtained from the nasal discharge of a pony. The original culture was sent by Dr. Mearns Fraser, medical officer of health of Portsmouth, who while investigating the causation of an attack of diphtheria PATHOLOGICAL SOCIETY OF LONDON. in a little girl had noticed that her father’s pony was sufferfrom a purulent and slightly sanguineous nasal discharge. ing The Bacteriology of Dysentery, Yellow Fever, and Diphtheria. were described which established the Experiments -The Way in whioh Bones Break.-The Relation rf of the bacillus. The horse had hitherto not been identity known, Mosquitoes to Malaria -The Composition and Action oj among animals, to suffer from diphtheria. Brown-Séquard’s Fluid.-Neutralisation of Culture Media. Dr. COBBETT also described experiments showing that A MEETING of this society was held on June 30th in the Diphtheria Toxin was Excreted in the Urine, both from Pathological Laboratories of the University of Cambridge by ’, susceptible and from relatively insusceptible animals-e.g., the invitation of Professor SIMS WOODHEAD, Dr. W. OSLER the guinea-pig and the rat. From these animals, injected with diphtheria toxin, the urine secreted during the next occupying the chair. Professor SIMON A. FLEXNER (Philadelphia) made a com- few hours was collected with a catheter and injected subcumunication on the Pathology of Tropical Dysentery. He said taneously into guinea-pigs. It produced an inflammatory that an acute and a chronic form could be distinguished on swelling at the seat of inoculation, followed by dry necrosis, clinical and pathological grounds. The acute form might falling out of the hair, and in one instance death. Control terminate fatally in from 48 to 72 hours or it might be re- experiments were made with the same urine to which a little covered from or become chronic. The chronic dysentery per antitoxin had been added. Other control experiments also .se of the tropics was amcebic in nature. The acute variety were made with the urine of normal animals. Dr. W. E. DIXON (Cambridge) made a communication on was not caused by amoebae; but from the stools a bacillus had been isolated differing from the normal intestinal flora and the Composition and Action of Brown-Sequard’s Fluid. He showing specific properties. It agglutinated with the blood gave an abstract of the results of experiments which he had serum of dysenteric cases. Its properties placed it very near performed by injections of orchitic extract of different the bacillus typhosus, from which organism it could be animals. The composition of orchitic extract of all animals distinguished by biological and physiological peculiarities. was practically identical. The active principles consisted The bacillus which was obtained from cases of dysentery chiefly of two bodies-(1) nucleo-albumin ; and (2) spermine. occurring in and about Manila apparently was identical with The former he showed was very toxic, producing great cardiac inhibition reflexly through the cardiac nerve centres. an organism isolated by Shiga from the disease endemic in Japan. From a case of dysentery contracted in Puerto The latter, spermine, which was also present in considerable Rico the same organism had been obtained. quantity in semen, produced its effect principally by proProfessor FLEXNER also made some remarks on the Sup- ducing congestion of the abdominal viscera, including both posed Bacillus of Yellow Fever. The widespread fatty the testes and ovaries. Dr. J. W. H. EYRE made a communication on the degenerations produced in the viscera in this disease were He remarked on the not special to this organism. Other organisms produced Neutralisation of Culture Media. these changes and also hyaline necroses, just as the yellow uncertainty of litmus paper and of litmus solution. He advocated a standard medium among English bacteriologists fever bacillus did. Dr. J. GRIFFITH (Cambridge) gave a demonstration on by the use of phenyl-thalein as an indicator of the alkalinity the Way in which Bones Break. He referred chiefly to the of culture media. Votes of thanks to Professor Sims Woodhead and the method of breaking by torsion. That was the easiest method of breaking a bone. He illustrated his remarks in the case University authorities and to those who had communicated of the femur, the ribs, and the clavicle and the tibia. A their researches terminated the meeting. spiral fracture resulted from torsion. If the long axis of the bone was bent as well as twisted the spiral would be shorter. Dr. GEORGE H. F. NUTTALL (Cambridge) gave a demonEDINBURGH OBSTETRICAL SOCIETY. stration upon the Relation of Mosquitoes to Malaria. The demonstration consisted in the exhibition of the developmental changes undergone by avian and human parasites in Exhibition of Specimens and Micro-photographs.-Suppression of Urine following Crlstitis.-Ccesarean Section followed species of culex and anopheles respectively, these being the Periby Sub-peritoneal illustrated by means of specimens, photo-micrographs, and

a house in the infected area some 14 days previously to his admittance to hospital. Remarks by Mr. BELL.-This form of plague is extremely fatal and I know of no cure here. The case came under treatment early and he was a strong healthy patient, but the effect of the carbolic acid was most marked, and I report the case in the hope that others will at once try it, especially on Europeans, who come under treatment as a rule early. It is now being tried on every case admitted to the Plague Hospital, and as soon as 50 cases have been under treatment the results will be communicated. In all this patient had 280 grains of carbolic acid without any symptoms of poisoning by the drug. The original trouble for which he came to hospital was unaffected both by the plague and its

at

Medical Societies.

’

Hysterectomy.-Cleansing

during Cæliotomy.-Eclampsia treated by Saline drawings. Living specimens anopheles maculipennis, and Veratrum Viride. Effusion caught by Dr. Nuttall in the vicinity of Cambridge, as also of culex, were shown in tanks, and their biological characters A MEETING of this society was held on June 27th, Dr. were referred to. Maps showing the geographical distribu. R. MILNE MURRAY, the President, being in the chair. tion of malaria over the world and its former prevalence in Professor A. R. SIMPSON showed (1) a Dermoid Cyst of England were exhibited, and the present geographical distri- the Ovary which formed the channel of a Fæcal Fistula; and bution of the genus anopheles, as far as was known, was (2) two Fibroid Uteri removed by Panhysterectomy. described. A decided agreement between the former distriDr. J. LAMOND LACKIE showed an Early Extra-uterine bution of malaria in England and the distribution of anopheles Gestation. Dr. J. HAiG FERGUSON showed a Uterus removed by (anopheles maculipennis, anopheles bifurcatus, anopheles nigripes) at the present time was observable. The studies Vaginal Hysterectomy for Cancer of the Cervix. Mr. J. STUART NAIRNE (Glasgow) showed a Uterus with regarding this distribution were, however, not as yet con. cluded. The development of human malarial parasites hac Placenta in situ removed from a Dwarf by Cscsarean Section been observed in nine species of anopheles in different parts oj at full term. Dr. N. T. BREWS showed (1) a Subperitoneal Fibroid the world (India, Africa, Italy, and the United States), of

toneum