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GRADUAL EVACUATION OF ASCITIC FLUID THROUGH A SLENDER CANNULA.
1831 of the Transactions of the Congress, but when the original papers and the discussions thereon came into the hands of the editors it appeared obvious that the balance to the credit of the honorary treasurers would prove insufficient in consequence not only of the great mass of material to be printed, but also of the heavy cost entailed by the distribution of the volumes to members, so large a proportion of whom reside either on the continent, in America, or in the Dominions beyond the An appeal to the officers of each section Seas. and subsection to raise an additional sum proportionate to the size of the section or subsection concerned produced the sum of C646 Os. 6d. Editorial curtailment of some of the papers anddiscussions, and the unexpected receipt of a sum of X347 Os. 7d. by sales of the Transactions, however, resulted in a balance of C337 19s. 8d. at the bank, and a credit balance with the publishers of oE59 2s. 4d. This balance has been returned to the respective donors in proportion to the amount subscribed. The finance committee draws special attention to the remarkable promptitude and success with which this great undertaking has been carried out by the editorial secretaries of sections and the editorial committee, and also to the excellence with which the volumes, which extend to 12,498 pages, and are printed in t]4ree languages, have been produced, in a space of little more than six months, by the Oxford Press. Now that all expenditure has been met a certain sum lies in the hands of the treasurers, which may still be slightly augmented by the sale of further copies of the Transactions, and it is recommended that it be left to the officers of the Congress to decide how the eventual balance from the general funds shall be disposed of. It is further recommended that the Royal Society of Medicine be asked to deposit the minute books and other records of the Congress in their library. At the final meeting of the organising committee on Tuesday, July 7th, the members of a National Committee of Great Britain and Ireland for the puroses of the International Congresses of Medicine will be nominated. The President of the Royal College of Physicians of London has issued invitations to a conversazione at the College in the evening at 9 P.M., which will close the official existence of the organising committee.
through the abdominal wall. The fluid must not contain fibrinous exudation, and it comes away rather slowly-from 1 litre to 112 litres in
GRADUAL EVACUATION OF ASCITIC FLUID THROUGH A SLENDER CANNULA.
IN the South African JJ:fedical Record of May.23rd Dr. J. L. Levin has described a curious accident -simultaneous dislocation of both shoulder-joints. He received an urgent message from a farm that a woman was in great pain, the cause of which could not be ascertained. On arrival he found a woman, aged 24 years, weeping copiously and half kneeling, half sitting on her bed, leaning forward resting on pillows, each arm slightly abducted with the elbows flexed to a right angle, and one forearm supporting the other. The history was that after retiring to bed and while talking to her husband she suddenly threw her arms about wildly and became unconscious for about a minute. When she recovered she complained of agonising pain round her On examination both shoulders correshoulders. sponded exactly, which somewhat obscured the diagnosis. Any attempt to place either hand on the opposite shoulder while the arm was pressed against the chest caused excruciating pain. Both shoulders appeared to be slightly flattened and the acromion processes projected slightly. The significance of this fact did not strike Dr. Levin until he was
A FEW surgeons have from time to time recommended the use of a cannula of very small bore for the evacuation of ascitic fluid, one of the most recent advocates of this method being Staff-Surgeon Dr. Buth, of Berlin. He employs what he calls a capillary trocar fitting into a cannula 8 cm. long and 1-!’F mm. in external diameter, with a bore of 1 mm., about one-twentieth of an inch, and several small lateral perforations near the end which enters the peritoneum. The other end is provided with an olivary enlargement for the attachment of an indiarubber tube which conveys the escaping fluid to a suitable receptacle. In his account of the operation, published a short time ago in the Deutsche Medizinische Wochen8chrift, he recommends that the patient should sit on a chair or bed and that the skin at the site of the puncture in the middle line near the symphysis pubis should be sterilised with iodine and anaesthetised. The sharp point is thrust quickly through the skin and then slowly in a downward direction
hour. A statement in tabular form shows that among Dr. Buth’s cases the most rapid evacuation was 5 litres in three hours, while the slowest He considers that a was 5! litres in five hours. puncture with this instrument is less trying for the patient than the use of the ordinary large trocar; that on account of the slow evacuation there is no danger of collapse ; and that there is no risk of wounding the epigastric artery, because repeated punctures may be made within a space the size of a shilling; the punctures have never been found to become unhealthy. The instrument used by Dr. Buth was supplied by Herr Berkholz, an
70, Kopenicker Strasse, Berlin. ARTIFICIAL TEETH
FOR THE
POOR.
THE amount of misery and ill-health due to the lack of means to obtain artificial teeth is incalculable-among the poor of London alone it must be enormous. Hitherto little has been done to remedy matters except through individual effort in those special cases which for some reason or another attract the notice of the charitable. We now learn that an attempt is being made to attack the problem in an organised fashion and on a large scale. In January last Mr. Edwin Tate generously offered a sum of C5000 to the authorities of St. Bartholomew’s Hospital to start a fund for assisting necessitous persons, being patients of that institution, to obtain artificial teeth. A scheme has now been prepared by the hospital and approved by Mr. Tate, and all the preliminaries are completed and the trust deed is ready for sealing. It is not necessary for us to dwell upon the benefit which such a fund, wisely administered, will confer upon those who need the help which it is designed to give; but the fact should be stated that further contributions are desired in order to extend and consolidate the It is fitting that the oldest hospital in work. London should show the way in this matter, and we hope that other institutions throughout the country will find the means to follow so useful and beneficent a lead. SIMULTANEOUS DISLOCATION OF SHOULDER-JOINTS.
BOTH
through the abdominal wall. The fluid must not contain fibrinous exudation, and it comes away rather slowly-from 1 litre to 112 litres in
GRADUAL EVACUATION OF ASCITIC FLUID THROUGH A SLENDER CANNULA.
IN the South African JJ:fedical Record of May.23rd Dr. J. L. Levin has described a curious accident -simultaneous dislocation of both shoulder-joints. He received an urgent message from a farm that a woman was in great pain, the cause of which could not be ascertained. On arrival he found a woman, aged 24 years, weeping copiously and half kneeling, half sitting on her bed, leaning forward resting on pillows, each arm slightly abducted with the elbows flexed to a right angle, and one forearm supporting the other. The history was that after retiring to bed and while talking to her husband she suddenly threw her arms about wildly and became unconscious for about a minute. When she recovered she complained of agonising pain round her On examination both shoulders correshoulders. sponded exactly, which somewhat obscured the diagnosis. Any attempt to place either hand on the opposite shoulder while the arm was pressed against the chest caused excruciating pain. Both shoulders appeared to be slightly flattened and the acromion processes projected slightly. The significance of this fact did not strike Dr. Levin until he was
A FEW surgeons have from time to time recommended the use of a cannula of very small bore for the evacuation of ascitic fluid, one of the most recent advocates of this method being Staff-Surgeon Dr. Buth, of Berlin. He employs what he calls a capillary trocar fitting into a cannula 8 cm. long and 1-!’F mm. in external diameter, with a bore of 1 mm., about one-twentieth of an inch, and several small lateral perforations near the end which enters the peritoneum. The other end is provided with an olivary enlargement for the attachment of an indiarubber tube which conveys the escaping fluid to a suitable receptacle. In his account of the operation, published a short time ago in the Deutsche Medizinische Wochen8chrift, he recommends that the patient should sit on a chair or bed and that the skin at the site of the puncture in the middle line near the symphysis pubis should be sterilised with iodine and anaesthetised. The sharp point is thrust quickly through the skin and then slowly in a downward direction
hour. A statement in tabular form shows that among Dr. Buth’s cases the most rapid evacuation was 5 litres in three hours, while the slowest He considers that a was 5! litres in five hours. puncture with this instrument is less trying for the patient than the use of the ordinary large trocar; that on account of the slow evacuation there is no danger of collapse ; and that there is no risk of wounding the epigastric artery, because repeated punctures may be made within a space the size of a shilling; the punctures have never been found to become unhealthy. The instrument used by Dr. Buth was supplied by Herr Berkholz, an
70, Kopenicker Strasse, Berlin. ARTIFICIAL TEETH
FOR THE
POOR.
THE amount of misery and ill-health due to the lack of means to obtain artificial teeth is incalculable-among the poor of London alone it must be enormous. Hitherto little has been done to remedy matters except through individual effort in those special cases which for some reason or another attract the notice of the charitable. We now learn that an attempt is being made to attack the problem in an organised fashion and on a large scale. In January last Mr. Edwin Tate generously offered a sum of C5000 to the authorities of St. Bartholomew’s Hospital to start a fund for assisting necessitous persons, being patients of that institution, to obtain artificial teeth. A scheme has now been prepared by the hospital and approved by Mr. Tate, and all the preliminaries are completed and the trust deed is ready for sealing. It is not necessary for us to dwell upon the benefit which such a fund, wisely administered, will confer upon those who need the help which it is designed to give; but the fact should be stated that further contributions are desired in order to extend and consolidate the It is fitting that the oldest hospital in work. London should show the way in this matter, and we hope that other institutions throughout the country will find the means to follow so useful and beneficent a lead. SIMULTANEOUS DISLOCATION OF SHOULDER-JOINTS.
BOTH