- Email: [email protected]
KING EDWARD'S HOSPITAL FUND FOR LONDON.
1071 extended downwards in conical form and ended at the ninth thoracic segment. A piece of the tumour examined microscopically showed a mass of conglomerate tubercle, caseous centrally, and surrounded by fresh nodules in which typical giant cells were found and abundant tubercle bacilli. Apart from the rarity of this condition, of which Herter reported three cases, collecting records of 24 others from the literature of the subject, this case is of interest from the correct diagnosis having been formed during life and from the admirable and instructive way in which it is recorded.
Scilly Isles, which represents fairly well the
weather in the Penzance district, had about the same average temperature as Nice and Florence, while as regards the average temperature of the night Scilly was superior to both the Italian and the Rivieran resorts, while in Torquay and Falmouth the nights were just as warm as those at Nice. At most of the English stations, too, the difference between the day and night temperature showed less range than some of those abroad. Nice, for instance, had a mean diurnal range of 13°, but at the Scilly Isles and Falmouth, as well as at Harrogate, the range was no more than 70, while at Torquay and Jersey it was only 8°. During the three months, December to February, the screened thermometer fell to 320 I or below on 11 nights at Biarritz, on six at Florence, on three at Nice, and on one occasion even at Rome. But Scilly was entirely without frost throughout the winter, the screened instrument only once descending to near the freezing point, and at Torquay and Falmouth there were only two or three slight frosts. The aggregate rainfall at the home stations was less than at some of those abroad although it had a month longer in which to fall. The number of days with rain are not strictly comparable, as a"day with rain " at the foreign stations signifies a day when at least four-hundredths of an inch of rain has fallen, while with us it means a day when at least one-hundredth of an inch has fallen. It is a pity that all the stations do not give the percentage of ozone present in the atmosphere ; at Torquay, where the borough meteorologist takes careful observations, the percentage of the possible amount for the whole winter was 47. It was least-38-in December and greatest-59-in February. A
KING EDWARD’S HOSPITAL FUND FOR LONDON. OUR readers will remember that the Prince of Wales, the President of King Edward’s Hospital Fund for London, announced at a meeting of the general council of the Fund held at Marlborough House on March 8th that a large sum of money, estimated to produce JM600 a year, had been promised by a friend if a further sum of double that amount were obtained by the end of the year. The object of the anonymous donor is to enable the council to make its distributions to hospitals without drawing upon its reserves as it had to do last year when a sum of over £18,000 was thus appropriated to complete Towards this object a donation of .E1000 the grants. has been received by the Fund from "G. W. C." and a legacy of R10.000 from Mr. F. S. Massy Dawson, the executor of the late Mr. Richard Hawkins Beauchamp. Mr Hugh C. Smith, the chairman of the executive committee, has issued an appeal for further donations towards making up the sum required and he announces that he will be glad to give any further information concerning the Fund. The address of the Fund is 81, Cheapside, London, E.C.
CASE OF TUBERCULOUS DEPOSIT IN THE SPINAL CORD IN THE COURSE OF PULMONARY TUBERCULOSIS.
THE EARLY DIAGNOSIS OF PERFORATION TYPHOID FEVER.
Dr. Ernst Oberndorfer of Berlin records in the Münchener Medicinische Wochensohrift, No. 3, 1904, a case of considerable interest from the Moabite Hospital at Berlin under the care of Professor Goldscheider. The patient was a man, 26 years of age, who had for some time suffered from tuberculosis of the lungs. He began to complain of disturbances of the act of defecation and difficnlty in emptying the bladder, with wandering pains in the epigastric and lumbar regions. Later a paresis of the left leg developed with some impairment of sensation of the lower half of the body. The condition was regarded as one of compression paraplegia and weight extension was applied; in spite of this the condition of the patient became rapidly worse, complete paraplegia with retention of urine developing. Meanwhile the pulmonary disease advanced rapidly and six weeks after admission to the hospital the patient died. Before death the original diagnosis of compression paraplegia was discarded and the correct one of tuberculosis of the spinal cord was made on the following grounds-the co-existence of the lung c ndition, the absence of the objective signs of vertebral caries, and the manner of spread of the cord symptoms beginning with unilateral paral sis and local patches of anmzthesia and gradually advancing to complete paralysis and loss o’ sensation. The necropsy confirmed the diagnosis : the vertebras and meninges were natural but in the lower dorsal region of the cord a bean-shaped swelling was found projecting slightly above the surface on the posterior aspect. A cross section was made at the level of the eighth thoracic segment, when a yellowish white tumour, sharply marked off from the softened cord tissue around, was exposed. It internal border was surrounded by a narrow zone of greyish red translucent tissue. The tumour occupied the whole of the left side and extended into the right side of the cord at this level, leaving only a small area of the white matter of the antero-lateral region unaffected. It
I
IN
MORE than a fourth of the deaths from typhoid fever due to perforation. The value of operation has been abundantly shown in recent years. At the Johns Hopkins Hospital six patients have been saved out of 14 operated on. Dr. H. W. G. Mackenzie has published an eminently practical paper in the Practitioner for January in which he points out that as good re ults may be obtained in general as in hospital practice if the practitioner is on the alert to give the patient the benefit of prompt operation. He very clearly states the point, in the early diagnosis of perforation. The danger of perforation commences with the disease and lasts until recovery is complete. Perforation may occur before the patient feels ill enough to take to bed or during convalesThe greatest risk is during the second, third, and cence. fourth weeks. Abdominal pain is the most imporhnt early symptom and may be the only one. It usually comes on suddenly and is severe and persistent. Vomiting, nausea, hiccough, frequent actions of the bowels, a rigor, sweatare
ing, mectal excitement, or collapse may precede, accompany, or quickly follow the onset of the pain. The nurse should be instructed to report at once to the practitioner the occurrence of pain or any other of these symptoms. When summoned the medical attendant should carefully examine the patient for the following signs of perforation. 1. There may be a change in the temperature-a sudden fall or a sudden rise, or a fall followed by a rise, or a rise followed by a fall ; but a steady temperature for a few hours does not negative perforation. 2. There may be a change in the pulse ; soon after perforation the pulse usually becomes more frequent and weaker. It is highly significant if the pulse in the few hours following the attack of pain becomes more rapid, running, and feeble ; but increased rapidity does 3. There may not invariably follow within a few hours. The development of a be a change in the facies. pinched or drawn look, depression of the angles of the
Scilly Isles, which represents fairly well the
weather in the Penzance district, had about the same average temperature as Nice and Florence, while as regards the average temperature of the night Scilly was superior to both the Italian and the Rivieran resorts, while in Torquay and Falmouth the nights were just as warm as those at Nice. At most of the English stations, too, the difference between the day and night temperature showed less range than some of those abroad. Nice, for instance, had a mean diurnal range of 13°, but at the Scilly Isles and Falmouth, as well as at Harrogate, the range was no more than 70, while at Torquay and Jersey it was only 8°. During the three months, December to February, the screened thermometer fell to 320 I or below on 11 nights at Biarritz, on six at Florence, on three at Nice, and on one occasion even at Rome. But Scilly was entirely without frost throughout the winter, the screened instrument only once descending to near the freezing point, and at Torquay and Falmouth there were only two or three slight frosts. The aggregate rainfall at the home stations was less than at some of those abroad although it had a month longer in which to fall. The number of days with rain are not strictly comparable, as a"day with rain " at the foreign stations signifies a day when at least four-hundredths of an inch of rain has fallen, while with us it means a day when at least one-hundredth of an inch has fallen. It is a pity that all the stations do not give the percentage of ozone present in the atmosphere ; at Torquay, where the borough meteorologist takes careful observations, the percentage of the possible amount for the whole winter was 47. It was least-38-in December and greatest-59-in February. A
KING EDWARD’S HOSPITAL FUND FOR LONDON. OUR readers will remember that the Prince of Wales, the President of King Edward’s Hospital Fund for London, announced at a meeting of the general council of the Fund held at Marlborough House on March 8th that a large sum of money, estimated to produce JM600 a year, had been promised by a friend if a further sum of double that amount were obtained by the end of the year. The object of the anonymous donor is to enable the council to make its distributions to hospitals without drawing upon its reserves as it had to do last year when a sum of over £18,000 was thus appropriated to complete Towards this object a donation of .E1000 the grants. has been received by the Fund from "G. W. C." and a legacy of R10.000 from Mr. F. S. Massy Dawson, the executor of the late Mr. Richard Hawkins Beauchamp. Mr Hugh C. Smith, the chairman of the executive committee, has issued an appeal for further donations towards making up the sum required and he announces that he will be glad to give any further information concerning the Fund. The address of the Fund is 81, Cheapside, London, E.C.
CASE OF TUBERCULOUS DEPOSIT IN THE SPINAL CORD IN THE COURSE OF PULMONARY TUBERCULOSIS.
THE EARLY DIAGNOSIS OF PERFORATION TYPHOID FEVER.
Dr. Ernst Oberndorfer of Berlin records in the Münchener Medicinische Wochensohrift, No. 3, 1904, a case of considerable interest from the Moabite Hospital at Berlin under the care of Professor Goldscheider. The patient was a man, 26 years of age, who had for some time suffered from tuberculosis of the lungs. He began to complain of disturbances of the act of defecation and difficnlty in emptying the bladder, with wandering pains in the epigastric and lumbar regions. Later a paresis of the left leg developed with some impairment of sensation of the lower half of the body. The condition was regarded as one of compression paraplegia and weight extension was applied; in spite of this the condition of the patient became rapidly worse, complete paraplegia with retention of urine developing. Meanwhile the pulmonary disease advanced rapidly and six weeks after admission to the hospital the patient died. Before death the original diagnosis of compression paraplegia was discarded and the correct one of tuberculosis of the spinal cord was made on the following grounds-the co-existence of the lung c ndition, the absence of the objective signs of vertebral caries, and the manner of spread of the cord symptoms beginning with unilateral paral sis and local patches of anmzthesia and gradually advancing to complete paralysis and loss o’ sensation. The necropsy confirmed the diagnosis : the vertebras and meninges were natural but in the lower dorsal region of the cord a bean-shaped swelling was found projecting slightly above the surface on the posterior aspect. A cross section was made at the level of the eighth thoracic segment, when a yellowish white tumour, sharply marked off from the softened cord tissue around, was exposed. It internal border was surrounded by a narrow zone of greyish red translucent tissue. The tumour occupied the whole of the left side and extended into the right side of the cord at this level, leaving only a small area of the white matter of the antero-lateral region unaffected. It
I
IN
MORE than a fourth of the deaths from typhoid fever due to perforation. The value of operation has been abundantly shown in recent years. At the Johns Hopkins Hospital six patients have been saved out of 14 operated on. Dr. H. W. G. Mackenzie has published an eminently practical paper in the Practitioner for January in which he points out that as good re ults may be obtained in general as in hospital practice if the practitioner is on the alert to give the patient the benefit of prompt operation. He very clearly states the point, in the early diagnosis of perforation. The danger of perforation commences with the disease and lasts until recovery is complete. Perforation may occur before the patient feels ill enough to take to bed or during convalesThe greatest risk is during the second, third, and cence. fourth weeks. Abdominal pain is the most imporhnt early symptom and may be the only one. It usually comes on suddenly and is severe and persistent. Vomiting, nausea, hiccough, frequent actions of the bowels, a rigor, sweatare
ing, mectal excitement, or collapse may precede, accompany, or quickly follow the onset of the pain. The nurse should be instructed to report at once to the practitioner the occurrence of pain or any other of these symptoms. When summoned the medical attendant should carefully examine the patient for the following signs of perforation. 1. There may be a change in the temperature-a sudden fall or a sudden rise, or a fall followed by a rise, or a rise followed by a fall ; but a steady temperature for a few hours does not negative perforation. 2. There may be a change in the pulse ; soon after perforation the pulse usually becomes more frequent and weaker. It is highly significant if the pulse in the few hours following the attack of pain becomes more rapid, running, and feeble ; but increased rapidity does 3. There may not invariably follow within a few hours. The development of a be a change in the facies. pinched or drawn look, depression of the angles of the