NOTE ON THE TREATMENT OF GALL-STONE.

351 temperature again became normal. From this, Dr. Manson infers that mere elevation of temperature is not by itself the cause of filarial periodicity. The paper is worthy of attentive study, and the Queketters"deserve the thanks of the profession for publishing such an expensive at which the

plate.

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NOTE ON

THE TREATMENT OF GALL-STONE. BY R. SHINGLETON

SMITH, M.D., B.SC.

PHYSICIAN TO THE BRISTOL ROYAL INFIRMARY.

IN THE LANCET of Sept. 18th, 1880, and in the ledica Record of March 15th, 1881, are reported cases of gal-stone treated by the administration of large doses of olive ol, with very remarkable and satisfactory results. It is statd that in both cases hundreds of gall-stones in various sh.ges of disintegration were discharged from the bowel, aid that the patients were permanently cured after one or tNN5 doses of olive oil, although repeated attacks of biliary coic had THE Graphic of last week contained an admirable repre- been present for twelve or eighteen months before The sentation of the interior of St. James’s Hall whilst the scene writer in the Medical Record considers it certain ahat in of a meeting of the International Medical Congress. The olive oil we have a substance which, when given in a dose engraving included good portraits of Sir Wiltiam Jenner, Sir of six or eight ounces within an hour, has the pnver of James Paget, and other prominent members of the profession. bringing away the contents of the g,tll-blarlder, ani apparently without pain, and the calculi are almost disinlegrated in the process. DR. ANGUS MUNRO, formerly resident surgeon at the A patient, a medical man between sixty and seventy Melbourne Hospital, with his slater and a young girl named of age, has been subject to attacks of biliary colic at years Randle, are reported to have been drowned near Wangaratta, intervals for the last six or seven years. The pain omes on while endeavoming to cross a nooded creek in a buggy. suddenly, and is relieved by nothing so well as injettions of morphia hypodermically. Of late these attacks have been more frequent, more prolonged, and more exhaustirg, espePROFESSOR ESlI1ARCH and Professor L4rGFECr have cially as they are generally accompanied by considerable had the honour of being presented to the Queen by the Crown vomiting, and great disturbance of the heart’s action, with prostration. On learning the effects of olive oil in the cases Princess of Germany. reported he determined to put the matter to the t(st in his own case ; he reasoned that it might do good, but could do no harm. Accordingly he procured a quantity of the finest salad oil, and took about six ounces within the space of one IMPORTANT DECISION. hour, sipping it slowly from time to time in small quantities and stopping as soon as any feeling of nausea was present. AT Wallingford Petty Sessions, on Friday, the 12th The result on the following morning he describes as folinstant, Mr. Arthur Augustus Sadgrove, of Didcot, a regis- lows :-" There was no action from the olive oil or the contered medical practitioner, was summoned by the Royal fection of senna taken very early this morning, but an enema down fseees of almost stonyhardness, and hundreds College of Physicians for that he did on the 19th day of brought of green masses of all shapes and sizes from canary-seed to a at New East otherwise Town, May, 1881, Hagbourne, horsebean ; some were imbedded in masses of Didcot, unlawfully, wilfully, and falsely take or use a good-sized hardened faeces, but floated as soon as separated ; others name, title, addition or description implying that he was were separate and were found floating on the surface of the registered under the Medical Act, 1858, as a Licentiate of water. The colour was pale-green ; some of them were the Royal College of Physicians of London, contrary to tianslucent. All were soft and flattened on pressure. The Sec. 40 of the Act. Mr. Witherington (of the firm of Blandy six ounces of oil appear to have been digested, saponified, and Witherington, Reading, instructed by Messrs. Field, or emulsionised, for there was no appearance of oil floating in the water of the enema." Many of these masses were Roscoe, and Company, of London, solicitors to the College) preserved for examination, but hundreds were thrown away. appeared for the prosecution. The defendant defended him- Three days afterwards they were submitted to me for exself. It appeared that in the autumn of hst year and up to’ amination. They were then soft and greasy to the touch, and including the 19th May fast, the defendant had onbut still coated with a greenish coloured film, which disseveral occasions amxed to certificates of births and deathsi appeared on touching any spot with the finger. They had after his name the registrable qualihcatiou of L.R.C.P. not become dry by exposure to air, and warmth increased without having been so registered, and, indeed, without their tendency to liquefy, so much so that on being carried having qualified himself for being so registered. From the; in a pill-box in the waistcoat-pocket they melted away, and evidence of Mr. James Warlters, registrar of births andleft simply a greasy stain in the box and in the pocket. In death-!, who produced a bundle of certificates signed by consistence and texture they resembled very soft soap, and the defendant, it appeared that, notwithstanding he had1 on being cut with a knife the section had a mottled appearin October last cautioned the defendant not to use ance and the knife was greasy. No nucleus was found in the registrable qualification of L.R C P. without being any of the masses, and they were all of similar texture. The first so q Ilalified, he continued to do so up to theshape varied considerably ; they were for the most part 19th May last. Other evidence having been given, in-- rouaded and oval, but so easily moulded that this varied cluding that of Dr. Pitman, registrar of the College off with the treatment, They were found to dissolve readily in Physicians, the defendant (who did not call any witnesses)) boiling alcohol, leaving only a small residue ; they also broke was asked by the Bench what answer he had to make to the e up in boiling water, forming an opalescent solution, at once charge. He practically admitted the offence, and that heN cleared by ether. The solution in alcohol gave little or no was still without the necessary qualihcatiot], but contended dprecipitation on cooling; no crystals of cliolesteride were prethat as the letter L was not added to the letters L.R.C.P.’. cipitated on cooling the hot solution in alcohol. The masses they could not be said to apply to the Royal College off were not acted on by strong sulphuric acid or by iodine. Physicians, London. He further stated that, having re-, The sediment in the cooled alcoholic solution consisted of a ceived in June lait a letter from the authorities at Somerset :t whitish powder insoluble in water, cold or hot, in nitric acid House, desiring him to discontinue the use of the qnnlitica-L- or liquor potassae. Drops of the ethereal solution evaporated tion complained of, he had not since used it. Mr. Witlierron a slide left oil globules, not quite liauid oil, but opalesbt cent and thickened to a semi-sotid consistence ; under the ington, having made a few observations, submitted that while the prosecutors did not wish to be harsh with the de- microscope these oil drops were seen to contain minute acicular crystals, like margarine. 3. fendant, it was a case which demanded a substantial fine. The Bench, after a short consultation, convicted the defen. LiMy examination led me to the conclusions that these dant in a penalty of ;tiS, together with f5 costs. masses were not composed of cholesterine, and tha. the

THE death is announced at Colaha, Bombay, on the 12th July, of Surgeon Henry A. Wall, of the Army Medical Department. Mr. Wall entered the army in March, 1880, and proceeded to India for a tour of service last trooping season. Mr. Wall was unmarried.

352 element in their composition was oil, possibly in a May 26th.—The patient vomited three times during the semi-saponification. In order to get, an unbiased night. The matter had no faecal odour. Two enemata were opition as to their chemical nature, I submitted a few of given on the following morning, the second being followed the masses to Professor Ramsay, of University College, by evacuation of scybalae. An ice-bag was applied to tumour, Brisol, for chemical examination. His report is as follows : and five grains of compound soap pill were given every four they consist for the most part of olive oil, and it is im- lioc.r,.3. In the afternoon the tumour remained the same size, poss’lle to separate from them any substance resemhling and resisted all moderate attempts at reduction. There was cholf:1terine, for the separation of the two is a very difficult nausea, accompanied by pain in abdomen and back. At probsm, the same solvents dissolving both. But under the 5 30 P.M. chloroform was administered, and Mr. Wood tried microscope it is possible to see with a very high power that taxis for a few minutes, but could not return any of the the onsistency of the masses is due to the presence of a hernia. An incision was therefore made over the tumour, greatnumberof very minute crystals, which appear to polarise down to the sac of the hernia, and the sac opened. A portion congested omentum was immediately disclosed, and be. lightto some extent, and which somewhat resemble crystals of of clolesterine. The fatty masses on burning give a neath the omentum lay a coil of intestine of a deep purple trace of residue, and that trace shows the presence of colour. There was very little, if any, fluid in the sac. Some adhesions existed between the omentum and sac of the a vey minute quantity of phosphoric acid by the most delicite test that can be applied-viz., ammonium molyb- hernia. Gnubernat’s ligament was notched, and an attempt date. All that I can venture to state, therefore, is that the made to reduce the bowel, but without success. A second incision was then made in the same part of the ligament, but masse are not a soap, but chiefly olive oil full of small crystas, which may or may not be cholesterine. I should the tumour would not go back into the abdounnal cavity. Mr. Wood found that the falciform margin of the fascia requie a very much larger quantity than you have given lata to which the gut was adherent formed the point of me todecide the point chemically." The results of Professor Ramsay’s examination quite resistance, though it was not necessary to divide it. The coincile with mine in these respects : (1) That the composi- bowel was drawn down, and the line of demarcation tion (f these bodies is totally different from that of an between the congested and normal intestine where constricordinary gall-stone, and (2) that olive oil is the principal tion had occurred was well marked, but there was no ulcerasubstance in their composition. It may, therefore, safely tion, neither had the serous coat lost its glistening appearbe interred that thev are 2ztestiazal concretions resulting ance. The exposed omentum was cut away, the stump of mass being first ligatured in sections with fine catgut. from the administration of the oil, and that they have not the been discharged from the gall-bladder by any mechanical The sac was next removed ; and lastly, by means of his hernia needle, Mr. Wood passed a strong piece of catgut or cheaiical action of the large dose of salad oil. At the time of my writing the patient is laid up with through the pubic portion of fascia, lata, Gimbernat’s ligaanother and more severe attack of biliary colic than he has ment, Poupart’s ligament, and then transfixed the neck of the ever had before. The bile-duct is completely obstructed, hernial sac, and drew these parts firmly together with the catgut, and the skin very deeply jaundiced. He followed up the which was then tied tightly, care being taken not to constrict first dose of oil with a second, but, in spite of this, continued the femoral vein. A drainage-tube having been placed in to have pain in the region of the liver, which at last cul- the wound, the skin was brought together with catgut sutures. The Listerian method was pursued throughout the minated in the present severe attack.’ It must be inferred from the experience of this case that operation. The patient made a rapid recovery; and on the day of discharge (June 24th) no impulse could be felt at the we are still unprovided with a remedy with the virtues wound. which have been of late attributed to olive oil. On June 28th the patient walked to the hospital, wearing A more complete chemical examination was not possible, an ordinary truss. No protrusion could be felt at cicatrix, as the masses had undergone liquefaction and dispersion was there any impulse when she coughed. when a further quantity was inquired for.

principal sta of

neither

Clifton. _______

____

THE SAMARITAN HOSPITAL.

A

Mirror OF

HOSPITAL BRITISH

PRACTICE,

AND

FOREIGN.

Nulla autem est alia pro certo noseendivia, nisi quamplurimas et morborum et dissectionum historias, turn aliorum turn proprias collectas habere, et inter se comparare.—MORGANI De Sed. et Caus. Morb., lib. iv. Proeemium.

KING’S COLLEGE HOSPITAL. STANGULATED

IRREDUCIBLE HERNIA ; REMOVAL OF OMENTUM AND SAC; OPERATION FOR RADICAL CURE; RECOVERY.

(Under the care of Mr. JOHN WOOD.) FOR the nctes of the following interesting case we are indebted to Mr. T. Hugh Smith, surgical registrar. Ellen ON-, aged fifty-six, was admitted on May 25th, 1881. The patient said that she had had a tumour in the right groin for threeyears which had varied in size and sometimes disappeared. For three or four days previous to admission her bowels had not been opened, the tumour had increased in size, and on the day before admission she vomited and suffered much from colicky pains. On admission the patient’s countenance was anxious. A hernial tumour, oval in shape, and about the size of a hen’s egg, lay with its long diameter parallel to Poupart’s ligament. The neck of the swelling was external to the spine of the pubes, and internal to the femoral artery. The skin over the mass was slightly red but not tender. 1

After recovery from this attack, a small circular colourless gall-stone found in the evacuations, and on examination was proved to consist of almost pure cholesterine. was

REMARKS ON ANTISEPTIC OVARIOTOMY BY MR. K. THORNTON.

ON Wednesday, Aug, 3rd, Mr. Knowsley Thornton made the following remarks to a number of the members of the International Medical Congress :This being, he said, the last of our regular operation days before the hospital is closed for its autumn cleaning, I think it is a good opportunity to make a statement as to the work done in my wards since the 1st of January in this year. I have pertormed ovariotomy twenty-eight times, and I have only lost one patient, a child of fifteen, from whom I removed a solid carcinoma, of7 lb. weight, involving both ovaries, the caecum and sigmoid flexnre, so that 1 had to carve the intestines out of the solid growth. She died of exhaustion in forty-eight hours. Every one of these operations was performed with the 2½ per cent. spray, and solutions of absolute phenol (pure carbolic acid), and in no case was drainage employed. All the wounds healed by firat intention, and the dressings were changed for the first time as a rule from the ninth to the twelfth day, when all the sutures were removed. Nineteen of the patients recovered without fever (i.e., the temperature never rose even during reaction beyond 101° F.) ; five had temperatures from 101 v° to 1034° during a few hours, but required no special treatment; four had temperatures from lu2 8° to 1046°, and required the use of the ice-water cap during periods of from thirty-nine hours to sixty-eight hours. These nine cases were all of more than usual gravity, with large tumours, extensive adhesions, long exposure, and much sponging. Only two of the patients remained in the hospital twecty-eight days after operation; one a patient from whom I removed an extensively adherent tumour weighing 80 lb. ; and the other one ot the cases requiring the ice-water cap ; a case of ruptured colloid, which I kept in bed Jonger than usual. The average stay in hospital after operation of the other patients was twenty days and a halt, the shortest seventeen days. There were no adhesions in fourteen cases; slight adhesions in one