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NORFOLK AND NORWICH HOSPITAL.
241 An apparently healthy man aged forty-nine years opened the door of a railway carriage just as the train commenced to move and fell somewhat heavily on his left shoulder. On being asked by the officials if he had hurt himself he replied "No"" and proceeded some two or three hundred yards from the station to his work, where he died within three-quarters of an hour of his falling from the train. On post-mortem examination I found the pericardium intact but distended with a mass of blood-clot and fluid blood. In front of the left auricle was a laceration one and a quarter - inches long through which a piece of clot protruded. The wall at the seat of the laceration was considerably thinned ; both ventricles were very much hypertrophied, the whole organ weighing 22 ozs. Beyond a slight abrasion over the right knee there was no external evidence of any injury, and there is little doubt that the cause of the rupture was the violent impact of the left shoulder on the platform. Soutbfields, S.W.
A Mirror OF
HOSPITAL
PRACTICE,
BRITISH AND FOREIGN. Nulla antem est alia pro certo noscendi via, nisi quamplurimas et morhistorias, tum aliorum tum proprias collectas h1bere, et inter se comparare.-MORGAGNI De Sed. et Caus. Morb.,
turum et dissectionum
--
RADCLIFFE
INFIRMARY,
OXFORD.
A CASE OF SUPPOSED PASSAGE OF THE STOMACH THROUGH A RENT IN THE DIAPHRAGM INTO THE PLEURAL CAVITY, THE RESULT OF AN INJURY ; RECOVERY.
(Under the
care
of Mr. A.
WINKFIELD.)
ESCAPE of the contents of the abdomen into the pleural cavity in consequence of injury of the diaphragm is a very fare condition, the symptoms produced by such escape being well exemplified by the careful report of this case. Such hernia (as it is, perhaps, wrongly called) is usually without any proper sac, although it may push some partially-ruptured pleura in front of it, and is nearly always on the left side. The injury to the diaphragm may be caused by a stab which has penetrated the chest wall, as in cases recorded by von Horockand Pestempski, the latter of whom succes,fully sutured the opening in the diaphragm after returning the protrusion, the wound of the chest wall having been enlarged; or more commonly a rupture of the muscular tissue is caused by a buffer accident, and the protrusion into the chest follows immediately. That such injury is not by any means immediately fatal, though producing profound disturbance at the time and troublesome symptoms later, is shown by the cases of Jacobsen3 and Farwell.4 Both patients ultimately died from intestinal obstruction the direct result of strangulation, but this did not take place until eighteen and sixteen years afterwards. Both Nauman 5 and O’Dwyerû have operated unsuccessfully for diaphragmatic hernia ; the former was unable to replace the escaped contents of the abdomen after operation from the abdomen in consequence of adhesions ; the latter, who opened the chest expecting to find an empyema, resected parts of the ninth and tenth ribs, reduced the hernia, and sutured the opening, but the boy, aged three and a half years, died six hours later. A boy, aged five years, was admitted into the Radcliffe Infirmary under the care of Mr. Winkueld with the history that he had fallen with a heavy iron gate upon him. He was collapsed and cyanotic, and some brandy-and-water was administered by the mouth. The left side of the chest was almost motionless and was tympanitic in resonance ; it was at iirst supposed to be pneumothorax, but an exploring 1
Sajous:
Annual of the Universal Medical
135.
2 3
4
Sciences, 1888, vol. ii.,
Ibid., 1890, vol. iii., C. 50. Ibid., 1894, vol. iii., C. 58. THE LANCET, June 30th, 1888, p. 1294. 5 Sajous, loc. cit., 1889, vol. iii., B. 62. 6 Ibid., 1894, vol. iii., C. 59.
passed in the fifth left interspace posteriorly drew off brandy-and-water instead of air, as was expected. There were some bruising and tenderness on the lower part of the right side of the thorax ; the breathing on that side was loud and exaggerated ; the left side moved but little in respiration. At the apex there were dulness and tubular breathing ; below the left apex there were tympanitic resonance and distant metallic tinkling. Posteriorly there was some slight needle
dulness with distant breath sounds. The heart dulness was obliterated; its sounds were most distinct above the sixth interspace on the right of the sternum, where its beat could be felt. Upon giving him liquids to swallow distant metallic sounds could be heard in the left half of the chest. For some three days after admission he was in a state of collapse, he could not sit up, there was marked dyspncea, and upon any slight exertion he became cyanotic. After a few days he began to improve generally, but the condition of the chest remained the same; he complained of severe pain in his left leg and at the back of the knee, but no injury could be felt in that region, and the hip upon examination was evidently free from injury or disease. He had lost flesh a good deal, but was now (Oct. 6th) able to get about without much dyspnoea, and be took food without pain ; the physical signs of the condition of the chest remained much as before. There has been no material rise of temperature throughout the case. Remarks by Mr. WINKFIELD.-The patient was lately shown before the Oxford Medical Society, when several gentlemen present examined him and agreed that the above diagnosis was probably the correct one. I mentioned One was two cases which I had previously met with. that of a blacksmith who over-reached himself when striking a blow with a heavy hammer, and was brought to the infirmary suffering from severe pain in the upper part of the abdomen. After lying quietly in bed for a few days he was suddenly seized with vomiting and became collapsed and died. Upon post-mortem examination there was found a rent in the left side of the diaphragm ; the stomach, spleen, and portion of the large intestine had passed through the rent into the pleural cavity. The second case was that of a boy who had been squeezed between the buffers of railway waggons. He was admitted soon after the last case. His aspect and condition were so like those of the last patient that attention was called to them. Upon examination a very similar condition to that of the boy whose case is related above was found. The patient remained in the infirmary for some weeks and then, leaving the hospital, he was lost sight of.
NORFOLK AND NORWICH HOSPITAL. A CASE OF DEATH FROM HÆMORRHAGE FOLLOWING OPERATION FOR TONGUE-TIE; NECROPSY.
(Under the
care
FOR the notes of the
of Mr. S. H.
case we are
BURTON.)
indebted to Mr. Hamilton
A. Ballance, house surgeon. A male child was born after a natural delivery at 5 P.M. The mother was attended by a midwife on Dec. 21st, 1896. temporarily employed by the Lying-in Charity of Norwich, though she had not obtained its certificate. About an hour after the birth the midwife said that the child was tonguetied, and using a sharp-pointed pair of scissors she proceeded to liberate it. She did not notice bleeding at the time of the operation, but on the evening of the same day blood was observed by the friends to be issuing from the child’s mouth. At noon the next day (the 22nd) as the bleeding continued the father went to the midwife’s house and fetched her to the case. The woman told the parents that the child was all right and that there was no need to be frightened. On this day the child passed dark blood by the bowel. The haemorrhage did not cease and the midwife was, therefore, again fetched on the evening of the following day. She then washed the mouth and the face of the child with warm water. The father requested that a medical man should be called in, but the midwife said that it was unnecessary and that if she was to blame she would take the responsibility. Eventually, however, she took the child herself to a medical man, who, after examining him and giving directions to the friends as to treatment, recommended that he should be taken to Mr. Burton. Mr. Burton found arterial bleeding going on in the anterior part
242 of the floor of the mouth and placed two ligatures on the the patient was found to be wasted ; his skin was sallow and bleeding points. He then sent the child to the Norfolk and dry, the conjunctive were slightly yellow, and his breath The thoracic and abdominal Norwich Hospital, where he was admitted at 10 P.M. on the emitted a sweetish odour. 23rd. On admission the child was pale and weak and the examinations disclosed, as irregularities, a distant sound of pulse was rapid and feeble. He was small, weighing only the heart at the site of maximum impulse, an encroachment. five pounds. On examination there was seen to be a cut in of the stomach note on to the left pulmonary axeas, and thethe floor of the mouth under the tip of the tongue between presence of a tumour mostly occupying the left epigastric one-half and three-quarters of an inch long, and extending and hypochrondriac regions. It was of the size of a fcetal from just to the right of the middle line away to the left, head presumably, firm, unmoved by respiration, but vibrating along the junction of the tongue and the floor of the with aortic pulsations. Percussion over the tumour gave mouth and exposing the muscular substance of the tongue. a dull note continuous with the left hepatic dulness, but The bleeding seemed to have stopped from the time of the it was elsewhere surrounded by a tympanitic note. The application of the ligatures. The child was put to bed, but urine was pigmented, of specific gravity 1025, and contained died iather suddenly in the early hours of the next morning casts, epithelial and hyaline ; also albumin and sugar-a, (the 24th). While in the hospital he passed some dark blood quantity of the latter. The patient looked ill. His pulse by the bowel, having apparently swallowed the blood as it was 140. On the 20th three ounces of greenish-brown turbid fluid were removed from the tumour by aspiration. The exuded from the wound in the mouth. Necropsy.-Post mortem all the organs were found to be fluid was alkaline, albuminous, contained no bile, pigments healthy, though extremely anaemic. In the stomach and or sugar, and emulsified oil. Its specific gravity was 1009. intestines throughout almost the whole of their length there All treatment proved unavailing and the patient sank and A ligature was seen on the died at 4 A.M. on Nov. 21st. was much.dark semi-fluid blood. left ranine vein, but whether this vessel or the artery was Necropsy.-Post mortem a large cyst with walls of tough the source of the major portion of the blood lost was not fibrous consistence (one-fifth of an inch thick) and a made out. potential capacity of about two pints was discovered in the Remarks by Mr. BALLANCE.-The above case may be oi ! lesser peritoneal cavity, with adhesions to the stomach and interest to medical men owing to the prominence of th to the concavity of the spleen, and occupying the site of the midwives question at the present time. An inquest was held normal pancreas. It had a smooth, pale inner surface with. and the jury returned a verdict of " Death from mis shallow sacculations, some of which and the floor of the cyst adventure." They also recommended that in future a medica L were occupied by a green, tough, loose substance of a colour man should be consulted should this operation be though j like that of boiled spinach. On the exterior of the cyst DOnecessary, and considered that the midwife was deserving o E normal pancreas could be found and the duct of Wirsung not be entered by a probe. At the duodenal end of censure for undertaking it. At the inquiry the woman state< 1 that she had frequently performed the operation before , the cyst, however, a stone the size of a pigeon’s egg was felt. always using sharp-pointed scissors, and that this was th 3 to be loosely impacted in the contiguous common bile-duct first accident she had encountered. and could only be removed by an incision into the gallbladder, which was filled with a loosely-packed mass of gallstones, some of which occupied the common duct. The intestines contained no gall-stones, the kidneys to the naked BRADFORD GENERAL INFIRMARY. eye appeared normal, and other organs as well. The microscopical examination of a section of the cyst wall by Dr. A CASE OF PANCREATIC CYST ASSOCIATED WITH GLYCOSURIA H. B. Gladstone showed clearly glandular remains here and AND GALL-STONES ; NECROPSY. there in dense fibrous tissue. Remarks by Dr. MORTON.- Whether repeated passages of (Under the care of Mr. HORROCKS.) g gall-stones causing chronic incomplete obstruction of the in our estimation of the THE change which has taken place intestinal common orifice of the bile and pancreatic ducts surgical importance of the pancreas is well shown by a can c be the cause of the cyst formation, or the gall-stone reference to earlier editions of surgical text-books. In fformation be simply secondary to a cyst of the pancreas ( any other cause), or whether the cyst and gall-stones France, for instance, in his work on surgery (1877) Tillaux (from I cannot pretend to adjudicate. No pancreatic a are unrelated states: " Of all the viscera contained in the abdominal was found. I am indebted to Mr. Horrocks for s stone cavity that of least interest to the surgeon is the pancreas,permission to publish this case and to Dr. Chapman for his. owing to its deep situation." The whole subject was dis-Iaassistance in the physical and chemical examinations. missed in a few lines. In a new edition (1888) its importance In this country was considered to justify a whole chapter. one of our text-books (1888) devotes a paragraph to the subject of cysts of the pancreas, and speaks somewhat uncertainly especially as regards treatment. In the last edition (1895) this subject is considered at some length and the treatment clearly laid down. The teaching is less certain as regards the causation of the cysts : I When they are PATHOLOGICAL SOCIETY OF LONDON. traumatic in origin it seems probable that laceration of the gland with haemorrhage occurs and that this is followed by Pifport on a Museum escape of the secretion from the torn ducts. In the cases in Non-calcifying Plastic Osteitis. which there is no evidence of injury it has been suggested Specimen of Malignant Enchondroma of the Testicle.Exhibition of Specimens. that a retention cyst forms as the results of some obstruction of the duct." The account of the post-mortem examination A MEETING of this society was held on Jan. 19th, Mr. in this case makes it possible that the gall-stone which was BUTLIINT, the President, being in the chair. found in the common duct was an important factor in the Mr. BERNARD PITTS and Mr. S. G. SHATTOCK gavea causation of the cyst of the pancreas, and the observation is account of a very unusual case, for which they therefore one of considerable interest. For the notes of this ventured to propose the name of Non-calcifying Plastic case we are indebted to Dr. Bruce Bachanan Moiton, resident Osteitis. A thin and careworn woman, aged thirty-nine dispensary surgeon. to St. Thomas’s Hospital wearing an The patient, a man aged fifty-six years, was admitted years, was to the Bradford General Infirmary on Nov. 19th, 1896, apparatus for a deformity of the right leg. She could suffering from pain of varying intensity in the region of only walk with difficulty and great pain. At the age the stomach, with nausea, occasional vomiting, a constant of thirty-one years she had a fall and struck her right leg. Three months later the knee became stiff and painful; twa sense of "heaviness"" and languor of three duration, and a tumour first noticed two months pre- years later, after a confinement, the knee became much She had since been a patient at several hospitals. viously in the upper part of the abdomen. Since his illness began he had been a little jaundiced and related the On examination the leg was found to be very wasted and passage of several small greenish stones. He also said that flexed at the knee almost to a right angle. There was an he had lost flesh steadily but had had no injury and could apparent displacement backwards of the tibia and fibula. assign no cause to account for his condition. On examination The upper third of the tibia was exceedingly tender, and distinct mobility was detected at what appeared to be the 1 Erichsen : Science and Art of Surgery. junction of the epiphysis and shaft ; this movement was. .
.
could
Medical Societies. -
.
months’
detailed
worse.
admitted
,
A Mirror OF
HOSPITAL
PRACTICE,
BRITISH AND FOREIGN. Nulla antem est alia pro certo noscendi via, nisi quamplurimas et morhistorias, tum aliorum tum proprias collectas h1bere, et inter se comparare.-MORGAGNI De Sed. et Caus. Morb.,
turum et dissectionum
--
RADCLIFFE
INFIRMARY,
OXFORD.
A CASE OF SUPPOSED PASSAGE OF THE STOMACH THROUGH A RENT IN THE DIAPHRAGM INTO THE PLEURAL CAVITY, THE RESULT OF AN INJURY ; RECOVERY.
(Under the
care
of Mr. A.
WINKFIELD.)
ESCAPE of the contents of the abdomen into the pleural cavity in consequence of injury of the diaphragm is a very fare condition, the symptoms produced by such escape being well exemplified by the careful report of this case. Such hernia (as it is, perhaps, wrongly called) is usually without any proper sac, although it may push some partially-ruptured pleura in front of it, and is nearly always on the left side. The injury to the diaphragm may be caused by a stab which has penetrated the chest wall, as in cases recorded by von Horockand Pestempski, the latter of whom succes,fully sutured the opening in the diaphragm after returning the protrusion, the wound of the chest wall having been enlarged; or more commonly a rupture of the muscular tissue is caused by a buffer accident, and the protrusion into the chest follows immediately. That such injury is not by any means immediately fatal, though producing profound disturbance at the time and troublesome symptoms later, is shown by the cases of Jacobsen3 and Farwell.4 Both patients ultimately died from intestinal obstruction the direct result of strangulation, but this did not take place until eighteen and sixteen years afterwards. Both Nauman 5 and O’Dwyerû have operated unsuccessfully for diaphragmatic hernia ; the former was unable to replace the escaped contents of the abdomen after operation from the abdomen in consequence of adhesions ; the latter, who opened the chest expecting to find an empyema, resected parts of the ninth and tenth ribs, reduced the hernia, and sutured the opening, but the boy, aged three and a half years, died six hours later. A boy, aged five years, was admitted into the Radcliffe Infirmary under the care of Mr. Winkueld with the history that he had fallen with a heavy iron gate upon him. He was collapsed and cyanotic, and some brandy-and-water was administered by the mouth. The left side of the chest was almost motionless and was tympanitic in resonance ; it was at iirst supposed to be pneumothorax, but an exploring 1
Sajous:
Annual of the Universal Medical
135.
2 3
4
Sciences, 1888, vol. ii.,
Ibid., 1890, vol. iii., C. 50. Ibid., 1894, vol. iii., C. 58. THE LANCET, June 30th, 1888, p. 1294. 5 Sajous, loc. cit., 1889, vol. iii., B. 62. 6 Ibid., 1894, vol. iii., C. 59.
passed in the fifth left interspace posteriorly drew off brandy-and-water instead of air, as was expected. There were some bruising and tenderness on the lower part of the right side of the thorax ; the breathing on that side was loud and exaggerated ; the left side moved but little in respiration. At the apex there were dulness and tubular breathing ; below the left apex there were tympanitic resonance and distant metallic tinkling. Posteriorly there was some slight needle
dulness with distant breath sounds. The heart dulness was obliterated; its sounds were most distinct above the sixth interspace on the right of the sternum, where its beat could be felt. Upon giving him liquids to swallow distant metallic sounds could be heard in the left half of the chest. For some three days after admission he was in a state of collapse, he could not sit up, there was marked dyspncea, and upon any slight exertion he became cyanotic. After a few days he began to improve generally, but the condition of the chest remained the same; he complained of severe pain in his left leg and at the back of the knee, but no injury could be felt in that region, and the hip upon examination was evidently free from injury or disease. He had lost flesh a good deal, but was now (Oct. 6th) able to get about without much dyspnoea, and be took food without pain ; the physical signs of the condition of the chest remained much as before. There has been no material rise of temperature throughout the case. Remarks by Mr. WINKFIELD.-The patient was lately shown before the Oxford Medical Society, when several gentlemen present examined him and agreed that the above diagnosis was probably the correct one. I mentioned One was two cases which I had previously met with. that of a blacksmith who over-reached himself when striking a blow with a heavy hammer, and was brought to the infirmary suffering from severe pain in the upper part of the abdomen. After lying quietly in bed for a few days he was suddenly seized with vomiting and became collapsed and died. Upon post-mortem examination there was found a rent in the left side of the diaphragm ; the stomach, spleen, and portion of the large intestine had passed through the rent into the pleural cavity. The second case was that of a boy who had been squeezed between the buffers of railway waggons. He was admitted soon after the last case. His aspect and condition were so like those of the last patient that attention was called to them. Upon examination a very similar condition to that of the boy whose case is related above was found. The patient remained in the infirmary for some weeks and then, leaving the hospital, he was lost sight of.
NORFOLK AND NORWICH HOSPITAL. A CASE OF DEATH FROM HÆMORRHAGE FOLLOWING OPERATION FOR TONGUE-TIE; NECROPSY.
(Under the
care
FOR the notes of the
of Mr. S. H.
case we are
BURTON.)
indebted to Mr. Hamilton
A. Ballance, house surgeon. A male child was born after a natural delivery at 5 P.M. The mother was attended by a midwife on Dec. 21st, 1896. temporarily employed by the Lying-in Charity of Norwich, though she had not obtained its certificate. About an hour after the birth the midwife said that the child was tonguetied, and using a sharp-pointed pair of scissors she proceeded to liberate it. She did not notice bleeding at the time of the operation, but on the evening of the same day blood was observed by the friends to be issuing from the child’s mouth. At noon the next day (the 22nd) as the bleeding continued the father went to the midwife’s house and fetched her to the case. The woman told the parents that the child was all right and that there was no need to be frightened. On this day the child passed dark blood by the bowel. The haemorrhage did not cease and the midwife was, therefore, again fetched on the evening of the following day. She then washed the mouth and the face of the child with warm water. The father requested that a medical man should be called in, but the midwife said that it was unnecessary and that if she was to blame she would take the responsibility. Eventually, however, she took the child herself to a medical man, who, after examining him and giving directions to the friends as to treatment, recommended that he should be taken to Mr. Burton. Mr. Burton found arterial bleeding going on in the anterior part
242 of the floor of the mouth and placed two ligatures on the the patient was found to be wasted ; his skin was sallow and bleeding points. He then sent the child to the Norfolk and dry, the conjunctive were slightly yellow, and his breath The thoracic and abdominal Norwich Hospital, where he was admitted at 10 P.M. on the emitted a sweetish odour. 23rd. On admission the child was pale and weak and the examinations disclosed, as irregularities, a distant sound of pulse was rapid and feeble. He was small, weighing only the heart at the site of maximum impulse, an encroachment. five pounds. On examination there was seen to be a cut in of the stomach note on to the left pulmonary axeas, and thethe floor of the mouth under the tip of the tongue between presence of a tumour mostly occupying the left epigastric one-half and three-quarters of an inch long, and extending and hypochrondriac regions. It was of the size of a fcetal from just to the right of the middle line away to the left, head presumably, firm, unmoved by respiration, but vibrating along the junction of the tongue and the floor of the with aortic pulsations. Percussion over the tumour gave mouth and exposing the muscular substance of the tongue. a dull note continuous with the left hepatic dulness, but The bleeding seemed to have stopped from the time of the it was elsewhere surrounded by a tympanitic note. The application of the ligatures. The child was put to bed, but urine was pigmented, of specific gravity 1025, and contained died iather suddenly in the early hours of the next morning casts, epithelial and hyaline ; also albumin and sugar-a, (the 24th). While in the hospital he passed some dark blood quantity of the latter. The patient looked ill. His pulse by the bowel, having apparently swallowed the blood as it was 140. On the 20th three ounces of greenish-brown turbid fluid were removed from the tumour by aspiration. The exuded from the wound in the mouth. Necropsy.-Post mortem all the organs were found to be fluid was alkaline, albuminous, contained no bile, pigments healthy, though extremely anaemic. In the stomach and or sugar, and emulsified oil. Its specific gravity was 1009. intestines throughout almost the whole of their length there All treatment proved unavailing and the patient sank and A ligature was seen on the died at 4 A.M. on Nov. 21st. was much.dark semi-fluid blood. left ranine vein, but whether this vessel or the artery was Necropsy.-Post mortem a large cyst with walls of tough the source of the major portion of the blood lost was not fibrous consistence (one-fifth of an inch thick) and a made out. potential capacity of about two pints was discovered in the Remarks by Mr. BALLANCE.-The above case may be oi ! lesser peritoneal cavity, with adhesions to the stomach and interest to medical men owing to the prominence of th to the concavity of the spleen, and occupying the site of the midwives question at the present time. An inquest was held normal pancreas. It had a smooth, pale inner surface with. and the jury returned a verdict of " Death from mis shallow sacculations, some of which and the floor of the cyst adventure." They also recommended that in future a medica L were occupied by a green, tough, loose substance of a colour man should be consulted should this operation be though j like that of boiled spinach. On the exterior of the cyst DOnecessary, and considered that the midwife was deserving o E normal pancreas could be found and the duct of Wirsung not be entered by a probe. At the duodenal end of censure for undertaking it. At the inquiry the woman state< 1 that she had frequently performed the operation before , the cyst, however, a stone the size of a pigeon’s egg was felt. always using sharp-pointed scissors, and that this was th 3 to be loosely impacted in the contiguous common bile-duct first accident she had encountered. and could only be removed by an incision into the gallbladder, which was filled with a loosely-packed mass of gallstones, some of which occupied the common duct. The intestines contained no gall-stones, the kidneys to the naked BRADFORD GENERAL INFIRMARY. eye appeared normal, and other organs as well. The microscopical examination of a section of the cyst wall by Dr. A CASE OF PANCREATIC CYST ASSOCIATED WITH GLYCOSURIA H. B. Gladstone showed clearly glandular remains here and AND GALL-STONES ; NECROPSY. there in dense fibrous tissue. Remarks by Dr. MORTON.- Whether repeated passages of (Under the care of Mr. HORROCKS.) g gall-stones causing chronic incomplete obstruction of the in our estimation of the THE change which has taken place intestinal common orifice of the bile and pancreatic ducts surgical importance of the pancreas is well shown by a can c be the cause of the cyst formation, or the gall-stone reference to earlier editions of surgical text-books. In fformation be simply secondary to a cyst of the pancreas ( any other cause), or whether the cyst and gall-stones France, for instance, in his work on surgery (1877) Tillaux (from I cannot pretend to adjudicate. No pancreatic a are unrelated states: " Of all the viscera contained in the abdominal was found. I am indebted to Mr. Horrocks for s stone cavity that of least interest to the surgeon is the pancreas,permission to publish this case and to Dr. Chapman for his. owing to its deep situation." The whole subject was dis-Iaassistance in the physical and chemical examinations. missed in a few lines. In a new edition (1888) its importance In this country was considered to justify a whole chapter. one of our text-books (1888) devotes a paragraph to the subject of cysts of the pancreas, and speaks somewhat uncertainly especially as regards treatment. In the last edition (1895) this subject is considered at some length and the treatment clearly laid down. The teaching is less certain as regards the causation of the cysts : I When they are PATHOLOGICAL SOCIETY OF LONDON. traumatic in origin it seems probable that laceration of the gland with haemorrhage occurs and that this is followed by Pifport on a Museum escape of the secretion from the torn ducts. In the cases in Non-calcifying Plastic Osteitis. which there is no evidence of injury it has been suggested Specimen of Malignant Enchondroma of the Testicle.Exhibition of Specimens. that a retention cyst forms as the results of some obstruction of the duct." The account of the post-mortem examination A MEETING of this society was held on Jan. 19th, Mr. in this case makes it possible that the gall-stone which was BUTLIINT, the President, being in the chair. found in the common duct was an important factor in the Mr. BERNARD PITTS and Mr. S. G. SHATTOCK gavea causation of the cyst of the pancreas, and the observation is account of a very unusual case, for which they therefore one of considerable interest. For the notes of this ventured to propose the name of Non-calcifying Plastic case we are indebted to Dr. Bruce Bachanan Moiton, resident Osteitis. A thin and careworn woman, aged thirty-nine dispensary surgeon. to St. Thomas’s Hospital wearing an The patient, a man aged fifty-six years, was admitted years, was to the Bradford General Infirmary on Nov. 19th, 1896, apparatus for a deformity of the right leg. She could suffering from pain of varying intensity in the region of only walk with difficulty and great pain. At the age the stomach, with nausea, occasional vomiting, a constant of thirty-one years she had a fall and struck her right leg. Three months later the knee became stiff and painful; twa sense of "heaviness"" and languor of three duration, and a tumour first noticed two months pre- years later, after a confinement, the knee became much She had since been a patient at several hospitals. viously in the upper part of the abdomen. Since his illness began he had been a little jaundiced and related the On examination the leg was found to be very wasted and passage of several small greenish stones. He also said that flexed at the knee almost to a right angle. There was an he had lost flesh steadily but had had no injury and could apparent displacement backwards of the tibia and fibula. assign no cause to account for his condition. On examination The upper third of the tibia was exceedingly tender, and distinct mobility was detected at what appeared to be the 1 Erichsen : Science and Art of Surgery. junction of the epiphysis and shaft ; this movement was. .
.
could
Medical Societies. -
.
months’
detailed
worse.
admitted
,