he had done to make so many tears flow. I do not know. I am afraid none of us has any adequate conception of how much good that hot-headed, hardheaded, big-hearted Canadian Scotchman did in the fair city of Toronto. HISTORY OF DR. M'FARLANE'S ILLNESS. A.H.W. On Friday, February 21, at 3 p.m., Dr. McFarlane was operating on a patient in the Toronto General Hospital. The case was one of gangrene of the toes from frost-bite, ard amputation of certain of the toes was performed. Whilst inserting the sutures, Dr. McFarlane ran a needle into the palmar aspect of the terminal phalanx of his left index finger with considerable force, the needle reaching the bone. He washed his finger carefully in carbolic lotion. There was no pain or uneasiness in the finger until the following morning (Saturday, February 22). The pain in the early morning was considerable, and he also complained of severe pain in the limbs; he took a dose of morphia, and subsequently went about as usual visiting his patients. He returned home at midday, and then complained of increased pain in the finger; this grew more severe, and early in the afternoon he was suffering greatly. He now complained of pain throughout the body generally, but particularly in the lower extremities and in the back; at 3 p.m. he was suffering agony, the pain in the limbs far exceeding that in the injured finger; gr. % morphia was administered hypodermically. The temperature at this time was normal. Under cocaine the palmar aspect of the index finger, which was slightly swollen, was incised with four parallel incisions down to the bone; there was scarcely any bleeding from the cuts; there appeared to be almost complete stasis of the circulation. The hand and forearm presented no swelling, but tenderness was noted on the extensor aspect as high as the middle of the forearm. The arm was placed in a carbolic bath (1-50). The pain in the limbs returned at night, and gr. morphia was administered at 10.45 p.m. The temperature at midnight was 103°; pulse 114. The bath was kept warm, and iodine was used alternately with the carbolic acid. In the morning (Sunday, February 23), the index finger was black and gangrenous up to the second joint; the back of the hand was somewhat swollen, and was very tender to the touch. Under cocaine some five or six parallel incisions were made in this region; some large veins bled freely, but the tissues presented a choked condition on section, having a gelatinous appearance. He had some slight tenderness over the back of the forearm and a little tenderness over the inner side of the arm, about three inches above the elbow-joint; this I atter was attributed to the pressure of the arm upon the edge of the bath. His general condition excited alarm; his temperature at noon was 102°, pulse 115. His complexion was somewhat dusky, and he appeared a little flighty at times when conversing with one. Towards evening, however, he seemed decidedly better. The temperature at 8 p.m. was 100%, and pulse 109. He had been troubled somewhat during the day with nausea. On Monday, February 24, the tenderness had increased considerably on the back of the forearm. Ether was administered, and some twelve or fifteen incisions, each from 11⁄2 to 2 inches in length, were made over the back of the forearm; the incisions were carried down to the deep fascia; the same choked, gelatinous condition of the tissues was found. A portion of this tissue was removed for the purpose of a bacteriological examination; cultures were made, and were found to consist of streptococcus pyogenes and staphylococcus pyogenes albus. Improvement again followed operation, and the temperature at 1.40 p.m. was 981; the pulse, however, was 104. Nausea, continued more or less all day, despite all efforts made to control it. Tuesday, February 25. The tender spot on the inner side of the arm above the elbow was found to be hard and brawny. Ether was administered, and several parallel incisions were made into this; the tissues presented the same gelatinous appearance. The nausea, from which he had been free for some hours previous to the operation, returned after the administration of the ether. Towards midnight hiccough began, and became troublesome. Morphia was administered and he fell asleep, but the hiccough continued during sleep nearly all night long. Wednesday, February 26. At 7.20 a.m., the temperature was 103°; pulse 116. The hiccough ceased about 9 o'clock, and during the remainder of the day he was almost entirely free from it. He expressed himself as feeling better, and his attendants thought his condition decidedly improved. In the evening his temperature was 102°, pulse 116. Towards midnight, however, the hiccough returned; he was delirious at times, and became restless. He had a dusky complexion, and his pulse was 120, very compressible; respiration 24. The hiccough kept up all night long. Thursday, February 27. The hiccough was very distressing for the greater part of the day; pulse very weak; he perspired very freely. Towards evening he was quite delirious, but he could be roused when spoken to, and would answer questions rationally. The wounds have shown no reaction whatever since incision. To-day, however, there was an angry red edge about each incision, presenting a very unhealthy appearance; there was no indication whatever of suppuration. Throughout there had been no recognizable affection of the lymphatic glands. The hiccough continued almost constantly. Friday, February 28. The pulse this morning was very weak, and was 140 per minute; the hiccough was most distressing and constant. At midday m200 of Edson's aseptolin were injected, with no appreciable effect. He had taken nourishment fairly well throughout his illness, and the bowels had been kept fully active by the administration of purgatives. Towards night the pulse increased in frequency, running as high as 152, and was very weak; the hands and feet became cold. He was delirious, and was continually muttering and talking in an incoherent manner. Towards midnight he became very restless; he could be roused, however, when spoken to, and recognized his friends. Morphia was administered, and he then became quiet; the hiccough was not so constant. He gradually became weaker, the respirations became irregular, and he died on Saturday morning, February 29, at 6.20 a.m. BY EDMUND E. KING, M.D. TOR., L.R.C.P. Lond., Surgeon to St. Michael's Hospital; Physician to House of Providence and Home for Incurables; Pathologist, Toronto General Hospital. WHE He had HEN the announcement of Herr Doctor Roentgen's wonderful discovery was made in December last, a new scientific epoch was begun. His first communication was made to the Wurzburg Physical and Medical Society, in a paper entitled " A New Kind of Rays." taken time to settle many important questions, and was sure of his ground before making any public announcement. He first took his professional colleagues into his confidence, and did not rush into the public press as many of his predecessors in great discoveries had done-he fully satisfied himself that he had a discovery before making it known. Its importance was too great to be long retained by the savants of Wurzburg, however, *Read before the Toronto Clinical Society. |