« ForrigeFortsæt »
of the third occipital nerve and under tion of the lesion being doubtful, the usual incover of the trapezius. Deeper down under cision in the middle line was made. The small incover of the complexus were found a series of testine, where seen, was very red and dull, there larger blended fusiform swellings on the fibres was no lymph to be seen, but this condition of of the so-called posterior cervical plexus. At redness decreased upwards and increased downthe same level, but extending forward into the wards until the region of the appendix was side of the neck, was a similar but larger tumour reached, when some flakes of lymph appeared, and on the external branch of the posterior primary a fæcal smell was noticed. The cæcum was firmly division of the fourth nerve.
bound down, and out of reach. An incision The neuromata were comparatively easily was therefore made at right angles to the shelled out of a distinct but thin and loosely original one into the iliac fossa. The appendix adhering capsule, and were cut away from the was then easily found, separated, and removed. entering and issuing nerve fibres.
At the junction with the cæcum was a small After the operation I discovered an area of perforation, through which fæcal matter was diminished sensibility on the right side of the escaping. During the operation the abdominal head close to the middle line, extending from cavity was continually flushed with hot saline the occiput upwards.
solution. This treatment entirely altered the In Fasciculus xi. of the new Sydenham condition of the patient. The collapse was Society's Atlas of Illustrations of Pathology is much lessened, and her condition during the a series of plates of similar conditions of course of the operation was far better than various nerves.
before it was begun. The wound was drained ; These tumours consist of fibrous tissue con- at the end of three days some fæces appeared in tained in the neurilemma, and their growth the wound. This soon disappeared, and the chiefly along the direction of the nerve fibres sinus closed without further trouble. She is gives to them their usual fusiform shape. now quite well.
FRED. J. T. SAWKINS, M.B., Ch. M., Syd. My opinion is daily confirmed that these cases College St., Sydney.
should never be abandoned, and are never to be
despaired of. Perforative Appendicitis.
FRANK TRATMAN, M.D. LOND, At 6 p.m. I was called to see a woman who was
Senior Surgeon, Perth Public Hospital. said to be dying in agony. She was lying in Perth, W.A. bed on the right side, with the knees drawn up, groaning in pain, the face and lips were bluish The Undulatory Impulse of Pericardial and cold, the hands and feet were cold, and the
Effusion. whole body bathed in perspiration. Vomiting and retching were continual; it was very In the article by Dr. Roberts on “ Pericarditis" evident she could not live very long.
in Allbutt's “System of Medicine," the following The patient at the time was too ill to give paragraph occurs (Vol. V., p. 762) :—"It is a her own history; all that could be drawn from disputed question whether pericardial effusion her was, that she had suffered previously from can produce any definite change in the character attacks of inflammation of the stomach, while of the cardiac movements, tactile or visible. her friends stated that she had had gastric Certainly the impulse observed over the upper ulcer.
part of the chest may be more or less unduThere was a tender area over the region of latory ; and a wave-like motion has been the stomach, and a well marked transverse described, which can be seen, but not felt, and crease across the abdomen, which seemed to is supposed to be communicated to the fluid by mark its lower border. There was also a the action of the heart. I must say that I tender area over the appendix, and the ab- have never been able to recognise this phenomdominal wall at that spot was slightly more enon positively. Some authorities regard an rigid. Although perforation into the undulatory impulse as a sign, not in favour of abdominal cavity had certainly taken place, it pericardial effusion, but against it.” Recently a was impossible to locate it. The available
case presented itself at the Prince Alfred history, and the local conditions, pointed to the Hospital, which throws considerable light on stomach first, and then to the appendix. this point. The patient was a boy, about fourteen
Although the woman was in a condition which years old, suffering severe cardiac embarrasswould formerly have been called dying, she ment. The area of pericardial dulness was was immediately operated upon. The loca- | much increased, and towards the lower part,
with each heart beat could be both seen and MIRROR OF HOSPITAL PRACTICE felt a diffuse impulse, which at once conveyed,
IN AUSTRALASIA. by its undulatory character to the sight and touch the idea of an organ vigorously moving and displacing fluid, much in the same way as
ADELAIDE HOSPITAL, S.A. the walls of a tank and the surface of the water COMPOUND FRACTURE OF SKULL—No Loss Of in an aquarium are disturbed by the submerged CONSCIOUSNESS-PARALYSIS OF LEFT SIDE gambols of some large marine animal, such as a -TREPHINING-RECOVERY. seal. A needle was inserted, but failed to (Under the Care of LEONARD W. BICKLE, withdraw fluid. Sudden death terminated the
F.R.C.S.E., Hon. Surgeon.) At the post-mortem, the pericardial sac was found quite lax, so that it could be easily seized with the fingers, and yet it contained On August 8th, 1901, the patient, a man, aged 22oz. of straw-coloured fluid, and surrounded a 21 years, was larking with a brother, and in greatly hypertrophied heart. There was some à dispute which arose the brother picked up a old peri- and endocarditis, and the usual results piece of road metal and threw it at the patient, of backward pressure. Now, in an ordinary striking him on the head. The wound bled case of pericardial effusion, the sac is tensely freely, and a doctor was sent for. It was late filled with fluid, and stretched to nearly its in the evening, and as the room was badly utmost capacity, its shape being such as will lighted examination was very difficult and yield the greater cubic contents. The con- unsatisfactory. There were no symptoms of traction of the heart can thus alter but little concussion or compression, and the case was the position of the fluid, merely increasing the treated as a scalp wound. On the 9th and already high pressure by altering the cubic 10th, patient was very well. On the 11th, in capacity without changing to any extent the the afternoon, about 4 p.m., he felt giddy, and position of the particles. Now if, as in the his left leg was weak On the 12th, Dr. H. the case cited, part of the fluid has been re- Russell was sent for, as the man seemed worse, absorbed, but owing to stretching, the being drowsy, and the left arm as well as the elasticity of the sac has been lost, and it does left leg paralysed. Immediate removal to the not accompany the absorption by contraction, hospital was advised. The patient remembers then the remaining fluid tends to collect in the distinctly all details, and that the jolting of the various pouches and dependent positions, and ambulance made his headache. He was adwith the different movements is hurried from mitted into the Victoria ward of the Adelaide one to another with
a consequent Hospital under undulatory motion. In just the same way, an State on Admission.—On seeing the patient extremely tense cyst feels to palpation like a shortly after admission he was found to be in a solid tumour, while in a laxer one fluctuation very drowsy condition from which he could be is easily detected. Probably in most cases of roused with considerable difficulty. His effusion, as the fluid is absorbed or removed by answers were, however, rational. The breathing aspiration, the stretched pericardium is stiil was slow and laboured ; the pulse about 46, resilient enough to contract pa'i passu, and it full; the pupils unequal; the left being widely is only in occasional cases, such as the above that dilated. There was complete paralysis of the this very marked phenomenon appears. The left arm and left leg. On examining the head failure of the exploratory needle to reveal fluid a small scalp wound about 1} inches long was is easily explained by supposing it to have found on the right side, the edges glued entered the collapsed portion of the partially together, a little sero purulent fluid coming distended sac.
from anterior end on pressure. On separating J. BURTON CLELAND, M.B., CH.M. Syd.,
the edges the finger came upon a well-marked Resident Pathologist, Prince Alfred Hospital. about half-an-inch in length and a quarter-inch
fracture with a portion of the outer table,
at widest part missing. Immediate trephining At a recent meeting of the Vienna Society of
was decided on. Surgeons a demonstration was given of a paratus for sewing up a wound after an operation. The
Operation.--A curved flap with its convexity verdict on it was that it was swift, easy to bandle and downwards was raised, having the wound about reliable. The aseptic state of the wounds after its use its centre. On exposing the skull it was found is better maintained than heretofore. The essential
to be extensively fractured, with brain matter feature of the apparatus is that the wound is not actually sewn up, but is held together by means of exuding. A large trephine was used and a minute clamps.
crown of bone removed. The inner table was
fractured, and the splinters driven into the remained helpless. A few days later he found brain substance. There was a small clot of he could move the arm from the shoulder. Ten blood between skull and brain. The dura days later he found that if he tried to close the mater was torn. The portion of the missing fingers of left hand he could not do so, but if outer table was found deeper in the brain, he shut the right hand at same time the left having been driven past the inner table. The would close too. It was interesting to watch brain was extensively lacerated and softened, the progress of recovery of the movements of the fore-finger passing in to its full length fingers They can now be moved by themselves. without least resistance. The softening ex- When seen on January 3rd, 1902, he could tended to the ventricle, as there was a free walk freely without a stick, with just a slight escape of cerebro-spinal fluid when finger was drag of the leg; the left arm can be moved in withdrawn. Douching with boracic acid solu- all directions from the shoulder and elbow; the tion was carried out, the flap sutured, the edges finger can be closed at will, but the full grasp of scalp wound cleaned, and a gauze drain of the hand has not yet returned. He looks inserted through it.
well, has no headache, and his intellect is as August 13th.—Patient very quiet and good as ever. fortable, no pain, quite intelligent.
Remarks.—The position of the hernia as seen August 16th.—Progress satisfactory, tempera- in the illustration (from photo by author) will ture normal, some movement in leg.
serve better than any description to locate the August 19th.—Doing well, wound clean, flap injury. The case is of marked interest in locaunited by first intention, drain left out.
tion of brain centres, and it is not a little August 23rd.—Good deal of pain, some bag. remarkable that so serious an injury should ging, and pus escaped from wound when opened have been unaccompanied by loss of consciousby probe, small tube inserted.
ness, and that the onset of symptoms should August 26th.—Some indications of hernia have been so gradual. cerebri. Graduated pressure by compresses boracic acid, formalin, and itrol (1-1000) was tried, and also free use of nitrate of silver HOSPITAL FOR SICK CHILDREN, stick.
H.G., 7 years of age, was admitted to the
History of illness.—The patient was suddenly attacked about six days ago with vomiting and diarrhea which continued almost incess
antly for three days. The attack was supposed September 10th.- Despite all treatment hernia to have been due to the eating of a “shop-made" has increased rapidly. Under chloroform the meat pie. Three days after the onset of the hernia was shaved off, and a silver plate, with illness the diarrhea suddenly stopped and since perforations in centre, was placed over trephine then the child has passed no motion, but the wound.
vomiting has continued, and all food is rejected. September 18th — Patient doing well, except Child is complaining of pain in stomach, most that plate was showing at one place where edge marked in region of the umbilicus (although carefully bevelled) had ulcerated On examination.—Child lying with both legs through. Edge trimmed under chloroform. flexed on abdomen. Face very
drawn. TemOctober 5th. —Plate still troublesome. The perature 101.89, pulse 128, respiration 36. trephine wound has cicatrised, so plate was Abdomen.-Distended and tympanitic in removed under chloroform. There has been no upper part. In left iliac fossa there is dulness. post anæsthetic sickness on any occasion. No marked tenderness over McBurney's point,
By this time the leg had so far recovered that nor any dulness in that region. Per rectum no he could get about with a stick; but the arm mass to be felt.
Operation. The abdomen was opened in Bastian points out how the doctrine of heterogenesis will middle line almost immediately. The appendix explain many of the difficulties which have long been was searched for and found healthy. The intes- well known and recognised by Darwin himself ; and
apparent in the doctrine of evolution, and which were tines were found to be matted together by thick how this will explain the persistence of the low forms purulent lymph, but there was no smell from of animal life, without assuming that they have abdomen. In the left iliac fossa were found persisted undeveloped through countless ages, and in
all parts of the world. While the appearances described numerous coils of small intestine-collapsed
and figured by Dr. Bastian may possibly admit of which had evidently given the dull note on another interpretation, one cannot but respect the percussion over that region. The coils of opinion of so able and scientific a worker, and all who intestine were brought to the surface, examined appreciate the motto “audi alteram partem,” will much carefully, and the purulent lymph removed. In enjoy the perusal of this contribution to a most
G.E.R. this manner the whole length of the intestine was examined, and found to contain no lesion until the upper portion of the jejunum was MATIERE MEDICALE ZOOLOGIQUE, HISTORIE DES reached. It was then seen that, corresponding DROGU ES D'ORIGINE ANIMALE, par H. Beaure. with the length of collapsed bowel, the
gard, Professeur à l'Ecole Supérieure de Pharmacie
de Paris, etc, Revisé par M. Coutière, Professeur mesenteric veins were thrombosed in several
agrégé chargé de Cours à l'Ecole de Pharmacie. places. There were about four thrombosed Avec préface de M. D'Arsonval, Professeur au veins to be seen ; the area of thrombosis being College de France. Paris : C. Naud, Editeur, 3 about an inch and a half long and about half
Rue Racine, 1901.
In order to understand the nature of this work, we an inch wide. The thrombosis of the mesenteric
may premise that the author was by nrofession a veins was apparently the cause of the collapse zoologist, and, becoming attached as professor to the of the bowel. The abdominal wound was Superior School of Pharmacy at Paris, naturally was closed after insertion of a glass drainage tubo. led to survey the natural history of animals from the The child gradually sank, and died in 36 hours' stand-point of the pharmacist.
Hence, while his object in this treatise is "to give time.
the history of the animals, and drugs of animal origin No post-mortem was allowed, but was hardly used in therapeutics,” there are certain points in which necessary, as such a thorough examination was
the result greatly differs from most of its predecessors. made during the operation.
The latter usually have been simple collations, or have contained zoological descriptions of so very compre. hensive and detailed a nature, as to consist of material of no use to the pharmaceutist who might be seeking
information about objects of special interest to himself, REVIEWS AND NOTICES OF BOOKS, The author, in well-chosen, clear language, gives
only such general information as regards classification, STUDIES HETEROGENESI. By H. Charlton
anatomy and physiology as will enable any one with Bastian, M.A., M.D., F.R.S. Lond. Emeritus
very moderate prelimioary knowledge to follow him in Professor of the Principles and Practice of Medi.
the detailed descriptions of the special objects which cine and of Clinical Medicine in University
subsequently are referred to. College, London ;
By avoiding over-elaboration in general matters, he Consulting Physician University College Hospital ; and Senior Physician tion upon many points hitherto misunderstood, or not
has been able to give very full and interesting informa. to the National Hospital for the Paralysed and
Much of the work, indeed, is composed of the Part First. With 210 illustrations from `photomicrographs. Williams and Norgate, been published in comparatively inaccessible forms.
results of years of original investigation, which have London, 1901.
This leads to a certain lack of proportion, which in In this memoir, Dr. Bastian returns to a subject the case of a mere text-book would be undesirable, but upon which, as he tells us, he has been silent for in a treatise of this nature is more than pardonable, twenty-nine years. He again enters vigorously upon a being counterbalanced by the valuable information defence of the position he took up in his work on the thus for the first time made easy of access. Particu. “ Beginnings of Life," published in 1872, and we larly interesting are the articles treating of the cannot but admire the keen scientific spirit in which cachalot, vesicating insects, and the genito-urinary the veteran physician again tackles the problem of glands of the mammifers. It is not likely that heterogenesis. In his leisure hours he has been making medical practitioners will be extensive patrons of such observations upon the life history of some of the low a work, but to the pharmacist it must prove of the forms of vegetable life, such as the confervæ, euglenæ, greatest interest. spirogyra, etc., and tells how from these vegetable The large number of illustrations, many of which forms he has seen emerge amcbæ and other low forms are in colours, enable the reader to follow the text of animal life. He has studied photomicrography with great ease. The price of the work is very specially that he might be able to present a clear and moderate in view of its contente, and the satisfactory unbiassed account of what has happened under his own form in which it has been issued. observations, and what, as he says, anyone who takes A melancholy interest attaches to this publication, the trouble can verify for himself. At the end of the for the author died before its issue, and it was therefore work are appended over 200 reproductions from left to others to take his place, their kindly expressions photomicrographs taken by the author himself, and of love and respect being incorporated in the form of which well illustrate the text. In conclusion, Dr. i a graceful prelude.
The exact period in the curriculum when
students should begin hospital work varies in MEDICAL GAZETTE.
different schools. In Sydney, for example,
students do not seriously enter upon hospital SYDNEY, 20TH FEBRUARY, 1902.
work until the beginning of their fourth year,
while in Melbourne they are required to attend MEDICAL EDUCATION IN AUS
the surgical department of the hospital in their TRALASIA.
second year. There is something to be said in
favour of both of these regulations. If, during Those who have read the discussions which the first three years students acquire all the have taken place in recent years at the meetings preliminary knowledge, and are free in their of the General Medical Council in London, on
last two years from attending a number of the question of medical education and the courses of systematic lectures, and able to spend medical curriculum will know what a difference practically the whole day in the wards and of opinion exists on this subject; and a review out-patients' rooms, then we think no better of the curricula at the different medical schools system could be adopted. For the students then in Australasia, which we present to our readers enters upon their strictly professional work, well in this issue, will confirm this statement so far grounded and fitted to make practical use of as this part of the world is concerned. While
their knowledge of the fundamental sciences. we are all agreed that at least five years of But unfortunately, at present, during the fourth study is necessary to enable the student to and fifth years the students are burdened with acquire a knowledge of the fundamentals of attendance on systematic lectures, demonstramedicine, there is much difference of opinion as tions, etc., which cut largely into their time for to how those five years can be spent to the best work in the wards and out patient departments, advantage. With the great increase in the and they are expected to acquire a knowledge last few years in our knowledge of the pre- of the principles and practice of medicine in liminary sciences, such as biology, anatomy, the course of nine or ten months in the last and physiology, greater demand is made upon year of their career, and are expected to pass the student's time in acquiring a knowledge of the final examination not only in the general those subjects sufficiently extensive to be of subjects of medicine, surgery, obstetrics, and service to him in his later studies of practical gynecology, but also in some special subjects, medicine and surgery. But a longer time spent as psychological medicine, ophthalmology, and
. in preliminary scientific study must of necessity public health. cut short the time for hospital and prac- If, however, students enter upon hospital tical work, and the difficulty is to arrive at a attendance during their second year of study, fair adjustment of the work of the different they are early in the course introduced to the years of the curriculum which will enable the practical subjects of their professional work ; average student to acquire a knowledge of his but at the same time it is impossible for them professional work, not only sufficient to satisfy to seriously profit by hospital attendance if the examiners, but what is of more importance, they are ignorant of the essentials of anatomy to fit him to carry on his studies after he has and physiology; and the time spent in hospital left his school, and to practise his profession attendance at this early period of their career with credit to himself, and benefit to his would more profitably be spent in acquiring a patients.
sound, practical knowledge of anatomy and