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NEW SOUTH WALES.
Armstrong, Dr. W. G., to be Lecturer in Infectious Diseases, Disinfection, and Sanitary Law at the Sydney Technical College. Hankins, G. T., M.R.C.S. E., L.S.A. Lond., to be a member of the Medical Board of New South Wales.
Hardcastle, Cooper, M.B. and M.S. Edin., to be Government Medical Officer and Vaccinator at Hillgrove, vice Dr. Massey, resigned.
Hill, Reginald Horace, J.S.A., Lond., to be Government Medical Officer and Vaccinator at Tocumwal, vice Dr. S. B. Eadon. Palmer, Dr. Arthur, to be Teacher of Physiology at the Sydney Technical College, vice Dr. R. E. Roth, resigned.
West, Francis William, M.B., M.Ch. Syd., to be Government Medical Officer and Vaccinator at Camden, vice Dr. G. L. Bell, resigned.
Barrett, James William. M.D., to be a member of the Medical Board of Victoria, vice William Snowball, M.B., deceased. Brett, Dr. John, to be President of the Medical Board of Victoria, vice Dr. Thomas Rowan.
Iredell, Mr., to be Honorary Surgeon to the Department for
Jackson. Dr., to be Honorary Oculist to St. Vincent's Hospital,
Mackenzie, John Hugh, F.R.C S., to be Officer of Health for the
Marr, Joseph Bell, L.R.C.P., to be a Public Vaccinator for the South-Western District.
Meares, Albert George, L R.C.P., to be Public Vaccinator for the South-Western District, vice J. F. Matthews, M.R.C.S., resigned.
Scott, James Andrew Neptune, M.B., to be a Public Vaccinator for the North-Western District, vice R. C. Brown, F.R.C.S, resigned.
Scott, John Daniel King, M.B., to be a Public Vaccinator for the
Tighe, John Michael, L.R.C.P., to be Officer of Health for the city of Hawthorn during the absence on leave of John Edward Andrew, L.R.C.P.
Williams. Dr. John, to be a member of the Council of the University of Melbourne.
Fooks, Edward Verdon Russell, M.R.C.S., L.R.C.P., to be a
Ick, Dr. T. E., to be Officer of Health at Broad Arrow, vice Dr.
Dods, Joseph Espie, M.B., &c., to be Medical Officer at Brisbane, Health Officer for the Port of Brisbane, and Visiting Surgeon to the Prisons at Brisbane, to the Fortitude Valley Police Gaol, to the St. Helena Penal Establishment, to the Lock Hospital at Brisbane, and to the Dunwich Benevolent Asylum, vice Charles James Hill Wray, L.R.C.P. and S. Edin., deceased.
Macdonald, Hugh, M.B. C.M. Edin., to be Resident Commissioner, Rotuma, and Stipendiary Magistrate and Health Officer for the district of Rotuma,
Savage, Dr. Vincent W., to be a Vaccinator for the District of Zeehan.
PROCEEDINGS OF AUSTRALASIAN MEDICAL
NEW SOUTH WALES.
Anderson, Arthur, M.B. M.Ch. Syd. 1902.
Capper, Harold Selwyn, M.D. Lond. 1901, L.R.C.P. Lond. 1899,
Clarke, Gother Robert Carlisle, M.B. M.Ch. Syd. 1902.
Morrison, David, M. B. B.S. Lond. 1894, L.R.C.P. 1895, M.R.C.S. 1895.
Rees, Walter Llewellyn, M.B. Syd. 1902.
Shorney, Albert Frank, M.2. Melb. 1899, B.Ch. 1901.
Tange, Frank Septimus, M.B. M.Ch. Syd. 1902.
Tudor-Jones, Evan, M.B. M.Ch. Syd. 1902.
Walch, Charles Nash Crosby, L.R.C.P. Lond. 1893, M.B. Durh. 1893, M.R.C.S. Eng. 1893.
For Additional Registration.
Deck, John Northcote, M.Ch. Syd.
Crozier, William, L.M. K.Q. C.P.I. 1877, L.R.C.S.I 1877.
For Additional Registration.
Macleod, Roderick Alexander, M.D. 1901 Univ. Glasg.
Shackell, Percy Moira, M.B. Melb. 1900, B.S. Melb. 1901.
JUTTNER-HAYNES.-On the 3rd June, at the Adelaide chapel of the Collegiate School of St. Peter, by the Rev. J. C. Haynes (father of the bride), Frank Julius Edward Juttner, M.B., Ch. B., of Tanunda, to Florence Maybell Birrell Haynes,
of St. Peters.
ROBERTSON-ANDERSON.-On June 21, at St. Arnaud, by
IRWIN.-June 17, at Singleton, Phoebe, beloved wife of Dr. William Irwin, and eldest daughter of Dr. S. T. Knaggs. LLEWELLYN.-July 2, at his residence, Braidwood, Dr. Rees Llewellyn, aged 59 years.
MALLAM.-June 19, at his residence, "Lalonia," Armidale, from pneumonia, Lawrence G. Mallam, M.B., second son of H. G Mallam, aged 42 years and 9 months.
SIMMONS.-On June 26, at his residence, "Larra," 31 Alma Road. St. Kilda, Edward Lamburn Simmons, F.R.C.S.E, the beloved husband of Frances Mary Simmons; aged 64 years.
THOMSON.-On June 10, after a short illness, Ellen Thomson, late beloved wife of Dr. James Service Thomson, of 370 Park Street, South Melbourne.
Smith, Amy Jane Guy, M.B. Lond. 1900.
Stock, William Henry, L.F.P S. 1867, L. and L.M. K. and Q. C.P.I. 1868.
Barrett, William Amherst Henry, L.S.A. Lond. 1884, L.R.C.P.
Holmes, Horace Isles, M.B. Melb. 1901, B.S. Melb. 1902.
BIRTHS, MARRIAGES AND DEATHS.
COURTNEY.-On June 13, at " Lynmere," Learmonth, the wife of Dr. C. A. Courtney-a daughter.
FRANCIS.-On May 19, at Bundaberg, the wife of T. W. Francis, M.R.C.S. (Eng.), L.R.C.P. (Lond.)—a son.
GIBBS.-On June 2, at Wattletree Road, Malvern, the wife of Richard Horace Gibbs, F.R.C.S., L.R.C.P. (Edin.)—a son. HOLT.-April 13, at Warwick (Q.), the wife of Dr. A. C. Holt, of a daughter (Phyllis Violet).
HOPE.-June 19, at Colac, the wife of W. W. Hope, M.B.-a daughter.
KERR.-At Forbes (N.S. W.), the wife of Dr. David Kerr-a son.
BUSBY-MOORE.-June 11. 1902, at Wesleyan Church, Burwood (N.S. W.), by the Rev. E. J. Rodd, assisted by Rev. J. G. Middleton, Hugh Busby, M.B., Ch.M. Syd., of Gulgong, eldest son of Alex. Busby, Esq., Murrurundi, to Ethel, eldest daughter S. W. Moore, Esq., M.P., Karoola, Ashfield. HARDMAN-AFFLECK.-Wednesday, April 23, at St. James' Church, Sydney, by the Rev. Charles Edward Amos, Robert R. Hardman, M.B., to Ada C. Affleck, M.B., Ch.M.
HYAM-SHIELDS.-On May 17, at Katoomba, N.S.W., by the Rev. St. Clair Bridge, Arthur Sydney, second son of the late Hon. S. H. Hyam, to May Agnes, widow of C. J. Shields, M.B., F.R.C.S.
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Dr. H. Skipton Stacy, 28 College-street, Sydney (late Resident Pathologist Sydney Hospital), examines pathological specimens, including Blood (Widal's reaction, corpuscular count, bacteriological examination of, etc.), Sputum, Urine, Tissues, and Throat Swabbings.
MALE ATTENDANT for mental, inebriate, or general cases, seeks engagement. References and testimonials show 13 years' experience, including five years as attendant at Callan Park Hospital for Insane, three years as wardsman in charge of Singleton Hospital. Address J. HILES, 161 Cecily Street, Leichhardt.
TRAINED MALE NURSE seeks engagement in mental or ordinary medical cases. Has had considerable experience in mental nursing, massage, etc., and is accustomed to travelling with patients to Europe and in the Australasian States. Unexceptional testimonials. References kindly permitted to Drs. F. N. Manning, Jarvie Hood, W. E. Warren, T. S. Dixson.
Address: R. T. O'NEILL, 68 Crown Street, near William St. (Late 17 Leicester St., Sydney.)
PERITYPHLITIS OR APPENDICITIS. By Jos. C. Verco, M.D. (Lond.), F.R.C.S. (Eng.), Adelaide.
I WILL read brief notes of two cases of inflammation of the parts about the appendix and cæcum, so as to emphasise one or two points in diagnosis and treatment of this very variable disease. The first is an instance of Appendicitis producing an abscess in the right hypochondrium.
I was called in consultation to see a woman, aged 58, who had been ailing for two or three weeks. She had a temperature of 100°F.; was not jaundiced; had no bile, sugar or albumen in her urine; no cough, and no affection of her heart or lungs. In the right hypochondrium, in the nipple line, there was a resisting mass, quite as large as a fist, moderately tender, not prominent, not very hard, with obscure margins not separate upwards from the edge of the liver, and rather resonant on percussion. It was not simply a distended gall-bladder, as its shape was not pyriform; it had not a definite outline, and there was pyrexia. The diagnosis given was an inflammation in the region of the gallbladder, probably starting from a cholecystitis, and possibly originating from gallstones, though no history of biliary colic could be elicited. It seemed to be not a hepatic abscess, because the swelling had no definite margin, and the liver did not appear to extend below so as to include it, and there had been no previous dysentery. I did not think it was an appendicitis, because of its situation just below and attached to the liver, because of the absence of any intestinal derangement, and the freedom of the region of the appendix from any evidence of disease. There was no tenderness or swelling in the right iliac region, and per vaginam or per rectum no pelvic abnormality could be detected. A serious prognosis was given, and the necessity for incision was suggested unless resolution occurred.
Two days subsequently the doctor was called to see her, as she had been seized with a sudden severe pain in the abdomen. He found her collapsed, in great pain, and with rigid abdominal muscles. He ordered her removal to a private hospital, where I saw her again within a few hours. Her pulse was then scarcely perceptible at the wrist, about 140, her hands were cold, there was general abdominal tenderness, and no lump was palpable where it was found previously. A ruptured abscess was diagnosed. She was at once put under ether, the abdomen was opened by a vertical incision
over the site of the swelling. The omentum was adherent to the abdominal wall and to the underlying large intestine, which appeared to be the hepatic flexure of the colon. On separating these from the parietes, there was a free flow of malodorous puriform serous fluid. The omentum and bowels were adherent to the lower edge of the liver. Getting to the right of the bowel, a lump as large as a mandarin orange was felt behind it, and a slough was visible presenting at a small opening in the mass. Drawing on this a narrow tube-like slough was extracted, and the finger in the aperture could feel a foreign body like a gallstone about as big as a pea. The gall-bladder was felt higher up under the surface of the liver; its fundus was not attached to surrounding parts, and it was natural but for some thickening of its walls. An incision was made through the loin, and a drainage tube carried into the abscess cavity; the peritoneal cavity was washed out with warm saline solution, and the anterior abdominal wound was closed. She lived for four days. At the post mortem the large intestine in the right hypochondrium proved to be the cæcum. Behind this lay an abscess over the lower end of the kidney; the ilium was in the pelvis, and ascended vertically over the brim to About three-quarters of an inch of the appendix join the cæcum a little below the kidney. remained attached to the caput coli, its lumen was patent, and it opened at the ulcerated distal end into the cavity of the abscess. The gall-bladder and the cystic and common ducts were healthy. The slough was the appendix, and the foreign body was an appendicular
The case conveys some valuable lessons :
1. An abscess presenting apparently in the region of the gall-bladder and with no manifestations in the iliac region may be due to an appendicitis. The absence of a history of biliary colic should rather negative its biliary origin and suggest appendicitis, which would be supported by freedom from icterus and biluria. While gallstones would be more probable than appendicular trouble in a woman of 58, age does not by any means preclude the latter.
2. Immediate operation is advisable in probable suppuration about the gall-bladder. Although from the situation of this abscess, deep in the lumbar region between the bowel and the kidney, it would have been a difficult one to deal with and to drain efficiently, still if it had been attacked before bursting it
would have been of a much greater size and might have been more readily reached from the front, and might have been stitched to and drained through the anterior abdominal wall.
3. The difficulty of deciding even when the abdomen is open what is being dealt with. With an abscess so near the gall-bladder, and a foreign body of the size and shape and colour of a gallstone, how naturally would one suppose he was dealing with the consequences of a calculous cholecystitis. The slough, in the shape of a tube, if encountered will, however, suggest an appendix, even close to the liver, and the foreign body will then be recognised as an appendicular concretion.
The second case is an example of Post cæcal abscess with marked paroxysmal abdominal pains.
M. V., girl, aged 9, was taken ill on the night of August 6th, 1900, with vomiting, which continued during the 7th, 8th, and 9th, after which date she was not sick. Her temperature was first taken on the 10th, and was found to be raised. From that time until I first saw her, on the 14th, it ranged up to 101 2, being always lower in the morning than at night. A lump was found midway between the navel and the anterior superior spine of the ilium, extending upwards and outwards through the right loin towards the ribs, obscure and tender. She suffered from definite attacks of griping pains, which seemed to come up to the tumour and cease. She had had poultices applied; these were continued. Her bowels were moved by enemata, and she was given morphia by the mouth for the relief of pain. Her pulse was 104, respirations 24. During the next four days her condition did not improve; her temperature rose to 102°, the swelling became slightly larger, and while the front of it was resonant there was an indistinct sensation of fluctuation in the flank. She was moved into the private hospital, Wakefield-street, and under an anesthetic I cut down in the right loin, separated the fibres of the abdominal muscles, struck pus with a needle behind the cæcum, laid the abscess open and drained it with a rubber tube. There was considerable discharge of foetid pus; the tube was left out on the tenth day. The griping paroxysmal pain did not leave her for some days. She left the hospital at the end of a fortnight, was kept quiet for a week or two at home, and has had no trouble of any kind with the bowel since, now nearly two years ago.
One circumstance which impressed me in this case was the severity of the tormina. The griping pains came in paroxysms, which lasted for half-an-hour, then disappeared for a considerable time. During the half-hour there
would be very many of these twisting pains moving up towards the tumour, and making the little patient cry out. These are referred to in textbooks as a symptom of intussusception, and as distinguishing it from perityphlitis. It must not, however, be regarded as pathognomonic. It certainly occurs in children in a very marked degree in the latter disease. Its presence and intensity gave me a little uneasiness about my diagnosis. But the fixity of the tumour which could not be moved, its obscurity of outline, the absence of mucous sanious stools, and the high temperature made me fairly certain it must be a perityphlitis, and not an invagination. The occurrence of such tormina is comprehensible enough in a typhlitis. There is more or less obstruction of the bowels at the cæcum, or colon, or iliocæcal valve, due to inflammatory exudation or to abscess pressure, or to accumulation of the fæces: and this will determine tormina in the ilium. These must therefore be regarded as quite a possible symptom in appendicitis, and not reliable for diagnosing it from intussusception.
The points of diagnosis between perityphlitis and intussusception might be given as follows:
A mass is palpable in the right iliac region, extending in the direction of the ascending colon. Which of the two complaints is it?
1. In intussusception the lump may be quite free from tenderness; in perityphlitis it may be so acutely tender as to render manipulation impossible. 2. In intussusception the mass may be well defined, easily and distinctly mapped out; in perityphlitis its limits may be very obscure.
3. In intussusception the sausage-shaped body may be so movable as to be rolled about in the abdomen; in perityphlitis it is quite fixed.
4. In intussusception the right thigh can be extended without pain; in perityphlitis it may be kept flexed, and passive extension inflicts pain.
5. In intussusception there is generally frequent movement of the bowels with sanious mucous stools; in perityphlitis the bowels may be confined.
6. In intussusception there are marked tormina, the pains seeming to focus in the lump: in perityphlitis these may be absent (sometimes, however, they are present, and severe).
7. In intussusception the temperature may be normal or subnormal; in perityphlitis it is raised.
Another point may be referred to, namely, the site of operation. When the front of the swelling is distinctly resonant, and the trouble appears to be chiefly behind the bowel-post cæcal-the operation wound is better placed well to the back. The abscess can then be struck without opening the peritoneal cavity. Should it prove necessary, the incision can easily be extended forwards so as to allow of operation from the front. In my case the anterior extremity of the oblique incision was three-quarters of an inch behind the spinoumbilical line.
[Read before the South Australian Branch British Medical Association.]
TWO CASES OF DOUBLE GLAUCOMA, WITH REMARKS ON ETIOLOGY.
By J. Lockhart Gibson, M.D. Edin., M.R.C.S. Eng., Hon. Ophthalmic Surgeon, Brisbane Hospital for Sick Children.
MRS. H., aged 60 years, was sent to me from an up-country town on the evening of August 16th, 1898. She gave the following history: Prior to May, 1898, she suffered for some months from occasional attacks of pain, with obscureness of vision. Since May sight had been as bad as now, viz., barely light from darkness, and pain has been excruciating. Pain has been controlled latterly by gr. of morphia, hypodermically, daily.
Examination.-Patient looks very weak and ill. Both eyes deeply injected. Pupils dilated, and give a greenish reflex; quite insensitive to light. Both corneæ very hazy, and quite insensitive to touch. Anterior chambers shallow. Tension of each eye is quite N+ 2. A red reflection obtained from each fundus, but corneæ and media too hazy to admit of any details being seen. There seems little to choose between the two eyes, but the left started first by patient's account.
A diagnosis of glaucoma was made, and immediate operation advised. Very little hope of improved eyesight was held out on account of the duration of the condition; but the likelihood of relieving pain seemed sufficient alone to justify operation, and the possibility of some improvement in sight strengthened this.
Under chloroform, following an injection of morphia, an iridectomy was performed on each eye in the early morning of August 17th. There was no pain subsequently. On the third day she counted my fingers at a yard. Her sight steadily improved until her corrected vision was R.E. partly. This vision was practically maintained up to August, 1900, when I saw her last, and I believe still is.
The vision in left declined and the eye sees, now, little but light from darkness. Its greatest improvement was fingers at 3 yds., in the temporal field.
Part of the cicatrix in the right eye became cystoid.
Her correction for right eye was + 3D cyl. axis horizontal. The left eye could not be so accurately estimated on account of its very defective sight, but I gave it a glass. Her temporal field in the right eye was good, but the nasal upper and lower fields very contracted. Tension in both eyes has been normal since operation.
Mrs. E., aged 49 years, was sent to me from an up-country town on February 19th of this year.
History.-Has been subject to severe headaches for many years. Eyes have been troubling for five or six months. The trouble began with a headache across the forehead and all round the face. Sight, she says, got a little bad. The pain went and came. It was mostly round the eyes at first, but for the last two months there has been shooting pain in the eyes, and the sight has been getting more affected, but it still varies somewhat. Used to see halos around the light before her eye got troublesome. For the first six weeks the pain kept her awake, but latterly she has slept well. Ezerine used by her medical adviser, who diagnosed glaucoma failed to relieve, and he advised her to consult me with reference to operative interference.
Examination.-Eyes not injected; pupils fully dilated; anterior chambers shallow; corneæ hazy, but sensitive to touch. Tension N + 1 to 2 in each. Vision: Right eye; fails to count fingers, but sees shadows in a small part of its temporal field; left eye counts fingers at 1 to 2 ft. if held in temporal field, can trace light imperfectly in nasal field; cornea too hazy to admit of any clear view of the fundus of either.
The patient was not highly intelligent, and she seemed dazed by the loss of sight and feeling of tension in her eyes. Glaucoma was diagnosed. Immediate operation was advised. Prognosis was guarded to unfavourable, though she was told that there was a possibility of improvement. The same afternoon, under chloroform, an iridectomy was performed on each eye. She was very hysterical for 36 hours afterwards, screaming and crying at short intervals. Sight steadily but slowly improved, until on March 9th her corrected vision was: Right eye, fingers in temporal field; Left eye,
; field of left eye very contracted, being 10 to 15 deg. in temporal, and little more than 5 deg. in the other fields. Her eyes were