HEALTH  SCIENCES  RESTRICTED 


HR01 588486 


HhBk 

Hi 

H 

f 

1     '-F 

■ 

■ 


I  §■ 


i 


R  f 


«IAL  W  ^.     V  ■     1  I 

Columbia  Btotoem'tp 
intljeCttjurfltatork 

College  of  ^fjpaicians;  anb  burgeons! 


I 


HENRY 
Medital  Books 


SAINT 


THOMAS'S   HOSPITAL 
KEPORTS. 

EDITED    BY 

Dr.  ROBERT  CORY  and  Mr.  FRANCIS  MASON. 


VOL.   XI. 


J.  & 


LONDON: 
A.  CHURCHILL,  NEW  BURLINGTON  STREET. 


MDCCCLXXXTI. 


FEINTED    BT    J.    K.    ADLABD,    BARTHOLOMEW    CLOSE. 


CONTENTS. 


PAGE 

I.  Disease  of  the  Aortic  Valves  probably  originating  in 
Malformation.  By  Thomas  B.  Peacock,  M.D., 
F.R.C.P.  .  .  .  1 

II.  Cases  of  Orbital  Cellulitis  presenting  unusual  Fea- 
tures, narrated  at  two  Clinical  Lectures  given  in 
the  Eye  Department  on  November  17th  and  24th, 
1880.     By  Edwaed  Nettleship  .  .         9 

III.  On  Topical  Applications  to  the  Cervix  Uteri  during 

Pregnancy.     By  Heney  GtEevis,  M.D.  .       19 

IV.  Further  Remarks  on  Anaesthetics.      By  S.  Osbork, 

F.R.C.S. .  .  .  .  .23 

V.  On  some  Cases  of  Paroxysmal  Pyrexia   simulating 

Ague.     By  William  M.  Oed,  M.D.,  F.R.C.P.     .      31 

VI.  Jottings  from  the  Surgical  Out-patient  Room.     By 

H.  H.  Clutton,  M.B.,  F.R.C.S.  .  .      45 

VII.  A  Case  of  Tricselian  Heart  with  Insufficiency  of 
the  Ventricular  Septum.  By  "W.  H.  Stone, 
F.R.C.P.,  &c.  .  .  .  .57 

VIII.  On  the  Use  of  the  Continued  Current  in  Diabetes. 
By  William  H.  Stone,  F.R.C.P.,  and  Walteii 
J.  Kilnee,  M.B.     .  .  .61 


iv  Contents. 


PAGE 


IX.  Contribution  to  Pathology  of  Double  Optic  Neu- 
ritis.    By  Walteb  Edmunds,  M.D.     .  .       71 

X.  Cases  of  Abdominal  Surgery.     With  Eemarks.     By 

Bernard  Pitts       .  .  .  .75 

XI.  Analysis  of,  and   Eemarks  on,  Thirty-one  Cases  of 

Enteric  Fever  treated  in  St.  Thomas's  Hospital 

during  the  past   Tear.     By   Seymoue  Tatloe, 
M.D.  Aberd.,  M.E.C.P.  Lond.                .  .      91 

XII.  Nerve-stretching  in  a  Case  of  Spinal  Meningitis  with 
Ataxic  Symptoms,  due  to  Injury.  By  H.  G. 
Aem^teong  ....     109 

XIII.  On  Cases  of  Injury  to  the  Optic  Nerve.     By  Edwaed 

Nettleship  ....     113 

XVI.  A  Case  of  Spondylolisthesis.  By  Eobeet  Coet,  M.D.     123 

XV.  Faecal  Eetention,  especially  as  it  affects  the  Caecum. 

By  John  Habley,  M.D.  Lond.  .  .     127 

XVI.  On  Measurement  in  the  Medical  Application  of 
Electricity.  By  W.  EL.  Stone,  F.E.C.P.,  &c,  and 
Waltee  Kilnee,  M.D.         .  .  .     147 

XVII.  On  Hydatid  Tumours  of  the  Abdomen  and  Tumours 

simulating  them.     By  J.  S.  Beistowe       .  .     153 

XVIII.  Congenital  Hypertrophy.     By  "William  Andeeson     165 

XIX.  Thomas  Bevill  Peacock,  M.D.,  F.E.C.P.    .  .     179 

XX.  Eeport  of  the  Obstetrical  Department  for  1880.     By 

Eobeet  Coet,  M.D.  .  .  .187 

XXI.  Medical   Eeport,   1880.      By    Geoege    Gullivee, 

M.A.,  M.B.  Oxon.  .  .  .  .201 

XXII.  Medical    Eeport,    1881.      By    Geoege    Gulliveb, 

M.A.,  M.B.  Oxon.  .  .  .  .239 

XXIII.  Surgical  Eeport,  1880.     By  Henry  Peect  Pottee, 

F.E.CS.  .  .  .  .  .277 


Contents.  ▼ 

PAGE 

XXIV.  Surgical    Keport,     1881.      By    "William    Henby 

Battle,  F.R.C.S.    .  .  .  .335 

XXV.  Statistical  Eeport  of  the  Ophthalmic  Department  for 

the  Tear  1880.     By  A.  D.  Davidson,  M.D.        .    397 

XXVI.  Statistical  Report  of  the  Ophthalmic  Department  for 

the  Year  1881.     By  J.  B.  Lawfoed      .  .    409 


LIST   OF  ILLUSTRATIONS. 


PLATES. 

TO  FACE 
PAGE 

Illustrating  Dr.  Peacock's  paper  on  Disease  of  the  Aortic 
Valves  probably  Originating  in  Malformation. 

Drawing  showing  the  adhesion  of  the  Eight  and  Posterior 
Aortic  Segments  forming  one  Curtain  which  falls  below 
the  level  of  the  other  Curtain  .  .  .8 


Illustrating  Dr.  Edmund's  paper  on  Pathology  of  Double 
Optic  Neuritis. 

The  upper  figure  shows  a  Transverse  Section  of  the  Optic 

Nerve  near  the  Eye,  magnified  about  25  diameters  .       74 

The  lower  figure  shows  a  portion  of  the  Circumference  of  the 

same  Nerve  more  highly  magnified    .  .  .74 


WOODCUTS. 


Illustrating  Mr.  Glutton's  Jottings  from  the  Surgical  Out- 
patient Room. 

PAGE 

Large  Vascular  Growth  in  the  Neck         .  .  .48 

Congenital  Hydrocele  of  the  Neck  .  .  .52 


Dr.  Cory's  Case  of  Spondylolisthesis    .  .  ,     125 


LIST   OF  SUBSCRIBERS. 


Abbott,  Charles  E.,  Braintree,  Essex 

Acland,  T.  D.,  M.B.,  St.  Thomas's  Hospital,  S.E. 

Adam,  A.  Mercer,  M.D.,  The  Churchyard,  Boston,  Lincolnshire 

Air,  Alexander  C,  88,  Kennington  Park  Road,  S.E. 

Allingham,    William,    F.R.C.S.,    25,    Grosvenor    Street,    Grosvenor 

Square,  W. 
Alliott,  A.  J.,  M.D.  Cantab.,  St.  John's,  Sevenoaks 
Amyot,  Thomas  E.,  F.R.C.S.,  Diss,  Norfolk 
Anderson,  Henry  B.,  78,  East  India  Road,  Poplar,  E. 
Anderson,  William,  F.R.C.S.,  13,  Welbeck  Street,  W. 
Armstrong,  John  C,  196,  Parrock  Street,  Gravesend 
Aveling,  C.  T.,  M.D.,  F.K.C.S.,  Portland  Place,  Lower  Clapton,  E. 

Ballance,  C.  A.,  St.  Thomas's  Hospital,  S.E. 

Bamber,  H.  K.,  5,  Westminster  Chambers,  S.W. 

Banham,  H.  F.,  M.B.,  219,  Glossop  Road,  Sheffield 

Banks,  W.  A.,  M.D.,  Rockland,  Maine,  U.S. 

Barker,  T.  A.,  M.D.,  F.R.C.P.,  27,  Wimpole  Street,  W. 

Barnes,  Robert,  M.D.,  F.R.C.P.,  15,  Harley  Street,  W. 

Baron,  Thomas,  Ulceby,  Lincolnshire 

Battle,  W.  H.,  St.  Thomas's  Hospital,  S.E. 

Bedford,  R.  J.,  Kegworth,  Leicestershire 

Bennett,    Sir   J.    Risdon,    M.D.,    F.R.S.,   F.R.C.P.,    22,    Cavendish 

Square,  W. 
Bernays,  Albert  J.,  M.A.,  Ph.  D.,  St.  Thomas's  Hospital,  S.E. 
Blaker,  N.  P.,  29,  Old  Steyne,  Brighton 

Bowen,  Essex,  M.D.,  E.R.C.S.,  Talbot  House,  Claughton,  Birkenhead 
Bristowe,  John  Syer,   M.D.,  F.R.C.P.,   F.R.S.,  11,   Old  Burlington 

Street,  W. 
Britton,  Thomas,  M.D.,  Savile  Park,  Halifax 
Brixton  Med.  Book  Soc,  per  J.  J.  Purnell,  F.R.C.S.,  Streatham  Hill, 

S.W. 
Brown,  Fred.  Gordon,  16,  Einsbury  Circus,  E.C. 
Brown,  G.  D.,  Henley  Villa,  Uxbridge  Road,  Ealing 
Browne,  Edgar  A.,  86,  Bedford  Street,  Abercrombie  Square,  Liverpool 

Cameron,  C,  3,  Charlton  Villas,  Harlesden,  N.W. 
Carpenter,  A.,  M.D.,  High  Street,  Croydon 
Carpenter,  Edward,  169,  Kennington  Park  Road,  S.E. 


x  List  of  Subscribers. 

Carter,  William,  M.B.,  LL.B.,  F.R.C.S.I.,  74,  Eodney  Street,  Liverpool 

Caudle,  A.  W.  \VM  Henfield,  Sussex 

Ceely,  Robert,  F.R.C.S.,  Aylesbury 

Chaffers,  Edward,  F.R.C.S.,  North  Street,  Keighley,  Yorkshire 

Chaldecott,  Charles  W.,  Dorking,  Surrey 

Chaldecott,  T.  A.,  M.D.,  Harcourts,  Chertsey 

Charles,  D.  A.,  M.D.,  Bellaghy,  Castledawson,  Co.  Londonderry, 
Ireland 

Charles,  T.  C,  M.D.,  St.  Thomas's  Hospital 

Clapton,  Edward,  M.D.,  F.R.C.P.,  F.R.C.S.,  10a,  St.  Thomas's  Street, 
S.E. 

Clapton,  William,  F.R.C.S.,  30,  Queen  Street,  Cheapside,  E.G. 

Clark,  Fred.  Le  Gros,  F.R.S.,  F.R.C.S.,  Sevenoaks,  Kent 

Ciark,  James  Henry,  Jamaica,  per  J.  W.  Goodinge,  Esq.,  18,  Alders- 
gate  Street,  E.C. 

Clarke,  Arthur,  Stock,  near  Ingatestone,  Essex 

Cleaver,  Henry  A.,  Croydon,  Surrey,  for  Book  Soc. 

Clifton,  G.,  53,  London  Road,  Leicester 

Clifton  Medical  Reading  Society,  per  T.  Kerslake  and  Co.,  Clifton 

Clutton,  H.  H.,  F.R.C.S.,  16,  Palace  Road,  Lambeth,  S.E. 

Cockell,  F.  E.,  jun.,  62,  Forest  Road,  Dalston,  E. 

Colby,  Wm.  Taylor,  M.D,  The  Mount,  New  Malton,  Yorkshire 

Corbin,  M.  A.  Bazille,  F.R.C.S.,  St.  Peter's  Port,  Guernsey 

Cory,  R.,  B.A.,  M.D.,  14,  Palace  Road,  Albert  Embankment,  S.E. 

Cowen,  Philip,  10,  Landseer  Road,  Upper  Holloway,  N. 

Crick,  Samuel  A.,  M.B.,  M.S.,  St.  Thomas's  Hospital 

Croft,  John,  F.R.C.S.,  61,  Brook  Street,  Grosvenor  Square,  W. 

Crofts,  William  Carrick,  Church  Gresley,  Burton-on-Trent 

Crosby,  T.  B.,  M.D.,  F.R.C.S.,  21,  Gordon  Square,  W.C. 

Cruise,  F.  R.,  M.D.,  F.K.Q.C.P.,  3,  Merrion  Square,  Dublin 

Denne,  T.  V.  de,  Cradley  Heath,  Brierly  Hill,  Staffordshire 
Denton,  Sam.  B.,  M.D.,  Ivy  Lodge,  Hornsea,  Hull 
Dixon,  Edward  L.,  M.D.,  M.R.C.P.,  9,  Winckley  Square,  Preston,  Lan- 
cashire 
Dobson,  Nelson  C,  F.R.C.S.,  27,  Victoria  Square,  Clifton 
Dukes,  Clement,  M.D.,  B.Sc.  Lond.,  Horton  Crescent,  Rugby 
Duncan,  W.  A.,  M.D.,  24,  George  Street,  Croydon 
Durham,  Arthur  E.,  F.R.C.S.,  82,  Brook  Street,  Grosvenor  Square,  W. 

Edwards,  Vertue,  Shottisham,  Woodbridge,  Suffolk 
English,  D.C.,  M.D. 

Elliott,  J.  W.,  4,  Finsbury  Square,  E.C. 
Elwin,  Charles  J.,  6,  City  Road,  E.C. 
Emson,  Alfred,  Dorchester 

Eve,  R.  W.,  M.B.,  Tyrwhitt  House,  101,  Lewisham  High  Road,  New 
Cross,  S.E. 

Farrant,  Samuel,  North  Street  House,  Taunton 


List  of  Subscribers.  xi 

Fell,  W.,  St.  Thomas's  Hospital,  S.E. 
Fletcher,  George,  M.D.,  Cantab.,  Earl  Soham,  Suffolk 
Fouracre,  Robert  P.,  1,  Alpha  Villas,  Hornsey  Road,  N. 
Fowler,  James,  13,  South  Parade,  Wakefield 
Franklin,  G.  C.,  F.R.C.S.,  5,  Welford  Road,  Leicester 

Gervis,  Frederick  H.,  1,  Fellows  Road,  Haverstock  Hill,  N.W. 
Gervis,  Henry,  M.D.,  F.R.C.P.,  40,  Harley  Street,  W. 
Gibson,  John  R.,  F.R.C.S.,  10,  Russell  Square,  W.C. 
Gillespie,  J.  W.,  M.D.,  25,  Porchester  Terrace,  "W. 
Goddard,  Eugene,  North  Lynne,  Highbury  New  Park,  N. 
Greaves,  Charles  A.,  M.B./LL.B.,  101,  Friargate,  Derby 
Greenfield,  Wm.  Smith,  M.D.,  University  of  Edinburgh 
Gripper,  A.  D.,  Musley  Hill,  Ware,  Herts 
Groome,  W.  W.,  M.B.,  Stowmarket,  Suffolk 
Grose,  S.,  M.D.,  F.R.C.S.,  Westbourne,  Melksham,  Wilts 
Guest,  Ellis  S.,  251,  Oxford  Street,  Manchester 

Giiterbock,  Dr.  P.,  Berlin,  per  Julius  Lessen  &  Co.,  13,  Ridgefield, 
Manchester 

Hague,  Samuel,  M.D.,  L.L.B.,  B.A.,  65,  Peckham  Grove,  Camberwell, 

S.E. 
Hardyman,  Charles  E.,  24,  Crockherbtown,  Cardiff 
Harley,  John,  M.D.,  F.R.C.P.,  F.L.S.,  39,  Brook  Street,  Grosvenor 

Square,  W. 
Harris,  Henry,  M.D.,  F.R.C.S.,  Trengweath  Place,  Redruth 
Haslam,  W.  F.,  St.  Thomas's  Hospital,  S.E. 
Hawkins,  William,  Abbotsbury,  Dorsetshire 
Hearnden,  William  Alex.,  M.D.,  Down  House,  Sutton,  Surrey 
Heygate,  William  N.,  St.  Thomas's  Hospital 

Hitchcock,  H.  K.,  M.D.,  Skibbereen,  Branksome  Park,  Bournemouth 
Howard,  R.  P. 

Howell,  Thomas  S.,  The  Old  Vicarage,  "Wandsworth,  S.W. 
Howse,  H.  G.,  M.S.,  10,  St.  Thomas's  Street,  Southwark,  S.E. 
Hullah,  Robert,  Lunatic  Asylum,  Grahamstown,  Cape  of  Good  Hope 
Hutton,  H.  R.,  St.  Thomas's  Hospital,  S.E. 

lies,  Daniel,  Fairford,  Gloucestershire 

Jacob,  E.  H.,  M.A.,  M.B.Oxon.,  12,  Park  Street,  Leeds 

Jackson,  James,  14,  Huntingdon  Street,  Barnsbury,  N. 

Jardine,  J.  Lee,  Capel,  Dorking,  Surrey 

Jefferson,  Thomas  J.,  M.D.,  Market  Weighton,  Brough,  Yorkshire 

Jones,  Evan,  Aberdare,  Glamorganshire 

Jones,  Sydney,  M.B.,  F.R.C.S.,  16,  George  Street,  W. 

Jones,  Thomas,  M.D.,  18,  Aldebert  Terrace,  Clapham  Road,  S.W. 

Kilner,  W.  J.,  M.B.,  104,  Ladbroke  Grove  Road,  North  Kensington  W. 
King,  Robert,  Hinton  Villas,  Uxbridge 

Laver,  A.  H.,  56,  Cemetery  Road,  Sheffield 


xii  List  of  Subscribers. 

Lawford,  J.  B.,  M.D.,  St.  Thomas's  Hospital,  S.E. 

Leeds  Medical  Society,  per  A.  F.  McGill,  F.R.C.S.,  35,  Park  Square, 

Leeds 
Lees,  Joseph,  M.D.,  21,  Brixton  Road,  S.W. 
Liebreich,  R.,  16,  Albemarle  Street,  W. 
Litteljohn,  S.  G.,  M.B.  and  CM.,  Central  London   District  School, 

Hanwell,  W. 
Lunn,  J.  R.,  Chief  Medical  Officer,  Marylebone  Infirmary,  W. 

Mac  Cormac,  Sir  William,  F.R.C.S.,  M.A.,  13,  Harley  Street,  W. 
Mackellar,  A.  0.,  F.R.C.S  ,  M.Ch.,  22,  George  Street,  Hanover  Square 
Maclagan,  T.  J.,  M.D.,  9,  Cadogan  Place,  Belgrave  Square,  S.W. 
Mac  Lean,  Allan,  Corby,  Grantham 
Maconcby,  John  K.,  M.B.,  B.A.,  F.R.C.S. I.,  Infirmary  House,  Down- 

patrick,  co.  Down 
Manchester  Royal  Infirmary,  per  W.  L.  Saunder,  Secretary 
Mann,  John,  3,  Warltersville  Road,  Hornsey  Rise,  N. 
Marcb,  H.  Colley,  M.D.,  2,  West  Street,  Rochdale 
Marsack,  Blackall,  Howard  Lodge,  Tunbridge  Wells 
Mason,  Francis,  F.R.C.S.,  5,  Brook  Street,  W. 
Maurice,  0.  C,  75,  London  Street,  Reading 
Maybury,  A.  V.,  M.D.,  Mile  End,  Portsmouth 
McKay,  W.  W.,  M.D. 
McSwain,  A.,  M.D. 

Mennell,  Z.,  Oxford  House,  Shepherd's  Bush  Road,  W. 
Miller,  Frederick  M.,  284,  Amhurst  Road,  E. 
Millman,  Dr.,  Asylum  for  Insane,  London,  Ontario,  Canada 
Milne,  C.  W.,  6,  Brunswick  Place,  Brixton  Hill 
Miskin,  G.  A.,  M.D.,  162,  York  Road,  Lambeth,  S.E. 
Morris,  C.  K.,  High  Street,  Spalding 
Morton,  John,  M.B.,  Eastgate  House,  Guildford 

Neate,  Chas.,  F.R.C.S.E.,  Stilton,  Peterborough 
Nettleship,  E.,  F.R.C.S.,  5,  Wimpole  Street,  W. 
Newsholme,  A.,  M  D.,  39,  High  Street,  Clapham 
Newth,  Alfred  Henry,  M.D.,  Hayward's  Heath,  Sussex 
Nowell,  Arthur  H. 

Odling,  A.  E.,  St.  Thomas's  Hospital,  S.E. 

Orange,  W.,  F.R.C.P.,  Broadmoor,  Berkshire 

Ord,  George,  F.R.C.S.,  Brixton  Hill,  S.W. 

Ord,  George  R.,  Streatham  Hill,  S.W. 

Ord,  William  M.,  M.D.,  F.R.C.P.,  7,  Brook  St.,  Hanover  Sq.,  W. 

Osborn,  S.,  F.R.C.S.,  10,  Maddox  Street,  W. 

Owen,  Charles  W. 

Palmer,  A.  M.,  Old  Whittington,  Chesterfield 
Palmer,  M.  H.  O,  London   Road,  Newbury,  Berks 
Payne,  J.  F.,  M.B.,  F.R.C.P.,  78,  Wimpole  Street,  W. 
Penhall,  John  T.,  M.D.,  F.R.C.S.,  5,  Eversfield  Place,  St.  Leonards- 
on-Sea 


List  of  Subscribers.  xiii 

Pern,  Alfred,  F.R.C.S.,  Botley,  Southampton 

Pilcher,  W.  J.,  F.R.C.S.,  High  Street,  Boston,  Lincolnshire 

Plowman,  S.,  St.  Thomas's  Hospital,  S.E. 

Pollard,  Frederick,  M.D.,  52,  Rodney  Street,  Liverpool 

"Portman  Medical  Book  Club"  per  E.  Owen,  F.R.C.S.,  49,  Seymour 

Street,  W. 
Powell,  J.  J.,  Heathlands,  Weybridge 
Purvis,  John  P.,  Royal  Hill,  Greenwich 

Rainey,  George,  St.  Thomas's  Hospital,  S.E. 

Radford,   Thomas,    M.D.,   F.R.C.P.,  F.R.C.S.,  Moor   Field,   Higher 

Broughton,  Manchester 
Ranger,  Wm.  Gill,  4,  Finsbury  Square,  E.C. 
Ravner,  H.,  M.D.,  Hanwell,  W. 
Reid,  R.  W.,  M.D.,  10,  Nottingham  Place,  W. 

Richmond,  Thomas  G.,  F.R.C.S.,  Prestbury,  Macclesfield,  Cheshire 
Robathan,  G.  B.,  20,  York  Villas,  Prestonville,  Brighton 
Roberts,    David    Lloyd,    M.D.,    M.R.C.P.,    23,    St.    John    Street, 

Manchester 
Rockliffe,  W.  C,  M.A.,  M.B.,  9,  Charlotte  Street,  Hull 
Rosser,  Walter,  M.D.,  Croydon 

Rossiter,  George  F.,  M.B.,  Cairo  Lodge,  Weston-super-Mare 
Russell,  J.  W.  L,  55,  Montgomery  Terrace  Road,  Sheffield 

Sams,  John  Sutton,  Eltham  Road,  Lee,  S.E. 

Saunders,  Charles  E.,  M.D.,  M.C.,  21,  Lower  Seymour  Street,  W. 
Saunders,  Edwin,  F.R.C.S.,  13a,  George  Street,  Hanover  Square,  W. 
Saunders,  H.  W.,  M.B.,  F.R.C.S.,  Carvalla  Lodge,  Upper  Tooting, 

S.W. 
Sedgwick,  James,  M.D.,  Boroughbridge,  Yorkshire 
Sedgwick,  L.,  M.D.,  2,  Gloucester  Terrace,  Hyde  Park,  W. 
Sergeant,  Ed.,  Bolton,  Lancashire 

Sharkey,  Seymour  J.,  M.B.,  16,  Palace  Road,  Lambeth,  S.E. 
Shaw,  John,  M.B.  Lond.,  Willoughby  Road,  Hampstead,  N.W. 
Sheppard,  C.  E.,  M.B.  Lond.,  St.  Thomas's  Hospital,  S.E. 
Simmonds,  H.  M.,  66,  Camberwell  Road,  S.E. 
Simon,  John,  C.B.,  F.R.S.,  F.R.C.S.,  D.C.L.,  40,  Kensington  Square,  W. 

Slaughter,'  W.  B.  }  care  of  Dr'  SlauShter>  Farningham,  Kent 
Smith,  Frederick  "W\,  40,  Newington  Causeway,  S.E. 
Smith,  Heckstall,  3,  Courtney  Terrace,  Hove,  Brighton 
"  South  London  Medical  Reading  Club  " 
Sparke,  G.  Whitefield,  Bath  House,  Mansfield,  Notts. 
Sprakeling,  Robert  J.,  Bootle,  Liverpool 
Staddon,  John  H.,  6,  Silent  Street,  Ipswich 
Statham,  Hugh  W.,  50,  Wobuin  Place,  W.C. 
Stewart,  Charles,  St.  Thomas's  Hospital,  S.E. 
Stocks,  Frederick,  421,  Wandsworth  Road,  S.W. 
Stone,    W.    H.,   M.A.,    M.B.,   F.R.C.P.,  14,    Dean's    Yard,   West- 
minster,  S.W. 


xiv  List  of  Subscribers. 

Strange,  W.  Heath,  M.D.,  2,  Belsize  Avenue,  Hampstead,  N.W. 

Stuart,  J.  B.,  Standishgate  House,  Wigan 

Sturton,  Hubert  W.  S.,  29,  Burney  Street,  Greenwich 

Summerhayes,  Henry,  B.A. 

Sutton,  F.  W.,  St.  Thomas's  Hospital 

Takaki,  Kanehiro,  Tokei,  Japan 

Taylor,  S.,  M.B.,  St.  Thomas's  Hospital,  S.E. 

Thompson,  F.  H.,  Cleobury  Mortimer,  Salop 

Towne,  A.,  364,  Kingsland  Road,  E. 

Treves,  W.  Knight,  F.R.C.S.,  31,  Dalby  Square,  Margate 

Turner,  Richard,  22,  School  Hill,  Lewes,  Sussex 

Twining,  F.  T.,  M.B.,  Metropolitan  Fever  Hospital,  Homerton,  E. 

Tyrrell,  W.,  95,  Cromwell  Road,  South  Kensington,  S.W. 

Vesey,  T.  A.,  M„B.,  A.B.,  CM.,  West  View,  Rosstrevor,  co.  Down 

Wadd,  Frederick  J.,  M.B.,  CM.,  Prospect  House,  Richmond 
Wagstaffe,  W.  W.,  B.A.,  F.R.C.S.,  2,  Palace  Road,  Albert  Embank- 
ment, S.E. 
"Walker,  R.,  M.D.,  Budleigh  Salterton,  Devon 
Waller,  Arthur,  B.A.,  14,  Gibson  Square,  Islington,  N. 
Walters,  F.  R.,  12,  Palace  Road,  Lambeth,  S.E. 
Ward,  Fred.  Henry,  County  Asylum,  Tooting,  S.W. 
Webber,  W.  W.,  Crewkerne,  Somerset 
Welch,  James  Kemp,  Christchurch,  Hants 
Wells,  T.  Spencer,  F.R.C.S.,  3,  Upper  Grosvenor  Street,  W. 
West,  James  F.,  F.R.C.S.,  117,  Hagley  Road,  Birmingham 
Wiglesworth,  J.,  M.B.  Lond.,  County  Asylum,  Rainhill,  near  Prescot. 
Wilkinson,  T.  M.,  F.R.C.S.  Ed.,  37,  Silver  Street,  Lincoln 
Wilks,  Samuel,  M.D.,  F.R.C.P.,  F.R.S.,  77,  Grosvenor  Street,  W. 
Williams,  John,  M.D.,  Swinton,  Manchester 
Williams,  Leonard,  M.A.,  M.B.,  Wheatlev,  Oxon 
Williams,  Rhys  W.,  M.D.,  19,  Whitehall" Place,  S.W. 
Wilson,  W.,  M.D.,  Florence,   care  of  Squire  and  Co.,  5,  Coleman 

Street,  E.C. 
Winstanley,  Clement,  Ingatestone,  Essex 

Wrench,  Edward  M.,  F.R.C.S.,  Park  Lodge,  Baslow,  Derbyshire 
Wright,  F.  J.,  M.D.,  Northumberland  House,  Stoke  Newington,  N. 
Wyman,  W.  S.,  M.D.,   F.R.C.S.,  Westlands,  Upper  Richmond  Road, 
Putney,  S.W. 

York  Medical  Society,  per  F.  Shann,  Esq.,  7,  Micklegate,  York 


In  Exchange. 

St.  Bartholomew's  Hospital  Reports 

St.  George's  Hospital  Reports 

Guy's  Hospital  Reports 

London  Hospital  Reports 

The  Manchester  Hospital  Reports 

The  Obstetrical  Society's  Transactions 

Proceedings  of  The  Medical  Society  of  London 

Transactions  of  The  Clinical  Society 

The  Journal  of  Mental  Science 

Royal  College  of  Physicians 

Royal  College  of  Surgeons 

The  Pharmaceutical  Journal 

Le  Progres  Medical  (Dr.  Bourneville,  6,  Rue  des  Ecoles,  Paris) 

American  Journal  of  Medical  Science 

Transactions  of  American  Medical  Association  (Dr.  Wm.  Lee,  2111, 

Pennsylvania  Avenue,  Washington,  D.C.,  America) 
American  Journal  (H.  C.  Lea,  706,  Sansons  Street,  Philadelphia) 
Transactions  of  New  York  Academy  (D.  Appleton  &  Co.,  16,  Little 

Britain) 
Walsh's  Retrospect  (Publisher  of),  Washington,  D.C.,  United  States 
Royal  College  of  Surgeons,  Ireland. 


DISEASE    OE    THE    AORTIC    VALVES 


ORIGINATING  IN  MALFORMATION. 


By  THOMAS  B.  PEACOCK,  M.D.,  F.B.C.P., 

HON.   CONSULTING   PHYSICIAN    TO    THE    HOSPITAL. 


Mary  Ann  Sims,  set.  11,  residing  at  Hampstead,  admitted 
into  St.  Thomas's  Hospital  under  Dr.  Peacock's  care,  March 
19,  1875,  having  been  ailing  for  about  four  years,  but  worse 
for  between  two  and  three  months.  It  was  stated  at  the  time 
of  her  admission  that  about  four  years  before  she  was  confined 
to  bed  for  two  months  with  pains  in  the  head  and  chest,  but 
that  she  had  never  had  rheumatism,  and  was  healthy  up  to  that 
time.  She  was  suffering  from  attacks  of  sickness  and  retching, 
with  shortness  of  breath,  and  had  been  under  treatment  at  the 
Hampstead  Consumption  Hospital.  Her  mother  died  sud- 
denly of  haemoptysis  six  years  ago.  Her  father  is  living,  and 
she  has  two  sisters  living,  but  lost  a  brother  by  some  chest 
affection  six  years  before.  She  has  a  pallid,  puffy  appearance, 
and  the  abdomen  is  tumid,  but  there  is  no  decided  dropsy. 
The  tongue  is  clean  and  moist,  pulse  112,  somewhat  feeble, 
respiration  32,  hurried  and  irregular.  The  action  of  the  heart 
is  tumultuous  and  visible  over  a  large  space ;  there  is  decided 
prominence  in  the  praecordial  region.  The  dulness  and  per- 
cussion begins  at  the  second  interspace,  and  becomes  entire  at 

VOL.  xi.  1 


2  Disease  of  the  Aortic  Valves 

the  third.  Laterally  it  commences  to  the  right  of  the  sternum, 
and  extends  beyond  the  line  of  the  left  nipple.  At  the  base 
there  is  a  systolic  murmur,  heard  most  distinctly  at  the  right 
side  and  upper  part  of  the  sternum  ;  it  is  short  and  rough,  and 
is  followed  by  a  soft  diastolic  murmur  which  is  propagated 
down  the  course  of  the  sternum.  Towards  the  apex  there  is  a 
creaky  murmur  which  is  clearly  of  independent  origin,  and 
may  be  presystolic.  It  is  not  heard  posteriorly.  There  may 
be  a  slight  purring  tremor  felt  at  the  apex. 

On  the  30th  she  is  reported  to  have  continued  much  the 
same.  She  had  very  little  cough  and  no  expectoration.  She  had 
the  attacks  of  sickness  occasionally,  and  sometimes  brought  up 
a  little  blood  with  the  violent  exertion.  There  was  much  sibilant 
and  sonorous  rhonchus  in  all  parts  of  the  chest.  The  physical 
signs  continued  as  before,  but  there  was  no  purring  tremor 
to  be  felt  at  the  apex. 

April  20th. — She  continued  much  the  same,  still  suffering 
from  occasional  attacks  of  retching  and  vomiting.  She  only 
brought  up  some  mucus,  occasionally  tinged  with  blood.  The 
murmur  heard  towards  the  lower  end  of  the  sternum  was  short 
and  terminated  abruptly,  and  was  probably  presystolic ;  but  at 
the  apex  it  apparently  became  systolic,  and  was  audible  behind. 
The  hepatic  dulness  was  wide  in  extent,  and  the  liver  could  be 
felt  extending  a  considerable  distance  below  the  ribs. 

30th. — She  has  been  on  the  whole  better ;  the  attacks  of 
retching  have  been  less  frequent  but  not  less  severe  than  they 
were.  The  physical  signs  are  much  the  same,  but  the  murmur 
towards  the  lower  end  of  the  sternum  is  characteristically  pre- 
systolic, and  is  not  audible  posteriorly,  but  there  is  scarcely 
any  thrill  to  be  felt  at  the  apex. 

May  11th. — The  sickness  has  been  less,  but  she  is  much 
prostrated  and  very  inert,  being  almost  always  asleep.  The 
murmurs  are  less  distinct,  the  action  of  the  heart  very  tumul- 
tuous. 

25th. — Condition  much  the  same,  except  that  she  was 
losing  strength. 

On  the  13th  of  June  the  dropsical  symptoms  had  become 
more  marked,  and  on  the  28th,  though  the  specific  gravity  of 
the  urine  still  continued  high,  there  was  fully  one-tenth  of 
albumen. 


probably  originating  in  Malformation  3 

On  the  22nd  of  August,  the  abdomen  having  become  very 
tumid,  she  was  tapped  ;  9|  pints  of  fluid  were  removed,  and  on 
the  20th  of  September  the  tapping  was  repeated,  and  10  pints 
of  fluid  were  evacuated.     She  died  on  the  20th  of  October. 

The  post-mortem  examination  was  performed  by  Dr.  Green- 
field the  following  day.  The  pleurae  contained  much  fluid, 
and  the  abdomen  was  much  distended  ;  both  lungs  were  com- 
pressed and  cederaatous.  The  liver  was  large,  and  weighed 
3  lbs.  11  oz.,  and  presented  a  marked  nutmeg  appearance. 
Spleen  natural,  somewhat  firm,  weighed  4^  oz.  Kidneys 
enlarged,  very  dense,  weighed  8^  oz.  The  capsules  were 
slightly  adherent,  the  surface  was  smooth.  The  cortex  some- 
what narrow  and  whole  organs  firm  and  dark,  presenting 
appearances  of  chronic  induration  from  congestion.  The 
heart  weighed  the  day  after  the  examination  and  when  deprived 
of  coagula,  20|  oz.,  and  there  were  the  remains  of  old  adhe- 
sions on  the  surface  of  the  pericardium,  more  particularly  on 
the  right  ventricle  and  auricle,  and  between  the  pulmonary 
artery  and  aorta.  The  auricles  and  ventricles  were  much 
hypertrophied  and  dilated,  and  the  lining  membrane  of  the  left 
cavities  was  somewhat  thickened  and  opaque,  and  the  mitral 
valve  also  was  thickened. 

The  girth  of  the  right  ventricle  was  79  Paris  lines  = 
17775  mm.  and  6*94  in. 

The  girth  of  the  left  ventricle  was  63  Paris  lines  = 
14175  mm.  and  5*59  in. 

The  length  of  the  cavity  of  the  right  ventricle  was  51  Paris 
lines  =  114-75  mm.  and  4*52  in. 

The  length  of  the  cavity  of  the  left  ventricle  was  45  Paris 
lines  =  10T25  mm.  and  3-99  in. 

The  thickness  of  the  walls  of  the  right  ventricle  was  at  the 
base  3  Paris  lines  =  6*75  mm.  and  '26  in. ;  at  the  midpoint 
2*5  Paris  lines  =  5*62  mm.  and  *22  in.;  at  the  apex  2  Paris 
lines  =  4-5  mm.  and  '199  in. 

The  thickness  of  the  walls  of  the  left  ventricle  was  5*5  Paris 
lines  =  1237  mm.  and  '48  in.;  7'5  Paris  lines  =  16*87  mm. 
and  621  in. ;  4*  =  9  mm.  and  *35  in. 

The  circumference  of  the  right  auriculo-ventricular  aperture 
45  Paris  lines  =  101  "25  mm.  and  3*99  in.;  of  pulmonic 
aperture  39  Paris  lines  =  87"75  mm.  and  3*46  in. 


4  Disease  of  the  Aortic  Valves 

The  circumference  of  the  left  auriculo-ventricular  aperture 
was  33  Paris  lines  =  74*25  mm.  and  2*98  in.  ;  of  aortic  aper- 
ture was  30  Paris  lines  =  67*75  mm.  and  266  in. 

The  right  and  posterior  aortic  segments  were  blended  to- 
gether, so  that  the  aortic  orifice  had  only  two  valves,  and  both 
of  them  were  much  thickened,  and  the  united  curtain  dropped 
below  the  level  of  the  other  curtain,  so  that  there  was  both 
obstruction  to  the  flow  of  blood  from  the  left  ventricle  into 
the  aorta  and  regurgitation  from  the  vessel  into  the  ventricle. 
(See  Plate.) 

It  will  therefore  be  seen  that  the  physical  signs  which  had 
been  observed  during  life  corresponded  with  the  condition  of 
the  heart  found  on  examination,  though  from  the  uncertainty 
of  the  character  of  the  apex  murmur  and  of  the  purring  tremor, 
the  diagnosis  of  the  mitral  stenosis  was  less  satisfactorily  estab- 
lished, and,  indeed,  the  constriction  of  left  auriculo-ventricular 
aperture  was  only  slight. 

There  are  several  points  of  much  interest  in  this  case. 

1.  It  affords  a  very  characteristic  example  of  disease  of  the 
aortic  valves  originating  in  malformation,  or  at  least  in  changes 
in  the  condition  of  the  valvular  apparatus  probably  occurring 
during  intra-uterine  life.  I  am  aware  that  this  view  as  to  the 
adhesion  of  the  valves,  since  I  expressed  it  in  the  Croonian 
Lectures,  delivered  before  the  Royal  College  of  Physicians  in 
1 865,  has  been  controverted,  and  by  writers  for  whose  opinions 
I  entertain  the  highest  respect ;  but,  in  the  absence  of  any 
explanation  which  seems  to  me  more  feasible,  I  am  disposed  to 
retain  my  original  views. 

Fusion  of  the  valves  has  been  ascribed  to  the  tearing  down 
of  the  adjacent  angles  of  attachment  of  two  of  the  segments, 
while  the  rest  of  the  curtain  escapes  laceration.  There  is  no 
doubt  that  such  giving  way  of  the  angles  of  attachment  of  the 
segments  does  occur,  but  certainly  not  frequently,  and  such 
accidents,  when  they  do  occur,  are  attended  by  symptoms 
which  are  quite  characteristic ;  and  the  accident  causes  such 
serious  interference  with  the  functions  of  the  heart  as  to  be 
incompatible  with  the  prolongation  of  life  for  any  considerable 
period.  In  the  present  instance  there  is  no  history  of  any  such 
occurrence,  and  the  probability  of  its  having  occurred  may 
safely  be  dismissed. 


probably  originating  in  Malformation.  5 

2.  It  has  been  supposed  to  be  due  to  inflammation  occurring 
after  birth;  but  this  would,  I  conceive,  be  necessarily  attended 
by  very  marked  symptoms  of  disease  which  could  scarcely 
escape  notice.  The  present  patient  had  never  had  any  such 
symptoms  as  far  as  could  be  ascertained,  and  though  she  had 
some  swelling  and  pain  of  the  ankles,  which  might  probably 
have  been  rheumatic,  that  only  occurred  a  year  before  her 
death  and  after  the  cardiac  symptoms  had  manifested  them- 
selves. The  fusion  of  the  segments  of  the  aortic  valves  is  pre- 
cisely similar  to  that  which  much  more  frequently  is  seen  in  the 
pulmonic  valves,  and  which  often  coexists  with  other  deviations 
from  the  natural  formation  of  the  heart,  of  the  intra-uterine 
origin  of  which  no  doubt  can  be  entertained,  so  that  there  is 
strong  reason  to  regard  the  fusion  of  the  aortic  valves  as  also 
congenital,  and,  indeed,  it  has  been  occasionally  found  in  foetuses 
which  have  never  breathed,  and  frequently  in  infants  dying 
shortly  after  birth. 

3.  Another  interesting  feature  in  the  case  was  the  peculiar 
attacks  of  retching  and  sickness  under  which  the  child  suffered 
all  the  time  she  was  in  the  hospital.  These  attacks  occurred 
every  two  or  three  days,  and  without  any  reference  to  the  times 
of  taking  food  or  to  the  character  of  the  food  taken,  and 
nothing  to  explain  them  was  found  in  the  stomach  after  death. 
They  could,  therefore,  only  be  supposed  to  depend  upon 
reflected  irritation  from  the  cardiac  disease. 

4.  A  third  very  interesting  feature  of  the  case  was  the  torpid 
condition  of  the  child  during  the  whole  of  the  time  she  was  in 
the  hospital.  Dr.  Rossiter,  the  then  house-physician,  said  he 
always  found  the  child  sleeping  when  he  was  in  the  ward. 
Her  temperature  also  was  throughout  always  low ;  at  first  it 
never  exceeded  97*4°  F.,  and  was  sometimes  as  low  as  96°.  In 
June  it  ranged  between  98-5°  to  95°,  scarcely  ever,  however, 
reaching  the  normal  standard.  The  only  alteration  which 
occurred  towards  the  end  of  life  was  that  it  rose  for  a  few  days 
at  the  time  when  the  child  was  first  tapped,  and  again  when 
the  second  tapping  was  performed.  During  the  last  weeks  of 
the  child's  life  it  ranged  from  98-4°  to  967°  and  95 -5°. 

I  append  a  record  of  the  daily  temparatures. 


Disease  of  the  Aortic  Valves 


A.M. 

P.M. 

March  23rd  .. 

.     97-4°    ... 

96-8° 

„      24th  .. 

.     97 

97-4 

„      25th  .. 

.     97-2      ... 

97 

„      26th  .. 

97 

— 

„      27th  .. 

.     97 

— 

„      29th  .. 

.     97 

— 

„      31st   .. 

.     97 

— 

June  9th 

.     96-4     ... 

— 

„      10th     .. 

.     97-5      ... 

— 

„      11th     .. 

.     96-7      ... 

97 

„      12th     .. 

.     98 

— 

„     13th     .. 

.     98-5      ... 

— 

Dropsical  symptoms  became 

markec 

„     14th     .. 

.    97-2      ... 

— 

„     15th     .. 

— 

97-3 

„     16th     .. 

.     96 

96 

„     17th     .. 

.     96-2      ... 

96 

„     18th     .. 

— 

96-8 

„     19th     .. 

.     95 

972 

„      20th     .. 

.     962      ... 

97-6 

„     21st      .. 

.     96 

97-1 

„     22nd    .. 

.     98 

97-2 

„      23rd     .. 

.     96-2      ... 

96-4 

„      24th     .. 

.     96 

— 

„      26th     .. 

.     95 

976 

„      27th     .. 

.     95-8      ... 

98 

„     28th  '  .. 

.     975      ... 

97-2 

Albumen  l-10th. 

„     29th     .. 

.     97 

98 

„      30th     .. 

.     95-8      ... 

98 

July  1st 

.     97-4      ... 

95  6 

„      2nd      .. 

.     97 

98 

„      3rd       .. 

.     96-2     ... 

98 

„     4th       .. 

.    97 

96-4 

„      5th       .. 

.     97 

97-2 

„      6th       . 

.     98'4      ... 

976 

„     7th       . 

.     962      ... 

98 

„     8th       . 

.     98-4      ... 

98-2 

„      9th       . 

.     956      ... 

96-2 

„     10th     . 

.     962      ... 

96-2 

„     12th     . 

.     97-2      ... 

986 

„      13th     . 

.     96-2      ... 

99-3 

„     14th     . 

.     993      ... 

97-6 

„     15th     . 

..     96-8      ... 

98-2 

„     16th     . 

.     96 

976 

„      17th     . 

.     97-4      ... 

981 

„     18th     . 

.     98-2      ... 

97-8 

A.M. 

P.M. 

July  19th 

..     96-4      .. 

96-2 

„     20th 

..     96 

.     96 

„     21st 

..     98-8      .. 

.     97-8 

„      22nd 

...     98-1      .. 

.     97-4 

„      23rd 

...     98-4      .. 

.     99-3 

„      24th 

..     98-8      .. 

.     98-4 

„      25th 

...     986      .. 

.     98-4 

„     26th 

...     97-4      .. 

.     976 

„     27th 

...     95-6      .. 

.     953 

„     28th 

...     972      . 

.     96 

„     29th 

...     97-4     .. 

.     98-2 

„      30th 

...     98-6      . 

.     96-7 

„      31st 

...     96-2      . 

.     96-5 

Aug.  1st 

...     971      .. 

.  101-4 

„     2nd 

...     96-4      . 

.     96 

„      3rd 

...     96-8      . 

.     97-3 

»     4th 

...     96-2      . 

.     96-8 

„     5th 

...     98-1      . 

.     98-6 

„     6th 

...     98 

.     98 

„     7th 

...     96-5      . 

.     98-6 

„     8th 

...     96-4      . 

.     97-8 

„     9th 

...     96-4      . 

.     98-5 

„      10th 

— 

.     973 

„     11th 

...     963      . 

..     96-7 

„      12th 

...     96-5      . 

.     96-4 

„      13th 

...     963      . 

.     97-8 

„      14th 

...     95-2      . 

..     96-8 

„      15th 

...     98-3      . 

.     97 

„      16th 

...     96-4      . 

..     976 

„     17th 

...     97 

..     98 

„      18th 

...     98-2      . 

.     97-8 

„      19th 

...     996      . 

..     98-2 

„     20th 

...     963      . 

..     98-3 

„     21st 

...     98-4      . 

..     98-5 

„     22nd 

...     98 

..     98-9 

Paracentesis. 

„     23rd 

...     97 

..     98-3 

„      24th 

...     98-4      . 

..     968 

„     25th 

...     97 

..     96-8 

„     26th 

...     97-2      . 

..     96-3 

„     27th 

...     96-8      . 

..     98-2 

„     28th 

...     967      . 

..     98 

„     29th 

...     97-6     . 

..     98-5 

„     30th 

...     96-4      . 

..     96-7 

„      31st 

...     97-4      . 

..     97-2 

Sept.  2nd 

...     967      . 

..     956 

„      3rd 

...     964      . 

..     956 

probably  originating  in  Malformation. 


A.M. 

P.M. 

A.M. 

P.M. 

Sept.  4th 

...     963 

..     96-8 

Sept.  22nd    . 

..     96 

— 

„     5th 

..     96-7      . 

..     97'4 

„      23rd     . 

..     956      . 

..     96 

„     6th 

...     96 

— 

„     24th     . 

..     954      . 

..     97-4 

„     7th 

..     956      . 

..     97-6 

„     25th     . 

,.  100 

..     96-5 

„      8th 

..     96 

..     96-6 

„      26th     . 

..     96-5      . 

..     98-4 

„     9th 

..     97-8      . 

..     98  6 

„      27th     . 

..     97-4      . 

..     97-7 

„      10th 

..     97-6      . 

..     98-7 

„     28th     . 

..     97 

..     97-6 

„     11th 

..     98-4      . 

..     98-5 

„     29th     . 

..     96 

..     96-3 

„     12th 

..     97-6      . 

..     97'4 

„      30th     . 

..     96 

..     95-7 

„     13th 

..     96-4      . 

..     96-6 

Oct.  1st 

..     95-7      . 

..     96-6 

„     14th 

..     96 

..     96-4 

„     2nd 

..     96 

..     96 

„      15th 

..     95-4      . 

..     999 

„     3rd 

..     96 

..     96 

„      16th 

..     96 

..     973 

„     4th 

..     96-7      . 

..     97-2 

„     17th 

..     96-2      . 

..     973 

„     5th 

..     96-7      . 

..     97-2 

„     18th    . 

..     96-2      . 

..     96-8 

„     6th 

..     98-4      . 

..     96 

„      19th 

..     956      . 

..     962 

„    7th 

..     96-6      . 

..     98-4 

„     20th 

..     96-2      . 

..     96-6 

„     8th 

..     97-5      . 

..     955 

„     21st 

Pi 

..     98-8      . 
iracentesis. 

..     99-5 

„     9th 

..     96-6      . 

"       ~ 

EXPLANATION   OP  PLATE 

Illustrating  Dr.  Peacock's  paper  on  Disease  of  the  Aortic  Valves 
probably  Originating  in  Malformation. 

It  shows  the  adhesion  of  the  right  and  posterior  aortic  segments  forming  one 
curtain  which  falls  helow  the  level  of  the  other  curtain. 


ST  THOMAS'S  HOSP.  K.EP.  N.  S.  VOL.XL 


Drawing    to    illustrate    D'T    Pectcoclc's      paper     on     disease 
of  the     aortic     valves     prohaloly       originating       in      mcd  — 

formatioia. It      shews      the       euihesion     of   -the   riqht 

and-    posterior       segments  ,    forming     one      curtain     which 
falLs    below     the     level     q£    the     other     curtain. 


i.  C°  imp. 


CASES 

OF  . 

ORBITAL   CELLULITIS    PRESENTING 
UNUSUAL    FEATURES, 

NARRATED   AT  TWO   CLINICAL   LECTURES   GIVEN  IN   THE  EYE 
DEPARTMENT,  ON  NOVEMBER  17th  &  24th,  1880. 


By  EDWAED  NETTLESHIP. 


Case  1. — Relapsing  double  orbital  cellulitis  in  a  very  gouty 
man ;  tendency  to  lymphatic  inflammations ;  gonorrhoea 
several  years  before,  but  no  syphilis ;  transient  severe  neuro- 
retinitis. 

Matthew  Taylor  A — ,  a  stout,  largely-built,  intelligent  man 
of  44,  a  baker,  was  sent  to  me  at  the  Eye  Department  by  Dr. 
Greenfield  on  April  24th,  1879,  for  my  opinion  as  to  the  cause 
of  the  defective  sight  in  his  right  eye. 

f  ft     _2  0_       +30S}lOnpflJv     +T5"*_-i     Tl 

V    3  ""  100^     _i_JL_-  C  20  nearly,       L  i  j. 

*  •   )  "•"  36  c  )  +36C 

(.L-fa  Hm.i       |£,  +A=U.     P.  8". 

The  right  disc,  notwithstanding  that  acuteness  of  sight  was 
almost  normal,  was  decidedly  pale  all  over  and  its  substance 
opaque ;   the  central  vessels  were  normal  and    there  were  no 

1  But  he  complained  that  ohjects  looked  "  dull "  with  this  eye,  and  the  pupil 
was  larger  than  that  of  the  other  eye. 


10  Orbital  Cellulitis. 

positive  signs  of  previous  neuritis.  There  was  no  colour 
defect.  Satisfied  that  the  optic  nerve  in  this  eye  was  diseased, 
I  obtained  the  following  history  : 

For  about  twelve  years  he  had  been  subject  to  <e  gout "  or 
"  rheumatic  gout,"  usually  having  about  two  attacks  each  year; 
and  he  was  in  fact  at  the  present  time  under  Dr.  Greenfield's 
treatment  for  a  passing  attack.  He  had  had  gonorrhoea  about 
twelve  years  before  and  had  lately  been  troubled  by  a  stricture, 
which  Mr.  Clutton  had  successfully  treated.  There  was  no 
history  of  syphilis. 

Seven  years  ago  he  had  an  attack  of  inflammation  of  the 
eyes,  in  which  the  "  whites  of  the  eyes  became  red  and  were 
swollen  over  the  pupil "  (chemosis  ?)  and  he  was  unable  to 
bear  the  light.  He  was  taken  to  Moorfields,  where  he  was 
told  that  he  had  "  acute  periostitis."  The  eyes  recovered  and 
remained  well  till  eighteen  months  or  two  years  ago  (i.e.  for 
a  period  of  about  five  years),  when  he  had  another  attack  of 
the  same  kind.  Since  then  they  had  been  often  rather  blood- 
shot. 

Though  the  man  gave  a  very  plain  and  graphic  account,  I 
must  confess  to  having  felt  some  doubt  as  to  the  correctness 
of  his  statements.  However,  just  a  week  afterwards,  on  May 
1st,  he  came  back  to  me  saying  that  he  had  got  another  attack 
of  his  "  periostitis." 

The  right  orbit  was  the  one  now  attacked  (the  right  disc  was 
the  one  previously  noted  as  pale).  It  had  began  two  or  three 
days  before.  There  was  much  congestion,  chemosis  with  some 
proptosis,  and  limitation  of  movement.  Pupil  inactive  and,  as 
at  the  former  visit,  rather  larger  than  the  left.  He  was  in  con- 
siderable pain,  and  pressure  over  the  supra-orbital  notch  was 
painful,  but  pressing  the  eye  back  in  the  orbit  was  not 
markedly  so.  He  was  ordered  five  leeches,  warm  fomenta- 
tions, and  a  purgative  and  alkaline  mixture. 

2nd. — Chemosis  less.      Three  more  leeches. 

5th. — The  left  is  now  attacked.  Three  leeches  to  left 
temple.      Atropine. 

8th. — Left  much  worse ;  dusky  swelling  of  lid,  extreme 
serous  chemosis,  very  little  discharge.  Conjunctiva  snipped. 
Says  his  water  is  very  thick.      Omit  atropine. 

9th. — Three  more  leeches  to  left  temple. 


Orbital  Cellulitis.  11 

14th. — Sight  of  left  'now  noted  for  first  time,  and  found 
very  defective  ;  only  sees  18  J.  and  is  not  improved  by  glasses. 
Disc  moderately  swollen  and  very  hazy ;  veins  dilated  and 
tortuous;  no  haemorrhages.  (No  note  as  to  right  at  this 
date.) 

14th. — Left  improving,  but  movements  of  globe  still 
restricted,  and  he  complains  of  diplopia.  There  is  now  enlarge- 
ment of  the  gland  above  the  left  elbow.  (He  also  shows  the 
scar  of  an  abscess  five  to  six  years  ago  in  the  same  part  of  the 
right  arm,  caused  by  an  abscess  in  the  finger.) 

Sight  of  left  still  only  18  J.  and  ^f0.  Hm.  }-Qi  but  not 
improved.  Pupils  both  act  very  badly  to  light ;  right  5±  mm., 
left  7  mm. 

19th. — Sight  of  left  improving,  16  J.  unaided,  and  10  J. 
with  +  Y^-. 

22nd. — Left  reads  6  J.  with  +  yj,  but  does  not  see  the 
middle  clearly.  Pupils  now  equal,  3  mm.,  but  dilate  scarcely 
at  all  when  covered.  Inward  movement  of  globe  still  defective. 
Considerable  neuro-retiuitis,  with  haze  and  swelling,  extending 
some  distance  into  the  retina,  veins  abruptly  kinked,  arteries 
not  diminished  and  pulsate  easily  on  pressure. 

On  28th  it  is  noted  that  the  left  cornea  was  not  anaesthetic; 
this  had  not  before  been  tested.  The  sight  of  this  eye  rapidly 
improved,  and  on  June  17th  he  read  1  J.  fairly  well  with 
+  -A-.  There  is  no  later  ophthalmoscopic  note  of  the  left 
eye,  and  no  note  as  to  the  condition  of  the  fundus  in  the 
right  during  this  attack,  but  the  attack  on  the  latter  side  was 
soon  over. 


Case  2. — Inflammation  in  both  orbits,  probably  cellulitis,  pos- 
sibly periostitis ;  temporary  iridoplegia  and  amblyopia ; 
perfect  recovery  ;  no  proof  of  syphilis  ;  severe  gout  in 
patient's  father. 

John  S — ,  set.  35,  came  to  the  South  London  Ophthalmic 
Hospital  on  January  8th,  1877,  with  slight  proptosis  and  some 
redness  and  swelling  of  the  ocular  conjunctiva  and  of  the 
eyelids ;  the  condition  was  symmetrical,  but  worse  on  the 
right  side.     It  had  been  coming  on  gradually  for  three  weeks 


12  Orbital  Cellulitis. 

on  the  right,  and  two  weeks  on  the  left  side,  and  had  been 
followed  by  some  swelling  of  the  cheeks,  traces  of  which  were 
still  apparent.  He  had  a  good  deal  of  pain  in  the  temples, 
and  pressure  over  the  eyes  was  painful,  but  there  was  no 
tenderness  of  the  accessible  parts  of  the  orbital  walls.  Pupils 
natural  and  sight  said  to  be  perfect  (not  tested).  I  thought 
there  was  some  thickening  of  the  roofs  of  the  orbits. 

He  denied  syphilis,  and  there  was  no  history  of  injury  or 
of  erysipelas.  No  otorrhcea.  Teeth  of  upper  jaw  perfect. 
I  afterwards  saw  the  eldest  of  his  two  children.  It  was 
weak  and  had  had  snuffles,  but  showed  no  certain  evidences  of 
syphilis.  Other  special  senses  perfect.  He  was  a  tall,  bony, 
pale  man,  of  rather  flabby  coarse  skin. 

Thinking  it  possible  that  he  had  some  periostitis  and  that 
it  was  syphilitic,  I  ordered  iodide  of  potassium  in  ten-grain 
doses,  afterwards  increased  to  twenty  grains. 

On  the  13th  the  pain  was  worse  and  chiefly  nocturnal,  and 
he  complained  of  giddiness  and  occasional  diplopia.  Walking 
and  noise  made  the  symptoms  worse. 

Vision  now  tested.  Right  10  J.,  slowly.  Examination 
showed  all  the  retinal  vessels,  both  arteries  and  veins,  very 
large,  but  no  other  change. — Left  4  J.  No  ophthalmoscopic 
note.  Pupils  small  and  not  acting  either  to  light  or  accom- 
modation. (From  the  later  notes  it  is  evident  that  the  above 
difference  in  the  sight  of  the  two  eyes  was  due  chiefly  to  a 
higher  degree  of  H.  in  the  right.) 

On  the  20th  it  is  noted  that  there  was  tenderness  on 
pressing  against  the  upper-inner  part  of  each  orbit,  and 
I  fancied  that  there  was  a  diffused  periosteal  thickening 
there. 

27th. — Sight  rather  better,  right  8  J.  slowly  with  +  -j1^. 
left  2  J.  unaided  ;  ophthalmoscopic  appearances  of  right  as 
before. 

February  10th. — There  is  less  swelling.  Has  been  having 
attacks  of  spasm  of  the  lids  and  watering.  Vision  about  the 
same.  Is  taking  iodide  of  potassium  gr.  xx  for  the  last  ten 
days.     Add  grey  powder  gr.  ij  once  a  day. 

By  the  24th  the  symptoms  had  almost  disappeared.  Ap- 
parent thickening  of  bone  at  the  upper  iuner  part  of  orbit  as 
on  admission. 


Orbital  Cellulitis.  13 

April  10th. — No  active  symptoms,  but  the  left  eye  still 
slightly  prominent. 

In  October,  the  left  still  slightly  more  prominent  than 
right.  The  conjunctiva?  of  the  eyeballs  look  rather  loose 
and  thickened. 

Vision      {  Right  ™  Hm-  2'5  D-  =  t^   8  J'  unaided' 
vision.    |  Left     2^  Hm    x       D  =2£  .  g  j    unaided. 

There  is  no  doubt  that  the  sight  was  somewhat  affected  in 
both  eyes  during  the  attack,  but  the  notes  are  not  complete 
enough  to  show  whether  it  was  chiefly  from  failure  of  accommo- 
dation or  from  affection  of  the  optic  nerves.  From  the  state 
of  the  pupils  it  seems  likely  that  the  ciliary  nerves  were  for  a 
time  involved. 

I  saw  him  again  in  August,  1880,  and  found  that  no 
relapse  had  occurred  and  that  vision  had  improved.  Right 
|§,  Hm.  2  D.  f  g.  Left  §  %,  Hm.  1  D.  Discs  healthy  ;  but 
pupils  not  noted.  The  apparent  thickening  of  the  orbit  is 
as  before,  but  on  careful  comparison  with  healthy  persons,  I 
doubt  whether  there  is  now  or  ever  has  been  any  morbid 
thickening. 

I  now  questioned  him  particularly  as  to  gout,  in  the  light 
of  the  former  case. 

The  patient  himself  has  never  had  the  slightest  arthritic 
symptom,  but  his  father,  a  painter,  suffered  severely  from 
gout,  being  hardly  ever  free  from  it,  and  he  also  had  colic 
severely. 


Case  3. — Severe  cellulitis  of  one  orbit,  with  neuro-choroido- 
retinitis  ending  in  atrophy ;  three  attacks  in  the  same 
orbit ;  ?  kidney  disease. 

Jane  W — ,  set.  36,  married,  came  for  advice  about  her 
right  eye  in  May,  1879.  Vision  in  this  eye  was  reduced  to 
counting  fingers  at  4',  best  on  the  temporal  side,  and  there 
was  no  direct  action  of  the  pupil.  The  disc  was  very  grey 
and  surrounded  by  very  large  areas  of  choroidal  atrophy  with 
pigment  accumulations,  some  of  which  were  in  the  retina ; 
the  retinal  vessels  were  not  much  altered.  The  left  eye  was 
perfect,  and  refraction  normal. 


14  Orbital  Cellulitis. 

She  said  that  a  year  and  three  quarters  previously  she  was 
treated  at  Moorfields  for  inflammation  of  the  right  eye.  It 
began  with  pain  when  the  eye  was  moved,  followed  in  a  few 
days  by  redness  of  the  eye,  pain  in  the  head,  and  swelling  of 
the  eyelids;  in  a  week  the  swelling  was  as  large  as  an  egg. 
At  the  end  of  about  four  weeks  from  the  onset  all  the 
symptoms  disappeared,  but  the  sight  was  in  its  present  state. 
No  abscess  formed. 

She  had  been  confined  eight  months  before  the  attack,  and 
two  months  before  it  had  had  "  inflammation  of  the  kidneys/' 
and  got  very  much  out  of  health.  (She  subsequently  brought 
her  Moorfields  letter,  on  which  "  cellulitis  "  was  diagnosed,  and 
detailed  notes  written.  Severe  neuro-retinitis  was  present 
early  in  the  case  ;  later  some  haemorrhages,  which  finally  gave 
place  to  pigment.  The  last  note  agreed  with  my  own.  The 
state  of  the  pupils  was  not  noted.  The  urine  during  her 
attendance  at  Moorfields  is  noted  as  healthy.) 

Nine  months  after  the  above  attack  she  had  a  second  on 
the  same  side,  and  a  third  also  in  the  same  orbit,  six  weeks 
later.     No  note  as  to  the  gout. 


Case  5. —  Unsymmetrical  orbital  cellulitis  following  severe  sore 
throat ;  strangulation  of  vessels  of  optic  nerve  ;  recovery 
without  suppuration. 

Clara  M — ,  set.  12,  was  sent  to  me  at  St.  Thomas's  Hospital, 
by  Dr.  Chabot,  on  April  1st,  1880. 

There  was  considerable  protrusion  of  the  right  eyeball,  with 
restriction  of  all  its  movements  and  partial  ptosis  ;  the  ocular 
conjunctiva  was  swollen,  particularly  at  the  lower-inner  part, 
where  the  swollen  membrane  formed  a  horizontal  ridge  ;  only 
slight  discharge.  The  left  eye  Avas  natural.  Both  pupils 
equal  and  active,  and  acuteness  of  vision  normal  in  each  eye. 
The  ophthalmoscope  showed  extreme  engorgement  of  the 
retinal  veins  in  the  affected  eye,  with  some  swelling,  but  very 
little  haze  of  the  disc  or  retina.  She  was  thin  and  ansemic 
and  ill.  The  glands  under  the  jaw  and  in  the  neck  were  a 
good  deal  enlarged,  more  so  on  the  side  of  the  affected  eye, 
and  there  were  some  enlarged  glands  (old)  in  the  right  groin. 


Orbital  Cellulitis.  15 

The  tonsils  were  red,  but  neither  enlarged  nor  ulcerated. 
There  was  no  evidence  of  lacrymal  obstruction.  She  was 
taken  into  the  hospital  under  the  care  of  Dr.  Bristowe.  The 
same  evening  her  temperature  was  10l*2°,  pulse  9G,  resp.  30; 
the  urine  contained  no  albumen,  and  no  visceral  disease  was 
detected. 

It  appeared  on  inquiry  that  she  had  been  out  of  sorts  all 
the  previous  winter,  and  had  had  chilblains  and  enlarged 
glands  under  the  jaw.  About  a  month  before  the  eye  sym- 
ptoms came  on  her  mother  had  brought  her  as  an  out-patient 
on  the  medical  side.  After  one  visit,  a  fortnight  before  I  saw 
her,  her  mother  thought  she  had  caught  cold ;  two  or  three 
days  later  her  throat  got  very  sore,  then  the  right  nostril 
became  stopped  up,  the  right  eye  began  to  protrude,  and  she 
became  quite  ill.  It  is  probable  from  the  mother's  descrip- 
tion that  she  had  an  abscess  in  the  right  tonsil.  There  was 
no  history  of  diphtheria  or  scarlet  fever  either  in  the  house  or 
neighbourhood. 

On  April  5th  all  the  eye  symptoms  were  slighter,  and  by  the 
12th  the  proptosis  had  nearly  disappeared,  but  as  late  as  the 
19th  there  was  still  decided  engorgement  of  the  retinal  veins 
and  slight  prominence  of  the  eye. 

Once  (about  the  8th)  there  was  a  threatening  of  the  same 
thing  on  the  left  side;  some  fulness  and  tenderness  occurred 
along  the  left  side  of  the  nose,  with  pain  in  the  eye  and  slight 
puffiuess  of  the  eyelids;  but  the  symptoms  went  no  further. 
She  said  that  the  first  thing  she  had  noticed  before  the  attack 
on  the  right  side  was  tenderness  along  the  corresponding  side 
of  the  nose. 

Whilst  in  the  hospital  the  morning  temperature  never 
reached  100°,  but  in  the  evening  it  was  several  times  up  to 
100°  and  101f5o.     It  became  rather  subnormal  before  she  left. 

Knapp  has  recently  published  a  case  of  orbital  cellulitis 
following  diphtheria  : — A  boy,  set.  6,  had  severe  diphtheria  of 
the  throat  with  great  swelling  of  the  fauces  and  an  abscess  in 
the  right  side  of  the  soft  palate.  Then  great  swelling  came 
on  in  the  parotid  region  of  the  same  side,  with  paralysis  of  the 
facial  nerve  and  cellulitis  of  the  same  orbit.  The  symptoms 
of  the  orbital  cellulitis  were  inflammation  of  the  lids,  proptosis, 


16  Orbital  Cellulitis. 

early  neuro-retinitis  (oedema),  and  inflammation  of  the  lids. 
The  child  died,  but  no  post-mortem  examination  could  be 
obtained  ('  Hirschberg's  Centralblatt/  1879,  p.  97). 

In  the  '  American  Journal  of  the  Medical  Sciences '  for 
April,  1880  (p.  429),  Dr.  Albert  G.  Heyl  gives  a  case  of 
"  Metastatic  Tenonitis  in  Diphtheria/'  which  apparently 
belongs  to  the  same  group.  A  man,  set.  53,  had  a  large 
diphtheritic  patch  on  the  left  half  of  the  pharynx,  and  became 
very  ill.  A  week  after  he  was  first  seen  a  large  swelling 
appeared  under  the  sterno-mastoid  muscle  on  the  same  side, 
and  at  the  same  time  the  corresponding  eye  began  to  swell 
and  project.  Dr.  Heyl  was  called  in  two  days  after  these 
symptoms  began,  and  found  marked  proptosis  of  the  left  eye, 
with  chemosis  and  congestion,  the  pupils  small,  slight  indis- 
tinctness of  the  margin  of  the  disc,  but  neither  then  nor 
subsequently  any  decided  changes ;  but  after  recovery  there 
was  some  defect  of  sight.  There  was  a  brawny  swelling 
under  the  sterno-mastoid,  "  evidently  due  to  the  enlarged 
lymphatic  glands,"  and  the  patient  was  in  a  typhoid  condition. 
The  orbital  symptoms  quickly  subsided,  lasting  only  a  week 
altogether,  and  he  made  a  good  recovery  ;  in  the  absence  of  any 
further  statement  as  to  the  swelling  in  the  neck  we  may 
probably  assume  that  it  also  disappeared  without  suppuration. 

Heyl  thinks  that  in  this  case  inflammation  extended  from 
the  diphtheritic  ulcer  to  the  deep  lymphatics  of  the  neck,  and 
thence  to  the  great  orbital  lymph-space  or  capsule  of  Tenon, 
which  has  been  demonstrated  by  injections  to  be  connected 
with  the  deep  cervical  lymphatics. 

In  connection  with  his  own  case,  Heyl  quotes  a  case  by 
Imre  (f  Klin.  Monatsbl.,'  June,  1876),  in  which  acute  non- 
suppurative inflammation,  beginning  in  the  orbit,  spread  to  the 
whole  side  of  the  face  and  temple,  as  a  typical  erysipelas. 
The  orbital  inflammation  was  considered  as  most  likely  a 
"  tenonitis."      It  may  be  contrasted  with  the  following  : 


Orbital  Cellulitis.  17 

Case  6. — Severe  phlegmonous  orbital  cellulitis  spreading  from  a 
swelling  under  the  lower  jaw ;  anesthesia  and  destructive 
ulceration  of  cornea ;  history  of  severe  traumatic  ecchy- 
mosis  of  same  eye  three  months  before ;   ?  renal  disease. 

James  C — ,  a  short,  puffy-looking  costermonger,  set.  44, 
struck  himself  a  severe  blow  on  or  about  the  left  eye  by 
running  against  the  corner  of  a  door.  He  stated  that  the 
eye  was  "  very  black/'  and  remained  much  swollen  for  some 
time.  Nothing  further  seems  to  have  happened  for  three 
months,  when,  without  any  apparent  cause,  swelling  came  on 
under  the  lower  jaw  on  the  same  (left)  side,  and  quickly 
spread  upwards.  This  swelling  began  on  a  Monday  evening 
(in  October,  1878),  and  by  the  evening  of  the  next  Wednesday 
had  reached  the  eyelids,  so  that  he  could  not  open  them. 
The  next  afternoon  (Thursday)  Mr.  Clutton  brought  him  to 
me.  There  was  brawny,  dusky  red  swelling  of  the  eyelids, 
chiefly  of  the  lower  eyelid,  and  at  one  part  of  the  latter  I 
thought,  and  I  believe  Mr.  Clutton  agreed,  that  distinct 
fluctuation  was  obtained.  There  was  chemosis,  with  decided 
protrusion  of  the  globe,  and  some  limitation  of  its  movements. 
I  have  no  note  of  the  sight  or  pupil,  and  did  not  make  an 
ophthalmoscopic  examination.  A  free  incision  was  made  into 
the  most  prominent  part  of  the  lower  lid,  but  no  more  than  a 
little  shreddy  discharge  came  away,  either  at  the  time  or  on 
subsequently  deepening  the  wound.  A  drainage  tube  was 
inserted,  but  without  effect,  and  the  general  swelling  did  not 
at  all  quickly  subside.  Two  or  three  days  after  the  incision 
was  made,  i.e.  about  six  days  after  the  attack  began,  the 
cornea  had  become  anaesthetic,  and  soon  afterwards  it 
ulcerated,  and  was  almost  completely  destroyed.  He 
remained  in  the  hospital  for  six  weeks,  and  on  leaving  it  he 
was  suffering  from  much  oedema  of  the  legs.  There  are  no 
notes  as  to  the  urine  or  as  to  the  physical  signs.  The  tem- 
perature was  only  once  as  high  as  101*6  . 


VOL.  XI. 


ON  TOPICAL  APPLICATIONS 


CERVIX   UTERI   DURING   PREGNANCY. 


By  HENEY  GEEVIS,  M.D. 


The  question  has  not  infrequently  been  raised  as  to  the  pro- 
priety of  making  topical  applications  to  the  cervix  uteri  during 
pregnancy ;  and  in  the  following  brief  remarks  I  propose  to 
refer  to  some  cases  in  which  such  applications  are  not  only  per- 
missible but  advantageous.  Of  chronic  endometritis  it  is  well 
known  sterility  is  a  not  uncommon  result ;  the  unhealthy  con- 
dition of  the  uterine  mucous  membrane  and  the  general  uterine 
hypersemia  occasioning  difficulty  in  the  fixation  of  the  ovum. 
And  where  the  endometrium  is  not  so  seriously  affected  as  to 
prevent  impregnation  but  is  yet  the  seat  of  a  certain  amount  of 
chronic  inflammation  early  miscarriage  is  very  apt  to  cccur. 
Endometritis,  indeed,  both  corporeal  and  cervical  shares  with 
flexions  the  chief  responsibility  in  the  production  of  early  abor- 
tions. And  I  am  not  sure  but  that  in  cases  of  abortion  said  to 
be  due  to  flexion  it  is  not  the  associated  endometritis  which  is 
the  most  active  predisposing  cause  of  the  abortion.  If,  there- 
fore, a  patient  come  with  a  history  either  of  sterility,  or  repeated 
abortions,  and  we  find  on  examination  the  usual  symptoms  of 
endometritis  obviously  it  is  our  duty  to  get  the  uterus  into  a 


20  On  Topical  Applications  to  the 

healthy  condition  both  with  respect  to  its  capacity  to  permit  and 
to  retain  a  conception.  But  suppose  a  patient  comes  who  is 
already  pregnant,  but  with  a  history  of  having  had  previous 
abortions — and  I  have  known  in  individual  cases  as  many  as 
fifteen  due  to  this  cause — and  on  investigation  we  find  a  more  or 
less  patulous  os,  its  lips  the  seat  of  granular  erosion,  with  muco- 
pus  issuing  from  the  interior  of  the  cervix,  and  more  or  fewer  of 
the  usually  associated  conditions  of  endometritis  such  as  uterine 
or  ovarian  tenderness  and  general  pelvic  discomfort,  I  believe  that 
much  may  be  done  to  improve  the  condition  of  the  uterus,  and  so 
lessen  and  in  many  cases  altogether  prevent  the  risk  of  abortion. 
Indeed,  I  have  known  this  result  to  be  obtained  in  numerous 
cases.  The  usual  local  treatment  of  chronic  endometritis  con- 
sists in  the  application  to  the  uterine  interior,  at  certain  inter- 
vals according  to  the  conditions  of  the  case  and  the  nature  of 
the  solution  used,  of  various  solid  and  fluid  substances  such  as 
nitrate  of  silver  in  stick  or  solution,  tincture  of  iodine,  gly- 
cerine of  carbolic  acid  of  varying  strength,  nitric  acid,  and  the 
acid  nitrate  of  mercury.  And  all  of  these  but  the  two  last  I 
have  used  in  different  cases  of  endocervicitis  in  pregnant  women 
with  marked  advantage,  but  of  course  with  this  distinct  limita- 
tion that  in  no  case  is  the  application  to  be  carried  quite  up  to, 
and  a  fortiori,  not  through  the  inner  os,  or  otherwise  the  very 
occurrence  we  are  anxious  to  prevent  is  likely  to  be  provoked. 
But  it  may  be  asked  how  can  applications  to  the  interior  of  the 
cervix  even  if  they  improve  its  condition,  lessen  a  tendency  to 
abortion  which  depends  mainly  on  the  condition  of  the  endo- 
metrium itself.  I  apprehend  the  explanation  is  at  least  two- 
fold. Just  as  there  is  a  tendency  for  disease  to  spread  by 
continuity  of  tissue  so  is  it  the  case  with  returning  health.  The 
improved  condition  of  the  cervix  promotes  and  carries  with  it 
an  improved  condition  of  the  uterine  tissues  generally.  And 
secondly,  the  cervix  has  well  known  reflex  relations  with  the 
uterus  itself,  and  by  promoting  a  healthy  condition  of  the  cervix: 
an  important  source  of  reflex  uterine  irritation  is  removed.  In 
ordinary  endometritis  we  usually  make  about  three  applications 
at  intervals  of  a  few  days,  after  each  period,  the  intervals  being 
longer  or  shorter  according  to  the  strength  of  the  application 
used,  leaving  at  least  a  clear  week  before  a  period  without 
applications.     But  in  the  endocervicitis  of  pregnancy  the  break 


Cervix  Uteri  during  Pregnancy.  21 

in  the  treatment  necessitated  by  the  recurrence  of  the  cata- 
menia  does  not  occur,  and  the  applications   may   be   steadily 
continued  until  the  object  is  attained.     The  applications   are 
made  in  the  ordinary  way  with  the  patient  in  the  lateral  position, 
through  a  bivalve  or  tubular  speculum,  and  by  a  modification  of 
Playfair's  probe  armed  with  a  film  of  cotton  wool  dipped  in  the 
solution    selected.     In  addition  to    the  tendency  to   abortion 
induced  by  chronic  inflammation  of  the  endometrium  there  are 
at  least  two  other  diseases  of  pregnancy  in  which  the  treatment 
of  endocervicitis  when  present  will  relieve  and  often  cure.     The 
first  is  sickness.     Endocervicitis  is  certainly  not  present  in  all 
these  cases,  but  in  all  cases  of  the  sickness  of  pregnancy  a  scien- 
tific treatment  includes  an  examination  of  the  uterus,  and  if 
endocervicitis  be  present,  in  the  great  majority  an  amelioration 
of  the  local  malady  is  followed  by  a  diminution  of  the  reflex 
disturbance.     It  is  now  known  also  that  if  there  be  sickness 
connected  with  anteflexion  of  the  gravid  uterus,  the  irritation 
due  to  tissue  compression  and  in  sequence  the  sickness  may  be 
relieved  by  careful  dilatation  even  of  the  inner  os,  and  that  with- 
out inducing  premature  uterine  action.     I  mention  this  merely 
by  the  way  as  an  illustration  not  only  of  the  dependence  of 
sickness  in  some  cases  upon  some  pathological  condition  of  the 
cervix  but  of  the  advantage  to  be  derived  from  local  treatment. 
The    second    class    of  cases    in    which    the    local    treatment 
of  endocervicitis  during  pregnancy  is  useful  includes  cases  of 
pruritus  accompanied  by  inflammatory  swelling  of  the  labia  and 
of  more  or  less  of  the  vaginal  mucous  membrane.     I  have  seen 
many  such  in  which  the  irritation  was  extreme  and  in  which  an 
area  of  eczematous  inflammation  spread  to  the  inner  surfaces 
of  the  thighs  and  over  the  lower  abdomen ;  in  some  of  which 
every  variety  of  lotion  and  ointment  had  been  used  and  all  sorts 
of  medicine  given,  but  without  any  relief  until  applications  were 
made   to   the  cervix  itself.     And  then  in   proportion  to  the 
improvement  in  the  cervix  occurs  an  improvement  also  in  the 
vulvar  inflammation.     I  may  add  that  this  holds  good  also  in 
many  cases  unconnected  with  pregnancy,  and  that  often  very 
intractable  cases  of  vulvitis  begin  to  improve  when  the  asso- 
ciated endometritis  is  cured.     I  have  also  seen  cases  of  endo- 
cervicitis   during    pregnancy  in  which  there  has  been    much 
abdominal  tenderness  and  pain  on  locomotion,  with  impairment 


22  On  Topical  Applications  to  the  Cervix  Uteri,  fyc. 

of  the  general  health,  loss  of  appetite,  and  tendency  to  palpita- 
tion, in  which  the  improved  condition  of  the  cervix  attained  by 
local  applications  has  been  followed  by  a  subsidence  of  the 
uterine  uneasiness  and  a  general  improvement  of  the  health. 
As  other  illustrations  of  the  impunity  with  which  various 
operations  may  be  performed  on  the  cervix  during  pregnancy,  I 
may  refer  to  the  cases  recorded  of  removal  of  polypi  and  epi- 
theliomatous  outgrowths  without  labour  being  induced.  In 
mentioning  these  four  classes  of  cases,  of  threatened  abortion 
with  or  without  any  history  of  its  previous  actual  occurrence  ; 
of  sickness,  of  pruritus,  and  of  general  uterine  uneasiness  with 
associated  reflex  neurotic  symptoms,  I  wish  merely  to  be  con- 
sidered as  referring  to  cases,  examples  of  which  have  not  infre- 
quently come  under  my  notice,  and  not  as  excluding  from 
treatment  cases  in  which  with  other  symptoms  the  same  local 
condition  is  found  to  exist. 


FURTHER  REMARKS  ON  ANESTHETICS. 


By  S.  OSBOEN,  F.E.C.S., 

CHLOEOFOEMIST    TO    THE    HOSPITAL. 


Being  desirous  of  making  a  few  alterations  to  the  previous 
"  Annotations  on  Anaesthetics,"  published  in  the  '  St.  Thomas's 
Hospital  Reports'  of  1880,  I  wish,  at  the  same  time,  to  add 
some  further  particulars  which  have  since  occurred  to  me. 

The  alterations  which  I  have  to  make  are  neither  important 
nor  numerous,  the  substance  of  what  I  theu  stated  I  still  adhere 
to;  but  finding  that  the  above  paper  has  been  recommended  as 
a  practical  guide  to  house  surgeons,  I  wish  to  make  a  few  addi- 
tional remarks,  due,  in  some  measure,  to  suggestions  made  by 
kind  and  interested  friends,  and  in  part  to  further  experience 
gained  in  the  administration  of  anaesthetics. 

When  ether  is  to  be  given  by  Clover's  portable  regulating 
inhaler,  two  ounces  of  ether — this  amount  being  equal  to  the 
contents  of  the  small  tin  porringer  placed  in  each  box — will  be 
found  sufficient  to  commence  with.  For  if  the  patient  struggle, 
a  larger  amount  will  overflow  and  allow  of  the  liquid  ether  to 
escape  into  the  inhaling  tube.  After  the  lapse  of  ten  to  fifteen 
minutes  the  amount  may  be  replenished  by  another  half  por- 
ringer full,  and  later  on,  if  the  operation  be  a  long  one,  by 


24  Further  Remarks  on  Anaesthetics. 

another  half  porringer ;  but  four  ounces  will  generally  be  found 
sufficient  for  the  longest  operation.  Ether  of  "720  sp.  gr.  is 
better  than  "735  as  it  combines  better  with  chloroform  and  has 
less  tendency  to  produce  hypersemia  of  the  bronchial  passages. 
Four  parts  of  ether  to  one  of  chloroform  is  a  very  useful  com- 
bination for  eye  or  rectal  operation s,  which  require  more  pro- 
found anaesthesia.  An  improvised  inhaler  may  be  well  con- 
trived out  of  an  inverted  soda-water  glass,  in  the  bottom  of 
which  is  placed  a  sponge  covered  by  a  napkin ;  the  latter,  coming 
over  the  rim  of  the  glass,  is  folded  backwards  on  the  outside. 

Clover's  gas  and  ether  inhaler  (Mayer  and  Metzler)  has  be- 
come now  the  favourite  apparatus  for  the  administration  of 
anaesthetics  in  several  of  the  London  hospitals.  Its  mechanism 
being  so  constructed  that  it  lies  in  the  power  of  the  adminis- 
trator to  give  first  nitrous- oxide  gas  alone,  then  a  combination 
of  gas  and  ether,  and  finally  ether  alone. 

The  advantage  of  quieting  a  patient  preparatory  to  the  giving 
of  ether,  by  the  administration  of  a  few  inspirations  of  nitrous- 
oxide  gas  is  so  very  slight,  that  the  usefulness  of  this  inhaler 
is  seriously  counter-balanced  by  the  increased  cost  of  the  instru- 
ment and  its  greater  cumbersomeness,  compared  with  Clover's 
portable  regulating  inhaler.  Another  advantage  stated  in  its 
favour  is  that  no  ether  is  wasted,  it  being  unnecessary  to 
empty  the  cylinder  after  each  operation,  but  only  to  close  the 
stop-cock.  But  comparing  the  small  amount  of  ether  now 
required  by  either  of  Clover's  inhalers  in  comparison  to  the 
large  amount  wasted  by  the  use  of  other  apparatus,  this  need 
hardly  be  mentioned,  and  taking  into  consideration  the  cost  of 
nitrous-oxide  gas,  the  expense  of  the  administration  far  exceeds 
the  saving  in  ether.  Another  point  in  favour  of  the  portable 
inhaler  is  the  larger  graduated  scale  for  the  regulation  of  the 
volume  of  ether  to  be  administered. 

An  objection  I  have  heard  raised  against  Clover's  apparatus 
is,  that  there  is  necessarily  a  certain  amount  of  carbonic  acid 
poisoning.  Such  is  undoubtedly  the  case,  but  the  success  of 
his  inhalers  is  quite  sufficient  to  override  this  objection. 

Ethidcne  dichloride  I  have  no  experience  of.  The  variabilitv 
of  its  composition  is  the  great  objection  to  its  use,  and  it  is  on 
this  account  that  I  prefer  to  use  ether, 


Further  Remarks  on  Anesthetics.  25 

Protoxide  of  nitrogen,  or  nitrous  oxide,  or  laughing  gas 
(Messrs.  G.  Barth  and  Co.),  is  used  principally  for  dental  ope- 
rations, where  the  extraction  of  teeth  and  such  operations  of 
short  duration  can  be  performed  within  a  few  minutes,  for  a 
prolonged  use  of  this  anaesthetic  is  dangerous,  and  therefore 
not  applicable  to  any  operation  of  magnitude,  or  rather  of  long 
duration,  the  two  being  almost  identical. 

Xitrous-oxide  gas  is  given  by  Clover's  combined  inhaler,  which 
I  previously  spoke  of  when  describing  the  inhalation  of  ether. 
One  minute  is  about  the  time  occupied  in  producing  insensi- 
bility with  nitrous-oxide  gas,  or  after  three  stertorous  inspira- 
tions have  taken  place  the  patient  will  be  found  in  a  condition 
fit  for  operation. 

Nitrous-oxide  gas  produces  great  congestion  of  the  vessels  of 
the  face  and  head  generally,  shown  by  the  lividity  of  the  coun- 
tenance, and  also  occasionally  causes  bleeding  from  the  nose  or 
even  haemoptysis.  Therefore,  in  a  case  of  severe  disease  of  the 
arterial  system,  such  being  operated  upon  for  ligature  of  a 
vessel  for  the  cure  of  aneurism,  I  should  not  administer  gas 
prior  to  the  giving  of  ether. 

In  some  patients  where  anaesthetics  have  been  taken  badly 
on  a  former  occasion,  small  doses  of  ether  and  chloroform 
taken  internally  have  been  recommended  with  a  view  of  getting 
the  constitution  accustomed  to  these  drugs. 

When  giving  anaesthetics,  the  head  of  the  patient  should  be 
kept  on  a  level  with  the  body  or  on  a  gradually  inclined  plane, 
not  doubled  forwards  by  too  great  a  number  of  pillows  under 
the  head,  for  by  so  doing  curves  are  made  in  the  windpipe,  but 
let  the  exit  from  the  lungs  to  the  mouth  be  in  one  straight 
line. 

To  know  when  the  patient  is  sufficiently  under  the  influence 
of  any  anaesthetic  for  the  operation  to  commence,  the  conjunc- 
tival surface  should  be  touched  with  the  tip  of  the  finger,  and  if 
no  reflex  action  takes  place,  shown  by  the  contraction  of  the 
orbicularis  palpebrarum  muscle,  a  sufficient  degree  of  insensi- 
bility has  been  produced.  The  corneal  surface  of  conjunctiva 
is  more  sensitive  than  that  covering  the  sclerotic ;  therefore,  if 
the  latter  shows  insensibility  when  touched  the  anaesthesia  will 
be  found  sufficient  for  ordinary  purposes;    insensibility  of  the 


26  Further  Remarks  on  Anesthetics. 

former  being,  of  course,  required  for  operations  upon  the  eye 
itself.  It  must  be  borne  in  mind,  however,  that  the  conjunc- 
tival surface  repeatedly  touched  by  the  finger  eventually  loses 
its  sensibility.  This  fact  must  be  borne  in  mind  by  the  chlo- 
roformist,  and  first  one  eye  and  then  the  other  be  touched,  or  a 
false  impression  that  the  patient  is  thoroughly  anaesthetised 
may  be  conveyed.  Paralysis  affecting  one  side  of  the  body  may 
also  occasion  loss  of  sensibility  of  one  conjunctival  surface. 

Dilatation  of  the  pupils  is  a  sign  of  the  anaesthetic  having 
been  pushed  to  a  sufficient  extent,  and  the  inhaler  should  be 
immediately  removed  from  the  face. 

Maccidity  of  the  limbs  is  no  sign  of  cutaneous  insensibility. 

How  long  does  it  take  to  get  a  patient  under  the  influence  of 
an  ansesthetic? 

Nitrous-oxide  gas  will  produce  insensibility  in  one  minute, 
but  the  effect  being  so  transitory  it  can  only  be  given  for  ope- 
rations which  can  be  completed  in  five  minutes.  Ether  given 
by  any  open  inhaler  will  not  produce  insensibility  under  eight 
or  ten  minutes  ;  when  given  by  Clover's  portable  inhaler,  insen- 
sibility can  be  produced  in  from  three  to  four  minutes,  and 
when  preceded  by  a  few  inhalations  of  nitrous-oxide  gas  in  from 
two  to  three  minutes.  But  if  nitrous  oxide  is  not  used  the 
space  of  time  occupied  in  producing  insensibility  is  the  same  in 
both  of  Clover's  apparatus.  The  time  occtipied,  however,  and 
by  any  apparatus,  is  always  shorter  in  the  warm  weather,  and 
a  longer  time  is  required  for  persons  of  strong  constitution 
or  accustomed  to  much  alcohol.  The  amount  of  the  anses- 
thetic required  varying  in  a  corresponding  degree  to  the  vital 
capacity  of  the  patient. 

Chloroform,  when  used  in  children  and  old  people,  produces 
insensibility  in  about  two  minutes  or  rather  less. 

How  long  may  a  patient  be  kept  continuously  under  the 
influence  of  an  anaesthetic  ? 

Nitrous-oxide  gas,  as  was  previously  mentioned,  can  only  be 
given  for  a  space  of  one  minute,  therefore  ether  or  chloroform 
is  used  when  duration  is  of  consequence,  and  of  the  two  I 
undoubtedly  give  the  preference  to  ether  on  account  of  its  being 
a  vascular  stimulant.     Two  hours  and  fifteen  minutes  is  the 


Further  Remarks  on  Anesthetics.  27 

longest  time  that  I  have  given  ether  continuously,  but  even 
then  after  discontinuing  the  application  of  the  mouth-piece  the 
patient  was,  of  course,  considerably  longer  in  a  state  of  uncon- 
sciousness, although  not  entirely  insensible,  as  shown  by 
touching  the  conjunctiva.  In  cases  where  anaesthesia  is  kept 
up  for  a  long  period,  shock,  partially  due  to  the  ansesthetie  and 
partially  due  to  the  operation,  is  developed  to  a  greater  or  less 
extent,  shown  by  coldness  of  the  surface  of  the  body  and 
extreme  prostration.  This  is  best  combated  by  the  application 
of  a  warm-water  bottle  to  the  cardiac  region,  and  subsequently, 
when  the  operation  is  completed,  by  an  egg-and-brandy  enema. 

Some  peculiarities  occasionally  occur  during  the  adminis- 
tration which  are  interesting  and  should  be  known  to  the 
administrator.  The  inhalation  of  ether  frequently  produces 
exanthematous  patches  on  the  face  and  upper  parts  of  the  body, 
and  I  have  known  a  case  to  be  removed  from  the  operating 
table  under  the  impression  that  the  patient  was  suffering  from 
one  of  the  eruptive  fevers  and  unfit  for  operation.  The  origin 
of  this  phenomenon  is  to  be  found  in  paralysis  of  the  vaso- 
motor nerves  by  the  anaesthetic.  I  should  mention  also  that 
if  any  skin  eruption  is  present  it  is  made  by  the  same  cause 
more  prominent. 

A  false  impression  when  feeling  the  pulse  may  be  very 
easily  conveyed,  as  in  a  case  I  remember  where  the  patient, 
lying  upon  the  arm,  compressed  the  main  artery  and  stopped 
the  pulse  greatly  to  the  consternation  of  the  anaesthetist.  The 
case  was  one  of  removal  of  a  tumour  from  the  right  scapula, 
the  radial  artery  being  abnormally  situated  and  absent  on  the 
right  side ;  the  patient  was  suddenly  brought  over  on  to  the 
left  side  for  the  convenience  of  the  operator,  and  the  left  radial 
was  stopped  by  compression  from  the  weight  of  the  body. 

Elevation  of  the  jaw,  by  pushing  the  angle  of  one  or  both 
sides  forwards,  acts  upon  the  tongue  and  gives  freer  respiration. 
The  converse  also  is  easily  seen,  as  I  have  frequently  demon- 
strated to  the  students,  that  by  pushing  the  lower  jaw  back- 
wards, the  breathing  can  be  immediately  impeded  or  altogether 
arrested.  As  it  is  difficult  to  raise  the  jaw,  both  hands  being 
occupied,  one  holding  the  pulse  and  the  other  the  inhaler,  I 
have  devised  an  underchin  support  which  I  call  jaw  compasses, 


28  Further  Remarks  on  Anesthetics. 

being  of  that  configuration,  for  the  purpose  of  going  behind  the 
angles  of  the  jaw  and  drawing  them  forwards  and  upwards. 
The  administration  by  this  procedure  being  considerably 
assisted.  A  circular  india-rubber  band,  similar  to  that  used 
for  keeping  letters  together,  passed  over  the  nose-piece  of  the 
inhaler  and  under  the  symphisis  of  the  chin,  will  also  answer 
the  same  purpose. 

The  administration  of  anaesthetics  for  cases  to  be  operated 
upon  for  the  cure  of  cleft  palate  are  always  troublesome, 
and  it  is  usually  found  that  chloroform  for  these  cases  is  best. 
Ether  causes  not  only  an  increased  secretion  of  saliva,  but 
also  increased  vascularity,  and  the  mouth  being  wide  open, 
patients  return  to  consciousness  sooner  than  when  chloroform 
is  given.  Another  difficulty  in  these  cases  is  the  insertion  of 
the  mouth-gag,  the  breathing  on  its  insertion  becomes  imme- 
diately impeded  by  the  tongue  being  thrown  backward  at  the 
same  time  as  the  lower  jaw  is  depressed.  A  good  mouth-gag 
is  much  wanted,  its  requirements  being  to  keep  the  mouth 
open,  to  draw  the  tongue  forwards,  and  to  push  the  lower  jaw 
forwards.  The  one  that  most  fully  meets  these  requirements  is 
described  in  the  *  London  Medical  Record '  (April  15th,  1881). 

The  use  of  chloroform  is  necessary  for  all  operations  upon 
the  interior  of  the  mouth  (removal  of  tongue,  &c),  for  the 
same  reasons  as  mentioned  when  speaking  of  cleft  palate. 
When  the  mouth  has  to  be  kept  open  for  some  time,  I  fre- 
quently use  Clover's  chloroform  bellows  manufactured  by 
Messrs.  Coxeter  &  Son,  whereby  a  mixture  of  chloroform  and 
air  is  blown  down  the  back  of  the  throat. 

The  question  whether  anaesthetics  should  be  given  at  all  in 
eye  operations  is  a  debatable  one,  the  vomiting  from  chloro- 
form and  the  vascular  turgescence  from  ether  being  the  objec- 
tions to  their  use.  I  consider  that  anaesthetics  are  always 
necessary  for  ophthalmic  operations  upon  children,  but  never 
for  adults,  except  in  cases  of  enucleation  and  for  operations 
upon  the  eyelids. 

Chloroformists  should  not  administer  anaesthetics  for  too  long 
a  time  at  one  sitting,  for  the  administrator  after  giving  anaes- 
thetics for  two  or  three  hours  consecutively,  becomes  somewhat 
anaesthetised  himself  and  lacks  that  amount  of  vigilance  which 


Further  Remarks  on  Ancesthetics.  29 

he  had  at  the  commencement,  and  ought  to  have  throughout 
the  whole  of  the  administration.  This  is  more  especially  the 
case  when  open  inhalers  are  used.  There  is  in  addition  great 
mental  strain  to  the  administrator  from  the  anxiety  and 
constant  watchfulness  entailed. 

The  element  of  danger  is  more  often  present  in  rectal 
operations.  Why  I  cannot  say  ;  but  undoubtedly  I  have  had 
and  others  also,  more  anxiety  over  the  administration  of 
anaesthetics  in  these  cases.  Whether  it  arises  from  the  fact 
that  all  bloodless  operations  are  dangerous  in  plethoric  indi- 
viduals, or  whether  diseases  of  the  bowel  are  unusually  depres- 
sing, and  that  the  highly  sensitiveness  of  the  rectum  requires  a 
greater  degree  of  anaesthesia,  I  am  not  in  a  position  to  say, 
but  the  fact  remains  the  same. 

In  cases  of  stoppage  of  the  heart's  action,  in  addition  to 
percussion  of  the  heart  with  the  wetted  end  of  a  towel,  artificial 
respiration  must  be  immediately  commenced,  because  the  stop- 
page of  both  factors  would  make  up  the  whole  fatality.  Inversion 
of  the  body  should  be  always  tried  if  stoppage  of  the  heart's 
action  occur.  The  head  being  lowered  and  the  legs  elevated 
the  blood  is  sent  to  the  upper  part  of  the  body  ;  a  similar  effect 
is  produced  but  less  quickly  by  the  application  of  bandages  up 
the  legs.  The  latter  may  be  adopted  with  great  advantage  in 
operation  about  to  be  performed  upon  anaemic  patients. 
Inversion  of  the  body  should  be  maintained  until  the  heart's 
action  is  resumed,  for  success  has  been  found  to  follow  this 
procedure. 

The  post-mortem  appearances  of  fatal  cases  show  that  hepa- 
tisation  of  the  lungs  with  adhesions  to  the  pleural  surface,  or  a 
fatty  heart,  or  one  having  adhesions  to  the  pericardium,  are 
more  especially  antagonistic  to  successful  anaesthesia. 


ON  SOME  CASES 


PAROXYSMAL  PYREXIA  SIMULATING  AGUE. 


By  WILLIAM  M.  OED,  M.D.,  F.E.C.P. 


The  recent  occurrence  in  the.jwards  of  two  cases  of  paroxymal 
pyrexia,  in  one  of  which  ague  was  simulated,  but  in  neither  of 
which  was  it  present,  induces  me  to  record  the  cases  in  the 
Reports,  and  to  compare  them  with  some  others  which  have 
come  under  my  observation. 

The  first  case  must  be  given  at  some  length,  owing  to  the 
great  variety  of  symptoms  and  morbid  conditions  associated 
with  the  supposed  ague. 

J.  J — ,  a  farm  labourer,  residing  at  Southborough,  near 
Bromley,  in  Kent,  was  admitted  into  St.  Thomas's  Hospital, 
under  my  care,  on  the  20th  March,  1880. 

He  was  a  well-made  and  fairly  nourished  man,  strongly 
anasmic,  with  a  faint  yellow  tinge  of  the  skin,  very  prominent 
eyeballs,  and  clear  conjunctivae.  He  had  never  been  abroad  ; 
had,  indeed,  always  lived  in  the  neighbourhood  of  Bromley, 
excepting  that  in  1879  he  stayed  at  Botherfield,  in  Sussex,  for 
six  weeks.  Neither  of  the  districts  mentioned  is,  so  far  as  I 
know,  malarious.  He  stated  that  he  had  always  been  pale ; 
that  he  had  never  had  scarlatina ;  that  he  had  had  rheumatic 
fever  at  the  age  of  seventeen,  without  suffering  subsequently 
from  any  shortness  of  breath;  that  he  had  never  had  syphilis. 

He  had  in   fact  believed  himself  to  be  quite  well  up    to 


32  Paroxysmal  Pyrexia  simulating  Ague. 

Christmas  day  last,  when  he  felt  out  of  sorts.  The  next  day- 
he  was  seized  with  a  "  shivering-fit  "  which  lasted  from  8  p.m. 
to  10  p.m.  and  was  followed  by  heavy  perspiration.  The  fit 
recurred  the  next  night  at  the  same  hour,  and  so  on  daily  for 
a  fortnight.  After  this  be  shivered  every  other  evening ;  later 
on  every  third  day ;  and  sometimes  at  longer  intervals.  The 
last  fit  occurred  on  the  day  before  his  admission.  During  this 
time  his  appetite  remained  fairly  good,  but  he  was  very  thirsty. 
He  supposed  himself  to  be  suffering  from  ague,  which  had, 
however,  resisted  the  ordinary  treatment. 

When  admitted  he  was  not  very  weak,  but  was  breathing 
quickly.  It  was  noticed  that  his  fingers  were  much  clubbed  ;  that 
he  had  a  scar  of  injury  on  the  right  cornea,  and  an  oval  scar,  also 
referred  to  an  injury,  over  the  right  tibia.  There  were  no 
scars  of  chancres  or  buboes.  He  complained  of  pain  in  the 
left  calf,  which  was  slightly  swollen  and  very  tender.  There 
wras  no  inflammation  or  distortion  of  any  joint. 

The  heart  was  distinctly  enlarged,  but  there  was  no  evidence 
of  pericardial  effusion.  There  was  a  marked  presystolic  thrill 
over  the  impulse ;  a  systolic  murmur  at  the  apex,  conducted 
into  the  left  axilla;  and  a  fainter,  apparently  independent, 
systolic  murmur  over  the  aortic  valve  ;  the  arteries  were  every- 
where much  thickened,  and  the  pulsation  of  brachials  and 
radials  was  clearly  visible. 

The  lungs  and  pleurae  were  clear. 

The  liver  was  somewhat,  the  spleen  considerably,  enlarged  ; 
both  organs  were  unduly  firm  to  the  touch,  but  not  tender. 

The  urine  was  of  1015  sp.  gr.,  smoky,  very  albuminous,  and 
contained  free  blood,  with  hyaline,  granular,  and  epithelial 
casts.  The  blood  contained  a  decided  increase  of  white  cor- 
puscles. 

On  the  day  after  admission  his  temperature  was  98°  early  in 
the  morning.  He  began  to  shiver  at  a  little  before  11  a.m., 
and  by  2  p.m.  the  temperature  was  104° ;  he  then  perspired 
freely  and  the  temperature  sank,  somewhat  slowly,  till  at  7.30 
it  stood  at  99-2°. 

The  next  evening  he  was  chilly  at  9,  the  temperature  being 
98*4° ;  at  midnight  the  temperature  was  102'3°,  and  it  remained 
at  that  height  for  some  hours ,  He  began  to  perspire  at  5  a.m. 
and  at  8.10  the  thermometer  did  not  rise  above  99"3°. 


Paroxysmal  Pyrexia  simulating  Ague.  33 

In  this  way  his  temperature  went  on,  rising  after  rigors  and 
falling  with  perspiration,  during  the  whole  time  of  his  stay  in 
hospital,  rather  more  than  five  weeks,  at  the  end  of  which  he 
died. 

During  the  whole  period  the  liver  and  spleen  remained  large, 
and  the  spleen  was  tender  for  one  week  shortly  after  his 
admission.  The  pain  and  tenderness  in  the  left  calf  persisted, 
but  no  hardness  accompanied  the  slight  swelling;  there  was  no 
other  evidence  of  phlebitis,  none  of  suppuration  there  or  else- 
where.    The  urine  continued  always  in  the  same  state. 

But  the  breathing  became  steadily  worse,  and  he  had  pain  in 
the  region  of  the  heart  about  ten  days  after  admission. 
The  pericardium  then  became  distended  and  friction  was  dis- 
tinctly heard  over  the  front  of  the  right  ventricle.  A  tricuspid 
murmur  also  came  into  play,  and  the  second  sound  of  the 
heart  became  excessively  accentuated  over  the  pulmonary 
artery.  No  effusion  could  be  detected  in  the  pleura,  but 
signs  of  oedema  of  the  lungs  appeared  and  increased  from  day 
to  day.  The  pericardial  friction  was  not  heard  after  a  few 
days,  and  the  amount  of  pericardial  effusion  varied  a  good  deal, 
though  the  marks  of  it  were  always  present.  The  tricuspid 
murmur  became  more  and  more  distinct,  and  pulsation  of  the 
veins  of  the  neck,  not  at  first  perceptible,  was  plainly  seen  by 
several  observers  four  days  before  his  death.  Vomiting  occurred 
on  the  day  of  his  admission,  the  ejecta  being  tinged  with 
blood.  It  recurred  the  day  before  death.  He  was  troubled 
with  diarrhoea  for  a  few  days,  but  the  stools  had  nothing  of  a 
typhoid  character. 

At  the  post-mortem  examination  the  following  lesions  were 
found  : 

1.  Pericardial  effusion  (15  oz.),  with  no  deposit  of  lymph  in 
heart  or  pericardium. 

2.  Dilatation  of  both  ventricles  with  hypertrophy  of  the  left. 

3.  The  posterior  set  of  chordse  tendinese  of  the  mitral  valve 
were  ruptured,  their  ends  clubbed,  and  covered  by  dark  clot. 
The  endocardium  showed  a  white  tract  where  the  free  ends 
would  have  played  against  it.  The  rest  of  the  valve  was 
natural.  There  was  no  effusion  in  pleurae ;  nothing  but  con- 
gestion and  oedema  in  the  lungs. 

4.  The  liver  was  large,  but  not  obviously  diseased. 
VOL.  xi,  3 


34  Paroxysmal  Pyrexia  simulating  Ague. 

5.  The  spleen  was  large,  much  congested,  and  friable  ;  there 
was  an  old  infarct  of  considerable  size  near  its  lower  border. 

6.  The  kidneys  were  large  and  pale  on  section,  being  good 
specimens  of  the  large  white  kidney  of  chronic  Bright's  disease. 

7.  The  stomach  and  intestines  were  healthy. 

8.  The  joints  were  healthy.  No  lesion  could  be  discovered 
in  the  left  calf ;  no  suppurations  or  embolisms  were  found  any- 
where save  what  was  noted  in  the  spleen. 

When  the  patient  was  admitted  the  diagnosis  appeared  to  lie 
between  ague,  suppurative  phlebitis,  pyaemia,  and  ulcerative 
endocarditis.  There  were  certainly  no  signs  of  enteric  or  of 
relapsing  fever,  none  of  tuberculosis  or  lymphadenoma,  none 
of  syphilis,  none  of  obstructions  in  the  urinary  or  biliary 
tracts. 

From  his  previous  history  ague  was  not  indicated,  but  there 
being  enlargement  of  the  spleen,  quinine  was  freely  administered 
for  a  fortnight.  At  the  end  of  that  time  the  pyrexia  was 
unchecked  and  new  symptoms  had  appeared. 

The  most  careful  examination  of  the  left  calf  and  of  the  body 
generally  failed  to  detect  any  sign  of  suppuration.  But  this 
could  not  be  held  decisive  at  first,  and.  it  was  not  possible  to 
the  last  to  exclude  this  cause  or  pyaemia,  particularly  in  face  of 
the  state  of  the  urine.  But  the  steady  development  of  new 
mischief  in  and  about  the  heart  pointed  more  and  more  to  the 
probability  of  the  existence  of  ulcerative  endocarditis.  Iodide 
of  potassium  was  given  for  ten  days  without  effect,  and  subse- 
quently salicylate  of  soda  proved  equally  useless. 

When  the  post-mortem  examination  had  enabled  us  to  see 
what  lesion  existed,  it  was  still  not  by  any  means  certain  what 
was  the  cause  of  the  intermitting  pyrexia.  On  the  whole,  I 
refer  it  to  the  state  of  the  mitral  valve  setting  up  from  time  to 
time  excitement  in  the  heart  and,  through  the  heart,  in  the 
nervous  system. 

The  next  case  to  which  I  will  refer  is  that  of  J.  B — ,  a  rail- 
way guard,  aged  fifty-nine,  under  my  care  in  St.  Thomas's 
Hospital  in  May  and  June  last. 

He  had  been  a  railway  guard  for  thirty  years,  and  had  never 
been  out  of  England  or  lived  in  malarious  districts.  Formerly 
he  drank  rather  heavily,  but  for  four  years  had  been  perfectly 
temperate. 


Paroxysmal  Pyrexia  simulating  Ague.  35 

One  evening,  eight  months  ago,  he  was  seized  with  pain  in 
the  belly,  which  became  more  severe  the  next  day.  On  the 
third  day  he  became  deeply  jaundiced,  and  has  been  so  ever 
since.  He  vomited  a  great  deal  during  the  attack,  and  when 
he  became  yellow  he  found  his  motions  "become  pale.  A  day 
or  two  later  the  motions  resumed  their  natural  colour,  and  the 
tint  of  his  jaundice  became  paler.  He  had  subsequently  many 
attacks  of  a  like  kind,  but  after  a  time  they  changed  in  cha- 
racter, shivering  and  sweating  taking  the  place  of  the  severe 
pain. 

When  admitted  he  was  jaundiced,  and  had  much  itching  over 
the  whole  body.  The  liver  was  much  enlarged,  but  was 
neither  painful  nor  tender ;  there  was  no  enlargement  of  the 
spleen  or  tenderness  in  the  splenic  region.  The  tongue  was 
covered  with  a  white  fur,  the  bowels  rather  confined,  and  the 
motions  at  present  were  of  a  rather  pale  brown  colour.  The 
temperature  was  normal,  and  no  disease  or  change  in  other 
viscera  than  the  liver  could  be  detected. 

On  the  eighth  day  after  his  admission  he  was  seized  with 
shivering,  vomiting,  and  a  little  pain  in  the  right  side.  After 
the  shivering  he  became  hot  and  perspired  freely,  and  the  tem- 
perature rose  from  98-7°  to  101'4°.  He  was  deeply  jaundiced 
next  day ;  the  urine  was  loaded  with  bile  pigment  and,  what  is 
in  my  experience  a  very  rare  occurrence,  gave  a  marked  reaction 
with  the  test  for  bile  acids ;  the  motions  were  pale,  but  the 
temperature  became  natural.  Eight  days  later  he  had  pain  in  the 
epigastrium  and  heavy  perspiration,  without  shivering  or  sick- 
ness; the  temperature  rose  to  101  •4°,  and  he  was  more  yellow 
next  day.  Eight  days  was  in  his  opinion  his  regular  period  of 
intermission,  but  he  now  went  on  for  twelve  days  without  an 
attack.  The  next  attack  was  less  severe  than  the  preceding, 
being  attended  by  neither  rigor  nor  vomiting,  and  the  tempe- 
rature reaching  only  100#6°.  He  remained  in  hospital  three 
weeks  longer,  and  had  no  more  attacks.  During  the  whole  of 
his  stay  the  motions  were  regularly  sifted  for  gall-stones  but 
none  were  found.  The  symptoms  from  the  first  pointed 
clearly  to  the  existence  of  gall-stones,  probably  impacted,  either 
sticking  in  the  vesical  duct  or  not  completely  blocking  the 
common  duct ;  with  this  there  was  abundant  evidence  of  gastro- 
duodenal  irritation.     The  treatment  was  therefore  directed  to 


36  Paroxysmal  Pyrexia  simulating  Ague. 

the  digestive  organs.  For  the  relief  of  his  constipation  he  had 
at  first  pills  of  ox-gall  and  aloes,  which  acted  very  well.  Sub- 
sequently he  took  a  drachm  of  sulphate  of  soda,  and  ten  grains 
of  the  bicarbonate  in  hot  water  twice  a  day  for  three  weeks. 
He  was  carefully  dieted,  at  first  on  milk  and  broths,  then  on 
soft  solids,  and  at  the  end  of  a  month  was  able  to  take  meat 
without  inconvenience.  He  went  out  much  improved  in 
strength,  and  having  gained  slightly  in  weight. 

The  third  case  is  that  of  a  lady,  aged  fifty-eight,  who  had 
passed  most  of  her  life  in  the  Mauritius.  After  being  free 
from  any  kind  of  malarious  illness  during  her  residence  in  that 
island  she  came  to  England,  and  before  long  began  to  suffer 
from  what  was  called  "  fever  and  ague."  She  used  to  have 
shiverings,  heats,  and  sweatings  at  irregular  intervals.  At  first 
these  were  unaccompanied  by  pain,  but  presently  a  pain 
increasingly  severe  and  attended  with  vomiting  was  felt  in  the 
left  iliac  region.  The  seizures  continued  for  months,  and  were 
regarded  as  an  outbreak  of  ague  latent  during  her  residence 
abroad.  Quinine  and  arsenic  were  poured  in  without  avail, 
till  one  day,  after  a  paroxysm  of  extraordinary  severity,  she 
passed  a  stone  the  size  of  a  bean  from  the  bladder.  Instant 
relief  followed,  and  six  months  have  since  passed  away  without 
any  return  of  fever  or  sweating. 

Lastly,  I  will  relate  shortly  a  history  which  has  interested 
me  very  deeply.  A  gentleman,  of  the  age  of  thirty,  who  had 
never  lived  in  the  tropics,  suffered  from  daily  attacks  of  high 
temperature  with  shivering  and  sweating.  I  was  called  to  see 
him,  and  found  a  sallow,  worn,  emaciated  man,  with  some 
enlargement  of  liver,  none  of  spleen,  no  indications  of  disease 
in  other  viscera,  with  marked  traces  of  severe  primary,  and  a 
history  of  secondary,  syphilis.  On  careful  examination  I  could 
not  satisfy  myself  that  he  was  suffering  from  malarious  fever, 
and  set  to  watch  him  in  order  to  find  out  if  there  were  any 
local  source  of  mischief — an  abscess  or  the  like.  Meanwhile 
he  took  quinine  in  large  doses,  and  the  fever  was  much 
reduced,  but  only  for  a  time.  The  temperature,  at  first  checked, 
rose  again,  and  the  whole  symptoms  were  in  process  of  full 
development,  when  Sir  William  Jenner,  who  replaced  me  in 
consultation,  suggested  that  the  syphilis  might  be  the  cause,  and 
advised  a  trial  of  iodide  of  potassium.     Thirty   grains  were 


Paroxysmal  Pyrexia  simulating  Ague.  37 

given  daily,  and  after  two  days  of  this  treatment  the  tempe- 
rature fell  and  the  rigors,  &c,  ceased.  So  far  as  I  know  they 
have  not  returned. 

Here,  then,  we  have  four  cases  of  paroxysmal  pyrexia  in  which 
malarial  poison  was  to  all  appearance  not  present,  in  which,  on 
the  contrary,  four  several  and  distinct  causes  of  the  phenomenon 
were  indicated.  The  necessity  of  diagnosing  the  cause  of  a 
paroxysmal  pyrexia  may  not  occur  very  often,  but  judging 
from  my  own  experience  it  falls  to  most  of  us  at  long  inter- 
vals. It  is  clear  that  our  treatment  can  only  be  effective  when 
our  diagnosis  is  correct.  The  four  causes  illustrated  by  my 
cases  are  far  from  being  the  only  possible  causes  besides  ague, 
which  have  to  be  considered  in  arriving  at  a  diagnosis.  The 
late  Dr.  Murchison,  in  one  of  his  last  published  clinical  lectures, 
enumerated  as  many  as  twelve  possible  causes,  namely  : 

1.  True  ague. 

2.  Enteric  fever. 

3.  Relapsing  fever. 

4.  Pysemia. 

5.  Pent-up  pus. 

6.  Ulcerative  endocarditis. 

7.  Tubercular  fever. 

8.  Lymphadenoma. 

9.  Syphilitic  fever. 

10.  Urinary  intermitting  fever. 

11.  Hepatic  intermitting  fever. 

12.  Morphia. 

We  cannot  now  consider  these  in  detail,  but  we  may  well 
recognise  and  bear  in  mind,  when  we  have  what  is  called  irre- 
gular ague  brought  to  us  for  treatment,  the  possibility  of  the 
case  not  being  ague  at  all  but  of  one  of  the  other  eleven.  For 
instance,  we  shall  be  careful  to  search  for  signs  of  abscess  in  all 
and  every  part  of  the  body,  to  examine  the  heart  for  indications 
of  the  state  of  the  valves,  the  lungs  for  indications  of  tubercle, 
the  genitals  for  indications  of  syphilis.  Even  where  there  is  a 
strong  primary  probability  of  the  presence  of  malaria,  as  in  the 
third  of  my  cases,  it  is  quite  possible  that  some  other  agent 
may  bear  the  actual  guilt.  Two  years  ago  I  witnessed  the  case 
of  a  distinguished  Indian  officer  who  had  intermitting  pyrexia, 
first  attributed  to  malaria,  next  to  hepatic  abscess,  and  at  last 


38  Paroxysmal  Pyrexia  simulating  Ague. 

proved  to  be  attributable  to  neither  of  them,  but  simply  to 
impacted  biliary  calculus. 


Details  of  Cases  1  and  2. 

Case  1. — Ulcerative  endocarditis. 

Jasper  J — ,  set.  23,  farm  labourer.  Admitted  20th  March;  died 
27th  April. 

Family  history. — Father  alive  and  healthy ;  mother  alive,  but  ill  of 
heart  disease.  They  have  had  fourteen  children :  six  alive,  the  rest  died 
young. 

Previous  history. — Has  always  been  pale.  Never  strong  framed. 
Had  rheumatic  fever  when  17  ;  has  not  had  dyspnoea  since ;  never  bad 
coughs.  Never  abroad ;  always  lived  in  Kent,  except  in  1879,  when  he 
went  to  Rotherfield,  in  Sussex,  and  stayed  six  weeks. 

Present  illness. — Quite  well  up  to  Christmas  Day,  1879.  The  next 
day  was  out  walking,  and  before  he  came  home  he  had  a  shivei'ing  fit, 
lasting  from  8  p.m  to  10  p.m.  When  he  got  home  he  went  to  bed  and 
perspired  a  deal ;  slept  fairly  ;  got  up  next  morning  and  went  to  work, 
but  returned  home  about  five  o'clock  because  he  felt  ill ;  went  to 
bed,  and  again  shivered  and  sweated.  After  this  he  gave  up  work 
and  remained  at  home,  not  keeping  to  his  bed,  but  going  out  of  doors 
occasionally.  During  the  next  two  weeks  he  shivered  every  evening 
between  eight  and  nine  o'clock ;  he  perspired  some  time  afterwards 
and  also  in  the  morning.  At  the  end  of  a  fortnight  he  shivered  on 
alternate  evenings  only ;  he  always  perspired  afterwards  and  passed 
much  water.  He  never  felt  hot  after  the  fits  of  shivering,  but  felt 
very  cold  at  the  beginning;  nothing  could  make  him  warm,  though  he 
remained  in  front  of  the  fire.  At  the  end  of  a  month  he  had  attacks  at 
intervals  of  three  days,  and  sometimes  of  a  week.  The  last  he  had  was 
on  Saturday  Mai'ch  19th.  All  this  time  his  appetite  was  fair,  but  he 
was  very  thirsty. 

State  on  admission. — Lips  ansemic.  Clubbing  of  fingers.  Waxy  appear- 
ance of  skin.  Scar  on  right  cornea,  with  cataract,  resulting  from  injury. 
He  complains  of  "  ague  fits  "  and  pain  in  left  calf.  No  oedema  of  ankles. 
No  distortion  of  metatarso-phalangeal  joints.  One  oval  scar  on  front 
of  right  tibia,  said  to  be  from  injury.  Left  calf  tender.  Chest  well 
formed.  Respiratory  movements  sluggish.  Comparative  dulness  at 
left  apex ;  vocal  resonance  equal  to  right.  A  little  pulsation  in  epi- 
gastrium. 

Heart.—  Apex  5—6  ribs,  two  inches  below  nipple,  just  outside 


Paroxysmal  Pyrexia  simulating  Ague.  3') 

its  vertical  line ;  dulness  extends  four  inches  from  mid- sternal  line  ; 
slight  presystolic  thrill.  Systolic  murmur  at  apex,  propagated 
into  axilla.  Faint  but  independent  systolic  murmur  at  base; 
over  pulmonic  area,  second  sound  very  loud  and  reduplicated. 
Arteries  thick,  visible  pulsation  in  arms. 
Liver. — Sixth  rib  to  one  inch  below  arch  in  nipple  line. 
Spleen. — Dulness  from  four  inches  above  costal  margin  to  one 
and  a  half  below. 

Tongue. — Thin  yellow  fur ;  moist ;  pale. 

No  vomiting  except  on  admission,  when  he  brought  up  blood. 
Bowels  regular.     No  headache.     Sleeps  badly. 

Urine. — 1015  ;  smoky ;  free  blood ;  hyaline,  granular,  and  epi- 
thelial casts.  Some  epithelium  from  pelvis  of  kidney.  Slight  indigo 
reaction. 

Blood  contains  some  increase  of  leucocytes — about  thirty  in  the 
quarter  of  an  inch  field. 
March  23rd. — About  the  same.  No  feeling  of  chilliness.  No  shiver- 
ing. Appetite  good.  No  pain  in  calf  when  he  got  out  of  bed  to  be 
weighed.  No  pain  or  tenderness  in  any  joint.  Temp,  at  2  a.m.  lOS^0, 
at  8  a.m.  98-6°,  at  1030  a.m.  99'5°.  Weight  9 st.  SJlbs.  No  pain  any- 
where. Tongue  somewhat  furred.  Perspired  yesterday  about  6  p.m. 
Pulse  102,  regular.     Urine  1015,  albumen,  blood,  few  casts. 

24th. — No  pain  in  any  joint.  Sounds  over  heart's  base  very  rough 
on  left  of  sternum,  rather  increased  by  pressure.  No  friction  over  lung 
bases. 

25th. — Feels  better ;  no  pain ;  appetite  good.  No  more  attacks  of 
shivering.  Temp,  last  night  100-5°.  Perspired  yesterday  evening. 
Heart's  dulness  up  to  second  space ;  no  fulness  in  knees ;  no  pleural 
effusion. 

26th. — Dulness  down  again  to  lower  border  of  3rd  left  costal  cartilage. 
No  effusion  in  pleura  or  joints,  Still  roughness  of  sounds  over  pul- 
monic area,  independent  of  murmur  at  apex,  which  is  heard  very  dis- 
tinctly over  left  back. 

27th. — Complains  of  pain  in  region  of  heart  and  palpitation,  also  in 
situation  of  lower  edge  of  spleen ;  no  tendeimess.  Over  heart  base  is  a 
harsh  friction  murmur.  No  pain  nor  swelling  in  any  joint.  No 
effusion  of  pleura. 

29th. — Slight  thrill  over  base  of  heart,  independent  of  that  at  apex. 
Dulness  up  to  second  space.  Friction  less  pronounced,  but  still 
present.  No  effusion  in  knees  or  pain  in  any  joints.  Some  friction 
over  left  lung  with  feeble  breath  sounds. 

30th. — Over  lower  half  of  left  lung,  at  end  of  inspiration,  is  a 
clicking  crepitation  sound,  with  vocal  fremitus  and  resonance  increased 
in  this  situation.  Heart  dulness  down  to  third  rib.  No  effusion  in 
joints. 


40  Paroxysmal  Pyrexia  simulating  Ague. 

31st. — Some  dulness  in  second  space.  Yocal  resonance  more  in- 
creased in  left  base.  Pulse  132.  Respirations  40.  Shivered  this 
morning. 

April  1st. — Severe  fit  of  shivering  this  morning  from  seven  to  nine, 
not  followed  by  any  sweating.  Spleen  harder ;  not  so  large ;  not 
tender.  No  effusion  in  joints ;  feels  better  on  the  whole.  Temp, 
during  rigor  101°. 

2nd. — Chill  this  morning,  but  no  distinct  rigor ;  feels  very  hot ;  passes 
much  water  after  chills.  Cardiac  dulness  up  to  third  rib.  No 
tenderness  over  spleen  or  liver.     Bowels  open. 

3rd.— No  chill. 

4th.— Slight  chill. 

5th. — Slight  chill  this  morning ;  feels  much  better ;  no  effusion  nor 
tenderness. 

6th. — Feels  much  better.  Not  so  thirsty.  Slight  chill  this  morning. 
Urine  1015,  small  amount  of  albumen. 

7th. — Yery  slight  chill.     Perspired  very  freely  during  night. 

8th. — Fit  of  shivering  this  morning,  lasting  half  an  hour.  Urine, 
sp.  gr.  1013,  some  albumen;  3pts.  11  oz.  passed  in  twenty-four  hours. 

9th. — Rigor  commenced  at  6  a.m.;  continuing  to  10  a.m.,  though 
not  so  severe  as  at  first.  Has  had  great  sensation  of  cold  and 
"  creeping  "  since  attack  commenced.  Perspiration  not  so  profuse  as 
usual.  Towards  lower  end  of  sternum,  over  region  of  tricuspid  valve, 
is  a  murmur  distinct  in  character  from  that  at  apex.  It  is  musical, 
and  occasionally  tbere  is  a  distinct  second  element  or  flap.  No  venous 
pulsation  detected.  Not  examined  posteriorly  on  account  of  his 
sweating. 

10th. — Feels  rather  better.  No  shivering  or  perspiration.  Throat 
sore.  More  cough,  with  considerable  expectoration.  Urine  2  pts.  13  oz. 
Mai-ked  presystolic  thrill  at  apex ;  there  is  also  a  pericardial  rub, 
heard  loudest  at  base,  but  also  propagated  down  sternum,  and  in- 
creased on  pressure.  The  mitral  murmur  is  distinctly  heard  poste- 
riorly in  a  line  with  vertebral  column. 

13th. — Says  he  cannot  sleep  well  owing  to  troublesome  cough.  No 
shivering ;  no  perspiration ;  sputa  less  livid,  more  frothy ;  less  tinged 
than  before. 

14tb. — Pain  in  cardiac  region ;  cough  more  troublesome ;  sputa 
frothy,  viscid,  and  tinged  with  blood.  Pain  in  knee-joints.  No  swelling 
or  redness  about  joints. 

15th. — Feels  better.  No  shivering;  no  perspiration.  Cough  less 
troublesome.     Sputa  less  viscid.     No  pain  in  knee-joints. 

19th. — Diarrhoea;  bowels  open  three  times  in  the  night  and  twice 
yesterday.     Complains  of  pain  on  the  inner  side  of  both  knee-joints. 

22nd. — Feels  better.  Bowels  moved  once  during  the  night.  No 
pain  in  knee-joints,    Sputa  watery,  partly  muco-purulent. 


Paroxysmal  Pyrexia  simulating  Ague.  41 

23rd. — Shivered  during  the  night;  also  profuse  sweating.  Temp, 
rose  with  the  shivering  to  101'4°.     Slight  pain  in  knee-joints. 

24th. — No  pain  in  knee-joints.  Distinct  pulsation  in  jugular 
veins.  Systolic  murmur  heard  very  distinctly  over  tricuspid  valve, 
as  well  as  at  apex.     Has  vomited  this  morning. 

27th. — Yomited  last  night.  Very  restless.  Bowels  moved  once 
during  the  night,  twice  this  morning.  No  pain  in  knee-joints.  Had 
no  shivering  nor  perspiration.     Appetite  bad.     Feels  very  weak. 

28th.— Died  at  6  a.m. 

Post-mortem. — Right  lung  2*5;  left  lung  l'lf ;  heart  1*1;  liver  4*14; 
kidneys  13;  spleen  1*1;  brain  3*1.  Body  well  nourished.  Skin  very 
pale.     Eyeballs  prominent.     Rigor  mortis  fully  marked. 

Head. — Membranes  and  brain  natural. 

Tliyroid. — Lateral  lobes  slightly  enlarged,  otherwise  natural.  Right 
pleura  contains  about  2|  oz.  of  pale  serum.     Left  pleura  natural. 

Pericardium  contains  15  oz.  of  pale  serum,  otherwise  natural.  Tis- 
sues in  mediastina  very  cedernatous. 

RigM  lung  somewhat  congested  and  very  cedernatous.  Bronchi 
congested,  otherwise  natural.    ■ 

Left  lung  same  as  right. 

Heart. — Bight  side  dilated  and  slightly  hypertrophied ;  contains 
a  large  quantity  of  partly  decolorized  clot ;  valves  healthy.  Left  side 
somewhat  dilated  and  hypertrophied ;  contains  partly  decolorised  clot. 
Mitral  valves. — The  posterior  set  of  chordse  tendinese  are  ruptured  and 
the  ends  somewhat  thickened,  and  are  separated  three  quarters  of  an 
inch  from  one  another,  and  are  covered  by  dark-coloured  clots  ;  the 
rest  of  the  valve  is  natural.     (Sent  to  museum.) 

Peritoneum  natural. 

Liver  large ;  natural. 

Spleen  contains  an  old  infai'ct  near  its  lower  border;  substance 
congested  and  friable. 

Kidneys  large,  swollen,  and  pale.     (Good  specimen  of  large  white.) 


Case  2. — Jaundice  with  obstruction. 

John  B — ,  a3t.  59,  railway-guard;  admitted  10th  May,  1880;  dis- 
charged June  30th,  1880. 

Family  history.. — Father  died  from  hernia.  Mother  healthy.  No 
history  of  gout  or  rheumatism. 

Previous  history. — Railway-guard  thirty  years.  Work-hours  range 
from  twelve  to  twenty.  Had  drank  a  good  deal  up  to  seven  years  ago. 
Temperate  for  last  four  years.  In  January,  1879,  had  a  long  chilling 
journey,  being  at  work  twenty  hours;  a  day  or  two  after  was  laid  up 
with  cold,  which  kept  him  indoors  for  a  fortnight. 


42  Paroxysmal  Pyrexia  simulating  Ague. 

Present  illness. — Eight  months  ago  was  unwell  for  several  days,  then 
one  evening  shortly  afterwards  was  seized  with  abdominal  pain ;  on  the 
following  day  pain  more  severe,  for  which  he  took  pills,  as  ordered  by  a 
doctor.  Nest  morning  began  to  get  yellow,  and  by  the  evening  was  of 
a  deep  tint.  Has  been  jaundiced  ever  since.  Was  very  sick  whilst  the 
pain  was  upon  him,  and  as  soon  as  he  noticed  his  jaundice  he  found  his 
motions  of  a  pale  colour.  After  the  attack  was  over  the  motions 
became  natural  again.  Has  since  had  repeated  similar  attacks,  at  first 
about  once  a  fortnight,  but  latterly  more  often.  During  each  attack 
there  has  been  an  inci'ease  of  jaundice,  which  has  lessened  again,  but 
never  entirely  disappeared. 

Weight  before  illness  12  st.  13  lbs. ;  after  six  months'  illness  10  st. ; 
now  9  st.  7  lbs.  (about).  Since  first  attack  he  has  been  unable  to  take 
solid  food,  without  vomiting.     Vomit  consists  of  mucus  only. 

Present  condition. — Rather  thin;  skin  and  conjunctivae  yellow ;  skin 
warm  and  moist.  Itching  all  over  the  body.  No  oedema  of  face  or 
legs. 

Respiratory  system. — No  cough;  no  expectoration.  Chest  well 
formed.     Good  expansion.     No  abnormal  physical  signs. 

Circulatory  system. — Pulse  70,  strong,  not  easily  compressible. 
Heart  normal;  apex  one  inch  and  a  half  below  nipple. 

Digestive  system. — Tongue  coated  with  white  fur.  Appetite  im- 
paired. Bowels  confined ;  motions  sometimes  pale,  sometimes  dark 
coloured,  the  change  taking  place  suddenly. 

Liver. — Dulness  from  upper  border  of  the  fifth  rib  m  the  nipple 
line ;  liver  can  be  felt  in  the  abdomen  one  inch  and  a  half  below 
the  ribs ;  vertical  extent  of  dulness  six  and  a  half  inches.  There 
is  at  present  no  pain  or  tenderness  in  this  region.  Spleen  not 
enlarged.     No  ascites. 

Urine. — Sp.  gr.  1015 ;  no  albumen,  no  sugar.     Bile  pigment  and 
bile  acids  both  distinctly  present. 
May  13th. — Colour  less  marked.     Urine  1014;  bile  acid  and  pigment; 
no  albumen. 

17th. — Had  a  little  pain  yesterday  afternoon  in  the  region  of  the  liver, 
lasting  half  an  hour ;  a  few  hours  after  he  noticed  the  jaundice  more 
intense,  and  his  urine  of  a  darker  colour.  Motion  about  the  same  in 
colour  (light  brown).     No  gall-stone  found.     Urine  1016,  dark  colour. 

19th. — Motion  rather  lighter  in  colour  after  an  attack  of  pain  and 
sickness  yesterday ;  he  vomited  his  dinner.     Jaundice  deeper. 

20th. — Jaundice  less.  Play  of  colours  in  the  urine  on  the  application 
of  HN03 ;  very  marked  reaction  of  bile  acids  present. 

26th. — Complained  of  little  pain  in  the  epigastrium  this  morning ;  it 
has  nearly  gone  now.     He  did  not  shiver.     Temp.  99"2° — 101-4°. 

27th. — A  little  more  jaundice.     Skin  not  so  irritable.     No  pain;  no 
sickness.    Motions  still  light  coloured.    Urine  1013 ;  much  less  pigment. 
Small  amount  of  mucus. 
June  4th.— Jaundice  better;  skin  not  irritable.    Has  passed  over  the 


Paroxysmal  Pyrexia  simulating  Ague. 


43 


usual  period  of  an  attack  of  sickness  and  pain,  without   any   suck 
coming  on.     Sleeps  better.     Bowels  open  daily ;  motions  rather  dark. 

7th. — Slight  pain  yesterday  afternoon  in  the  liver.  No  rigor ;  no 
vomiting.  Rise  of  temp,  to  100-6°.  Motions  pale  after  pain;  urine 
also  higher  coloured. 

.  16th. — Yesterday  passed  a  pale  stool.  Ate  some  meat  for  the  first 
time.  No  pain  nor  sickness.  No  rise  in  temp.  From  this  time  he 
improved  steadily,  and  had  no  more  pyrexia. 

Weight— May  10th,  8  st.  7|  lbs. ;  May  17th,  8  st.  9^  lbs. 


May  10th.— 1  p.m 985° 

„    —6  p.m 98-8 

11th— 9.30  a.m 977 

„    —6.45  p.m 98-2 

12th.— 8.30  a.m 97*9 

„    —  6.30  p.m 980 

13th.— 8.30  a.m 977 

„    —2.30  p.m 98-0 

„    —6  p.m 98-4 

14th.— 8.30  a.m 976 

„    —8  p.m 97-0 

15th.— 8.30  a.m 97"2 

„    —6.20  p.m 98-2 

16th.— a.m '. 97'4 

„    — p.m v 98"  6 

17th— a.m ." 974 

„    —p.m 98-2 

18th.— a.m 987 

„    —6.5  p.m 101-4 

(Rigor;  vomited.) 

„    —9.45  p.m 100-0 

19th.— 8.30  a.m 98-5 

„    —5.20  p.m 99-0 

20th.— 8.20  a.m 98-3 

„    —2.20  p.m 98-8 

„     —5.55  p.m 98-2 

21st.— a.m 979 

„    —p.m 98-4 

22nd— a.m 97'6 

„    — p.m 98'6 

23rd.— a.m 96-8 

„    —p.m 98-3 

24th.— a.m 97-6 

„    —p.m 98-4 


Temperature  record. 

May  25th.— a.m 97'6° 

„     —p.m 97-4 

26th.— a.m 98-2 

„    —11.25    99-2 

„    —3.35  p.m 101-4 

(Vomiting;  perspiration;  no  chill.) 

26th.— 8  98-2 

27th.— a.m 977 

„    —p.m 980 

28th— a.m 97-0 

„    —p.m 97-8 

29th.— a.m 97-4 

„     —p.m 97-4 

30th.— a.m 97-4 

„     —p.m 98-2 

31st.— p.m 980 

June  1st. — a.m 975 

„  — p.m 97*7 

2nd.— a.m 97*4 

3rd.— a.m 97-4 

„  —p.m 98'0 


4th.— a.m 97-8 

„  — p.m 97'6 

5th.— a.m 979 

„  — p.m 98-5 

6th.— a.m 97-8 

„  —3.10  p.m 1006 

(Pain;  no  vomiting;  no  rigor.) 

6th.— 8p.m 98-5 

7th.— a.m , 97-5 

„   —p.m 98-3 

9th.— a.m 97"5 

„   —p.m 98-2 

10th.— a.m 97-4 


44 


Paroxysmal  Pyrexia  simulating  Ague. 


June  10th. — p.m. 
11th. — a.m. 

„  —p.m. 
12th.— a.m. 

„  — p.m. 
13th. — a.m. 

„  —p.m. 
14th. — a.m. 

„  —p.m. 
15th. — a.m. 

„  —p.m. 
16th. — a.m. 

„  —p.m. 
17th.— a.m. 

„  —p.m. 
18th. — a.m. 


97-6° 
97-0 
97-8 
97-3 
98-2 
97-7 
98-2 
97-4 
97-9 
98-0 
98-4 
97-8 
98-4 
98-1 
98-4 
98'2 


„     —p.m. 
21st. — a.m. 


June  ISth.— p.m 98-2° 

19th.— a.m 97'7 

„    —p.m 97-9 

20th.— a.m 97'4 

98-4 

97-9 

„     —p.m 98-6 

22nd. — a.m 

23rd— p.m 

24th.— p.m 

25th. — a.m 

„     —  p-m 

26th.— a.m 

„    —p-m 

27th.— p.m 97-6 

28th.— p.m 97-8 


97-0 
98-0 
97-9 
972 

98-0 
98  4 
98-0 


Treatment. — Bed  Ticket. 

May  10th.— Fellis  Bovini  gr.  v ;  Ext.  Aloes  Barb.  gr.  iv ;  in  pil.  ij. 
h.  s.  s. 
01.  Ricini  §ss.     Oras,  si  opus  sit. 
„     13th—  Pil.  o.  n. 

„     Sodse  Sulph.  3j ;  Soda3  Bicarb,  gr.  x ;  ex  Aq.  %ij  ;  b.  d.  s. 
June  28th.— M.  Stomach.,  §j  t.  d.,  to  take  out  with  hhn. 
Diet—  Milk.    Beef  Tea.    June  3rd.— Mixed.    June  24th.— Fish. 


JOTTINGS    EHOM    THE    SUBGICAL   OUT- 
PATIENT BOOM. 


By  H.  H.  CLUTTON,  M.B.,  F.R.C.S., 

ASSISTANT   SURGEON   TO  THE   HOSPITAL. 


The  following  cases  occurring  amongst  the  out-patients  I 
have  thought  worthy  of  record  in  the  e  Hospital  Reports :' 
Fracture  of  clavicle  by  muscular  action. 
Large  vascular  growth  in  the  neck. 
Nsevi  of  the  face  treated  by  electrolysis. 
Congenital  hydrocele  of  the  neck. 
Multiple  lipomata. 


Fracture  of  clavicle  by  muscular  action. 

Fractures  of  the  long  bones  by  muscular  action  are  suffi- 
ciently rare  to  be  worth  recording,  and  more  especially  is  this 
the  case,  when  such  an  accident  occurs  in  a  bone  that  is  not 
ordinarily  exposed  to  great  muscular  strain  or  the  weight  of 
the  body.  Hamilton  records  six  cases  of  fracture  of  the 
clavicle  by  muscular  action,  and  one  only  of  these  did  he 
himself  see ;  and  Gurlt  also  has  collected  twenty  cases,  but 
it  is  quite  evident  that  he  has  availed  himself  of  Hamilton's 
list,  for  he  quotes  the  same  cases,  so  that  probably  there  are 
not  more  than  twenty  which  are  well  authenticated  up  to 
1864. 


46  Jottings  from  the  Surgical  Out-Patient  Room. 

The  case  that  came  under  my  observation  was  a  married 
woman,  E.  M — ,  set.  38,  who  presented  herself  in  my  out- 
patient room  complaining  of  a  swelling  on  her  right  collar- 
bone. She  stated  that  six  months  previously  she  was  quite 
well  and  working  hard,  but  one  day  she  was  employed  beating 
carpets,  and  in  throwing  a  heavy  Brussels  carpet  over  a  "  line  " 
suddenly  felt  an  acute  pain  in  the  right  shoulder.  She  found 
she  could  no  longer  raise  her  arm  to  continue  her  work 
and  went  home.  On  examination  she  discovered  the  swelling 
in  its  present  position  and  about  the  same  size.  The  skin  in 
a  few  days  became  quite  "  black,"  and  remained  discoloured 
for  a  fortnight.  She  also  kept  her  bed  for  some  days,  but 
had  no  doctor.  The  pain,  which  lasted  for  fully  a  month, 
prevented  her  from  using  her  arm.  On  examining  the  right 
clavicle  it  was  quite  evident  that  there  had  been  a  fracture ; 
the  fragments  were  in  the  usual  position,  and  united  by 
a  considerable  quantity  of  new  bone.  The  axes  of  the  two 
halves  did  not  correspond  to  the  known  curves  of  the  clavicle. 
There  was  so  much  displacement,  as  to  give  the  impression 
that  there  was  a  third  fragment  between  the  two  at  right 
angles  to  both,  but  this,  T  have  no  doubt,  was  merely  uniting 
callus.  The  fracture  was  firmly  consolidated,  neither  pain, 
mobility,  nor  crepitus  being  present.  As  far  as  one  could 
ascertain  she  had  no  predisposition  to  spontaneous  fracture, 
never  having  previously  sustained  such  an  injury.  Her  con- 
finements, too,  had  always  been  natural. 

It  is  stated  in  one  of  our  most  honoured  books  on  surgery 
that  "  it  is  a  generally  received  opinion,  however,  that  no 
long  bone  can  be  broken  in  its  shaft  by  the  mere  contraction 
of  its  muscle,  unless  impaired  by  some  morbid  change  in  its 
structure."  In  studying  the  twenty  cases1  before  alluded  to, 
which  are  for  the  most  part  fully  reported  in  Gurlt's  '  Hand- 
book of  Fractures,"  it  seems  to  me  rather  an  assumption 
to  believe  that  in  all  these  cases  there  was  some  vague 
disease  or  predisposition  to  fracture,  of  which  no  previous  or 
subsequent  history  existed  to  support  such  a  conclusion. 
They  are  mostly  men  of  middle  age  (between  thirty-five  and 
fifty,   who  were   at   the  time    of  the    accident  making  some 

1  Guilt,  '  Handbuch  tier  lehre  von  den  Knochenbriichen,'  Thl.  T,  s.  232,  No.  10  j 
9.  245,  Nos.  96—107 ;  Thl,  II,  s,  593,  Nos,  28—34, 


Jottings  from  the  Surgical  Out- Patient -Room.  47 

sudden  and  violent  effort,  which  threw  a  considerable  strain 
upon  the  clavicle,  such,  for  instance,  as  "  lifting  a  heavy 
basket  to  place  it  on  his  head,"  "  lifting  stones,"  "  a  carter 
giving  his  horse  a  backhanded  blow  with  his  whip,"  "  a 
labourer  throwing  building  stones  from  below  upwards," 
"  another  throwing  a  heavy  shovelful  of  rubbish  on  to  his 
cart,"  "  a  Mulatto  trying  to  beat  his  dog  with  a  heavy  whip," 
"  a  powerful  railway  labourer  throwing  with  force  a  heavy 
shovelful  of  earth  on  to  his  truck."  Fourteen  out  of  the  twenty 
were  men  ;  of  the  other  six,  five  were  women  and  one  a  child. 
There  were  also  two  whose  sex  is  not  mentioned.  Nine  out  of 
the  twenty  cases  were  fractures  of  the  right  clavicle,  three  of 
the  left,  and  in  the  remaining  eight  it  is  not  stated  on  which 
side  the  fracture  occurred.  Out  of  the  twenty  only  three  are 
related  to  have  had  any  constitutional  disease.  The  Mulatto 
died  of  phthisis  three  years  afterwards.  A  woman,  not  quoted 
above,  aged  sixty-eight,  had  a  "  periosteal  abscess  "  in  the 
site  of  fracture,  and  was  possibly  the  subject  of  syphilis  ;  and 
the  third  case  was  a  sergeant  of  forty  years  of  age,  ill  in  bed 
writh  slight  inflammation  of  the  ankle-joint,  who  suddenly 
moved  the  left  arm  backward  in  drawing  up  the  bedclothes, 
and  felt  a  sudden  pain  in  the  left  clavicle.  This  subsequently 
proved  to  be  fractured,  and  became  very  much  swollen. 
He  had  suffered  previously  from  scorbutus,  and  was  at  the 
time  very  weak  from  long  service.  He  subsequently  deve- 
loped a  false  joint  at  the  seat  of  the  fracture.  There  is  no 
mention  in  any  of  the  other  cases  of  any  constitutional 
disease,  nor  is  it  stated  that  the  patients  suffered  from  any 
other  fracture. 

In  the  case  here  reported  two  years  have  elapsed  since 
she  met  with  her  accident,  and  there  have  been  no  other 
symptoms  to  indicate  any  general  or  special  disease  which 
would  predispose  to  such  an  occurrence.  I  cannot  help 
thinking  that  the  complicated  action  of  muscles,  called  into 
play  by  the  movements  described  above,  combined  with  the 
suddenness  of  the  efforts  necessarily  made  to  accomplish  such 
an  action,  as  throwing  the  end  of  a  heavy  carpet  over  a 
"  line,"  is  quite  sufficient  to  account  for  the  occurrence  of 
such  an  accident  as  the  fracture  of  some  part  of  the  lever. 


48 


Jottings  from  the  Surgical  Out-Patient  Room. 


Large  vascular  growth  in  the  neck. 

The  accompanying  woodcut,  taken  from  the  photograph  of  a 
baby  eight  months  old,  represents  an  enormous  vascular  growth 
apparently  springing  from  the  parts  beneath  the  lower  jaw. 


Martha  B —  was  seven  months  old  when  brought  by  her 
mother  to  the  out-patient  room.  She  was  stated  to  have  been 
born  with  a  considerable  swelling  in  the  submaxillary  region 
on  the  right  side.  This  swelling  remained  stationary  for  the 
first  few  months  of  infant  life,  and  then  suddenly  in  one 
month  grew  with  such  rapidity  as  to  be  more  than  double  its 
original  size.  For  some  few  weeks  before  coming  to  the 
hospital  it  had  remained  in  much  the  same  condition.  It 
was  an  exceedingly  large  irregular  growth,  spongy  and  elastic 
on  palpation,  and  capable  of  considerable  reduction  by 
pressure  with  the  fingers  ;  there  was,  however,  no  pulsation. 
The  skin  stretched  over  the  growth  was  thin,  and  had  in 
many  parts  a  blue  tinge  from  the  close  proximity  of  large 
vessels  which  could  be  emptied  by  pressure.  The  skin  was, 
however,  in  no  part  invaded  by  nsevoid  tissue.  The  mouth 
was  kept  widely  open  by  the  enormous  size  of  the  tongue, 
which  was  apparently  gorged  with  blood.  Large  tortuous 
vessels  could  be  seen  on  the  under  surface  beneath  the  mucous 


Jottings  from  the  Surgical  Out-Patient  Room.  49 

membrane.  The  tongue  was  not  uniformly  enlarged,  but 
presented  a  median  narrow  strip  of  almost  normal-looking  tissue, 
whilst  the  two  sides  occupying  each  nearly  half  the  tongue,  were 
swollen  in  the  manner  described  above.  The  vessels  evidently 
sprang  from  the  deeper  parts,  and  occupied  principally  the 
floor  of  the  mouth  pushing  the  tongue  forwards.  The  front 
of  the  neck  was  also  apparently  involved,  for  one  could  not 
feel  the  thyroid  and  cricoid  cartilage,  and  with  difficulty  could 
make  out  the  trachea,  just  above  the  sternum.  Laterally  it 
overlapped  the  sterno-mastoids,  more,  as  is  seen  in  the  woodcut, 
on  the  right  than  on  the  left.  The  aspect  of  the  child  was 
the  most  piteous  that  could  well  be  seen.  Her  mouth  was 
kept  permanently  open ;  the  tongue  protruding  between  the 
gums  had,  in  its  anterior  part,  become  quite  dry  and  hard  from 
exposure  to  the  air.  The  facial  muscles  had  produced,  for  so 
young  an  infant,  the  most  unnatural  wrinkles,  which  seemed 
never  to  be  obliterated,  and  could  hardly  be  exaggerated 
in  the  occasional  whine  which  represented  what  might  be 
called  an  attempt  at  crying.  The  whole  produced  the  most 
painful  impression  of  conscious  suffering  that  I  have  ever  had 
the  misfortune  to  see  in  one  so  young. 

For  some  months  the  child  had  been  unable  to  take  her 
mother's  breast,  and  was  fed  entirely  with  a  teaspoon. 
The  breathing  was,  towards  the  latter  part  of  the  time  in 
which  she  was  under  observation,  considerably  impaired.  She 
was  brought  to  the  hospital  for  about  six  weeks,  and  then 
died  at  home.  The  mother  persistently  refused  admission 
into  the  hospital,  which  was  constantly  urged  upon  her,  as 
much  in  the  interests  of  the  child  as  for  the  sake  of  a  post- 
mortem examination. 


Navi  of  the  face  treated  by  electrolysis, 

A  nsevus  on  the  face  is  always  of  great  interest  to  the 
surgeon,  for  he  has  here  to  exert  his  ingenuity  to  destroy  the 
growths,  and  at  the  same  time  to  produce  as  small  a  scar  as 
possible.  Oftentimes  mere  "  specks "  at  birth,  they  after- 
wards in  a  few  weeks  grow  with  great  rapidity,  and  if  not 
quickly  destroyed  or  removed  become  a  source  of  great  dis- 

vol.  xi.  4 


50  Jottings  from  the  Surgical  Out-Patient  Room. 

figurement.  Besides  numerous  instances  of  such  growths  om 
the  less  important  parts  of  the  face,  such  as  the  cheeks  and 
forehead,  where  the  naevus  can  be  treated  with  some  facility,  a 
few  cases  have  appeared  in  the  out-patient  room  of  more  than 
ordinary  interest.      Such  were  the  following  : 

L.    P — ,  a  female,    set.  three  months.      A   small  red  spot 
was  first  noticed  on  the  extreme  tip  of  the  nose  when  three 
weeks  old.     This  steadily  increased  till    the  nose   projected 
like    a   mushroom,  the  tip  being  about  the  size  of  an   adult 
thumb    as    the    child    cried.     The    whole    thickness    of   the 
nose     at     this    spot     was     occupied    by    a    nsevoid     growth. 
Tying   was   here   out   of   the   question.      The  actual    cautery 
would  have   done  too  much,  destroying  as  it  does  en  masse. 
There  was  the  same  objection   to  caustics.      Excision  was  also 
impracticable,  as  one  could  not  take  it  away  without  removing 
the  whole  of  the  extremity  of  the  nose.     Electrolysis  appeared 
more  feasible,  as  centres  of  slough  might  be  produced  by  its 
means  through  the  whole  thickness,  and  from  thence  coagu- 
lation and  contraction  spread  throughout  the  growth.      This 
was    accordingly   done,   from    six    to  eight   cells   only  being 
employed,  so  as  to  avoid   an  extensive  slough.     It  was  soon 
apparent  that  some  contraction  was  taking  place,  and  that  it 
did  not  swell  quite  so  prominently  when  the  child  cried  as  it 
did  before.     As  soon  as  the  small  puncture  had  quite  healed 
and  the  scab  fallen  off  the  process  was  repeated,  and  in  three 
months  enough  had  been  done  to  make  it  evident  that  coagu- 
lation and  contraction  were  taking  place  throughout  the  whole 
growth.     The  child  was  then  six  months  old.     Left  alone  for 
three  months  it  continued  to  contract,  till  at  last  there  was  no 
visible  swelling  at  all  when  the  child  cried,  and  the  extremity 
of  the  nose  felt  quite  hard.     This  treatment  had  proved,  then, 
quite  successful  in  a  case  in  which  one  could  not  remove  the 
whole    growth.     An    exactly   similar    naevus    occupying  the 
extremity  of  the  nose  is  under  my  care  at  the  present  time, 
and  the  same  treatment  is  being  successfully  followed. 

M.  B — ,  set.  6  weeks.  The  mother  had  noticed  a  small 
red  speck  on  right  upper  eyelid  at  birth,  which  had  been  rapidly 
increasing  during  the  last  few  weeks.     Nearly  the   whole  of 


Jottings  from  the  Surgical  Out-Palient  Room.  51 

the  right  upper  eyelid,  both  in  its  thickness  and  in  its  breadth, 
was  occupied  by  a  rapidly  growing  nsevus.  All  other  treat- 
ment except  that  of  partial  destruction  seemed  unsuitable. 
Total  destruction  would  have  infallibly  produced  ectropion  of 
an  aggravated  character,  as  the  growth,  besides  affecting  the 
skin,  was  evidently  growing  luxuriantly  between  the  skin  and 
tarsal  cartilage,  and  from  thence  backward  under  the  frontal 
bone.  Electrolysis  was  here  quite  successful.  A  few  cells 
only  (from  six  to  ten)  were  used  so  as  to  avoid  an  external 
slough.  The  needles  made  to  penetrate  the  whole  thickness 
of  the  growth  left  behind  a  tunnel  of  destroyed  tissue,  from 
which  coagulation  and  consolidation  spread  through  the  whole 
naevus.  The  battery  had  to  be  applied  several  times  to  small 
spots,  which  continued  for  some  time  to  spring  up  at  the  margin 
of  the  growth  ;  and  in  two  months  it  seemed  quite  cured. 
However,  some  time  after,  when  the  baby  was  about  six  months 
old,  it  was  brought  back  again  with  the  eyelid  almost  as  full, 
and  swelling  as  before  when  the  child  cried.  This  was  very 
disappointing,  but  a  second  application  in  the  same  way  again 
procured  its  consolidation. 

Edw.  J.  H — ,  set.  6  months,  was  brought  to  the  hospital 
with  a  prominent  neevus  at  the  root  of  the  nose,  completely 
filling  up  the  interval  between  the  eyes.  The  skin  and  sub- 
cutaneous tissue  were  both  involved  by  the  nsevus,  which  formed 
a  considerable  tumour  when  the  child  cried.  By  electrolysis, 
using  only  ten  cells,  consolidation  was  effected.  It  became 
almost  entirely  solid  after  a  few  applications,  the  perforation 
made  by  the  needle  healing  with  a  depressed  cicatrix. 
Sufficient  discharge  only  was  produced  to  keep  a  small  scab 
adherent  to  the  surface  till  the  small  circular  cicatrix  had  been 
perfected.  In  a  few  weeks  the  tumour  had  shrunk  considerably, 
although  some  of  the  peripheral  part  was  still  spongy.  The 
mother  ceased  bringing  her  baby  to  the  hospital  as  she  considered 
it  cured.  In  six  months  it  was  evidently  beginning  again  to 
increase,  so  she  brought  him  back,  and  we  resumed  the  treat- 
ment by  electrolysis  to  the  outlying  parts  of  the  growth.  It 
soon  began  to  shrink  and  was,  I  believe,  eventually  completely 
cured,  shrinking  up  into  a  small  puckered  mass  at  the  root  of 
the  nose.     I  have  not  seen  the  child  since,  but  I  have  no 


52  Jottings  from  the  Surgical  Out-Patient  Room. 

doubt  even  this  small  amount  of  swelling  has  become  much 
reduced  in  size.  The  charming  part  of  this  treatment  by 
electrolysis  is,  that  you  can  regulate  the  amount  and  extent  of 
destruction  by  including  a  few  more  cells  within  the  circuit  or 
by  reducing  the  number.  And  at  the  same  time  the  action  is 
not  confined  to  the  superficial  part  of  the  growth,  but  may  be 
made  to  extend  through  the  whole  depth  by  pushing  the 
needles  or  electrodes  farther  into  its  substance.  Large  deep- 
seated  naevi  on  the  extremities  or  trunk  may  be  made  to  slough 
out  en  masse  by  a  current  from  thirty  to  forty  cells  ;  and, 
with  the  same  instrument,  by  merely  reducing  the  number  of 
cells  a  modified  action,  extending  through  the  whole  naevus, 
may  be  effected,  as  in  the  cases  quoted  above.  That  there  is 
a  tendency  to  recurrence  after  such  partial  treatment  as  is  here 
discussed  there  can  be  no  doubt.  But  then  one  must  here  re- 
collect that  it  is  only  recommended  for  such  cases  as  these  on 
the  face,  in  which  total  destruction  for  various  reasons  is  quite 
inadmissible.  I  think,  too,  that  by  keeping  the  case  always 
under  observation  the  slighest  recurrence  can  be  at  once 
checked  in  its  growth. 


Congenital  hydrocele  of  the  neck. 

A.  D — ,  set.  2,  was  in  the  condition  represented  in  the 
accompanying  woodcut,  which  was  obtained  from  a  photo- 
graph  on    August  14th,  1877.     The  tumour  was  noticed  at 


the  child's   birth,  and  had   gradually   increased  in  size  from 
that  time  to  the  present.     On   examination  it  proved  to  be 


Jottings  from  the  Surgical  Out-Patient  Room.  53 

apparently  a  simple  cyst.  There  were  no  irregularities  of 
outline  or  inequalities  of  consistence  on  palpation.  A  wave 
was  easily  transmitted  from  end  to  end  of  what  seemed  to  be 
an  unilocular  cyst.  There  was  nothing  to  indicate  the  ex- 
istence of  any  solid  matter.  The  situation  was  peculiar,  and 
more  on  that  account  than  on  any  other  have  I  been  induced 
to  publish  it.  It  was  situated  entirely  in  front  of  the  sterno- 
mastoid,  between  the  latter  and  the  lower  jaw.  Although 
the  cyst  overlapped  this  muscle  and,  in  fact,  rested  upon 
the  clavicle,  by  turning  the  child's  head  towards  the  opposite 
shoulder  and  carefully  raising  the  tumour  one  could  feel 
the  sterno-mastoid  throughout  its  entire  length  distinctly  be- 
hind the  cyst,  while  the  deep  parts  of  the  tumour  seemed  to 
have  connection  with  the  tissues  between  the  jaw  and  the 
sterno-mastoid.  Such  congenital  cysts  are  almost  invariably 
seated  in  the  neighbourhood  of  the  clavicle,  producing  large 
bulging  swellings  simultaneously  in  the  axilla  and  the  neck. 
The  cervical  portion  of  the  growth  is  then  generally  to  be 
felt  in  the  posterior  triangle  behind  the  sterno-mastoid.  But 
in  this  case  there  was  nothing  whatever  to  be  felt  in  the 
posterior  triangle  or  in  the  axilla. 

On  August  21st  the  cyst  was  tapped  with  trocar  and 
cauula.  Six  ounces  of  bloody  fluid  of  the  colour  of  port-wine 
were  evacuated,  but  the  sac  was  not  entirely  emptied.  Some 
solid  matter  could  then  be  felt  between  the  angle  of  the 
jaw  and  the  sterno-mastoid,  but  no  other  cyst.  Six  drachms 
of  Tinctura  Iodi  and  water  in  equal  parts  were  then  injected. 
In  two  hours  the  swelling  had  increased  to  half  its  original 
size,  but  it  subsequently  began  to  diminish,  the  skin  hanging 
in  folds  where  before  it  had  been  tense.  This  shrinking 
continued  till  September  3rd,  when  the  sac  began  to  fill 
rather  rapidly.  There  were,  however,  no  signs  of  inflamma- 
tion. 

On  September  4th  it  was  again  tapped  and  injected  with 
four  drachms  of  Tinctura  Iodi  and  water  as  before,  four 
ounces  of  bloody  fluid  having  been  first  withdrawn.  This 
completely  emptied  the  sac,  and  one  could  then  feel  more 
distinctly  a  solid  mass  in  front  of  the  sterno-mastoid,  as  pre- 
viously indicated.  The  same  evening  the  swelling  had 
almost  regained  its  original  size,  but  from  this  time  the  dimi- 


54  Jottings  from  the  Surgical  Out-Patient  Room. 

nution  was  continuous  and  uninterrupted  till,  in  November, 
all  that  could  be  felt  was  a  solid  lump,  about  as  big  as  a  walnut, 
beneath  the  angle  of  the  jaw. 


Multiple  fatty  tumours. 

In  last  year's  '  Hospital  Reports '  I  related  two  cases  in 
which  the  forearms  were  covered  with  multiple  fatty  tumours 
symmetrically  disposed.  Since  then  another  patient  has  pre- 
sented himself  with  his  body  covered  in  a  similar  manner. 
During  the  present  year,  1880,  there  have  also  been  several 
cases  recorded  in  the  'Brit.  Med.  Journal/  by  three  different 
observers.  In  each  of  these  cases  the  tumours  were  remark- 
able for  their  symmetrical  arrangement,  and  in  occupying  the 
limbs  rather  than  the  trunk.  The  forearm  and  thighs  were 
the  parts  affected,  and,  separately  examined,  the  growths  pre- 
sented the  ordinary  characters  of  fatty  tumours. 

Tn  the  cases  reported  by  me  last  year  the  tumours  were  of 
small  size  and  symmetrically  placed  upon  the  forearms.  They 
had  been  suddenly  observed,  and  did  not  subsequently  increase 
in  size  or  number.  The  present  case  is  a  still  more  extra- 
ordinary one  than  either  of  the  preceding. 

Wm.  S — ,  set.  44,  waiter,  had  noticed  lumps  behind  his  head 
for  about  five  weeks  before  he  came  to  the  out-patient  room 
of  St.  Thomas's  Hospital.  He  thought  that  they  had  been 
increasing  slightly  since  first  noticed.  He  did  not  know  that 
he  had  any  others.  On  examination  we  found  that  he  had 
the  most  remarkable  development  of  fatty  tumours,  all  placed 
with  the  most  accurate  regard  for  symmetry  on  both  sides  of 
the  median  line  of  the  body.  At  the  back  of  his  head, 
occupying  nearly  the  whole  of  the  occipital  region,  were  two 
large  fatty  tumours,  one  on  each  side  of  the  ligamentum 
nuchse,  stretching  upwards  on  to  the  scalp  as  far  as  the 
superior  curved  lines  of  the  occipital  bone,  and  forward  as  far 
as  the  attachment  of  the  sterno-mastoid  muscle  to  the  mastoid 
process.  Equal  in  size,  symmetrical  in  position,  similar  in  all 
their  characters  to  one  another  they  presented  a  most  quaint 
appearance.  A  little  lower  down  but  quite  separate  from  the 
above  were  two  others,  one  on  each  side  of  the  spinous  process 


Jottings  from  the  Surgical  Out-Patient  Room.  55 

of  the  seventh  cervical  vertebra.  These  were  quite  distinct  from 
one  another,  and  placed  in  identically  the  same  position  on 
-each  side  of  the  spine.  These  four  tumours  together  formed 
a  splendid  likeness  of  the  corpora  quadrigemina,  with  a 
median  and  transverse  groove  separating  them  from  one 
another.  Beneath  the  jaw  on  each  side  were  other  similar 
growths,  forming  an  almost  complete  collar  of  fat  round  the 
neck,  but  each  development  of  fat  was  distinctly  a  growth 
which  could  be  separated  from  the  surrounding  tissues,  and 
presumably  therefore  provided  with  a  distinct  capsule. 

Other  fatty  tumours  were  sprinkled  all  over  the  back, 
occupying  pretty  nearly  the  same  positions  on  each  side  of  the 
body,  but  not  quite  so  symmetrical  as  the  above  ;  they  varied 
in  size  from  an  orange  to  a  small  nut.  In  the  lumbar  region 
there  was  one  large  one  on  each  side.  On  the  abdomen  he 
had  also  a  very  curious  symmetrical  arrangement  of  similar 
growths.  Immediately  below  the  umbilicus,  on  each  side  of 
the  median  line,  were  two  rather  prominent  fatty  tumours, 
soft,  and  rather  more  diffused  than  is  ordinarily  the  case,  but 
yet  sufficiently  isolated  to  make  one  feel  sure  that  a  capsule 
would  be  found  if  the  growth  were  removed.  Above  the 
umbilicus  were  two  other  growths,  similarly  situated,  but  not 
•quite  so  distinctly  separable  from  the  surrounding  tissues  as 
the  others,  forming,  as  it  were,  a  transition  between  the 
ordinary  constitutional  development  of  fat  and  a  fatty  tumour. 
At  each  flexure  of  the  elbow  was  a  small  lobulated  growth, 
but,  with  this  exception,  there  were  none  to  be  discovered  on 
the  extremities.  The  patient  came  under  Mr.  Croft's  care  in 
the  hospital,  and  had  both  occipital  tumours  removed.  They 
proved  to  be  ordinary  lipomata. 

Multiple  fatty  tumours  are,  I  am  sure,  not  so  uncommon 
as  they  are  ordinarily  supposed  to  be.  I  would  submit  that 
when  they  do  occur  they  have  a  more  or  less  symmetrical 
arrangement,  not  quite  so  accurately  placed  perhaps  as  in  the 
case  here  recorded,  but  still  equally  occupying  the  two  halves 
of  the  body.  If  the  limbs  are  occupied  by  such  growths,  it 
will  be  the  same  portion  of  the  body  that  is  affected  on  the 
two  sides,  e.g.  both  forearms.  If  the  trunk  is  the  part 
involved,  there  will  be  an  almost  equal  number  on  each  half. 
i  have  observed  similar  cases  in  the  practice  of  other  surgeons, 


56  Jottings  from  the  Surgical  Out-Patient  Room. 

and  have  come  to  the  above  conclusion.  It  is  difficult  to 
give  any  explanation  for  this  symmetrical  disposition,  except 
that  of  constitutional  diathesis.  They  generally  appear  at  a 
time  of  life  when  fat  is  developed  largely  upon  the  surface  of 
the  body.  A  solitary  fatty  tumour  looks  like  an  accidental 
occurrence,  but  when  the  same  growths  appear  in  large 
numbers  in  the  middle  period  of  life,  they  seem  to  be  a 
development  of  fat  in  a  slightly  aberrant  form;  the  fat  is 
encapsuled  instead  of  being  diffused  over  the  surface  of  the 
body. 


A  CASE  OF   TEIC.ELIAN   HEAET 


INSUFFICIENCY  OF   THE   VENTRICULAB 
SEPTUM. 


By  W.  H.  STONE,  F.K.C.P.,  &c. 


Mary  H — ,  set.  19,  admitted  into  Christian  Ward  November 
17th,  1880.  Presented  February  9th,  1881.  Keadmitted 
March  28th.     Died  March  31st. 

The  patient,  a  stout,  muscular  girl  of  dark  and  cyanotic 
appearance,  stated  that  she  had  been  of  similar  aspect  since 
birth,  and  that  she  had  suffered  from  dyspnoea  after  exertion. 
She  was  also  subject  to  vertigo.  Three  years  before  admission 
she  had  an  attack  of  rheumatic  fever.  This,  as  far  as  she 
knew,  had  not  been  accompanied  by  any  heart  complication, 
nor  had  any  treatment  been  directed  to  that  organ.  She  had 
not  noticed  any  alteration  in  symptoms  since  the  occurrence 
of  the  rheumatism. 

On  the  13th  October,  1880,  she  attended  as  out-patient 
under  the  care  of  Dr.  Sharkey,  who  at  once  substantiated  the 
fact  of  congenital  heart  disease,  although  he  was  unable  to 
state  its  exact  nature.  He  recommended  her  for  closer 
examination  as  in-patient. 


58  A  Case  of  Tricalian  Heart. 

On  admission  she  made  little  complaint;  slight  cough  and 
short  breath,  with  pain  in  the  left  side,  forming  the  principal 
symptoms.  The  appetite  was  good,  the  bowels  regular.  The 
catamenia,  however,  had  always  been  irregular,  scanty,  absent 
for  periods  of  six  and  thirteen  weeks.  The  skin  was  healthy 
though  livid ;  the  temperature  97*6.  The  right  jugular  vein 
was  seen  to  pulsate  when  she  first  came  in,  but  this  sign  dis- 
appeared after  a  night's  rest.  The  chest  was  well  expanded,  no 
pulmonary  disease  existing  at  any  part. 

The  pulse  was  rather  irregular,  small,  and  thready,  giving  a 
very  imperfect  tracing  with  the  sphygmograph  ;  the  curve  ap- 
proximating in  character  to  that  found  in  cases  of  ordinary 
mitral  insufficiency. 

There  was  a  distinct  systolic  thrill  over  the  cardiac  region, 
most  marked  at  a  part  halfway  between  the  left  mamma  and  the 
sternum,  and  conveyed  upwards  in  a  diagonal  line  from  the 
midsternal  point  towards  the  outer  extremity  of  the  left 
clavicle.  This  was  accompanied  by  a  loud  rough  sound,  also 
systolic  in  rhythm,  most  accentuated  at  the  point  covering 
anatomically  the  origin  of  the  pulmonary  artery.  It  was  not 
loud  at  the  apex  of  the  heart ;  was  almost  lost  to  the  right  of 
the  sternum,  but  was  audible  over  the  upper  part  of  the 
scapula  posteriorly,  and  less  distinctly  lower  down.  The  heart 
was  somewhat  enlarged  towards  the  left  side. 

The  liver  and  spleen  were  not  enlarged.  There  was  no 
anasarca  or  albuminuria.  I  was  able  fully  to  concur  in  Dr. 
Sharkey's  view  that  the  disease  was  congenital,  not  due  to  the 
rheumatism.  On  the  question  of  the  actual  abnormality, 
while  admitting  the  difficulty  of  diagnosis,  I  ventured  on  a 
few  purely  physical  and  hydrostatic  comments.  In  the  first 
place,  the  thrill  and  murmur  were  strong,  evidencing  consider- 
able mechanical  force.  Secondly,  they  were  fluid  sounds, 
produced  by  a  powerful  eddy  or  current  sufficient  to  put  the 
inert  mass  of  the  sternal  parietes  into  sensible  vibration. 
Thirdly,  they  occupied  exactly  the  situation  of  the  pulmonary 
artery.  I  did  not  think  that  an  opening  in  the  foramen  ovale 
could  cause  so  powerful  a  tremor,  for  lack  of  strength  in  the 
cavities  on  either  side  of  it.  Therefore  it  must  be  between 
ventricles  or  arteries. 

To   the   latter   opinion   I   somewhat   erroneously    inclined, 


A  Case  of  Tricalian  Heart.  59 

chiefly  from  the  high  position  of  the  point  of  greatest  inten- 
sity, but  also  because  a  pervious  ductus  arteriosus  seemed  to 
me  to  give  the  nearest  mechanical  conditions  needed  for  pro- 
ducing the  actual  phenomena.  Another  physical  point  noted 
was  the  similarity  of  the  sphygmographic  tracing  to  that  of 
mitral  disease.  The  leakage  was  evidently  taking  place  during 
systole,  while  the  arterial  orifices  were  patulous,  exactly  as  in 
regurgitation  through  the  mitral  valve.  It  now  occurs  to  me 
that  if  the  communication  were  above  the  sigmoid  valves  the 
murmur  should  be  double  and  not  strictly  systolic  as  this  was 
It  will  be  worth  watching  for  this  in  future  cases. 

The  case  offered  little  to  note  on  its  first  appearance  beyond 
the  attempt  at  physical  diagnosis  above  given.  The  patient 
went  out  after  between  two  and  three  months  stay  in  the 
hospital,  somewhat  relieved,  but  in  all  organic  respects  un- 
changed. In  about  six  weeks  she  returned,  and  walked  into 
the  ward  during  my  visit.  I  am  therefore  able  to  state  that 
she  presented  no  cerebral  or  other  serious  symptoms,  and  was 
accommodated  with  a  bed  in  the  usual  way.  She  complained 
chiefly  of  severe  headache.     She  died  in  two  days. 

Post-mortem  examination. — Heart  not  excessively  enlarged, 
the  vessels  springing  from  it  quite  normal.  Ductus  arteriosus 
not  pervious.  Water  injected  into  the  left  ventricle  through 
the  aorta  came  out  freely  through  the  pulmonary  artery.  On 
inserting  the  finger  through  the  pulmonary  valves  it  met  with 
an  obstruction  about  an  inch  and  a  half  beyond  them.  The 
auricles  were  normal  as  regards  capacity  and  thickness  of 
walls.  They  communicated  by  a  slit-like  fissure  at  the  anterior 
edge  of  the  septum,  such  as  is  not  uncommon  without  pro- 
ducing any  pathological  effect.  The  walls  of  the  right 
ventricle  were  hypertrophied  to  exactly  an  equal  thickness  with 
those  of  the  left.  The  cavity  of  the  ventricle  was  divided  into 
two  chambers,  one  much  smaller  than  the  other,  and  almost 
completely  shut  off  from  it  by  a  firm  fleshy  partition.  These 
two  were  in  communication  through  a  small  circular  aperture 
with  cartilaginous  margins,  studded  with  vegetations  the  size  of 
millet-seeds,  and  about  a  quarter  of  an  inch  in  diameter.  The 
small  oval  chamber  was  an  inch  and  a  half  long,  situated 
between  the  general  ventricular  cavity  and  the  pulmonary 
valves.     These  were  quite  healthy.     The  septum  between  the 


60  A  Case  of  Triccelian  Heart. 

ventricles  was  perforated  by  a  large  semilunar  orifice  in  its 
upper  and  "  undefended  space." 

Brain. — On  removing  the  dura  mater  the  surface  was  found 
to  be  excessively  congested  on  both  sides.  Purulent  inflamma- 
tory deposit  extended  over  the  inter-pyramidal  spaces  and  the 
pons.  On  the  lateral  surface  of  the  right  occipital  lobe  in  its 
lower  part  was  a  soft,  dark,  circular,  sloughy  patch,  about 
three  quarters  of  an  inch  in  diameter,  which  proved  to  be  an 
old,  thick-walled  abscess  cavity  containing  fetid  brown  pus, 
and  which  had  burst  into  the  posterior  horn  of  the  right 
lateral  ventricle.  This  cavity  contained  a  quantity  of  similar 
fetid  pus.  The  parietal  vessels  were  injected,  and  the  inflam- 
mation appeared  to  have  extended  into  the  underlying  sub- 
stance, though  the  whole  change  was  obviously  secondary  to 
the  bursting  of  the  abscess  into  it.  There  was  much  softening 
of  the  brain  substance  round  the  abscess^  but  no  clot  in  the 
right  posterior  cerebral  artery. 


ON  THE  USE 


OP   THE 


CONTINUED    CUEEENT    IN    DIABETES. 


By  WILLIAM  H.  STONE,  F.E.C.P., 

AND 

WALTEE  J.  KILNEE,  M.B., 


The  suggestion  of  employing  electricity  in  the  form  of  a 
constant  current  in  cases  of  diabetes  appears  to  date  from  the 
year  1861 ;  on  September  2nd  of  which  year  Mons.  Mariano 
Semmola  read  a  paper  before  the  French  Academie  des 
Sciences,  recorded  in  the  c  Comptes  Rendus'  of  that  date.  He 
states  his  views  as  to  the  causation  of  the  disease  at  consider- 
able length  in  twenty-one  propositions,  referring  to  a  previous 
paper  brought  before  the  same  Society  six  years  earlier.  Gene- 
rally he  attributes  its  occurrence  either  to  exaggerated  glyco- 
genic action  of  the  liver,  or  to  default  of  respiratory  oxidation. 
The  distinction  between  these  two  forms,  he  thinks,  can  be 
made  out  by  the  permanence  or  the  transient  nature  of  the 
phenomenon,  and  by  the  large  or  small  quantity  of  sugar 
excreted.  Where  glycosuria  accompanies  disease  of  the  nervous 
system  the  series  of  symptoms  is  of  a  double  nature.  The 
first  follows  convulsive  affections,  such  as  epilepsy  and  hysteria, 
it  is  usually  of  short  duration  and  evanescent ;    the  second, 


62        On  the  Use  of  the  Continued  Current  in  Diabetes. 

which  accompanies  organic  cerebral  disease,  must  be  looked  on 
as  a  glycogenic  stimulation  of  the  fourth  ventricle,  and  persists 
as  long  as  the  brain  disease  itself,  developing  in  direct  ratio 
to  the  proximity  of  the  brain-lesion  to  the  roots  of  the 
pneumogastric  nerve.  A  more  or  less  definite  congestion  of 
the  floor  of  the  fourth  ventricle  he  considers  to  be  the  patholo- 
gical condition  constantly  observed  in  diabetic  patients.  The 
action  of  electricity  seems  to  point  to  the  disease  having 
begun  in  an  essential  neurosis,  which  would  offer  a  reason- 
able chance  of  cure.  This  view  is  strengthened  by  the  fact 
that  when  diabetic  patients  are  not  carried  off  by  tuberculosis, 
the  cause  of  death  is  usually  some  nervous  crisis,  such  as 
epilepsy  or  dyspnoea  due  to  apoplexy  of  the  Pons  Varolii.  In 
his  fifteenth  and  following  propositions  M.  Semmola  states  that 
stimulation  of  the  pneumogastric  nerve  by  a  direct  current  of 
sufficient  force  constantly  produces  a  diminution  in  the 
quantity  of  sugar  eliminated,  and  sometimes  in  the  bulk  of  the 
urine  itself.  These  effects  are  passing  and  only  last  from  five 
to  ten  hours.  Occasionally,  however,  they  are  more  durable, 
and  may  amount  to  organic  cure.  He  gives  a  case  of  a  girl, 
aged  17,  who  became  diabetic  and  amaurotic  at  the  same  time 
from  a  fright,  and  who  recovered  under  galvanism.  Electricity 
he  considers  not  only  a  valuable  therapeutical  agent  in  such 
cases,  but  also  useful  in  diagnosis  as  a  means  of  distinguishing 
between  an  idiopathic  neurosis,  and  one  symptomatic  of 
cerebral  lesion. 

As  auxiliaries  to  electrical  treatment  he  recommends  wet 
packing,  large  doses  of  cod-liver  oil,  and  increasing  doses  of 
sulphate  of  strychnia,  raised  to  "03  of  a  gramme,  or  very 
nearly  half  a  grain,  daily. 

The  merit  of  this  somewhat  forgotten  memoir  consists  not 
only  in  the  clearness  of  the  issues  it  raises,  but  also  in  the 
important  distinction  between  neurotic  and  organic  glycosuria, 
which  must  have  struck  every  independent  observer.  The 
clear  establishment  of  such  a  difference  also  goes  far  to  explain 
the  very  variable  results  of  treatment  in  this  most  intractable 
disease,  and  the  want  of  success  which  has  attended  the  labours 
of  conscientious  observers.  It  may  be  worth  while  to  put  on 
record  cases  which,  although  one  of  them  terminated  fatally, 
present  many  points  of  physiological  interest. 


On  the  Use  of  the  Continued  Current  in  Diabetes.        63 

Case  1. — James  V — ,  set.  52,  instrument  maker.     Admitted 
into  Arthur  Ward  September  20th,  1880. 

He  stated  that  for  the  last  ten  or  twelve  years  he  had 
suffered  from  bronchitis  in  the  winter,  but  had  never  had 
haemoptysis.  The  present  illness,  however,  dated  from  two 
years  ago,  when  he  noticed  frequent  micturition,  with  increased 
quantity  of  urine,  and  very  ravenous  appetite.  These  sym- 
ptoms were  accompanied  by  much  loss  of  flesh,  thirst,  and 
coldness  of  the  extremities.  It  was  five  months  before  he  sought 
medical  advice,  and  about  eighteen  months  previous  to  ad- 
mission he  was  taken  into  Guy's  Hospital,  where  he  remained 
for  five  months  under  the  care  of  Dr.  Wilks.  He  improved  con- 
siderably during  that  period.  From  September/ 1879,  to  May, 
1850,  he  attended  as  out-patient  of  St.  Thomas's  Hospital,  and 
since  the  latter  date  he  had  no  regular  advice,  but  continued 
taking  opium  pills,  which  he  had  "  saved  up  "  during  previous 
treatment.  He  stated  that  the  urine  averaged  five  or  six  pints 
daily,  bnt  had  risen  to  nine  pints.  It  tasted  sweet  at  times, 
and  at  others  bitter ;  in  the  latter  case  being  very  dark  in 
colour.  The  bowels  had  been  loose  formerly,  but  costive  of 
late.  He  knew  of  no  cause  for  the  illness,  and  entirely  denied 
any  fright,  mental  shock,  or  anxiety. 

On  admission  he  proved  to  be  an  intelligent  man,  by  trade  a 
surgical  instrument  maker,  a  fact  which  was  of  service  in  the 
use  of  galvanism.  The  skin  was  dry  and  rough;  the  eye-sight 
dim,  with  occasional  double  vision.  The  pulse  68,  rather  weak. 
The  heart  sounds  were  normal.  The  chest  showed  the  usual 
signs  of  emphysema,  with  effacement  of  the  cardiac  dulness. 
The  liver  was,  for  the  same  reason,  somewhat  pushed  down- 
wards, but  not  enlarged,  tender,  or  altered  in  resistance ;  its 
margin  could  just  be  felt  below  the  ribs.  The  tongue  was 
clean.  The  bowels  were  relaxed  to  the  extent  of  diarrhoea,, 
with  eleven  evacuations  in  the  twenty- four  hours.  The  urine 
on  the  following  day  amounted  to  73  oz.,  with  a  sp.  gr.  of  1040. 
The  temperature  was  throughout  slightly  subnormal,  97° — 98°. 

On  the  27th  he  had  bilious  vomiting  and  continued  diarrhoea, 
the  quantity  of  the  urine  being  somewhat  less  in  consequence. 
He  was  in  the  habit  of  taking  crude  opium  in  2  gr.  doses, 
twice  or  thrice  daily,  and  at  first  expressed  a  strong  craving 
for  the  drug.    He  was  ordered  Codeia  gr.  ij,  ter  die,  which  gave 


64        On  the  Use  of  the  Continued  Current  in  Diabetes. 

him  considerable  relief  and  enabled  him,  of  his  own  accord,  to 
discontinue  the  opium.  His  chief  complaint  at  this  time  was 
of  failing  eyesight. 

On  October  12th  he  was  examined  by  Mr.  Nettleship,  who 
reported  that  the  ophthalmoscope  gave  negative  results,  that 
there  was  no  sign  of  cataract.  There  was  well-marked  central 
scotoma  to  colours,  and  that  the  case  te  resembled  tobacco 
amblyopia,  possibly  accelerated  by  ill  health,  but  not  due  to 
diabetes. "  During  the  first  week  of  October  the  urine  averaged 
84  oz.  daily,  and  contained,  on  quantitative  examination,  about 
5  oz.  of  sugar.  The  treatment  consisted  solely  of  the  codeia 
named  above,  which,  on  the  14th  of  October,  was  replaced  by  a 
lemonade  made  with  acid,  phosph.  dil.  gss.  ad  ^ij,  sweetened 
with  glycerine,  and  flavoured  with  lemons. 

On  the  18th  of  October  this  improvement  noted  at  first  was 
not  maintained,  and  the  codeia  was  resumed,  but  the  quantity 
of  urine  rose  to  102  oz.,  on  the  20th  to  139  oz.,  on  the  23rd 
and  25th  to  150  oz.,  with  a  specific  gravity  of  1040.  The 
falling  off  in  condition  was  so  obvious  that  the  lungs  were 
again  carefully  examined  with  a  view  to  detect  signs  of  latent 
phthisis,  which  were  not,  however,  found. 

He  remained  very  ill  during  the  month,  and  on  the  28th  his 
weight  sank  to  8  st.  2|  lb.  On  the  31st  the  urine  was  160  oz., 
and  on  the  3rd  November  it  rose  to  the  highest  quantity 
recorded,  viz.  170  oz.,  with  an  occasional  sp.  gr.  of  1045. 

On  November  4th,  seeing  the  threatening  nature  of  the 
symptoms  and  the  total  ineffectuality  of  treatment,  Dr.  Stone 
suggested  the  use  of  the  continued  current  to  the  head.  After 
consultation  with  Dr.  Kilner  it  was  decided  to  employ  an 
ascending  current  from  the  nape  of  the  neck  to  the  forehead  ; 
the  negative  pole  being  placed  in  the  former  region,  the  positive 
in  the  latter.  The  current  was  of  1500  micro-vebers  in  strength, 
and  was  at  first  continued  for  seven  minutes.  It  gave  him 
no  uneasiness,  and  he  thought  himself  temporarily  better  after 
it.  It  was  from  the  first  obvious  that  the  action  of  electricity 
in  a  case  of  depraved  nutrition,  probably  due  to  disorder  of  the 
organic  nervous  centre,  should  not  be  merely  stimulant  and 
occasional,  but  catalytic  and  constant.  The  patient  himself 
was  therefore  entrusted  with  a  powerful  bichromate  battery 
of  thirty  cells,  made  by  Dr.  Stone,  and  directed  to  use  the 


On  the  Use  of  the  Continued  Current  in  Diabetes.        65 

strongest  current  he  could  bear  with  comfort,  as  above  de- 
scribed, twice  or  thrice  a  day.  All  kinds  of  mechanical 
contact-makers  and  commutators  were  discarded,  and  the 
battery,  instead  of  being  screwed  up  in  a  French-polished  box, 
was  ranged  in  three  sets  of  ten  cells  on  the  ward  table.  A 
simple  binding-screw  was  attached  to  the  required  cell.  It 
was  thus  easy  to  see  what  was  being  done,  and  impossible  to 
err  as  to  the  real  direction  of  the  current.  On  electrical 
measurement,  Dr.  Kilner  found  the  strongest  current  he 
could  bear,  from  nape  to  forehead,  to  be  one  of  10,000 
micro-vebers.  But  a  more  moderate  current  of  1800  micro- 
vebers  was  begun  with  and  increased  to  2000  micro-vebers ;  it 
seemed  to  answer  all  purposes.  The  patient  himself  entered 
heartily  into  the  treatment,  and  from  the  first  declared  him- 
self better.  The  earliest  symptom  to  amend  was  the  eyesight, 
and  the  pinched  expression  of  the  face,  which  soon  disappeared, 
with  rapid  recovery  of  flesh,  amounting  to  4  lb.  within  a  few 
weeks. 

On  December  6th  the  urine  measured  80  oz.  of  sp.  gr.  1040. 
The  thirst  was  less.  He  did  not  require  opium,  though  he  still 
took  the  codeia  thrice  daily  in  2  gr.  doses.  The  note  taken  by 
the  house-physician  on  that  day  says,  "  Patient  uses  14  cells  of 
the  bichromate  battery  ;  is  very  much  better."  The  improve- 
ment was  maintained  until  December  23rd,  when  some  diges- 
tive disturbance  was  relieved  by  a  dose  of  jalap.  On  that  day 
the  quantity  of  water  was  74  oz. 

On  the  27th  the  sp.  gr.  was  found  to  be  1038,  the  quantity 
68  oz.  On  fermentation  the  sp.  gr.  only  sank  to  1026,  indi- 
cating a  reduction  of  sugar  excreted  from  5  to  about  2  oz. 
daily. 

On  January  7th  the  urine  was  quantitatively  tested  by  Dr. 
Bernays  in  consequence  of  a  severe  relapse  accompanied  by 
febrile  symptoms  which  had  necessitated  the  omission  of  the 
electricity.  It  was  of  sp.  gr.  1042,  containing  sugar  8-00  and 
urea  097  per  cent.,  with  a  trace  of  albumen.  It  had  sunk  in 
quantity  to  under  50  oz.  daily.  The  febrile  access  proved  to 
be  due  to  perinoeal  abscess,  which  was  opened  on  the  12th. 

On  the  13th  the  quantity  of  urine  rose  again  to  100  oz. 
Directly  he  could  leave  his  bed  he  recommenced  the  use  of  the 
battery  with  the  greatest  vigour,  from  a  conviction  that  it  was 

vol.  xi.  5 


66  On  the  Use  of  Continued  Current  in  Diabetes. 

of  service  to  him.  He  was  now  able  to  bear  a  current  of 
10,000  micro-vebers  from  twenty-two  of  the  bichromate  cells 
above  mentioned.     This  was  on  Jan.  20th. 

On  the  22nd  the  quantity  of  urine  was  58  oz.  It  continued 
at  a  comparatively  reduced  standard  until  February  9th,  on 
which  day  a  large  carbuncular  boil  began  to  form  at  the  back 
of  the  neck,  where  the  negative  pole  of  the  battery  had  been 
applied.  The  use  of  galvanism  was  then  finally  discontinued. 
The  patient  became  much  worse,  restless,  semicomatose,  with 
raw  excoriated  tongue,  unable  to  take  food  or  stimulants. 
The  quantity  of  urine  rose  to  110  and  120  oz.  The  tempera- 
ture remained  at  98*6°  Fahr.  In  this  condition  he  remained 
until  February  21st,  when  it  sank  to  96-2.  On  the  following 
day  he  died. 

The  question  of  diet  has  in  these  notes  been  reserved  to  the 
end.  It  was  never  very  strict,  Dr.  Stone  having  found  that 
patients  usually  refuse,  after  a  time,  to  submit  to  very  severe 
regimen,  and  thus  that  opportunity  for  investigation  is  lost. 
It  consisted  of  extra  meat,  green  vegetables,  eggs  and  butter, 
with  a  pint  of  bitter  ale  and  three  ounces  of  whisky,  daily. 

It  may  be  noted  that  family  history  threw  no  light  on  the 
nature  of  the  case.  The  father  died,  set.  65,  of  phthisis  ;  the 
mother,  set.  60,  of  what  was  termed  "  ulceration  of  the  liver ;" 
of  two  brothers,  one  was  drowned  at  sea,  the  other  was  alive 
in  good  health.  Three  sisters  died  in  infancy.  No  member 
of  the  family  suffered  from  diabetes. 

On  post-mortem  examination  the  large  carbuncle  was  found 
to  extend  no  deeper  than  the  subcutaneous  fascia.  The  liver, 
spleen,  and  all  other  thoracic  and  abdominal  organs  were 
normal.  The  brain  weighed  3  lb.  6  oz.  It  was  large,  firm, 
decidedly  vascular,  but  exhibiting  no  other  naked-eye  appear- 
ances. 

The  pons  varolii  and  medulla  oblongata,  on  examination  by 
Dr.  Dickinson,  showed  enlargement,  by  erosion,  of  the  peri- 
vascular canals  in  the  lower  part  of  the  medulla  near  its  centre, 
in  the  olivary  body,  in  the  upper  part  of  the  medulla,  close  to 
the  floor  of  the  fourth  ventricle,  and  in  the  anterior  part  of  the 
pons  between  the  roots  of  the  crura  cerebri.  In  the  two  latter 
positions,  both  of  which  were  in  or  close  to  the  median  plane, 
minute  collections  of  brown  matter  were  to  be  seen,  external  to 


On  the  Use  of  Continued  Current  in  Diabetes.  67 

the  vessels,   which   consisted   of   blood-corpuscles   apparently- 
extruded  during  life. 

Case  2. — G.  G — ,  set.  31,  labourer.  Admitted  May  17th, 
1881,  into  Arthur  Ward.  There  appeared  to  be  nothing  special 
in  his  family  history  or  in  his  previous  condition.  He  was  in 
the  army  in  1869,  when  he  had  an  attack  of  scarlet  fever.  He 
suffered  from  ague  for  three  months  when  aged  fourteen.  No 
syphilis,  no  evidence  of  intemperance,  though  he  had  taken 
spirits  freely  since  his  illness. 

He  stated  that  the  present  symptoms  commenced  in  March, 
1881,  between  two  and  three  months  before  applying  at  the 
hospital.  The  access  was  rather  sudden,  coming  on,  as  he 
expressed  it,  "  all  at  once/'  He  first  noticed  thirst,  emaciation, 
a  large  discharge  of  urine,  which  obliged  him  to  keep  a  pail  in 
his  bedroom,  and  general  gastric  symptoms  with  vomiting. 
His  appetite  became  ravenous,  the  bowels  obstinately  costive, 
the  skin  and  mouth  dry.  He  complained  of  flying  pains  in  the 
abdomen,  back,  and  legs,  with  great  loss  of  strength.  He  had 
been  subject  to  boils.  No  reason  could  be  assigned  for  the 
attack.  His  work  during  the  previous  winter  had  consisted  of 
washing  bottles  and  tubs,  necessitating  some  exposure  to  the 
weather  and  to  steam ;  but  he  had  not  endured  any  privation, 
nor  had  he  undergone  any  mental  shock  or  anxiety. 

For  five  weeks  he  had  measured  the  daily  amount  of  urine, 
which  averaged  over  sixteen  pints  daily. 

On  admission  his  expression  was  anxious  and  his  manner 
dull.  He  complained  of  pains  in  the  abdomen  and  legs,  of 
great  hunger,  thirst,  and  constant  micturition.  The  skin  was 
harsh  and  dry;  the  tongue  dry,  furred,  and  cracked.  The 
bowels  were  costive.  On  the  right  arm  were  the  scars  of  old 
boils.  Sight  dim.  On  examination  the  chest  was  found  to  be 
normal,  the  heart  sounds  regular  and  healthy. 

The  abdominal  walls  were  tense,  slightly  tender  on  the  left 
side.  The  hepatic  dulness  extended  from  the  upper  edge  of  the 
fifth  rib  to  half  an  inch  below  the  costal  cartilages  on  the  right 
side.  Its  lower  edge  could  be  felt,  firm  and  somewhat  tender. 
The  splenic  dulness  was  not  enlarged. 

The  urine  was  of  sp.  gr.  1042,  acid,  containing  sugar  in 
abundance.     Temperature  97'4°,  at  which  point  or  rather  less 


68  On  the  Use  of  Continued  Current  in  Diabetes. 

(97*0°)  it  remained  throughout.  He  was  placed  on  a  moderately- 
regulated  diet,  and  the  state  of  the  bowels  attended  to.  As 
soon  as  he  had  become  settled  the  quantity  of  urine  was  care- 
fully measured.  On  the  21st  he  passed  twenty-four  pints,  in 
which  the  quantity  of  sugar  was  found  by  careful  analysis  to  be 
38  gr.  per  oz.  He  was  very  weak,  especially  in  the  legs, 
giddy,  parched  in  the  throat,  and  unable  to  swallow.  On  the 
22nd  diarrhoea  set  in,  which  continued  until  the  24th,  leaving 
him  very  prostrate.  On  the  25th  this  was  checked,  and  the 
use  of  the  continuous  current  from  about  ten  bichromate 
batteries  was  commenced. 

It  was  difficult  at  first  from  the  low  intelligence  of  the  patient 
to  obtain  any  satisfactory  measurements.  The  current  was 
passed  from  the  nape  of  the  neck,  where  the  negative,  to  the 
forehead,  where  the  positive  pole  was  placed.  Large  carbon 
electrodes,  covered  with  lint  and  soaked  in  solution  of  salt  and 
water  were  employed.  After  some  practice  a  current  of  20  to 
25  milliwebers  was  obtained  through  a  very  variable  resistance 
which  never  sank  below  2000  ohms. 

On  the  26th,  after  the  third  application  of  the  battery,  which 
he  was  instructed  to  use  twice  or  thrice  daily  under  the  sister's 
supervision,  he  expressed  himself  as  better,  and  stronger  in  his 
legs.  In  the  twenty-four  hours  preceding  he  passed  only  12 
pints  14  oz.  of  water,  of  sp.  gr.  1032,  containing  32  gr.  of  sugar 
per  oz.  This  would  give  6592  gr.  of  sugar  as  against  14592  gr. 
passed  five  days  previously. 

The  rest  of  the  clinical  history  may  be  summed  up  in  a 
table. 


Date. 

Quantity. 

Gra.  of  sugar  per  oz, 

May  27th 

11  pints  15  oz. 

— 

„     28th 

.        14     „ 

— 

„    29th 

15     „     12    „ 

33  gr.  per  oz. 

„    30th 

Quantity  stationary. 

35    „ 

June  3rd 

11  pints  8  oz. 

24    „ 

On  June  6th  the  patient,  who  had  always  been  of  a  morose 
and  querulous  temper,  left  to  try  some  other  hospital.  The 
last  analysis  on  June  3rd  gives  184  oz.  containing  4416  gr.  of 
sugar. 


On  the  Use  of  Continued  Current  in  Diabetes.  69 

After  the  recent  valuable  researches  of  Mr.  Gore  in  electrical 
osmose  and  diffusion,  the  statement  of  M.  Semmola,made  twenty 
years  ago,  confirmed  as  it  is  by  the  above  cases,  deserves  careful 
reconsideration.  The  chemical  effects  of  the  galvanic  current, 
employed  in  its  continuous  form,  undoubtedly  require  develop- 
ment, in  opposition  to  the  purely  stimulant  action  on  nerve  and 
muscle  of  the  induced  current.  The  fact  of  a  definite  polarisation 
of  the  tissues  included  in  a  galvanic  circuit,  leading  to  a  reverse 
current  of  a  secondary  character,  has  been  shown  both  by  Cyon, 
of  St.  Petersburg,  and  by  Onimus,  of  Paris.  It  would  almost 
seem,  in  this  instance,  as  if  an  inhibitory  alteration  of  osmose 
could  be  transmitted  downwards  from  the  governing  centre, 
under  the  catalytic  influence  of  the  voltaic  current,  to  the 
secreting  organ  at  its  peripheral  extremity. 


CONTRIBUTION 


TO 


PATHOLOGY  OF  DOUBLE  OPTIC  NEURITIS. 


By  WALTER  EDMUNDS,  M.D. 


The  following  case  is  recorded  on  account  of  its  bearing  on 
a  question  to  which  a  good  deal  of  attention  has  been  given  of 
late — namely,  by  what  process  intracranial  disease  causes  the 
double  optic  neuritis  which  so  frequently  accompanies  it  ? 

Kate  C — ,  set.  8,  was  run  over  by  a  horse  and  cart,  receiving 
injuries  which  proved  fatal  in  twenty-four  hours.  At  the 
post-mortem  examination  a  large  laceration  of  the  liver  with 
extravasation  of  blood  and  rupture  of  the  right  kidney  was 
found  j  there  was  also  a  fracture  in  the  middle  fossa  of  the 
base  of  the  skull ;  it  did  not  pass  into  either  orbit,  nor  into  the 
immediate  neighbourhood  of  the  optic  nerves.  There  was 
some  meningitis  at  the  base  of  the  brain.  On  removing  the 
optic  nerves  it  was  noticed  that  they  were  of  a  reddish  colour 
and  that  there  was  some  pyriform  swelling  of  the  nerve 
immediately  behind  the  eye.  The  nerves  were  hardened  in 
Muller's  fluid  and  alcohol. 

Transverse  sections  of  the  nerve  were  made  at  different 
levels,  and  longitudinal  sections  through  the  optic  disc,  and 
that  part  of  the  nerve  immediately  behind  it.  On  examining 
the  transverse  sections  microscopically  there  was  seen  in  the 
outer  sheath  an  increased  number  of  staining  nuclei  of  the 


EXPLANATION  OF  PLATE. 

The  upper  figure  shows  a  transverse  section  of  the  optic  nerve  near  the  eye. 
It  is  magnified  about  25  diameters.  There  is  a  dense  zone  of  inflammatory 
material  between  the  two  sheaths.  Some  inflammation  is  seen  in  the  trabecular 
between  the  nerve-bundles. 

The  lower  figure  shows  a  portion  of  the  circumference  of  the  same  nerve  more 
highly  magnified. 


S .  TH  0'JYLA.S  S  H  0  S  P  .  RE  P .  N .  S  .VOL  21  .P  L .  I . 


^4.SwT'.-' 


Wtafr.-Wi-wman  feCn.sc-. 


CASES  OF  ABDOMINAL  SURGERY. 

WITH   REMARKS. 


By  BERNARD   PITTS, 

BESIDBNT    ASSISTANT    STTBGEON. 


The  following  cases  present  a  few  points  of  interest  in  rela- 
tion to  abdominal  surgery.  I  have  therefore  ventured  to 
record  them  briefly.  They  have  been  under  my  care  in  the 
hospital  during  the  last  year.  I  wish  to  express  my  indebted- 
ness to  the  surgeons  for  their  kindness  in  giving  me  the  oppor- 
tunity of  treating  them. 

Case  1. — Intestinal  obstruction  ;  abdominal  section ;  discovery 
of  a  stricture  ;  sigmoid  flexure  stitched  to  the  margins  of  a 
separate  incision  in  the  left  groin ;  recovery. 

Sarah  C — ,  a3t.  42,  admitted  February  19th,  1881 ;  married, 
one  child.  Had  good  health  till  twelve  months  ago.  During 
last  year  she  suffered  from  slight  occasional  pain  in  the 
epigastric  region.  Eor  several  months  the  bowels  have  been 
more  or  less  constipated,  i.  e>  open  only  every  three  or  four 
days. 

Three  weeks  before  admission  the  bowels  were  opened  by 
castor  oil,  and  fourteen  days  ago  an  enema  brought  away  a 
little  fsecal  matter.  During  this  time  the  taking  of  solid  food 
has  always  been  followed  by  vomiting,  and  nothing  has  passed 
per  anum  for  fourteen  days.      She  has  had  frequent  attacks  of 


76  Cases  of  Abdominal  Surgery. 

severe  griping  pain  in  the  epigastric  region,  and  this  pain  was 
especially  severe  for  two  days  previous  to  admission. 

On  admission,  February  19th,  no  stricture  of  the  rectum 
could  be  felt.  There  was  considerable  abdominal  distension, 
the  coils  of  bowel  in  the  lower  abdomen  being  especially  pro- 
minent. Some  dulness  in  the  flanks,  changing  with  position. 
Tongue  dry;  expression  anxious.  Constant  sickness,  unable 
to  retain  anything  except  small  quantities  of  milk  and  soda 
water.  Several  enemata  were  given  without  effect.  The  tube 
was  passed  eighteen  inches. 

February  21st. — No  improvement ;  patient  is  weaker.  The 
stomach  will  not  retain  even  fluids  now.  Mr.  MacCormac, 
under  whose  care  the  patient  was  admitted,  saw  her  in  the 
morning,  and  advised  an  exploratory  operation,  but,  being 
unable  from  indisposition  to  operate,  asked  me  to  take  charge 
of  the  case.  On  the  evening  of  the  21st  I  made  a  central 
abdominal  incision  under  the  spray,  and  introduced  my  hand 
into  the  abdomen.  About  one  pint  of  coloured  serous  fluid 
escaped.  The  small  intestines  were  distended,  slightly 
injected,  and  granular  in  appearance.  The  descending  colon 
and  caecum  were  distended.  An  annular  stricture,  hard  and 
firm,  was  discovered  at  the  junction  of  the  sigmoid  flexure 
with  the  rectum,  completely  closing  the  gut  but  not  implicating 
the  surrounding  parts.  A  tube  was  passed  into  the  rectum, 
and  felt  projecting  against  the  stricture,  which,  by  further 
pressure,  was  easily  displaced  upwards.  An  opening,  one  inch 
long,  was  now  made  in  the  left  groin,  at  the  outer  third  of 
Poupart's  ligament,  by  incising  the  abdominal  wall  from  with- 
out inwards  upon  the  first  finger  of  the  left  hand  placed  within 
the  abdominal  cavity.  By  keeping  the  left  hand  in  the  abdo- 
men the  intestines  were  prevented  from  escaping  at  the  central 
wound.  The  segmoid  flexure  was  drawn  towards  the  colotomy 
wound  and  secured  there  by  silk  sutures  passed  through  the 
peritoneal  and  muscular  coats  of  the  bowel.  The  abdominal 
cavity  was  now  cleansed,  the  central  wound  closed,  and  both 
wounds  were  dressed  antiseptically.  Morphia  was  adminis- 
tered subcutaneously,  and  nutrient  enemata  ordered. 

About  fourteen  hours  after  the  operation  the  dressing  was 
cut  away  over  the  wound  in  the  groin,  and  the  cut  margin  of 
the  central  dressing  carefully  sealed  by  strapping  dipped  in 


Cases  of  Abdominal  Surgery.  77 

carbolic  lotion.  The  larger  central  wound  was  thus  com- 
pletely protected.  The  bowel  was  then  incised,  gas  and  eight 
ounces  of  dark  fluid  evacuation  immediately  escaped.  Faeces 
continued  slowly  to  flow  for  the  next  six  hours. 

In  the  evening  the  patient  seemed  much  relieved.  Tempe- 
rature normal.  Able  to  take  a  little  fluid  by  the  mouth  with- 
out vomiting.  Nothing  worthy  of  record  occurred  during  this 
patient's  convalescence.  She  made  an  uninterrupted  recovery. 
By  a  little  care  with  the  dressings,  and  by  changing  the 
central  dressings  about  every  second  day,  and  by  carefully 
securing  that  margin  of  the  dressing  bordering  the  colotomy 
wound  with  strapping,  I  was  enabled  to  keep  the  central 
incision  antiseptic  throughout. 

She  is  now  (six  months  after  the  operation)  in  good  health, 
and  able  to  do  hard  work.  The  colotomy  wound  is  about  the 
size  of  the  little  finger,  without  any  prolapse.  She  passes  a 
good  deal  of  her  faeces  the  natural  way,  but  occasionally  has 
some  pain  and  passes  a  little  blood  from  the  rectum.  Con- 
siderable relief  is  experienced  by  having  the  artificial  opening 
occasionally  dilated. 

Remarks. — An  abdominal  exploration  was  performed  in  this 
case  on  account  of  the  obscurity  of  the  symptoms,  and  one 
was  disposed  to  it  by  the  fact  that  the  enema  tube  could  appa- 
rently be  passed  such  a  long  distance  and  a  considerable 
quantity  of  fluid  injected.  When  the  abdomen  was  opened, 
and  while  the  hand  was  grasping  the  stricture,  I  took  the 
opportunity  of  having  the  tube  passed  again,  to  ascertain  how 
such  a  mistake  could  have  arisen  ;  and  I  found  that  when  the 
end  of  the  tube  reached  the  stricture  it  displaced  it  with  the 
sigmoid  flexure  upwards.  The  flexible  tube  then  turned  on 
itself,  but  at  such  a  distance  from  the  anus  as  to  defy 
detection.  An  opening  in  the  abdominal  wall  opposite  to  a 
part  of  the  sigmoid  flexure,  well  removed  from  the  disease, 
was  easily  made  by  cutting  down  upon  the  finger.  By  waiting 
till  the  next  day  before  opening  the  bowel,  the  abdominal 
cavity  was  completely  and  antiseptically  shut  off.  In  illustra- 
tion of  this  point,  I  may  mention  a  case  in  which  I  performed 
lumbar  colotomy  a  few  weeks  since  for  malignant  disease  of 
the  rectum.  I  did  the  operation  antiseptically,  and,  as  there 
were  no  urgent  symptoms,  I  did  not  incise  the  bowel  until  two 


78  Cases  of  Abdominal  Surgery. 

days  had  elapsed  after  the  operation,  and  in  this  way  complete 
primary  union  of  the  wound  was  obtained.  If  the  peritoneum 
had  been  wounded  in  the  operation  there  would  have  been 
much  less  anxiety  as  to  the  result  after  taking  these  precau- 
tions. I  believe  the  intestine  should  never  be  opened  in  the 
first  instance,  unless  the  delay  of  a  few  hours  would  be 
dangerous.  But  to  return.  There  would  not  have  been 
much  difficulty  in  bringing  the  sigmoid  flexure  up  to  the  cen- 
tral wound  and  attaching  it  there,  as  was  done  in  the  two  cases 
reported  in  the  Clinical  Society's  f  Transactions '  of  1879 ; 
but  I  preferred  to  make  an  independent  opening  in  the  groin, 
since  it  is  more  in  the  natural  course  of  the  intestine,  an 
altered  position  favouring  after  troubles  ;  and  one  was  enabled 
also  to  keep  the  larger  wound  dressed  antiseptically,  and  after- 
prolapse  must  be  much  less  likely  to  occur  when  the  parietal 
wound  is  small. 

The  choice  of  operation  in  cases  of  intestinal  obstruction, 
where  the  obstruction  is  not  very  acute  and  where  there  is  no 
stricture  to  be  felt  in  the  rectum,  and  the  previous  history 
throws  little  light  on  the  case,  is  often  a  very  difficult  question. 

Colotomy  is,  in  many  such  cases,  an  operation  as  it  were  at 
a  venture  ;  so  much  so,  that  the  surgeon  sometimes  thinks  it 
necessary  to  do  right  colotomy,  so  as  to  include  the  chance  of 
the  obstruction  being  higher  up  in  the  large  intestine. 

By  making  a  central  incision  antiseptically  large  enough 
for  the  introduction  of  the  hand,  the  presence  or  absence  of 
stricture  in  the  large  intestine  can  easily  be  determined  without 
any  very  great  manipulation  of  the  abdominal  cavity.  If  a 
stricture  be  found  a  colotomy  can  be  done  with  the  greatest 
ease,  and  the  operation,  if  undertaken  before  the  patient  is  in 
extremis,  can  be  done  as  in  the  above  case  with  every  anti- 
septic precaution.  There  need  be  practically  no  colotomy 
wound  to  heal. 

I  believe  that  it  is  most  likely  that  the  growth  causing  the 
stricture  in  this  case  was  columnar  epithelioma.  A  short 
time  ago  I  was  shown  a  sigmoid  flexure  taken  from  an  old 
man  who  had  died  of  acute  obstruction  supervening  on  chronic 
obstruction  of  two  years'  standing.  There  was  an  exactly 
similar  annular  constriction,  which  microscopical  examination 
revealed  to  be  columnar  epithelioma. 


Cases  of  Abdominal  Surgery.  79 

The  question  suggests  itself,  whether  one  would  be  justified 
in  attempting  to  remove  the  piece  of  bowel  involved  by  making 
a  fresh  abdominal  incision. 

At  the  first  operation,  of  course,  the  woman  was  too  ill  for 
any  treatment  beyond  the  immediate  relief  of  symptoms. 

May  26th,  1882. — I  have  seen  this  patient  several  times 
during  the  last  year.  She  continues  in  good  health,  and  suffers 
very  little  inconvenience  from  the  preternatural  opening.  I 
have  on  several  occasions  had  to  dilate  the  opening  to  give  her 
more  complete  relief  to  the  obstruction  by  the  stricture.  I 
have  tried  in  vain  to  persuade  her  to  come  into  the  hospital 
again  for  the  purpose  of  removal  of  the  diseased  bowel.  I  fear 
that  now  the  stricture  may  have  acquired  adhesion  to  sur- 
rounding structures.  I  am  glad  to  see  that  Mr.  Bryant  has 
lately  removed  successfully  such  a  stricture  after  colotomy, 
and  that  the  operation  that  I  hinted  at  when  writing  this 
paper  a  year  ago  is  now  a  recognised  one  in  surgery.  Mr. 
Marshall  has  also  recently  published  a  case  very  similar  to  my 
own,  but  in  which  he  removed  the  diseased  bowel  at  the 
primary  operation.  I  should  imagine,  however,  that  in  most 
cases  it  would  be  preferable  to  relieve  the  condition  of  obstruc- 
tion first,  and  to  perform  the  colectomy  at  a  subsequent  date. 

Case  2. — Intestinal  obstruction ;  abdominal  section  ;  a  portion 
of  intestine  discovered  free  in  the  abdominal  cavity,  which 
had  been  strangulated  in  the  left  inguinal  canal ;   death. 

C.  H — ,  male,  set.  45 ;  admitted  April  9th,  1881,  under  the 
care  of  Dr.  Bristowe,  suffering  from  constant  fecal  vomiting 
and  distension  of  the  abdomen.  There  was  no  appearance  of 
any  hernia,  but  the  patient  stated  that  he  had  been  subject  to 
a  hernia  on  the  left  side  for  ten  years.  The  rupture  was 
of  small  size,  and  had  been  always  reducible.  He  had 
never  worn  a  truss,  and  had  not  suffered  any  inconvenience 
from  it. 

Three  days  before  admission  he  was  seized,  whilst  at  work, 
with  violent  pain  in  the  abdomen,  followed  a  few  hours  after- 
wards by  sickness.  The  hernia,  he  stated,  was  not  then  down. 
He  was  treated  by  a  doctor,  who  gave  him  several  doses  of 
aperients,  and  administered  enemata.     The  bowels  did  not  act, 


80  Cases  of  Abdominal  Surgery. 

and  the  patient  became  rapidly  worse,  vomiting  became  more 
frequent,  and  for  twenty-four  hours  previous  to  admission  very 
offensive  in  character.  Patient  stated  very  positively  that  his 
hernial  swelling  came  down  whilst  vomiting  on  the  morning  of 
admission,  but  went  back  almost  directly,  just  as  usual. 

On  admission  he  was  constantly  bringing  np  large  quantities 
of  stercoraceous  vomit  of  pea-soup  consistence.  The  abdomen 
was  moderately  distended,  and  was  resonant  all  over.  Some 
pain  was  complained  of  across  the  umbilical  region,  but  no 
tenderness  or  fulness  at  any  particular  part  could  be  detected. 
The  left  inguinal  canal  was  carefully  explored,  and  seemed  a 
little  more  patent  than  the  right.  Temp.  97"8°.  Tongue  dry 
and  brown  ;  great  thirst.  Anxious  expression.  No  hiccough. 
Urine  rather  scanty,  but  free  from  albumen.  An  enema 
brought  away  two  small  lumps  of  faecal  matter.  The  passage 
of  the  long  tube  caused  a  good  deal  of  pain  at  the  upper  part 
of  the  rectum.  It  could  not  be  passed  for  more  than  nine 
inches.  Dr.  Bristowe  saw  the  patient,  and  ordered  him  to  be 
kept  under  the  influence  of  morphia  during  the  night.  The 
next  morning  he  was  much  worse — skin  cold  and  clammy,  and 
temperature  greatly  depressed,  96°  in  axilla.  At  Dr.  Bris- 
towe's  request  I  made  an  antiseptic  exploration  in  the  middle 
line.  There  was  no  ascitic  fluid.  The  intestines  were  slightly 
injected  and  distended.  Following  the  distended  bowel  down- 
wards (without  allowing  any  protrusion),  a  knuckle  of  ileum 
was  found  lying  in  the  central  part  of  the  abdominal  cavity, 
which  had  evidently  been  constricted  in  the  greater  part  of  its 
circumference ;  it  was  dark  in  colour,  with  a  well-defined  line 
of  constriction,  and  the  intestine  below  this  was  completely 
collapsed.  Inspection  of  the  inner  wall  of  the  abdomen 
showed  a  white  line  of  slough  around  the  left  internal  abdo- 
minal ring,  so  that  it  was  clearly  evident  that  the  knuckle  of 
intestine  had  been  strangulated  there  unknown  to  the  patient, 
and  had  then  become  reduced.  The  piece  of  bowel  looked 
perfectly  recoverable ;  nothing  further  could  be  done.  The 
abdomen  was  closed,  and  the  wound  dressed  antiseptically. 
The  line  of  treatment  was  now  quite  clear,  and  no  more  efforts 
made  to  open  the  bowels  by  enemata.  Small  nutrient  enemata 
were,  however,  given  and  retained.  His  temperature  two  hours 
after  operation  became  normal,  he  expressed  himself  free  from 


Cases  of  Abdominal  Surgery.  81 

pain,  he  had  less  vomiting ;  hut  later  in  the  evening  he 
became  very  delirious,  the  urine  was  exceedingly  scanty,  and 
he  died  about  twelve  hours  after  the  operation.  The  post- 
mortem examination  revealed  nothing  beyond  what  was  deter- 
mined at  the  operation. 

Remarks. — The  man  was  closely  questioned  on  his  admis- 
sion, but  was  positive  that  he  had  no  pain  or  tenderness  in  the 
situation  of  his  hernia.  The  symptoms  were  far  in  excess  of 
what  one  should  expect  from  the  condition  of  the  gut.  The 
intestine  was  not  disengaged  at  the  time  of  the  operation,  for 
the  constricted  bowel  was  found  far  away  from  the  inguinal 
region,  and  before  any  traction  was  made  on  the  intestine.  I 
have  thought  the  case  worth  recording  on  account  of  the  im- 
possibility of  making  any  diagnosis  before  exploration,  and  of 
the  unusual  severity  and  continuance  of  the  symptoms,  appa- 
rently due  to  paralysis  of  intestine  after  a  comparatively  mild 
strangulation.  Possibly  the  repeated  aperients  that  were 
given  at  the  time  the  gut  was  strangulated  and  subsequently, 
might  account  for  this  otherwise  puzzling  fact. 

Case  3. — Strangulated  inguinal  hernia  ;  reduction  by  taxis  ; 
continuance  of  the  symptoms ;  exploration  of  abdominal 
cavity  ;  discovery  of  gangrenous  bowel ;  symptoms  relieved ; 
death  from  pneumonia  and  exhaustion  ten  days  after 
operation. 

Robert  A—,  set.  45,  admitted  December  26th,  1880,  at  8.30 
p.m.,  with  right  inguinal  hernia  strangulated.  He  had  had  a 
hernia  for  fifteen  years,  had  never  worn  a  truss,  and  had  fre- 
quently enjoyed  intervals  of  freedom  from  protrusion,  although 
his  occupation  was  laborious.  There  was  no  history  of  previous 
trouble  with  the  hernia,  which  had  been  always  easily  reducible. 
At  2  p.m.  on  the  day  of  admission  the  hernia  came  down. 
He  failed  to  reduce  it.  Before  coming  to  the  hospital  he 
vomited  twice. 

On  admission  patient  had  a  broken-down  cachectic  appear- 
ance. The  hernia  was  the  size  of  a  duck's  egg  and  incom- 
plete; rather  tense,  without  impulse,  and  with  some  pain  at 
the  neck  of  the  sac.  Expression  normal ;  tongue  clean. 
There  was  some  swelling  of  the  epidydimis  and  cord  to  be  felt 

VOL.   XI.  6 


82  Cases  of  Abdominal  Surgery. 

below  the  hernia.  The  bowels  had  been  open  in  the  morning. 
Gentle  taxis  was  tried,  and  the  swelling  seemed  to  diminish  in 
size.  An  icebag  was  applied.  He  took  milk  and  ice  through  the 
night  without  being  sick.  An  enema  was  given  without 
result. 

The  next  morning  the  swelling  seemed  much  less  tense,  but 
he  had  been  a  little  sick  once  ;  the  vomit  was  composed  of  a 
little  curdled  milk.  Taxis  under  an  anaesthetic  was  tried,  and, 
with  very  little  manipulation,  all  the  swelling  disappeared, 
leaving  the  inguinal  canal  quite  clear.  The  bowel  slipped 
into  the  abdomen  in  the  usual  manner,  but  without  a  definite 
gurgle.  In  the  evening  the  patient  was  quite  comfortable ; 
there  was  neither  pain  nor  sickness,  tongue  clean,  temperature 
98-4°. 

The  next  morning  he  was  ordered  a  truss.  At  12  a.m.  on 
the  same  day,  however,  he  vomited  some  clear  watery  fluid 
after  sucking  ice.  In  the  evening  there  was  some  slight  dis- 
tension of  the  abdomen,  with  tenderness  over  the  situation  of 
the  internal  ring.  The  sickness  had  not  recurred.  Pil.  Opii, 
gr.  i,  given,  and  icebag  reapplied. 

December  29th  (7  a.m.). — Was  slightly  sick  after  iced 
water.  An  enema  returned  without  result.  Abdomen  rather 
distended  and  tympanitic ;  tenderness  and  fulness  of  the 
inguinal  canal.  No  direct  evidence  of  any  fresh  protrusion. 
Tongue  moist,  but  a  little  furred  down  centre.  Temperature 
normal.  In  the  evening  some  leeches  were  applied  over  the 
tender  part. 

30th. — Sick  twice  this  morning,  bringing  up  brownish  sour 
fluid.  Expression  anxious.  Abdomen  more  distended  and 
tympanitic  ;  tenderness  less  marked  ;  legs  not  drawn  up.  As 
improvement  was  taking  place,  and  there  was  evident  obstruc- 
tion, I  decided  to  explore  the  canal ;  and,  at  3  p.m.,  I  cut 
down  antiseptically.  The  sac  was  inflamed  and  thickened, 
and  a  little  clear  fluid  escaped  from  it.  A  small  tag  of 
omentum  was  just  visible  at  the  internal  ring.  On  making 
traction  on  this  a  large  mass  of  omentum  was  drawn  down, 
exhibiting  at  one  point  a  small  patch  of  lymph,  as  if  it  had 
been  lying  against  some  inflamed  structure.  To  make  room, 
I  ligatured  and  removed  the  omentum,  enlarged  the  ring,  and 
introduced  the  finger  into  the  abdominal  cavity.     Discovering 


Cases  of  Abdominal  Surgery.  83 

nothing,  I  then  extended  the  incision  outwards  in  the  abdo- 
minal wall  for  about  two  and  a  half  to  three  inches.  The 
caecum  showed  itself,  was  drawn  down,  and  found  to  be  normal, 
with  the  stump  of  the  removed  omentum  attached  to  it. 
Another  part  of  the  large  intestine  was  then  drawn  down, 
much  changed,  ashy  grey  in  colour,  and  soft,  for  the  extent 
of  about  two  inches  in  length,  and  for  the  greater  part  of  its 
circumference.  The  margin  of  the  bowel  around  was  dark 
and  greatly  congested.  The  caecum  was  returned,  and  the 
part  of  the  bowel  which  seemed  damaged  beyond  recovery  was 
attached  by  its  congested  margin  to  the  edges  of  the  lower 
part  of  the  wound  by  a  number  of  fine  sutures  passed  through 
the  peritoneal  and  muscular  coats.  The  incision  in  the  abdo- 
minal wall  was  then  closed  by  deep  silk  sutures,  and  antiseptic 
dressings  applied.  In  the  evening  the  patient  expressed  him- 
self as  much  more  comfortable.  Temp.  97*4°;  still  sick. 
Subcutaneous  injections  of  morphia  (one  third  of  a  grain)  were 
given  every  six  hours. 

31st. — Temp.  99*8°.  The  dressings  were  removed,  and  the 
bowel,  which  was  not  quite  black,  incised.  Nutrient  enemata 
ordered  every  four  hours.  During  the  next  three  days  the 
patient  greatly  improved,  was  able  to  take  milk  and  stimulants 
by  the  mouth.  The  sickness  ceased,  and  plenty  of  faecal 
matter  escaped  from  the  artificial  opening.  The  abdomen  was 
much  less  distended,  and  the  tenderness  had  disappeared. 

From  this  time  the  man,  though  relieved  of  all  abdominal 
symptoms,  began  to  lose  strength  and  flesh,  notwithstanding 
the  administration  of  brandy,  eggs,  and  strong  beef  tea.  He 
died  on  January  8th,  ten  days  after  the  exploratory  operation. 

A  post-mortem  was  made,  and  the  portion  of  intestine 
opened  was  found  to  be  the  hepatic  flexure  of  the  colon.  The 
adhesions  of  the  edges  of  the  bowel  to  the  wound  were  firm, 
and  the  omental  stump  healthy.  There  was  no  trace  of 
general  peritonitis,  and  the  rest  of  the  intestines  were  quite 
healthy.  The  kidneys,  heart,  and  liver  were  normal.  Lungs  : 
left  upper  lobe  congested,  lower  more  or  less  consolidated, 
mainly  in  patches  in  the  central  part.  The  right  lung  con- 
tained in  the  lower  part  some  irregular  patches  of  consolida- 
tion. 

Remarks,— This  patient   was  admitted    into    hospital   very 


84  Cases  of  Abdominal  Surgery. 

shortly  after  the  commencement  of  symptoms.  He  had 
suffered  from  hernia  for  many  years.  The  strangulation  did 
not  appear  at  all  of  an  acute  character,  and  the  hernia  dis- 
tinctly got  less  tense  with  the  application  of  ice.  Complete 
reduction  was  affected  under  ether  with  great  ease,  and  no 
apprehension  was  felt  as  to  the  result.  All  symptoms 
appeared  to  have  been  relieved. 

On  the  reappearance  of  sickness  and  some  tenderness  about 
the  sac,  I  treated  the  case  as  inflammatory,  but  when  the  signs 
of  obstruction  became  more  decided,  I  determined  to  explore 
the  sac,  thinking  from  the  fulness  about  it  that  possibly 
strangulation  had  recurred,  or  that  the  reduction  had  not  been 
so  complete  as  I  had  imagined. 

Finding,  on  exploration,  that  the  sac  was  really  empty — in 
the  face  of  the  symptoms — I  felt  bound  to  proceed  with  an  ex- 
ploration of  the  abdomen  in  the  neighbourhood  of  the  hernia. 

The  relief  given  by  having  the  piece  of  damaged  bowel 
brought  outside  the  abdominal  cavity  was  very  marked.  By 
waiting  a  few  hours  before  opening  the  bowel,  the  abdominal 
cavity  was  shut  off,  and  peritonitis  was  avoided.  The  abdo- 
minal exploration  had  also  all  the  advantages  of  being  per- 
formed with  antiseptic  precautions.  The  absence  of  general 
peritonitis  was  remarkable,  since  the  bowel  had  actually  become 
gangrenous  within  the  peritoneal  cavity,  and  by  the  operation 
was  just  saved  from  perforation. 

The  case  was  a  tempting  one  for  the  removal  of  the 
damaged  intestine,  but  T  feared  to  attempt  it,  thinking  the 
man  would  best  be  immediately  relieved  by  an  artificial  anus. 
A  peculiar  feature  in  this  case  was  that  bowel  constricted  so 
severely  as  to  lose  vitality  should  have  so  easily  been  reduced 
by  taxis  and  without  rupture. 

Case  4. — Imperforate  rectum  ;   Littre's  operation  ;   death  six- 
teen days  after  operation  from  surgical  kidneys. 

J.  W — ,  male,  aged  two  days,  admitted  January  19th,  1881, 
for  absence  of  aual  orifice.  Child  fairly  nourished,  with  slightly 
jaundiced  complexion,  and  greatly  distended  abdomen.  For 
twenty-four  hours  before  admission  the  infant  had  been  con- 
stantly sick.     No  impulse  of  bowel  could  be  felt  in  the  peri- 


Cases  of  Abdominal  Surgery.  85 

neum.  Chloroform  was  administered,  and  a  catheter  passed 
into  the  bladder.  A  slight  trace  of  meconium  was  observed 
coming  with  the  urine.  An  incision  was  made  in  the  peri- 
neum, and  an  attempt  made  to  find  the  rectum  without 
success.  The  bladder  was  subsequently  carefully  searched  for 
any  communication  with  the  bowel.  An  incision  was  then 
made  in  the  left  groin.  The  small  intestine  first  presented 
itself  in  the  wound,  but  the  sigmoid  flexure  was  easily  found, 
fastened  to  wound,  and  then  opened.  For  the  next  five  days 
all  went  well,  there  was  free  discharge  from  the  artificial  anus, 
first  of  meconium,  and  then  of  ordinary  faecal  evacuation. 
The  abdomen  became  natural,  without  evidence  of  peritonitis, 
and  nourishment  was  taken  well.  Some  prolapse  of  mucous 
membrane  of  the  bowel  then  took  place,  and  the  child  began 
to  emaciate,  nourishment  was  ill  borne,  and  the  urine  became 
offensive  and  contained  some  purulent  matter.  Death  occurred 
on  February  16th,  sixteen  days  after  the  operation. 

A  post-mortem  examination  was  made.  The  sigmoid 
flexure  was  found  firmly  adherent  to  the  wound  in  the  groin. 
On  injecting  water  into  the  bowel  it  was  seen  to  issue  by  a 
fine  stream  from  the  penis.  The  wound  in  the  perineum  was 
still  open,  and  led  up  to  a  mass  of  fat  in  the  pelvic  cavity. 
The  rectum  was  found  to  be  somewhat  dilated  towards  its 
extremity,  turning  forwards  anteriorly,  and  ending  in  the  floor 
of  the  urethra,  just  anterior  to  the  veru-montanum,  by  a  com- 
munication the  size  of  a  crow-quill.  The  mucous  membrane 
of  the  bowel  being  continuous  with  that  of  the  urethra.  The 
mucous  membrane  of  the  bladder  was  rather  injected.  The 
kidneys  were  large;  the  left  contained  numerous  small,  scattered 
abscesses,  and  in  the  right  were  also  a  few  small  points  of 
suppuration.  No  trace  of  peritonitis  was  found,  and  the 
remaining  viscera  were  healthy. 

Remarks. — The  cause  of  death  was  evidently  surgical 
kidney,  secondary  to  the  irritation  caused  by  the  presence  of 
faeces  in  the  bladder,  combined  with  the  irritation  produced  by 
the  exploration  of  the  bladder  in  the  attempt  to  find  the 
communication  with  the  rectum. 

Beyond  the  slight  discharge  of  some  meconium  which  had 
collected  in  the  bladder,  the  child  for  the  first  few  days  had 
apparently  no  urinary  trouble,  and  the  sequence  in  so  young  a 


86*  Cases  of  Abdominal  Surgery. 

subject  of  kidney  mischief  I  was  not  at  all  prepared  to  expect, 
and  did  not  make  any  effort  to  cleanse  the  bladder. 


Case  5. — Acute  intussusception ;  manipulation ;  recovery. 

G.  G — ,  male,  aet.  4£,  admitted  April  24th,  1881,  under  Dr. 
Stone.  Early  on  the  morning  of  admission  the  child  had 
a  constant  desire  to  pass  a  motion,  and  after  some  hours  passed 
with  much  pain  a  semi-solid  evacuation.  The  symptoms 
of  abdominal  uneasiness  began  at  6  a.m.,  the  motion  was  passed 
at  ]  1  a.m.  By  the  mother's  statement  the  child  then  became 
cold  and  seemed  in  agony.  No  blood  or  discharge  was 
noticed  with  the  motion.  In  the  afternoon  he  was  brought 
to  the  hospital.  When  seen  by  Dr.  Acland,  the  house  physi- 
cian, the  child's  face  was  pinched  and  pale,  the  extremities 
cold,  the  legs  flexed,  the  abdominal  walls  tense,  and  an  elon- 
gated tender  mass  was  felt  in  the  left  hypochondrium,  extend- 
ing through  the  left  lumbar  and  iliac  regions.  Shortly  after- 
wards vomiting  occurred,  associated  with  much  rectal  tenesmus, 
and  the  passage  of  blood  and  mucus.  In  the  rectum,  about 
one  and  a  half  inch  from  the  anal  aperture,  a  soft  mass  could 
be  felt  with  a  distinct  central  orifice,  and  on  withdrawal  of  the 
finger  a  discharge  of  blood  and  mucus  occurred.  At  6  p.m., 
twelve  hours  after  the  first  symptoms,  I  was  requested  by  Dr. 
Gulliver  to  try  inflation  of  the  bowel  with  air.  This  was 
attempted  under  chloroform,  but  at  first  entirely  failed.  The 
child  was  then  suspended  by  the  heels  and  gentle  manipula- 
tion (with  one  finger  in  the  rectum,  and  the  hand  grasping  the 
tumour  in  the  iliac  fossa)  was  tried.  The  swelling  under  the 
taxis  receded,  so  as  to  be  only  perceptible  at  the  splenic 
flexure,  but  could  not  be  made  to  travel  further  by  manipula- 
tion. Inflation  with  air  was  now  again  resorted  to,  and  the 
swelling  was  visible  travelling  round  to  the  csecal  region,  and, 
on  continuance  of  gentle  inflation,  the  whole  abdomen  was  soon 
uniformly  distended  with  air,  and  all  trace  of  localised  swelling- 
lost.  The  child  slept  for  two  hours  after  the  chloroform,  and 
was  then  given  an  enema  of  starch  and  opium.  He  made  an 
uninterrupted  recovery,  passing,  however  (after  taking  solid 
food  for  the  first  time),  a  little  blood  with  the  motion  on  the 
fourteenth  day.      The  child  was  in  consequence  kept  a  little 


Cases  of  Abdominal  Surgery.  87 

longer  on  fluids,  but  left  the  hospital  quite  well  on  May 
12th. 

Remarks. — The  very  completeness  of  the  intussusception  in 
this  case  rendered  the  application  of  taxis  almost  as  definite  as 
for  the  reduction  of  a  hernia.  Under  chloroform  the  swelling 
could  be  picked  up  with  the  fingers,  and  the  sudden  slipping 
upwards  of  the  invaginated  portion,  gave  the  sensation  of  the 
reduction  of  a  hernia,  but  with  an  absence  of  gurgling. 

Probably  a  few  hours  more  delay  in  bringing  the  case  to 
the  hospital  would  have  rendered  reduction  by  manipulation 
impossible.  And  I  certainly  did  not  in  this  case  expect  that 
reduction  would  have  so  easily  been  effected. 

When  the  child  was  straining  before  the  administration  of 
chloroform,  the  intussusception  was  almost  presenting  at  the 
anus.  Inflation  alone  had  very  little  chance  of  success,  as 
there  was  no  room  for  the  proper  introduction  of  the  tube  into 
the  rectum. 

Case  6. — Unusually  large  femoral  hernia  with  symptoms  of 
strangulation ;  reduction  by  operation  of  six  feet  of  intes- 
tine ;  radical  cure  ;  recovery. 

William  P — ,  set.  45,  baker.  Admitted  August  20th,  1881, 
with  a  large  femoral  hernia,  irreducible,  and  apparently 
strangulated. 

Patient  had  had  a  hernia  for  fifteen  years.  When  first 
noticed  it  was  about  the  size  of  a  nut,  and  could  be  reduced. 
It  gradually  increased  in  size  and  became  irreducible.  For 
the  last  eight  years  it  has  remained  about  the  same  size.  The 
hernia  was  always  a  little  smaller  when  he  was  lying  down. 
He  had  never  worn  a  support  or  truss,  and  he  never  had  pain 
in  the  hernia  before. 

Patient  stated  that  at  11.30  a.m.,  whilst  at  work,  he  was 
seized  with  severe  pain  in  the  abdomen,  radiating  from  the 
upper  part  of  the  neck  of  the  hernia.  He  swallowed  a  dose 
of  castor  oil,  but  was  immediately  sick.  On  admission  he 
had  very  violent  pain  at  the  neck  of  the  sac,  extending  towards 
the  umbilicus.  The  tumour  was  rather  larger  than  a  man's 
head,  tympanitic  in  part,  not  tense,  and  there  was  no  impulse 
on   coughing.     There  was  a  hard  tender  swelling  at  the  neck 


88  Cases  of  Abdominal  Surgery. 

of  the  sac,  quite  different  in  character  to  the  rest  of  tha 
tumour.  A  slight  gurgling  sound  was  heard  on  manipulation 
at  the  lower  part  of  the  sac.  The  acute  pain  was  relieved  by 
a  subcutaneous  injection  of  morphia.  Several  icebags  were 
applied  over  the  hernia,  and  a  simple  enema  administered 
without  result. 

August  21st. — The  severe  griping  pain  had  left  him,  but 
there  still  remained  much  tenderness  about  the  neck  of  the 
sac.  Small  quantities  of  milk  were  retained  by  the  stomach. 
Injections  of  morphia  were  given  during  the  day,  and  at  night 
an  enema  of  castor-oil  was  administered,  which  was  followed 
by  the  evacuation  of  some  faecal  matter. 

22nd. — Patient  looking  anxious.  More  tenderness  about 
the  neck  of  the  sac ;  abdomen  a  little  more  distended ; 
swelling  at  the  neck  of  the  sac  harder  and  more  distinct.  As 
there  was  evidently  some  localised  mischief  at  the  neck  of  the 
sac  it  was  determined  to  operate  at  once.  At  11  a.m.  I  tried 
taxis  under  ether  without  any  alteration  taking  place  in  the 
tumour.  The  hernia  was  then  very  carefully  washed  with  car- 
bolic soap.  An  incision  was  then  made  under  the  spray  over  the 
neck  of  the  sac,  and  as  relief  was  not  obtained  the  sac  was 
opened.  About  one  pint  of  turbid  serum  escaped.  The 
incision  was  prolonged  down  to  the  bottom  of  the  sac.  The 
contents  were  the  caecum  and  ascending  colon,  together  with 
5  or  6  feet  of  small  intestine,  and  a  large  quantity  of  omentum, 
which  was  adherent  to  the  bottom  of  the  sac.  Part  of  the 
omentum  was  inflamed  and  pressing  against  the  caecum.  The 
intestines  were  considerably  injected.  The  opening  at  the 
crural  ring  admitted  two  fingers,  it  was  slightly  enlarged  with 
the  hernia  knife.  I  then  removed  a  very  considerable  quantity 
of  omentum,  ligaturing  it  close  to  the  caecum,  in  several  places, 
with  stout  silk.  By  patient  manipulation  of  about  twenty 
minutes  the  intestines  were  all  returned  into  the  abdominal 
cavity.  The  sac  was  dissected  out,  during  which  a  large 
number  of  vessels  required  ligaturing.  The  portion  of  sac 
removed  measured  26  inches  in  circumference,  and  was  very 
thick  and  cartilaginous  in  places. 

A  radical  cure  was  now  attempted,  by  passing  a  number  of 
stout  catgut  ligatures  through  the  cut  edges  of  the  sac,  and  by 
this  means  the  abdominal  cavity  was  shut  off.    A  large  portion 


Cases  of  Abdominal  Surgery.  89 

of  redundant  skin  was  removed  (28  inches  in  circumference), 
drainage  tube  introduced,  and  the  wound,  which  was  8  or  9 
inches  in  length,  brought  together  by  silk  sutures.  Antiseptic 
dressings  were  then  applied.  The  patient  suffered  a  good 
deal  from  shock  for  the  first  few  hours  after  the  operation, 
but  in  the  evening  he  rallied,  and  appeared  quite  comfortable. 
He  has  had  no  abdominal  disturbance  since  the  operation. 
Antiseptics  were  left  off  on  August  29th. 

Sept.  3rd  (twelve  days  after  operation). — The  bowels  have 
been  open  naturally.  Patient  is  taking  ordinary  diet.  Abdo- 
men free  from  distension  or  para ;  wound  looking  well ;  a 
good  deal  of  discharge  from  the  lower  part.  Temperature 
normal. 

Oct.  13th. — Patient  convalescent. 

Remarks. — I  have  recorded  this  case  because  from  the  size 
of  the  hernia  the  operation  amounted  to  an  abdominal  ex- 
ploration. The  operation  was  performed  at  an  earlier  period 
than  is  usually  recommended,  considering  the  size  of  the 
hernia,  and  that  no  very  urgent  symptoms  were  present. 
There  was,  however,  very  definite  local  mischief  about  the 
neck  of  the  sac,  and  the  patient  was  not  improving.  I  felt 
that  if  the  operation  was  postponed  until  the  patient  was  more 
exhausted  he  would  have  a  much  worse  chance  of  recovery. 

About  one  year  and  a  half  ago  it  fell  to  my  lot  to  have 
charge  of  a  case  of  femoral  irreducible  hernia,  of  about  the 
same  size,  in  a  woman.  The  operation  was  delayed  for  several 
days  because  there  was  gurgling  to  be  felt  in  the  tumour,  and 
was  only  determined  upon  when  vomiting  became  urgent. 
Death  occurred  a  few  days  afterwards  from  exhaustion. 

The  rate  of  mortality  after  operation  in  very  large  hernias, 
umbilical  or  otherwise,  is  very  high,  and  is  clearly  dependent 
more  on  delayed  operation  than  on  the  acuteness  of  the 
symptoms.  The  surgeon  fears,  in  fact,  to  have  a  large 
quantity  of  intestines  exposed,  but,  considering  how  tolerant 
the  abdominal  cavity  is  of  gentle  and  cleanly  manipulation 
and  the  sense  of  security  that  one  feels  in  hospital  practice 
now — by  the  use  of  antiseptic  precautions — I  believe  that  most 
surgeons  would  agree  that  interference  should  not  be  delayed 


90  Cases  of  Abdominal  Surgery. 

in  these  cases,  when  it  is  certain  that  distinct  local  mischief 
is  going  on  in  the  hernia. 

It  is  of  great  after  advantage  to  the  patient,  when  the  sac 
has  been  opened,  not  only  to  relieve  the  condition  for  which 
the  operation  was  performed,  but  to  endeavour  to  evacuate 
the  whole  contents  of  the  sac,  and  thus  to  relieve  him  from 
the  burden  of  an  irreducible  hernia. 

The  radical  cure  as  attempted  certainly  very  much  lessens 
the  tendency  of  the  hernia  to  recur,  and  enables  the  man  to 
wear  a  much  lighter  form  of  truss ;  but  further,  the  shutting 
off  in  this  way  of  the  abdominal  cavity,  must  have  a  very 
important  influence  on  the  chance  of  recovery.  The  rapid 
adhesion  of  the  peritoneal  surfaces  to  one  another,  prevents  in 
a  great  measure  the  possibility  of  any  septic  process  gaining 
access  to  the  abdominal  cavity,  and  thus  in  a  short  time  after 
the  operation  complete  antisepsis,  which  is  so  difficult  or 
impossible  to  maintain  for  any  length  of  time  in  this  situation, 
becomes  a  matter  of  secondary  importance. 


ANALYSIS  OF,  AND  REMARKS  ON, 


THIBTY-ONE  CASES  OE  ENTEEIG  EEVEB 


TREATED  IN  ST.  THOMAS'S  HOSPITAL  DURING  THE  PAST 

YEAR. 


SEYMOUR  TAYLOR,  M.D.  Abeed.,  M.R.C.P.  Lond., 

DEMONSTRATOR  OF   ANATOMY. 


Of  31  cases  of  enteric  fever  admitted  into  St.  Thomas's  during 
the  eight  months  from  August,  1880,  to  March,  1881,  4  were 
treated  by  Dr.  Bristowe,  8  by  Dr.  Stone,  12  by  Dr.  Ord,  and 
by  Dr.  Harley. 

Table  I. — Shows  the  admissions  for  each  month. 


August    . 
September 
October  . 

.  4 
8 
6 

November 

10 

December 

0 

January 
February 
March     . 

2 
0 
1 

31 


We  have  again  to  note  the  prevalence  of  the  fever  during  the 
month  of  November,  and  also  a  remarkable  absence  or  diminu- 


92 


Analysis  of,  and  Remarks  on, 


tion  of  cases  during  the  succeeding  four  months.  The  fre- 
quency of  the  fever  during  November  is  in  accordance  with  our 
figures  of  last  year,  but  it  is  contrary  to  the  experience  of  the 
London  Fever  Hospital,  which  records  a  slight  preponderance 
of  cases  in  October. 

Sex  and  age. — The  sexes  of  our  cases  were  equally  divided, 
16  being  females  and  15  males.  As  regards  age,  the  youngest 
was  9,  the  eldest  40,  both  in  females. 


Table  II. — Ages  of  patients. 


Under  5 
years. 

5  to  10 
years. 

10  to  15 
years. 

15  to  20 
years. 

20  to  30 
years. 

30  to  40 
years. 

40  to  50 
years. 

0                2 

10 

8 

9 

2 

0 

=  31. 


The  mean  age  of  the  38  cases  was  19  years,  individually 
for  females  19*7,  for  males  18*5. 

The  preceding  table  shows  the  remarkable  and  well-known 
prevalence  of  the  fever  amongst  persons  under  30  years  ;  thus, 
29  out  of  the  31  are  under  that  age,  or  over  93  per  cent.  We 
had  no  case  admitted  under  5  years,  or  over  40. 

Deaths. — Three  patients  died,  all  of  them  being  males.  The 
death-rate  thus  amounted  to  9'6  per  cent.,  or  1  in  10£  cases. 
This  mortality  rate  is  more  favourable  than  in  any  of  the  four 
years  we  have  analysed  the  typhoid  epidemics;  but,  as  the 
number  of  cases  this  year  is  considerably  smaller  than  hitherto, 
the  statistics  on  this  heading  are  manifestly  of  little  value  by 
themselves. 

The  ages  of  those  who  died  were  12,  21,  and  25  respectively, 
the  fatal  termination  happening  on  the  thirty-fourth,  thirty- 
fifth,  and  thirteenth  day  of  fever. 

The  post-mortem  examinations  revealed  perforation  in  two 
cases,  whilst  the  third  was  complicated  with  contracted  granular 
kidneys. 

On  carefully  examining  the  notes  of  onset  of  illnesses,  we 
have  again  to  draw  attention  to  the  sudden  commencement  of 
the  disease.  The  fever,  in  the  great  majority  of  our  cases,  did 
not  come  on  gradually ;  but,  on  the  other  hand,  patients  were 
able  to  accurately  fix  the  date  of  their  seizure.     The  modes  of 


Thirty-one  Cases  of  Enteric  Fever. 


93 


onset  were  various,  and  although  the  histories  of  the  majority 
of  our  cases  failed  to  record  a  prostrating  character  of  com- 
mencement, still  its  date  was  very  reliably  fixed,  whether  by 
rigors,  or  by  vomiting,  or  by  belly  pains,  or  by  diarrhoea. 

The  following  table  (III)  will  show  the  duration  of  illness 
previous  to  admission  : 

In  3  cases,  5  days  and  under. 


„14 

„  8 
»  4 
„    2 

31 


6  to  10  days. 
11  „  15     „ 
21  „  30    „ 

the  date  of  origin  is  doubtful. 


Total  duration  of  illness. — The  average  duration  of  febrile 
condition  was  practically  five  weeks  (four  weeks,  six  days). 
But  it  must  be  borne  in  mind  that  this  statement  is  made  only 
from  those  cases  which  recovered,  and  which  were  not  compli- 
cated by  relapse,  thus  eliminating  any  possible  extremes  caused 
by  early  death  or  prolonged  relapses.  The  termination  of  the 
fever  is  fixed  at  that  period  when  the  morning  and  evening 
temperatures  were  normal  for  two  successive  days. 

Table  IV. — Duration  of  febrile  state  in  28  cases  of  recovery  ; 
stated  in  weeks. 


Recovery  in  3rd  week 

1 

Recovery  in  7th  week 

.   3 

4th  „ 

.   5 

8th  „ 

.   2 

5th  „ 

.  10 

11th  „ 

1 

„     6th  „ 

.   5 

12th  „ 

1 

The  seven  cases  in  which  convalescence  did  not  occur  till 
after  the  sixth  week  were  all  well-marked  cases  of  relapse. 
The  case  in  which  fever  was  prolonged  into  the  twelfth  week 
was  possibly  a  good  example  of  secondary  relapse,  which 
occurred  in  the  ninth  week,  with  renewed  eruption,  but  asso- 
ciated with  congestion  of  the  bladder  and  pleurisy. 

Of  the  three  fatal  cases  the  onset  was  accurately  fixed  in  two  ; 
in  the  third  it  is  stated  approximately.  Thus,  death  oc- 
curred : 


94 


Analysis  of,  and  Remarks  on, 


on  the 


and  on  the 


13th  (about) 

34th 

35th 

5th 

11th 

28th 

day  of  fever, 
day  of  residence. 


The  mean  length  of  residence  in  the  hospital  was  nearly  eight 
weeks  (53'8  days).  Three  patients  were  presented  in  the  fifth 
week,  2  in  the  sixth,  4  in  the  seventh,  7  in  the  eighth.  The 
shortest  period  of  residence  in  cases  other  than  fatal  was  twenty- 
seven  days  ;  the  opposite  extreme  was  the  case  of  double  relapse 
before  mentioned,  and  who  remained  149  days  under  treat- 
ment. 

Eruption. — The  typical  rash  was  observed  on  admission  in 
19  cases,  which  are  classified  below  as  regards  the  date  of 
appearance  of  eruption  and  its  duration. 

Table  V. — Spots  were  present  on  the  day  of  admission. 

In  2  cases  on  the  7th  day,  lasting  5  and  9  days  respectively. 


„  4 

8th     , 

,  „  1,  5,  6  (fatal),  and  42  days  respectively.  This 
last  was  a  relapse. 

„  3 

9th     , 

,        „        1  (fatal),  8,  and  32  days  respectively. 

H 

10th     , 

„       1  day. 

»    1 

11th     , 

,        „      58  days.     A  double  relapse. 

„    1 

12th     , 

»      18     „ 

„    1 

13th     , 

,        „       7    „ 

„  3 

15th     , 

,  ,,  4, 14,  and  19  days  respectively,  the  last  being 
a  relapse. 

,.  1 

21st     , 

(about),  lasting  4  days. 

>,  1 

22nd    , 

,     lasting  3  days. 

„  1 

24th     , 

,         „       5     „     (fatal). 

The  above  figures  speak  for  themselves.  They  are  not,  of 
course,  conclusive  upon  which  to  establish  statistics  as  to  date  of 
appearance  and  duration  of  spots,  since  the  eruption  was  present 
on  admission.  They  show,  however,  that  the  rash  may  be 
present  at  a  very  late  period,  even  after  the  third  week,  unless 
we  look  upon  those  cases  with  eruption  after  the  twenty-first 
day  as  probable  relapses,  a  supposition  which  the  histories  of 
their  previous  illnesses  by  no  means  warrants. 


Thirty -one  Cases  of  Enteric  Fever.  95 

Table  VI. 

On  the  other  hand,  the  rash  appeared  after  admission  in 
seven  cases,  thus  : 

In  1  case  on  the  7th  day,  lasting  29  days.     A  relapse. 

„  1  „         11th     „  „        2     „ 

„  2  „        12th     „  „        5  and  7  days  respectively. 

„  1  »         13th     „  „        3  days. 

,    1  „        22nd    „  „        3     „        Not  a  relapse. 

„  1  „         28th     „  „        4    „         In  a  relapse. 

The  average  date  of  appearance  of  rash  in  those  cases  in 
which  it  was  observed  on  admission  was  on  the  twelfth  day. 
This,  of  course,  may  be  fallacious,  as  we  have  no  means  of 
ascertaining  whether  spots  were  present,  and,  if  so,  at  what  date, 
prior  to  the  patient's  coming  into  the  hospital.  On  the  other 
hand,  the  second  table,  showing  the  date  the  eruption  appeared 
subsequent  to  admission,  is  free  from  the  above  objection.  We 
find  that  in  the  seven  such  cases  the  average  date  of  first  erup- 
tion was  the  fifteenth  day,  appearing  in  the  earliest  case  on  the 
seventh  day  and  lasting  twenty-nine  days,  and  in  the  latest  on 
the  twenty-eighth  day  and  lasting  four  days.  This  was  during 
a  relapse,  there  having  been  no  spots  during  the  primary  fever. 

Besides  the  above,  in  5  cases,  or  16*1  per  cent,  there  was  no 
appearance  of  rash  during  their  stay  in  the  hospital.  Of  these 
five,  two  were  admitted  during  the  first  week  of  their  illness,  and 
one  each  in  the  third,  fourth,  and  fifth  weeks.  It  is  more  than 
possible  that  in  the  latter  three  cases  the  eruption  may  have 
been  present  before  they  came  under  hospital  observation.  Of 
the  five  cases  without  rash  four  were  females,  one  male ;  none 
of  them  died.  These  figures  would  seem  to  point  to  an  error  in 
the  theory  that  spots  are  more  frequent  in  young  children 
and  females  ;  or,  in  other  words,  that  the  rash  is  best  marked 
in  such  patients  who  have  delicate  skins.  The  respective  ages 
of  these  five  patients  were  11,  15,  17,  18,  30  years. 

In  Case  10  there  appeared  at  the  end  of  the  twelfth  week  an 
eruption  resembling  the  tache  bleuatre  of  French  authors,  with 
the  exception  that  it  was  elevated  above  the  surrounding  skin. 
This  was  the  prolonged,  double-relapse  case  of  Dr.  Harley's. 

Temperature. — On  the  two  following  pages  are  tabulated  the 
average  temperatures  for  morning  and  evening,  together  with 


9G  Analysis  of,  and  Remarks  on, 

their  variations,  of  the  31  cases,  thus  showing  the  course  of 
fever  in  the  different  patients. 

The  number  of  cases  of  hyperpyrexia  were  very  few  ;  hence 
the  use  of  the  graduated  bath  has  been  limited  in  this  year's 
epidemic.  For  example,  in  ten  cases  only  (almost  one  third),  of 
which  two  were  fatal,  did  the  thermometer  register  105°  Fahr., 
and  in  only  three  of  these  did  the  fever  rise  above  this  point. 
The  highest  recorded  temperature  was  105*6°,  which  occurred 
on  the  seventeenth  day  of  the  disease.     The  patient  recovered. 

A  highest  temperature  of  104°  and  below  105°  was  frequent, 
namely,  in  13  cases,  or  nearly  a  half,  with  one  death ;  whilst 
temperatures  between  102°  and  104°  included  8  cases,  or  over  a 
fourth.  There  were  no  highest  evening  temperatures  below  102°. 

In  12  cases,  or  38'7  per  cent.,  the  highest  point  of  the  fever, 
so  far  as  was  observed  by  us,  occurred  on  the  day  of  admission. 
This  is  a  point  to  which  we  have  drawn  attention  in  previous 
years,  and  upon  which  we  shall  dilate  at  a  future  period  in  our 
digest  of  the  last  three  year's  epidemics. 

On  the  other  hand,  very  low  morning  temperatures  were  fre- 
quent, for  we  find  one  with  a  record  of  94°,  five  with  95°,  and 
sixteen  with  96° ;  or,  in  other  words,  21  cases  whose  lowest 
morning  temperatures  were  between  94°  and  96°.  Only  one 
of  these  was  fatal,  a  boy,  aged  twelve  years,  in  whom  the 
temperature  suddenly  fell  from  102'4°  to  96*8°  at  the  date  of 
perforation  of  the  bowel. 

"Whilst  on  this  subject,  we  think  that  sufficient  attention  has 
not  been  given  to  convalescence  temperatures.  It  is  an 
acknowledged  fact  that,  in  fevers  terminating  by  crisis,  such 
crisis  is  generally  in  the  form  of  a  sudden  fall  of  temperature 
from  previous  fever  heat  to  a  normal  or  even  subnormal  range. 
But  we  find  that  such  is  frequently  the  case  in  enteric  fever 
— that  is  to  say,  not  unfrequently  we  have  met  cases  in  which 
there  is  a  sudden  fall,  often  amounting  to  5°  or  6°,  and  once  to 
10°,  and  without  perforation,  or  haemorrhage,  or  diarrhoea,  to 
account  for  such  a  fall.  There  may  have  been  a  sweating,  or 
in  one  case  severe  delirium,  and  even  a  diarrhoea,  to  mark  this 
crisis,  but  that  such  phenomena  are  of  a  critical  nature  is  proved 
by  the  temperature  showing  no  reactionary  return  above,  or 
only  slightly  above,  the  normal  range. 

Besides  this,  our  figures  lead  us  to  the  conclusion  that  such 


Highest  Lowest 

evening  morning 

temperature.      !  temperature. 


10 


13 


1-1 


104-6,  day  of 

admission,  8th 

103  6,  day  of 

admission,  8th 

104-8,  23rd 

104-4,  day  of 

admission,  12th 

103-6,  13th 

104-0,  25th 

1050, 11th 

105-0,  24th 


1050,  day  of 
admission,  15th 

105-0,  59th,  or 
3rd  of  relapse 


104-8, 19th 
105-2,  34th 


105-0,  32nd,  or 
10th  of  relapse 

105-0,  9th 


15     104-4,  25th 


960,  23rd 

96-8,  15th 

97-2,  32nd 
96-2,  42nd 

97-2,  26th 
96-4,  35th 
962,  22nd 

95-0,  25th 


96-8,  26th 


95-8,  69th, 
or  13th  of 

relapse 

97-8,  38th 
98-6,  35th, 
day  of  death 


96-8, 47th, 
or  25th  of 

relapse 
96-0,  35th 

96-4,  48th 


1st  week, 
average. 


100-0 


100-0 


103-2 


3-2 


103-1  3-1 


2nd  week, 
average. 


M. 


991 

102-0 

101-2 

102-0 

99-6 


101-8 


101-7 


99-4 

99-6 
100-1 


102-7 

103-5 
102-5 
104-6 
102-9 


103-9 


1039 


102-1 

103-5 
103-3 


3rd  week, 
average. 


M. 


2-1 


2-2 


2-7 


3-0 


97-5 
100-2 

99-8 

99-9 

998 

101-8 

101-3 

99-2 


102-6 
102-5 


E. 


100-0 
101-6 

102-2 
101-6 

102-5 


4tli  week, 
average. 


M. 


104-0  2-2 


103-6 
101-9 


1043 

104-4 


98-0 


97-6 


3-2   986 


101-1 

100-9 
102-9 


2'3 


2-7 


3-1 


3-3 


970 

97-4 

100-8 
99-1 


981 
99-7 
96-8 

98-5 


E. 


96-8 

98-2 

103-1 
102-3 

99  2 


99-7  102-6 
98-8 


97-9 
100-4 


102-0 
102-6 


101-5 


99-2 


102-8 


100-4 
102-6 


103-5 
104-2 


102-8 


101-2 


4-3  102-6 104-0 


2£ 

2-2 


1-5 

1-G 


1-3 

2-0 

1-4 


Thirty-one  Cases  of  Enteric  Fever. 


96* 


Hialiest 
evening 

temperature 


104-6,  day  of 
admission,  8th 

103-6,  day  of 

admission,  8th 

104-8,  23rd 

111  1),  ,l:iv  Of 

admission,  12th 
103-6,  13th 
1040,  25th 
1050, 11th 

105-0,  24th 


1050,  day  of 
admission,  15th 


105-0,  59th,  or 
3rd  of  relapse 


104-8, 19th 
1052,  34th 


105-0,  32nd,  or 
10th  of  relapse 


105-0,  9th 
104-4,  25th 


Lowest 
temperature 


96-0,  23rd 

96-8,  15th 

972,  32nd 
96-2,  42nd 

97-2,  26th 
96-4,  35th 
96-2,  22nd 


95-8,  69th, 
or  13th  of 

relapse 

97-8,  38th 
98-6,  35th, 
day  of  death 


96-8, 47th, 
or  25th  of 

relapse 
96-0,  35th 

96-4,  48th 


104-0,  day  of    96-2,  51st 
admission,  8th 

104-6,  day  of  |  94'0,  27th 
admission,  10th 

105-0, 12th     100-8,  10th 


102-6,  20th 
104-6,  9th 

1052,  11th 
103-8,  11th 
104-4,  day  of 
idmission,  8th 
J02-2,  day  of 

admission,  10th 

101-6,  15th  day 
103  6,  day  of 

admission,  15th 
1040,  day  of 

admission,  24th 

103-8,  day  of 

admission,  8th 

104-8,  day  of 

admission,  29th 

105-6, 17th 

103-8,  8th 


97-0,  28th 
96-6,  20th 

96-2,  26th 
95-0,  26th 
95-8,  25th 

95-4,  24th 

96-2,  28th 
96-6,  34th 


96-2,  19th 
970,  46th 


97-6,  41st 
98-0,  24th 


102-0 
101-2 
102-0 


103-5 
102-5 
104-6 
102-9 


99-6 

1001 

101-2 
101-5 

101-9 


103-5 
103-3 


103-7  2-5 
103-4  1-9 
103-81-9 


102-2 
101-0 
100-8 


104-5 
103-2 
1036  2-8 


100-0 
101-6 

102-2 
101-6 
102-5 
104-0 


1013 
2 


1026 
102-5 


2-5    97  0 
97-4 


Kins 
99-1 


103-0 
101-9 


104-a 

1044 


100-9 
102-9 


102-9  30 
102-42-4 


98-7  100-9  2-2 
989  1020i3-l 


looi 

1 1  ii  IT, 
98-2 


103-6  3-2 
102-92-4 
102  0  3-8 


5 
102-2 


102-7 
99-4 


103-1 

102-3 


1-1    98-1 
102-6  2-9   99-8 
2-0    97-1 


97'9 

100-4 


102-0 
102-6 


100-4 
102-6 


103-5 
104-2 


101-2 
104-0 


100-2 
99-3 


98-51-0 
102-2  3-6 


102-5 
101-2 


980 
100-8 


104-2 
1040 


98-8 100-5 
99-8 102-9 


99-0 

101-6 


103-1 
1023 


104-9  2-2  101-9 
10202-6    97-0 


102-9 
973 


103-0 
103-3 


97-3 

101-5 


100-0 
100-5 


101-6 
5 


103-6 
101-3 

99-3 


98 
98-3 


100-7 
102-2 


99-6 
101-3 
99-9 


M.       E.      V 


97-8 


07-9 
97-0 


lltli  week, 
average. 


The  variation  in    the  5th   week  was 
due  to  orchitis. 


Slight  relapse  in  the  5th  week. 


A  fall  in  the  average  of  3rd  week  was 
associated  with  hemorrhage. 

There  was  in  the  5th  week  a  sudden 
immense  fall  of  temperature  from 
105°  to  95°,  with  no  haemorrhage 
or  diarrhoea,  but  marked  delirium 
and  subsequent  low  temperatures. 

A  relapse  occurred  in  the  5th  week, 
hyperpyrexia  being  treated  with 
graduated  baths.     Good  results. 

A  relapse  in  the  5th  week,  but  with 
no  fresh  spots ;  a  second  relapse  i: 
the  9th  week,  with  fresh  spots  and 
renewed  delirium. 

The  temperature  was  controlled  in  the 
2nd  and  3rd  weeks  by  graduated 
baths,  and  in  the  4th  and  5th  weeks 
by  cold  sponging.  The  great  fall 
of  temperature  on  day  of  death 
probably  denoted  perforation,  which 
was  verified  by  p.m.  examination 

Relapse  in  the  4th  week,  commencing 
on  23rd  day,  with  fresh  spots. 

Relapse  in  the  4th  week,  commencing 
on  the  24th  day  with  fresh  spots. 

A  relapse  occurred  in  the  4th  week, 
with  fresh  spots,  and  a  marked 
recrudescence  in  the  9th  week. 
Temperature  controlled  by  spong- 
ing. 

Relapse  at  end  of  4th  week. 


Death  on  13th  day.  P.m.  showed 
collapse  of  lungs  and  early  inter- 
stitial nephritis. 

Complicated  by  abortion  on  the  20th 
day  of  fever. 


Death  on  the  34th  day  from  perfora- 
tion, hence  low  averages  of  tempe- 
rature in  the  5th  week. 


Admitted   during   5th 
declining. 


M.  Morning.     E.  Evening.     V.  Variations. 


Thirty -one  Cases  of  Enteric  Fever.  97 

falls  of  temperature  below  normal  during,  or  at  the  date  of 
commencement  of  convalescence,  is  generally  indicative  of  a 
prolonged  severe  attack  if  seen  in  adults,  but  that  it  is  an  espe- 
cially well-marked  feature  in  young  subjects ;  nay,  that  it  is 
perhaps  the  rule  rather  than  the  exception  in  such  patients. 
We  have  frequently  been  able  to  recognise  an  enteric  tempera- 
ture paper  by  its  presenting  towards  its  end  a  frequency  of 
figures  ranging  from  94°  to  97-5°  Fahr.  To  be  more  exact, 
we  have  taken  a  mean  of  averages  of  morning  and  evening 
temperatures  in  12  such  cases  during  the  first  week  of  con- 
valescence, and  we  find  that  the  evening  temperature  averaged 
97*5°,  the  morning  96-8°;  and  that  the  average  age  of  the 
12  to  have  been  seventeen  years,  although  it  includes  one 
patient  who  was  forty  years  old,  but  in  whom  the  fever  process 
was  continued  by  relapses  over  twelve  weeks'  duration. 

Pulse. — There  is  nothing  exceptional  to  be  observed  this  year 
about  the  pulse-rate.  Most  of  the  facts  recorded  in  previous 
years  may  again  be  noted.  Thus,  in  twelve  cases,  or  38*7  per 
cent.,  the  greatest  frequency  of  pulse  was  on  the  day  of  admis- 
sion. This  exactly  corresponds  in  number  with  that  of  highest 
temperatures  on  the  day  of  admission ;  and  further,  of  the 
twelve  individual  cases  which  presented  the  highest  fever  on 
admission,  no  fewer  than  eight  of  them  also  had  a  highest 
pulse-rate  on  the  same  day.  This  again  confirms  our  sus- 
picion that  removal  of  patients  to  a  hospital  is  a  strong  factor 
in  producing  constitutional  disturbance  and  apparent  high  fever. 

In  only  four  cases  was  the  highest  pulse  noted  below  100 ; 
the  lowest  rate  of  them  being  72  in  a  man  aged  37.  A  pulse  of 
between  100  and  120  was  observed  in  twelve  cases,  and  of 
between  120  and  140  in  ten  cases,  of  which  one  was  fatal. 

A  pulse-rate  of  140  and  upwards  included  four  cases  with 
two  deaths;  the  greatest  frequency  being  156,  which  rate 
occurred  twice. 

In  the  three  fatal  cases  the  rate  of  pulse  amounted  to  126, 
144,  and  150  respectively. 

We  take  it  as  indicative  of  the  mildness  of  last  year's 
epidemic  that  in  only  two  patients  was  the  systole  at  all  defi- 
cient in  power  or  tone.  Reduplication  of  the  first  or  second 
sounds  happened  occasionally  in  the  cases  which  were  compli- 
cated with  lung  or  renal  mischief. 

VOL.  xi.  7 


98  Analysis  of,  and  Remarks  on. 

Diarrhoea  in  more  or  less  severity  occurred  at  one  time  or 
another  in  twenty-eight  out  of  the  thirty-one  patients.  In  the 
other  three  it  was  absolutely  absent  from  beginning  to  end  of 
the  fever. 

But  the  above  statement  must  be  supplemented  by  further 
figures,  which  are  interesting  from  their  bearing  on  hospital 
practice  in  enteric  fever.  There  existed  diarrhoea  in  moderate 
degree  in  seven  cases  with  two  deaths,  in  severity  in  eight 
cases  with  one  death,  and  very  severely  (amounting  to  over 
six  evacuations  per  diem)  in  two  cases. 

But  our  investigations  should  not  stop  at  this  point  or  they 
may  be  misleading.  On  further  analysis  of  cases  we  find  that 
out  of  twenty-eight  patients  who  had  diarrhoea,  in  more  or  less 
severity,  in  eleven  of  them,  or  39'2  per  cent.,  there  also  existed 
constipation  at  one  or  other  period  of  their  illness.  The  consti- 
pation was  not  unfrequently  obstinate,  it  occurred  oftenest  about 
the  fourth  week  and  lasted  during  early  convalescence ;  and, 
as  Ave  have  formerly  seen,  the  means  adopted  to  overcome  it 
have  led  in  some  cases  to  recrudescence  and  even  to  relapse. 

The  use  of  enemata  in  the  treatment  of  our  hospital  enteric 
fever  cases  has  been  as  frequent,  if  not  more  frequent  than  that 
of  any  other  remedial  agent,  and  certainly  much  more  exten- 
sive than  remedies  to  check  the  opposite  condition,  diarrhoea. 
Various  reasons  and  causes  have  been  given  to  account  for  this 
frequency  of  constipation.  We  suggested  last  year  that  the 
presence  of  diarrhoea  may  probably  indicate  extension  of  the 
fever  process  to  the  solitary  glands  of  the  large  intestine,  and 
apparently  the  post-mortem  examinations  on  our  three  fatal 
cases  of  this  year  somewhat  strengthened  this,  as  two  out  of 
three  had  well-marked  lesion  of  the  great  bowel,  and  both  had 
marked  diarrhoea. 

Again,  it  is  interesting  to  note  the  possible  factor  of  season  of 
year.  For  example,  out  of  ten  cases  admitted  during  November 
one  half  had  constipation  at  some  period  of  their  fever,  this  being 
nearly  a  sixth  part  of  the  whole  number  of  cases  under 
review. 

On  the  other  hand,  it  would  be  of  great  interest  to  compare 
statistics  of  constipation  occurring  in  hospital  enteric  patients 
where  a  milk  diet  is  strictly  ordered  and  rigidly  enforced,  with 
similar  figures  from  cases  in  private  practice  where  there  is 


Thirty-one  Cases  of  Enteric  Fever.  99 

often    reason    to    doubt    that   regimen    is    not   so    faithfully 
observed. 

Abdomen. — Belly  symptoms  occurred  in  every  case  except 
two ;  of  these  "  gurgling  "  or  pain  in  the  right  iliac  fossa  was 
frequent,  including  twenty-two  cases.  There  was  splenic  en- 
largement in  seventeen,  whilst  distension  of  the  abdomen 
existed  at  one  time  or  another  in  all,  and  notably,  as  might  be  ex- 
pected, in  those  who  had  diarrhoea  at  all  approaching  to  severity. 
Tongue. — A  condition  of  this  organ,  viz.  thickly  coated  with 
yellowish  fur,  with  a  tendency  to  redness  at  the  tip  and  edges, 
and  which  may  be  looked  upon  as  almost  typical  of  the  fever, 
occurred  in  the  early  stage  of  nearly  all  the  cases.  But  that 
certain  conditions  of  the  tongue  are  sure  indications  of  grave 
symptoms,  and  an  accompaniment  to  high  fever  is  further 
established  by  the  following  figures.  The  tongue  was  dry  in 
eight  cases,  dry  and  brown  in  nine,  and  tremulous  in  four, 
amounting  to  twenty-one  cases  in  all,  which  include  all  the 
three  fatal  cases,  and  all  those  (10)  who  had  a  temperature  of 
105°  or  upwards.  This,  again,  coincides  with  our  experience 
of  former  years.  Fissuring  was  noted  in  four  cases,  as  was  also 
a  glazed  condition  of  the  organ. 

Respiration. — The  average  rate  of  respiration  was  28,  but  it 
must  be  stated  that  the  frequency  was  not  invariably  noted. 
The  highest  frequency  was  40  in  a  boy  with  healthy  lungs,  the 
lowest  22,  also  in  a  boy.  Auscultation  revealed  pulmonary 
disorders  in  twenty-seven  out  of  the  thirty-one  cases,  but  in 
the  majority  it  only  amounted  to  the  congestion  so  frequently 
met  with  in  typhus  and  other  specific  fevers.  In  nine  out  of 
the  twenty-seven  there  were  severe  lung  complications,  however, 
which  are  referred  to  further  on. 

No  chemical  observations  were  made  on  the  respired  air, 
nor  were  any  volumetric  measurements  taken.  The  peculiar- 
character  of  respiration  known  as  "  Cheyne-StokesV  is  recorded 
as  occurring  once. 

Urine. — The  only  clinical  observations  made  in  respect  of 
urine  were  specific  gravity,  the  presence  or  absence  of  albumen, 
with  the  addition  (especially  in  Dr.  Ord's  wards)  of  an  exami- 
nation for  the  presence  of  indican. 

The  sp.  gr.  ranged  from  1010  without  albumen,  in  a  woman 
aged  29,  to  1034  without  albumen  or  sugar,  in  a  girl  aged  11. 


100  Analysis  of,  and  Remarks  on, 

There  were  only  five  cases  with  a  sp.  gr.  lower  than  1015,  and 
four  with  a  higher  sp.  gr.  than  1030. 

As  regards  the  presence  of  albumen  it  was  detected  in  eight 
cases,  in  six  of  whom  it  was  certainly  only  temporary,  and  in  the 
remaining  two,  although  not  noted  as  such,  there  is  every  reason 
to  believe  it  was  temporary  only,  its  presence  being  probably 
due  to  slight  renal  congestion  parallel  to  a  similar  congestion 
which  was  present  in  the  lungs,  and  which  occurs  in  most 
specific  febrile  processes.  Of  the  eight  cases  in  which  albumen 
was  observed,  its  presence  was  detected  on  admission  in  six.  In 
the  other  two  it  appeared  on  the  seventeenth  and  thirty- third 
days  respectively.  An  indican  reaction  in  the  urine  was 
demonstrated  in  all  cases  of  severe  diarrhoea  without  exception. 
Its  presence  was  better  marked  at  some  periods  of  the  fever 
than  at  others,  but  our  experience  leads  us  to  the  opinion  that 
in  a  great  majority  of  cases  it  may  be  detected  in  the  early 
stage  of  diarrhoea,  and  that  the  reaction  disappears  or  becomes 
fainter  as  the  purging  ceases  or  convalescence  approaches,  but 
that  it  may  again  be  detected  in  the  urine  during  a  relapse, 
especially  if  belly  symptoms  are  at  all  prominent.  We  are 
convinced  of  its  diagnostic  value  and  aid  in  cases  presenting 
any  obscurity  or  doubt. 

Delirium. — We  have  endeavoured  in  former  reports  to 
associate  delirium  with  the  occurrence  of  high  fever,  and  we 
have  suggested  that  this  coincidence  in  a  measure  tends  to 
point  to  the  administration  of  graduated  baths  in  hyperpyrexia 
as  a  curative  agent,  since  by  reducing  the  temperature  we  also 
relieve  the  delirium.  Or,  in  other  words,  the  delirious  state  is 
in  many  cases  symptomatic  of,  and  caused  by,  high  fever,  and 
by  lowering  the  heat  of  a  patient  we  control  delirium.  Now, 
marked  delirium  occurred  in  eleven  cases,  or  within  a  fraction 
of  35  "5  per  cent.  The  intensity  of  the  delirium  varied  from 
"slight  rambling"  which  included  three  cases,  to  "moderate" 
(two  cases)  and  "  severe"  under  which  category  the  remaining 
five  are  placed.  In  five  of  the  eleven  cases  the  greatest  intensity 
of  delirium  or  its  very  onset  exactly  corresponded  in  date  with 
that  of  highest  temperatures,  and  in  three  others  the  events  were 
only  two  days  apart.  In  the  remainder,  however,  (3)  there 
was  a  week  intervening  between  the  two  phenomena,  the  date 
of  highest  fever  preceding  that  of  delirium.     Further,  in  all 


Thirty. one  Cases  of  Enteric  Fever.  101 

cases  in  which  delirium  was  severe  the  thermometer  registered 
105°  or  upwards.  We  may  also  observe  that  in  those  cases  (2) 
in  which  a  graduated  bath  was  used  or  cold  sponging  employed 
to  reduce  temperature,  the  most  marked  effect  on  the  patient 
was  to  restore  the  mind  to  consciousness,  however  severe  the 
delirium  may  have  been  beforehand,  but  that  wandering  again 
returned  whenever  the  temperature  rose  to  its  previous  level. 

Other  nervous  symptoms  recorded  in  addition  to  the  above 
were  marked  subsultus  and  picking  of  the  bed-clothes  in  two 
cases,  one  of  them  terminating  fatally. 

Complications. — We  have  continued  the  plan  of  classification 
of  complications  which  has  been  adopted  in  former  years,  and 
was  initiated  by  Dr.  Ord.  Under  this  method  complications 
are  divided  into  four  groups  :  the  first  comprising  such  "  acci- 
dents "  as  may  occur  during  any  febrile  process ;  the  second, 
such  disorders  as  are  somewhat  related  with  the  fever ;  the 
third  group  includes  any  disorder  or  sequel  as  is  related  with 
any  constitutional  idiosyncrasy,  or  any  particular  condition  of 
the  patient. 

In  Group  I  there  are — 

(1.)  Orchitis,  one  case,  on  the  11th  day,  unattended  by  urethral  discharge. 

(2.)  Cystitis,  one  case,  on  the  38th  day,  in  a  male  aged  37. 

(3.)  Retention  of  urine,  one  case,  in  a  male  aged  25. 

(4.)  Delusions,  one  case,  from  the  15th  to  43rd  day. 

(5.)  Albuminuria  in  eight  cases  (previously  noted). 

(6.)  Vomiting  (urgent)  in  one  case. 

In  Group  II — 

(1.)  Congestion  of  lungs  (marked)  in  two  cases.     The  apex  was  the  seat  of 

affection  in  one,  but  with  no  subsequent  physical  signs  of  phthisis. 
(2.)  Pneumonia  (severe),  two  cases. 
(3.)  Bronchitis,  one  case. 

(4.)  Pleurisy,  four  cases.     In  one  it  wa3  double 
(5.)  Epistaxis,  one  case. 
(6.)  Hematuria,  one  case. 

(7.)  Peritonitis  and  perforation,  two  cases,  on  31st  and  33rd  days  respectively. 
(8.)  Deafness,  two  cases. 

In  Group  III — 

1.)  Endocarditis,  five  cases,  of  which  one  must  be  considered  doubtful  from 

the  character  and  situation  of  the  murmur. 
2.)  Gouty  inflammation  of  joints,  one  case. 

(3.)  Abortion,  one  case,  on  the  20th  day.     The  period  of  frequency  was  not 
accurately  stated. 


102  Analysis  of,  and  Remarks  on, 

The  above  list  includes  many  trivial  disorders  which  may  be 
perhaps  considered  hardly  worthy  of  being  classified  as  compli- 
cations.    But  the  clinical  history  of  enteric  fever  teaches  us 
that  there  are  few  diseases  which  bring  in  their  train  such  a 
number   of    undercurrent    disorders  of  a  more  or  less  grave 
character.      The    severity,  character,   and  complexity  of  such 
complications  seem  to  be  influenced  by  the  special  character  of 
the  fever,  its  duration  or  its  intensity ;  and  also  in  no  small 
measure  by  the  constitutional  weakness,  or  especial  proneness 
to  maladies,  induced  by  certain  taints  (hereditary  or  acquired) 
of  the  individual.     And  this  in  a  great  measure  constitutes  the 
basis  of  Dr.  Ord's  classification  of  complications.     We  know  of 
no  disease  which  more  thoroughly  tests  the  weak  points  in  a 
subject's   health,    or   which  leaves  him  more  liable,  by    the 
exhaustion  it  produces,  to  take  on  a  diseased  condition,  from 
which  he  would  probably  have  escaped  had  he  not  contracted' 
the  fever.     This  feature  is  not  a  novelty  to  observers,  and  is 
constantly   acknowledged  and    recognised  as  producing  diffi- 
culties of  diagnosis.     Undoubtedly  a  tubercular  diathesis  which 
otherwise  might  have  remained  with  no  appreciable  manifesta- 
tion for  perhaps  years,  may  be  made  active  by  the  fever  pro- 
cess.    Again,  we  have  seen  it  light  up  an  ague  which  had 
remained  dormant  for  months  ;  and  in  more  than   one  case  of 
so-called  strumous  glands  the  subsequent  convalescence  after 
enteric  was  delayed  by  exacerbation  of  the  adenoid  induration, 
leaving  the  patient  in  a  more  damaged  condition  than  previous 
to  the  fever.     In  addition,  it  is  probable  that  the  severity  of  an 
epidemic  may  be  gauged  by  the  different  characters  of  the  com- 
plications, and  the  different  organs  or  tissues  they  affect.     For 
example,  last  year's  epidemic  was  undoubtedly  a  mild  one,  as  is 
shown  by  the  decreased  number  of  our  patients,  and  also  by 
the  fact  that  there  were  a  goodly  number  of  cases  admitted  into 
St.  Thomas's  which  were  almost  undoubtedly  enteric  fever,  but 
presented  a  deficiency  of  pronounced  symptoms,   and  which 
frequently  terminated  abruptly,  or,  as  has  been  aptly  termed, 
abortively.     Such  cases  are  commented  on  by  Murchison,  and 
would  probably,  as  he  points  out,  have  been  included  in  former 
years  under  the  heading  of  simple  fever. 

But  some  complications  which  were  frequent  during  a  former 
year  of  severe  epidemic,  and  which  were  most  frequent  in 


Thirty -one  Cases  of  Enteric  Fever.  103 

severe  cases,  are  conspicuously  absent  or  nearly  so  from  this 
year's  list.  Deafness,  for  example,  was  only  observed  in  two 
cases.  Epistaxis  and  intestinal  haemorrhage  are  also  almost 
eliminated,  as  is  also  urgent  vomiting.  All  this  tends  to  sup- 
port the  opinion  that  certain  complications  indicate  the  severity 
of  an  attack  of  enteric  fever ;  and  conversely,  that  the  mildness 
of  an  epidemic  may  be  recognised  by  their  less  frequent  occur- 
rence. 

Treatment. — On  this  subject  there  is  very  little  to  add  in  this 
year's  report  to  what  has  been  said  in  former  years.  The  use 
of  salines  has  been  slightly  more  frequent  than  that  of  mineral 
acids,  a  fact  which  may  be  accounted  for  by  the  non-prevalence  of 
diarrhoea.  But  it  is  interesting  to  note  that  out  of  twelve  cases 
no  less  than  eight  had  no  medicines  at  all,  and  the  remaining 
four  only  occasional  and  temporary  remedies  to  check  a  ten- 
dency to  diarrhoea.  That  is  to  say,  that  had  such  patients 
remained  free  from  purging  or  diarrhoea  at  all  approaching  to 
severity,  the  bed  tickets  of  nearly  half  the  cases  would  have 
been  without  prescriptions  for  ordinary  febrile  remedies ;  and 
this  expectant  line  of  treatment  has  been  general  with  all  the 
physicians  alike  at  St.  Thomas's. 

When  diarrhoea  has  called  for  treatment,  opium  or  its  deri- 
vative, morphia,  has  been  employed,  most  frequently  in  the 
form  of  enemata  with  starch,  and  only  occasionally  has  it  been 
given  by  the  mouth.  There  seems  an  increasing  tendency  to 
treat  diarrhoea  by  this  method,  as  being  probably  most  expedi- 
tious in  action. 

For  high  temperatures,  quinine  has  been  given  in  some  three 
or  four  cases,  but  with  only  partial  success.  It  has  undoubtedly 
controlled  hyperpyrexia,  but  only  very  temporarily,  and  then 
only  when  given  in  such  doses  as  produced  effects  which  may 
be  called  toxic. 

In  only  two  cases  (Nos.  9  and  12)  were  graduated  baths 
administered;  and  although  one  of  the  patients  died,  it  is 
claimed  that  the  baths  effected  their  immediate  purpose  in  both. 
The  cause  of  death  in  the  fatal  case  was  perforation,  the  fatal 
event  occurring  three  weeks  after  bathing.  There  will  be 
found  below  a  table  showing  the  dates  at  which  such  baths  are 
given,  with  their  effects  on  the  temperature  and  pulse.  We 
may  state  that  the  condition  which  has  generally  guided  the 


104 


Analysis  of,  and  Remarks  on, 


prescribing  of  a  graduated  bath  has  been  that  of  a  temperature 
of  105°,  and  showing  a  rising  tendency,  or  the  occurrence  of 
that  observation  at  such  period  of  the  day  as  would  probably 
prognosticate  a  greater  heat  at  night.  Thus,  if  the  thermo- 
meter recorded  105°  or  upwards  at  about  4  o'clock  in  the  after- 
noon, there  was  good  reason  to  infer  that  the  highest  point  of 
hyperpyrexia  had  not  yet  been  reached ;  and,  as  we  have  shown, 
the  great  fatality  in  enteric  fever  in  cases  when  the  temperature 
rose  to  106°,  any  remedial  agent  which  shall  rapidly  and  safely 
reduce  such  heat  seems  clinically  indicated. 

The  effect  of  such  baths  on  the  temperatures  was  very  marked, 
as  will  be  seen  below ;  and  a  similar  observation  applies  to  the 
pulse  frequency.  We  have  before  drawn  attention  to  the 
abatement  of  delirium. 

In  the  second  bath  case  cold  sponging  was  subsequently 
resorted  to  when  the  thermometer  in  the  axilla  registered  104"  2°, 
with  signs  of  its  still  rising. 


Table  VII. 

—  Of  graduated 

baths,  fyc. 

Bath, 

Case. 

Date. 

Hour. 

Day 
ot 

temp. 

Dura- 
tion of 

temp. 

Pulse 
fell 

Remarks. 

fever. 

from 

bath. 

from 

from 

No.  9 

1st  bath 

Sep.  27 

5.30  p.m. 

26th 

95°  to 
76° 

in  20 
min. 

105°  to 

101-5° 

120  to 
112 

y> 

2nd    „ 

„    27 

10.30    „ 

26th 

95°  to 

78° 

» 

104-8°  to 
102-4° 

132  to 
120 

No.12 

1st     „ 

„   29 

9.0      „ 

14th 

95°  to 
75° 

>9 

104-7°  to 
98° 

108  to 
84 

Death  3  wks. 
afterwards. 

2nd    „ 

,,   30 

7.10  „ 

15th 

Not 

Not 

105-0°  to 

Not 

noted 

noted        97° 

noted 

In  another  case  (No.  15)  cold  sponging  was  applied  for  three 
days,  whenever  the  temperature  rose  to  104°,  with  good  effect, 
reducing  the  heat  generally  by  2°,  but  only  temporarily. 

The  treatment  of  constipation  has  given  rise  to  more  anxiety 
than  that  of  diarrhoea,  owing  to  its  great  prevalence  either 
during  the  fever  or  convalescence  ;  and  it  will  be  seen  further 
on,  that  from  the  relation  of  constipation  to  relapses  and  recru- 
descences it  is  an  important  subject. 

Again,  as  in  the  opposite  condition,  the  general  practice  at 


Thirty-one  Cases  of  Enteric  Fever. 


105 


St.  Thomas's  has  been  to  administer  remedies  by  the 
rectum.  Simple  enemata,  or  with  castor  oil  added,  have  been 
used  freely,  the  bowels  not  being  allowed,  as  a  rule,  to  remain 
without  an  action  for  a  longer  period  than  three  days. 

As  regards  drugs  used  in  the  treatment  of  delirium,  there  is 
very  little  to  be  said  beyond  that  reported  in  former  years. 
Chloral  seems  to  have  been  more  freely  used  than  previously  ; 
also  large  doses  of  bromide  of  potassium.  Opium  was  pre- 
scribed for  this  symptom  much  less  frequently. 

Stimulants  form  an  interesting  item  in  the  dietary  columns. 
Eight  patients,  or  £5'8  per  cent.,  were  treated  entirely  without 
alcohol.  But  it  is  obvious  that  in  such  a  few  cases  the  parti- 
cular practice  of  one  physician  may  greatly  affect  figures  in  their 
relation  to  the  general  rules  of  practice  in  hospital  wards  ;  and 
we  find  such  has  been  the  case,  one  physician  using  much 
less  alcoholic  stimulant  than  his  colleagues. 

Alcohol  (brandy  or  port  wine)  was  ordered  in  two  cases  only 
on  admission;  in  four  during  the  second  week  of  fever;  in 
five  during  the  third  week ;  in  four  in  the  fourth  week ;  in  five 
in  the  fifth  week ;  in  two  in  the  sixth ;  and  in  one  during  con- 
valescence ;  making  twenty-three  altogether.  The  amount  of 
stimulant  varied  from  two  ounces  of  port  wine  to  eight  ounces 
of  brandy  per  diem,  the  wine  having  been  given  most  fre- 
quently towards  the  end  of  the  fever,  whilst  brandy  was 
almost  entirely  restricted  to  those  days  when  the  fever  was  at 
its  height. 


General  Table  of  Relapses. 


Table  VIII. — Of  duration  in  days  in  the  relapse  cases. 


Case. 

Age  and  sex. 

Primary  fever. 

Intermission. 

Relapse. 

Total  duration 
of  fever. 

No.  9 

16     F. 

25 

2 

17 

44 

„  10 

40     F. 

44 

13 

22 

79 

„  13 

14     M. 

21 

1 

26 

48 

»  14 

12     M. 

20 

3 

26 

49 

„  16 

21     M. 

27 

7 

18 

52 

106  Analysis  of,  and  Remarks  on, 


Abstract  of  Cases  of  Relapse. 

Case  1.  Severe  primary  attack,  lasting  into  the  fourth  week; 
relapse  on  the  twenty-eighth  day  ;  graduated  baths ;  recovery. — 
(No.  9),  A.  P — ,  set.  16,  milliner,  admitted  into  Lydia  Ward, 
under  Dr.  Ord,  September  9th,  1880,  on  the  fifteenth  day  of 
fever. 

On  admission  she  had  high  temperature  (105°),  diarrhoea,  a 
copious  eruption,  distended  abdomen,  with  pain  and  gurgling 
in  right  iliac  fossa.  Her  fever  abated  in  the  fourth  week,  but 
on  the  twenty-eighth  day  the  temperature  again  rose  from 
98*5°  the  previous  evening  to  100-2°,  and  continued  high 
during  the  following  week,  with  fresh  spots,  delirium,  but  less 
severe  diarrhoea  than  during  the  primary  attack,  and  eventually 
constipation  during  convalescence.  The  hyperpyrexia  during 
the  relapse  was  treated  by  graduated  baths  with  good  results. 

There  was  no  error  of  diet  to  account  for  relapse. 

Case  2.  Primary  attack  mild ;  relapse  on  the  twenty-eighth 
day,  with  subsequent  remission  of  fever  ;  and  fresh  hyperpyrexia 
on  the  fifty-seventh  day,  due  to  complications ;  recovery. — 
(No.  10),  S  C — ,  aet.  40,  female,  cook,  admitted  to  Christian 
Ward,  under  Dr.  Harley,  on  the  14th  September,  1880. 

She  had  been  ill  ten  days  on  admission.  The  first  attack 
was  comparatively  mild,  though  prolonged.  There  was  a  well- 
marked  eruption  with  distended  abdomen,  spleen  felt  below 
the  ribs,  and  slight  diarrhoea ;  but  the  temperature  was  not 
particularly  high  (104-4°).  On  the  forty-fourth  day  the  tempe- 
rature was  normal,  but  at  the  commencement  of  the  ninth 
week  there  was  a  sudden  rise  of  temperature  from  normal  to 
103-2°,  and  eventually  on  the  fifty-ninth  day  to  105°,  a  pulse 
rate  of  156,  renewed  diarrhoea  with  haemorrhage  and  spots, 
also  a  return  of  delirium.  The  date  of  convalescence  was 
postponed  to  the  seventy-ninth  day  by  such  severe  complications 
as  pleurisy,  albuminuria,  and  congestion  of  the  mucous  mem- 
branes of  the  bladder  with  heematuria. 

The  commencement  of  the  relapse  occurred  two  days  after 
the  ordering  of  fish  in  the  patient's  dietary. 


Thirty -one  Cases  of  Enteric  Fever.  107 

Case  3.  Mild  attack ;  severe  relapse  on  the  twenty-third  day , 
recovery. — (No.  13),  J.  F — ,  set.  14,  male,  admitted  to  Arthur 
Ward,  under  Dr.  Harley,  on  October  1st,  1880,  being  the 
eighth  day  of  fever. 

On  admission  the  belly  was  tympanitic,  spleen  to  be  felt 
below  the  costal  arch,  pain  and  gurgling  in  the  right  iliac  fossa ; 
the  temperature  was  1036°,  which  was  the  highest  point 
attained  during  the  primary  fever,  gradually  subsiding  till  the 
twenty-second  day,  when  it  was  as  low  as  96-70.  There  were 
no  spots,  and  no  diarrhoea  during  the  primary  fever. 

The  relapse  commenced  on  the  twenty-third  day,  the  tempe- 
rature running  up  to  104°  during  the  forty-fourth  week  and  to 
105°  in  the  fifty-fifth  week.  A  typhoid  eruption  first  made  its 
appearance  on  the  sixth  day  of  relapse  or  the  twenty-eighth  of 
fever,  and  there  was  attendant  delirium,  a  pulse  rate  of  124° 
(highest),  but  again  constipation,  as  in  the  first  fever.  Con- 
valescence was  not  attained  till  the  fiftieth  day. 

There  was  no  direct  connection  between  diet,  and  the  relapse, 
although  it  occurred  eight  days  after  "  Bread-and-milk  "  diet 
was  ordered.  It  may  be  noted,  however,  that  the  bowels  were 
constipated  and  were  only  relieved  by  enemata. 

Case  4.  Mild  primary  attack,  short  intermission  ;  relapse  on 
the  twenty-fourth  day. —  (No.  14),  A.  J — ,  set.  12,  male,  admitted 
to  Arthur  Ward,  under  Dr.  Harley,  on  the  6th  October,  1880. 
Ill  three  days  before. 

On  admission  there  was  gurgling  in  right  iliac  fossa ;  spleen 
to  be  felt  below  the  ribs,  but  absence  of  diarrhoea ;  the  eruption 
made  its  appearance  on  the  seventh  day.  He  had  also  right 
pleurisy  and  congestion  of  the  lung.  During  the  first  week  of 
fever  the  temperature  was  not  high,  averaging  103*  1°,  but  with 
marked  morning  remissions,  the  variations  averaging  3*1°. 
Subsidence  took  place  during  the  third  week  (twentieth  day), 
although  the  temperature  was  never  quite  normal  during  the 
remission.  On  the  twenty-fourth  day  there  was  a  return  of  fever, 
with  a  fresh  eruption  on  the  thirtieth  day,  or  seventh  of  relapse  ; 
but  again  there  was  constipation,  and  also  an  absence  of 
delirium.  A  normal  temperature  was  not  reached  till  the 
fiftieth  day. 

The  relapse  began  on  the  evening  of  the  day  on  which  animal 
food  was  first  allowed. 


108  Thirty-one  Cases  of  Enteric  Fever. 

Case  5.  Severe  primary  attack ;  relapse  on  the  thirty-fifth 
day  ;  recovery. — (No.  16),  T.  H — ,  aet.  21,  male,  carman,  was 
admitted  into  George  Ward,  under  Dr.  Ord,  on  the  19th 
October,  1880.     He  had  been  ill  seven  days  before. 

Copious  rash  on  admission,  slight  delirium,  and  no  diarrhoea, 
the  bowels  being  moved  as  a  rule  once  a  day.  There  was  ten- 
derness and  gurgling  in  the  right  iliac  fossa,  but  no  enlarge- 
ment of  spleen  to  be  felt.  The  average  evening  temperature 
gradually  declined  from  103*7°  in  the  second  week  to  102*9° 
in  the  third,  and  100*2°  in  the  fourth.  This  was  followed  by 
a  complete  week  of  normal  temperatures  ;  but  on  the  thirty- 
fifth  day  there  was  again  a  rise  to  100*4°,  and  eventually  to 
103*4°.  Fresh  eruption  on  forty-second  day  or  eighth  of 
relapse,  but  no  diarrhoea.  He  was  well  on  the  fifty-second 
day. 

The  relapse  seems  to  be  connected  with  the  use  of  laxatives, 
although  it  commenced  three  days  after  a  dietary  of  "  Bread 
and  butter." 

In  concluding  the  remarks  on  relapses  during  last  year,  there 
may  be  noticed  the  comparative  few  number  of  cases,  the  non- 
severity  of  the  primary  attacks,  which,  taken  with  an  absence  of 
severity  of  other  usually  well-marked  symptoms,  probably  indi- 
cate the  mildness  of  the  epidemic.  It  is  an  interesting  coinci- 
dence that  those  cases  which  were  complicated  with  relapse 
should  have  been  admitted  into  the  hospital  within  a  short  time 
of  each  other,  that  is  to  say,  during  a  space  of  six  weeks,  from 
September  9th  to  October  19th. 


NEEVE-STRETCHING 


IN    A   CASE   OP 


SPINAL  MENINGITIS  WITH  ATAXIC  SYMPTOMS, 
DUE  TO  INJURY. 


By  H.  G.  AKMSTKONG, 

ASSISTANT   SUEGEON,   BOYAE   BEEKSHIEE   HOSPITAL. 


The  following  case  of  nerve-stretching,  which  was  done  with 
the  idea  of  relieving  pain,  may  be  of  some  interest.  It  was 
one  of  the  first  done  in  this  country,  and  the  result  has  been 
more  successful  than  that  of  most  cases  hitherto  published. 
The  patient  had  been  under  the  care  of  Mr.  Heap,  surgeon  to 
the  Reading  Amalgamated  Friendly  Societies,  who  called  me 
in  to  see  him,  and  to  whom  I  am  indebted  for  the  notes  of 
the  previous  history. 

Previous  history. — G.  M — ,  set.  40,  married,  had  followed  the 
business  of  a  bricklayer.  At  the  age  of  eighteen  had  gonor- 
rhoea and  a  chancre,  but  does  not  recollect  having  any  secondary 
manifestation  of  syphilis.  Has  always  been  temperate  and 
regular  in  his  habits.  Has  been  married  twenty-one  years, 
during  which  time  his  wife  has  had  seven  children,  of  whom 
one  is  now  living,  three  were  born  dead,  and  three  died  within 
a  year  of  birth.  Until  his  present  attack  has  had  good  health. 
Five  years  ago  he  fell  from  a  scaffold  astride  a  piece  of  timber, 
injuring  his  lumbar  and  coccygeal  regions,  which  laid  him  up 
for  about  a  week.     On  resuming  work  he  often  had  severe  pains 


110         Spinal  Meningitis  treated  by  Nerve-stretching. 

in  the  sciatic  regions,  accompanied  by  violent  tetanic  spasms, 
which  prevented  his  continuing  work  for  a  week  or  two  at  a 
time.  The  attacks  of  pain  and  spasm  increased  in  severity  and 
became  more  frequent,  and  three  years  ago  he  gave  up  work 
altogether,  stating,  as  the  reason,  "  that  he  could  not  feel  his 
feet  when  going  up  a  ladder."  During  these  three  years  he 
has  gradually  got  worse,  and  twelve  months  ago  had  to  take  to 
his  bed,  from  which  he  has  rarely,  and  for  the  last  four  months 
not  at  all,  been  able  to  get  up. 

Present  condition. — Is  a  short,  thick-set  man,  with  florid 
complexion  and  bright,  intelligent  face.  Muscles  well  deve- 
loped ;  skin  healthy.  Complains  of  very  severe  lightning  pains, 
confined  principally  to  the  legs  and  lower  parts  of  the  body, 
though  they  are  occasionally  felt  in  the  upper  extremities. 
These  pains  sometimes  last  continuously  for  several  days  and 
nights  together,  but  at  other  times  are  momentary.  Their 
severity  is  invariably  aggravated  by  any  change  of  weather, 
especially  during  rain  or  high  wind.  The  lancinating  pains  and 
tetanic  spasms  in  the  lower  limbs  can  always  be  produced  by 
pressure  on  the  skin  over  the  coccyx.  Does  not  attempt  to 
leave  his  bed,  as  on  trying  to  walk  he  falls  down.  Has  no  diffi- 
culty in  raising  a  leg  from  the  bed,  but  it  is  thrown  violently 
from  side  to  side,  and  he  is  unable  to  replace  it  on  any  given 
spot.  Has  entire  loss  of  patellar  tendon  reflex,  and  complete 
anaesthesia  of  both  lower  extremities  up  to  the  groins  ;  sexual 
power  is  lost  but  not  desire.  Has  occasional  attacks  of  gastralgia 
and  disturbances  of  the  bladder  and  rectum.  The  electric 
excitability  of  the  muscles  in  the  lower  limbs  is  partially  lost. 
Vision  good,  and  no  cranial  nerves  seem  to  be  affected. 

March  27th,  1881. — The  patient  being  held  in  the  lithotomy 
position,  I  cut  down  on  the  left  sciatic  nerve,  about  two  inches 
below  the  tuber  iechii,  and  holding  it  between  the  finger  and 
thumb  of  each  hand,  stretched  it  violently.  No  anaesthetic  was 
used,  and  the  patient  experienced  no  pain,  either  in  the  cutting 
through  the  skin  or  while  the  nerve  was  being  stretched.  The 
wound  was  stitched  up  and  dressed  with  thymol  lotion  (1 — 8). 

28th. — Has  passed  a  very  restless  night.  Complains  of 
shooting  pains  in  all  parts  of  the  body,  more  so  in  the  arms 
and  shoulders  than  he  has  ever  had  them  before.  Temp.  99-5°^ 
pulse  100. 


Spinal  Meningitis  treated  by  Nerve-stretching.         Ill 

30th. — Still  has  pain,  but  not  so  violent. 

31st. — Much  better,  pains  very  slight.  Tactile  sensibility  is 
returning,  as  he  can  feel  a  finger  drawn  over  the  plantar 
surfaces. 

April  2nd. — Has  had  no  pain  for  twenty-four  hours. 

7th. — Tactile  sensibility  has  returned  over  the  whole  of  both 
lower  extremities,  the  prick  of  a  pin  being  distinctly  felt  in  the 
thighs. 

12th. — While  lying  on  his  back  raised  his  legs  easily  from 
the  bed  and  held  them  out  straight,  without  any  waving  from 
side  to  side,  and  had  no  difficulty  in  replacing  his  foot  on  any 
indicated  spot.     No  pain. 

15th. — Has  tenderness  along  the  left  sciatic  nerve,  and  a 
return  of  the  severe  pains. 

25th. — Free  from  pain ;  is  dressed  and  sitting  up,  and  with 
very  slight  assistance  can  walk  round  the  room. 

From  this  time  he  gradually  improved,  and  on  the  12th  of 
May  walked  out,  which  he  has  continued  to  do  regularly.  Has 
return  of  pain  whenever  there  is  a  change  of  wind,  but  very 
slight  compared  with  that  previous  to  the  operation.  Sexual 
power  is  restored. 

June  24th. — This  morning  walked  a  distance  of  seven  miles 
before  breakfast  without  fatigue.  Is  much  improved  in 
appearance,  having  put  on  flesh  since  the  operation.  Sleeps 
well,  and  is  seldom  troubled  with  pain,  which  is  only  of  a 
trifling  character.     Spends  most  of  the  day  in  the  open  air. 

September  24th. — During  the  last  three  months  has  con- 
tinued much  in  the  same  state  with  reference  to  his  power  of 
locomotion.  Has  return  of  the  lancinating  pains  at  intervals. 
These  intervals  are  gradually  becoming  shorter,  and  the  pains 
are  again  becoming  more  severe  in  character,  but  he  still  states 
that  they  are  "  nothing  like  "  what  they  were  before  the  opera- 
tion.    In  walking  he  exhibits  the  characteristic  ataxic  gait. 

October  7th. — No  change  since  the  last  note. 

Although  the  patient  seems  to  be  gradually  relapsing  into  his 
old  condition,  a  fair  amount  of  success  may  be  claimed  for  the 
operation.  Before  it  was  done  his  lower  limbs  were  in  such  a 
perfectly  anaesthetic  condition  that  he  was  able  to  undergo  it 
without  the  slighest  sensation  of  pain.  For  twelve  months 
before  he  had  been  almost  entirely  unable  to  walk,  and  for 


112         Spinal  Meningitis  treated  by  Nerve-stretching . 

three  months  had  been  confined  to  his  bed  ;  and  the  lancinating 
pains,  from  which  he  was  never  free  for  more  than  two  hours  at 
a  time,  were  so  severe  as  to  make  his  life  a  burden  to  him. 
The  result  of  the  nerve-stretching  has  been  the  recovery  of 
cutaneous  sensibility,  and  almost  complete  relief  from  the  severe 
pains  and  tetanic  spasms,  and  after  a  few  weeks  the  ability  to 
walk  from  eight  to  ten  miles  without  fatigue.  That  this  was 
the  result  of  operating  on  one  sciatic  nerve  is,  I  think,  a  point 
of  much  interest,  showing  that  whatever  the  effect  of  stretching 
a  nerve  may  be,  it  acts  in  some  way,  not  on  the  periphery,  but 
on  the  nerve  centre.  How  the  effect  is  produced  there  is  no 
satisfactory  evidence,  but  this  should  not,  I  think,  be  any  objec- 
tion to  the  operation.  Many  of  our  most  useful  drugs  act  in  a 
way  equally  mysterious. 


ON  CASES 


OP 


INJUEY    TO    THE    OPTIC    NEUVE, 


By  EDWAED  NETTLESHIP. 


(Clinical  Lecture,  given  January  16th,  1882.) 


The  following  observations  are  printed  nearly  as  they  were 
given,  with  the  omission  of  some  unimportant  remarks.  I 
have  since  referred  to  previous  publications,  and  added  refer- 
ences to  them  in  the  footnotes.  It  will  be  seen  that  the  cases 
and  observations  here  offered  agree  very  closely  with  those 
already  published  by  Berlin,  Leber,  and  others. 

In  many  instances  nerves,  when  cut  or  wounded,  undergo 
repair  and  regain  their  functions ;  but  the  optic  nerve  seldom 
recovers  from  accidental  injuries  which  are  sufficient  to  cause 
immediate  serious  damage.  This  fact,  which  it  is  of  import- 
ance to  bear  in  mind,  might  perhaps  be  accounted  for  in  several 
different  ways.  No  doubt  in  many,  probably  in  nearly  all,  the 
cases  of  damage  to  the  optic  nerve  the  injury  is  either  a  serious 
crushing  of  a  certain  length  of  the  nerve  in  the  optic  canal,  or 
a  combination  of  crushing  and  tearing,  from  either  of  which  it 
would  be  less  likely  to  recover  than  from  a  simple  section.1 

There  may  also  be  peculiarities  in  the  anatomical  relations 
of   the   optic  nerve  which    render  its  repair  less  easy.      The 

1  The  cut  ends  of  the  optic  nerve  have  been  found  united  after  the  operation 
of  optico-ciliary  neurotomy,  an  operation  upon  blind  eyes,  revived  within  the  last 
three  or  four  years,  and  since  largely  performed  on  the  Continent  and  in  America, 
instead  of  enucleation,  for  the  prevention  of  sympathetic  mischief. 
VOL.    XI.  8 


114  Injury  to  the  Optic  Nerve. 

optic  nerve  i8  surrounded  by  a  very  distinct  lymphatic  space 
enclosed  by  a  sheath  of  dense  fibrous  tissue  (the  "  dural " 
sheath),  and  surrounding  another  thinner  but  still  by  no  means 
loose  sheath,  which  closely  invests  the  nerve  (inner  or  "  pial  " 
sheath).  The  nerve  itself  is  subdivided,  as  are  other  nerves, 
into  many  little  bundles  by  trabecular  of  fine  fibrous  tissue 
(neurilemma),  and  this  tissue  is  more  abundant  and  more 
closely  felted  together  than  in  common  nerves,  so  that  the 
separate  bundles  of  the  optic  nerve  cannot  be  easily  separated 
and  followed  up  by  dissection  as  they  can,  e.g.  in  the  sciatic. 

If  the  nerve  be  divided  in  front  of  the  optic  foramen,  it  is 
possible  that  the  movements  of  the  eyeball  may  interfere  with 
the  quiet  apposition  of  the  cut  ends,  or  that  the  loose  and 
abundant  orbital  fat  may  be  intruded  between  them.  Such 
an  explanation  might  hold  good  when  the  damage  was  caused 
by  a  direct  thrust  through  the  orbital  structures  from  in  front, 
as  in  a  case  which  I  had  the  opportunity  of  seeing  under  Mr. 
Hutchinson's  care  at  Moorfields,  and  which  is  published  in 
his  paper  on  the  pupil  in  '  Brain/1  But  in  the  more  common 
cases  the  accident  is  an  injury  to  the  head,  probably  causing 
fracture  of  the  roof  of  the  optic  canal,  with  crushing  of  and 
haemorrhage  into,  the  nerve,  or  perhaps  occasionally  tearing 
of  the  nerve  on  the  brain  side  of  the  canal.  Both  conditions 
have  been  shown  to  occur  in  fatal  cases  of  fracture  of  the  base 
of  the  skull.2 

When  a  cut  nerve  does  not  reunite  it  undergoes  degenera- 
tion. After  unrepaired  wounds  of  the  optic  nerve  we  should 
therefore  expect  what  we  find,  viz.  that  after  a  time  the  optic 
disc  shows  signs  of  atrophy. 

The  interval  between  the  injury  and  the  occurrence  of  visible 
ophthalmoscopic  changes  would  no  doubt  depend  partly  on 
the  distance  of  the  injured  spot  of  nerve  from  the  eyeball.  It 
is,  on  a  priori  grounds,  very  unlikely  that  this  would  often  be 
near  the  globe,  and  the  fact  that  the  central  retinal  vessels 
have,  in  all  the  cases  that  I  have  seen,  remained  pervious,  is 
proof  that  the  seat  of  damage  in  them  lay  behind  the  point 
(about  a  quarter  of  an  inch  from  the  sclerotic)  at  which  these 

1  '  Brain,'  vol.  i,  p.  165. 

9  R.  Berlin,  '  Trans.  Internat.  Med.  Congress,'  iv,  115.     London,  1881. 


Injury  to  the  Optic  Nerve.  115 

vessels  enter  the  nerve.  It  is  no  doubt  nearly  always  in  or 
behind  the  optic  canal,1  and  the  earliest  sign  of  atrophy  of 
the  disc  may  therefore,  with  some  probability,  be  taken  as  a 
measure  of  the  time  occupied  by  the  atrophic  process  in 
descending  about  one  inch,  or  rather  more,  of  the  nerve.8 

In  Case  3  the  disc  was  "  pale  and  not  quite  clear  "  just 
two  weeks  after  the  accident. 

In  Case  5,  examined  under  difficulties,  two  weeks  and  a 
half  after  the  accident,  the  disc  was  normal  or  doubtfully  pale, 
but  at  the  end  of  six  weeks  was  atrophied  all  over. 

In  Case  2  there  was  advanced  atrophy  with  slight  mistiness 
one  month  after  the  accident. 

In  some  comparatively  recent  cases  (Cases  2  and  3,)  the 
disc  may  be  slightly  misty  at  the  borders,  but  in  others  (Case 
4,  e.g.)  it  is  perfectly  clear  and  sharply  defined.  It  is  possible 
that  the  haze  observed  in  Cases  2  and  3  was  indicative  of 
degeneration  rather  than  inflammation,  for  there  were  no 
other  signs  of  neuritis,  such  as  swelling,  vascular  turgescence, 
or  haemorrhage.  In  old  cases  the  disc  is  perfectly  clear,  of  a 
white  colour  with  a  yellowish  tinge,  presenting  a  shelving 
atrophic  cup,  or  at  least  great  exaggeration  of  the  ordinary 
physiological  cup,  with  very  marked  stippling  from  exposure 
of  the  cribriform  lamina,  i.e.  no  evidence  of  adventitious 
products  such  as  we  often  see  after  papillitis  and  in  grey 
"  progressive "  atrophy.  The  retinal  arteries  are  usually 
somewhat  too  small  but  never  thready,  and  can  always  be 
proved  to  be  pervious,  by  pulsating  on  pressure. 

In  five  of  the  following  six  cases  the  eye  was  quite  blind 
(no  perception  of  light) ;  in  Cases  1  and  7  No.  20  J.  could  be 

1  Berlin's  cases  examined  post-mortem  prove  this. — Loc.  cit. 

Experimental  division  of  the  optic  nerve  and  its  blood-vessels  has  heen  found 
to  produce  a  bloodless  condition  (iscbsemia)  of  the  retina,  followed  by  atrophy. 
Division  of  the  nerve  far  behind  the  eye,  without  injury  to  the  blood-vessels, 
caused  atrophy.  Division  of  the  nerve  at  the  optic  foramen  caused  no  visible 
atrophy  of  the  disc,  even  after  many  months  (sic).  Temporary  compression  of 
the  optic  nerve  caused  sudden  retinal  opacity  around  the  disc,  which  disappeared 
when  the  compression  was  removed  (compare  the  appearances  in  embolism). — 
Marckwort,  referred  to  in  Knapp's  '  Archives  of  Ophth/  x,  502  (1881). 

8  In  two  cases  Leber  and  Deutschmann  observed  signs  of  atrophy  three  weeks 
after  the  injury  to  the  head. — *  Graef e's  Archives,'  xxvii,  1 ;  abstract  in  '  Oph- 
thalmic Review,'  December,  1881,  p.  34, 


116  Injury  to  the  Optic  Nerve. 

made  out  in  some  parts  of  the  field,  and  in  Case  4  the 
damage  to  the  nerve  was  temporary,  and  may  have  been  due 
to  compression  by  blood  in  the  optic  canal.1  It  is  interesting 
that  in  Case  1,  though  vision  was  very  bad,  there  was  no 
colour-blindness,  whilst  in  Case  7  there  was  decided  colour- 
blindness. 

The  state  of  the  pupil  is  very  characteristic  of  disease  of 
one  optic  nerve  in  all  these  cases.  When  both  eyes  are  equally 
lighted  it  is  usually  a  little  larger  than  its  fellow ;  when  the 
blind  eye  is  shaded  and  lighted  its  pupil  remains  unaltered 
(absence  of  direct  reflex  action)  •  when  the  sound  eye  is  shaded 
and  lighted  the  pupil  of  the  blind  eye  usually  acts  quite  well 
(presence  of  indirect  reflex  action).  Its  contraction  during 
accommodation  (associated  action)  is  noted  as  quite  good  in 
Case  3.  In  Case  6  eserine  and  atropine  were  found  to  act 
as  usual  upon  the  iris  of  the  blind  eye. 

As  to  the  kind  of  accident  and  position  of  the  injury,  we 
find  that  in  four  of  the  cases  there  was  a  fall,  in  which  the 
temporal  or  frontal  region  was  struck  on  the  same  side  as 
the  eye  afterwards  found  to  be  blind.  In  Case  6  the  fore- 
head was  struck,  and  in  Case  8  the  "  top  of  the  head." 
In  Case  5,  where  the  child  fell  from  a  great  height,  the  seat 
of  the  blow  on  the  head  is  not  stated,  but  there  was  con- 
tusion of  the  lids  and  protrusion  of  the  blind  eye  imme- 
diately after  the  accident.  In  Case  6  the  man  fell  down  a 
ship's  hold,  and  the  base  of  the  skull  was  probably  fractured 
by  the  jam  communicated  through  the  spinal  column.  In 
the  majority  of  the  cases  no  severe  head  symptoms  followed 
the  accident.3 

The  blindness  was  discovered  almost  immediately  after  the 
fall  in  Cases  3  and  7,  and  the  following  morning  in  Case  2 ; 
in  the  others  the  sight  was  not  tried  until   several  days  after. 

'  Berlin  also  suggests  that  in  recoverable  cases  there  has  probably  been  sub- 
vaginal  or  intra-cranial  haemorrhage. — Ophth.  Soc.  of  Heidelberg,  1879 ; 
reported  in  '  Ann.  d'Oculistique,'  t.  83,  p.  69  (1880). 

2  It  may  be  observed  here  that  in  all  probability  some  of  the  cases  in  which 
injury  to  the  frontal  region  has  been  supposed  to  cause  loss  of  sight  in  some 
unexplained  manner  through  the  medium  of  the  fifth  nerve,  were,  in  truth, 
examples  of  damage  to  the  optic  nerve  by  orbital  fracture.  This  view  is  also 
taken  by  Fernandez  ("  On  Amaurosis  from  Lesions  of  the  Orbital  Region," 
'  Amer.  Journ.  Med.  Sci.,'  1881.—'  Lond.  Med.  Record,'  1881,  474). 


Injury  to  the  Optic  Nerve.  117 

There  is  no  reason,  however,  to  think  that  the  blindness  was 
other  than  an  immediate  result  of  the  accident  in  any  of  the  cases. 
I  have  never  yet  seen  a  case  in  which  both  nerves  were 
involved;  probably  when  this  occurs  the  case  generally  ends 
fatally  from  extensive  damage  to  the  brain.1 

Case  1.  Atrophy  of  the  optic  disc  after  injury  to  the  optic 
nerve. — Mr.  W — ,  a  student,  states  that  four  years  ago  he 
fell  from  a  bicycle  and  struck  his  right  temporal  region.  Some 
concussion  but  no  severe  symptoms  followed.  When  the 
swelling  had  subsided  three  or  four  days  later  he  found  the 
right  eye  almost  if  not  totally  blind;  it  afterwards  improved  a 
little. 

The  accident  occurred  on  Nov.  25th,  1877.  On  Dec.  3rd 
(eight  days  later)  he  consulted  Mr.  Power,  to  whom  I  am 
much  indebted  for  the  following  notes.  Mr.  Power  writes  : 
"  I  saw  him  on  Monday,  3rd  Dec,  about  seven  days  and 
fifteen  hours  after  the  accident.  On  making  a  prolonged  and 
careful  ophthalmoscopic  examination  after  the  instillation  of 
atropine,  I  satisfied  myself  that  the  disc  of  the  right  eye  was 
paler  than  that  of  the  left.  It  was  sufficiently  marked  to 
enable  me  to  give  a  tolerably  certain  forecast  that  the  disc 
would  become  perfectly  white  from  lesion  of  the  optic  nerve, 
the  seat  of  lesion  being  the  foramen  opticum  (in  all  probability), 
and  that  no  recovery  of  vision  would  take  place.  The  pupil 
contracted  well  with  reflex  (indirect),  but  scarcely  at  all  by  the 
direct,  action  of  light.  His  vision  slowly  improved  to  about 
!u)o">  a^  wai°h  ^  remained  stationary  as  long  as  I  saw  him. 
The  field  of  vision  was  greatly  limited  :  outwards  20°,  upwards 
10°  to  20°,  inwards  40°,  downwards  30°  to  40°.  There  was 
not  the  slightest  blurring  or  haziness  of  the  disc  when  I  first 
saw  it.  It  was  simply  paler  than  the  other.  It  afterwards 
became  white  throughout." 

May,  1881. — Right  pupil,  no  direct  action;  indirect  action 
normal.  He  sees  20  J.  best  at  the  lower  part  of  the  field. 
The  rest  of  field  almost  absent.  No  defect  for  colours,2  though 
they  all  look  very  dark. 

1  Both  nerves  have  been  found  torn  across  behind  the  optic  foramina. — Post- 
mortem by  Berlin,  loc.  cit. 

2  I  tested  him  carefully  and  repeatedly  with  Holmgren's,  Stilliug's,  and  Bull's 
tests. 


118  Injury  to  the  Optic  Nerve. 

Ophthalmoscopic  examination, — Disc  atrophied,  yellowish- 
white  ;  lamina  cribrosa  exposed ;  deep  physiological  cup. 
Arteries  diminished  but  not  extremely ;  they  pulsate  on 
pressure. 

Case  2. — Complete  blindness,  with  pallor  of  the  disc,  after  a 
blow  on  the  eye,  probably  rupture  of  the  optic  nerve,  ?  damage 
to  the  facial  nerve  on  same  side. — Richard  C — ,  set.  61,  farmer, 
living  at  Spalding,  in  Lincolnshire ;  sent  by  Dr.  Morris. 

One  month  ago  he  became  "  dizzy  *'  one  evening  after  dark, 
and  fell,  striking  his  right  eye  on  the  hard  ground  ;  he  was  not 
stunned.  The  eye  was  bruised  and  bled  a  little.  Found  he 
could  not  see  anything  with  it  next  morning.  It  was  a  good 
deal  swollen,  a  bad  black  eye,  and  has  remained  blind  ever 
since.  During  the  week  or  two  previous  to  this  fall  had  had 
several  similar  attacks  of  dizziness  but  never  a  fit.  The  fall 
was  not  followed  by  any  weakness  of  the  limbs.  Since  the  fall 
he  has  noticed  a  little  twitching  of  the  same  side  of  the  face. 

July  26th,  1880. — He  is  in  good  health,  ruddy,  spare,  strong. 

Vision. — Right,  blind ;  pupil,  no  direct  action ;  acts  well 
indirectly  ;  no  action  with  accommodation  ;  same  size  as  left. 
Left,  §g  H.m.  1  D.  fg  +  4-5=1  J.  well  at  10";  pupil 
normal  to  light,  acts  slightly  to  accommodation. 

Considerable  convergent  strabismus,  concomitant  and  con- 
stant (old)  j  rather  small  twitchings  of  muscles  of  right  side  of 
face  (mouth  and  eyelids  and  levator  palpebral,  but  not  the 
orbicularis  palpebrarum).  The  right  eye  looks  a  little  more 
prominent  than  the  left. 

Ophthalmoscopic  examination. — Right  optic  disc  shows  yel- 
lowish pallor  all  over,  and  is  rather  misty.  Arteries  consider- 
ably diminished,  but  pulsate  easily  on  pressure.  Veins  normal 
or  ?  too  large.    No  other  changes  (erect  image).    Left,  normal. 

Case  3.  Rupture  of  optic  nerve. — Amy  H — ,  set.  54, 
married,  living  at  17,  Dacre  Street,  Westminster. 

On  March  23rd,  1880,  in  going  down  the  area  steps,  she 
slipped  and  fell  into  the  area,  striking  the  temple  and  elbow. 
Was  not  stunned  or  ill.  The  left  eyelids  swelled  up  at  once, 
and  afterwards  she  had  fl  two  black  eyes/'  Half  an  hour 
alter  the  accident  she  found  on  trying  that  she  could  not  see 
firelight  with  the  left  eye  when  the  right  eye  was  closed ;  this 


Injury  to  the  Optic  Nerve.  119 

was  not  because  she  could  not  open  her  eye,  for  on  doing  so 
she  could  see  nothing. 

April  5th,  1880. — Remains  of  extensive  ecchymosis  of  skin 
of  left  temple  and  eyelids,  but  none  of  the  conjunctiva  nor 
eyeball ;  no  irregularity  of  bone.      Movements  normal. 

Vision. — Right,  vision  not  noted,  but  doubtless  good. 
Left,  no  perception  of  light  ;  pupil  usually  3|  or  4  mm., 
compared  with  3  to  3|  mm.  in  right.  No  direct  action  to 
light,  but  acts  well  with  right  (indirect  action). 

8th. — Just  the  same.  Both  pupils  act  quite  well  to  accom- 
modation and  convergence. 

Ophthalmoscopic  examination. — Left,  optic  disc  pale  and  not 
quite  clear.      Veins  normal,  and  arteries  pulsate  on  pressure. 

Case  4.  Recovery  from  amaurosis  after  injury  to  head 
(vision  failing  two  or  three  days  after  injury  ?)  ;  haemor- 
rhage from  nose  six  days  after  injury. — Eliza  B — ,  net.  50, 
(Elizabeth  Ward,  Mr.  Sydney  Jones).  On  November  12th, 
1881,  in  the  evening,  she  fell  on  a  kerb-stone  and  cut  her  right 
temple;  admitted  immediately;  was  unconscious  for  four 
hours.  She  found  vision  of  right  eye  defective  on  the  14th, 
after  closing  the  eyes  for  a  moment  because  they  ached ; 
believes  she  could  see  well  with  it  before.  Pupils  said  to 
have  been  equal  on  the  14th. 

15th. — Cannot  count  fingers  with  right  eye.  No  note  of 
pupils. 

18th. — Some  epistaxis,  chiefly  from  left  nostril. 

19th. — Pain  across  forehead  and  eyes.  Clots  of  blood 
from  mouth  when  she  blows  nose. 

24th. — Right  eye,  no  changes  in  fundus  or  media;  bare 
perception  to  light  even  when  concentrated  by  lens. 

I  did  not  see  her  agaiD,  but  the  house-surgeon,  Mr. 
Marlow,  assured  himself  by  examination  that  the  sight  of  the 
eye  had  improved  very  markedly  when  she  left  the  hospital  on 
December  7th. 

Case  5.  Blindness  of  one  eye  and  paralysis  of  same  sixth 
nerve  after  injury  to  head,  with  proptosis. — Alfred  W — ,  set.  6  ; 
admitted  under  Sir  W.  McCormac,  on  August  30th,  1881.  Fell 
out  of  third  floor  window  ;  admitted  immediately ;  bleeding 
from  nose,  vomiting  of  blood,  and  collapse ;  no  bleeding  from 


120  Injury  to  the  Optic  Nerve. 

ear ;  proptosis  of  left  eye  with  contusion  of  lids ;  no  haemor- 
rhage on  inner  surface  of  lids  nor  under  conjunctiva.  Right 
pupil  larger  than  left. 

September  17th. — Appears  quite  blind  of  left  eye;  still 
some  proptosis  ;  outward  movement  entirely  lost.  Pupil  con- 
siderably larger  than  right ;  no  direct  action  to  light,  but  it 
acts  indirectly  to  some  extent.  Examination  difficult  from 
restlessness  and  from  mucus  about  lids,  but  the  condition  of 
pupil  is  probably  accounted  for  by  the  amaurosis. 

Ophthalmoscopic  examination. — Left  optic  disc  normal,  or 
perhaps  pale.  Right  pupil  and  optic  disc  normal.  Child  is 
dull,  but  fairly  intelligent. 

October  14th. — Left  optic  disc  atrophied,  yellowish  paper- 
white,  quite  clear,  and  margins  sharp  and  regular ;  vessels 
about  normal.  Pupil,  no  direct  action,  moderate  but  not 
quite  full  indirect  action  ;  it  is  usually  rather  larger  than  right. 
Left  external  rectus  has  nearly  recovered,  but  still  has  slight 
convergent  strabismus  of  this  eye.  Right  eye,  optic  disc 
normal  and  sees  well,  pupil  normal. 

Case  6.  Atrophy  of  optic  disc  after  injury  to  head ;  inter- 
mittent neuralgia  of  same  fifth  nerve  for  many  years  previously. 
Probably  rupture  of  nerve  high  up,  or  compression  in  optic 
foramen. — George  H — ,  set.  27  (Sir  W.  McCormac,  Leopold 
Ward).  Fifteen  months  ago  fell  about  twenty  feet  down  hold 
of  ship,  sustaining  a  compound  fracture  of  right  thigh,  and 
was  insensible  for  a  week.  There  was  no  external  injury  to 
the  head,  and  he  appeared  to  have  no  cerebral  symptoms. 
The  doctor  told  him  that  immediately  after  the  accident  he 
vomited  some  blood.  As  soon  as  he  was  sensible  (a  week 
after  the  accident)  he  found  right  eye  quite  blind,  as  it  is  now. 
Believes  there  was  no  redness  or  ecchymosis  about  the  eye. 

Present  condition  (January  20th,  1881). — Right  diverges; 
no  perception  of  light  in  daylight  nor  to  concentrated  gaslight. 
Right  pupil,  no  direct  action, indirect  action  good;  usually  rather 
larger  than  left  (as  3|  to  3)  ;  action  to  accommodation  indefi- 
nite ;  it  makes  a  brief  contraction  and  dilates  again.  Left 
pupil  acts  perfectly  to  light,  but  not  so  visibly  to  accommoda- 
tion. 2.30  p.m. — Eserine  to  right  pupil.  3.15. — Pupil  = 
1*5  mm.      Two  drops  of  atropia,  gr.  iv  to  5J  >  4  p.m. — Pupil  = 


Injury  to  the  Optic  Nerve,  121 

6|  mm.      11  a.m.   (next  day). — Pupil  still  =  6|   mm.      Left, 
vision  ■§■§•  and  1  J.,  p.  6";   H.m.  *5  or  -75  D. 

For  teu  years  liable  more  or  less  to  attacks  of  pain  in  this 
eye  and  temple ;  dates  it  from  ague.  The  left  never  affected. 
They  are  sometimes  quite  regular  daily,  and  this  usually  occurs 
in  tropics.  At  home,  when  he  has  them,  they  are  quite  irre- 
gular in  interval.  An  attack  lasts  one  to  two  hours  and  does 
not  affect  vision.  No  pain  elsewhere;  no  radiation  to  other 
branches  of  fifth.  He  asks  whether  a  carious  first  upper 
molar  on  left  side  may  be  the  cause  of  these  attacks  ;  it  is  not 
tender  now,  but  he  cannot  eat  on  it. 

Ophthalmoscope. — Left  normal.  Right,  greyish  atrophy, 
with  some  diminution  of  arteries,  but  veins  about  normal ; 
refraction  emmetropic  or  slightly  myopic.  Optic  disc  shows 
large  shallow  cup  occupying  greater  part  of  surface,  except  at 
nasal  side.  Lamina  cribrosa  more  visible  than  usual.  Pulsa- 
tion test  is  difficult  to  apply,  but  I  think  arteries  pulsate. 

On  subsequently  comparing  this  disc  with  that  of  a  case  of 
ataxy  with  typical  grey  discs,  the  optic  disc  appeared  rather 
yellowish  than  greyish. 

Case  7. — Mr.  C —  (sent  to  me  by  Dr.  Leeson)  fell  from  his 
horse,  striking  his  forehead,  and  was  stunned  for  a  few  hours. 
Almost  immediately  afterwards  he  found  the  right  eye  very 
defective,  and  it  has  remained  so,  though  he  thinks  the  sight 
varies  somewhat  on  different  days.  His  face  was  bruised,  but 
he  was  not  ill,  and  two  days  after  the  accident  he  took  a  long 
journey.      He  has  become  deaf  in  the  left  ear  since  the  fall. 

July  24th,  1880.— Vision.— Right,  ■££$  and  letters  of  20  J. 
Left,  yf  ;  refraction  slightly  hypermetropic. 

Right  pupil  same  size  as  left  when  both  are  open ;  very 
slight  direct  action  to  light,  indirect  action  normal.  By  the 
ophthalmoscope  the  disc  is  seen  to  be  very  pale  and  slightly 
hazy,  the  central  vessels  of  ordinary  size,  and  the  arteries  pul- 
sating on  pressure ;  some  mottled  blood  in  retina  near  the 
disc,  and  near  the  yellow  spot  a  good  deal  of  bright,  white, 
dotted  retinal  opacity,  exactly  as  in  albuminuric  retinitis,  but 
less  regularly  distributed.  Left  eye  normal  in  all  respects. 
On  trying  the  right  eye  for  colour-blindness  I  found  (by  the 
wool   test)   that   he   confused   pink    with  pale  green,  and  full 


122  Injury  to  the  Optic  Nerve. 

bright  green  with  a  greenish  brown,  whilst  with  the  other  eye 
he  made  no  mistakes. 

The  retinal  degeneration  here  was  probably  a  result  of 
changes  set  up  by  extensive  haemorrhage.  The  haemorrhage 
may  have  been  due  to  a  coincident  blow  upon  the  eyeball,  to 
rupture  of  retinal  veins  compressed  by  effusion  of  blood  into 
the  optic  nerve-sheath,  or  possibly  to  passage  of  blood  from 
the  sheath  into  the  eye,  though  this  last  would  be  difficult  to 
understand.  The  coincidence  of  retinal  haemorrhages  with 
distension  of  the  nerve-sheath  by  blood  after  fracture  of  skull 
has  been  proved  post  mortem  by  Gowers  (Dr.  S.  H.  Burton)1 ; 
and  a  similar  condition  figured  by  Poncet,2  after  cerebral 
haemorrhage. 

Case  8. — John  G — ,  aet.  59  (under  the  care  of  Mr.  Croft), 
fell  from  a  cart  on  to  the  top  of  his  head  one  month  before  I 
saw  him  ;  he  said  the  eyes  were  not  struck.  The  left  eyelids 
and  eye  were  much  "  bloodshot,"  but  the  lids  were  not  swollen. 

July  26th  and  29th,  1878. — Left  eye  has  bare  perception  of 
light ;  pupil  usually  rather  larger  than  the  right ;  very  slight 
direct  action  to  strong  light,  indirect  action  free.  Optic  disc 
decidedly  pale,  il  pallor  not  very  great  but  quite  definite,"  as 
compared  with  the  right ;  there  is  neither  haze  nor  swelling. 
The  central  vessels  are  of  about  normal  size ;  the  arteries 
cannot  be  seen  to  pulsate  on  pressure  even  by  the  direct 
method  (perhaps  owing  to  some  nuclear  haze  of  the  lens), 
though  in  the  other  eye  they  are  easily  seen  to  pulsate. 

On  testing  his  optic  nerves  with  galvanism  it  was  found 
that  while  two  cells  gave  a  distinct  flash,  on  making  or 
breaking  the  current  over  the  sound  (right)  eyebrow  and 
orbital  rim,  six  cells  were  needed  when  the  poles  were  over 
the  blind  (left)  eye.  Whether  this  showed  that  the  damaged 
optic  nerve  was  still  able  imperfectly  to  conduct  the  current 
to  the  brain,  or  whether  the  stimulus  was  conveyed  through 
the  structures  to  the  healthy  (right)  retina,  may  be  open  to 
question.  As  there  was  some  perception  of  light,  and  some, 
however  slight,  direct  action  of  the  pupil  to  light,  the  former 
explanation  seems  probable. 

1  '  Medical  Ophthalmoscopy/  2nd  edition,  Case  49,  p.  337. 

2  '  Atlas  des  Mai.  de  l'CEil,  &c.,'  pi.  xxxii. 


A  CASE   OF   SPONDYLOLISTHESIS. 


By  ROBERT   CORY,  M.D. 


Cases  of  spondylolisthesis  are  rare,  and  are  therefore  worth 
recording  when  met  with.  The  following  case  is  one  which 
was  admitted  into  St.  Thomas's  Hospital  under  the  care  of 
Sir  Wm.  MacCorinac,  having  been  sent  as  a  patient  to  Mr. 
Cluttou,  and  it  was  through  their  courtesy  that  I  was  enabled 
to  obtain  the  notes  of  the  case. 

Harriet  P — ,  set.  26,  residing  at  Crondall,  Hants,  was 
admitted  into  St.  Thomas's  Hospital  on  the  26th  of  May, 
1881.  She  was  married  in  1876,  and  her  first  child  was 
born  dead  at  full  time  on  the  17th  April,  1877.  The  labour 
was  tedious,  but  otherwise  natural,  and  no  instrumental  aid 
was  needed.  Her  second  child  was  born  prematurely,  when 
six  and  a  half  months  pregnant,  on  the  13th  May,  1878. 
Dr.  T.  J.  Burroughs,  of  Crondall,  who  attended  her  in  this 
and  in  her  subsequent  confinement,  has  kindly  written  to 
inform  me  that  he  turned  the  child  in  order  to  deliver  her 
as  quickly  as  possible  on  account  of  haemorrhage  produced  by 
placenta  prsevia,  and  that  he  had  some  difficulty  in  so  doing. 
From  this  time  to  the  present  she  has  suffered  from  a  slight 
dull  aching  pain  in  her  back,  which  she  called  "  weakness." 
Her  third  confinement  took  place  at  full  time  on  the  1st 
February,  1881.  Dr.  Burroughs,  with  the  assistance  of  a 
friend,  turned  this  child   also,  and    thus  with   much    difficulty 


124  A  Case  of  Spondylolisthesis. 

delivered  the  extremities  aiid  trunk,  but  they  were  obliged 
ultimately  to  perforate  the  head  to  effect  its  delivery.  After 
this,  her  last  confinement,  she  had  phlegmasia  dolens  of  the 
left  leg,  and  the  pain  in  her  back  became  much  worse.  Her 
leg  soon  got  better,  but  the  pain  in  her  back  became  still  worse. 
As  soon  as  she  began  to  get  about  she  experienced  great 
difficulty  in  walking.  On  or  about  the  12th  of  May,  1881, 
she  fell  down  from  loss  of  power  in  her  legs,  and  after  this 
her  legs  started  much  before  going  to  sleep.  The  loss  of 
power  gradually  passed  off,  so  that  on  the  26th  of  May,  the 
day  of  her  admission  to  the  hospital,  she  was  able  to  stand 
and  walk  a  short  distance  by  herself,  but  so  doing  caused 
her  much  pain. 

When  admitted  to  the  hospital  she  complained  of  much 
pain  in  her  back  and  lower  abdomen.  She  could  stand  and 
walk  a  short  distance,  but  was  quite  unable  to  stoop  to  pick 
up  anything.  Her  general  health  was  good  and  her  tempera- 
ture was  and  remained  normal.  On  examining  her  back, 
extreme  lordosis  of  the  lumbar  region  of  the  spine  was 
noticed,  and  a  marked  depression  just  above  the  sacrum. 
Pressure  over  the  normal  position  of  the  last  lumbar  vertebra, 
where  the  depression  was  deepest,  gave  her  much  pain.  On 
examining  the  abdomen  the  projecting  bodies  of  the  lumbar 
vertebrae  could  be  easily  felt  almost  on  a  level  with  the  pubes, 
there  being  just  room  to  press  the  fingers  into  the  pelvis 
between  the  projecting  mass  and  the  symphysis. 

The  woodcut  on  the  opposite  page,  copied  from  a  photograph 
taken  on  thelOth  June,  1881,  gives  a  very  faithful  representation 
of  the  appearance  of  the  back  and  the  abdomen. 

The  external  measurements  of  the  pelvis  were  as  follows  : 


Between  the  highest  points  of  the  iliac  crests  . 

„       anterior  superior  spines 

„       posterior  superior  spines 

,,       great  trochanters 
From  the  symphysis  pubis  to  the  1st  sacral  spine 

„     the  spine  of  the  2nd  lumbar  vertebra  to  top  of  the  sacrum 
Height  of  patient  .... 


By    vaginal    examination    the    internal   conjugate   diameter 


Ft. 

In. 

0 

10* 

0 

9f 

0 

2 

0 

lit 

0 

61 

0 

1* 

4 

9f 

A  Cose  of  Spondylolisthesis 


125 


126  A  Case  of  Spondylolisthesis. 

was  ascertained  to  be  less  than  two  inches.  The  cervix  uteri 
could  be  felt  wedged  in  between  the  pubes  and  the  bodies  of 
the  projecting  vertebrae,  allowing  it  no  antero-posterior 
movement  whatever. 

During  her  stay  in  the  hospital  she  gained  much  in 
strength,  and  with  the  help  of  a  spinal  support  which  was 
made  for  her  she  was  able  to  get  about  with  little  or  no  pain. 

Unfortunately  her  height  had  never  been  previously  taken, 
so  that  it  is  impossible  to  say  how  much  shortening  has 
taken  place,  but  Dr.  Burroughs,  who  has  known  her  for  eleven 
years,  thinks  she  is  at  least  two  inches  shorter  now  than  when 
she  was  married  in  1876.  Since  leaving  the  hospital  up  to 
the  present  time  (May  1882)  her  health  has  continued  good 
and  menstruation  regular.  She  is  able,  with  the  aid  of  the 
spinal  support,  to  walk  two  miles  without  much  discomfort. 

There  have  been  two  causes  assigned  for  the  occurrence  of 
spondylolisthesis ; *  one  a  developmental  one  advanced  by 
Lambl,  the  other  a  pathological  one  advanced  by  Kilian. 

Dr.  Lambl's  views  were  either  (a)  that  in  consequence  of 
hydrorachis  of  the  lower  part  of  the  spinal  column,  the  inferior 
articular  processes  of  the  last  lumbar  vertebra,  which  normally 
have  their  articulating  surfaces  looking  forwards  and  a  little 
outwards,  become  twisted  so  that  they  look  more  outwards, 
thereby  allowing  them  to  slip  between  their  fellow  articulating 
processes  ;  or  (b)  that  in  consequence  of  the  development  of 
an  incomplete  sixth  lumbar  vertebra  (which  may  or  may  not 
occur  in  combination  with  a  hydrorachis)  having  a  very  thin 
body  but  a  more  or  less  complete  arch,  the  upper  lumbar 
vertebra  are  thrust  forward  as  by  a  wedge  driven  in  from 
behind. 

Kilian's  views  were  that  either  from  a  scrofulous  or 
tuberculous  dyscrasia,  a  local  softening  occurred  between  the 
last  vertebra  and  the  sacrum  and  in  the  ligaments,  attended 
or  followed  by  inflammation. 

In  the  case  just  described,  it  seems  probable  that  the  cause 
is  to  be  found  in  the  latter  of  these  two  views. 

If  we  take  a  fifth  lumbar  vertebra  and  a  sacrum  and  place 
them  in   position,   and    imagine  that    the  intevertebral   disk 

1  See  Dr.  Barnes'  paper  on  the  subject,  in  the  '  Obstetrical  Transactions,    page 
78,  vol.  vi. 


A   Case  of  Spondylolisthesis.  127 

originally  existing  between  them  and  the  body,  but  not 
the  arch  of  the  first  sacral  vertebra,  has  been  removed  by 
disease,  we  can  readily  understand  how  such  a  condition  might 
give  rise  to  their  dislocation  ;  for  the  fifth  lumbar  vertebra 
would  become  tilted  by  the  falling  of  its  body,  and  this  would 
occasion  its  posterior  portions,  including  the  inferior  articular 
processes,  to  be  raised  ;  and  this  might  occur  to  such  an 
extent  as  to  allow  of  the  latter  slipping  over  the  articular 
processes  of  the  sacrum. 

Exactly  the  same  condition  would  arise  on  the  supposition 
of  an  incomplete  sixth  lumbar  vertebra  existing  having  a  more 
or  less  complete  arch  but  scarcely  any  body. 


F^CAL  RETENTION,  ESPECIALLY  AS  IT 
AFFECTS   THE   GMGJJK. 


By  JOHN  HAELEY,  M.D.  Lond. 


Constipation  is  often  the  forerunner  of  enteric  fever,  and 
so  far  may  be  regarded  as  a  factor  of  that  disease. 

I  believe  I  may  go  even  further  and  state  that  constipation 
is  occasionally  the  sole  cause  of  enteric  fever. 

Those  who  regard  this  disease  as  specific  will  not,  of  course, 
assent  to  this  proposition,  but  they  are  compelled  to  admit 
that  simple  enteritis,  more  or  less  general,  may  be  a  con- 
sequence of  constipation,  and  the  question  is  thus  resolved  into 
the  identity  of  simple  and  so-called  specific  enteritis.  I  have 
long  ago1  admitted,  if  not  proved,  the  identity,  and  therefore 
must  needs  call  attention  to  this  point  in  the  present  com- 
munication. 

There  is  of  course  no  morbid  condition  more  frequently  wit- 
nessed than  constipation.  A  retention  of  the  contents  of  the 
colon  for  forty-eight  hours  is  sufficient,  in  some  persons,  to 
tender  the  faeces  hard  and  lumpy ;  and  there  are  hosts  of  people 
who  think  they  pay  proper  attention  to  the  wants  of  nature  if 
they  unload  their  bowels  once  in  two  or  three  days.  Nor  is 
the  number  of  those  who  habitually  go  a  week  very  small. 
While  constipation  is  the  commonest  ailment  that  comes  under 
our  notice,  how  rarely  do  we  seem  to  trace  it  to  a  fatal  issue, 

1  "  Enteric  Fever,"  •  Reynolds'  System  of  Medicine.' 
VOL.  XI.  9 


130  Faecal  Retention,  especially 

and  to  study  its  effects  after  death  ?  "  seem,"  I  say,  for  I  an* 
convinced  that  many  a  fatal  attack  of  enteric  fever  has  its 
origin  in  constipation. 

Nor  is  death  from  simple  idiopathic  constipation  a  very 
common  event.  I  can  myself  adduce  two  instances  from  my 
own  practice,  and  show  from  a  number  of  others  how  soon 
matters  assume  a  grave  aspect  when  the  bowels  are  allowed 
to  become  slowly  impacted  with  feces. 

In  order  to  trace  the  effects,  both  local  and  constitutional, 
of  constipation,  I  will  briefly  give  the  history  of  three  cases 
which  will  serve  to  illustrate  the  condition. 

Case  1  is  that  of  an  elderly  lady  who  had  resided  for  many 
years  in  India;  she  came  under  my  care  during  the  last 
thirteen  years  of  her  life,  and  died  at  the  age  of  seventy-nine 
of  an  attack  of  constipation.  Throughout  life  she  was 
satisfied  if  her  bowels  acted  twice  or  thrice  a  week,  but  when 
away  from  home,  or  if  there  was  the  slightest  risk  of  her 
privacy  being  disturbed,  she  would  allow  a  week  or  longer  to 
elapse  before  she  got  relief  of  her  bowels.  She  led  an  active 
life,  walking  a  good  portion  of  each  day,  and  as  often  as  she 
felt  bilious  took  a  colocynth  pill  and  so  got  what  she  regarded 
as  sufficient  relief.  As  she  grew  older  and  less  capable  of 
exercise,  the  bilious  attacks  became  more  frequent  and  violent, 
and  then  it  was  that  my  aid  was  sought,  and  I  learned  from 
her  maid  the  real  state  of  affairs,  namely,  that  her  mistress 
usually  went  to  the  closet  only  once  a  week,  that  her  motions 
were  always  scybalous,  and  that  when  matters  came  to  a 
climax  and  strong  purgatives  were  used,  a  vast  quantity  of 
lumpy  fseces  were  discharged.  "  Do,  sir,  get  mistress  to  pay 
more  attention  to  her  bowels,  for  these  attacks  make  her 
dreadfully  ill ;  and  I  am  sure  she  will  do  herself  harm  by 
neglecting  herself  in  the  way  she  does,"  was  an  appeal  which 
her  intelligent  maid  made  to  me  more  than  once.  The 
patient  herself,  however,  thought  but  lightly  of  the  matter. 
She  as  good  as  told  me  that  once  a  week  was  often  enough 
to  attend  to  such  a  disagreeable  duty ;  and  when  I  suggested 
the  occasional  use  of  an  enema ;  "  Don't  mention  such  a 
thing  again/'  she  said,  "  I  would  rather  die  than  use  it. 
Give  me  any  medicine  excepting  castor  you  like,  and  I  will 
take  it." 


as  it  affects  the  Ccecum.  131 

Such  was  my  patient.  Whenever  a  repetition  of  the  usual 
pill  failed  to  remove  the  obstruction,  she  was  attacked  with 
bilious  vomiting,  and  from  the  quantity  discharged  it  was 
evident  that  the  amount  of  unused  bile  retained  was  some- 
what commensurate  with  that  of  the  retained  faeces.  The 
vomiting  of  bile  usually  continued  uncontrolled  for  twenty- 
four  hours,  and  was,  of  course,  attended  with  great  prostration. 
The  usual  remedies  were  five  to  ten  grains  of  calomel 
with  half  a  grain  of  opium,  and  an  effervescing  draught  of 
citrate  of  soda  and  hydrocyanic  acid,  at  intervals.  A  little 
iced  brandy  and  water  was  the  only  sustenance  that  could  be 
retained,  and  this  was  as  often  rejected  as  not.  As  soon  as 
the  bowels  were  relieved  the  attack  subsided. 

The  attacks  recurred  pretty  regularly  at  intervals  of  three 
or  six  months,  and  on  one  occasion  calomel,  and  subsequently 
a  large  dose  of  compound  colocynth  pill,  failing  to  open  the 
bowels,  I  said  "  My  only  safe  resource  is  the  enema.'J  I 
explained  its  simple,  direct  action,  and  the  danger  of  forcing  a 
passage  from  above.  She  shook  her  head,  smiled,  and  said, 
"  Give  me  a  good  dose  of  Croton  oil,  that  I  know  will  be 
effectual."  I  was  obliged  to  yield,  and  fortunately  the  result 
was  satisfactory. 

I  now  provided  the  maid  with  an  india-rubber  enema 
apparatus,  showed  her  the  use  of  it,  and  urged  her  to  get 
her  mistress  to  use  it.  But  the  lady's  conservatism  and 
abhorrence  of  everything  that  savoured  of  French  customs 
got  the  better  of  her  own  sound  judgment  and  of  our  entreaties  ; 
and  it  was  only  in  her  last  attack,  and  a  few  hours  before  her 
death,  that  I  disregarded  her  scruples,  and  for  the  first  time 
washed  a  few  large  scybala  coated  with  fluffy  mucus  from  the 
rectum.  But  this  time  the  vomiting  caused  rapid  prostration, 
and  she  was  "  in  extremis  "  and  died  unrelieved  of  her  con- 
stipation about  ten  hours  after  the  commencement  of  the 
attack. 

Case  2  will  serve  to  illustrate  a  passive  variety  of  the 
same  condition.  The  subject  was  an  old  servant  of  my  own, 
a  little  spare  woman,  nearly  seventy  years  of  age.  I  was 
once  asked  to  see  her,  and  found  her  in  bed,  prostrate,  with  a 
dry  brown  tongue  and  a  pulse  of  80.      She  could  give  me  no 


132  Faecal  Retention,  especially 

further  account  of  herself  than  that  she  had  completely  lost 
her  appetite,  and  was  too  weak  to  go  about  her  work.  She 
looked,  indeed,  as  if  she  were  going  to  have  typhus  fever,  but 
the  skin  was  cool  and  free  from  rash.  On  examining  the 
thin  abdomen  I  could  distinctly  feel  nodular  fseces,  and  then 
I  discovered  that  she  was  habitually  constipated,  and  that  the 
bowels  had  not  acted  for  seven  or  eight  days.  A  clyster  of 
soap  and  water  followed  by  a  dose  of  castor  oil  brought  away 
a  large  quantity  of  scybalous  matter,  and  she  was  well  again 
in  the  course  of  a  few  days,  but  continued  weak  for  several 
more.  During  the  time  she  was  in  my  service  she  had  three 
such  attacks,  exactly  similar,  the  dry  brown  tongue  being 
very  characteristic.  I  prescribed  an  aperient  pill,  giving  her 
warning  not  to  neglect  the  action  of  the  bowels,  and  she  has 
followed  my  directions  and  experienced  no  more  attacks.  She 
is  still  living  near  the  age  of  eighty. 

These  two  cases  illustrate  the  difference  in  the  symptoms 
which  attend  the  same  condition  in  different  individuals.  The 
one  (Case  1)  was  an  excitable,  highly  emotional  person ;  the 
other  was  of  a  placid  disposition,  and  had  no  tendency  to 
vomiting. 

Such  an  individual  it  appears  was  the  subject  of  Case  3, 
who  actually  died  of  constipation  without  any  indication  of 
obstruction. 

Case  3.  Fatal  constipation  without  prominent  symptoms. — 
Charles  C — ,  set.  17,  was  admitted  moribund  into  the  London 
Fever  Hospital,  13th  November,  1866.  No  history  could  be 
obtained  of  him,  except  that  he  had  been  very  weak  and  "  out 
of  sorts."  His  body  was  spare  almost  to  emaciation,  the  skin 
supple,  free  from  rash,  and  cold,  the  hands  and  feet  dusky, 
the  eyes  sunken,  the  pulse  thready,  the  tongue  moist  and 
dirty  ;  the  abdomen  was  not  enlarged,  and  it  had  a  doughy, 
inelastic  feel.  He  was  free  from  pain  or  distress — apathetic, 
indeed — and  took  drinks  with  difficulty.  He  did  not  rally, 
and  died  next  day. 

After  death. — The  small  intestine  was  found  void  of  faecal 
matter,  the  mucous  membrane  everywhere  injected  and 
covered  over  with  a  layer  of  purulent-looking  mucus,  the  sur- 


as  it  affects  the  Ccecum.  133 

face  beneath  was  red,  vascular,  bare,  and  in  patches  consider- 
ably inflamed.  The  whole  of  the  large  intestine,  from  the 
opening  of  the  vermiform  appendix  to  within  two  inches  of 
the  anus,  was  impacted  with  fseces ;  in  the  colon  formed  into 
tripartite  masses,  each  lying  in  a  separate  cell,  and  only  attached 
to  the  mass  above  and  below  at  the  centre,  where  it  was 
three  quarters  of  an  inch  thick.  The  colon  was  contracted  on 
these  scybala  so  as  to  have  a  very  regular  nodular  appearance. 
The  csecum  was  filled  with  one  large  mass  of  very  stiff,  dark- 
greenish  fseces,  weighing  about  a  pound.  On  raising  the 
scybala  from  the  mucous  surface,  this  was  found  to  be  vascular 
and  covered  over  with  a  thick  layer  of  yellow  opaque  mucus, 
and  at  some  parts,  in  the  caecum  especially,  the  mucous  mem- 
brane was  much  inflamed.     All  the  other  viscera  were  healthy. 

Here  is  a  case  in  which  constipation  set  in  gradually, 
attained  its  fullest  development,  was,  as  far  as  could  be  ascer- 
tained, wholly  uninterfered  with,  and  was  thus  allowed  to  run 
its  fatal  course.  Let  us  consider  the  effects,  both  local  and 
general,  which  are  consequent  upon  such  a  condition. 

The  earliest  effect  of  constipation  is  the  absorption  of  mois- 
ture, and  the  conversion  of  the  soft  fseces  into  lumps  or 
nodules.  A  considerable  amount  of  mucus  is  secreted  and 
incorporated  with  the  fasces  as  a  normal  process,  and  it  would 
appear  that  there  is  no  diminution  of  the  amount  of  mucus 
thrown  out  when  the  fasces  are  retained,  for  one  of  the  most 
obvious  effects  of  constipation  is  the  formation  of  a  thick  layer 
of  opaque  mucus  upon  the  surface  of  the  scybala,  filling  up  the 
interstices  between  the  nodules,  and  when  placed  in  water  seen 
as  a  thick  fluffy  coating.  Such  a  layer  of  mucus  no  doubt 
acts  as  a  protective  covering,  and  at  the  same  time,  by  obstruct- 
ing osmosis,  prevents  the  absorption  of  faecal  matter.  But 
retained  mucus  is  itself  liable  to  putrescent  change.  Ozsena, 
for  example,  is  commonly  produced  by  the  decomposition  of 
retained  mucus ;  it  becomes  opaque  and  purulent,  and  then 
very  soon  disorder  arises  in  the  germinating  layer,  the  blood- 
vessels become  congested,  growth  ceases,  the  mucous  membrane 
softens,  and  the  unhealthy  surface  easily  bleeds  and  soon  pre- 
sents patches  of  erosion.  If  this  state  of  unhealthy  congestion 
of  the  mucous  membrane  be  not  relieved  by  the  expulsion  of 


134  Fcecal  Retention,  especially 

the  unhealthy  contents  of  the  bowel,  irritation  and  pain  sooner 
or  later  ensue,  as  the  immediate  forerunners  of  inflammatory 
action.  It  is  but  reasonable  to  expect  that  lymphatic  irrita- 
tion would  arise  very  soon  in  such  a  condition  as  this,  and  thus 
the  solitary  and  agminated  glands  would  be  involved,  when 
the  symptoms  would  be  indistinguishable  from  those  of  deve- 
loped enteric  fever.  I  could  adduce  several  instances  of  this 
transition,  but  I  will  content  myself  with  the  following  case, 
which  will  easily  be  recognised  as  a  link  in  the  chain  : 

Case  4.  Fcecal  accumulation  in  the  c&cum  inducing  some  of 
the  symptoms  of  enteric  fever. — James  R — ,  set.  40,  a  large, 
rather  fat  man,  a  policeman,  was  admitted  into  the  London 
Fever  Hospital,  8th  June,  1871,  on  the  fourteenth  day  of  his 
illness.  He  gave  the  following  account  of  himself: — The  day 
before  his  illness  commenced  he  accommodated  a  colleague,  who 
had  just  left  the  Fever  Hospital  convalescent  from  an  attack  of 
relapsing  fever,  with  a  bed,  and  was  disgusted  by  a  bad  smell 
arising  from  his  clothes.  Next  day,  when  on  duty,  he  felt  an 
icy  chilliness  and  pain  in  the  legs.  On  the  second  day  he  had 
pain  in  the  abdomen,  and  he  applied  to  a  medical  man  who  gave 
him  pills  "  to  work  it  off."  The  pills  acted,  and  he  continued 
on  duty  until  the  ninth  day,  and  then  took  to  his  bed,  where  he 
remained  until  the  day  (fourteenth  of  the  illness)  of  his  admis- 
sion. At  this  time  there  had  been  no  action  of  the  bowels  for 
ten  or  eleven  days.  The  mind  was  clear,  tongue  moist  with  an 
even  coating  of  white  fur,  the  skin  coldish  and  free  from  rash, 
pulse  100  and  weak.  There  were  pain,  tenderness,  and  fulness 
in  the  right  iliac  fossa  ;  the  rest  of  the  abdomen  was  rather 
doughy  to  the  feel.  There  was  anorexia,  but  he  took  fluids. 
Hot  fomentations  were  applied  and  stimulants  administered. 
Excepting  a  pain  in  the  right  gluteal  region,  extending  to  the 
knee,  and  very  free  perspiration  with  beads  of  sweat  on  the 
forehead,  he  continued  in  the  same  state. 

On  the  sixteenth  day  half  an  ounce  of  castor  oil  was  given ; 
it  acted  once  moderately.  On  the  eighteenth  day  the  pulse 
was  120,  the  temperature  only  slightly  elevated,  the  skin  free 
from  rash  and  still  perspiring,  the  tongue  still  moist  with  a 
dirty-white  fur.  A  simple  enema  produced  two  loose  stools, 
the  first   containing   scybala.     The   next   day  (nineteenth)    a 


as  it  affects  the  Caecum.  135 

defined,  hard,  tender  tumour,  in  which  the  patient  experienced 
some  throbbing,  could  be  felt  in  the  csecal  region,  the  fulness 
and  solid  feeling  passing  upwards  to  the  hepatic  region.  A 
light  loose  stool  was  discharged  spontaneously  to-day.  He 
was  now  ordered  daily  enemata  of  castor  oil  and  the  continued 
application  of  linseed  and  mustard  poultices  to  the  right  iliac 
region.  The  first  enema  produced  a  loose  yellow  stool  with  a 
few  hard  scybala  as  big  as  filberts. 

On  the  twentieth  day  the  throbbing  had  ceased,  the  abdo- 
men was  less  full,  and  now  the  tumour  in  the  csecal  region  was 
appreciable  to  the  eye,  lying  in  the  iliac  region ;  it  was  firm 
and  not  very  tender,  and  reached,  on  the  left  side  to  within  two 
inches  of  the  mesial  line  upwards ;  to  the  hepatic  region,  and 
downwards  two  inches  below  the  level  of  the  anterior  superior 
spine  of  the  ileum.  The  breath  had  a  disagreeable  sweet 
odour. 

During  the  next  two  days  there  were  eight  or  nine  loose 
stools — a  very  copious  relief.  These  evacuations  consisted  of 
disintegrated  faeces,  being  thin  and  yellow  without  scybala. 

On  the  twenty-second  day  a  great  diminution  of  the  faecal 
tumour  was  noticed,  and  manipulation  gave  very  little  pain. 

On  the  twenty-third  day  there  was  a  marked  improvement 
in  the  general  condition,  and  the  tumour  was  no  more  percep- 
tible than  the  sigmoid  flexure  before  a  natural  evacuation. 
The  tongue  was  still  covered  with  a  thick  white  fur,  the  skin 
was  cool  and  occasionally  perspiring  very  freely ;  the  patient 
was  comfortable  but  feeling  weak. 

During  the  next  few  days  the  enemata  continued  to  bring 
away  large  quantities  of  faecal  matter,  and  this  part  of  the  treat- 
ment was  now  finally  omitted. 

On  the  twenty-eighth  and  thirtieth  days  a  very  copious 
semisolid  stool  was  discharged  each  day,  the  tongue  began  to 
clean,  and  the  appetite  to  reappear.  Fish  was  allowed,  but 
it  appeared  to  provoke  diarrhoea  and  was  discontinued  next 
day.  Perspiration  was  still  profuse,  the  abdomen  retracted, 
and  the  caecal  tumour  quite  gone.  The  bowels  continued  loose 
for  the  next  seven  days,  two  or  three  stools  in  the  twenty-four 
hours,  the  motions  being  watery  and  light  yellow. 

This  outbreak  of  diarrhoea  was  preceded  by  the  appearance 
of  a  few  rose  spots  upon  the  trunk  on  the  thirty-second  day. 


136  Faecal  Retention,  especially 

At  the  end  of  a  week  the  motions  acquired  a  natural  consist- 
ence, and  there  was  no  further  development  of  rash  after  the 
thirty-second  day.  Perspiration  still  continued  profuse  at 
times,  and  the  pulse  declined  to  84.  The  patient  was  very 
weak,  and  there  was  considerable  emaciation.  It  was  the 
forty-seventh  day  before  the  appetite  returned  and  he  was  able 
to  take  solid  food.  He  regained  his  strength  slowly,  and  was 
discharged  on  the  sixty-fourth  day. 

In  this  history  we  see  some  things  which  resemble  enteric 
fever  and  some  that  do  not.  As  resemblances  I  may  point 
to  : — 1.  The  onset — disgust  of  a  bad  odour.  2.  The  long  con- 
tinuance of  the  symptoms  (two  months  and  more),  and  the 
prostration  and  emaciation  attending  them.  3.  The  develop- 
ment of  a  rose  rash. 

The  differences  appear  at  first  sight  even  more  positive : 
1.  There  is  a  large  fsecal  accumulation  with  constipation.  2. 
An  absence  of  fever,  the  temperature  never  rising  beyond  99°, 
except  on  the  day  after  his  admission  when  it  was  101°.  3. 
A  moist  skin  frequently  bathed  in  sensible  and  distressing 
perspiration.  4.  A  continuously  moist  tongue.  5,  and  lastly, 
the  need  of  a  purgative  treatment. 

Those  who  are  fond  of  classification — artificial  distinctions, 
I  would  rather  call  it — will  perhaps  be  quite  satisfied  that  the 
case  I  have  narrated  in  brief  above  is  not  one  of  enteric  fever. 
But  when  we  come  to  analyse  these  resemblances  and 
differences  we  find  that  they  have  no  real  worth.  Thus  a 
squeamish  stomach  is  surely  to  be  expected  when  the  bowels 
are  blocked  and  the  appetite  gone.  Prostration  with 
emaciation  is  an  invariable  attendant  on  enteric  fever,  and 
must  be  regarded  as  the  direct  result  of  arrest  of  nutrition. 
But  such  arrest  of  nutrition  would  equally  happen  in  a  case 
of  grave  constipation  such  as  the  present  or  Case  3,  which  is 
even  more  to  the  point. 

A  successive  crop  of  rose  papules  appearing  daily  for  three 
or  four  days  occurs  in  considerably  less  than  half  the  cases  of 
enteric  fever,  and  it  must  be  granted  that  in  many  cases  the 
rash  when  present  does  not  amount  to  more  than  was  noted 
in  the  case  recorded  above.  For  my  part  I  cannot  regard 
this  as  very  important   evidence  of  the  existence  of  enteric 


as  it  affects  the  Caecum.  137 

fever,  but  I  would  say  of  this  symptom  as  of  the  rest,  "  vale  at 
quantum  valet." 

As  to  the  differences.  A  reference  to  the  history  of  the 
case  will  show  that  constipation  persisted,  or  that  enemata  and 
purgatives  were  required,  up  to  the  thirty-second  day  ;  then 
a  few  rose  spots  appeared,  and  the  bowels  became  loose — two 
or  three  light  yellow  stools  in  the  twenty-four  hours — and  con- 
tinued so  for  a  week.  But  constipation — I  will  not  say  to  the 
extent  of  a  large  palpable  faecal  mass — is  a  very  common  event 
in  enteric  fever.  Indeed,  if  I  look  back  to  the  cases  which 
have  occurred  in  my  practice  during  the  last  three  or  four 
years,  I  find  several  cases  in  which  enemata  have  been  required 
throughout  the  attack,  and  in  the  majority  they  have  been 
needed  in  the  early  as  well  as  in  the  convalescent  stage  of  the 
disease.  Constipation,  therefore,  affords  no  distinction.  In 
the  case  narrated  the  pain  produced  by  pressure  of  the  lumbar 
plexus  is  significant  of  the  amount  of  the  accumulation. 

Perspiration,  excepting  as  a  crisis,  is  certainly  not  common 
in  enteric  fever ;  but  to  mention  only  one  instance,  I  have  this 
winter  treated  a  severe  case  in  Arthur  Ward  in  which  frequent 
and  severe  sweats  were  for  three  weeks  a  distressing  symptom. 

The  only  real  distinction  which  remains  is  in  respect  of  the 
temperature.  Normal  temperatures  have  indeed  been  noticed 
in  attacks  of  enteric  fever,  but  like  continuous  perspiration 
they  are  the  exception. 

Thus  between  two  groups  of  symptoms,  the  one  produced 
by  faecal  accumulation  and  obstruction  and  the  other  by  the 
cause  of  enteric  fever,  we  fail  to  find  any  essential  distinction. 

The  connection  between  the  two  morbid  conditions  may  be 
shown  to  be  still  closer.  In  the  case  of  constipation  while 
the  caecum  was  full  there  was  anorexia.  As  soon  as  the 
obstruction  was  removed  the  appetite  returned,  but  the  fish 
that  was  then  taken  provoked  diarrhoea.  The  mucous  membrane 
was  still  thin,  bare,  irritable,  congested,  not  to  say  excoriated, 
and  ready  to  resent  any  annoyance^ 

If  the  faecal  matter  had  been  allowed  to  remain  undisturbed 
in  the  intestine  for  some  days  longer,  severe  febrile  symptoms 
would  no  doubt  have  been  developed,  and  then  probably  the 
case  would  have  been  regarded  by  all  who  saw  it  as  one  of 
enteric  fever. 


138  Faecal  Retention,  especially 

I  pass  now  to  make  a  few  remarks  on  the  treatment  of 
faecal  retention  involving  the  caecum.  The  subjects  of  it  are 
numerous.  The  condition  itself  is  very  often  regarded  as 
typhlitis  and  perityphlitis. 

I  have  at  the  present  time  two  patients  in  St.  Thomas's 
suffering  from  this  affection,  and  a  brief  account  of  these  will 
serve  to  illustrate  the  treatment. 

In  these,  which  may  be  taken  as  typical  cases,  the  accumu- 
lation in  the  caecum  was  but  a  part  of  the  general  constipation. 
The  first  object  of  treatment  was  to  unload  the  colon  by 
the  use  of  saponaceous  and  oleaginous  enemata,  given  at 
intervals  of  six  or  twelve  hours  according  to  urgency.  After 
the  evacuation  of  a  fair  amount  of  fsecal  matter  has  been  thus 
elicited,  I  give  half  an  ounce  of  castor  oil  with  two  teaspoon- 
fuls  of  brandy,  and  eight  or  ten  minims  of  tincture  of  opium, 
and  repeat  the  dose  after  every  evacuation  produced  by  the 
enemata.  By  these  means  we  may  succeed  in  producing  two 
or  three  fsecal  motions  in  the  twenty-four  hours  to  the  great 
relief  of  the  patient.  The  faecal  tumour  will  be  found  to 
decrease  and  become  less  tender  from  day  to  day,  and  in 
cases  of  ordinary  severity  the  caecum  will  be  emptied  in  the 
course  of  a  week,  and  the  patient  restored  to  convalescence. 
Where  there  is  much  pain,  a  hot  linseed  and  mustard  poultice 
should  be  kept  applied  to  the  abdomen. 

The  subsequent  treatment  should  be  that  of  enteric  fever, 
and  for  a  week  at  least  after  all  pain  and  febrile  disturbance 
have  ceased,  no  solid  food  should  be  given. 

If  the  case  have  been  a  severe  one  and  the  symptoms  of 
long  continuance,  as  in  No.  4,  there  is  commonly  a  tendency  to 
reaccumulation  in  the  csecum.  To  avoid  this,  an  occasional 
dose  of  castor  oil  should  be  given,  a  compress  worn  with  a 
flannel  bandage  over  the  region  of  the  csecum,  and  frictions 
occasionally  used  over  the  part ;  strychnia  in  some  tonic 
infusion  may  be  given  to  promote  tone  in  the  weakened 
intestinal  wall. 

Inveterate  paralysis  of  the  large  intestine  sometimes 
follows  an  attack  of  constipation,  the  colon  becomes  distended 
with  air  to  an  enormous  size,  its  flexions  can  be  traced  by 
the  eye,  and  there  is  much  difficulty  in  securing  the  evacua- 
tions, which  are  formed  into  clay-like  balls  often  as  large  as 


as  it  affects  the  Caecum.  139 

the  patient's  fist.      Two   such   cases    have    come    under    my 
notice. 

But  to  return  to  the  ordinary  cases  : 

Case  5.  Gradual  constipation  followed  by  the  sudden  appear- 
ance  of  symptoms  of  obstruction  in  the  caecum. — Louisa  B — , 
set.  19,  a  stout,  healthy  domestic  servant,  was  admitted  into 
Christian  Ward,  18th  March,  1882.  She  had  never  had 
illness  until  eight  days  before,  when  she  was  taken  with 
vomiting  and  pain  in  the  right  side  of  the  abdomen ;  there 
was  complete  anorexia,  frequent  chilly  sensations  followed  by 
heat.  These  symptoms,  including  the  vomiting  of  green 
bilious  fluid,  continued  up  to  the  time  of  admission.  The 
bowels  she  said  had  acted  regularly  up  to  the  first  day  of  her 
illness,  and  she  was  obliged  to  take  to  her  bed  on  the  fifth 
day. 

On  admission  on  the  eighth  day  the  cheeks  were  flushed, 
temp.  102*2°,  pulse  104,  tongue  coated  with  white  fur,  red 
at  edges,  inclined  to  become  dry,  much  pain  and  tenderness  in 
the  right  iliac  fossa,  and  resistance  of  the  rectus.  The  bowels 
had  not  acted  for  a  week. 

A  simple  enema  brought  away  a  very  copious  natural 
evacuation.  A  grain  of  opium  was  given  by  the  mouth  and  a 
linseed  and  mustard  poultice  applied  to  the  abdomen. 

Ninth  day. — A  diaphoretic  mixture,  every  four  hours,  and 
five  grains  of  Dover's  powder  with  two  grains  of  mercury  and 
chalk,  night  and  morning,  were  prescribed. 

Tenth  day. — Improved,  temperature  declined  to  100°,  pulse 
84,  pain  and  tenderness  much  less,  and  she  bore  palpation  fairly 
well.  A  well  defined  solid  rounded  tumour  was  felt  lying  in 
the  iliac  fossa  and  extending  vertically  to  the  liver  and 
towards  the  left  to  about  two  inches  from  the  mesial  line.  A 
simple  enema  was  now  given  every  day  and  followed  by  half 
an  ounce  of  castor  oil  with  eight  minims  of  tincture  of  opium, 
and  continued  until  the  seventeenth  day,  when  the  bowels 
acted  spontaneously  and  freely  this  and  the  following  day. 

On  the  nineteenth  day  another  dose  of  oil  and  laudanum  was 
given  ;  two  days  afterwards  the  previous  medicines  were  omitted 
and  quinine  mixture  prescribed. 

On  the  twenty-third  day  she  was  convalescent  and  left  her 
bed. 


140  Fcecal  Retention,  especially 

On  admission  the  patient  had  the  aspect  and  general 
symptoms  of  enteric  fever,  but  the  accumulation  in  the  caecum 
was  evident.  Her  statement  that  the  bowels  had  been  acting 
regularly  up  to  the  time  of  her  admission  was  no  doubt  correct, 
for  a  gradual  accumulation  of  faeces  in  the  caecum  is  quite 
consistent  with  a  daily  action  of  the  bowels.  Young  people 
are  not  usually  particular  in  ascertaining  the  quality  and 
amount  of  their  evacuations,  and  if  they  have  a  movement  of 
the  bowels  every  day  they  regard  that  as  satisfactory  whether 
large  or  small. 

As  to  the  progress  of  the  case,  this  was  uniformly  satis- 
factory, the  temperature  declined  and  was  normal  after  the 
sixteenth  day.  The  evacuations  were  copious  and  consisted  of 
normal  broken  down  faeces  without  scybala.  The  caecum 
was  still  full  and  tender  on  the  fourteenth  day.  On  the  six- 
teenth day  tenderness  was  absent,  and  on  the  eighteenth  day 
it  was  wholly  relieved  of  its  contents,  and  felt  like  a  movable 
cord  beneath  the  now  lax  abdominal  wall.  Desire  for  food 
returned  on  the  sixteenth  day,  and  she  was  allowed  fish  on 
the  seventeenth  day,  and  left  her  bed  on  the  twenty-third  day. 

Case  6.  Constipation,  acute  pain  in  the  right  iliac  region, 
and  vomiting  after  a  hearty  meal  of  whelks  ;  fcecal  tumour  of  the 
ccecum  ;  convalescence  after  twelve  days. — Henry  B — ,  set.  25, 
a  strong,  healthy,  well-nourished  man.  He  never  had  any 
illness  like  the  present,  and  admitted  that  he  had  paid  little 
attention  to  the  action  of  his  bowels. 

On  the  18th  of  March  he  ate  heartily  of  whelks,  and  some 
hours  afterwards  was  suddenly  taken  with  severe  pain  in  the 
abdomen  and  vomiting  of  a  green  fluid.  He  was  admitted 
into  Arthur  Ward  early  next  morning.  The  temperature  was 
101 -4°,  he  lay  on  his  back  with  the  legs  drawn  up,  and  had 
much  pain  and  tenderness  in  the  right  iliac  fossa,  which 
appeared  a  little  fuller  than  the  left.  The  rectus  was  very 
resistant,  and  the  part  was  too  painful  to  bear  handling. 
The  bowels  had  not  been  open  for  several  days.  Hot 
poultices  were  applied,  simple  enemata  given  every  three 
hours,  and  a  grain  of  opium  by  the  mouth.  In  the  afternoon 
the  temperature  rose  to  102-2°.  Four  or  five  dark  fluid 
motions  without  scybala  were  elicited  by  the  enemata.     In 


as  it  affects  the  Caecum.  141 

the  evening  half  an  ounce  of  castor  oil  with  eight  minims  of 
tincture  of  opium  was  given  by  the  mouth.  Bilious  vomiting 
however  recurred,  and  as  this  dose  was  probably  rejected, 
another  was  given,  which  was  followed  in  the  course  of  a  few 
hours  by  a  very  copious  evacuation  of  a  somewhat  pasty  con- 
sistence and  dark  yellowish-green  colour. 

Third  day. — There  was  a  little  relief  of  the  abdominal  sym- 
ptoms, but  he  still  lay  on  the  back  with  the  legs  drawn  up; 
the  loaded  caecum,  still  very  tender,  could  now  be  distin- 
guished ;  temperature  101°,  pulse  100,  tongue  moist,  with  a 
thin  white  fur.  A  simple  enema,  followed  by  a  dose  of  castor 
oil  (^ss)  and  laudanum  (niviij),  was  given  daily  for  the  next 
week.  The  evacuations  were  free,  composed  of  light  yellow 
disintegrated  faeces  with  a  few  hard  lumps  the  size  of  nuts. 

On  the  sixth  day  the  csecum  was  much  less  tender,  it  was 
still  full,  and  distinctly  nodular  to  the  feel.  After  this 
date  the  improvement  was  rapid,  and  by  the  twelfth  day  the 
accumulation  was  completely  removed,  the  bowel  could  be 
handled  freely,  and  it  was  contracted  to  a  soft  rope-like  band. 
Between  the  third  and  ninth  days  the  temperature  was  usually 
about  1°  above  normal,  being  100°  on  only  one  occasion. 
Afterwards  it  declined  and  remained  normal. 

He  was  allowed  fish  on  fourteenth  day.  Convalescence  was 
uninterrupted,  and  he  left  the  hospital  on  the  21st  day. 

In  this  case  there  was  pre-existing  constipation,  and  the 
ingestion  of  a  hearty  meal  of  indigestible  food  developed  the 
symptoms  of  the  latent  obstruction  by  causing  the  descent  of 
more  faecal  matter  into  the  caecum  when  already  over-charged. 
The  symptoms  arose  soon  after  a  meal,  the  usual  provocative 
of  peristaltic  action  in  the  digestive  tube. 

So  far  I  have  only  spoken  of  constipation  as  it  affects  the 
mucous  membrane,  and  I  exclude  the  foregoing  cases  from  the 
condition  which  is  commonly  designated  typhlitis. 

Inflammation  of  the  whole  of  the  coats  of  the  caecum  must 
result  as  a  matter  of  course  whenever  retention  remains  long 
unrelieved.  To  make  my  paper  more  complete  I  will  there- 
fore add  two  more  cases,  one  in  which  incipient  inflammation 
probably  involved  the  caecum,  and  another  in  which  inflam- 
mation passed  into  ulceration  and  perforation. 


142  Fcecal  Retention,  especially 

Case  7.  General  constipation ;  retention  of  fcecal  matter  in 
the  caecum,  fever,  local  pain  and  constipation. — Eliza  S — ,  set. 
19,  a  healthy,  well-developed  girl,  had  been  poorly,  and 
attending  Queen  Charlotte's  Dispensary  for  headache  for 
some  weeks.  The  bowels  had  been  acting  every  other  day, 
and  she  was  doing  her  ordinary  work,  when  on  17th 
September,  1871  (first  day  of  her  illness),  she  was  taken  with 
a  sudden  pain  in  the  right  side  of  the  abdomen  with  vomiting. 
The  symptoms  continuing,  she  was  admitted  into  the  London 
Fever  Hospital,  Sept.  21st.  When  I  saw  her  the  bowels 
had  not  acted  for  eight  days.  She  complained  of  much  pain 
in  the  iliac  and  lumbar  regions  of  the  right  side,  the  csecal 
region  was  full  and  very  tender,  and  occupied  by  a  smooth 
rounded  mass  lying  between  the  anterior  superior  spine  of  the 
ileum  and  the  costal  arch.  Pulse  120,  temperature  104°. 
The  skin  injected  and  dry,  the  cheeks  flushed,  tongue  moist, 
furred  with  red  edges.  A  few  hard  nodules  (scybala)  could 
be  felt  in  the  left  iliac  region.  A  simple  enema,  and  half  an 
ounce  of  castor  oil  by  mouth  were  given  immediately,  and 
these  were  followed  in  the  course  of  a  few  hours  by  two  very 
large  motions,  composed  in  part  of  healthy  soft  faecal  matter 
and  in  part  of  rounded  scybala  the  size  of  walnuts,  and  of  the 
consistence  of  moderately  soft  cheese.  Hot  fomentations 
were  applied.  This  was  followed  by  relief  of  pain  and 
sickness. 

On  the  eighth  day  of  the  illness  (the  eleventh  since  the 
primary  constipation)  an  enema  of  castor  oil  and  turpentine 
(of  each  an  ounce)  was  given.      This  returned  without  effect. 

Twelfth  day. — Pulse  106,  temperature  102°,  tongue  as 
before  moist,  the  dorsum  with  a  thick  dirty  yellow  fur,  the 
margin  red ;  the  abdomen  a  little  full,  everywhere  soft, 
resonant,  free  from  tenderness,  excepting  on  the  right  side, 
which  is  still  occupied  by  a  vertical  tumour,  whose  rounded 
border  lies  two  and  a  half  inches  to  the  right  of  the  median 
line.  She  could  not  bear  the  slightest  pressure.  Six  leeches 
were  applied  over  the  caecum,  and  half  an  ounce  of  castor  oil 
given  by  mouth.  The  bowels  were  freely  relieved  of  much 
firm,  healthy  faecal  matter,  and  were  subsequently  loose  for 
twenty-four  hours.  Next  day  the  tumour  was  considerably 
less  and  the  general  condition  improved. 


as  it  affects  the  Caecum.  143 

On  the  fifteenth  day  the  flush  was  gone,  pulse  72,  temper- 
ature normal,  abdominal  fulness  and  local  tenderness  also 
gone,  and  the  belly  was  now  soft  and  flat.  Only  a  little 
thickening  could  be  felt  in  the  place  of  the  former  tumour. 
No  action  of  the  bowels  for  two  days.  Tongue  clean  and  wet, 
rather  purplish ;  the  appetite  returned,  and  in  the  course  of 
a  few  days  she  was  able  to  leave  her  bed.  The  subsequent 
treatment  consisted  of  an  occasional  small  dose  of  castor  oil 
and  a  simple  enema. 

Case  8.  Constipation,  followed  by  fever  and  stercoraceous 
vomiting :  perforation  of  the  caecum  and  stomach. — Richard  H — , 
set.  43,  well  nourished,  had  been  ill  thirteen  days  before 
admission  into  the  London  Fever  Hospital  with  constipation, 
anorexia,  and  latterly,  continued  fever.  T  first  saw  him  on 
12th  April,  1870,  on  the  fourteenth  day  of  his  illness ;  the 
pulse  was  100,  temp.  99*6°,  tongue  whitish  and  moist,  the 
bowels  open,  and  he  was  hungry.  Very  little  change  was 
experienced  until  the  eighteenth  day,  when  he  had  a  slight 
rigor  with  loss  of  appetite.  On  the  twenty-second  and  twenty- 
third  days  the  bowels  were  loose,  the  motions  pale  and  watery, 
and  there  was  profuse  perspiration,  the  skin  being  cool,  and 
the  pulse  as  yet  had  exceeded  116  on  one  day  only,  now  it  was 
106.      A  little  sordes  still  remained  on  the  teeth. 

On  the  twenty-fifth  day,  the  abdomen  became  tense  and 
tympanitic.  There  was  no  tenderness  on  making  slight  pressure, 
but  he  has  suffered  a  good  deal  of  pain  in  the  epigastrium  ; 
tongue  dry  and  wrinkled,  the  cutaneous  veins  of  the  abdomen 
large,  the  pulse  100. 

On  the  twenty-sixth  day  the  abdomen  was  less  tense,  and 
there  were  two  abundant  watery  stools  during  the  night,  of  the 
colour  of  burnt  umber;  the  breath  had  a  distinct  pyaemic 
odour  ;  the  patient  was  apathetic  and  apparently  comfortable. 
He  continued  in  the  same  state,  and  on  the  twenty-ninth  day 
he  vomited  for  the  first  time  about  twelve  ounces  of  brown 
bilious  fluid.  Next  morning  about  an  ounce  and  a  half  of 
grumous  fluid,  resembling  pea-soup,  was  rejected.  In  the 
afternoon  of  this  day  the  vomit  had  a  distinctly  stercoraceous 
odour,  and  consisted  of  pale,  ochre-coloured,  opaque  matter, 
floating  on   and    marbling   a  light    yellowish-brown   mucous 


144  FcBcal  Retention,  especially 

fluid.  The  bowels  acted  at  intervals,  the  motions  having  the 
characters  last  described.  The  abdomen  was  smaller  and 
softer,  the  veins  less  distinct,  and  free  from  pain  and  tender- 
ness.     The  prostration,  however,  was  increased. 

On  the  thirty-first  day  he  lay  in  a  half-recumbent  position, 
sunken,  cold,  clammy  and  apathetic  with  a  strong  post-mortem 
odour  of  the  breath.  He  vomited  frequently,  rejecting  in  all  as 
much  as  four  quarts  of  bright  gamboge-coloured  matter  of  the 
consistence  of  thick  gruel,  and  with  a  powerful  faecal  odour ;  a 
similar  fluid  ran  from  the  rectum  every  few  minutes.  The  next 
day  the  symptoms  were  unchanged,  save  that  the  abdomen  had 
become  soft  and  doughy  to  the  feel,  with  a  central  area  of  dull 
percussion  ;  the  previously  thready  radial  pulse  was  now  imper- 
ceptible, and  he  died  tranquilly,  retaining  consciousness  to  the 
last. 

After  death. — The  abdomen  was  retracted  and  dusky,  the 
recti  and  other  muscles  of  the  abdominal  wall  almost  black. 
The  median  incision  below  opened  a  sac  corresponding  to,  and 
coextensive  with,  the  pelvic  cavity ;  it  extended  three  inches 
upward  from  the  symphysis  pubis,  and  extended  laterally  from 
one  iliac  crest  to  the  other  ;  it  was  limited  above  by  a  straight 
wall  formed  by  the  coherent  coils  of  the  small  intestine ;  below, 
by  the  bladder,  which  contained  half  a  pint  of  urine  ;  behind,  by 
the  sacrum  and  rectum ;  in  front,  by  the  abdominal  wall.  A 
strong  membrane,  apparently  of  not  recent  formation,  was 
reflected  from  the  edge  of  the  adherent  coils  of  the  intestine  to 
the  peritoneal  covering  of  the  hypogastric  region. 

The  sac  was  everywhere  closed  except  where  it  communi- 
cated with  the  caecum  ;  its  inner  surface  was  covered  with  a 
granular  villous  growth  of  a  light  brown  colour,  stained, 
indeed,  by  the  contents  of  the  sac,  its  large  cavity  being  full 
of  bright  yellow  grumous  fluid,  a  little  thicker  than  that  which 
had  been  vomited  but  otherwise  exactly  resembling  it.  The 
caecum  and  ascending  colon,  which  formed  the  boundary 
of  the  sac  on  the  extreme  right,  presented  four  rounded  per- 
forations, the  lowest  at  the  bottom  of  the  caecum  by  the  side 
of  the  vermiform  appendix,  the  second  just  above,  the  third 
(which  was  the  largest,  and  about  three  quarters  of  an  inch 
wide)  two  inches  higher  up,  and  the  fourth  an  inch  and  a 
half  above   this.      These   openings  into   the   sac    had    thick, 


as  it  affects  the  Ccecum.  145 

almost  villous  lips,  as  if  formed  of  everted  mucous  membrane. 
The  coils  of  intestine  were  flaccid,  of  a  leaden  hue,  and  adhe- 
rent by  organised  membrane.  The  opening  of  the  vermiform 
appendix  was  small  and  healthy,  and  the  organ  itself  lay  com- 
pressed against  the  walls  of  the  faecal  sac.  The  colon,  sig- 
moid flexure  and  rectum  were  quite  healthy  and  empty ; 
neither  the  jejenum  nor  the  ileum  showed  any  signs  of  ulcera- 
tion, but  were  full  of  fluid  like  that  in  the  sac.  On  dissecting 
out  the  adherent  coils  of  the  intestines  numerous  small 
isolated  abscesses  were  discovered  here  and  there. 

A  second  faecal  sac,  apparently  quite  distinct  from  the 
former,  and  only  communicating  with  it  through  the  bowel, 
lay  deep  in  the  right  hypochondrium  between  the  abdominal 
wall  and  matted  coil  of  intestine,  and  limited  above  by  the 
gall  bladder  and  the  under  surface  of  the  liver.  The  contents 
were  identical  with  those  of  the  largest  sac.  On  opening  the 
stomach  the  mucous  membrane  showed  patches  of  slight  con- 
gestion ;  in  the  posterior  wall  was  a  round  aperture,  with 
smooth  edges,  nearly  large  enough  to  admit  the  tip  of  the 
index  finger;  it  communicated  with  an  enlarging  passage, 
which  seemed  to  end  in  a  cul-de-sac  above  the  head  of  the 
pancreas,  but  which  probably  communicated  with  the  sac  of 
the  small  omentum,  in  which  there  was  also  a  collection  of 
faeculent  fluid. 

Excepting  the  stomach  complication  and  its  results,  an 
almost  identical  case  was  admitted  under  my  care  very  soon 
afterwards,  and  this  was  equally  unsatisfactory  in  reference  to 
the  previous  history.  In  neither  case  could  I  assign  the  date 
of  perforation  with  any  degree  of  certainty,  but  my  impression 
was  that  it  had  occurred  in  both  cases  before  admission.  The 
perforation  of  the  stomach  in  the  case  narrated  here,  appeared 
to  have  happened  subsequently  to  those  of  the  caecum — on  the 
25th  day  ?  This  was  probably  the  cause  of  the  vomiting,  for 
the  faecal  sac,  into  which  the  pelvic  cavity  was  converted, 
formed  a  diverticulum  to  the  caecum,  and  communicated  so 
freely  with  it  that  there  did  not  seem  the  least  liability  to 
obstruction. 


VOL.  XI.  10 


ON    MEASUREMENT    IN    THE    MEDICAL 
APPLICATION  OE  ELECTRICITY.1 


By  W.  H.  STONE,  F.E.C.P.,  &c, 


WALTEE  KILNEE,  M.D. 


Dr.  Stone  commenced  by  stating  that  the  subject  had  been 
suggested  by  Lieut-Col.  Webber,  the  chairman,  and  that  the 
details  the  authors  proposed  to  give  that  evening  were  mainly 
preliminary  to  fuller  treatment,  which  they  hoped  to  offer  at 
some  future  period. 

Medical  electricity,  he  said,  had  been  up  to  now  a  hetero- 
geneous mixture  of  loose  statements,  doubtful  diagnosis,  and 
erroneous  therapeutics.  Glaring  instances  of  these  were 
given.  With  hysteria,  Metallotherapy,  and  magnetic  appliances, 
they  did  not  propose  to  deal :  science  is  in  far  too  elementary 
a  state  to  see  through  these  obscure,  though  real  phenomena. 
Probably,  the  key  to  the  great  enigma  of  the  connection 
between  electricity  and  nerve-force  had  yet  to  be  found.  The 
bold  statement  that  "  electricity  is  life  "  is  demonstrably  false 
in  many  particulars.  Speaking  generally,  medical  electricity 
had  suffered  from  its  exclusive  handling  by  physiologists  and 

1  Read  before  the  Society  of  Telegraph  Engineers  and  Electricians  on  Thurs- 
day, March  9th,  1882. 


148  Measurement  in  the  Medical 

physicians,  who  might  receive  valuable  help  from  physicists; 
indeed,  the  writers  of  the  paper  were  actually  soliciting  such 
assistance  at  the  hands  of  this  young  and  active  society. 
Medicine  and  its  kindred  arts  lend  themselves  ill  to  measure- 
ment :  the  tone  of  mind  required  for  their  practice  is  rather 
judicial  than  computative ;  it  is  oftener  concerned  with  weigh- 
ing evidence  and  balancing  alternatives  than  with  solving 
equations.  But  men  who  work  by  measurement  are  usually 
sterling  and  accurate  men  ;  indeed,  Prof.  Schuster  has  recently 
shown  how  mathematics  can  help  science.  Where  measure- 
ment can  be  used,  it  should  be  used ;  and  this  was  their  text 
for  the  evening. 

The  speaker  then  proceeded  to  divide  the  forms  in  which 
electricity  had  been  used  medically  into  four,  namely : — (1) 
continuous  currents,  (2)  continuous  currents  made  to  intermit, 
(3)  induced  currents,  termed  generally  "  Faradisation,"  (4) 
statical  electricity.  The  last  of  these  was  the  first  employed, 
but  it  had  given  the  least  satisfactory  results  of  any.  The 
third  method  had  been  far  the  most  deeply  studied. 
Duchenne's  great  work  on  i  Localised  Electrisation '  early 
drew  attention  to  this  department.  That  genuine  and  inde- 
fatigable observer  was  able  to  point  out  so  many  definite 
diagnoses,  and  to  isolate  so  many  new  nervous  and  muscular 
diseases  by  means  of  the  induction-coil,  that  this  instrument 
had  been  given  somewhat  excessive  prominence  as  a  thera- 
peutic agent.  Physiologists  had  also  found  in  it  a  convenient 
stimulant  for  testing  the  action  of  nerves  and  the  irritability 
of  muscle;  perhaps  also  the  localisation  of  brain-functions. 
Hence  muscular  contraction  and  the  action  of  intermittent 
currents  in  alternate  directions  had  been  too  much  relied  on 
as  evidence  of  activity.  One  chief  object  of  the  paper  was  to 
point  out  that  the  future  of  electro-therapeutics  lies  more  in 
the  continuous  current,  used  either  in  its  first  or  second  form, 
the  latter  of  which  has  hitherto  received  little  or  no  attention. 
In  confirmation  of  these  views,  extracts  were  read  from  Prof. 
ErVs  valuable  memoirs  in  l  Ziemssen's  Cyclopaedia  of 
Medicine.' 

Before,  however,  a  single  step  could  be  taken  in  this  scien- 
tific path,  we  must  have  some  tolerably  accurate  mode  of 
measuring  the  agent  we  are  employing.     It  is  obvious  that 


application  of  Electricity.  149 

the  units  used  should  be  as  far  as  possible  those  generally 
adopted  in  the  scientific  world. 

To  begin  with  Resistance  :  This  in  the  human  body  is  singu- 
larly great,  and  is  especially  located  in  the  epidermis,  which, 
when  dry,  is  an  excellent  insulator.  Wetting  it  with  sulphate 
of  zinc  or  common  salt  in  solution  diminishes  this  resistance 
very  materially ;  though  even  when  care  is  taken  in  this 
respect  the  residual  opposition  to  a  current  is  large.  From 
hand  to  hand  it  is  usually  about  6000  ohms.  In  the  larger 
bulk  of  the  trunk,  from  the  sacrum  to  the  nape  of  the  neck, 
it  never,  even  after  long  wetting,  sinks  much  under  1500 
ohms.  That  of  the  head,  from  nape  to  forehead,  is  about 
2000  ohms.  In  one  case  it  was  more  precisely  1930  ohms,  in 
an  adult,  and  in  another,  a  child,  2500  ohms.  The  resistance 
of  different  tissues,  though  not  exactly  to  the  present  purpose, 
had  been  studied  by  Prof.  Eckhard,  who  stated  that  muscle  was 
the  best  conductor,  and  that  this  being  taken  as  a  unit, 
cartilage  would  have  a  resistance  twice,  tendons  and  nerves 
about  2*1,  and  bone  nineteen  times  as  great.  Matteuci  states 
that  muscles  conduct  four  times  as  well  as  nerves,  brain,  or 
spinal  cord.  The  resistance  of  the  skin  varies  from  day  to 
day,  being  modified  by  moisture,  and  by  the  fulness  of  the 
capillary  vessels.  In  a  particular  case  the  positive  pole  of  a 
battery  was  placed  on  the  sacrum  of  a  child,  and  the  other  on 
the  leg,  over  the  extensors  of  the  foot.  By  using  the  same 
current,  and  adding  quickly  a  known  resistance,  the  resistance 
of  the  body  was  at  first  found  to  be  11,250  ohms,  which,  on 
thoroughly  soaking  the  skin,  was  reduced  2875  ohms.  Three 
days  previously  the  resistance  before  soaking  was  13,000 
ohms,  and  after  that  process  sank  to  3000  ohms.  Personal 
idiosyncrasy  exercising  an  influence,  a  delicate  skin  conducting 
better  than  one  which  is  coarse.  The  face  and  neck  offer  the 
least,  the  soles  and  palms  the  greater,  resistance.  Disease 
causes  variation  of  conductivity  :  the  skin  over  affected  muscles 
in  lead  paralysis  has  its  resistance  increased,  while  in  many 
old  cases  of  hemiplegia  it  is  decreased  to  a  greater  or  less 
extent  according  to  the  amount  of  atrophy  which  has  taken 
place. 

The  resistance  of  muscle  in  disease  is  sometimes  diminished, 
sometimes     augmented.     Augmentation  takes  place,    at    the 


150  Measurement  in  the  Medical 

commencement  of  degenerative  changes,  from  the  inferior  con- 
ductive power  of  fat  to  that  of  healthy  muscle.  In  a  case  of 
infantile  paralysis,  the  sound  leg  had  a  resistance  of  2500 
ohms,  the  affected  leg  of  3250  ohms.  In  a  wasted  muscle  of 
many  years'  standing,  the  enormous  resistance  of  16,500  ohms 
was  reached.  It  was  both  easy  and  desirable  to  multiply  facts 
such  as  these. 

The  second  preliminary  point  was  the  current  which  could 
be  borne  with  impunity.  Here  results  were  very  discordant. 
In  the  three  fatal  cases  from  touching  the  conductors  of 
dynamo-machines,  at  a  music-hall,  in  the  Russian  Navy,  and 
at  Hatfield,  the  necessary  facts  for  measurement  were  absent ; 
although  Dr.  Siemens  had  stated  that  he  had  often  taken  a 
current  sufficient  to  produce  a  powerful  light  with  impunity. 
In  a  case  now  in  St.  Thomas's  Hospital,  a  current  of  50  milli- 
webers  was  borne  with  difficulty,  and  one  of  20  milliwebers 
with  ease  and  great  benefit.  A  case  of  diabetes,  recorded  by 
Dr.  Stone  in  the  '  Proceedings  of  the  British  Association  at 
York  '  in  1881,  took  about  10,000  micro-amperes,  or  10  milli- 
webers, through  his  head,  from  nape  to  forehead,  after  some 
practice,  using  for  its  production  from  15  to  20  cells  of  a 
bichromate  battery.  The  particular  battery,  however,  mattered 
very  little ;  Leclanche's,  bichromates  and  zinc-carbons  with 
sulphate  of  mercury,  all  act  well,  and  need  not  be  of  large 
size  or  small  resistance.  One  was  shown,  in  which  test-tubes 
filled  with  mercuric  sulphate,  containing  free  acid,  formed  the 
jars ;  another  in  which  a  rod  of  zinc  of  ^"  diameter,  and  a 
similar  sized  carbon,  such  as  is  used  in  electric  lamps,  were 
immersed  in  the  bichromate  solution.  Connection  was  here 
made  with  the  carbon  by  a  piece  of  drawn  tube  sprung  on  to 
it,  thus  doing  away  with  the  use  of  clamps.  All  these,  as  well 
as  most  of  the  apparatus  shown,  were  made  in  Dr.  Stone's 
workshop,  chiefly  with  his  own  hands. 

In  consequence  of  the  high  resistance  of  the  skin,  it  was 
essential  to  give  a  large  size  to  the  poles  employed  for  apply- 
ing the  current,  &c.  Amalgamated  zinc,  with  the  mixture  of 
potter's  clay  kneaded  with  a  solution  of  common  salt,  used 
in  physiological  experiments,  laid  over  it,  was  perhaps, 
theoretically,  the  best;  but  powdered  carbon  placed  in  a  bag 
and  immersed  in  salt  and  water,  answered  equally  well ;  or 


application  of  Electricity.  151 

the  surgical  appliance  termed  Spongio-piline,  a  thick  felt, 
backed  by  india  rubber,  through  which  a  well-tinned  copper 
wire  was  threaded,  so  as  to  encompass  its  whole  circumference 
without  anywhere  projecting  so  as  to  touch  the  cuticle.  The 
poles  could  hardly  be  too  large. 

A  convenient  form  of  Thomson  galvanometer  with  graduated 
shunts,  due  to  Dr.  Kilner,  was  shown,  and  also  a  simple  but 
effective  instrument  for  producing  intermissions  in  the  current 
at  any  required  interval  of  time.  This  apparatus  consisted  of 
a  metronome  with  contact-pieces  dipping  into  mercury  cups  at 
each  oscillation,  a  condenser  being  placed  under  the  instru- 
ment to  get  rid  of  the  extra  current,  and  so  to  equalise  the 
physiological  effects  of  the  making  and  breaking  currents. 

The  measurement  of  induced  currents  presented  consider- 
able difficulties.  The  Conference  at  Paris  had  recommended 
the  use  of  standard  induction-coils,  but  this  method  does  not 
give  any  but  arbitrary  measures.  Dr.  Stone  had  tried  and 
showed  a  vacuum-tube,  in  which  the  tension  of  air  could  be 
varied  by  combining  it  with  a  barometric-column  and  a 
movable  cistern.  This  gave  a  ready  means  of  varying  the 
force  of  the  discharge,  by  using  it  as  a  shunt  of  variable  resist- 
ance, and  had  the  interesting  results  of  shunting  the  "  make- 
current  "  at  a  definite  point,  while  allowing  the  "  break- 
current,"  which  is  about  six  times  stronger,  to  pass  between 
the  platinum  points ;  thus  obtaining  an  induced  current  in  one 
direction  only.  Latterly  he  had  adopted  also  condensers  of 
definite  capacity  charged  to  definite  potentials.  The  writers 
were,  however,  still  experimenting  with  another  method, 
depending  on  Sir  W.  Thomson's  determinations  of  spark- 
length.  The  most  practical  method,  at  present,  seemed  to  be 
to  pass  a  continuous  current  of  measured  strength  through  an 
automatic  commutator,  which  at  alternate  oscillations  diverted 
it  in  one  and  the  other  direction.  If  there  was  any  real 
physiological  value  in  rapid  reversals  of  direction,  as  was 
claimed  by  some  experimenters,  it  could  thus  be  secured,  with- 
out the  use  of  an  induction-coil.  Another  form  of  rotating- 
commutator  was  also  shown,  in  which  an  ebonite  cylinder, 
pressed  on  by  six  springs,  at  each  quarter-turn  connected, 
first,  the  condenser  to  the  battery,  so  as  to  charge  it,  and  then 
discharged  it  through  the  patient.     To  obviate  the  necessity 


152    Measurement  in  the  Medical  application  of  Electricity. 

of  employing  a  large  battery  with  the  condenser  arrangements 
Planters  secondary  battery  could  be  charged  in  parallel  posi- 
tion from  a  small  number  of  Grove's  cells,  and  discharged 
through  the  condenser  in  series.  In  all  these  contrivances, 
however,  as  the  current  gained  in  tension,  it  seemed  to  lose 
somewhat  in  chemical  and  catalytic  power,  and  to  assimilate 
gradually  to  the  static  form. 

In  the  discussion  which  followed  Mr.  Preece  pointed  out 
that  the  use  of  electricity  for  curative  purposes  had  been 
advocated  as  long  ago  as  the  year  1759,  by  John  Wesley,  and 
recommended  the  use  of  the  dynamometer1  for  the  measure- 
ment of  induced  currents,  as  this  instrument  gave  indications 
in  the  same  direction  with  all  currents.  Prof.  McLeod,  Mr. 
Fitzgerald,  and  Prof.  Ayrton  also  made  comments  on  the 
paper. 

1  The  instrument,  suggested  by  Mr.  Preece,  has  since  been  successfully  con- 
structed by  Dr.  Stone,  using  for  the  movable  coil  aluminium  wire  covered  with 
silk.  The  lightness  and  high  conductivity  of  this  metal,  added  to  its  exti'eme 
ductility,  render  it  especially  fit  for  this  purpose.  The  suspension  is  bifilar, 
formed  of  fine  silver  gilt  wire,  also  an  excellent  conductor,  each  suspending 
filament  forming  one  of  the  electrodes. 


ON 

HYDATID  TUMOURS  OF  THE  ABDOMEN 

AND 

TUMOURS   SIMULATING   THEM. 


By  J.  S.  BEISTOWE. 


Case  1.  Hydatid  tumours  in  abdomen  associated  with  preg- 
nancy ;  hydatid  thrill  in  small  hard  tumour  only. — E.  A.  W — , 
a  married  woman,  aged  26,  was  admitted  under  my  care  on  the 
28th  February,  1882. 

She  has  been  a  healthy  woman,  and  has  had  three  children, 
and  believes  herself  to  be  now  four  months  gone  in  her  fourth 
pregnancy.  During  her  last  pregnancy,  about  two  and  a  half 
years  ago,  she  first  observed  a  swelling  in  her  abdomen  about  the 
size  of  a  hen's  egg,  which  she  thought  would  disappear  after  her 
confinement.  It  has,  however,  increased  uniformly  though 
slowly  since  that  time,  and  has  latterly  been  at  times  tender 
and  painful — the  pain  being  of  an  aching  character.  About  a 
month  ago  she  first  noticed  a  second  tumour. 

The  patient  is  well  nourished  and  healthy  looking,  but  pale. 
She  complains  only  of  pain  and  enlargement  of  the  abdomen. 

On  examination,  the  belly  is  found  to  be  large  and  irregular 
in  form,  and  to  measure  thirty-six  inches  round  at  the  level 
of  the  umbilicus.  Four  distinct  tumours  are  easily  discovered 
in  it.  One,  the  largest,  roughly  speaking  of  the  shape  and  size 
of  a  cocoa  nut,  occupies  the  left  hypochondriac  and  lumbar 


154  Hydatid  Tumours  of  the  Abdomen, 

regions,  encroaching  below  on  the  upper  and  outer  part  of  the 
umbilical  region.  It  occupies  as  nearly  as  possible  the  position 
which  an  enlarged  spleen  might  occupy,  produces  a  manifest 
bulging  of  the  surface  of  the  part  of  the  abdomen  in  which  it 
is  situated,  and  slight  bulging  of  the  lower  ribs  on  the  same 
side,  and  can  be  traced  far  back  into  the  loin.  It  is  scarcely 
movable  with  respiration,  dull  on  percussion  (the  dulness 
extending  upwards  to  the  seventh  rib),  tense,  elastic,  and 
fluctuating.  The  spleen  cannot  be  recognised  independently  of 
it,  but  a  distinct  interval  of  resonance  separates  it  from  the 
adjoining  liver.  The  second  tumour  (that  which  she  first  recog- 
nised a  month  ago)  is  ovoid  in  shape,  and  about  the  size  of  a 
large  orange ;  it  lies  to  the  right  of  the  navel,  occupying  the 
outer  part  of  the  umbilical  and  part  of  the  adjoining  right 
lumbar  region ;  it  is  dull  on  percussion,  not  so  tense  as  the 
other,  but  fluctuates  distinctly.  It  is  slightly  movable.  The 
third  tumour  springs  apparently  from  the  left  iliac  fossa, 
extending,  however,  slightly  to  the  right  of  the  median  line. 
It  is  about  the  same  size  as  the  last,  softer  and  much  less  dis- 
tinctly defined  than  either  of  the  others,  and  perhaps  rather 
more  freely  movable  than  they  are.  The  remaining  two 
tumours  are  hard,  unyielding,  and  apparently  solid ;  the  larger 
of  the  two,  a  flattened  ovoid  body  about  as  large  as  a  pigeon's 
egg,  lies  usually  immediately  below  the  second  of  the  above- 
described  tumours,  but  it  is  freely  movable,  and  can  be  made  to 
slide  between  its  neighbour  and  the  abdominal  parietes,  and 
indeed  can  be  readily  displaced  as  much  as  three  or  four  inches 
from  its  original  site.  The  fifth  tumour  is  about  half  the  size 
of  the  last,  is  as  freely  movable  as  it,  is  not  always  discoverable, 
but  generally  lies  somewhere  between  the  first  and  second 
tumours.  The  abdominal  parietes,  except  where  they  are 
stretched  over  the  tumours,  are  soft  and  flaccid,  there  is  no 
trace  of  ascitic  fluid,  or  of  any  morbid  condition  whatever 
beyond  what  has  been  described,  and  usually  there  are 
intervals  of  resonance  between  the  three  larger  tumours,  and 
between  them  and  the  liver. 

No  other  disease  whatever  was  discovered. 

Although  fluctuation  was  present,  no  typical  hydatid  thrill 
could  be  detected  in  the  larger  tumours.  There  was  no  doubt, 
however,   that  at  any  rate    the  larger  tumours  were  hydatid 


and  Tumours  simulating  them.  155 

cysts ;  and  it  was  assumed  that  the  two  smaller  ones  (though 
feeling  solid)  were  of  the  same  nature. 

On  the  2nd  March,  Tumour  No.  1  was  aspirated  with  a 
fine  trocar  and  cannula,  and  sixteen  ounces  of  transparent,  straw- 
coloured  fluid  were  removed  from  it.  No  attempt  was  made  to 
empty  it.  The  fluid  was  void  of  albumen,  contained  excess  of 
chlorides ;  and  under  the  microscope  a  few  hooklets,  but  no 
echinococci,  were  found.  She  vomited  during  the  night  follow- 
ing the  operation ;  and  for  two  or  three  days  the  temperature 
was  febrile,  rising  as  high  as  101°,  the  pulse  was  rapid,  and  she 
had  some  tenderness  and  uneasiness  in  the  situation  of  the 
tumour.     It  also  became  nearly  as  large  as  it  was  at  first. 

On  the  7th,  having  been  well  for  two  days,  Tumour  No.  2 
was  aspirated  in  the  same  way  as  the  other,  and  about  twenty 
ounces  of  fluid  were  removed  from  it.  This  was  colourless, 
transparent,  free  from  albumen,  and  abounding  in  chlorides. 
No  echinococci  or  hooklets  were  discovered.  Vomiting,  eleva- 
tion of  temperature,  and  quickening  of  pulse  followed  this 
operation  as  they  had  done  the  other.  But  all  subsided  after  a 
day  or  two. 

At  the  end  of  a  week  or  so,  both  tumours,  which  had  been 
tapped,  were  much  smaller  and  more  flaccid  than  they  were 
before  tapping,  but  still  fluctuated  distinctly ;  and  a  well- 
marked  thrill  (scarcely  the  typical  hydatid  thrill,  however)  was 
presented  by  both  of  them.  My  house  physician,  Mr. 
Carpenter,  about  this  time  bethought  him  of  percussing  the 
two  small,  hard,  apparently  solid  tumours  which  I  have  spoken 
of  as  Tumours  4  and  5,  and  to  his  surprise,  on  percussing  No. 
4,  the  larger  of  the  two,  he  obtained  from  it  a  most  unmistak- 
able hydatid  thrill.  He  pointed  out  this  circumstance  to  me, 
and  from  that  time  until  the  patient  left  the  hospital  I  had 
frequent  opportunities  of  verifying  and  demonstrating  to  my 
class  the  fact  that  the  most  typical  and  exquisite  hydatid  thrill 
that  I  think  I  ever  observed  could  be  elicited  from  this  tumour 
by  percussion.  We  failed  to  obtain  the  same  phenomenon  from 
the  smaller  one  of  the  two. 

After  the  second  tumour  had  been  tapped  my  intention  was 
to  proceed  as  soon  as  convenient  to  the  tapping  of  Tumour 
No.  3,  or  that  which  lay  in  the  lower  part  of  the  abdomen  and 
on  the  left  side. 


156  Hydatid  Tumours  of  the  Abdomen, 

On  two  or  three  consecutive  occasions  I  examined  it  with  the 
intention  of  forthwith  operating  j  but  on  each,  although  it  was 
as  obvious  as  any  of  the  others  had  been  (forming  a  visible 
rounded  projection,  being  dull  on  percussion,  and  capable  of 
accurate  definition  by  manipulation),  in  the  course  of  examina- 
tion it  became  more  and  more  difficult  to  define  it ;  and  conse- 
quently, although  I  could  still  recognise  it  vaguely  and  by  the 
presence  of  dulness,  I  decided  on  each  occasion  to  defer  para- 
centesis until  my  next  visit.  I  must  acknowledge  that  I  had 
not  hitherto  given  much  thought  to  her  asserted  pregnancy ; 
and  that  it  had  not  struck  me  that  this  tumour,  which  lay  to 
the  left  of  the  median  line,  might  be  the  pregnant  uterus.  At 
length,  however,  I  began  to  suspect ;  and  then  on  instituting 
a  careful  stethoscopic  examination  of  the  supposed  hydatid 
cyst,  I  discovered  without  much  difficulty  the  beats  of  the  foetal 
heart,  and  was  able  to  demonstrate  the  foetal  cardiac  sounds  to 
my  class. 

She  was  discharged  a  month  after  admission ;  the  tapped 
cysts  at  this  time  having  undergone  considerable  diminution. 
But  she  felt  well,  was  anxious  to  resume  her  domestic  duties, 
and  promised  to  return  on  some  future  occasion,  if  not  before, 
at  any  rate  after,  her  confinement.  The  typical  hydatid  thrill 
in  the  small,  hard  tumour,  was  found  after  its  first  discovery 
to  be  always  obtainable. 

Case  2.  Abdominal  cancerous  and  hydatid  tumours. — J.  B — , 
a  stoker,  set.  41,  was  admitted  under  my  care  on  the  22nd 
November,  1881.  Has  had  good  health  until  recently,  with 
the  exception  that  twenty-one  years  ago  he  had  a  sharp  attack 
of  ague,  which  lasted  for  fourteen  weeks.  His  present  illness 
came  on  about  fourteen  weeks  ago  with  severe  pain,  chiefly  in 
the  lumbar  vertebrae  and  left  loin,  shooting  to  angle  of  scapula 
and  front  of  chest.  This  has  been  incessant  ever  since,  but 
liable  to  exacerbation,  and  on  the  whole  increasing  in  severity 
down  to  the  present  time.  He  describes  it  as  of  a  gnawing 
character.  Not  long  after  the  commencement  of  his  illness  he 
began  to  complain  of  difficulty  in  passing  his  water,  which 
came  away  in  a  small  stream ;  and  of  obstinate  constipation. 
In  these  respects  he  has  improved  lately.  He  has  complained 
much  of  flatulence,  and  distension  of  the  abdomen,  and  almost 


and  Tumours  simulating  them.  157 

complete  anorexia;  and  he  has  rapidly  lost  flesh  and  strength. 
The  pain  has  prevented  him  from  sleeping. 

He  is  much  emaciated,  has  a  very  dark  complexion,  and  an 
expression  of  great  anxiety.  He  complains  of  weakness,  loss 
of  appetite,  constipation,  abdominal  tenderness,  and  severe 
pain,  which  is  nearly  constant,  in  the  left  loin  and  in  other 
parts  of  the  abdomen  and  back.  His  abdomen,  which  is  some- 
what full  and  tense,  is  so  extremely  tender  that  he  can  scarcely 
bear  to  have  it  touched,  much  less  examined.  He  lies  habitually 
on  the  right  side,  and  the  lower  ribs  on  that  side  bulge  some- 
what. 

There  is  no  disease  discoverable  in  the  chest,  and  the  urine 
is  normal.  Tongue  clean.  Pulse  feeble,  rapid.  Temperature 
101-8°. 

He  was  treated  with  morphia,  which  had  the  effect  of  largely 
allaying  his  constant  pain,  and  so  far  diminished  his  abdominal 
tenderness  that  in  the  course  of  a  few  days  the  condition  of  the 
abdomen  could  be  carefully  investigated.  It  was  now  found 
that  the  liver  was  much  enlarged.  Its  dulness  extended  from 
the  sixth  rib  in  the  nipple  line  to  near  the  umbilicus.  The 
lower  margin  of  the  organ  was  hard,  defined,  and  pretty  regular 
in  outline ;  the  surface  of  the  organ  between  the  edge  and  the 
ribs  was  hard,  and  on  the  whole  smooth,  but  a  little  to  the  left 
of  and  below  the  ensiform  cartilage  there  was  a  flat,  roundish 
projection,  apparently  about  an  inch  in  diameter.  The  liver 
moved  freely  during  respiration.  No  enlargement  of  the 
spleen  was  detected.  But  in  the  lower  part  of  the  left  hypo- 
chondriac region,  and  extending  also  into  the  adjoining  lumbar 
and  umbilical  regions,  was  a  hard  rounded  tumour,  about  the 
size  of  a  small  orange.  This  was  fixed,  and  the  respiratory 
movements  had  no  influence  over  it.  Deeply  seated  between 
the  umbilicus  and  right  groin,  but  nearer  the  groin,  was 
another  hard,  rounded,  immovable  tumour,  about  as  large  as  a 
hen's  egg.     There  were  no  signs  of  ascites. 

On  the  28th  it  was  noted  that  his  pains  had  been  much 
relieved,  and  that  he  felt  better  and  more  cheerful.  But  there 
was  no  improvement  as  regards  strength,  and  his  bowels  had 
not  been  relieved  since  admission.  On  making  a  digital 
examination  of  the  rectum  a  soft  and  apparently  ulcerated 
mass  was  found  projecting  from  its  posterior  wall,  at  a  distance 


158  Hydatid  Tumours  of  the  Abdomen, 

of  about  two  inches  from  the  anus.  The  finger  could  not  be 
passed  beyond  it. 

From  this  time  onwards  there  was  little  change,  except  that 
he  gradually  became  weaker  and  more  emaciated.  At  one 
time  he  complained  of  severe  pain  along  the  left  great  sciatic 
nerve ;  and  towards  the  end  of  his  illness  some  oedema  appeared 
in  the  lower  extremities.  His  temperature  varied  from  98°  to 
102'4°,  and  his  pulse  (which  was  very  small  and  feeble)  from 
92  and  120. 

He  died  on  the  24th  December. 

The  post-mortem  examination  was  made  next  day. 

The  liver  (which  weighed  seven  pounds  one  ounce)  was 
adherent  to  the  diaphragm,  studded  thickly  with  large 
cancerous  masses,  of  which  one  projected  from  the  surface  in 
the  situation  in  which  a  hard  nodule  had  been  detected  during 
life,  and  contained  embedded  in  its  right  lobe  a  largish  hydatid 
cyst,  with  thickened  and  im  some  places  calcareous  walls,  and 
containing  many  hydatids  and  echinococci. 

Two  hydatid  cysts  were  found  in  connection  with  the  peri- 
toneum. The  larger  one,  which  was  above,  sprung  from  the 
great  omentum.  It  was  about  the  size  of  a  jargonelle  pear, 
somewhat  pyriform  in  shape,  but  irregular,  and  presenting  one 
or  two  rounded  projections.  It  had  dense  fibrous  walls,  about 
one  eighth  or  one  tenth  of  an  inch  thick,  and  contained  within 
it  innumerable  small  hydatids.  The  smaller,  which  was  below, 
sprung  from  the  mesentery,  and  was  embedded  in  a  mass  of 
cancerous  glands.  It  was  rounded,  but  irregular  in  form,  and 
presented  generally  the  same  characters  as  the  other. 

The  retro-peritoneal  glands  were  the  seat  of  cancerous 
growth,  which  growth  also  invaded  the  pancreas  and  the  left 
supra-renal  capsule. 

The  spleen  was  small. 

All  the  other  abdominal  viscera,  including  the  peritoneum 
itself,  were  healthy,  with  the  exception  that  another  hydatid 
tumour  was  discovered  in  connection  with  the  lower  part  of  the 
rectum,  and  had  doubtless  formed  the  tumour  recognised 
during  life. 

The  thoracic  organs  were  all  healthy. 

Case  3.   Parovarian  cyst  simulating  an  hydatid  tumour.— 


and  Tumours  simulating  them.  159 

K.  E.  M — ,  a  plump,  healthy-looking  girl,  set.  17,  was 
admitted  under  my  care  on  the  22nd  March,  1880.  She  gave 
the  following  history  of  herself: — About  a  year  and  a  half  ago 
she  first  noticed  a  swelling  in  the  lower  part  of  the  belly,  which 
gradually  increased  in  size  until  the  abdomen  generally  became 
distended  with  it.  She  had  had  occasional  pain  after  exertion, 
mainly  in  the  right  lumbar  region,  but  in  all  other  respects 
seems  to  have  been  perfectly  well.  No  sickness  or  loss  of 
appetite ;  no  affection  of  the  bowels  or  urinary  organs ;  no 
dropsy  in  the  legs ;  no  palpitation  or  difficulty  of  breathing. 
The  catamenia  first  appeared  about  a  year  ago,  but  have 
appeared  rarely  and  scantily  since. 

On  admission  there  was  manifest  uniform  and  painless 
enlargement  of  the  belly,  which  measured  thirty-three  inches 
and  a  half  in  girth  at  the  umbilicus.  There  was  dulness  on 
percussion  all  over  the  front  from  the  pubes  to  the  epigastrium, 
with  resonance  in  the  flanks  and  an  interval  of  resonance 
between  the  upper  part  of  the  dull  area  and  the  liver  and 
spleen.  The  dull  area  did  not  shift  with  the  movements  of  the 
patient,  was  oval  in  form,  the  long  diameter  being  vertical  and 
corresponding  to  the  mesial  line  of  the  abdomen.  It  measured 
probably  twelve  or  thirteen  inches  in  length,  and  eight  or  nine 
in  breadth.  It  was  remarkably  thin  in  proportion  to  its  other 
dimensions,  appearing  to  be  not  more  than  two  or  three  inches 
thick.  It  was  also  very  flaccid,  and  the  fluctuation  produced  in 
it  by  percussion  was  remarkably  prolonged,  suggesting  the 
hydatid  thrill,  excepting  that  the  successive  waves  gave  the 
impression  of  being  large  and  individually  appreciable.  The 
liver  and  spleen  presented  no  signs  of  enlargement.  The  urine 
was  normal.     The  thoracic  organs  were  healthy. 

On  the  28th  menstruation  came  on;  it  was  scanty,  and 
continued  until  the  1st  April. 

On  the  7th  April  a  small  trocar  and  cannula  were  intro- 
duced, and  about  two  pints  and  a  half  of  colourless  transparent 
fluid  were  removed.  This  had  a  specific  gravity  of  1012,  gave 
no  reaction  with  nitric  acid  or  with  heat,  but  yielded  a  copious 
precipitate  with  nitrate  of  silver,  which  was  soluble  in  nitric 
acid.     No  hooklets  were  detected  in  it. 

Nothing  of  any  importance  happened  subsequently.  After 
the  operation  the  dulness  on  percussion  extended  up  to  the 


160  Hydatid  Tumours  of  the  Abdomen, 

umbilicus,  but  the  tumour  in  the  course  of  a  few  days  became 
indistinguishable  as  a  tumour,  and  the  girth  of  the  abdomen 
was  reduced  to  twenty-seven  inches  and  a  quarter.  The 
tumour  did  not  refill,  and  at  the  time  of  her  leaving  the 
hospital  on  the  15th  May,  although  there  was  still  some 
dulness  on  percussion  in  the  lower  part  of  the  abdomen,  no 
definite  tumour  could  be  felt,  no  fluctuation  could  be  elicited, 
her  abdomen  was  not  noticeably  large,  and  she  felt  and  looked 
well. 

It  was  believed  at  first  that  the  tumour  was  an  hydatid  cyst, 
but  its  flaccidity,  its  thin  walls,  its  large  superficial  extent,  its 
behaviour  after  tapping,  its  solitariness,  and  a  comparison  of 
the  case  with  published  cases  of  parovarian  dropsy  satisfied  me 
that  the  cyst  was  one  of  parovarian  origin. 

Remarks. — The  three  cases  above  recounted  have  been  brought 
together  in  the  same  paper,  because,  although  the  chief  points 
of  interest  in  each  case  are  special  to  itself,  there  are  still  more 
or  less  obvious  clinical  relationships  between  them. 

In  the  first  case,  a  woman  who  stated  that  she  was  three  or 
four  months  gone  in  pregnancy,  presented  five  obvious  abdo- 
minal tumours,  of  which  three  were  large,  rounded,  and  elastic, 
and  fluctuated  more  or  less  distinctly ;  and  two  were  small, 
hard,  and  judging  from  palpation  solid.  There  was  no  doubt 
in  my  mind  that  the  three  large  tumours  were  hydatid  cysts ; 
and  I  had  good  reason,  therefore,  to  assume  that  the  smaller 
bodies  also  were  hydatid  cysts.  Two  of  the  large  cysts  were 
successively  punctured,  and  from  each  of  them  was  withdrawn 
the  fluid  characteristic  of  living  hydatid  cysts,  in  one  instance 
hooklets  of  echinococci  being  discovered.  The  third  large  cyst, 
I  reserved  to  the  last.  I  confess  that  for  some  time  I  did  not 
doubt  that  this,  like  the  other  two,  was  hydatid.  Although 
situated  at  the  lower  part  of  the  abdomen,  it  lay  almost  entirely 
to  the  left  of  the  median  line,  it  formed  like  the  others  a  distinct 
circumscribed,  roundish  protrusion,  and  it  appeared  to  fluctuate. 
But  it  was  a  curious  circumstance,  to  which  I  have  already 
referred,  that  on  each  occasion  when  I  intended  to  tap  it,  it 
modified  its  character  under  manipulation,  it  became  less  and 
less  distinct  until,  though  dulness  on  percussion  still  remained, 
I  decided  to  defer  the  operation  to  a  future  occasion.     There 


and  Tumours  simulating  them.  161 

can  be  no  doubt  that  this  peculiar  behaviour  of  the  tumour  ought 
to  have  suggested  to  me  at  first,  what  struck  me  later,  that  I 
was  not  here  dealing  with  an  ordinary  defined  and  unchange- 
able cyst,  but  with  a  cyst  having  muscular  parietes  which  were 
capable  of  undergoing  alternate  contraction  and  dilatation,  that 
in  fact  the  tumour  was  not  an  hydatid  cyst,  but  the  gravid 
uterus.  When  at  length  this  suspicion  flashed  across  my  mind, 
I  began  to  attach  importance  to  her  statement  that  she  was  in 
the  family  way,  which  hitherto  I  had  not  given  any  thought  to, 
and  I  did  what  I  ought  to  have  done  at  first,  namely,  examined 
the  tumour  with  the  stethoscope.  The  result  was,  as  I  have 
stated,  that  I  easily  detected  the  pulsations  of  the  foetal  heart, 
and  was  able  to  demonstrate  the  phenomenon  to  my  class.  I 
give  the  clinical  facts  of  the  case  as  they  presented  themselves 
to  me,  because  by  having  them  thus  placed  before  him  the 
reader  is  more  likely  to  be  impressed  with  the  considerations 
which  at  first  misled  me  with  regard  to  the  uterine  tumour, 
and  with  those  which  finally  led  me  to  a  correct  diagnosis,  and 
thus  to  learn  from  the  case  the  lesson  which  it  teaches.  It  is 
true  that  no  harm  was  done,  but  it  is  quite  clear  that  I  was  on 
the  verge  of  doing  harm. 

The  other  point  of  special  interest  in  this  case  is  connected 
with  the  hydatid  thrill.  Feeling  sure  that  this  was  a  case  of 
hydatids,  I  endeavoured  to  elicit  the  hydatid  thrill  in  the  three 
larger  cysts,  and  so  also  on  several  occasions  did  my  house 
physician,  and  others  who  saw  the  case  with  me.  There  was 
no  doubt  obvious  fluctuation,  at  any  rate  in  the  two  which 
were  tapped ;  and  some  of  my  class  believed  they  recognised 
the  hydatid  thrill.  I  did  not,  however,  myself  feel  justified  in 
allowing  that  we  ever  obtained  from  them  the  genuine,  or  at 
any  rate,  the  typical  thrill.  Fortunately,  my  house  physician 
was  not  content  with  only  examining  the  three  larger  cysts, 
but  he  percussed  also  the  smaller  ones ;  and  to  his  surprise,  as 
has  been  already  stated,  he  detected  in  the  larger  of  the  two 
apparently  hard  solid  tumours  a  most  marked  thrill  on  per- 
cussion. This  fact  I  and  others  verified  subsequently  over  and 
over  again.  The  thrill,  which  was  perhaps  the  most  exquisite 
example  of  the  hydatid  thrill  I  have  ever  felt,  was  obtainable 
with  the  greatest  ease  and  without  fail.  Until  this  time  I 
must  acknowledge  I  had  no  suspicion  that  the  thrill  could  be 
vol.  xi.  11 


162  Hydatid  Tumours  of  the  Abdomen, 

obtained  from  such  tumours ;  and  so  far  as  I  recollect  I  had 
never  on  any  previous  occasion  percussed  such  tumours  with  the 
object  of  thus  ascertaining  whether  or  not  they  were  hydatids. 

In  the  second  case,  a  man  was  admitted  who  for  some 
months  had  been  losing  flesh  and  strength,  had  been  vomiting, 
and  had  had  intense  abdominal  pain  ;  and  who,  on  admission, 
was  found  to  have  a  large  irregular  liver,  with  one  distinct  hard 
nodule  in  it,  and  two  rounded  but  somewhat  irregular  tumours 
in  other  parts  of  the  belly.  The  view  I  took  of  the  case  was,  I 
suppose,  the  natural  view  to  take  under  the  circumstances.  It 
was  that  the  patient  was  suffering  from  abdominal  (probably 
peritoneal)  cancer,  with  secondary  cancerous  growths  in  the 
liver.  That  the  affection  of  the  liver  was  cancerous  was  a 
diagnosis  which  rested  mainly  on  the  detection  of  tumours  in 
the  belly.  These  latter  tumours,  however,  turned  out  to  be 
hydatids ;  so  that  the  diagnosis  of  cancer  of  the  liver,  which 
was  in  fact  correct,  rested  on  an  erroneous  appreciation  of  the 
facts  of  the  case.  "Whether  I  should  have  ventured  to  diagnose 
cancer  of  the  liver  had  I  known  the  real  nature  of  the  abdo- 
minal tumours  outside  the  liver  I  do  not  know.  Probably  I 
should  not.  This  case  occurred  before  the  former  one.  But  I 
cannot  doubt  now  that  had  the  tumours  in  the  peritoneum  been 
percussed  the  hydatid  thrill  would  have  been  detected  in  them, 
and  my  diagnosis  of  the  case  would  have  been  modified. 

The  third  case  I  have  recited  was  also  one  from  which  I 
learnt  an  important  lesson.  A  young,  healthy-looking  girl 
had  a  large  flaccid  abdominal  cyst,  which,  springing  from  the 
pelvis,  occupied  nearly  the  whole  of  the  front  of  the  abdomen. 
It  was  evidently  thin-walled,  and  it  fluctuated  with  remarkable 
distinctness.  Indeed,  the  fluctuation  was  so  distinct  and  so 
prolonged  that  over  and  over  again  I  discussed  with  my  class 
whether  or  not  it  ought  to  be  regarded  as  a  modified  hydatid 
thrill — I  say  modified  because  (although  it  was  prolonged)  the 
successive  waves  were  large  and  individually  recognisable,  and 
did  not  collectively  constitute  a  mere  tremor.  On  tapping  the 
cyst  we  removed  a  considerable  quantity  of  limpid  colourless 
fluid,  like  water,  of  very  low  specific  gravity,  free  from  albumen, 
and  containing  a  largish  quantity  of  chlorides — a  kind  of  fluid 
which  is  generally  regarded  as  characteristic  of  hydatid  cysts. 
No   parasitic  elements,    however,  were   discovered   in   it.     A 


and  Tumours  simulating  them.  163 

further  point  of  interest  about  the  case  was  that  the  cyst,  after 
paracentesis,  underwent  such  extreme  collapse  that  its  re  mains 
could  scarcely  be  distinguished,  and  in  a  short  time  all  recog- 
nisable traces  of  it  had  disappeared  absolutely.  This  pheno- 
menon confirmed,  of  course,  what  had  been  recognised  before, 
that  the  cyst  wall  was  extremely  thin,  but  was  not  compatible 
with  what  we  know  of  the  structure  of  hydatid  cysts,  and  of  the 
behaviour  of  the  contents  of  such  cysts  after  tapping.  If  the 
case  was  not  one  of  hydatids,  what  was  it?  Shall  I  confess 
that  I  could  not  at  first  answer  the  question,  and  that  it  was 
only  after  consulting  Dr.  Barnes's  and  Dr.  Matthews  Duncan's 
writings  that  I  satisfied  myself  that  the  case  was  one  of 
parovarian  dropsy?  I  was  well  acquainted  with  the  morbid 
anatomy  of  parovarian  cysts,  the  extreme  tenuity  of  their  walls, 
and  the  watery  character  of  their  contents.  I  had  in  former 
years  seen  them  and  examined  them  in  the  dead-house.  But 
I  had  never  seen  one  larger  than  an  orange,  and  I  think  the 
description  given  of  them  by  Virchow  corresponds  with  my 
experience.  However,  there  can  be  no  doubt  that  they  do 
occasionally  attain  large  dimensions,  and  there  can  be  no  doubt, 
I  think,  that  this  was  a  typical  and  striking  example  of  the 
disease.  It  is  clear,  therefore,  that  they  are  apt  to  simulate 
hydatid  tumours  in  some  of  those  features  which  are  supposed 
to  be  most  typical  of  hydatids,  and  thus  to  mislead  the  unwary 
practitioner. 


CONGENITAL    HYPERTROPHY. 


By  WILLIAM  ANDERSON. 


Cases  of  giant  growth  of  the  hands,  feet,  and  other  portions 
of  the  frame  are  too  seldom  met  with  to  receive  the  attention 
which  their  peculiarities  deserve,  hence  the  condition,  although 
well  known  to  English  surgeons,  has  scarcely  found  a  place  in 
our  text-books. 

The  earliest  examples  recorded  in  this  country  were  those  of 
Dr.  Reid,  published  in  the  f  London  and  Edinburgh  Monthly 
Journal  of  Medical  Science '  for  March,  1843,  but  before  this 
date  a  characteristic  case  of  makrodactyly  had  been  carefully 
described  by  von  Klein,1  and  other  instances  had  been  brought 
forward  by  Beck,2  and  Wagner.3  Reid's  paper  was  followed 
by  a  valuable  article  by  Curling,4  and  contributions  by  Ideler,5 
Adams,6  Devouges,7  Chassaignac,8  Annandale,9  and  others,  but 
the  first  attempt  to  classify  the  cases  was  that  of  Busch10  in 

1  '  Journal  der  Chirurg.  und  Augenheilk.,'  v.  Graefe  u.  Walther,  1824. 

2  *  Med.  Annalen,'  v.  Puchelt,  Chelius,  u.  Niigele,  1836. 

3  '  Schmidt's  Jahrbucher,'  1842. 

4  '  Medico-Chirurgical  Transactions,'  vol.  xxviii. 

5  '  Dissertation,'  Berlin.     Quoted  by  Busch.     See  below. 

6  '  Lancet,'  Aug.,  1858. 

7  '  Bulletin  de  la  Soc.  Anat.,'  1856. 

8  'Bulletin  de  la  Soc.  de  Chirurg.,'  1st  series,  vol.  xviii.  '  Gazette  des  Hopi- 
taux,'  1858. 

9  '  Malformations,  Diseases,  and  Injuries  of  Fingers  and  Toes,'  1865. 

10  "  Beitrage  z.  Kentniss  der  Angeb.  Hypert.  der  Extrem."  '  Langenbeck's 
Arch.,'  1867. 


]  66  Congenital  Hypertrophy. 

1866.  Since  this  time  many  additions  have  been  made  to 
the  literature  of  the  subject,  amongst  which  a  paper  by  Trelat 
and  Monod1  deserves  especial  mention.  The  most  recent  works 
are  those  of  Vogt2  and  v.  Fischer,3  by  the  latter  of  whom  the 
various  forms  of  the  affection  are  elaborately  analysed  and 
illustrated. 

The  condition  may  be  defined  as  a  gigantic  growth,  probably 
congenital  in  origin,  of  various  segments  of  the  body  exclusive 
of  the  viscera.  It  is  almost  invariably  unilateral,  and  is  gene- 
rally limited  to  one  extremity  or  portion  of  an  extremity ;  it 
tends  to  implicate  especially  the  bony,  ligamentous,  and  integu- 
mentary tissues,  and  is  frequently  associated  with  lipomata,  and 
with  angiectases  and  angiomata  in  connection  with  the  circula- 
tory and  lymphatic  systems.  It  does  not,  as  a  rule,  impair  to 
any  important  extent  the  functional  capacity  of  the  part. 

The  name  "  congenital  hypertrophy,"  by  which  the  affection 
is  now  most  commonly  known,  is  open  to  criticism.  There  is 
little  doubt  that  the  abnormality  always  has  its  origin  in  foetal 
life,  but  as  yet  direct  evidence  of  its  existence  at  birth  has 
seldom  been  adduced.  In  only  three  cases,  those  of  Owen,4 
Higginbottom,  and  Friedberg,5  has  it  been  averred  that  the 
deformity  was  seen  immediately  after  the  delivery  of  the  child, 
and  on  the  other  hand,  in  at  least  one  case,  that  of  Lannelongue,6 
a  macrodactylie  elephantiasique  in  a  child,  appeared  to  have  as 
its  exciting  cause  an  operation  for  the  separation  of  two  united 
fingers.  It  is  certain  that  if  the  enlargement  be  always  present 
at  birth  it  is  never  so  disproportionate  as  to  interfere  with 
parturition,  nor  is  it  in  general  even  sufficiently  marked  to 
attract  the  notice  of  the  parents  or  friends  :  the  colossal  pro- 
portions subsequently  observed  are  hence  the  result  of  excessive 
growth  in  early  infancy  and  childhood. 

The  right  to  rank  with  the  hypertrophies  is  much  more 
doubtful  than  the  intra-uterine  origin,  for  although  in  certain 
cases,  at  present  not  specially  distinguished  from  the  rest,  the 

1  "  De  Thypertrophie  unilaterale,"  'Arch.  gen.  de  Medecine,'  May  and  June, 
1869. 

2  '  Deutsche  Chirurgie,'  Lief.  64. 

5  "  Der  Riesenwuchs,"  '  Deutsche  Zeitschrift  fur  Chirurgie,'  1880,  Ed.  12. 

4  Quoted  by  Curling  (1.  c.) 

5  '  Petersburger  Med.  Zeitsch.,'  Bd.  14,  1863. 

6  « Bulletin  de  la  Soc.  de  Chirurgie,'  Dec,  1880. 


Congenital  Hypertrophy.  167 

ordinary  characters  of  true  hypertrophy  are  present,  in  the  great 
majority  of  instances  the  unequal  distribution  of  the  hyper- 
plasia amongst  the  different  tissues,  the  frequent  association  of 
other  congenital  deformities,  of  tumour  growths,  and  of  anchy- 
losis and  articular  distortions,  together  with  the  defective  ratio 
that  the  arterial  supply  and  functional  power  bear  to  the  amount 
of  constructive  material,  relegate  the  pathological  process  to  a 
lower  status  than  that  occupied  by  the  true  hypertrophies. 

The  etiology  is  very  obscure.  The  affection  is  not  hereditary, 
and  it  cannot  be  attributed  to  any  known  influences  arising 
during  intra-uterine  life,  but,  as  in  most  congenital  deformities, 
it  has  frequently  happened  that  the  mother  has  been  able  to  con- 
jure up  some  reminiscence  of  the  period  of  gestation,  which  to 
her  mind  affords  a  perfectly  satisfactory  clue  to  the  mystery.  V. 
Klein  relates  in  his  case  of  makrodactyly  that  the  mother  while 
pregnant  was  bitten  in  the  hand  by  a  goose.  A  history  of  a 
fright  was  given  in  Adam's  case,  and  in  the  instance  reported 
at  the  end  of  the  present  paper,  a  giant  growth  of  the  lower 
extremity  was  attributed  to  the  mother  having  been  trodden 
upon  by  a  cow.  Such  mental  impressions  are  probably  mere 
coincidences,  and  are  often  greatly  exaggerated  in  narration,  but 
until  the  possibility  of  their  connection  with  foetal  lesions  is 
disproved,  it  is  unadvisable  to  leave  any  facts  of  the  kind 
unnoted. 

Parts  affected. — A  peculiarity  of  the  abnormality  is  its 
almost  invariable  limitation  to  one  side  of  the  body.  Only 
three  bilateral  cases  have  been  observed;  those  of  Curling  (I.e.), 
Owen  (related  by  Curling),  and  Annandale,  and  in  all  of  these 
the  makroplasia  was  limited  to  the  digits.1  The  nsevi  with 
which  the  hypertrophy  is  often  associated  are  also  nearly 
always  confined  to  the  affected  side,  but  in  two  cases  published 
by  Chassaignac  and  Friedberg,  they  were  found  also  upon  the 
non-hypertrophied  side,  and  in  a  second  case  of  Chassaignac's 
were  present  only  upon  the  unenlarged  parts  of  the  body. 

The  extent  of  the  parts  involved  ranges  from  a  single  digit 
to  an  entire  half  of  the  body.  When  a  whole  limb  is  impli- 
cated the  growth  is  always  proportionately  greater  at  the  distal 

1  V.  Fischer  describes  the  case  of  Devouges  as  one  in  which  parts  on  both 
sides  were  afi'ected,  but  a  reference  to  the  original  and  to  Chassaignac's  report 
upon  the  same  patient  shows  that  the  hypertrophy  was  unilateral. 


168  Congenital  Hypertrophy. 

extremity,  but  colossal  development  of  the  hand  or  foot  seldom 
includes  the  whole  of  the  digits.  The  localisation  of  the  affec- 
tion does  not  appear  to  be  related  to  any  special  vascular  or 
nervous  territories  ;  thus,  in  makrodactyly,  the  regions  of  dis- 
tribution of  the  digital  branches  of  both  median  and  ulnar 
nerves  may  be  encroached  upon,  while  parts  supplied  by  either 
or  both  of  these  may  escape  intact. 

Commonly,  however,  both  on  the  hand  and  foot,  the  hyper 
trophy  selects  a  series  of  digits  on  the  inner  or  outer  side  of 
the  member,  for  example,  on  the  first  and  second,  or  first, 
second  and  third,  the  fourth  and  fifth,  or  the  third,  fourth 
and  fifth,  not  attacking  them  capriciously  and  without  order ; 
and  coexistent  circumscribed  lipomata  are  almost  invariably 
limited  to  that  portion  of  the  palm  or  sole  which  corresponds 
to  the  enlarged  fingers  or  toes. 

Its  course  is  always  in  a  certain  sense  progressive.  Occasion- 
ally it  appears  to  keep  pace  throughout  with  the  general  growth 
of  the  body,  but,  in  nearly  all  cases,  at  some  period  the  abnormal 
growth  strides  in  advance,  so  that  the  disproportion  of  the 
affected  part  to  the  rest  of  the  body  becomes  more  and  more 
pronounced.  Its  progress  may  be  uniform  and  continuous, 
or  terms  of  slow  increase  or  apparent  arrest  may  be  succeeded 
by  a  new  and  rapid  development. 

In  some  instances  the  process  does  not  extend  beyond  the 
primary  limits,  while  in  others  it  may  spread  centripetally,  and 
often  at  a  very  rapid  rate,  as  in  v.  Fischer's  case  (1.  c),  in 
which  amputation  of  an  hypertrophied  finger  was  followed 
within  a  few  months  by  hypertrophy  of  the  whole  limb.  The 
appended  case  serves  also  as  an  example  of  a  well-marked 
progressive  increase  of  the  giant  growth. 

The  addition  of  new  tissue  goes  on,  as  a  rule,  without  pain, 
inflammation,  or  interference  with  function ;  but  in  a  case  of 
v.  Fischer's  burning  pain  was  associated  with  trophic  ulceration, 
and  Friedberg's  patient,1  who  appeared  to  be  the  subject  of 
an  associated  elephantiasis  Arabum,  had  symptoms  that  some- 
what resembled  the  inflammatory  crises  of  elephantiasis. 

The  task  of  classification  has  hitherto  been  rendered  some- 
what difficult  by  the  smallness  of  the  number  of  fully-reported 
cases.     The  latest  labour  in  this  direction  is  that  of  v.  Fischer 
1  '  Virchow's  Archives,'  1867,  vol.  xl. 


Congenital  Hypertrophy.  169 

(1.  c),  who  divides  the  condition  according  to  extent  into  three 
classes : — (1)  general  hypertrophy  involving  the  whole  body;  (2) 
unilateral,  affecting  one  half  of  the  body ;  and  (3)  hypertrophy 
limited  to  one  extremity  or  to  one  side  of  the  face.  The  latter 
class  is  separated  into  (a)  symmetrical  cases  of  true  giant 
growth,  in  which  all  the  tissues  are  proportionately  enlarged, 
the  limbs  symmetrically  built,  and  more  or  less  serviceable; 
and  (b)  false.  These  are  in  turn  subdivided  into  smaller 
groups,  amongst  which  is  recognised  a  giant  growth  dependent 
upon  abnormal  development  in  certain  of  the  soft  parts,  the 
skeleton  not  taking  part  in  the  process.  This  arrangement  is 
an  amplification  of  that  previously  adopted  by  Busch,  who, 
however,  omitted  the  first  class,  gave  the  name  of  u  general 
hypertrophy "  to  the  second,  and  made  no  attempt  to  go 
beyond  the  division  of  the  third  class  ("partial  hypertrophy  ") 
into  two  forms,  one  corresponding  to  the  symmetrical  hyper- 
trophy of  Fischer,  the  other  distinguished  by  the  association 
of  the  bone  enlargement  with  a  disproportionate  increase  of 
the  soft  parts,  and  especially  of  the  adipose  tissue. 

The  classification  of  v.  Fischer  is  in  many  respects  unsatis- 
factory. Setting  aside  the  question  whether  mere  extent  of  a 
pathological  process  such  as  that  under  consideration  can  be 
accepted  as  a  good  basis  for  a  primary  grouping,  it  may  be 
pointed  out  that  the  class  of  "general  hypertrophy"  is  at  present 
only  a  possibility.1  "  Unilateral  hypertrophy  "  differs  only  from 
the  third  class  in  attacking  more  than  one  segment  of  the 
affected  side,  and  although  it  may  present  the  same  varieties 
with  respect  to  tissues  implicated  as  the  limited  form,  no 
distinction,  as  in  the  latter,  between  symmetrical  and  false 
has  been  considered  necessary.  Again,  the  analysis  of  the 
third  class  into  "  symmetrical "  and  "  false  "  will  not  bear  close 
examination,  as  in  many  of  the  examples   of  the  so-called 

1  V.  Fischer  bimself  appears  to  be  doubtful  of  the  existence  of  cases  that 
can  be  placed  .under  this  heading,  but  nevertheless  alludes  to  three  or  four 
examples  published  by  Friedreich  ('  Virchow's  Archives,'  Bd.  43)  and  Frankel 
('  Virchow's  Archives,'  Bd.  46).  Reference  to  the  original  reports  will  show 
that  these  are  altogether  hors  de  propos,  as  in  each  instance  the  pseudogigantism 
began  after  puberty,  and,  unlike  congenital  hypertrophy,  was  associated  with 
great  muscular  enfeeblement  and  peculiar  constitutional  symptoms.  The  occa- 
sional occurrence,  however,  of  bilateral  makrodactvly  prepares  us  for  the  future 
production  of  true  examples  of  a  general  bilateral  Riesenwuchs. 


1 70  Congenital  Hypertrophy . 

"  symmetrical "  variety  it  may  be  shown  that  the  implication  of 
structures  is  by  no  means  uniform  or  general,  for  although 
the  veins  may  have  undergone  marked  chauge,  the  arteries 
are  not  enlarged;  the  tendons  near  their  insertion  into  the 
hypertrophied  bones  may  be  gigantic,  but  the  muscles  are  not 
excessively  developed;  and  the  subcutaneous  tissue  may  be 
considerably  thickened,  while  the  papillary  layer  of  the  skin 
takes  no  share  in  the  increase  of  structure.  In  such  a  case  a 
part  may  be  enlarged,  with  preservation  of  an  apparent  sym- 
metry in  its  own  proportions,  to  three  or  four  times  its  normal 
bulk,  yet  its  arteries  and  some  other  structures  may  differ  in 
no  respect  from  those  of  the  normal  side. 

The '  false '  hypertrophy1  of  Busch  differs  from  his  symmetrical 
form  only  in  the  disproportionate  growth  of  certain  of  the  soft 
parts,  but  v.  Fischer  proposes  to  admit  into  the  former  group 
conditions  in  which  a  limb  is  increased  in  size  solely  by  an  exces- 
sive growth  of  fat,  or  by  development  of  angiectases  or  angiomata 
in  connection  with  the  lymphatic  or  blood  vascular  systems. 
The  propriety  of  introducing  this  new  element  into  an  already 
overstrained  classification  is  very  questionable,  especially  as 
scarcely  a  single  case  is  recorded  that  can  pass  unchallenged 
into  the  category.  No  example  of  a  purely  lipomatous  Riesen- 
wuchs  is  known,  and  the  same  may  be  said  of  pseudo-hyper- 
trophy of  a  limb  constituted  by  a  lymphangioma  cavernosum  ; 
even  the  case  of  lymphangiectasis  narrated  by  v.  Fischer  him- 
self can  scarcely  be  admitted,  as  the  growth,  which  first  showed 
itself  in  the  penis,  apparently  did  not  commence  until  the  age 
of  seven. 

The  essential  distinction  of  the  cases  of  "  congenital  hyper- 
trophy "  apppears  to  be  into  true  and  false,  and  it  is 
advisable  that  these  terms  should  be  applied  in  all  cases, 
irrespective  of  extent.  It  is,  moreover,  necessary  that  the 
apparently  symmetrical  cases  should  be  displaced  from  their 
association  with  genuine  hypertrophy,  a  task  of  some  difficulty, 
owing  to  the  imperfection  of  most  of  the  reports. 

True  unilateral  hypertrophy  may  be  accepted  as  a  fact,  but 
is   comparatively   rare.     The    cases    described    long   since  in 

1  This  term  is  not  used  by  Busch,  but  is  here  applied  as  a  convenient  desig- 
nation for  his  second  form  of  '•'partial  hypertrophy,"  which  corresponds  in  some 
degree  to  the  "  false  "  of  v.  Fischer. 


Congenital  Hypertrophy.  171 

general  terms  by  Geoffroy  St.  Hilaire,1  as  marked  by  an  unequal 
development  of  the  two  sides  of  the  body  in  one  or  more 
regions,  were  probably  of  this  nature,  and  a  few  may  be  selected 
from  the  medical  periodicals,  as  having  a  somewhat  doubtful 
claim  to  the  same  position.  Ollier's  case2  appears  to  be  entitled 
to  a  place  in  this  class.  In  this  the  face,  thorax,  abdomen,  and 
both  extremities  of  one  side  were  uniformly  larger  than  the 
corresponding  parts  of  the  opposite  half  of  the  body.  The 
vascularity  of  the  hypertrophied  side  was  increased,  the 
temperature  elevated,  and  the  limbs  were  more  powerful. 
There  were  no  nsevoid  growths,  and  it  is  noteworthy  that  in 
association  with  an  absence  of  evident  abnormality  of  thoracic, 
pelvic,  and  abdominal  viscera,  the  mammary  glands  preserved 
their  symmetry.  The  cases  of  Devouges  and  Adams  also 
presented  certain  points  of  resemblance  to  true  hypertrophy. 
In  the  former  the  whole  of  one  side  was  hypertrophied,  except 
perhaps  the  abdominal  wall,  where  nothing  unusual  was  noticed. 
The  details  are  very  imperfect,  but  according  to  the  patient's 
statement,  the  strength  of  the  arm  on  the  hypertrophied  side 
was  greatly  in  excess  of  that  of  its  fellow.  In  Adams's  case 
the  giant  growth  of  the  right  lower  extremity  was  apparently 
uniform,  and  the  femoral  and  all  other  accessible  arteries  were 
considerably  enlarged,  but  nothing  is  said  as  to  muscular  power. 
In  this  as  in  the  last  example  nsevi  were  present.  In  two 
instances  of  unilateral  hypertrophy  of  the  face  described  by 
Friedrich3  and  Passauer,4  the  increased  growth  involved  the 
whole  of  the  parts  of  the  affected  side,  even  to  the  teeth  and 
tongue,  and  in  Friedriclr's  patient,  and  in  a  case  brought  by 
Dr.  Heumann  before  a  Medical  Congress  in  Darmstadt,  the 
hair  was  more  developed,  and  the  secretion  of  saliva  was 
excessive  on  the  affected  side.  The  muscular  power  and 
arterial  supply  were  not  specially  referred  to.  The  coexistence 
of  a  purulent  otorrhoea  on  the  enlarged  side  in  both  of  these 
cases  is  significant,  as  it  indicates  a  possibility  that  the 
hypertrophy  was  acquired. 

1  '  Histoire    generate   et   particuliere  des  anomalies   de    l'organization   chez 
l'hornme.' 

2  '  Gazette  Medicale  de  Lyon,'  July,  1862. 

3  '  Archives  fur  Path.  Anat.,'  vol.  xxviii,  1863. 
'  Virchow's  Archives/  Bd.  xxxvii,  1866. 


172  Congenital  Hypertrophy. 

In  false  hypertrophy  the  size  of  the  part  is  augmented  by 
an  unequally  distributed  hyperplasia  of  the  skeleton  and  soft 
parts.  Almost  all  the  cases  narrated  in  detail  are  of  this  kind. 
In  nearly  all,  the  arterial  supply  is  proportionate  only  to  the 
normal  size  of  the  part,  and  the  functional  capacity  (power, 
sensibility,  &c),  although  not  seriously  altered,  is  to  some 
extent  deteriorated.  The  cases  may  be  for  practical  purposes 
divided  into  two  groups  : 

1.  Without  deformity,  the  general  symmetry  of  the  part 
not  being  obviously  altered. 

2.  With  deformity. 

a.  From  predominant  development  of  the  adipose  or  vascular 
tissues. 

b.  From  secondary  articular  distortions. 

c.  From  associated  defects  of  development,  as  syndactyly,  &c. 
The  condition  of  the  different  elements  of  the  enlarged  part, 

as  revealed  by  the  investigations  of  Busch  and  others,  is  as 
follows : 

Bones. — The  bones  are  always  enlarged  (if  v.  Fischer's 
additional  group  be  excluded).  Their  general  shape  is 
commonly  preserved,  but  occasionally  their  extremities  may  be 
deformed  by  outgrowths  at  the  line  of  junction  with  the 
articular  cartilage.  The  hypertrophy  reaches  its  greatest  pro- 
portionate extent  in  the  digits,  while  increase  in  size  of  the 
bones  of  the  forearm,  arm,  leg,  and  thigh,  is,  as  a  rule,  only 
demonstrable  during  life  by  admeasurement  of  length.  No 
histological  abnormality  has  been  detected  in  the  osseous 
tissue. 

Joints. — The  articular  surfaces  may  present  no  peculiar 
features,  but  in  some  cases  the  cartilages  show  irregularities 
of  surface.  The  ligaments  are  usually  greatly  thickened.  The 
synovial  membrane  commonly  has  the  ordinary  characters, 
varied  only  by  an  excessive  development  of  the  plicae  adi- 
posse. 

The  range  of  motion  is  sometimes  normal ;  in  other  cases,  the 
voluntary  movements  are  more  or  less  diminished  in  extent, 
while  a  fair  amount  of  passive  mobility  is  preserved ;  and  in 
others,  there  is  complete  ankylosis. 

Distortions,  such  as  lateralisation  and  hyperextension,  are 
frequent. 


Congenital  Hypertrophy.  17$ 

Muscles  and  tendons. — The  tendons  inserted  into  the  enlarged 
bones  have  been  found  proportionately  over-developed.  The 
muscles,  however,  are  seldom  hypertrophied,  and  occasionally, 
as  in  Busch's  case,  may  undergo  an  atrophy  secondary  to  the 
impaired  mobility  of  the  joint.  In  a  case  of  v.  Fischer's 
muscular  hypertrophy  was  demonstrated,  but  no  evidence  of 
increased  power  was  present,  and  judging  by  the  comparative 
disuse  of  the  limb,  it  is  probable  that  the  strength  was 
lessened.  The  muscular  power  is  probably,  as  a  rule,  so  far 
augmented  in  response  to  functional  necessity  that  the  enlarged 
part  may  be  used  without  more  sense  of  effort  than  that  which 
accompanies  the  same  actions  on  the  normal  side,  as  in  Wagner's 
case  (I.e.),  in  which  the  hand  weighed  about  twelve  pounds,  and 
yet  could  be  moved  with  perfect  ease;  there  is,  however, 
rarely  any  such  absolute  increase  of  strength  as  would  indicate 
a  genuine  muscular  hypertrophy.  Devouges'  and  Adams' 
cases  may  be  referred  to  as  possible  exceptions. 

Blood-vessels. — The  arteries  in  all  the  instances  of  false 
hypertrophy,  with  the  exception  of  Reid's  cases,1  were  of 
ordinary  size  and  not  enlarged  in  proportion  to  the  gigantic 
development  of  the  part  to  be  nourished.  This  is  a  fact  of 
considerable  pathological  significance. 

The  veins  and  capillaries,  unlike  the  arteries,  appear  especially 
liable  to  change.  Varicosities  of  the  veins  are  very  common, 
and  in  some  cases  great  thickening  of  the  walls  may  be  super- 
added (Busch,  1.  c). 

In  Wagner's  case,  the  fingers  of  the  hypertrophied  hand  were 
said  to  become  as  red  as  a  <{  Blutschwamm  "  when  the  member 
hung  down,  the  arteries  being  nevertheless  of  normal  size. 

Angiectases  and  angiomata  are  frequently  seen.  Capillary 
nsevi  of  enormous  extent  sometimes  coexist  (as  in  Adams'  case, 
in  which  the  whole  lower  extremity  and  buttock  were  involved), 
and  are  usually,  but  not  invariably,  confined  to  the  hyper- 
trophied parts. 

The  lymphatics  are  liable  to  dilatation,  and  may  form  diffuse 
swellings  or  soft  tumours  of  considerable  extent.  The  glands, 
however,  are  never  affected. 

1  It  is  somewhat  curious  that  iu  all  three  of  Dr.  Eeid's  cases,  which  in  most 
respects  were  of  the  ordinary  type,  the  arteries  are  said  to  have  presented  the 
exceptional  peculiarity  of  enlargement. 


174  Congenital  Hypertrophy. 

The  nerve  trunks  appear  to  be  normal.  The  condition  of  the 
nerve  centres  has  not  yet  been  investigated. 

The  integuments  nearly  always  participate  in  the  changes, 
but  the  alterations  are  scarcely  hypertrophic.  The  subcutaneous 
adipose  layer  commonly  shows  a  diffuse  thickening,  and  in 
addition  may  undergo  a  circumscribed  hypertrophy  in  the  form 
of  large  lipomatous  pads,  which  are  almost  always  found  upon 
the  flexor  aspect  of  the  member  affected,  and  correspond  in  situa- 
tion and  extent  to  the  bony  enlargement ;  but  the  papillary  and 
epithelial  layers  do  not  undergo  any  sensible  changes,  nor,  as  a 
rule,  are  the  hairs  or  sebaceous  follicles  more  developed  than  on 
the  opposite  side.  The  nails  of  hypertrophied  digits  generally 
undergo  proportionate  development.  The  secretion  of  perspira- 
tion is  not  sensibly  altered  in  amount  or  character.  The 
cutaneous  sensibility  is  variously  described  as  unaffected  or 
diminished,  never  increased.  It  is  probable,  as  v.  Fischer 
suggests,  that  careful  examination  with  the  sesthesiometer, 
&c,  would  generally  reveal  an  impairment  of  the  faculties. 
A  reduction  of  the  sensibility  to  heat  and  pain  was  found  to 
accompany  the  tactile  defect  in  v.  Fischer's  case.  Pain  is 
rarely  complained  of.  Burning  pain  was  present  in  association 
with  trophic  ulceration  in  a  case  of  v.  Fischer's,  and  pains  of  a 
rheumatic  character  appeared  in  the  instance  now  reported, 
but  this  symptom  probably  formed  no  part  of  the  original 
disease. 

The  temperature  of  the  part  is  generally  normal.  By 
exception,  a  rise  of  2°— 2±°  Fahr.,  of  2°— 6°  Fahr.  (Reid),  and 
of  \ — 1°  Cent.  (Trelat  and  Monod),  has  been  recorded. 

Pathological  complications  are  rarely  met  with.  Trophic 
ulceration  appeared  in  a  case  of  v.  Fischer's  ;  and  in  Friedberg's 
case  an  eruption  resembling  pemphigus  was  noted,  but  probably 
was  not  directly  connected  with  the  congenital  hypertrophy. 
Inflammatory  crises,  corresponding  to  those  of  elephantiasis 
arabum,  have  been  seen  in  only  one  instance,  and  in  this  the 
condition  appeared  to  be  complicated  by  true  elephantiasis. 

Associated  defects  of  development  are  not  rare  in  connection 
with  makrodactyly.  They  may  consist  of  multiplication, 
dwarfing,  absence,  or  fusion  of  parts. 

Pathology. — The  origin  of  the  process  is  very  obscure,  and  it 
cannot  be  said  that  the  existing  theories  cast  much  light  upon 


Congenital  Hypertrophy .  175 

it.  The  views  as  to  its  pathological  origin  propounded  up  to 
the  present  time  are  four  in  number  : — (1)  Congenital  lesion  of 
vaso-motor  centres,  leading  to  vascular  stasis  ;  (2)  A  primitive 
vice  of  the  middle  lamina  of  the  blastodermic  membrane  ;  (3) 
partial  intra-uterine  strangulation  of  the  affected  member ; 
and  (4)  an  inherent  tendency  of  the  tissues  to  appropriate  an 
excess  of  nutriment.  Of  these,  the  first  is  perhaps  the  most 
suggestive,  but  leaves  in  obscurity  the  unequal  distribution  of 
the  hyperplasia.  The  second,  a  rather  unsatisfactory  suggestion, 
is  opposed  by  the  fact  that  the  walls  of  the  trunk  which  are 
directly  formed  from  the  middle  lamina  are  comparatively 
seldom  implicated.  The  third  fails  to  explain  cases  in  which 
the  entire  half  of  the  body  is  affected.  Lastly,  the  fourth  and 
perhaps  the  oldest  view,  though  less  open  to  objection  thau  the 
others,  resembles  the  second  in  only  removing  the  difficulty  a 
step  back,  and  gives  us  a  new  problem,  the  explanation  of  the 
abnormal  greed  of  certain  elementary  parts.  For  the  present 
the  question  must  be  left  open  until  sounder  data  are  afforded 
by  future  opportunities  of  pathological  investigation. 

Case  of  congenital  hypertrophy  of  the  left  lower  extremity. — 
J.  C — ,  a  married  woman,  aet.  25,  attended  as  an  out-patient  at 
St.  Thomas's  Hospital,  in  May,  1881. 

History. — From  the  time  of  the  patient's  earliest  recollection, 
the  left  foot  has  been  larger  than  the  right.  There  is,  however, 
no  evidence  as  to  the  condition  of  the  part  at  birth. 

Up  to  the  age  of  twenty,  the  increase  of  the  affected  member 
was  apparently  in  proportion  to  the  general  growth  of  the  body. 
After  this  period  and  shortly  after  her  marriage,  she  noticed  a 
considerable  enlargement  of  the  leg,  and  soft  tumour-like 
prominences  appeared  over  the  knee  and  upper  part  of  the 
tibia.  The  abnormal  development  now  made  a  perceptible 
and  independent  progress,  and  three  and  a  half  years  later, 
after  the  birth  of  her  third  child,  the  makroplasia  invaded  the 
thigh  and  buttock. 

The  process  was  painless  and  the  functions  remained  un- 
impaired until  about  three  months  before  admission,  when  the 
left  knee  and  ankle  were  attacked  by  symptoms  of  a  rheumatic 
character,  which  have  left  a  certain  amount  of  weakness  and 
discomfort  of  the  limb. 


176  Congenital  Hypertrophy. 

She  has  had  three  children,  aged  respectively  fifteen  months, 
three  years,  and  four  years,  and  is  now  in  the  third  month  of 
her  fourth  pregnancy.  Catamenia  have  been  suppressed  since 
marriage,  probably  owing  to  the  absence  of  any  interval  between 
pregnancy  and  lactation. 

Her  health  has  always  been  good. 

The  family  history  is  negative  as  regards  the  existence  of 
inherited  tendency  to  disease  or  malformation.  Her  children 
are  all  alive  and  well. 

The  patient  volunteered  the  statement,  as  an  attempt  to 
explain  the  deformity,  that  a  few  months  before  her  birth,  her 
mother's  foot  was  trodden  upon  by  a  cow. 

Condition  on  admission. —  Left  lower  extremity,  including 
buttock,  generally  but  not  uniformly  enlarged.  The  excessive 
development  is  greatest  in  the  foot,  and  is  limited  almost 
entirely  to  the  inner  half  of  the  member.  The  front  of  the  leg 
and  the  knee  present  soft  tumours. 

Foot. — First  and  second  toes  of  colossal  proportions ;  the 
enlargement  depends  chiefly  upon  a  makroplasia  of  the  phalanges 
and  heads  of  the  metatarsal  bones.  Superficial  soft  parts  more 
or  less  thickened  over  the  whole  foot,  but  especially  over  the 
inner  half  and  on  the  plantar  surface,  forming  in  the  latter 
situation  a  thick  callous  pad  of  squarish  outline,  extending  from 
the  roots  of  the  toes  to  the  middle  of  the  sole  ;  behind  this  is 
a  small  circular  nodule  of  similar  character  and  also  distinctly 
marginated. 

The  affected  bones  preserve  their  normal  contours.  The 
second  toe  is  relatively  more  hypertrophied  than  the  first ;  and 
is  separated  from  it  by  a  distance  of  about  half  an  inch.  The 
nail  of  the  great  toe  is  enlarged  in  proportion  to  its  phalanx, 
but  that  of  the  second  toe  is  comparatively  small  and  partly 
concealed  by  the  overlapping  integuments. 

The  joints  are  mobile,  but  the  range  of  voluntary  movement 
is  somewhat  diminished. 

The  tendons  on  the  extensor  aspect  are  apparently  enlarged, 
but  it  is  difficult  to  define  them  accurately. 

Leg  increased  in  girth,  principally  by  augmented  thickness  of 
the  subcutaneous  fatty  layer ;  anterior  aspect  of  its  upper  two- 
thirds  occupied  by  an  oval  tumour  of  soft  elastic  consistence, 
continuous   at  its  margins  with  the  thickened  adipose  tissue  of 


Congenital  Hypertrophy.  177 

the  rest  of  the  limb,  and  presenting  over  its  most  prominent 
part  a  neevoid  dilatation  of  capillaries. 

Knee  shows  a  similar  increase  of  subcutaneous  adipose  tissue, 
and  in  front  and  at  the  sides  soft  prominences  like  that  over 
the  tibia,  but  without  naevoid  patches. 

Thigh  and  buttock  enlarged  in  circumference.  Superficial 
tissues  thickened,  especially  on  outer  side.  Labium  not 
affected. 

The  condition  of  the  bones  of  the  thigh  and  leg  cannot  be 
ascertained.  The  muscles  are  not  sensibly  hypertrophied. 
The  skin  is  smooth  and  hairless,  as  on  the  normal  side,  and 
when  examined  under  a  power  of  30  diameters  shows  no 
peculiarity.  The  corium  and  cuticle  do  not  appear  to  participate 
in  increase  of  tissue. 

The  general  tactile  sensibility  is  reduced  by  about  one  third 
as  compared  with  that  of  the  opposite  limb,  and  is  most  blunted 
over  the  nsevoid  patch  on  the  leg.  The  sensibility  to  heat  and 
pain  is  diminished  in  like  proportion. 

Circulatory  system  shows  no  abnormality.  Pulsation  of  left 
femoral  artery  not  perceptibly  different  from  that  of  the  right. 
No  enlargement  of  superficial  veins.  Lymphatic  glands  normal. 
Functions  of  limb  not  greatly  altered.  The  patient  now  com- 
plains of  the  weight  of  the  foot  and  supervention  of  fatigue  on 
slight  exertion,  but  this  symptom  is  of  recent  date,  and  appa- 
rently connected  with  a  rheumatic  attack.  The  gait  is  some- 
what awkward,  but  there  is  no  limping. 

The  surface  temperature  is  normal. 

Perspiratory  secretion  augmented  at  the  upper  part  of  the 
thigh,  but  in  the  rest  of  the  limb  is  not  different  from  that  of 
the  opposite  side. 

The  measurements  taken  are  as  follows  : 

Left.  Right. 

Length  from  ant.  superior  spine  of  ilium  to  minor 

malleolus  (in  inches)        ....  31£       ...         33 

Length  of  foot  from  extremity  of  heel  to  end  of 

great  toe         .         .         .         . 
Circumference  of  thigh  (middle)    . 

„  knee    

„  leg  (middle) 

„  foot    (around  head  of  metatarsal 

bone) 10|       ... 

VOL.   XI.  12 


10i       .. 

8* 

18*       .. 

16 

16 

12 

13*       .. 

11* 

178  Congenital  Hypertrophy. 

Left.  Right. 
.   Circumference   of  great  toe  (over  head  of  meta- 
tarsal phalanx)       .         .         .           5£  ...  3 
„                 second  toe  (at  bulb)     .         .         .           5  ...  If 

Remarks. — This  case  may  be  described  as  one  of  giant  growth 
of  one  extremity,  with  tumour  formation  in  connection  with 
the  superficial  soft  parts.  The  osseous  hyperplasia  was,  as 
usual,  most  marked  at  the  distal  end  of  the  limb,  and  did  not 
affect  all  parts  of  the  foot  to  a  like  extent.  Growth  was  pro- 
gressive, and  increased  most  rapidly  after  the  ordinary  body 
growth  had  almost  reached  its  complete  development. 

The  structures  principally  concerned  in  the  textural  increase 
were  the  bones  and  subcutaneous  fat;  the  tumour  prominences 
on  the  leg  and  knee  were  probably  lymphangiectases.  On  the 
other  hand,  there  was  no  indication  of  excessive  development 
of  muscle,  the  blood-vessels  were  not  perceptibly  dilated  or 
thickened,  the  lymphatic  glands  were  not  enlarged,  and  the 
skin  showed  no  change  beyond  the  diminution  of  its  sensory 
functions. 

There  is  no  reason  to  doubt  the  intra-uterine  origin  of  the 
affection,  although  no  positive  information  on  the  point  was 
forthcoming. 

The  patient  ceased  attendance  after  the  third  visit,  and  the 
subsequent  progress  of  the  case  could  not  be  ascertained. 


ToIUu6trat&  Mr  Wr>v Andersons  Artccl&  otv  Con^erataJy  Hypertrophy . 


THOMAS  BEVILL  PEACOCK,  M.D.,  E.E.C.P. 


By  the  death  of  Dr.  Peacock  the  medical  profession  in  London 
has  lost  one  of  its  best  known  and  most  respected  members, 
and  St.  Thomas's  Hospital  one  of  its  chief  ornaments.  He 
had  been  ailing,  however,  for  some  years,  and  his  death,  though 
sudden  at  the  last,  was  not  unexpected.  In  February,  1877,  he 
was  present  at  Sir  James  Paget' s  Hunterian  Oration,  and  was 
to  have  been  a  guest  at  the  Hunterian  banquet  later  in  the 
day.  But  his  seat  remained  empty,  for,  while  dressing  for 
dinner,  he  was  suddenly  struck  down  by  an  attack  of  left  hemi- 
plegia. This  illness,  which  attacked  him  entirely  without 
warning,  laid  him  up  for  many  months,  and  led  to  his  giving 
up  all  his  more  important  public  appointments.  After  a  partial 
recovery  he  resumed  private  practice,  and  continued  to  take  an 
active  part  in  the  proceedings  of  societies,  and  to  publish  valu- 
able papers  on  various,  but  mainly,  clinical  subjects.  He 
laboured,  however,  under  the  heavy  disadvantages  of  failing 
physical  power  and  mental  weariness,  which  were  painfully 
apparent  to  his  friends.  About  fifteen  months  ago  he  expe- 
rienced a  second  slight  seizure,  which  affected  his  right  side 
slightly,  but  from  which  he  recovered.  His  last  and  fatal  attack 
occurred  on  the  30th  of  May,  1882,  in  St.  Thomas's  Hospital, 
whither  he  had  accompanied  some  friends  for  the  purpose  of 
showing  them  over  that  institution.  He  fell  down  in  one  of 
the  corridors,  was  carried  unconscious  into  one  of  the  wards  to 
which  he  had  formerly  been  physician,  and  died  that  same 
evening  in  the  very  place,  tended  by  the  very  nursing  staff, 
and  under  circumstances  which,  could  he  in  health  have  deter- 
mined the  conditions  of  his  death,  he  would  probably  have 
chosen. 

Dr.  Peacock  was  born  at  York  on  the  21st  December,  1812, 


180  T.  B.  Peacock. 

of  Quaker  parentage,  his  father  being  Thomas  Peacock,  a  mer- 
chant of  that  town,  his  mother,  Sarah  Peacock  (formerly  Bevill), 
a  native  of  Cambridgeshire.  He  had  several  brothers,  none  of 
whom  attained  adult  age,  and  several  sisters,  of  whom  only  two 
survive.  Shortly  after  his  birth  his  family  removed  to  Scar- 
borough. At  nine  years  of  age  he  was  sent  to  a  boarding-school 
at  Kendal,  kept  by  a  Mr.  Samuel  Marshall,  of  whom  he  always 
spoke  with  great  respect.  He  remained  there  until  he  was  six- 
teen, and  then,  being  opposed  in  his  wish  to  become  a  sailor,  he 
elected  to  enter  the  medical  profession,  and  was  apprenticed  to 
Mr.  John  Fothergill,  a  surgeon  of  Darlington,  with  whom  he 
remained  five  years. 

On  the  completion  of  his  term  of  apprenticeship,  in  the  year 
1833,  he  was  entered  as  a  student  at  the  newly-established 
Medical  School  of  University  College,  London,  and  here  com- 
menced his  life-long  friendship  with  Dr.  Davies-Colley,  of 
Chester.  He  attended,  amongst  others,  the  lectures  of  Dr. 
Elliotson  on  Medicine,  and  those  of  Mr.  Samuel  Cooper  on 
Surgery ;  and  Dr.  Davies-Colley  records  the  painstaking  care 
with  which,  evening  after  evening,  he  used  to  elaborate  the 
extensive  notes  of  lectures  he  had  taken  during  the  day.  While 
pursuing  his  medical  studies  he  also,  at  his  father's  request, 
turned  his  attention  to  dentistry,  and  for  a  while  spent  some 
time  each  day  with  the  late  Mr.  Nasmyth,  the  eminent  dentist 
of  George  Street,  Hanover  Square.  Of  this,  however,  he  soon 
tired,  and  thenceforth  gave  his  undivided  attention  to  medi- 
cine. His  clinical  studies  were  pursued  at  St.  George's 
Hospital. 

In  1835  he  became  a  member  of  the  Royal  College  of  Sur- 
geons and  a  Licentiate  of  the  Society  of  Apothecaries.  At 
this  time  he  fell  into  delicate  health  and  was  advised  to  take  a 
sea  voyage.  Consequently  he  went  to  Ceylon  as  surgeon  to  a 
ship,  and  the  next  year  (1836)  made  a  second  voyage  to  the 
same  place.  It  was  probably  just  after  this  that  he  studied  for 
some  months  in  Paris. 

Dr.  Peacock's  first  important  appointment  after  he  had 
qualified  was  to  the  house- surgency  of  the  Infirmary  at  Chester, 
in  which  town  his  family  had  taken  up  their  residence  from 
about  the  time  when  he  first  went  to  London.  This  was  early 
in  1838.     He  remained  here  four  years,  and  during  the  whole 


T.  B.  Peacock.  181 

of  this  time  worked  with  extraordinary  zeal,  taking  copious 
notes  of  cases,  performing  and  making  exact  records  of  post- 
mortem examinations,  and  putting  up  numerous  valuable  pre- 
parations. He  always  looked  back  with  peculiar  pleasure  to 
the  years  he  spent  at  Chester,  and  regarded  them  as  an 
important  era  in  his  professional  life. 

In  1841  he  went  to  Edinburgh,  where  he  graduated  in  1842. 
While  there  he  acted  for  a  time  as  house-physician  to  the 
Royal  Infirmary,  and  was  also  appointed  pathologist,  the  duties 
of  which  office  he  performed  with  the  zeal  and  scrupulous  accu- 
racy which  characterised  all  his  work.  Of  Edinburgh  he  had 
ever  a  vivid  and  grateful  recollection,  and  attributed  much  of 
his  success  in  later  life  to  the  experience  and  knowledge  he 
acquired  there.  Especially  he  used  to  speak  in  the  warmest 
terms  of  the  teaching  of  the  late  Dr.  Alison,  and  of  the  friends 
he  then  made.  There  is  no  doubt  that  the  experience  he 
gained  there,  particularly  in  respect  of  fevers  and  morbid 
anatomy,  was  of  the  highest  value  to  him. 

He  came  to  London  in  1843  or  1844,  and  in  this  latter  year 
became  a  Licentiate  of  the  Royal  College  of  Physicians.  His 
first  appointment  as  physician  in  London  was  to  the  Aldersgate 
Street  Dispensary  ;  his  next  to  the  Royal  Free  Hospital.  About 
this  time  also,  with  the  assistance  mainly  of  the  Gurneys,  Bar- 
clays, and  Tuckers  (with  which  latter  family  he  was  connected 
by  marriage),  he  started  in  Liverpool  Street  the  City  of  London 
Hospital  for  Diseases  of  the  Chest,  which  later,  and  mainly 
through  his  own  exertions  and  influence,  developed  into  the 
now  celebrated  Victoria  Park  Hospital  for  Diseases  of  the 
Chest,  an  institution  for  which,  not  unnaturally,  he  had  ever  a 
deep  affection,  to  the  service  of  which  he  devoted  a  large  por- 
tion of  his  active  professional  life,  and  with  which  he  kept  up 
a  close  connection  to  the  day  of  his  death. 

In  1849  he  obtained  the  assistant- physiciancy  to  St.  Thomas's 
Hospital,  and  at  the  same  time  severed  his  connection  with 
the  Royal  Free  Hospital.  From  the  Aldersgate  Street  Dispen- 
sary he  had  previously  retired.  From  this  time  forth  he 
devoted  himself  with  unwearied  zeal  to  the  duties  of  his  two 
hospital  appointments — duties  which  were  never  allowed  to 
interfere  with  one  another,  and  to  which  the  claims  of  private 
practice  were  always  postponed. 


182  T.  B.  Peacock. 

At  St.  Thomas's  he  very  soon  made  his  influence  felt; 
the  thoroughness  and  conscientiousness  of  his  work,  and  the 
extent  and  precision  of  his  pathological  and  clinical  know- 
ledge, soon  attracted  the  students  ;  and  his  genuine  kindness 
and  his  simplicity  of  manner  won  for  him  the  respect  and  affec- 
tion of  all  with  whom  he  became  closely  associated.  These 
characteristics  he  maintained  during  the  whole  period  of  his  con- 
nection with  the  hospital. 

Almost  from  the  first  he  took  an  active  and  leading  part  in 
the  affairs  of  the  Hospital  and  School.  He  lectured  for  some 
years  on  Materia  Medica,  and  for  more  on  Medicine;  and 
during  the  later  period  of  his  service  acted  also  as  Dean  of  the 
Medical  School.  Further,  for  some  time  after  its  first  esta- 
blishment, he  conducted  the  skin  clinique.  He  was  not  even 
satisfied  with  these  duties,  but  always  took  a  warm  and  active 
interest  in  the  School  of  Nursing  at  St.  Thomas's,  and  for 
many  years  delivered  an  annual  course  of  lectures  on  Medicine 
to  the  nurses.  He  was  promoted  to  be  physician  to  the 
hospital  in  1862,  and  retired  after  his  severe  illness  in  1877, 
when  the  honorary  title  of  consulting  physician  was  conferred 
upon  him. 

Dr.  Peacock's  love  for  his  profession  was  genuine  and 
unfailing.  From  first  to  last  he  kept  careful  notes  of  all  his 
cases,  and  of  the  pathological  lessons  of  such  as  proved  fatal, 
and  he  was  indefatigable  in  dissecting  and  putting  up  morbid 
specimens.  The  valuable  material  which  he  thus  accumulated 
must  have  been  enormous.  Nor  was  it  wasted,  for,  if  not  a 
voluminous  writer,  he  was  at  any  rate  a  frequent  writer,  and 
his  writings  always  bore  the  impress  of  close  observation  and  of 
laborious  accuracy  and  fulness.  To  a  large  extent,  his  more 
important  contributions  to  medical  literature  were  condensed 
epitomes  of  his  experience  and  reading,  and  abounded  in  careful 
and  well-considered  statistics.  They  were  generally,  therefore, 
less  adapted  for  continuous  reading  than  for  close  study  and 
frequent  reference.  His  contributions  to  journals  and  to  the 
transactions  of  societies,  more  especially  the  Pathological 
Society,  were  almost  innumerable.  His  more  important  works 
were  his  treatise  on  the  "  Influenza  of  1847,"  his  lectures  on 
the  "  Varieties  of  Continued  Fevers  and  their  Discrimination," 
his  lectures  on  the  "  Malformations,  &c,  of  the  human  Heart," 


T.  B.  Peacock.  183 

his  Croonian  lectures  on  "  Some  of  the  Causes  and  Effects  of 
Valvular  Disease,"  his  report  on  "  Diseases  of  Metalliferous 
Miners/'  and  his  treatise  on  "  Prognosis  in  Valvular  Diseases 
of  the  Heart." 

As  a  teacher  he  exhibited  the  same  qualities  as  he  did  as  a 
writer  ;  he  was  conscientious,  laborious,  methodical,  accurate, 
and  statistical.  His  instruction,  whether  by  the  bedside  or  in 
the  Lecture  Theatre,  was  always  valuable,  if  somewhat  dry. 
As  a  lecturer  he  made  no  attempt  at  eloquence,  and  never 
enlivened  his  discourse  with  gleams  of  humour  or  appropriate 
anecdotes,  but  he  was  singularly  fluent  and  clear,  and  always 
said  exactly  what  he  meant  to  say,  and  always  gave  due  credit 
to  the  numerous  authorities  whom  he  quoted.  In  the  wards  he 
was  always  most  considerate  and  kind  to  patients,  and  courteous 
to  nurses  and  to  students.  He  taught  well  and  accurately, 
but  his  method  of  teaching  was  not  interesting  or  attractive. 
It  consisted  mainly,  in  fact,  of  a  careful  personal  examination 
of  each  patient,  and  in  dictating  aloud  to  his  clerks  (who  were 
expected  to  take  his  words  down  exactly)  the  results  of  his 
examination,  his  diagnosis,  and  treatment. 

Next  to  his  profession  Dr.  Peacock  loved  travelling.  From 
his  earliest  childhood  he  had  especially  an  intense  love  for  the  sea. 
But  his  journeys,  which  were  frequent,  and,  even  during  the 
failing  health  of  his  later  years,  extended  to  the  shores  of  the 
Mediterranean,  to  North  America,  and  to  the  Brazils,  were 
always  largely  spent  in  adding  to  his  knowledge.  He  made  a 
point  of  inspecting  all  important  picture  galleries,  and  of 
studying  architecture  and  archaeology,  subjects  on  which  he 
was  well  informed ;  and,  whenever  the  opportunity  offered,  he 
never  failed  to  visit  and  make  notes  of  hospitals  and  of  hospital 
practice.  Several  papers  recording  the  results  of  such  inquiries 
have  appeared  from  time  to  time  in  the  medical  journals.  In 
his  pleasures  as  in  his  work,  he  was  alike  methodical  and 
earnest. 

It  is  difficult  to  give  an  adequate  description  of  Dr.  Peacock's 
personal  appearance  and  private  character.  To  those  who  did 
not  know  him  intimately  (and  he  had  few  intimate  friends)  he 
was  simply  a  middle-sized,  slim,  sandy-haired,  homely- looking 
man,  grave  and  reserved  in  manuer.  He  was  certainly  not  a 
demonstrative  man,  and  he  took  a  very  serious  view  of  life,  its 


184  T.  B.  Peacock. 

duties  and  responsibilities.  But  he  had  many  fine  qualities ; 
and  those  who  knew  him  best  appreciated  these  most.  He  was 
perfectly  conscientious  and  truthful;  he  never  spoke  against 
his  neighbour,  and  always  recognised  and  acknowledged  the 
good  qualities  that  those  with  whom  he  was  brought  into  con- 
tact possessed.  He  was  slow  to  form  opinions,  but  when  he  had 
formed  them  he  adhered  to  them  with  great  tenacity,  yet  he 
was  in  no  sense  bigoted ;  he  was  a  man  of  great  resolution  and 
courage,  and  whatever  he  had  determined  to  do  he  did  it  with  all 
his  might,  in  spite  of  all  opposition  and  all  discouragements. 
Notwithstanding  his  apparent  coldness,  no  man  was  kinder  or 
truer-hearted  than  he;  no  man  was  more  capable  than  he 
of  self-sacrificing  generosity;  and  few  men  were  really  more 
emotional.  He  was  a  warm  and  faithful  friend ;  and  he  loved 
children.  He  was  deeply  religious,  but  his  religion,  like 
everything  else  about  him,  was  unostentatious ;  it  formed  an 
essential  part  of  his  life,  and  influenced  all  his  thoughts  and 
actions,  but  he  rarely  spoke  of  his  religious  views,  and  always 
treated  the  opinions  or  convictions  of  others  with  tenderness 
and  respect.  We  have  said  that  he  loved  his  profession,  but 
he  loved  it  even  more  for  the  good  it  enabled  him  to  do  his 
fellow  creatures  than  for  its  scientific  interest. 

Probably  the  chief  cause  of  his  apparent  coldness  was  the 
disappointment  and  sorrow  which  attended  his  domestic  life. 
In  1850  he  married  Cornelia  Walduck,  a  lady  of  the  same 
persuasion  as  himself,  a  devoted,  loving  wife,  who  warmly  aided 
him  in  all  his  works  of  charity,  and  possessed  nearly  every 
qualification  to  make  him  happy.  But  she  remained  childless, 
and  his  great  longing  was  to  have  children  growing  up  around 
him.  She  had  delicate  health,  and  was  on  that  account  a 
constant  source  of  anxiety  to  him,  and  in  1869  died  after  a 
brief  illness,  leaving  him  a  solitary  man.  Her  loss  was  indeed 
a  grievous  loss  to  him,  and  he  never  recovered  from  it.  His 
loneliness  was  increased  of  late  years,  also,  by  the  fact  that 
most  of  the  medical  friends  with  whom  he  had  been  chiefly 
familiar  had  left  the  neighbourhood  in  which  he  resided 
throughout  the  whole  of  his  London  career,  either  being 
carried  off  by  death  or  having  migrated  to  the  west.  And  for 
the  last  five  years  of  his  life  failing  health  prevented  him  from 
availing  himself  of  such  opportunities  of  social  intercourse  as 


T.  B.  Peacock.  185 

still  offered  themselves.  He  continued  a  frequent  attendant  at 
the  meetings  of  the  Pathological  Society,  but  otherwise  his 
evenings  were  almost  all  spent  at  home,  arranging  his  papers, 
collecting  facts  and  statistics,  or  writing  articles  for  the 
societies  or  journals. 

Dr.  Peacock's  life  was  not  an  eventful  one ;  and  it  remains 
only  to  add :  that  he  was  a  Fellow  (since  1850)  of  the  Royal 
College  of  Physicians,  and  had  filled  the  offices  of  Senior  Censor 
and  Croonian  Lecturer ;  that  he  and  Dr.  Wilks  were  the  first 
appointed  Examiners  in  Medicine  to  the  Royal  College  of  Sur- 
geons ;  that  he  was  for  many  years  physician  to  the  National 
Provident  and  to  the  Friend's  Assurance  Companies ;  that  he 
was  a  Fellow  of  the  Royal  Medical  and  Chirurgical  Society,  and 
a  member  severally  of  the  Anthropological  Institute,  the  Patho- 
logical Society,  and  the  Hunterian  Society;  that  at  the  time 
of  his  death  he  was  Consulting  Physician  to  St.  Thomas's 
Hospital  and  to  the  Victoria  Park  Hospital ;  that  a  few  years 
since  he  received  a  gold  medal  from  the  College  of  Surgeons 
for  a  valuable  series  of  preparations  which  he  had  presented  to 
the  museum  of  that  institution ;  that  for  many  years  he  had  a 
large  private  practice ;  and  that  his  name  deserves  to  be  held 
in  remembrance,  not  only  for  the  good  work  which  he  did  as  a 
hospital  physician,  teacher,  and  lecturer,  not  only  for  the  valu- 
able writings  of  which  he  was  the  author,  but  fully  as  much  for 
the  facts  that  he  was  the  founder,  and  for  many  years  the  main 
support,  of  the  Victoria  Park  Hospital  for  Diseases  of  the 
Chest ;  and  that,  if  not  the  actual  founder,  he,  more  than  any 
one  else,  was  instrumental  in  bringing  the  Pathological  Society 
of  London  into  existence,  and  in  maintaining  its  efficiency  and 
reputation.  One  of  his  chief  sources  of  pride  was  his  election, 
not  many  years  before  his  death,  to  be  its  President. 

His  mortal  remains  rest  beside  those  of  his  deeply-mourned, 
dearly-loved  wife,  in  the  quiet  " Friends'  Burial  Ground"  at 
Tottenham. 

J.  S.  B. 


REPORT   OF 

THE    OBSTETEICAL    DEPARTMENT 

FOR   1880. 


By  ROBERT   CORY,  M.D. 


The  Resident  Accoucheurs  foe  the  year  were  Messrs.  C.  A.  Ballancb, 
Hutton  Castle,  A.  Newsholme,  and  J.  Shaw. 


From  the  1st  of  January,  1880,  to  the  31st  of  December, 
1880,  both  dates  inclusive,  2119  women  were  attended.  Of 
these,  2097  resulted  in  single  births,  20  in  twins,  and  2  in 
triplets.  There  were  12  cases  of  abortion  among  the  single 
births  and  2  among  the  twin  cases. 

In  the  following  table  the  presentations  of  the  children  are 
classified : 


Among  the  2097 
single  births. 

Among  the  20 

cases  of  twins, 

and  2  cases  of 

triplets. 

Total 

Vertex 

2042 

19 

2061 

Breech 

22 

7 

29 

Superior  extremities,  includ- 

ing the  shoulder    . 

2 

3 

5 

Head  and  hand     . 

7 

0 

7 

Inferior  extremities 

4 

10 

14 

Feet  and  hands    .         .         , 

2 

0 

2 

Face  and  forehead 

6 

0 

6 

Abortions 

12 

4 

16 

Not  stated  . 

0 

3 

3 

2113 


188        Report  of  the  Obstetrical  Department  for  1880. 
Of  the  2116  cases  attended, 


330  were  1st  labours. 


323    , 

,     2ud 

325     , 

3rd 

306     , 

4th 

209     , 

5th 

156     , 

6th 

143     , 

7th 

110     , 

8th 

69     , 

9th 

64  were  10th  labours. 


33 

»    Hth      „ 

21 

„    12th      „ 

19 

„    13th      „ 

5 

„    14th      „ 

2 

„    15th      „ 

1  was  a  16th  labour. 


2116 


In  3  cases  the  number  of  confinements  is  not  stated. 


The  following  table  shows  the  number  of  women  confined 


at  each  consecutive  year  of  life 
and  the  oldest  47  years  of  age. 


the  youngest  mother  being  17, 


At  the  age  of. 

No.  of  women  confined. 

At  the  age  of. 

No.  of  women  confined 

17 

7 

33 

64 

18 

28 

34 

65 

19 

52 

35 

58 

20 

94 

36 

61 

21 

111 

37 

43 

22 

110 

38 

55 

23 

128 

39 

35 

24 

125 

40 

35 

25 

156 

41 

25 

26 

132 

42 

18 

27 

129 

43 

18 

28 

123 

44 

10 

29 

126 

45 

5 

30 

120 

46 

1 

31 

80 

47 

1 

32 

99 



2114 


In  5  cases  the  ages  of  the  mothers  are  not  stated. 


Report  of  the  Obstetrical  Department  for  1880.        189 


Forceps  Cases. 

The  forceps  were  used  in  83  cases.      The  reasons  for    their 
use  may  be  tabulated  as  follows  : 

f  14  from  contracted  pelvis. 
9      „     inertia. 


Delay  at  the  brim  of  the 
pelvis  .         .         .        . 

- 
39 

12 

2 
1 

„     faulty  position  of  heads 
„     pendulous  abdomen. 
„     a  large  head. 

Delay  at  the  outlet 
Tedious  labours    . 

14 
17 

>    1 

„     rigidity  of  cervix. 

Delay  of  after-coming  head  . 

2 

Prolapse  of  cord  . 
Placenta  prsevia 
Accidental  haemorrhage 

4 
1 
2 

Large  vaginal  cystocele 
General  dropsy    . 
No  statement 

1 

1 
2 

83 

There  were  24  cases  of  primiparse  among  the  83  forceps  cases, 
which  gives  a  percentage  of  28"9 ;  the  percentage  of  primiparse 
among  the  2119  cases  being  15*5. 

Rupture  of  the  perineum  took  place  in  7  of  these  cases, 
3  of  which  were  primiparse. 

In  11  of  the  cases  forceps  had  been  used  on  former  occasions, 
and  in  3  version.     One  mother  died  from  haemorrhage. 

Of  the  83  children  delivered  with  the  forceps,  8  were  still- 
born, and  1  had  facial  paralysis,  which  passed  off  in  five  days. 

Cases  of  Version. 

Podalic  version  was  resorted  to  in  6  cases  (among  the  single 
births)  for  the  following  reasons  : 

No.  of  children 
stillborn. 
Presentation  of  the   superior   ex- 
tremities, including  the  shoulder    3  .  1 
Induced  labour               .                .1.1 
Prolapsed  funis               .                 .     1             .  1 
Inability  to  apply  the  forceps        .1            .             1 


190       Report  of  the  Obstetrical  Department  for  1880. 
Cephalic  version  was  resorted  to  once  for — 

No.  of  children 
stillborn. 

Placenta  prcevia  .  .1  .1 

One    mother    died   on   the    fifth    day    after   delivery   from 
septicaemia. 

In  5  of  the  7  cases  the  children  were  stillborn. 


Placenta  fr^evia. 

There  were  3  cases  of  placenta  prsevia,  the  particulars  of 
which  are  stated  below : 


No. 

Age. 

Confine- 
ment. 

Sex. 

Whether  pla- 
centa prsevia 
was  partial  or 
central. 

Treatment. 

Result  to 
Mother. 

Result  to 
Child. 

380 
1827 
1921 

40 
25 
32 

11th 

5th 

12th 

M. 
M. 
M. 

Central 
Partial 
Partial  ? 

Separation  of  placenta ; 
cephalic  version ;  for- 
ceps 

Separation  had  occurred 
he  fore  assistance  ar- 
rived ;  foot  presented 

Placenta  was  in  vagina 
when  attendant  ar- 
rived ;  premature  child 
expelled  by  the  natural 
powers 

Good 

Ditto 
Ditto 

Stillborn. 
Ditto. 
Ditto. 

Breech  Presentations. 

The  Breech  presented  in  22  cases  among  the  single  births, 
which  gives  a  proportion  of  1  in  every  96  births.  In  11 
of  the  cases  the  children  were  stillborn.  3  of  the  stillborn 
children  showed  signs  of  intra-uterine  maceration. 


Cases  in  which  Ferric  Chloride  was  Injected  into 
the  Uterus. 

The  following  table  gives  the  cases  in  which  the  uterus  was 
injected  with  a  solution  of  ferric  chloride.  They  were 
altogether  6  in  number,  and  the  women  in  3  cases  made  good 


Report  of  the  Obstetrical  Department  for  1880.        191 

recoveries.  In  3  cases  death  followed,  but  the  fatal  result 
cannot  be  attributed  in  any  way  to  the  injection  (see  cases  of 
maternal  deaths  at  the  end  of  this  report). 

In  all  the  cases  the  injection  of  the  iron  solution  served  its 
purpose  immediately  except  in  one,  viz.  2134,  in  which  it  had 
to  be  repeated  before  haemorrhage  ceased. 

In  2  of  the  cases,  viz.  2141  and  427,  hot-water  injections  had 
at  first  been  ineffectually  tried. 

The  solution  used  was  the  Liquor  Ferri  Perchloridi  Fortior 
of  the  British  Pharmacopoeia,  and  the  strength  mentioned  in 
the  table  refers  to  this  as  mixed  with  water  in  the  proportion 
named. 


Result 

Strength 

Reasons 

Mo. 

Age. 

ment. 

Date. 

Complications. 

to 
mother. 

of 

solution. 

for 
employment. 

2169 

28 

6th 

Jan.  3 

None 

Death 

1  in  5 

Severe 
haemorrhage. 

2134 

36 

9th 

Jan.  8 

Pre-partum 

haemorrhage ; 

forceps 

Ditto 

» 

Ditto. 

2141 

33 

7th 

Feb.  8 

Vaginal  cysto- 
cele ;  forceps 

Recovery 

" 

Ditto. 

25 

30 

5th 

Mar.  9 

None 

Melancholia; 
ultimate  re- 
covery 

1  in  6 

Ditto. 

292 

43 

9th 

Mar.  30 

Twins 

Death 

» 

Ditto. 

427 

28 

3rd 

May  10 

Forceps 

Recovery 

>j 

Ditto. 

The  strong  solution  of  ferric  chloride  was  also  used  in  2 
other  cases  on  a  swab,  to  stay  haemorrhage  proceeding  from 
the  lacerated  cervix  uteri.     In  both  cases  effectually. 

Hot-water  injections  into  the  uterus  at  temperatures 
varying  from  115°  Fahr.  to  120°  Fahr.  were  used  in  11  cases 
for  the  purpose  of  arresting  haemorrhage.  They  were  suc- 
cessful in  9  cases,  but  failed  in  two. 

Maternal  Deaths. 


Five  maternal  deaths  occurred  during  the  year,  or  '236  per 
cent.  The  following  table  gives  an  outline  of  the  cases.  They 
will  be  found  more  fully  given  at  the  end  of  this  report. 


192        Report  of  the  Obstetrical  Department  for  1880. 


No. 

Age. 

Confine- 
ment. 

Sex. 

Result 
to  child. 

Causes  of  death. 

Bate  of 
confinement. 

Date  of  death. 

2162 

30 

7th 

M. 

S.B. 

Septicaemia 

March  10 

March  12. 

2169 

28 

6th 

M. 

L. 

Post-partum       haemor- 
hage 

Jan.  3 

Jan.  3. 

2134 

36 

9th 

M. 

S.B. 

Pre-   and    post-partum 
haemorrhage 

Jan.  8 

Jan.  8. 

292 

43 

9th 

TM. 

LP. 

S.B. 
L. 

"1  Case  of  twins  ;  post- 
J  partum  haemorrhage 

March  30 

March  30. 

1357 

27 

1st 

fM. 

is 

L. 
L. 

L. 

1  Case  of  triplets  ;  sep- 
|      ticaemia 

July  31 

August  4. 

Of  the  Children. — The  number  of  births  among  the 
2119  women  attended  during  the  year  was  2143;  there  being 
20  cases  of  twins,  and  2  cases  of  triplets.  Of  these,  1107 
were  males  and  1026  were  females  ;  the  sex  of  10  of  the 
children  is  not  stated. 

Among  these  there  were  95  cases  of  stillbirths,  being  in  the 
proportion  of  1  stillbirth  in  23'35  cases,  or  4*48  per  cent. 

The  characters  of  the  labours  in  which  they  occurred 
are  given  below  : 

Natural  labours 22 

Intra-uterine  maceration 16 

Abortions 16 

Premature  births      ........  7 

Uncomplicated  forceps  cases      ......  3 

Presentations  of  upper  extremities    .....  1 

Presentations  of  lower  extremities    .....  3 

Breech  presentations 8 

Plural  births 8 

Placenta  prsevia 1 

Accidental  haemorrhage    .......  4 

Prolapse  of  cord         ........  3 

Version  for  contracted  pelvis .1 

Craniotomy       ........  2 

95 

Besides  the  stillbirths  23  children  are  reported  as  dying 
during  the  first  week  of  their  life. 


Report  of  the  Obstetrical  Department  for  1880.        193 


Plural  Births. 

The  following  tables  give  particulars  of  the  cases  of  twin 
and  triplet  births  : 

Twins. 


to 

Result 

c  1 

r>  .               Sex- 
Date 

c 
r 

to 
Child 

Presentations. 

Condition  of 

No. 

Age. 

■^iC 

of 
birth. 

o 

placenta. 

O 

L 

0 

d 
1 

*j    "2 

1st  child. 

2nd  child. 

i  rt 

o* 

1-1 

CI 

2104 

39 

6 

Jan.  3 

M 

M 

B 

L 

L 

Head 

Head 

Separate. 

2041 

27 

6 

Feb.  15 

M 

M 

R 

L 

L 

Ditto 

Breech 

Single. 

479 

31 

2 

March  12  M 

M 

B 

L 

L 

Ditto 

Ditto1 

Ditto. 

114 

21 

1 

March  22  F 

F 

B 

L 

L 

Ditto 

Feet 

Ditto. 

292  43 

9 

March  30  F 

M 

1) 

L 

1) 

Breech 

Right  knee. 

Ditto. 

944  36 

14 

May  10 

M 

M 

B 

DjD 

— 

8 

Separate. 

1041 

40 

10 

June  11 

M 

F 

It 

L  L 

Head 

Breech 

Ditto. 

697 

42 

9 

June  27 

M 

M 

B 

L  D 

Ditto 

Feet 

Single. 

1053 

20 

2 

July  17 

M 

F 

B 

L 

L 

Ditto 

Ditto 

Separate. 

1238 

22 

5 

July  25 

M 

M 

B 

L 

L 

Ditto 

Head 

Ditto. 

1451 

34 

8 

Aug.  24 

F 

F 

R 

L 

L 

Ditto 

Feet 

Single. 

1294 

26 

4 

Aug.  30 

F 

F 

B 

L 

L 

Ditto 

Hand 

Ditto. 

1359 

31 

4 

Sep.  10 

F 

F 

B 

L 

L 

Ditto 

Feet 

Separate. 

1819 

30 

6 

Sep.  30 

M 

M 

B 

L 

D 

Breech 

Shoulder 

Ditto. 

1690 

36 

6 

Oct.  19 

F 

M 

B 

L 

L 

Ditto 

Breech 

Single. 

1969 

19 

1 

Oct.  27 

M 

M 

B 

D 

D 

Premature 

5  months  3 

— 

1781 

34 

7 

Nov.  5 

M 

F 

B 

L 

I) 

Feet 

Feet 

Single. 

1578 

25 

5 

Nov.  26 

F 

F 

i: 

L 

L 

Head 

Ditto 

Separate. 

1995 

37 

3 

Dec.  25 

M 

M 

B 

L 

L 

Ditto 

Ditto 

Ditto. 

2379 

35 

9 

Dec.  25 

M 

11 

It 

D 

D 

? 

? 

Single. 

Triplets. 


No. 

< 

"3 
<=  s 

»<§ 

a 
o 

u 

Date 

of 

birth. 

Sex. 

o 

5 

a 

"3 

Result 

to 
children. 

Presentations. 

Condition 

of 
placenta. 

|H 

-a 
a 

r6 
M 

2 

-a 

* 

1st  child. 

2nd  child. 

3rd  child. 

1357 
1953 

27 
41 

1 

9 

July  31 
Nov.  24 

MP 
F  ,F 

F 
F 

D 
R 

L 
D 

L 
D 

L 
L 

Shoulder 
Head 

? 
Head 

Head 
Ditto 

No  state- 
ment. 
Ditto. 

1  Premature  (seven  months)  ;  both  children  died  same  day. 

2  Abortion  (four  months  and  a  half). 

3  Abortion  (5  months). 

VOL.  XI.  13 


194        Report  of  the  Obstetrical  Department  for  1880. 

The  placentee  of  the  twin  births  were  separate  in  9  cases, 
single  in  10;  in  1  the  condition  is  not  stated. 

The  condition  of  the  placentae  of  the  triplet  births  is  not 
stated. 

The  twin  children  were — 

In  10  cases,  both  males ; 
„      5     „        „      females ; 
,,     5     „      male  and  female. 

The  triplet  children  were — 

In  1  case,  1  male  and  2  females ; 
„        3  females. 


Malformations. 
Five  cases  of  malformation  are  reported. 


No. 

Sex. 

Malformation. 

1990 

F. 

..    .     Harelip. 

2048 

M. 

Harelip  and  cleft  palate. 

133 

M. 

Cleft  palate. 

616 

M. 

Absence  of  inter-auricular  septum. 

1581 

M. 

Spina  bifida. 

The  case  of  absence  of  the  inter-auricular  septum  was  one  of 
considerable  interest,  on  account  of  the  following  history  : 

The  child  lived  ten  hours,  and  died  with  symptoms  of 
asphyxia,  jaundice,  and  vomiting  bloody  mucus.  The  jaundice 
was  general,  and  the  conjunctivae  were  strongly  tinted. 

On  examining  the  body  after  death  it  was  found  to  measure 
471  mm.  (18£  inches),  and  to  weigh  2800  grms.  (6  lbs.  £§  oz.). 

The  heart  was  large,  it  weighed  33*1  grms.,  whereas  the 
normal  weight  of  the  heart  of  a  new-born  child  of  the  above 
size  is  about  17  grms.  There  was  no  septum  between  the 
auricles. 

The  liver  was  large,  and  of  a  dark  chocolate  colour.  The 
bile- ducts  were  patent.  The  common  bile-duct  measured 
37  mm.,  and  blue  fluid,  when  injected  into  it,  flowed  freely, 
first  into  the  gall-bladder  and  then  through  the  bile-ducts  into 
the  liver. 

The  spleen  weighed  45'9  grms.,  a  weight  at  least  three  times 
greater  than  normal. 


Report  of  the  Obstetrical  Department  for  1880.        195 

The  other  organs,  viz.  lungs,  kidneys,  and  thymus,  were  of 
average  weight,  and  apparently  healthy. 

The  mother  is  the  second  wife  of  her  husband.  She  has  had 
one  other  child  born  at  full  time,  which  lived  twenty-eight 
hours  and  died  jaundiced,  and  with  other  symptoms  similar  to 
the  second  child  ;  she  has  also  had  a  miscarriage  at  the  second 
month,  between  the  births  of  these  children.  She  has  not 
suffered  from  any  symptoms  referable  to  heart  disease,  but  she 
has  a  distinct  blowing  endocardial  systolic  murmur,  to  be  heard 
over  the  region  of  the  pulmonary  valve  and  down  the  left  side 
of  the  sternum. 

The  husband  has  served  in  the  army.  He  has  no  heart 
murmur.  By  his  first  wife  he  had  eight  children,  all  of  whom 
survived  their  births  and  were  healthy.  Two  are  still  living, 
the  others  died  abroad  of  scarlet  fever,  sunstroke,  &c. 


Cases  of  Maternal  Deaths. 

2162.  She  had  been  in  labour  for  thirty-six  hours.  Ergot  had  been  given,  and 
the  long  forceps  applied  ineffectually.  The  resident  accoucheur  then  turned  the 
child,  and  delivery  was  by  this  means  soon  accomplished. 

Shortly  after  this  the  woman  had  a  strong  rigor,  followed  by  high  tempera- 
ture, delirium,  and  vomiting.  She  rapidly  grew  worse.  The  pulse  became  quick 
and  feeble.     There  was  slight  pain  in  the  right  iliac  fossa. 

The  uterus  was  washed  out  with  a  solution  of  Condy's  fluid,  but  the  patient 
died  at  7.30  p.m.  on  the  12th  March,  forty-eight  hours  after  her  delivery. 

2169.  S.  J— ,aet.  28,  was  confined  about  5  a.m.  on  the  3rd  of  January,  1880,  of 
a  living  male  child,  after  a  natural  labour.  It  was  her  sixth  confinement.  Post- 
partum haemorrhage  came  on  two  or  three  hours  after  delivery.  A  large 
quantity  of  blood  was  lost  before  any  assistance  could  be  obtained.  As  soon  as 
the  resident  accoucheur  arrived  he,  at  8  a.m.,  injected,  after  removing  clots  from 
the  uterus,  a  solution  of  perchloride  of  iron  (1  in  5),  which  at  once  arrested  the 
haemorrhage.  By  this  time,  however,  the  woman  had  first  lost  vision  and  then 
became  unconscious  ;  she  afterwards  revived  a  little.  Dr.  Cory  was  sent  for,  and 
on  his  arrival  he  determined  to  try  transfusion  of  blood. 

Roussel's  apparatus  was  adjusted  to  the  arm  of  the  blood-giver,  and  the  patient, 
who  was  lying  on  her  left  side,  was  gently  turned  over  on  her  back,  to  facilitate 
the  opening  of  her  vein,  but  before  the  latter  was  done  the  patient  had  a  strong 
convulsive  seizure,  affecting  all  parts  of  the  body — at  first  tonic  and  then  clonic  ; 
features  distorted,  edges  of  mouth  drawn,  eyes  staring,  legs  extended  and  rigid, 
arms  slightly  bent ;  duration,  two  minutes.     An  incision  was  then  made  over  one 


196       Report  of  the  Obstetrical  Department  for  1880. 

of  the  veins  of  her  forearm,  but  before  it  could  be  opened  the  patient  was  breath- 
ing her  last  irregular  respirations.     She  died  in  less  than  two  minutes. 

2134.  A.  W — ,  set.  36,  was  confined  on  the  8th  of  January,  1880,  of  a  stillborn 
male  child.  It  was  her  ninth  confinement,  and  she  considered  herself  about  seven 
months  pregnant.  The  resident  accoucheur  was  first  called  to  the  case  on  the 
7th  of  January,  by  the  obstetric  clerk,  in  consequence  of  pre-partum  haemorrhage. 
He  examined  the  patient  by  passing  his  hand  into  the  vagina ;  the  os  was  suffi- 
ciently open  to  admit  one  finger.  He  could  feel  no  placenta.  As  the  bleeding 
had  quite  ceased,  and  had  never  been  serious  he  applied  a  binder  firmly 
over  the  uterus,  gave  one  grain  of  opium,  ordered  all  nourishment  to  be  taken 
cold,  and  ten  grains  of  gallic  acid  to  be  taken  every  four  hours.  He  also  left 
instructions  that  if  the  bleeding  returned  a  message  should  be  sent  at  once  to  the 
hospital. 

Jan.  8th,  6  a.m.,  he  was  called  again.  On  his  arrival  he  found  the  patient 
blanched,  lips  colourless,  extremities  cold,  pulse  130,  at  times  running  and 
1mperceptible,  frequently  fainting,  vomiting  all  food,  and  blood  steadily  flowing 
from  vulva.  He  was  then  informed  that  the  bleeding  had  been  going  on  since 
10  p.m.  the  previous  evening,  and  no  explanation  could  be  given  by  the  nurse  as 
to  why  she  had  not  sent  for  assistance  earlier.  The  amount  of  blood  lost  was 
very  great. 

As  the  os  was  still  in  the  same  condition,  the  membranes  were  ruptured  and 
the  binder  firmly  applied.  This  stopped  the  haemorrhage.  Barnes'  bags  were 
used  for  the  purpose  of  dilating  the  cervix,  forceps  applied,  and  the  child 
delivered  in  about  forty  minutes  from  the  time  when  the  first  bag  was  intro- 
duced.    The  placenta  was  found  to  have  been  completely  detached. 

As  haemorrhage  continued  a  solution  of  perchJoride  of  iron  (1  in  4)  was 
injected,  and  the  bleeding  thereby  checked,  but  as  it  was  not  absolutely  arrested  a 
fresh  quantity  of  the  same  solution  was  injected.  After  this  there  was  no  bleeding 
whatever.  Dr.  Cory  was  sent  for  as  the  patient  was  apparently  sinking.  He 
tried  transfusion,  but  the  apparatus  (Dr.  Roussel's)  became  immediately  clogged, 
and  before  it  could  be  cleared  the  patient  had  expired. 

292.  E.  E — ,  set.  43,  was  confined  on  the  30th  of  March  of  twins  (female  and 
male).  The  breech  of  the  first  child,  which  proved  to  be  a  female,  and  the  right 
knee  of  the  second  child,  which  proved  to  be  a  male,  presented. 

Shortly  after  the  birth  of  the  first  child  the  woman  fainted,  so  that  the  delivery 
of  the  second  was  expedited.  A  great  quantity  of  blood  immediately  followed 
after  the  birth  of  the  second  child  ;  the  placenta  was  therefore  removed  at  once, 
and  hot  water  injected  into  the  uterus.  This  failed  to  stop  the  haemorrhage.  Per- 
chloride  of  iron  was  then  used  with  good  effect;  the  woman,  however,  did  not 
rally ;  she  had  convulsive  seizures,  and  became  unconscious.  Dr.  Cory  was  sent 
for,  and  on  his  arrival,  ten  minutes  after  the  message  was  despatched,  he  found 
that  the  woman  had  already  been  dead  three  minutes. 

1357.  B.  C— ,  set.  27,  was  confined  on  the  31st  of  July,  1880,  of  three  living 
female  children.  The  shoulder  of  the  first  child  presented,  it  was  turned  and 
delivered ;  the  second  child  was  also  turned  and  delivered ;  and  the  third  child 


Report  of  the  Obstetrical  Department  for  1880.        197 

was   delivered   by   the   forceps.      The   mother   had   septicaemia,   and    died    on 
August  4th. 


Cases  of  Craniotomy. 

919.  Mrs.  T— ,  a?t.  34,  was  confined  on  the  29th  of  August,  1880.  It  was  her 
seventh  confinement.  Labour  had  commenced  twenty-four  hours  previously,  and 
although  the  cervix  rapidly  dilated  no  advance  was  made.  The  forceps  were 
nsed  by  the  resident  accoucheur,  but  without  avail.  Dr.  Cory  was  sent  for,  and 
he  reapplied  the  forceps  with  no  better  result ;  he  therefore  performed 
craniotomy  in  the  usual  way,  using  the  craniotomy  forceps  as  extractors.  The 
child  was  a  male. 

History. — The  woman  had  been  married  ten  years.  Her  statements  concern- 
ing her  former  confinements  were  as  follows  : 

1st  confinement,  in  labour  1  week,  child  stillborn. 

2nd  „  „  3  days,  „  delivered  with  forceps. 

3rd  „  „  1  week,  „ 

4th  ,,  a  miscarriage  at  the  7th  week. 

5th  „  in  labour  4  days,  child  stillborn. 

6th  „  a  miscarriage  at  the  3rd  month. 

The  woman  made  a  good  recovery. 

1368.  M.  C — ,  set.  22,  was  confined  on  the  11th  of  November,  1880.  It  was  her 
first  confinement.  When  the  obstetric  clerk  arrived  he  found  that  the  funis  was 
prolapsed  and  pulseless ;  he  therefore  sent  for  the  resident  accoucheur,  who, 
failing  to  replace  the  cord,  further  dilated  the  cervix  with  Barnes'  bags,  and  then 
applied  the  forceps,  but  without  avail.  Dr.  Cory  was  then  sent  for,  and  he, 
finding  the  conjugate  diameter  only  about  three  inches,  the  result  of  rickets,  at 
once  performed  craniotomy.  The  child,  a  small  female,  was  easily  extracted 
with  the  craniotomy  forceps.     The  woman  made  a  good  recovery. 


MEDICAL  AND  SUEGICAL  KEPOETS, 


MEDICAL    REPORT. 

18  80. 


By  GEORGE  GULLIVER,  M.A.,  M.B.  Oxon., 

MEDICAL   REGISTRAR. 


PREFACE. 

But  little  alteration  has  been  made  in  the  present  Report 
from  that  of  previous  years.  The  extended  column  of  age  has 
been  continued,  but  it  has  not  been  attempted  to  give  the 
duration  of  each  patient's  illness  before  admission,  as  it  was 
found  impossible,  in  the  great  majority  of  cases,  to  determine 
this  with  any  accuracy.  The  special  tables  have  been  continued 
as  in  previous  years.  Two  of  these,  showing  the  complications 
of  acute  rheumatism  and  the  causation  and  complications  of 
chorea  respectively,  have  been  added  in  consequence  of  a 
resolution  which  was  passed  at  a  meeting  of  the  Association  of 
Registrars  to  the  London  Hospitals.  The  nomenclature  of  the 
College  of  Physicians  has  been  for  the  most  part  adhered  to. 


Table  I. —  General  Medical  Statement. 


Number  of  Medical  Beds   ... 

Number  of  patients  in  Medical  Wards,  Jan.  1st,  1880  .. 
„  „        admitted  during  the  year  1880 

Total 
„  „        in  Medical  Wards,  Dec.  31st,  1880   .. 

„  „        treated  to  a  termination  during  1880 

„  „        discharged  or  died  during  1880 : 


Cured 

Relieved 

Unrelieved  or  other  causes 

Died 


Males. 

62 
737 

799 

,    70 

745 


Females. 

73     . 

806     . 

879     . 

87     . 

820     ., 


191 

Total. 

135 

1543 

1678 

157 
1565 


Males. 

Females. 

Total.   R 

...  282 

..  375  . 

.  657  ... 

...  262 

..  247  . 

.  509  ... 

...   57 

..   83  . 

.  140  ... 

...  144 

..  115  . 

.  259  ... 

...  745 

..  820  . 

.  1565  ... 

Rate  per  ceut. 

41-99 

3252 

8-95 

16-54 


Total     ...  ...     745     ...     820     ...   1565     ...  lOO'OO 

Average  number  of  days  of  each  patient's  stay  in  hospital — 37. 
VOL.   XI.  14 


202 


1880— Medical. 


^ 


-o 
« 


5^ 


e; 


W 

W 
< 


CO 

W 
3 

A  nurse  in  hospital. 

6  cases  arose  in  hospital,  1  was  a  student. 

Complicated  with  acute  nephritis. 

Arose  in  hospital. 

5  cases  patients   or  nurses,  3  were 

students. 
The  fatal  case  malignant. 

In  1  uraBirtic  convulsions,  1  had  old 
heart  disease. 

Both  hospital  nurses. 

In  fatal  case  temp,  rose  to  107"3°. 

In  fatal  case  ruptured  vessel  found 

in  floor  of  ulcer. 
In  1  larynx  deeply  ulcerated. 

■a 

s 

^ 

:  rH         rH 

:    :        :        :    :  <n    :        :        :        :        :  c* 

a 

:  i-t        : 

:         rH             ;      ;X>      :         rH             :         rH         tJI       ; 

oJT3 

Eh 

a 

W      § 

^ 

a 

;  co          i 

eo 

O 

ph 

rH  CM  rH       ;  rH         .O                 CO       ; 
.  i-l 

rH  CM  CD  05          CO              !          t-<              :  CO 

NH 

a 

:  ko    :  r-i  oo      oo            ;    : 

:    :  oo  cd      ■*      rH        :        :nh 
.    :  eo  cq                           :         : 

■5° 

6 

:    :    :    :  <-h        :            :    :        :        :    :  ©    :        :        :        :        :    :    : 

O    C3 
25  £ 

•"*  oo  m  x>  oo        :            :    :        :        :  o  oo    :        :        :        :        :    :    : 

HHMNM              .                    •-             -             .  1>  kD       -             -             .              •             ... 

be 

<! 

09  mao 

09- 

os- 

:  "-<          rH 

:    :  sq    :        :        ;        ;        :  oq 

ot- 

;  rH  tJI  c?q       rH          ;          :          ;     ; 

08- 

rH  i-l  1-H       :  i>        l> 

•HM-*          "31              :          rH          CO  rH 

:      cq  rH                 : 

05- 

;  00           •*                   CO  rH 

rH-OO-^P          CO          rH          H          rH-H^rH 

■  co  eq 

oi-s 

rH 

ih  co        :             :  n 

::■*■"*         :        :        :        :    : 

9  Jtapun 

kO 

;ko-<#             :    :      rH        ::oqiH        ;        ;        ;        ;: 

ag 

Ph 

hnh     :«      oo           eo    :               rH  cq  co  oi      eo               ih         •  \a 
:  r*                         .        .              oa  rH                 :                 : 

s 

•  kO       •  rH  cq          00                     ;CO          r-t              ;       ;  kO  t>          kO          r-l          rH          ^  N  H 

:         :      rH                      .                      .    .  -#  cq 

'R°X 

Ht»HH-*          CD                 CO  CO          rH          H  N  W  lO          00          rH          <M          -*I>r-l 

cq      ih                                          t>  t? 

CO 

■3 

CO 

3 

CO 

w 
m 

■0 
H 
go 

w 

« 

-«1   a 
M  rC 

ffl 

1      I 

SM 

.So'              "    .     '  u    '  S    *        o"    " 

-.         fl  *>                                        2          O              "T3 

ft      g  .2             ts'S^Sy         «m 
"3,      2s               ^  £       -  £  S           2-2 

^          SO3,       •||'«P,HW'a          fH.WrH 

Sq         CO  ^          g  .2  £    O  rH  <N         CO              ■*"  kfl  CO 

rl     0)       ,^ 

....    11? 

£,3 
I'S 

kH   J* 

■1      1^2^ 

r*  C/J                                     v                             tH  rH                                                         v 

•sis^Bay                                              -sisXrEuy 

1880— Medical. 


203 


eg  vs 

a 

^3 

■p 

o 

P..2 

J 

^> 

co 

S     »h 

,d 

o 

t~ 

g     « 

„ 

o 

rH 

c 

u 

s 

Pi 

a  «• 

C 

l^ 

.a 

Ph 

a 

.5 
"o 

o  a 
&  ° 

c 

© 

00 

,os 

i-C 

a 

U 

u  -u 

0 

— 

£3   a> 


eg   a>   ^  5   *h 
o  i 


io-1-1 


2  a 


®,3 

o   * 

ft 


^K 


.a  -a 
■if  s 
?  - 


e  •«  rd       .<s 


O     *= 

,' '  >■ 

*■   " 

u  "S 

OS    A 

^r-l 

P,  JU 

^T3 

u  3 

+»     fl 

hn  g 

05    05 
eg      „ 

.5  oT 

^S    03 

O     (XI 

p,8 

a  u 

a.  S 

a'3 

fl  id 

^  Cm 

J  *"§)3 


OS  TJ 


CM               CO 

:    :    :    :  r-t 

:    :    :  eo 

H 

rH                 lO 

(M         : 

■"*    :    :    :    : 

ih     :    :  hh 

:  iH  iH    : 

Hri     ;     : 

:  rH  in    : 

r-i   iH        ;  rH 

rH 

x> 
cm 

lOHri 

:    :    :  cm 

■*    :    :    : 

rH 

CO 

qo  cm    : 

o 

iH 

ih    ;    :  ih               th  cm    :  co    : 

rH       :  CO 

CO 

i^  co     :    :  <n  r-t     • 

CO           ■     . 

:    :    :    :                 :*-::: 

I-H   rH   iH   l-H 

■*    :  ■* 
i-i    • 

1>         >H 

qo  co    ;    ;    ;  co    • 
<n         ...         : 

:    :    :    :             :        :    :        :    :  cm    :    :    :  ih 

:    :                  :    ;r-i     ■_ 

::::             :        ::      cm  >h  ih    ;    ;    ;  ih 

r-i  cm                 :    :    :    : 

:    :    :    :             -.         :    :      im     :  co     :  m  co  -* 

.       .       .       .                                  .       .          iH 

:     :                   :  cm     :     : 

rH      : 

■  r-i       :  r-i                     :          rH-          CO  N  CO  H       •       ■  ■* 

:         .                   .              •       cm                   :     : 

rn     :                  :  r?     :    : 

Tf(rHlMr-H                   CM               :;          CO  CO  "*  CM   rH   rH 
•       •           CO 

;  r-i                        HiOH       ;H 

;  r-i 

r-i          iHX>;C0rH                                   ;(M          05::;rH; 

CO     .     •     .          . 

^-<    : *-<                 :,a        :i-i 

:        :  cm    :  cm    :          »o         :    :      co    :    :    :    :    : 

r-i     :                       :     :     :  co     : 

:    :  r-i    :        :  r-t    :    :    :          >h        ;            :::::: 

r-i  r-i    :    :                     :    :    :    :  co 

•    •         -iHtHcocM           co         ::      'jco  ohmh 
:    :    :    :        :                                      :    :      co 

:       •  r-i  CM  CO                        rH  <M  rH       •  CO 

:    :                              »h        : 

,H  r-i  iH  iH          iH  CO  rH  •"#  rH                 <M          rH  CM          -#  eO  00  CM       ;MOHHH       ;  rH                            •  ^1  H  »  lO 
H                                      iH                               10                            -         rH                            ■ 

riHrlH          rH  ■*  CM  J>-  CO                 °°          HN          »05COnM'*jrlHNN'*                        H  CD  O)  CO  » 
r-i                                          r-i                                  r-i           r-i                          r-i                                                                         r-i 
r-i 

•-    m    OT    -3    a    O 

:£  eg  or-.-  -h 
-w  eg  Jh  ^  .h  « 
ot   ot   eg   o  ■— ■   a 

t>  00  OS  ©    rH 


SrH  .2 


S  P/S 


'EHrHHfl- 


O  -5? 


-       QFh 


a  ""if  1 

OT    S    03    P 
o-     0>  ^    tn 

S  -a  os  _ 
a  ^  =  « 

0)    eg 


OT    O 


85 


2  -a  •£  bn 

rfl       ^     .—       03 


'  a  a 


QJ      OT 
.S     OT  .3   ^     0J 

_  ^  "S  .S  8  "S 
a  £  £  a  S  a  a  "Su^  -g  ^-§ 

<ltcoOMHO  cb'Ph  O  S  Q 


a  rn  a  c  v 

a  'a  o  a.  S 

S-a  g  a  3 

a  a  a)  >a  D 
Ch^khkhO 


204 


1880 — Medical. 


- 

< 


F    a; 


fc"3 

rg  a 

c  2 

O   -^ 


6c  & 

~  3 

I  § 

^  °< 

fa  *3 


"3  3  S-B 


05  a-s^.a 


O    rO 
fl    -*- 

«C    O 

a  m 
o  &    • 

°gs 

(.J3 

D  J     JO 

*   sj    o 

cs  _a  o 
*-tf  a 

—   rr-      S 

Cu  gj    3 

o    *  ** 

o 


SB    3 

lg 

*t 

03  ~u> 
O 

o  o 


spa 


•3 

3 

fe                    N 

CO          W5  CO  "^ 

x    I         ^ 

r-*    :    :    : 

rH          m  CO  00 

i  3* 

a  > 

rH 

a 

i  'O 

P3  S 

p4 

CO       •       :  rH                 iH                               rH                        Oi       • 

-       .                                                                             .          r-t       .       . 

s 

NNH       ■                                                    rH              •         1>       ;  -^f 

!                                                                                                rH        . 

T3 

5 
o 

fe 

i>::::                                   :      eo      io  -#  o 
.    .                  .                                              .-1 

s    i 

i-i     •                                                                lO        rH        N  "*  o 
.                                                                         CO 

09  J8A0 

09- 


08- 


01-9 
9  J-'Pin 


•i«»»x 


rH       ;  CO  (N   rH       ; 
Ht-  O  <N   rH  rH 


5  -S  2 

^  °  g 

w  s  2 

fc  .£  J* 


o 


o 


1880—  Medical. 


205 


—  2  '£     . 

•+*  IS    ..a 

^  *j®  p. 

fl         3    >■» 

o  a  o  — 

CM  -^>    to  '-3 

a  «  « 
S  c  «  w 

«     OJ     <2   =*H 

-M      ft   S      ° 

rC  4J  r-  a 
■c  >>-e  "55 


r«2    5H 

a    a    m 


£ 


CS      •  « 

°    60 

<s  a 

as   a 

<»«*-!•« 

fci    o . « 

0)  ■— I 

5     ®  ^ 

s  J?  ^ 

s    1 

id  a2 

03    ■  j3 

i  a  2 

-a  -,  a 
^=3  a 


«  .9 


a  <u 
co  o 


as 


CS 


03       . 

w  S  i; 
— •  a  s> 

"3  ""  'A 
«    O 


t3  53  ■  -g 


a 

achea. 
rachea 
venals 
of   ski 

a 

43  ■*.   t  fcc« 

a 

*s  °  &.a  .a 

M 

acaa 

o 

.2  '35  13    P  Jg 

•-  l  3   n  od 


a  a 


p    03 


O  t3 


13  T3    O  H  13  JT-' 

«  a   H  a   s  i<  J 
<u   a>   S   5  -*a   as    c3 

*  *.2   2t2  ««Ja 

*  *  *"  *"  ^    °    £ 
1-trH  m  Ph 


■°  "Sip 


P  w  .3  f-i  a 


a  g  a 


13    OS 


"?    <"    O    h 

a 


03 .; 


01    0)  ~S  -jj     03 

Ph  i-h  H 


io    :        :        :    :  ih                     : 

r-H        •                ■                •        . 

:»(ON      ;h      ;                  :            :                    rH  rH  rH               rH 

00  CM         r-i         CO       : 

l-H 

l-H 

;  X>  rH  CO  CO  CO  Tji                 CM              : 

'.  '~i             : 

*-    :         :         :    : 

:  t>    :  o  cm         :             :         : 

co  -*         :         :    : 

:■*     :N(N     :     :              :         : 

oo 

co         :  cm 

CO  00  00  00  CM  CM  rH                 rH              ; 
CM           r-t 

CO 

00 

i— i 

rlHO'tfflaOtOH                  i-H           l-H 
r}<  i-l  rH 

rH                             l-H 

t+i        CM  co 

■*  CM 

■*  rH 


::         :         :::                    i-h             ;;  co  rH  cm     .  i-h  i-h           r-irH                      ; 

CO;rH                  ;  i-H                           r-t                        ;  OS  CM  -^  CO  CM      ;               rH 

1-1 

OS!          CM          rH  CM  rH                               r-t                     ■       •  <-t  IO  O  <£>  Tfl  -^1                 rH 

:                                                              :    :  <n       rH 

l>  ifl          in          rH 

■h  m<e  n  ■rjuflH            i-h 

CM          rH 

i-t  C-J 

O  rH          rH          HI> 
IM                   rH 

rH       •  t~  00  5D  CO       • 
•   CM            rH 

:  co 

t^.    :      o       n« 

:  cm  oo  t>  o  i-h    : 

i-H          ~H 

:    :  sm          r-t 

<m    :        :      w    : 

:  i-h  co     :  co    :    : 

r-*    :        :        :    : 

©••C-lNtfSrH                               (M                     -eOCO-HJllO-^COrH                 -H 

co    :                                                                 io  h  o) 

rH   Tfl   rH                   i— 1 

OltOOOm^rH                               rH                 HHHiOMMOJlS                 COrH                            ;HH                 rH 
CO                    rH                                                                                                                  IO   rH    (M    rH 

sa 


rH  Ph       Ph 


PhG 


02 

oS  * 

§§.2 
m  r<  .« 
w    t>  t3 

gal 

CO  O    «h 

q      Ph 


g         s5 

03  g    cs 

t,  «  u  o  a 


•sts^ibuv 


'H-< 


a 

"  a  e  f  .1 

bo 
a 

a  w  s  s  is 

< 

o    oo<ji 

206 


1880— Medical. 


**$ 


Eh 


CO 

M 

P3 

Due  to  old  syphilitic  disease. 

In  1  fatal  case  epitheliomatous,  in  the 
other  simple,  complicated  with  sur- 
gical kidneys. 

In  2  fatal  cases  malignant  stricture 
of  pylorus,  in  the  other  extensive 
ulceration  of  anterior  wall. 

In  2  fatal  cases  intussusception :  in  1 
no  permanent  obstruction,  in  1  no 
P.M. ;  in  1  colotomy  was  successful. 

Both  contracted  in  tropics. 

?  malignant,  communicating  with  ab- 
scess,   which   had  also    perforated 
through  into  stomach. 

Great  hypertrophy  of  coats  of  large 
intestine,  chronic  peritonitis,  cys- 
titis, surgical  kidney. 

s 

a)  -a 

-  <u 

a  > 
p.  2 

fA 

ih     ; 

r-i                        i-l 

IN             :    : 

:  eo          -^ 

:  i-i             : 

a 

r1-1             : 

fe 

:    :             :  eo 

•>                  : 

a 

i— i  i— i             ;  cm 

:                     r-i 

:  cm 

o 

!*< 

cm  oi    :    :          N  -*  r-i  -*    ;            ■ 

ioh    •  r-i 
r-i        : 

s 

i-nn    :    ;          nhio    :    :             :          cm  as  cm    :  -<? 

3    D. 

11 

-5  o 

d 

"3 

:    •    •  i-*             •    •    •    ■  oo          eo             •    -co    •    • -*               ■* 
.     .    :■*             ....p-i                           ..         .:oo               i-i 

^43 

o  (M(0  05           eo  ira  i>  w  eo           ©           eo  cm  w>  o  cm    • 

•rji  r-i          Oi                 i-Hi— I(Mi— 1                 CD                 HHHW  W       ■                            '■ 

bo 

09  -wao 

:     :              :  (M  i— I    ;    ;           r-i 

cm    :    : 

09- 

r-i 

■                          ;  05  H      ;  H                i— t 

cm  i-i    ; 

09- 
0f- 

:  eo             ;  cm  eo  «o  ih             : 

cm    :    : 

I-H 

eo  ih    :             :  cm    :  co  co           r-i           i-i  ■<?     :  cm 

08- 

co    ;    ;          cm  ih  r-i  cm    :             :             :  *>  >-i    : 

i—l 

02- 

r-i  co    :    ;          cm    ; 

:    :            :          <-i  co    :    :  ■* 

01  -9 

i-i  i-1    :    :            :    : 

i-i     :    :  r-i 

9  MPun 

:  ih    :    :            :    : 

:    :          <n 

:  <M     :    : 

Z  o 

Ph 

no    :    :          nj>hhh 

IOH       ;HH                        r-i 
■-I 

a 

hioh  eo          cm  co  o    :  -#          10          cm  as  eo  <n  ■*    : 

TOoj 

CO  Tfl  rH  CO                 TfOfDHia                lO                 CN  -#  ->*l  CM  »fl  r-1                        r-i 
I-H                                              iH            I-H                                                              <N 

CO 

■3 

w 

CO 

p 

W                                 OS                  rl                         2                 V3                                                      _,                 q-l 
<3                         -5"                    So                                t^S° 
i-i                            O*              c3              ,£3    o                3                                  ^r^i 

«      •  •  •  S        a  •  -f -I        |         •  •  -3  .  8        -fi  ■ 

*               8        1     -i  a  *S        ^            ^gm=g        % 

» * -j  .2  ■?  2      %  .s  1  *  l      -a       "1  * -^i  §      s  § 

bS-S^&S       ^&2<s§       1          ftS-si.!       .2*^ 
> 

1880 — Medical. 


207 


a  £ 

oa   o3 

"Soj 

A 

S  p. 

T 

+3 

(3  T3 

T? 

«    B 

o> 

S    «3 

9  ffi  o3 

00  ~  '£  „£> 


O    -—      »H      <U 


-a.S 


rH  °' 


B    2    (J    H    * 
03    a  IS  B 

,03     03  .Ti     00        • 


«H   ' 


jOSOo 


a  2 


a  '-1  n  "S 

ills 

g   e:   a  +a 

»  so  2 

5     °o 


& 

T3 


ra  i— I    B  _ 
O  6X3  3 

a  lis 

•2    £.3    B 


.2  o  o 


P*-Q  rH    O    03 


3  s-g 


03-Q 


H         rH 


fi  °  a  O. 


u 

<u  3 

Fh 

or 

o 
s 

3<g 

£ 

is 

*   o 

0J 

rH 
rH 

a 

00 

S3  2 

eg 

00 

09 

In!43 

fcc 

"3 

•  -.  o 

6C«H 


r^ti  9  c  » 


O    a>    c  "S 


r-2 


:               <n  co 

:  co 

rH 

:      «o                 : 

i— i 

r-i                            :  r-i 

•  r-H 

•  rH 

t-i 

rH      co                 : 

:  >h 

rH 

<M 

rH 

IN  Oi 

CO                                  rH 

•>*       ■*                IN 

i— i 

rH 

T-t 

:  CO 

CD                               rH 

co       io                eo 

CO 

:  <n 

co     :  10     :    ; 

:                      :                    <n    :         : 

:    :  n                 : 

1-1    :  *-*    :    :          *-< 

hh    j                                          :    :        :                 : 

:    :    :                 :  *-*    :    :    :    :    :             :  <m    :    :    :                     : 

m               <-\ 

:    :    :                 :<M    :iHih    :«o             : 

IM 

rH                            : 

:    :    :                 :    :    :    :  w    :  oo             : 

r-<  r-4  CO                                   ; 

co      oo                  ; 

:  rH                                  rH  rH  rH       ; 

:  *>           i-h 

:    :  ■"*                    i-h 

rH           HI                          rH 

I-H 

rH       ;  <M                        rH       ;  IN  rH 

rH  ■* 

:    :  cm                      : 

IN         IN                      CO 
<N 

:    :    :                   h                   i-h  <n      as 

:    :    :               <**:'-<: 

rH  <-<                       : 

:    :                          :                    i-i           t-t                  : 

rH  IN       ;                        HI'JMHlfi 

IN  N                       '  rH 

:    :  co                    i-h                    cn 

■*         ©                     CM 
CO 

rH   rH  rH  rH       ■  TJH 


rH  rH  rH  rH  CO 


Tfl  ITS  t}<  IN  CO  IN  CO 


rH  IN  rH  rH  Ci 


■8  3    •  =*-!  2f 


03    S-" 


rS    5.9 


lorl 

rQ    Hi 

S    03    03 


-w    H    S    oo 


ocwo 


S  3 

b   3   o 
ti        a>   B   B 

>  Da's." 

S    o    03  _, 

'S'oJ'S  1 
oo  ,  ^2  oo  -2 

0J      OJ      —      QJ      5 


>5 

•  >i 

M 

r^ 

a  fl 

■a)  TJ 

ft 

as. 

O'R.- 

B0 

|H     SJ 

m 

Pi  o 

< 

-^■5 

H 

fc    to 

m 

w   ca 

M   bc^ 

w 

P    B 

U«j3 


208 


1880— Medical. 


Paroxysmal. 

1  complicated  with  surgical  kidney. 

Intense  inflammation  with  effusion  of 
lymph  principally  in  ventricles. 

In  1  tubercle  of  membranes  of  brain 
solely ;  1  associated  with  cystitis 
and  surgical  kidneys. 

10  right,  15  left.  In  the  child  post- 
scarlatinal. No  P.M.  in  fatal  cases. 
In  1  embolism  of  arteria  cent, 
retinae  during  life,  the  other  pro- 
bably due  to  haemorrhage. 

In  1  into  right,  in  2  into  left  ventricle. 

3  on  right ;  2  on  left  side.  In  one 
M.  cordis  with  embolism  of  mid. 
cerebral  artery. 

In  fatal  case  abscess  of  cerebellum 
due  to  necrosis  of  petrous  bone; 
1  recovered  after  well-marked  sym- 
ptoms. 

•a 

s 

fa 

:    :    •    :    :               i-i      cm             :                   th  cm             ; 

g 

:           <M                     co  co           r-i 

i-3 

fa 

s 

fa 

:           >o 

a 

eqHHHH 

id 

fa 

s 

:    :    :  r-i    : 

:          eo 

i-l 

1h       ■ 

1-3 
-5   O 

6 

fa 

o  a 

i-i  ©  **  i-i  2                :        :          o>                    :    :          ■& 
co  -*  co  ko  J3                 •        -          ia                     •    •          t» 

< 

09  -w^O 

ih    :    :    :    : 

;                 tfS                               i— 1  r-C                     ; 

09- 

;                 \Sl                               rlH                     ; 

os- 

:          <d                   hh             : 

ot- 

:             ;  rH  rH 

co          oo 

rH                 r-l 

os- 

i— 1 1— i  t-h  i— i    : 

CM 

iH 

Oo- 

cm              : 

rH 

01-9 

:               rH 

s  japua 

:    :    :    :    :               '_|         :             : 

u   ^ 

—  s 

£  1 

3  ° 
S5  o 

P=J 

:    :    :    :    :              i-i      n          uo                  t-i  <m 

s 

IMHHNr- 1                            :"5                 ©                               CM  CO                 <N 
CM 

-I«'401 

(Mi— 1  i-l  CM  r-l                        r-l         X>                 lO                               CO  1(5                 <N 
CM 

CO 

W 

6  I                             £ 

§  %     5     •   j       •           8,  • 

o§                 ►,     1     .a     «                       .2  *> 

°  >,  *e         e«             ^Oggg                                        g   *              g 
Est1           -s       co  on  -s                     _»                     S  *;            K 

»SS.S  a    .      ^      H^S       S          .3                  1  2          »2 

S3  5 1  -S  "S  '£  -J  fe      S  g  js      1        "3.               £2         2 

£   t>    u    g    S  53    2        Q   P    S<       .2                9                           ^^                » 

Wffiooo      ^      CO      H         M                 o  o         o 

1880— Medical. 


209 


s  o 
.2  a> 

Ph  ^ 

<=  a 

§  * 

T3  r-l 
fO    .« 

c3    CA 


rS  ' 
a>    r\. 


, — s  03    0> 

6 


B     tt    <D 

TJ  S    ° 

.2  ea  °* 

«4H     "    .£ 

S  *"  &1 
be  >s  o 

-3  * 

•a  a  ^  •« 

2s.2« 

■p,*  «^» 

*■*;  i<  ft 

+j     M  p, 

15   8    e3    c3 


SM    03  2 

•S  "-i  a! 

o  is  a  S 

W  O  S 

rt}     Sh     rrt  CO 

5  o-   h  2   „: 


93  ^  £ 

s  «  « 


6D  .- 

-J 

a   aj 

■fi 

B    S 

*    sfl 

O 

a)    p 

C3 

e8  TJ 

*•? 

U. 

a  .  to  5p 


.2  -  S  g  o 

]  £  §  I  £ 

^  .2  S  •*  .§ 

*s  a. 2 -a 

es^  £,  bf)> 

m   -P  m     08     fl 

r*  •«  "J    r-    rr 


S  "I 

^rH     bC 

•h  a  t3 


09 

ja 

sa 

o 

o 

0) 

a 

>i 

fl 

th 

08 

0) 

Pi 

M 

o 

■a 

=w    oj    o   to 


"3? 

:         ;          i-i             :    :    :    : 

:<-h                 :    :        :    :    : 

CO 

;                                    ;      ;      ;  rH 

:  n                  :    :         :    :    : 

t-l 

:      co 

o      co 

lO          O                 lO                     •  rH  r- 1 

t»      co                         : 

NHffi                        r-ICO              ;  i-H  <N  i-H 

i-H          Tfl                 i-H                 rlrtH 

■^i;0                      CO  lO         ^H      ;Nn 

r-i 

:        :  ih    :                   co 

rH                     ... 

nhn    ;                ;    ;        :    :    :    :    : 

;                 rH          rH              '  ^i       '             *                 CO                     \             ' 
cl.                            .             ■                                          ... 

himm    ;im                 :;        ::::: 

<M  CO  OS  £>.  CO 


:             :         :      co     :  co         : 

::::::  r-i    :    :                  ;    •         ; 

>-h             :               ih               i-i 

::<n:::<m:i-i               nh         ; 

:  <-i    : 

i-l                     ;          CM          r-i  N  r-l          ^1 

:  <n 

r-i     :    :  Tfi  r-i  co                  :  «s      cq 

(M                 H          Ol         HN-*          il 

<-*    : 

:    :    :  <n  rH  co               <m    :      n 

rH      ;  rH 

eg             :        ;      co    :  co      ih 

rH 

;  rl  H  rl  H                        ;  r-i            ; 

.    .              i— i                .            : 

i-H  rH      ; 

i-i             :         :         •  r-i  co      -tf           o 

r-l                 (M                     .       : 

:  rH  co    :    :  r-i                               : 

im             ::::>-•:           co             :    : 

:    :    :    :    :  r-i                 ;  ih        ;  n    :  i-i    : 

:             :         :         :    :  »h         :             :             :    : 

:    :    :     :    :  >-i                  :    :         :    :    :    :    : 

co            :        :      co  r-i  io      o          as             •  ■— i 

CO                 r-l 

•    :  oo  co  co  o               ih  co         :  i-i  w  r-i    : 
.    .               rH                                                 : 

CO                 r-i          r-l          CD-*£^          H*                 Tfl                 HHNHHNt«      ;■*                        COlO          -rfi-l-CSIr-l 
r-l                        rH                                                                                                          -r-l                                                               I 

as           r-i      r-+      asioca      ■*           co           hnnhh^om^               -*x      -*<mocjcoi-i 
rH                cq       co           co                                        r-i       <M 

a      £>      So 


»d 

*$>> 

~. 

"ea  n< 

a 

a. 

Ph-eJ 

O      Sow      W 


o 


g     03 


«30P-iJ£rOc8<l> 

7j      r*      rl     H      S-    If;     0J      H* 

^       «       S.-P      B.2      CI      rl 
08       C-lIj        Dri       O       I       « 

rHMHHcHfHCCrTHrM 


2  3 


03    x 

03     q} 


"*«>  co 


o  a)  ■a..s 

ill**-* 


S  a 


o  •  -    fc, 

r^PrM 


,2  =  2 

rH   <JrH 


210 


1880— Medical. 


"53 

S5 
o 


w 
HH 

PQ 
< 


CO 

< 

a 

[a 
p3 

Due  to  a  malignant  tumour  in  neck. 

Due  to  an  injury. 
?  Post  diphtheritic. 

Probably  due  to  a  fit. 

In  one  probably  post  scarlatinal. 

Erosion  of  oesophagus  and  stomach. 

Drop  wrist. 

2  re-admissions. 

1  by  belladonna  liniment ;  1  by  liq. 
atropia?. 

4  suicidal,  1  accidental :    oedema  of 
lungs  in  fatal  case. 

13 
5 

pH 

:       »H       rH                : 

a 

:  r-( 

.    :      cm         ;             : 

£-3 

Ih     CD 

a  > 

P-i 

:      ih        :            : 

a 

:     **<       :           : 

Mo 

p-i 

r-i  rH  i-H 

IN 

r-l             ;                   ; 

a 

rH 

:      ■*         :             : 

13 

p-i 

:    t    :i~t      fH    :              i-h 

:        :        :          «o 

a 

i-H  rH      :  <M  -^  N         CO         -^                r-l 

3- 

^  o 

09 

o 

"3 

:    :    :    :        :    :                :        ::::::     jh                    : 

^5 

j>  ©  t?  co      oo  co              i>    :  <n  \a  «o  \a  t>  co      i>      ■>*          vo 

rHr-ICNrH                 iH                                   .  i-H          -<JI                               r-l 

Si 
•3 

09  "ao 

:    :    :    :    :        :      "*             : 

09- 

:                 :  i-i 

r-l      :      .  r-t      ;         r-l             ; 

09- 

iH  r-( 

:    :    :i-i     ■*        :           : 

o*- 

:  rH 

r-i  i—i  eo    :     -t-        :          ih 

08- 

r-t 

r-l 

:  ih 

:          iH              :                 rH 

os- 

:    :    :  i-i      »h    :                : 

:        :        :          w 

oi-s 

:        :      i-H          cm 

9  rapufl 

h       :       :           : 

s  1 

K  o 

Ph 

i-l  i— 1   rH  iH          rH  CN                        t-I 

;          CO          rH                 «D 

a 

::::        ::                 :  i-t  i-t  rH  i-h  cm  •*  <n      o      -#          ^h 
.     .     .     .          .     .                                                              rH 

"WI 

r-tiHi-lr-t          MN                        r_)r-|,_|rHi-lt»-'JI<N          CO          W                *> 

i-l 

gj 

CO 

<4 
W 

CO 

s 

K  T     2?   •    •   •!   •    •               

Bel*  1  •-&&1     |l-S|-l  •;■••§     3 

|II|  in  hi    |.*i|L!ii  s  1    i 

Q           £s       ajs-2       j-           s^"  u,2  5  »  n  "<       «       &           2 

1—1                sS          >-,Ji    «j    S        fl               Ov-3  Jl3^    oi  /*    Oh+=        r-<         3              £3 

Ph      ccSOcg      O          cm^cc  W&nrH»0<3      <j       a          S 

t— 1                                                                                                         '>                                                                                                     .1-4 

>                                              B                                          MM 

1880 — Medical. 


211 


T3  .-w  T3 


rs    'o  .a 


g   -eo 


9  2 

3  •rH 


ft 


8  2 


s.s 


o  3  a  g       <a       » 
"j  is  r"      .2       <«  ■ 

O    t.    £ 


<»   rrj 


OJ      ft      .    -g 

2-d  a  <u 

2  a>  °  S 
J3  6c"S  «S 
-°  «o  ° 
-a  "S  .S  "3 


S      .2.2 

2  So 

a         9   eS 

■H  03    > 

IT         oS  ^ 

s      ft  a 


"S  _j 


.  a 

.-a  a 

<o*  S 

a  os  a 

o  £  © 

■H  cj  e 

^.2  ft 
oj   bbc4_i 


=4H 


to     «-■     ,_, 

-£  a 

■•■«    tO   0J 

■3  g^ 
fe  5  >, 

oj   a>   s* 
rs  *>-   o3 

2  o  a 

03  -u    g 
^  N  CO 


:    :  <n                  ■-•:::        ::        :    :    :   :        :            :    :rn 

:    :                      :    :    :    :         :    :         :    :    :  *>      in           rH  <n 

.     ■     .    .         .    .         .    .    .           ,-i 

MffANHH 

lO^Jtr-t                                   ;  CO  t-  CJ          r-i  O]          i— 1  CO       •       ;          I>                 CO-* 

CO  CO      :     :     :  i— I           ;  iD  10                         i— 1     ;     ;     ;           ;     ;           :     :  CO  (N           ; 

::::::      i— 1 1— i  i-i                      :  in     :  i— i         ::         :i— icoco      so           Hr i 

r-i    :  ih    ;    ;    ;      oo  cr>  <n                   <n 

<N  ■*          I— 1  rH          I— 1  (N 

-*      i»          r-i    ; 

MtJI  H  HH  H          -*  rH  lO                                   • 
rH    rH 

*  th         ;  rn         :    ; 

rH          rH                 HH 

(M   rH       :::;           CM   rH       ; 

rH     :         :     :         :    : 

:        :          r-t    ; 

(OlONrlHH  IfflOQO 


(M0ONO3 


rH  CO   CO  OS 


Hi    <\ 

g   M 
H  O 

Em 


M 


COlON  HHH  ID  Oi  00 

6 

a 
*  «  .   .   . 

-w  M    o    fl 

.    .a    ,'j  o  a    .    , 

fc  -S  >  .2 .2  '-H  «  £  "S  03 
glS^§S§|     Sri 

g  <3  S  r3  CO  CO  W  H         PhCh 


.2  s  r3  rQ 


o  .5  .2  .a 

r<       ■       U      U 
•43  ~—      0J     OJ 


WrH^pH  PH<d  PHUCPP  O 


a -a 


212 


1880— Medical. 


s 

© 


Hi 

M 


CO 

W 

s 

(23 

For  convulsions.     P.M.  the  kidneys 
were  found  to  be  contracted  gra- 
nular. 

In  1  also  sub-involution. 

Natural  labour  at  term. 
Of  right  leg. 

R 

PH 

:    :    :    :                 :      ih                 : 

a 

£>rs 

-  > 

Id  .2 

Sm" 

•    :   :   :  rH               : 

a 

pi  | 

fe 

:  >-i  ih    :             r-i 

^ 

5Q 

s 

S 

& 

nh    ;h    ;                ; 

;                      lO         NHriW 

s 

Bd 

"8 
N 

aiflOOM              i>        :              eo      ocovoeci 

H^  MH  IN                                    .                     i— 1         <N         <N  CO 

60 

«1 

09  -I3A0 

09- 



09- 

:  ih    :    :                 : 

Qf- 

N           ;  iH  rH                   rH 

Tp          r-l  rH 

(M 

08- 

:    :  i-i    :                :      h              cm      r-i 

iH  CO 

06- 

h    :                        : 

oi-s 

S  Japan 

^   us 

So 

54 

IN  rH  i-H   <N  r-l                        T-l          r-l                        CD          N  H   H  lO 

s 

I                                  NHrlNH                      r-liH                      V         NHHIfl 

CO 

-«J 

CO 

R 

SI                   *            8>    "S            *     b      * 

g§        .a  .*  .       t  .*  .      i  .o  .ell 

gg         .s2«?l         ?s§§         ieSS^S'g 

a  3      •  1 1  8  g  |       |  -o  |  -§       II  "  «  1  a  § 

SO       ts.g  s  o.sj           Sr  ^-           o^gug  tog 
B                                    ^ 

1880— Medical. 


213 


s 

-gus 

►a 

Ward. 

Ward. 

Ward. 

tal. 

Ward. 

Id      Ward. 

n  Ward. 

wards, 
pital.    Had 
mg  a  typhus 

Pi  - 
a 

CD     rj 

CD      • 
CO     og 

«     2 

53  a 

bc'rf 

.2  ^ 

ital. 

in  shortly 
atory  punc- 
t. 

s 

a 

'p,  *  jq 
■  fe    " 

C    2 

.5     =3       • 
®    a   o 
£  -2   a 

•a                    nj.2  c  »H\ 
>                     H  >  •=  O       -g 

a.s.8i  °  a  a  »  a  a£ 

oSSSS  p  p  3  o  p!> 

£  p  p  p  p  £  £  ^  &  £ 

.5   J;   O  ^ 

co   >  -^   cd 
•r*    a:         -f3 

o.S"*  a 
g^  3^= 

PqS£ 

f    CD 

r^      CO 

08      g 

w  ° 

CO 

a  o5  g 
o  3  > 

S     CD 

2-a 
a  ^ 
^  -a 

?     CD  T3 

w 

a  §  "  o 

-2  gILg  2 

■pH  3  a 's  -3 

^co 

o  o             ooSS 

cm  o 

o 

o 

© 

cocooo      <ooo5o3o 

H  CO 

CO 

co 

cocoaoco      co  co  pi  zd 

fe  <» 

co 

HHOOCO          r-l  rH 

CD  r- 1 

r-l 

2  -w 

^; 

r-l 

nh     „    -  ^  ed  •*"  2"  cm 

cm  P1^ 

^ 

rH 

-rH 

CO 

i-H 

^  ^ 

(S 

d 

ft 

ddgda'daSV 

2  -2    • 
a  Q.-0 

a   cd   ca 

1-5  CO  pq 

^2 
CD 
pq 

> 
O 

^5 

oo 

oooooooooo 

ooo 

d 

O 

dP 

o  at 

sssssssgg 

Ci 

o 

CO 

co 

rH 

cd 

en 

CO  CO 
r-l  iH 

CO^f 

1> 

co 

io  i—i 

CM      „ 

oq  +3  eo 

co 

i-i 

CD 

CO 

Is 

O  CM 

(M  ,_| 

rtgH 

CO 

"S 

>*  d 

>>  bC  > 

u 

CD     <2 
PS 

R 

o  <u 

«    J)    «    «l    ftO    O    5    q)    ft 
P  Q  ft  Q  ^  £  £  H,  Pq  «J 

HZ 

CD 

p 

o 

O 

a 

• 

• 

BO 

Pi 

S- 

c  g< 

O    o 

d    m 

> 
....            CD       ...       . 

^5  C4H 

• 

.3 

CD 

CD     rf 

«J4 

"3  Jj 

"3  "S 
oooo«-^oooo 

a 

o    O  J 

o 

.a 

-s  a 

££ft 

R 

tfS 

PPQP^coPQPP 

PPH 

p 

P 

PqP-H 

■a 

a 

u 

•     • 

3 

2  •  •  a 

.    .    . 

.      . 

■^       § 

t-i 

<2 

»s    r       i°     s  ■•" 

01 

•      GO 

W     -          a    "  g«g 

... 

R 

o 
r»a 

•  43 

•J2   "   o  .«  o   o  3       ^,   * 

OS 
CD 

O 

09 
"cO 

in  S        3           CO        oj  -S 

M 

^a 

1—1 

WO        CO               ev.        W  P 

Z3 

Ph 

fh|«                         h]« 

to  vO 

N^I^WlO^'*      1     O  rH 

io  io  cm 

to 

CM 

i>CD 

-U 

CM 

1    CM  .-1 

rH   CM  CM 

CO 

CM 

CM 

CO 

&H*S 

pq'  j§  g  p4  g'g'&;^g§ 

pq  p4  fe 

Eq 

pq 

pq'S 

3 

dntO 

Ph  Ph  pq  P  pq  p"  pq'  co"  pq  ci 

pq'cq'o 

<5 

w 

Jg 

H?« 

w  ^'  cj  <3  i-j  pC  ,4  |  ^  o 

<JHg 

3 

< 

<» 

214 


1880— Medical. 


Table  IV. — Showing  the  relative  frequency  of  the  various  com- 
plications of  Acute  Rheumatism  in  the  first,  second,  and 
third,  or  later  attack. 


ACUTE  RHEUMATISM. 

E-i 

Dis- 
charged. 

Died. 

= 

o 
i 

e 
1 

— 

Q 

T 

o 
1 

c 

1 

o 

6 

Per 
cent. 

M. 

F. 

M. 

F. 

Total  of  cases 

1st  attack 
2nd     „ 
3rd      „ 

Heart : 

Normal      . 

1st  attack     . 
2nd     „ 
3rd      „ 

Transient  murmur     . 
1st  attack     . 
2nd     „ 
3rd      „ 

Pericarditis 
1st  attack     . 
2nd     „ 
3rd      „ 

Mitral  regurgitation  . 
1st  attack     . 
2nd     „ 
3rd      „ 

Mitral  obstruction     . 
1st  attack     . 
2nd     „ 
3rd     „ 

Aortic  regurgitation . 
1st  attack     . 
2nd     „ 
3rd      „ 

Aortic  constrictiou     . 
1st  attack     . 
2nd     „ 
3rd      „ 

Pleuro-pneumonia 
1st  attack     . 
2nd     „ 
3rd      „ 

118 
63 
32 
23 

42 

25 
9 

8 

9 

4 
5 

33 

19 

9 

5 

53 
24 
16 
13 

7 
1 
2 
4 

7 
1 
2 
4 

6 
1 

4 

1 

54 
24 
17 
13 

11 
5 
6 

1 

2 

7 
5 
3 

10 
9 
5 

i 

2 

1 
3 

2 

64 
39 
15 
10 

14 
4 
2 

3 
3 

12 

4 
2 

14 

7 
8 

1 
1 

2 

1 
1 
1 

... 

6 
4 

2 

1 

1 

1 
1 

3 

1 

39 

24 

13 

2 

9 

2 

2 
2 

6 
4 
1 

12 
9 
2 

2 

1 

2 
1 

36 

15 

12 
9 

6 
5 
3 

2 

1 

6 
3 
4 

3 

5 
5 

23 
11 

\ 

5 
2 
3 

12 
8 

2 
1 

53-2 

27 

19-5 

34 
39-8 
28 
34-7 

7-6 

63 

15-6 

27-8 
30 
28 
21-6 

44 
38 
50 
56-5 

5-9 

16 

6-3 

17-3 

5-9 

1-6 

6-3 

17-3 

5 
1-6 

123 
43 

4 

3 

1 
1 

1 

1 

1 

5 
1 

1 

3 

1 
3 

1 

3 

3 

3 

1 

3 

1 
2 
1 

1 

1 

2 

1 

1 

1880— Medical. 
Table  IV — continued. 


215 


ACUTE  RHEUMATISM. 

o 
H 

Dis- 
charged. 

Died. 

a 

P 

o 

o 

a 
1 

o 
°? 

T 

o 
1 

© 

CD 

T 

> 

o 

Per 
cent. 

M. 

F. 

M.     F. 

Tonsillitis      . 

1st  attack     . 
2nd     „ 
3rd     „ 

Acute  nephritis 

1st  attack     . 
2nd     „ 
3rd      „ 

Jaundice        . 

1st  attack     . 
2nd     „ 
3rd      „ 

Delirium        . 

1st  attack     . 
2nd     „ 
3rd     „ 

5 
3 

2 

1 
1 

1 

1 

2 
1 
1 

1 
1 

3 

2 

1 

1 

1 

1 

1 

2 
1 

1 
1 

1 

4-2 

47 

8:7 

•85 
16 

•85 

*4-3 

1-7 
1-6 
3 

Table  V. — Showing  the  causation  of  cases  of  Chorea,  the 
number  of  cases  which  were  unilateral  during  the  whole 
attack,  and  the  presence  or  absence  of  a  cardiac  murmur. 


CHOREA. 

o 

Dis- 
charged. 

Died. 

a 
P 

o 

1 
ita 

o 

CI 

1 

o 

CO 

1 

o 
-1- 
1 

o 
1 

o 
I 

O 

> 
O 

Per 
cent. 

M. 

F. 

M. 

F. 

Total  of  cases 

Cause : 

I.  History  of  rheumatism  . 
(a).  Personal 
(b).  Family 
II.  Grave  nervous  shock 

Family  history  of  ner- 
vous disease    . 
Unilateral  during  whole  period 
of  attack .... 
With  cardiac  murmur : 

(a)  Transient 

1st  attack 
2nd     „ 
3rd      „ 

(b)  Permanent 

1st  attack 
2nd     „ 
3rd      „ 

23 

9 

7 
5 
9 

6 

4 

4 
3 
1 

10 
6 
2 
2 

4 

2 
2 
2 
2 

4 

2 

2 

18 

7 
5 
3 
6 

2 

4 

1 
1 

3 
2 
2 

1 

"i 
l 

3 

1 
1 
1 
1 

1 

1 

1 

20 

8 
6 
4 
8 

5 

3 

2 
1 

6 

2 
2 

39 
30 
21-7 
39 

26 

17-8 

17-8 

45-3 

216 


1880 — Medical. 


"3  P, 
oj  oj 
>  a 


•g  aj 

P*  t.   o) 
o  _<3 


S    « 


6  2  i  i  6  *d 

IS  -^73  03  g    g 

>a «    .  S  »  q 

s  S  «  p  g  > 

"S  ^  "S  «  «? 


-2  6p  E?  y  «  5 


•a  8  C  b 


a>    O    S 


P    u    to  4J    OS 


°  2  -g  "S  .s 

J3  cj  , 2  «o 
tip  <"  p  S  oj 

I  'P    »  o-  9    oj     . 

;  a  Eg  .2  .  s 


"2   a3 

a£> 

fc  «s 

OS 

6c--2 

0J  •  -« 

IS* 

03     CD 

>>  03 
OJ     j. 

6c. 2 

p    3 

03 

oj 

«4-l     Si 

o  o 

bCta 

tT  6X3 

o  a 
>  ■3 

a   c 

rP     °J 

os  cs 

O  -w 

o 
to"  P 

•s| 

P    P 

rP      0J    rp    .3      P 

s  is  s  ^  .2  a 

p  "B-a  p  S  3  s 


<u   IS   oj  --* 
bio   ft* 

8381 

o 


S| 


■3    it    4 

®  IS  "S 


p  .3,  os 

«4-  "fi  .5 
o  o- 


3  a 
<< .« 


<»    u      .PS 


a  p°S)S 

S  .p  a  a 
>s  fee  3 

a  -3    P.  t. 


2  s 


p< 
oj   - 
q    P<1S  t1 


OJ    S,«    O 


^3  ja 
6C-u    e3 

a  Pi 

-*  u  es 
a,  x  g 
go   oj   > 


«  O  j 


o  2 

2    M' 


?  <u  tu  0?  a  p 


■g  ft* 

03  <1 


oj     OJ 
If  <P 

0J     qj 


O     3 


S-    c  ^ 


,  JJ«H     *     g 

■•si;! 

(■ago 

>  p  a 

oj  .3    fc,     • 

P   3   s- 
«  °  S  K 
S'+l       >p 

■"2 1|  I 

03     P<"o3     S 

too   *^"£ 


a  o 

5    P 
oj    o 


S3 


o    •- 

■U     3J 

a 

^  03 


-.     ~.  O 


2.   .  £ 


7j 


tH       ^     i 


Eg  a 


■oj  o 


«  g  3  b 
fill 


1 1  1 1  § 
to  «=«  5 
.1  p      2  p 

■2^2  ■* 

B  «  S: 

**   OJ  i 

oj  a 


IS 


a 


O  a  ^ 


S2 


6C  P  ^ 


3« 


O  cV]  <« 

1-1  o  ., 

£  ^  M  t3 

I  ill 

U    0J 

•73    -*3     OJ 

P      ..^      rJ 

""  u  P  53 
O  G."# 
6C       r-l 

D   I     ^'n    60    . 

^ja"  j=  t3  p  n3 

■+?  "2  P   C   £ 

05   S  «  -§   s 

a,  6c  g^ 

s  i  :l  ^  1 

'ps  S  a  I  ^ 

:   3   ?7«   P 

p  6c  i  i-H  a 


=3  p^  o-;  -e  ts 

»£    '-    oj  r?" 


I     a  ;s  . 


0J  CH 


a  °-> 
Pfe 

03  "^ 


0j 


03     P- 


3  a  p  =4-i     p  -° 

o    St;         H    cj 
P    «    °    °  O    3 

<e  -s  ts  a  -•  *  s 

go  J. 2  "a       7 

>   g   s   6c  3  a,    1 

<!  6c  P  —       3 

1  °  .,  d  >. "    • 

WS^bS3 

2  ^  oj  g  p-  S  p 


1»  -5  3  6*5 


lri4  x  ^a   bcja 


6C  _. 
^  P 


o>  ^ 


I    P    &  .3 
:S  3  p   g. 


S    0J  -o 

a  a 


so 


.  p 

2fO 


kj  r:     w    *-!  -^     wj  .— 


t>^  M    t-    ^  ^3    ^ 
-S    oj    03    «    p  -P 


ri4      2     « 


0j  Ti 
03     0J     0J 

6C^    S: 


£    P 


>a  ^r-i  -P    a  J= 
P  <N 


©  Sp 


p 


<4H    Jo  2  ^  «2  "43    &(M 


oj  53  73 

,2  "S  oo 


-3    6C 


So  S5  2  P 


I  -P    O 


r^  'P     & 

2     a     03 

o  o 

6C- 

oj  •«  -j-  *3  g 
."2  3  p  _g  fe 
p  "*  k„t3  £ 


03     1,'  O  .b« 

oj  ,5  a  p; 

M  P     a 


00  "tl  «»H   H 


O 


1880— Medical. 


217 


..    >  -3    g<  .  43  -S  "S  1 


l.*>,«-2tH*Hn;aja>aj 


-x  P™<   o  !? 


5H 


# 


Sfs  2 


•g  a       o>  a  a> 

s  S  ^  8 

.o  .a 


a      *  (.  • 


0> 


0) 


O    O    oj 


a 


a 

tH      -a   — H      fl 

>■  c8  a  ■§ 
a>  P  a 


00  3J 


in  2  » 
MS* 

a)  ,a  _ 


*  <x>  .a  a 

3  o  p9   a 

«*  u  a 

H      fl      S 

t?wsa 

9 


03  ^ 

33 


o  a>  eg 
3  «  §,.S  .3  .5     . 

ri  O  £-»     □  »— t 

fi-S  <»  3.a 


Si  5C 


,2  a       £  ^3  S  <"  8  .2 


■*  5  ©  <" 


-  TO  w  —  ^  ^_ 
g  3  fee  S  o  o 


t3   o 


&,-3    5    d 


s  5  a  S 
o  a  *a  .2 

c3  aH    Ph  ao 


t3      . 


«  rg  s  a  'a 

o>  a)  _  <u  a  ©  2 

>    »i    -    tl;  h    s  a 


^^2  6c=2£°c'a^ 


So  ■   aj   o3  tj 

«  a  r2  3  a 


55     P<  5     5     C5  I— I 


a  ©  ^ 
<u  S  p2i  3   a  t. 

a        »■«  ■  53 

♦»  2  83,© -a  > 
o  5  b  a  a  •  a 


rf     ri     b     T, 


0  5  a>  3 


.©    5 
«M    > 

©.3 


bo  c* 

3  *  - 

-s  a  Ph 


o 


-2  2  jb"3  n  £  2  3  'a  o 


a  a 


>,*=£■  q---       a        .    .  *a  ««h  ,„  i-i 

"J5  S  SW'S   "> 


3  o    O'-' 

a  oi  *a  _Fi  -^  o  _ 

3  -3  ,£3  CD    Jp 

o    .        \m    I 

1"  53  .»Jz  sa    - 

a  »^  -  -^h 


a  5  <u  a  o  .2 

2  §      "hS  t 

3  bS    ••>   a    S 


gs, 


09 


^3i  a- 


a 


AS  2  §  "S  * 


?2l' 


-a  ••>  2 


oQ'S 


3  s  U«2gal|S^2^ 

-  a?  a  «        g^3^3_.2  "^  S3  2  a>  a  'a 
e«      t>      -a       2  <u  «  .3  w  ^!  .-S  -a  ai 


o  cj  o  a  ^-i 

*  .    fc    ^     3 

3'2  be*  ^  g 


2  <B  2  .3  5a 


c3  N    O 


bo 


c«    & 


•9    3 


£232 


°  a    .  a  t»  53 

rf  =3  a  8  -g  & 
—  it. 


s  3  -p  ^  '§"  o  •  3 
t^  co      -a  Q  «  3  ea 

a      "is  a.—  j*       a> 

6E©     1  g    O    1)    t'j 

*,H  '.43  a  >>"  a'aij 

a    ,5«2'3fl9S3 

«  £  a  gN  ^ra-2^ 
aagaj        r^^"i3 


2*5 
7"S^  a^5 


W 


53^3 


^OS  •3<?1'3«>tHrH 

aiii_a  ^-n4jh  Ojjr-ta 
a  fl  «— 'c  "^  tn  a«  p  >a 
S>a  h  £S  S  P10  S  t)<H  ! 

z  —   -/j  ^-1   c  -w  a   o 


■■*  A1-1  o  3^3-a 

^3  .2  g  ih  *»  •"  a  -a 
^3  ^3  S       ^      -a  bx 


a--*  ,a 


O    CS    o  '" 

a  w  "^  -** 

3  "s  a  o 

+j    Ph. 3  00 


"S  a" .3  £~g 
8.2  53  § 
o   cs   <P  "3   « 


2  <^"S 

o  be  "3 

o  «  a  .„»  '     5  0)  ft 

-*j       ea  c  o  a  a  2 

•  g=2  o  *  3  fe;       ^ 
a  tn  *h             o  t3        a>  s-1 

&  j5  a  be  «  3  3  be  5  eo 

C8    03    o3F-53-lrOtvi^OoO 


GQ 


— i  a  P  ^ 

S  go  g:  i5  ^j 

0  «r°c2  o  » 
S^      I?  gj  £  1  -2  s^     .s-S  5  9  - 


^  •«  c2       3  «  -a  .SP.S  -a 

W   —  "*»      S..S      ^      "      ^      K. 

a  3    .  a  bo  3       a  «  •*> 
^a-3^  o  £'Sc      fl  ® 

8       «m   „:   2   «   h   S  "a         &n^       'H  -o   S 
a  >,ga  P  "a  £  o3.S-3'3  S  =  £  » 

^a3piaJ^J.s^§^--3-§^g 


-  — - 


VOL.  XI. 


h.Oh 


15 


218 


1880— Medical. 


s 


5 
a 

a. 

a. 
a 

S 

u 

o 
E 

c 

Aneurysm  of    abdominal   aorta, 
commencing  at  opening  in  dia- 
phragm, and  extending  to  third 
lumbar  vertebra.  Involves  supe- 
rior mesenteric,  commencement 
of  left  renal  artery,  and  cceliac 
axis.     It  contains  much  lami- 
nated clot.     It  presses  on  infe- 
rior   cava    and    common   iliac 
veins,    especially     left.       Left 
renal  passes  in  front  of  sac,  and 
is    much    stretched.      Tumour 
measures     5|     by    6£    inches. 
Some  calcareous  plates  in  tho- 
racic   aorta.       Heart    normal. 
Kidneys  congested.     Other  or- 
gans natural. 

03 
O 

be 
o 

N 

o. 
■a 
a 
d 

a 
c 

3 

rt 

a 
o 

5? 

May  25th. — Fairly  nourished.  Pulsa- 
ting tumours  in  left  hypochondrium. 
Murmur  over  it  systolic  and  prolonged 
into  diastole.  Heart  normal.  Slight 
difference  in  puuils.  Urine,  sp.  gr. 
1024,  clear,  acid,  albumen  £.  June 
10th. — Right  pulse  much  stronger 
than  left.  July  23rd. — Pain  worse. 
Tumour  larger ;  thrill  and  bruit  over 
it.  Urine,  sp.  gr.  1024,  much  albu- 
men, free  blood- cells.  Aug.  7th. — 
Since  last  note  only  18  to  20  oz.  of 
urine  per  diem.  Vomiting  from  time 
to  time.  Pain  worse.  14th. — Left 
leg  has  become  swollen.  Frequent 
vomiting.  Pulse  very  feeble.  Gra- 
dually sank,  and  died  on  the  16th. 
No  rise  of  temperature. 

June  19th. — Emaciated.  Heart  en- 
larged.  Systolic  murmur  at  apex 
conducted  to  axilla  and  diastolic  mur- 
mur at  base.  In  epigastrium  a  pulsa- 
ting tumour  with  thrill  and  loud 
blowing  systolic  murmur  over  it. 
Urine,  sp.  gr.  1010,  no  albumen.  Signs 
of  old  choroiditis  (?  syphilitic)  in  eyes, 
and  some  old  iritis  in  right.  No 
oedema  of  legs.  Pulsation  equal  in 
both  femorals.  September  23rd. — Has 
been  much  troubled  with  her  eyes.  No 
additional  symptoms. 

o 

15 

a 
o 

Had  syphilis  15  years 
ago.      Pain    in    back 
and    abdomen    for    5 
years.  Constant  gnaw- 
ing pain,  not  radiating 
in  any  direction.     In 
St.  George's  Hospital 
several  times. 

Quite   well   except  for 
slight  palpitation   till 
5  years  ago.     Then  a 
severe      fright      and 
severe  attack  of  rheu- 
matism.     Since   then 
violent        palpitation 
from  time  to  time,  and 
some  pain  in  epigas- 
trium.   For  12  months 
has  been  getting  worse 
and    sight    has    been 
failing,    and    she   has 
had  much  pain  in  eyes. 

*! 

q                                          ri 

-a 

bB 
E 
ce 

-a 
P 

Aug.  16 
Nov.  1 

r6 

May  25 
June  19 

Occupatiou. 

Porter 
Married 

1  !BJ 

a      = 

G.  T., 

40, 
M. 

E.  S. 
63, 
F. 

1880— Medical. 


219 


g 


03  T3 
•S    6U.3 


,2  S  8     . 
0  a  *  S  J:  «  a;  5  S 


> "  B  '.  \,  a  d,ra 

•    ^    it 

ao»  fc I  -^  oi  © 
to   a  P    6DO«h 


,~a 

.3 

ic  »a  j— 


*       I     rg 

HI       '       2. 


!PW  § 


0)    rO 

»  ^3    _■  JB    0 

6o  s  .a  a  o 

.  bu  +3  2  'B 
?  ?>  '*-  °a  =*-< 

IB^J    JO 

i<,j  a."    - 

J3  —  *  -^  ^ 

^  ns   a        ■** 

*  9  "  S  > 

S3  tc  S 


a   t. 


•+-■    05 


to  O    o 

£  a        «  " 

rs  -S  -o  «  os 

^  ►,  _eS    ■    a> 

ff  43  ,*f    03    oj 

<u  «h  *3  -a   a 

°  _.  ?=  2  ■*» 

m  si    t-  .3  ■  — 

<x>  o>  a  ,    a> 

gg-SS 

O  c3  =*-     >     0>  ' 

CO  -#J     O     O     >   , 


"3   oB»fl 

-.«  £    «  .3   55   v    ?.    2 

3  ^  (u*i  «  xr;<H 


IB      S-i    

0    B  «*  -2  ts  M 

"3U3.S  £  3.1 


3,  *-    !3  ,3    2  •S    S*    fc- 

I       O     Si    r-l  JJH 


•SCOT'S    4)  CO 

So 


'£.2 


o  t.  &%  -3  -a  «5  2  1 

£  «q       ^=  -g  ^h  ^-i  r=  _o 

3  a  a*  ?  2  ira 

a  c  co  ^  3  a  to 

s*  a    ' 


•    .  —  51— '-to^H„  _3*JN—   ~^7«=a 
§  fell  I    iS£-2=2S©T5  B   I-S31 


I   0/3S     BO     0)     = 
I  I— I     C«     03    1— I    rH     U  A 


B-o'?,  ^3 


«i  —   o 

CO   -^  *"^ 


3    ^    S 


N    p    o    O 
n    t-    =0    on 


osPmgg  Swo  3  S^3  3 


,2  "g  •"  CO  3  -S    «0O    SC3   g    '■ 


a,  ii 


s  a  ^j  »o  rt 


03  t.  53 


»'3o     -IS 

a  ^  cu  cu 


!-  r-H 


S^  J"S>S 


3 


a'.S  ja  o  P  ~  S  -g'g  S-2 


tc.2  ■«  •£  •« 

n  2-2  -°a 


0  — ■  Ph 
C.5    I 


CM 


60 

.  as  m  * 
,  cs  a  +3  - 
i  03  te  .5  S 


'2  cu  «  '-S  ^ 


S'C    ho 

cfa-sa-SlgaNs-d 

,s  «a.H*.  >  34J       s 

^  ^  02    I  -2  S  ex)  be  I    P.E-1  jq        £ 

_     to  J    a 


a"  3 

._    T3 

rS  cs 

!*:  03 


■2 
o  ^ 


,^3  a  o  S 


^ai  Sj3  o  o  "S  J5  ht  o  a 


ad 


c   >> 

to  a   S   £ 
a   a   2   ^   w 

°  .2  oi    60  6D.£  5 


rO      O 

"  ^3 


'a  03 


-ii  - 


3  co  * -a  « -2f  S"&S  3te^ 
has   o   a  B   Cl^   u  «   h 


03 


w 


W5 
N  05 

o» 


•H   -^ 


I  J. IS 

a      -s  its 
a>  cb   03  S 

o      ?   cs    1 


•SiOp. 
-3  CL  o  P^ 
6C  3    o    a 


.2  a  2" " 

a^  3  • 

GO  «D    aj 

■£,  co    . 

a. -2  ^3 


iis    (1    o         »    X    j 

^f     s     OJ     CJ      ',     h     QJ     ^       ' 

3  »  _a  »  ,1?  -a  w  *.*;£ 


•"»      ^        ^-        CP        U         L.         • 

a  co  c      .2  a  ^-3 


a'&i 


£  P,  §  -c  'C  „/&  to  . 

f.  1  •«  -     2  «  t5  =3 
ea  o>  ,3 


03      Pn   £    r-J      O 


co    2  -a    • 

-    o  -^ 


01  P5  ,3 

CO  "     U 


§Oc52^ 


B   5   1° 

.3S§ 


3.   CD  HH    •—    H   .- 
CO  =H  *     Phi-I     3- 


i^p 


1        1      CO      •      o 

-3  03  s-  -e  .a 

^   g   03  03  -g 

3  >>  *  3 

o^:  ■*  op  s 

>    fc  (M    >    2 

S'Sl 

1 .2  5)  S 


S^3 


5  ^  3  S  .5  °  .2  S  -5 


03    3 

g  V. 
3  _rf 


_o    »-og^ 


^S    J) 


u  .2  '£  03 


-  g.tfS  ol  S.S 


2^ 


ft 


220 


1880 — Medical. 


5g    «  -g        ^    eS    3    g 

a  3  "g        5  ®   _ 

.■+3        »  d  £  •-  «  ± 
Jj  SM  ...      -fesls 
S  2      -a  fl  o  ?  > 
"■5        «  o  £  & 
<  S  oJ  bo  «"3 

be  bo  b  2  -u  t3  £ 


-3 


3   -u  _2    CD     3    43 

_  -S    o3  "3    fen  m 


p,g."g  So1 

cd  ^ 


O  ^  .3  -»   cd    O 

3  «  S.^5 


3*a  a 


0)    O     «     l, 


agSS 


2   3 


3  cm 

2  5,2 

CD  "*     0J  ~ 


S-g  fS  °  2 

Zj  — <  _Q     CO     3 


j4-3    a    o    ri    cd    Z3 

tu    3 


•S-S«s 


,3   c   oT 

§  _3 


3    3) 


OS   C*J 


!<Ss- 


o  a 


S3  ""*■ 


"3 

o 


s  o  .2  ?  -S  S3 


g-5>35a-iS5fi.s'Sg» 


3  a, 
-   >   £   eS   3        a> 


,,-  cd  >-,  cd 
3  3  eS 
,3    bp-J3    g 

2  _,  m 
-S         S.3-S 


5?o  5  * 

3        CO  ^3 
-3 


M 


?->r^     r- 


£  ^3    >>  o>    3 

%  t  J  °  a 


o 


0) 


CD 


<U    bc£ 
a   «-   5 

£  §o.2 


bo  I 

F      CD     CO      bB^ 


g  5,  "^  *  &  ^3  5  §  1  g  | 

g   «    cs   h  .      . 

,  oo  1   I     .g   I     „   •.*-'  g    .  & 

(CO    08  rH  rH  ,Q  rH  rH    3  tf    o  OCM    3 


"3    "  .32    33 

ea    u  CD  -3  -3 

o  <a  >  a.  5i 

"g  «  I3  2  i 

0-| 


P,H 

.co  : 


co 


K'O    03    3 
bC  O    >>  fl 

■»    a) 


SO 


O    O     g  +s    O    o 


oS^   3 
Q  g 


ir 


h  o  » 
3    <u   2 

ss-g 


Si 

u  r3 


CM 


^3 


.2  *  g  S 

S  3  §    . 


In 

be  a  'S 

v85 


2    O  <M^3 

-s.-a  as- 

a)    tp  frl    aj 
«"-^      •    3 

o  -g.^co 

^5  ' 

8"!  ^"5 
S  2^^2 


2  3   I.  -S  5 

5    Q.-3    "  00 
CD    •« 

03.  CO  H5 


CD     3 


^co^ 


3 

g-I 


«S  -3 


S  3  p   I 


■<  c  c 

5    g  J* 

io     .« 

H    _3    '<*> 


"I  s S  .S  I 

°2 


a  «s  h  s  •« 


S  s 

3    •« 

i-S-s 

!  .3    S 


3  oo 

CD  4? 

H  o 


£  J3 

°  2 

bo  «3 


•g  fe  cd  ja  P-'*   I 

^  yct-i    *   t2    OS  -3 

I" 


^-.   ri   cu 


*e3    ?} 


-dco 


S  §5 


3  ' 


SP       00    ej 


c£  3  .2P CO  "2  g 

3    >  -3  CM  -S    S 


^3    P. 


L   3^3    5<H 
^         O  ^^ 

£    8    3°S-H 

=  s  5  oO 

03    t>    to  ^t 


>    ta«H    bC  g 

1  8  -S  &  eo 

CD  *    CO    o 

=g  be- 


s 


S2.SS 


1 5  S  %  bc? 


2    03  ' 


.9  os 


m 


6  3 

be  cb 


■  ©^  2 

§  2 


(<     '  S3  J 

«  .2  g  5s  *3 

5  ^  3    3  *S 

<t-    0  ft  cd    **■ 

T3  gn 


e    "o 

2  =0 

a  g 


CD    —    -       fe 
STSh    ecTu    co    5»/3   8  J00    oo 


08  rH 


o 

h    3    s 


^     >    -tf     CO     0Q 


4 


^1 


X9S  pun 


1880 — Medical. 


221 


*-J  -w 


»-a  a 


tJD 


o   O    S    fa    3 

3  ~  g  -5  »  «c  §  £0,3 
Is     2-S  "  ••  § 


s  «  > 


»  9 


ej   >  °  a> 


S   9. 


M 


§  a 


a  o  re<  3  -5  ~  S  p<-r 

i      S    /j     =      »   -     »     IO     ? 


1  ^  .5  >  i  1 1  £3  8  .a  3  J  £  5 

Sl^-S""5       S-2§c.a-S-a.-3 

o3a7-t>        ""  13  •-    2    O    g    JJ1 


«  P< "  a  13  «  §  <« 

03    •»>  a    B  {aj.S 

JS    00  03  aT-f 

q  a  a  a   b  (o  5 


03rt.-*-3         ""'  ^3  •«    i*    O    li    LT 

S  j  >>.*  -g  pq  -J  -a  8 
bo  « 


*Ul  If 


s  ..a  &s  s  q,  I  »-••  Ite  ps  s 

fc    >   O    o   O    '    S   5    S    *          «J    ><>.    o 


S'Sl  >  ft 

*.££-§  3 
^  o 
"a  M 

•s  .a  -5 


fa  t-H     O 

eo  ©  o 

«H2 


Iw  g 


to    .  a  *      o  2  a 
"  cc  2 ""  E      °  a 

si  5     &u  a  3 


03  i> 

■B        .  CO 

*  -a  »  =5 

**    x^  fa  Tfa 


So  0,5,  s?" 


fa    08 


0.  ? 


3B*o3--Hg3fao3« 

~*    ^i   *-t     O     fa*   el     ©  •""     03 

13  •<  S  «    03    a«4H'3^ 


So"  I    I 


=*>  ^ 


a-s< 


"SiSsS* 


00    ai    a 
1    h  "s;  *"  i-S  *3 
^fa^3"13faa^) 

a.  §  =g  >  g».S  "S  S   I.  3  .g>  d  ^ 

a  1  a,"  a3  _  fa  g^  «  ^  s  *  f^ 

g£gS|*-g>l  ..agj^-g 

.§  '&.§  a  §  s  §  "S  -E  .3  ^  ■&  hnQ 

43  s  °1  s  S  1  "  -  ftoA  c 
^^  §3  -  a  '. 


oa 


1  cs  a  -a 


-5^3 


Tfl    o    >  ^5  ^3  .2 


to  "*  _B 

o>  a  +3 
a  - 


00    C3  rH    00    O 


C  ^3  .=  kT     w 
fa  -ij  -ta  r*  T3 


p,  P  ng 


"3  -a  Sd  a  a.  fa 


cn  S  o  .a   '.  a  *»  fa  .a  »  be  o>  w 

1  *3>>sh  '-^ s.    -•  "a  a 


-   03  A  r-(  5 


w  3  <£ 

•       a  T3 


a.  a  a 
l   «      «3  3  2  a 
1    a  -d    I    u  |  1 


.  fa  a" 

isS a  SmSss 


a  : 


ja  S 


o  oS  o 


X 


-  &*> 


^. 


^3  X    w  fa  S  (»    ., 

-w     ""    U  3  T!     I      3 

l"^  §  Ilfe§  a 

a^  oj^;  Bi3<M  a  os 
<3 


a 


fa  o 


aS3fa?„a«>4'i 
S  a   ..'g^iH  2  J 


•5  fa  •= 
9,2 


&^ 


b-3 


03    4)  O  .Bv-3 

fa  S  rt  u  § 

■8    «    ll    M 

a  «s^= 


a>    OB'S  ^i    j^ 

S.S  -3  a  2/ 

8 1  1. 1" 


«  »  _ 

fa  a  qo 

0)    «- 


&£  •«  -s  -a 


a      a  a.d 

J>    6C  be  _  r-l 


»a,£~a'a^«a. 

^■s-ssas^l-H**  3-2 


-*  S  a 


00  "^ 


P    B    00    00    flhTJ^    o>    33(M    u    S    OS 


-  .5  &      fa  5  S 


oj  a)  2:  > 
■  ^  a  bc^s  a 


S  i  fa«> 


2  ►>  °° 

5     O)     00    +3 


.    03  J5  =H 

^o?.3 


fap_<oo_,       ujja.       « 

P  o       *>  a  S 
be  w  —  g-i  .5  & 


03  'd    c3 


«^a 


P1|1.B«  sits  1^|1  III  1  !g£3eci 

OJ-Ja    O    a*a    »H    03-2^3    C>'0^r3    S*>,3    BSoSoo&.S^B 


a  t-. 


222 


1880—  Medical. 


s  e 


S  °  o 

03  >3    «    'oS    P* 

c  s     a  s 

5  s  £  s «: 


*"2 

s  J43 
§5  1 

4J      C      OS 

c«  is  -o 
a  -5  * 


«J  2-p 


rt  s  2 
p  a  43 


(3^ 
'be  « 
'S   B 

o    > 


43    • 
~<  43  <o 

;  S  -o  o 
;  -a  5  t3 

'7S  &  > 

'    d   bOcS 

qa  be43 

10    ".P 

•5  ».£P 

3 

o  '+3  .13 


CS 


P-P 


a  be-^-E 


03     03  tH    5 

p>  s^.'S  'E  o> 

»    3fl 


cs 


bB'os 

0 


P   o 


be 


a>  43   o  os 

P    ^      0>  ^ 

*"  =»  is  'O    • 

>^4V f?  a  a 

*  si  §  £ 

0>    4=  fl 

«m  'H  _-  2  e 


o  P 


u,     *      P      > 


01     00 


P  .2 


OP     *. 


11     p     0>     rt 
P-   CS     P,   S 


o  .2  s 


p  •«    ^  a  s  » 

a«-p    I.  p^.o 
a,        «u  43   Q  JS>-g 

>43  43    «    §•§* 

a  g '2  ^   ...SP-2 

°  -3  ^  «S  £  g 


3   IS  S5SS 

^■s  a.  *>»  a-= 

O  t>  'O  43  ja    a,  i> 

5a     P     O  _a     P 

«  ►    S  2  few  o 


S«JS 


ti  "rt  43    >    O 
«    g|    g    8^ 

§  2  *  S.^  5  * 


0)  .r 


hj«    to  I 


>    0> 


rs^a 


60S.' 


P    P    > 
O    03    03 


*  -8*3  2 

»  o>  a      w 
-p  f*i  P^'-S  "S  -° 


^  +3 

03  z;    as    w 

p    43    43 


^^^  I  2N 

^-d-S    .J 


s  s  a 


«  -—  _  2  -S 

D-   o  —  ,-   * 
I        '-"   P 


.£PS£ 

S-i     P. 


Ph  P 


a 


i  T3    C3    P 

p  I-  ^ 

!    eS    P 


■^    P 


EPSrc 


c-l 


SS  =5^§ 


p 

'3  p..  S  ^3 


a,  J  „    d    »    »    3  -      -OS 


OS    s    o 


^3ii 
f.S  d 


X!     «   }*     OS     S-c     03 


a  2  2  a  p  .5°.^ 


8  ^ 

p 


>~.-c 


-      w 


•^  'C  iN    m 


s  s  s-c.3 


Ph3 

S  8 
p  p 

1*?  J 


£  OJJ.^      Q 


&Ph 


2=h 


co    P    os      .  ^3    O 


P     O     o^     . 

•a  ^^  p  as 
■S  2-*--^     a 

P  u'h-u  j;  — 
•  "E  P  "hr  S  "S  ^  ^ 
O  I— '  |S<    t,T3|-J    CO,i3 


1  ,P    rt    CS 

:  «  o  & 


cc 


CB 


p    0    P-T3    Jj         t, 

o  P-S5  bo  ?  .S'S 


c«  'd 


be  «J 

E  -p 


.5  S  ? 

fc^  0>  »n)oo  "^  bJD 
3  3N  D  •! 
— .  .S  43  -P 

P-"    «7V2    S 


^;  .S         43  Ja 

I-    rS   'S  _ 

Pl»»1   =*H      O   12      P  X 

O    O    O    o    os    CS  W 


Tr   Jt  rtV    'rt  "t^   _^ 


;  J3 

be  J  Tc  g  '»«  if? 
g    P.  QQ  J3     P  "g 

p   o   P  '5  -i- 
P  ^  S  " 

P  .S    o>  _    os 
43    S    3  43    P 

>j^  cL_2  be  -i 


be  oj   be  oj 

3S8I-1 


S   S  9   2  rs 


-grS  p 
oo  g.  2' 

os   g  <» 


2    fe 


o  P 


g.S   2  P   i!S 


03    U 
i-     P 

<u  o 

43  43 

>-43 


QJ'H      O 

Ph  "^ 
t-l    os 

0)  ®  S 
-—  t>  43 
43    o    «-> 

3      5 

t3    P    h 


l&A 


a)    oj.      os    cu  m_  +j 

^    c°     43  43,S -P 


Pi 


5    os 

Kr-p 
«  g 


8  be»^S^  5" 
>   S  —   a  _  «  ^ 

O    P  -^    CS    P    {3    P 


p,8 


3*2 

_J !    ^  o5  ~ 

"3    ^43  -« 

a^oo42 


ii  ^s 


*  *  43  . « 


^  -l« 


scfl  Si 


^^ 


Scq 


3-3 
-p.f 


p  -p  ,;  Vi  — 


•3  "3  ®  P  . 


MS 

as  a 


H^J-, — i     os    fi 
CO    CS  42 
i-l  43    CS 


-f=  T3  43 

£•55   £ 


S  .2  ?! 
p>  E  *" 

os  k^    3  , 


o   ? 


i»  co  a 


O  —     CS    O  43 

a  •""  he  be  o 

-       ^"c? 
.2  os    £    ; 

.2      -?  4=  43  ; 

-g    P    C    9    P 


p*>0  c  p+2  p<o 


o   o>   o 


a,  AS   h^ 


E'g  e 
o  P--g 

.2  43    g 
43  j     « 


43    P    cs 


rt 

P 

43 

> 

M 

^ 

a 

49 

s 

hr 

Uh 

p  2  ^.§  -?  *  s  --"  *  S  3  S  r§ 

as    cs  ■**    cs    be_  43    oj    fe  43    >  43  -31 
os    t*    fc>    p.a'C    s,,4h    p         as         oo  ' 

>>22oPrfJp      _-fl, 
-o  3^_^"  *^  o^-g      ?o2 

as        43    . *        S,„'^P'aPr 

-^  S  ■=  cs  §  o.i 
«   £  .-2  -f        beO  = 

O    os    «    P  T3    b        — 

a ,  a       os  *    •  ^ 

frS  I  «r  g  •§  8  I 

H  ^  3  &  2  P.-2 .2  =3 

«ttH.„rT3     0343     OS     O   'C     05     0- 


r-{  M  od  ~o  ^ 

00    -P    00      fe     43 

P  8  e  " 


P  2 


u  °0 

3  oo 


p  •* 

p  CM 

»-9 


XJ$  PUB 

's9b 


cc  os 

IS 


1880 — Medical. 


223 


2  p,       *  2  *-  2  2  « 


w    —    m    ^ 

bc~  -  - 

S    2    es    C3 

-^  s  >  * 

gg-fg, 

oi   S  a,  73 

_  -c  +;  t; 

»   ci    2    « 

-a  .aj  ,q  p, 


I  w  "'g-B  I'll  ^  S  I 

bo  a  2  .2  v&  c^  4* 

.2    s».  *    60 
J3  £?  05  ;  " 


PhS.2 

0>     "  5     03 

2  w  23  o>  u  H  oTos  <u 

MSS-alE...  g  §fl 


pt 


& 


05  £ 


>  J5>    -    a.    .    es  h3 
<-   o         o  "S  ^  _2  •--' 

60         felH         -5 


=*-    55  ."2    05 

-  o  2  -a  s 


a  x> 


.S-3  g:  s  -^  c„ 

S-w  05T3^-e:^Je3r^aai 


o  3  ^  n,  pd  c_;  2 

05  .2  O  05  —    2      -a) 

,g     S  &P    g     05  *   :2  ^     5?  O  ^ 

•a       g  a  os 
-u  -a  o  -  -a       a 


-a  "3  °  a  05 

:a        Sh  ■«  JS         05  ^3 

^   >is-S  Ha 


a 


^es 

"a  ^3 


"""a^j^aairT^soo       a  05  k  °  a  -a 


3    oj    O 


E  h  p,u«'(. 


-    O 


m    J«    .•    05    S    es    b£-^3    05    3     -..g  — ■  .2  '£  ,a    bc3  *) 

a  55  h  g„o  05-3-5  p.  go  "5  r^^j  jg  •aVra  0 


-73  ' 


fc 


-   >  -  s  a 

*>    5  «  o>  he  05 

o  ^  .  05  3  u  -r 

.  >  5  s?  . 

"?n  "3  ^  5  05 

SP  »  u  ;  cj  o  i, 

O     S  "pB  P,r-I 


■      "^    'O      _J      K       "      W 


J:  s2  ■"  O  £  f, 


CO    bo-f    ^ 


=   f  * 


c     «  05     h   .S   — 

.5     2  1-      3     05     05 

*  S.  v-  ^  o  _es  -a 
.2  S*5F«'3*g  a 

03     >>.S     5     05     g     05 

ti^  9  a  "8  -a  2 

s  .a  p  a  a  2  5 


-2    =     3     >v^ 


>  J2  la^    - 

4J  ^  i    S  ii  -ti 

a  .a  £  a  -a  ^  r 

jr  a  v  —  05  05  oi 

O       _^       jj  05   a 

,_  13     05  ,*' 


„  •=  bo5  -g  -S  2  J  .2  *  "  &  I 
^.S.2^5S^.S.5.2S 


o  00 
bc'43        +3   be 
a  es  ^  "g  a 

s  1 1  o  "1  -I  i 

o  05  rM  bxjo  a  g 


0  h» 

£     05 

be 

13  sa 

J2  13 

s 

05   'O 

>  "5 

W 

*5 

e3          05 

05 

^3 

s   and 
.     Two 
r becara 

-3 

r»    CH 

bo 
2  oJ 

bo 

C3 
00 

's  a 

0  a 
os  _a 

d 

o 


^^S 


224 


1880— Medical. 


■a 

ess      appears 
jably  to  have 
ed  as  an  em 
which     bur 
wn  deep  intc 
men,  and  at 
e  found  vent 
umbilicus. 

a 

s-S 

E  «5 

a  ©  2       o  og 

E  s 

The      il 
most  p 
comme 
pyema, 
rowed 
the  ab 
same  t 
throug 

o 
D-c 

■      t*    0/    „« 

•- :    en  *-i    Q> 


^3   »  js 
o  * 

a  s^ 

0V    rS        05 

-s  °  . 

CO 

o      •    © 

►si's 


•Sfl 

OS    r*^      03 

J  J  3 

*•§  a 

o  +>    g 

-J  •  s 

»    ID  J3"J 


x?  bc-^  S  1-  i3  &c  J?  .2 
&   o  2  s  -a  m  - 

05    to  "^    «  •-    _ 

-S  ^  «fi  §  *  -  *  '-i  1 


u    —    — 
do   a)   a> 


oo    O 

3    C 


s  .3  .2 


S3    rf^ 

2  *=- 


'a  S"? 
os  *  5s 


53* 


O    60 


T3    >->  &  OS 


TJ-S    fc 

-2.1  & 

05    -4-  J3 
O    ft  03 


os  -u  -a 


Oh  fl 

a  § 


sa  S  g  a 


2  •<  §  ® 

3  j-  "3  =4-1   s 
oj       =*-i   o3  n  a)  -g 


!    o  ^3 
>         -u 

!  -oo 


ft& 


^  ~  £  -S  J  £  «  .%* 

W  S  a  -a  p\o<,  -o  =j       a 

«   «         fe   Sc2  «*        js   8l 

.—    !>  -3  •»  Sol* 

a  s5  s  *q  o  &.^>  c  a  o 


fa 


.5.5.2 


0?  "3    >> 


a  2- 


05  «e 
as  .3 

.3  *  * 

4J    Ac! 

CO 

*  s  > 
flT-a 

O    n    fa 


-3  a 

•o  2 
a  a 
3*2 


Xi  ^    fj    ©    0    u 

a  'Sna 
e>  2  a> 


fe  a  a 

jg    PhCC 


0J    53    id 


a  <D  £ 

"Ofl  o 

(3  =tt 


.a       s  oo  '*- 
tc  to  o  o>  © 

eJSP° 

o3    B    So    = 


-^   -*J    oo 

o  ^3  a  e 

00     hQ  bJD^H 

.2  "C  'oo  ^ 
03       .    <U    r; 

ft.9"3 

a  a'S  * 
§.2  *  & 

«  ft-a,5 

.3  osQ  -a 
.£  ^a      'a 

a  o  is  =« 

ra  o  oo  o 


.2-3^  g 
«  &.SJ 

*p    o  "     0 


05 


!    to  O 

■  "  ft 
1  2  a 


O     05 


a  e»  w 

o  "a3 


05 


':=3  g, 


^s  a  s  e 

j*    f*    ft=3    o 


a  i  ^  o 

^3    o5    05  =4-1 


m  2  a 

Ms 

^>    05  P 


Tr* 

^3 

H 

C5 

g.2 

99 

a 

00 

•  -H 

o 
a 

«     00 

OB 

— 

CO 

a 

°->  b 

B 

•p.  si 

y4 

n 

P 

-a  a  oo  >-  S  i  a 

=2  |  Ija     £  I 

ta  a  t5  t,  "  « 

o?  -a  rt  13  >    .  « 

A  -.      QJ      flj  00 

|>^Ja|j 

2  p  05  ^  2  %  a 

•a  o  a  -  -r  *  * 

-4--  p — '  a   ~   >~  5-  ^j 


-a  =£13  -s 


O    S)  , 


lO  J3 


02    & 


'—     —  I— - 
"3  13     . 


a  a52  g 
2  a-a  g 

rK     05     &    OO 


t°  0-1  K^    0* 

ni  r^  0D  Q3 

3  05    g 

3  s  »  a 


.-         X^:    si   fl 
a  13   »   tc^J   2 

•3  J  «g  S  "g  S 

4-^  __  -»    o.  a 


13    e5 


O    &.. 


13    u 

a>  a 
a£ 


6C  „;  -a 


05     05 

"     00 
0) 

qa 

oo  rr 

fl«a 

a,  o  o 

a 

a  a 

a  (h  o 

03  13  ,2 


X83   |)UB 


>+.s 


5C   &H 


1880— Medical. 


225 


i*-g    9^    1 


g    f    O    J 


<U    *     * 


^   qj 


2      !S  o  „  ■  -g  £ 


s 
n 

..    o 
C    u 


S'S^ol 
fl  £  -3  2 
o      S3 

T3  T3  #S    H 


«    a.    C    E 

'S3U  c 

-B      -    =K 


A. 5 

00  ^  £ 

-g  *  5  -o"  fog 


ft 


03 


QJ 


co  *o 


to 


CD 


.-h    O    ft  ITS 


js  ■*=>  -g       £ls  ** 

3   bo.SPfi   >   o  .d 

«*    CO    to    O  <H    O 


,  «H 


,§    ft™    D,tH    «3«( 


s 
© 

I 

*© 


^ 


5^ 


X 


1-1 


V 


to  h 
3  a 


"  £  a 


A«A 


32 

00  S  'O  -33   - 

,£3  <U.2    CD  ^    03    3  " 

.60  I  t    p,  g    P    to 

_,  P    l-H  o         o    co  « 
5.         .-  o    ..  -u    cs   o 

g  g  cuJ   oj  »        ^  1 

-     O  2     M     tOCOrQ'a     21 


;  ^  9  <b 


S  a>  o 

O        M 

ft    « 


S-'nd  So     .  *S  « 
■eo  s  ftja  ^,2 

S  ^=  «      fa  .SP  § 


3  3 


Ill's, 

o  <<-i  a 

03 


>    C 


03  ^2  H   B  w 


=  ao  ft  s 


H     eg  CO 

"2     *co 

*  §  s» 


pi  p- 


o   o 

>  a 


O    aj 
o 

03 

.  * 

tog 


05  J3  5  N  .3 


ci  -e 
1.3 


£   e3  -w 

S  Phi-i 


cu    ao 
(h    03 

5W. 


CO 


—  ft  V 

*    w  • 

9  8,2 -8  I 


•h  2  2^3  SI 


5  ^2  3 


T3    9 


1— 1   o 


03  o 
a>   '— 


S^ 


^  »^   a  j) 


S^  8 


Ci    co 
i^  o 


o 


00  '3    B 


a  >s_ca  o 


Stt 


33    o3  i-t    0J    t. 
^3    cj        — '  t3 


tO  o3  1 


B  9 


13    O 

s  -a  g"   a  %y  & 


...  a  co 


S's      bE 


o  « 


9  2  be 


1  -       > 

'    03    U    U  Ph 


p<5   -« 

«  OQ  ^j  cS  +3 


H  O 
.  00 

e  00 


to  00 


226 


1880— Medical. 


03    ^T3 

■*  a  a. 
to  5  3 
VE    p.  03 

be  © 
.2    .*■ 

§-s  § 

Be  6 

O    O         ■ 

a  £  t, 
*   3 


>-*     0!      •        • 

03   eS   x   a 

13  &  "  g 


B  .8 .2  £  g 

3    X    E    eS    S 


02     > 


"S  .13    ^  I3    it 

**  13    03    g  -fe 

bc«  g  «- 
-w  •£  en  _ 
trt       °      *a 

03  p<  co    as 

a  p<  a  'a 

O  T3     «   -3 

03    2     X 

o,     .   p.  a   as 

U    03    Pi 


■a.!!!«'35P 


PQ 


u  p,,p  -u  *j 


H    co    oQ    O  i 


P<  03        . 

«    B  TJ 

O     O     03 

"« -a  "S 
8,2=2 

S   >   * 
p  a  03 

■      eo  oj 
o         P 

d  b  ea 
'55  +3  be 

p.  (3  be 


C    f2    0)  J3  i 
3         ^    a 


o  a  2  p-a 


*    a 


U  r&    w 
^     03       - 
CO     CS 


2  ^  a  a  2 


*  5  "5 


e  s 


bCfQ 


us 


to  ~j    03    d 


3.2  S 

3  fe  a 
03  «  a 

'■  §.2^ 

1  ,S    .P 

!  *&     p    -U 

i     >  J 

1  aJS  %• 


«0^ 


p„p  .g  .5  £ 


'J     S     S 


B 


■     ■+»      »      "•    A 

o  Jp  pYgj ; 

2  *  F^-S 
^  §  S  S> 

|  .2  7,  g,  S  . 
.  >j  bp_  ^ 

5  -3  -2  .2  o 

>     03     P     P     — 

,5  ftce  S  c 


g  03  s 


I   2i 


be  c3 

a  "S  a 


i^2  ^ 
_2   o   3  ^ 


i  1  "fiS1!  i a 

H  5  o'-t's  ?  p, 

^  oi  ;«  ji  u 
2  03  c  5=2  §  g'O 


2  I 
I  " 

I    o 


o  OS   p  o  — 

^CO^'BrP    C3+ihJ    CI 


5,ao 

TO    o 


£  o  p  "3J 

P     03  * 

O  et-i    X  CO 

!  l^'  I 

:  ^    »   C    -' 
CD    2  -f5  fO 


*2 

;  a 


-     P,«fH   _   , 

3  *3% 

^   03   be    .   5*1 
_£-  .P"  co    P.  o 

bc^  T5  *S  A 

P  pij  "S     CO 

•£     .»   03  -—     .^'co 

I    "3^    £     .    >» 

*^^c5? 
^  2  §       2  5s 


**3 


M 


ij 
m 

Eh 


Q  «P     03 

I  -J  >>  s 


■  33  3  _£3    5 


a    °33 


03  K 
P.^ 


-S  tS 


■     n,     CO     w 

o  2 


03  00    9" 


—     03 

a  a 

a  .2 


p.'C  o 


CO  03 
^  03 
-    03 

'P  »v 

■   -3 


* . «  ft  e-  ?  a  u 


33-r.H  g 


H  -O  -S  .S  *   S 


03 

03  °_ 
,A     '"  °° 

~»    oj  O 


P.CO  ^3T5^H 


S  a 

03    XI 

£  2, 

oo 
I 

*.S 
•  +=■ 

— -     03 

■&VS 


i     03  'O 

p  a 


2  «j 


01      rS  C 

.2  2  5  « 

a.2o» 

^H  CM 

£?s  a  2 

03  53  53  I 

>  a   c«  I 


B-o  a 


bc_ 

a  t#  >  p 

S rH      .S 

'a  S5^  p 

O  w     p    o 


>     03  _p 


B'j 


T3 


03   $   a 


.5   ea  -a   ts 
«   be  be  be - 

P,   0)  •£     03 


£?« 


-^  a 


ffl  5-  m  3  S 


Ph  o 


-u  ^4  _ 

P     03  — 
03     03 


be-^ 


p     P     03 


>  Ph  rH  ch 

Cm 


.a  o  ^ 

a 


r3  ° 

~'S  a 


P. -a   o  « 

a  <J  -S  ^3 


-    03     p     CO 

br  P  *~    « 

«  s 

IS*  p 

e=*^ rs 

rrj  03     03 

3,     °     " 

_,  3  5a  t3 
"2  be  cs  cs 

3--  03 

ej  53    03  £1 

.P       03      S- 

-w    O 

.2  .2  S  .2 


10  2  2S  2  w-a 
k  «  g  be  %  3  .2 
°      Sc6  »  -eS 


I  a  s 


oc  A 

Jo  .2 
-a 

-2  a 
«a  -3 

o  ? 
a  «> 

•p  3 
a  03 
^3  ^ 


**»  -    ^*  53    tS 


O  53 

Ph  03 


03         eS    5P^ 
>    m  5  •; 

cj  03  —  -<  ; 


03    £    o  53    O 


a  a-a 


S    2    *    03  ~  '-^ 


X     C3 


^     SI 


t,    cs    ~    el    03 
cs   bc-i  be  p   03 

03     03     CS     03     —   _p   ( 


^a 


_;  co  — 


1880— Medical 


227 


*-t  r^     0)     jfl     CJ     S 


i-a 


3=  is 


oS    >• 


3  a> 


§  ^  o  ©  £  £  j?  o; 

0)    3    O 


-"-* 


a)  q-i  T3 


S  g  h 

P3    3    o    © 
<£:=     3^ 


O  r^J 


Sl|° 

en  00  .B      *  H 
P.43 


>>£ 


^3 


u  'u  +?  .a    03  ,a 


*h  .a    „ 

.2  Ph 

•+o>  a  B 
C  £  03 
es  ^j     ^ 

B 

B^ 


?T3 


bfl 


>  a 


fl-l  a 


5    01  -W    e    09 

.2  "S       ° 

5      6C.5  ° 
2    .  t*  ^  <u 

S     (h     0J     CO    ,£) 
+2  "72     CO     P-  — 


11  on 


a  5  Js  -s  %  £k 


«-  o 

a;    a) 

"BJ'S     ' 


a 


:  X>  SB'S 


•  u  8.3 

CO    0^43 

S3  so 

bog 
S    OS'S 
C    g    E    to 

£  x  os  a> 
a  °       Sih 


«     „     QJ 


Ph  os  08  5  ,2  .5 


©    _•  "if    ©    b£i  E      I      CO     •-   r- 

11  ail* SIS* 

*-h        to    B    "*  OJ  fi  'r1    is 


o  .2   o    •-  a 
B   to  0   E   os 


I    *©  Ph 

pP  03  t^     Ph 

3  •=  s  -  °  g, 

"5  g  £  =2  o  -u  3 


r-i  00     B     •"    0J  t>  •«     £ 

I  g  „*  *  5  5  o  §<  J  »  ffl 


g   S  *"   C  C  Q   Ph 
1.1   «   H 

p°J  0  -5  ■&£  i  I  •!  !>  s 

3ua  rH  oj  o  o<R  £  «  s 


.a  TS 


rs.      ■*> 


'O    1-    oS  to 

oj   B  *" 

U    oj  "B 

P.—  O 

d,    <u    c3  += 

d  fc  P 

T3  T3  °      > 

t„     ^     to  CM     ;_, 

es  CO    cS  O    OJ 


>-,  CO 


SP  Ph  S  S  .S  ^°«   a* 

^SSftpH^caH 

o  es  ^  03  p  a  .  a 


6C 


.2  te  o   c«  J   „ 
p  2  s  2  .2 


.2  a  S  8  S  a      •  I.  «2 


O      C»    r* 


3-IS-sfe 


Ph    >  Ji    *£># 


■*  a  e 


o  3 

—    03    to 
O 


^a  e  § 

■7;    aj   oj  .B 

,=     tfl     *H    -4J 


^    oj    B    A    0) 
to    U  -to    u 

s   O1S41 


^s    |,=  1 


g-g'O'g    03 
>  •=    oS 


00  ^5 


'fc  2-13 


O    3    g  -iS    Ph  pey 
o  es        as   g  ft   O 

01  o  g  »£  a 
e  »  0^  oh        o 


_ifl«fH 


E  .2 


QJ    03  -ta  rO 


rtJHJ    e 


b  i 


a  2jS  >, 

oj    p  ♦=    es    t» 
"  "S        T3    B 

PhjE         e     . 

,a  §»  gtj 

i  >o  2  IS  o->  .2 

.CO    S*j2'0 


03  5a 

£    03 


•     OB  re  r«     A 
g     hC"S     "^     Ph 


o*    s.h    J   to    S    o   fl 

g  g-  &  a^tS  g^  g 

2    Ph«   -   P^W.S  ^o 


P      O    rP    "B 
H   hrH  B 


ce'o  2  P  Ph 
003=w^ 


cp    s 
S3  b 


a  > 


B    CJ 
!  ^4    O 


>    0) 

OS     o  tu 

Ft  "**  (H 

pV,  to  o> 


a  "S  e  be  c£  2 
+0  2  o       ^Bh 

^&3  a     bc 


a  -=  H  0  b 

•^  _0J  =H  ._   ^ 

1J     CD     S  ^  Tj    ^     CC 


)  OJ     CJ 


3     OS     B 


K 


1  ^5    03  SB  CO  T3  =2 


^5 


«fe 


3- 10" 


228 


1880 — Medical. 


i 

to 
© 


X 


B 


-"  g 


a  c  o 


jj   ai  «   •" 

1"     K  C     r< 

O    «  2    S 

S«  o,2 


^    60 

c3   03  ^  *o 


&a 


_3>    e3 


9  is  a 


a,  p,ja 


£»  S  o  "S  ^  5  8 


■8*3  8 


"3  S  S 


So        e«  S, 

£  o«  «  a 

83  M  *Ph  g     8 

8  a  ; 


32 


§8^^B 
is  'O  rs  .    c< 


a -3 


^     S     £     ?-     5     QJ  ' 


g  °t>  p.^ 

£    «,  g-S,* 

*^u   »   e    a 
^    o   S   ^   «   « 

£  *.££  --g 
ft  -S  «S  F  £  0* 


a  .a 

0)     CO 

a  g 
o  « 

O    ao 

3^ 


5  a-s  8 

a  j^os 


On  CL, 

Ma 


S3 


0> 


&  a  .  a 

£  o3  a  o 

CO    6C+S  ,£> 


o3  a 


oMr 


© 


> 


8 

I4 

V. 

5* 


4 


3 

I 

w 

B 

H 


S  fe»  a  -a 

J^«  bp 

"S5  £ 

riet 
d  ca 
gin 

stt 

03  o>  s_  a 

ftiOO    g 

'    be      -° 

a 

H 

8 

p- 
p. 

09 

S 
5 

eft  frontc 
o  large  ra 
hich  had 
aris,  and 

o 

S 

a  F  a 
«g.5       g 

a*3 

part 
ed  u 
rhag 
3  len 

Oh 

u  -a  fe  a 

oj   bD  2   o> 

15  g  a  -3 
§,2  8  a 

^  a-a  a 

D-tM    . 

ose. 
herni 
us    0 
knew 

comal 
right 
fund 
but 

3 
o 

p. 
S 
>> 

"3  os  a  jj" 

t»    03    OS    PL, 

|  Ph  be  ■ 

5  »  I  o 

SJ-S  a 


aj 


"SH 


^3    O    aj  i* 


i    ™    h 

>j  s  a  o 

0j    O    03    U 

all  -a 

§^» 

« •§  g  '-S 

(Ofl   $   » 

-  g.S  5^ 
•<     


a  oo 


03 


>  oo 

O  i-H 


a 


1880 — Medical. 


229 


3     .2-3  « 

e  2  ^  .2  -o 
a--  2-5.2 

.  g  a  g-| 
3&s~J 


\JS<  ■•■- 


bo  03 


oj.2  >  a 
£.2  «  8 
«  £  > 

3    03  ~*    °0 

Q,  >     S3     >> 

.S~      M 

to-S  « 
2  2t3    • 

US  •■'  <u  -g 

£  bole  § 
.a  a  o,-e    . 

S  SI  | "3 

_  45  a>  o  a 

60 


s  s-e  s  §  § 

«   *  W  .2  >»  g 


S  fl 
i  fl"gl 

id  «n 


•  s 

^2 
o>  o< 


3  s  a  «m 

O  ^  o    «J 

a  a  M  - 

a  °  ..  9 

H  -J3       "™ 

O  Ti  " 

cb  „2  a  -fl 

-fl  3  2 


.fl    3 

§bc  g 


— i  03    6> 


^^ 


^ 


a<r-  13 


S        •  >>     "fl  >-  a      ^»^s 

•*        "O    03  43         i;    «*iS    » 


S»SM 


-a  "B  a 

§/o  bb 

2-? 


-  fl 
a  35  o*_: 

1H    ^    O    * 
60  bcO    O 


03  C    O  t*-i    03 
03    O    _   O    bD 


o5   >   ■ 


&  '5  =3  I  *crS  S 

©    g    °    |    3  S    =0 

a  5  «  5.  2  °  -»  .S  —  fcf 

,3  oa  -u  *=  -S  i;  r1 


fl^ 


-O  'S    fl    «3 


w 


'  M 


§fc 


co 


g§-§3. 


2  « 


-5c  a  3  an  § 

-o  .2  (2  -2  W  a>  -3 

03    p."    O  03    03 


-.2* 

•s  a 

8  2  b 

a    fl 

be  2 


.2  53 

TO     p^ 

o  ts  a  • 

J3   43   43 

a  a 


*sj  I  !i  Lai 


Q  -fl  £ 


03    S        ""J? 

'Sd  *  9  2* 

CB  M  iH  .9 


I    .2  a  1  h 

^  £  -    i    3 

rg  ^  «  H  pu    - 


03  A*    QJ      Q    ?4_ 


Pifl    O    91 


-^0,03 


'3  £-2 
bclz 


o  .2 
.!3   _,  .5  *" 


fV.aflg-ssHgoi'So, 


-^^1 


fl  ^5  | 


»H    «    P-.-«  ^3 


?"       S-g  o 


go  S  QO  -f  >  s 

3   «   OH    S    - 


oT^B    2P  ~T  to 


a  »  Bns-g    ^  a 


CB 


03 


03  CM   ej 


a  s 

0)     03 


a 


ii 


_   .SOS'S. 
5.2  5-03NEH  ^^  Tc-03 


'fl  fl  .„ 

fl  —  J     >,« 


ns-^flfl^,    203'303'fl 

I      -g  a  v  a  fl  2  .a  » 


43      ■       03     to     ^7 

03  n3    >    o3  _>> 
aj    53    03  hj    03 

ns  03^^-g 


C3    >^ 


T3    0) 
'3    ~ 


03     S     g     PH-S     g     ^43 

•a  ft  o 


a  9  s 

a«s5 


a  X)    o3    cb  13 

rA    fl       " 


a  a    .** 


3-2  fl^^^H^, 

Qi    03    03  'r*    w    ^  ^^ 

g  -a  bo  i*^ 


o> 


4J  «     -5^ 


.2-5^ 
1-fl  S 


cc  • 


Bfl    g  -a    03     b 
.03     fc     3  -fl   "fl 


CO  ,£3  „fl 

be  A 
c.2 

I  olS.n.26 


M 

'  -  S3    60 

~  .a  IP  ^  .2 

^  43  os  a 


U  J3    h  '-5    on 


a  Q 
5a  2 

03    fl 


"S  °o 


60 

3 


U  00 


O     .    .P     -    • 


H 


230 


1880— Medical. 


a   a  2  -a 

<a  jS  s 

||  || 

*    ®    9  "m 

32-H  9  1 

eS    Q-i  o 

CO    q    OS  o 

CB  'g 

9    *"  9 

-  *  ®  8 

^   -    6o  > 


es  >•.  2! 

s  s  g 

w     2     QJ 

g  2  £ 

©    80 

«-2  j 

E  S  > 
5  "^ 

-u   9  -2 
Co 

••■§  * 

.2  9  S 

es  •- •  & 


.2  ^£ 

a  g.s 

.9°cS    3 

a?     '& 

,9     CB 


"    9 


2  **  2 

*!*• 

*    O    g    8 

••  a .«  3 

6o  5.5,* 

9    °-  ._    n 

9  -2 


S  J?—.    9 
©  S  ^3   9 


9    s 


S^a 

2    5s    hi 


i'H  a  a 

I    «3    >»  9 
.2-9    « 


5 


21  I 

CB   i — i      tf 

60  g    9 

9-S3 
pa  °^ 


w    0)    5 


a)   .3  ^3 

)X    ci    n 


co    — 
Si,*3    9 

£Pcb  8 


"■<"  5.  2 


0-3  s 

'«£    cj    K 


CS    ™    a    O    r*    ^h 

8  '6o  g  ova 


9    3  9 

— i    £    as  9 

o   as  a> 

S  g  w 

S      >,    ..  O 

O  H    f»>  01 

m    <u    ®  fl 

a  so    9  ej 

•la  3  £? 

-83*  ° 

<o  cb 

60  2   . •  -9 

^   w   x  o 
9    8    9,-S 

9  -2   eS  <-. 


a 

9    §    5 


J2  s  su  qj  o  a. 

-    Q*cb    . 

-9       -3 

9 


v    o    s    rr  j-i  _ 

60  _  r-O    **  -g  "« 


9-3 


o"     "      0)      «      O 

?3  -»  a  o  v 
o  >3  5  &,.£ 

9  tt-i 
to    co    o 


5"M 


9    .„  «    °*  g 

OtJ    3    S    O 

3  .2  -S  a'* 

m  S  "9  9 
"  ¥  H'S  O 
9    60  9  ^  „W 


£  e5 

o  e  «  a 

a   g  »  a 

a   9  ja  u 

>,  o  u  o 

-a  "^  a 
§  ..  P." 

oj  6c  >>  S 

ASS'S 


^•5  9 


g    O  J3 


'-   -w  ^5  _Q     w 


j  a^ 


?s 

to 

o 


e2 


2-oV  a 
•2  g  s 

-9  Oo 


a  j 


.5Pa  a, 


IS 


a  a  p 

CD    cu 

«>  -9  o 

-u  9 

•~C4_ 

as  ^h 

&~  " 

I  •  rt  a>   2 

I.  "S  60.9 


e«    in    S 

9  pa  ^a 

JT  . « 


a  a 


■<*l    .«    9 


S3      n  a 


a  s 


S  o)  a  «  S 
a  o  hS  a;  33 
i-s 


«H    9«1>.    /t 

o  "        a  J?  2 

9  2-^ 
eS    «  -^ 

2    §    9 

3.3  g 
-SI'S' 

9    51    9  ' 

g  «  a 
a  co  a 

■J.I3- 

'S  "es    I   ' 


-.  a  §  * 

cu    eS  "J3 

js.:n 
.2^8  ►, 


13  2  . 

as   a  9 

t3  'u  <u 

T3P  a 

2  3 

CO     "S  en 

3  ^  O 
.2  -9 

as   6c  cu 

S  'S  " 

-t3    o  =»-  (, 


o  OS 


"\     — ■       TO  " 

T3    9-*  2 

as  •-"  r3  " 

*  ■»  s 

9    §    <u  9 

as  g^  fe2  _ 

^  a  a  9  acs  o  &h 


as  fc  a  a> 


eo 
>>5 


9    fe 


l?5^! 


CO    O    O 


.2^-i    gOO-rj  T"- 


60 -u 
cS  J3 

60 


CO  >    oj    5  ■" 


afl  ^ 


a  ■"  a  «  „• 

O    es    ©         3 

»-  "flo 

g  -i^a  6o§  a. 

!"«  cb  j  .3  8  ^ 

a  ^  2  o 


■§°a  I 

S  as  9  -• 
9  rrl  .O  ^5 
a    u  9   « 


^dg"3  a 

»  §  o  a  * 

&^    ^    9  0 


•«  *  w  -a  3  -°  .2  J 


>-.^-s  3 


as  ^9 


JS*»s 


fi* 


co     .  -w  r^ 

co  -e 


60  _ 
eS   cb 

60        cb    60  S  ".3 

P,c2    £  CO    >>  cS 


; «  "3   (Vg   9 

!  °  >,«  h  5  « 

j        -t  -2   a)  ."a  -rt 
>   >>-g   ei^!    a   cb 

*  cb    r      crS 

O    eS  M  cn    o  <1 


S'S   6b 

13  <3 


as    es 
2    ^*, 


Q    £ 


O    ^H 


g  as  co 

•a  a  t3 

■  fl   rt    id 


0)     s.     SB  .S 

;S4Sg.ss.aifil|| 

•  ^eo  a^a  ana  r»H  «M  3 


t-i  *a  cb 

eS  g  jj 
p^^a  eS 
•<1  co 

sl  3 

a  6o  o 

.2*B  ■* 

°  !» 

00    9    > 

a  5  ai 

O     P  =H 

as  sfcl 
a         c3 

i    a  ^ 

.a  eu 

9,2fi 

+s  «o 

OJ   9 

2  1* 

-S^-60 
*-.  "S   as 
8  p-i 


S 


3  Si 

."2     CB     CB 

O    61 -S 


2  S5 


°  3  « 


^3  a  'o 
a°§^ 


■*  o 


&H 


a 


.9  S i -o 

5    s 


1880 — Medical. 


231 


i    5   5    2  -P    rf   jj 


3ftS5- 


05    O    ^    O   o 


a  s  e 


«  oft  3d 


.a 

ODrrt    cu 
.a  -S  ' 


£'-8 


be 


a. 


S3 
-M      «D 

-a  9 

3  CM 

6C  O 


s.a  srfg  2 

puZS        d  .2  2 

*  *  0,2-55 
■S  a 


:W  &" 


5.2 


o  g. 


■3  a  3  >■-£,£  » 

'  h  -a 


ra  o  o 

0)    d  f 
co  -7!    r* 


if  l  .1 

!  "*   be  cd 


I  °  *g  g  a  s  fe 


a 


a-=> 


3.S 


;   £*£ 
i -a  S 


3    * 


CD  T3    >    O  tJ  ' 

=.  «  °  -3 .2 


a-S| 

to"  § 

S3    M 


JS  ™<Z 


*a  .1  £  =g  >s 

f!J         a 


^  ss  "3 
t  3 


=H     O 


<u 


w    rH 


a  9 


a  3  p 

co    a    ^ 
C3    fee 


a,  in  a  ,2  cu  rjjj 
5  I  -I  -g  |m 


.2- a 
8  S 


si    cu    P-n 


^-3  3 

.5  So 


&-? 
to  .to  ft 
fee 


CD 


CO 

«i    p 


r3    b  ew  r3    s3 


£3 


J5"S  5  &, 


CD  rt 

•°  a"* 

a.S 

•"  -a  ^a 

.5        cu 


3   a   «io 
c   a  ,2  <u 

CD     cS 


■S  3-3 


£1*  CP 


ft  H 


_  a  =h  -a  o 
o^a  a/C  _ii  £  O 


,  -a  cb 

>  2 -a 


oH 


2  2"* 

£   — '     CU 

O  ,3  "3 

1)  >T-J 

an  a,  o 


O    £    S3 
CU  r^     CO 


*  a 


A-S 


OS    ■« 


0] 


>-. 


0)1 


iH 


a  ^ -a 
.2  a  2 


01 


a  -S  |  .a  1  =2 


O  « : 


_  M  ,a  s  a  * 


C3 


a  -s  g.S3^ 


rt     C     00 


2 '3 


=  «^^^ 


..  \f 


fl_  a 

S  ■  a  2  " 

ect  <P 

a  cu 


P  o 

CO  iH 


H  a  u  n  its  9- 

c  a  —    I  ih 


<u  "3  'S  2  ft  a,-t5 

a  s« 

°    2  N 

CO     w 


CO 


(.  J33 


-w     U    ®  J 


S3    ^3   rr?      CJ   ^ 


ra  T3 


S    eo  i 


ftd.*2  3  „s  Scotch  a  o 
"   NW    O    Phi-H  . 


«H     CU     >j  -       ■       CO 

d    ajV.    an 


£ 


.5  H3  <3  Pm  a 


,5  6C^  &S  J 
p  p  co  tj  N  n3 

I.  ^3  ch  o 

<a  s3  _ft  r^  o "  cu 
a  o  a 


•2S, 
W3=2 


o  CQ 


a  " 


2  ° 

a  « -e 


*  #g  ^  a  ^ 

2  '3d  co  vs  co  j> 

6p.jH  ^  cs  a>  P 

2  a  «     a  „ 

»-   cu   cu  ^_  .a  o 
CD 


Z     to 

I     CO  .2 

r3      S3    'Vl 


rtU    tj)     , 

a  ft  a  co 

CU     ft     SS     >l 
CD    O-.  rt    cS 

rOO!    o-O 


T3 
6D 


60 

P 
<5 


pq 


8 


SPECIAL  ABSTRACTS. 


I.-SCARLET  FEVER. 


With  the  exception  of  the  following  there  was  no  very  remarkable  case. 

E.  Q — ,  set.  15,  female.  A  younger  sister  of  the  patient's  was  suffering  from 
a  severe  attack  of  scarlet  fever  at  home.  On  Thursday,  July  2nd,  patient 
had  been  in  her  usual  health  and  very  good  spirits.  On  the  morning  of  the 
next  day  she  complained  of  her  throat  feeling  sore,  but  she  continued  up  all  day, 
and  was  engaged  all  the  afternoon  in  washing  some  of  her  sick  sister's  clothes. 
The  sore-throat  got  worse  towards  the  evening,  and  on  Saturday  morning  she 
was  delirious  and  in  all  respects  much  worse,  and  continued  so  till  the  evening, 
when  she  was  brought  to  the  hospital  and  admitted  ahout  7.30.  Her  sister  had 
died  in  the  morning.  On  admission  she  was  a  well-nourished  girl,  unconscious, 
with  no  eruption  visible  on  skin,  but  the  tonsils  were  swollen,  and  there  was  a 
white  patch  on  the  left.  Temp.  103-4°.  After  sponging  the  body  became  very 
livid,  and  a  petechial  eruption  appeared  all  over  it.  The  temperature  rose  to 
105'3°,  and  she  died  two  hours  after  admission. 

Post-mortem. — The  mucous  membrane  of  the  pharynx  was  much  congested, 
the  tonsils  were  much  swollen,  and  in  each  was  a  large  abscess  containing 
yellowish  pus.  There  was  no  obvious  change  in  any  other  organ.  The  spleen 
was  small. 


II.— TYPHUS   FEVER. 

Both  cases  nurses  in  hospital. 

Case  1. — M.  C — ,  aet.  22.  During  the  last  month  has  been  nursing  three 
patients  suffering  from  typhus  fever. 

On  November  15th,  1879,  had  headache  and  nausea,  no  vomiting.  Felt  very 
cold,  but  no  rigor.  Has  lost  her  appetite  and  felt  pains  all  over  her  and 
lassitude.     Has  had  no  diarrhoea. 

On  November  18th  spots  were  first  noticed  on  back  of  wrist,  chest,  abdomen, 
and  upper  part  of  thighs.  The  temp,  was  1046°.  The  urine  contained  no 
albumen.  Tbe  next  day  the  eruption  was  very  copious,  and  on  the  20th  she  was 
delirious.   The  temp,  reached  105°,  and  the  urine  contained  a  trace  of  albumen 


1880 — Medical.  233 

From  this  time  she  passed  into  a  typhoid  condition,  lying  on  her  back,  very 
restless,  moaning,  passing  her  evacuations  in  bed.  The  temperature  remained  up 
with  scarcely  any  remission,  the  highest  noted  being  105"6°,  and  the  lowest 
102°,  and  it  generally  reached  or  exceeded  104°.  On  the  27th  it  sank  to  lOO^0, 
but  rose  again  in  the  evening  to  lOZ'tf.  On  the  29th  it  was  noted  that  she  had 
the  physical  signs  of  pneumonia  at  the  base  of  both  lungs.  On  the  1st  of 
December  the  temperature  sank  to  98°.  On  the  3rd  the  rash  was  fading  but 
still  present;  she  was  still  in  the  typhoid  condition.  On  the  evening  of  the 
same  day  she  fell  into  a  deep  sleep.  On  the  evening  of  the  4th  she  was  quite 
rational  but  drowsy,  and  had  ceased  to  pass  her  evacuations  in  bed.  From  this 
time  she  continued  to  do  well,  with  the  exception  of  a  rise  of  temperature,  which 
lasted  for  a  few  days,  and  was  apparently  due  to  some  recrudescence  of  the 
pulmonary  complication. 

She  was  treated  with  carbonate  of  ammonia  and  from  4  to  6  ounces  of  wine. 
On  the  29th  of  December  she  was  sponged,  and  temp,  fell  from  104°  to  102'6o. 

Case  2.— M.  A.  V—,  set.  35,  admitted  December  30th,  1879.  Had  been 
nursing  the  last  patient.  Not  felt  well  for  fourteen  days.  On  the  26th  com- 
plained of  headache,  felt  very  cold  on  the  28th,  and  on  the  29th  had  general 
pains  in  limbs  and  more  headache.  The  temperature  on  the  30th  was  103*8°. 
On  January  1st  the  eruption  was  first  noticed,  and  was  very  copious  next  day. 
On  the  night  of  the  5th  she  rambled  slightly  for  the  first  time  and  continued  to 
do  so  the  whole  of  the  next  day.  On  the  7th  she  was  very  deaf,  but  quite 
rational.  Rash  had  nearly  faded.  Temp.  101°.  She  had  had  no  diarrhoea.  On 
the  9th,  the  thirteenth  day  of  the  disease,  the  temperature  fell  to  normal,  was 
slightly  raised  the  next  day,  and  from  that  time  forward  patient  continued  to 
improve.  The  highest  temperature  reached  was  105"2°  on  the  third  day.  With 
that  exception  it  never  reached  104°. 


III.— PYEMIA. 

Four  cases.    All  arose  from  causes  more  or  less  different. 

Case  1 — Male,  set.  20.  Admitted  January  8th,  1880.  Fourteen  days  before 
admission  ran  a  splinter  into  little  finger.  The  inflammation  spread  up  arm, 
and  three  days  before  admission  was  seized  with  shivering  and  great  pain  in  side 
of  chest.  On  admission  he  had  pleurisy,  and  pericarditis  soon  set  in,  and  he  had 
from  time  to  time  pain  and  swelling  of  joints.  The  temp,  was  101°  on 
admission  ;  urine  normal.  Case  ran  a  very  chronic  course.  Temperature  con- 
stantly raised,  but  never  above  103°.     Died  on  February  17th. 

Post  mortem. — No  abnormal  condition  of  joints.  Both  pleursa  adherent 
throughout.  Pericardium  much  thickened  and  contained  a  pint  of  pus.  Lungs 
generally  congested  and  cedematous.  Liver  "  nutmeg."  Spleen  very  large. 
Kidneys  healthy. 

Case  2. — Male,  set.  6.     Admitted  February  5th  for  symptoms  of  chronic  lung 
disease,  with  supposed  empyema  at  right  base.     Aspirator  needle  was  inserted 
into  dull  part  of  right  pleura  three  times  without  fluid  being  found.     After  the 
third  tapping  symptoms  of  pysemia  rapidly  set  in  and  he  died  on  April  1st. 
VOL.   XI.  16 


234  1880— ilf edical. 

Post  mortem. — Much  tubercular  excavation  of  lungs.  Large  caseous  mass  at 
right  base.     Pus  in  all  the  joints. 

Case  3.— Female,  set.  13.  Admitted  June  22nd.  Died  next  day.  Taken  ill 
five  days  before  admission  with  headache,  pains  in  right  knee  and  in  abdomen. 
Delirious  before  ad  nission.  Supposed  to  be  suffering  from  rheumatic  fever. 
Said  not  to  have  had  rigors.  On  admission  looked  very  ill;  skin  dry;  temp. 
101"2° ;  right  knee  and  index  finger  swollen  and  red;  also  oedema  and  great 
tenderness  over  right  tibia.  She  was  delirious  through  the  night,  and  next  day 
there  were  signs  of  pleuro-pneumonia  and  pericarditis,  and  a  tolerably  copious 
pustular  eruption  had  come  out  over  the  body.  There  had  been  no  shivering. 
Highest  temp.  102,6°.     Died  in  typhoid  condition. 

Post  mortem. — Layer  of  pus  separating  periosteum  from  bone  over  whole  of 
front  of  right  tibia.  Pus  also  in  joints.  Pericarditis  and  small  abscess  in  heart 
wall.     Infarcts  in  lungs  and  kidneys. 

Case  4. — Female,  pet.  36.  Admitted  October  30th ;  died  next  day.  Ten  days 
before  admission  had  a  miscarriage,  and  since  then  had  been  seized  with  pain  in 
joints.  On  admission  pain  and  swelling  in  knees  and  ankles.  General bronchitic 
sounds  over  chest.  Sordes  on  lips.  Fetid  discharge  from  vagina.  During  the 
night  passed  into  a  typhoid  condition.  Temp,  rose  to  105"5°,  and  she  died  next 
morning. 

Post  mortem. — Pus  in  left  knee-  and  ankle-joints,  and  in  right  shoulder-joint. 
No  infarcts  in  internal  organs.  General  peritonitis.  Spleen  very  large  and 
soft. 


IV.— SPORADIC   CRETINISM. 

One  male  and  one  female.     Not  related. 

Case  1. — Male,  83t.  17.  Father  and  mother  healthy.  Patient  is  the  third  of 
six  children,  all  the  others  being  well.  Patient  born  at  full  time.  Appeared 
well  till  four  years  old,  when  he  began  to  mope.  Since  then  growth  has  been 
stunted  and  intellect  has  not  developed. 

On  admission  looks  as  if  six  or  seven  years  old.  Is  three  feet  high,  limbs  thick 
and  clumsy,  abdomen  swollen.  Head  large,  forehead  prominent,  eyes  small  and 
wide  apart,  nose  flattened,  lips  thick,  mouth  large  and  gaping.  Skin  dry  and 
hard.  His  walk  is  rolling.  Generative  organs  ill  developed.  No  hair  on  pubes. 
A  soft  elastic  lump  on  each  side  of  neck,  just  above  clavicle.  Is  amiable  in 
disposition,  but  obviously  defective  in  intellect.  Memory  is  fairly  good  and  has 
great  affection  for  his  mother.  Understands  what  is  said  to  him,  and  answers 
simple  questions  well,  but  slowly.  Cannot  read  or  write,  or  count  more  than  as 
far  as  three.     Is  cleanly  in  habits.     Urine  normal.     Temp,  rather  subnormal. 

Case  2. — Female,  set.  7.  Father  and  mother  and  four  brothers  and  sisters 
healthy.  Nothing  noticed  till  patient  was  two  years  old,  when  she  began  to 
become  deficient  mentally  and  bodily.  Legs  gave  way  under  her,  and  she  would 
laugh  and  cry  without  reason.  On  admission  she  was  completely  idiotic,  could 
not  talk  or  walk.     Much  the  same  general  condition  as  in  the  last  case,  but  more 


1880 — Medical.  235 

exaggerated.  Had  the  same  swellings  over  clavicles.  Hair  very  harsh  aud  dry. 
She  appeared  to  be  passionate,  and  during  her  stay  passed  all  her  evacuations  in 
bed. 


V.— ANEMIA. 

Sixteen  cases  :  four  males,  twelve  females.  In  one  male  the  disease  was  fatal, 
and  in  one  other  male  and  one  female  it  was  probably  pernicious. 

Abstract  of  fatal  case. — F.  M — ,  sat.  37,  farrier.  Admitted  January  30th. 
Died  February  22nd. 

Family  history. — One  brother  died  with  symptoms  like  those  of  the  patient. 
History  otherwise  good. 

Previous  history. — Nothing  remarkable.     No  history  of  syphilis. 

Present  illness. — About  one  year  ago  face  became  suddenly  white  and  puffy, 
and  at  same  time  he  suffered  from  vomiting.  Has  had  pains  in  chest  since  and 
felt  otherwise  weak  and  ill.     Has  had  no  haemorrhage. 

On  admission  he  was  well  nourished,  but  intensely  anaemic.  Eyelids  cedema- 
tous,  and  legs  slightly  so.  Pulse  114,  weak,  compressible.  Haeruic  murmur  at 
base  of  heart.  Temp.  100-2°.  Urine  normal.  It  was  subsequently  noted  that 
the  white  corpuscles  were  not  in  excess  in  the  blood,  that  the  urine  on  one 
occasion  contained  a  trace  of  albumen,  but  on  other  occasions  was  normal,  that 
the  spleen  was  enlarged,  and  that  there  was  a  haemorrhage  into  one  of  the 
retinae.  The  day  before  his  death  he  complained  of  pain  below  left  ribs,  and 
became  delirious,  passing  his  evacuations  in  bed.  The  temperature  throughout 
was  somewhat  elevated,  but  the  highest  point  reached  was  10r7°,  two  days 
before  death. 

Post  mortem. — Body  exceedingly  well  nourished.  No  haemorrhages.  Heart 
generally  enlarged.  Showed  well-marked  fatty  degeneration.  Spleen  large. 
No  other  remarkable  appearance.     Condition  of  blood  not  noted. 


VI.— ERYTHEMA  NODOSUM. 

Eight  cases,  all  females.  Youngest  9,  eldest  30.  In  all  cases  there  was  more 
or  less  fever,  the  highest  temperature  noted  being  103-6°.  In  two  cases  spots 
were  noticed  on  the  arms  as  well  as  the  legs.  In  three  cases  there  was  tonsil- 
litis accompanying  the  eruption,  in  two  there  was  a  systolic  murmur  at  the  apex 
of  the  heart,  in  two  a  family  history  of  rheumatism,  and  in  one,  which  ensued  on 
confinement,  there  was  complete  alopecia  and  a  mammary  abscess. 


VII.— BRONCHOCELE. 

Fatal  case  was  a  female,  aged  33.  Had  had  the  swelling  ever  since  she  could 
remember,  but  it  had  increased  rapidly  during  last  four  months,  and  for  two 
mouths  she  had  been  subject  to  spasmodic  attacks  of  dyspnoea,  has  lost  her  voice, 
and  has  fits  of  choking  when  she  swallows.     On  admission  had  a  large  broncho- 


236  1880— Medical. 

cele  in  neck,  mainly  in  left  side,  and  which  presented  what  appeared  to  be 
fluctuating  spots.  Voice  hoarse,  breathing  stridulous,  left  vocal  cord  paralysed. 
One  of  the  fluctuating  spots  was  punctured  with  a  trocar,  but  nothing  came 
away.  About  a  fortnight  after  admission  she  was  seized  with  a  violent  fit  of 
dyspnosa.  Free  incisions  were  made  into  the  gland,  with  the  effect  of  causing  a 
copious  flow  of  blood,  and  the  discharge  of  some  grumous  matter,  apparently 
from  a  cyst  in  interior  of  tumour.  Trachea  could  not  be  felt  by  finger. 
Patient  was  much  relieved.  For  about  six  weeks  she  continued  free  from 
violent  spasmodic  attacks,  there  was  a  good  deal  of  discharge  from  the  wounds, 
and  slight  occasional  rise  of  temperature.  Eventually  she  was  seized  with 
a  second  violent  attack  of  dyspnoea ;  incision  was  again  made  into  the  tumour  ; 
the  trachea  was  with  great  difficulty  found.  It  was  much  flattened ;  a  tube  was 
introduced,  but  the  patient  had  ceased  to  breathe. 


VIII.— EXOPHTHALMIC   GOITRE. 

Fatal  case. — A  female,  set.  30.  Eyes  noticed  to  be  prominent  for  four  years. 
During  same  period  had  suffered  from  great  palpitation.  Swelling  of  neck 
noticed  for  eighteen  months,  and  has  been  increasing  ever  since.  Has  been 
subject  to  fits  of  dyspnoea  quite  lately.  Catamenia  have  always  been  irregular, 
and  for  the  last  two  years  absent  entirely. 

On  admission,  the  breathing  was  stridulous  and  the  heart's  action  excited,  but 
there  was  no  murmur.  There  was  great  exophthalmus  and  a  large  bronchocele 
in  neck.  The  breathing  continued  stridulous,  and  four  days  after  admission  she 
was  seized  with  a  sudden  fit  of  dyspnoea  and  died. 

Post  mortem. — The  bronchocele  was  found  to  consist  of  the  greatly  enlarged 
thyroid,  the  extremities  of  which  surrounded  and  constricted  the  trachea  and 
oesophagus,  meeting  behind.  The  thymus  also  was  of  unusually  large  size. 
Nothing  remarkable  in  the  other  organs. 


IX.— CEREBRO-SPINAL   MENINGITIS. 

One  case,  fatal. 

A.  G — ,  set.  4.  Admitted  November  5th;  died  November  11th.  Measles  two 
months  ago.  On  October  29th  stayed  away  from  school  on  account  of  headache, 
since  then  confined  to  bed.  Delirium  since  the  30th.  Screams  constantly. 
Passes  water  in  bed.     No  fits. 

On  admission  she  was  very  drowsy,  almost  unconscious,  only  screaming  when 
touched.  No  paralysis,  and  no  discharge  from  ears.  Temp.  99°.  Whilst  in  the 
hospital  patient  had  a  number  of  opisthotonic  convulsions,  during  which  the 
pupils  were  widely  dilated.  There  was  occasional  vomiting.  Temperature 
generally  normal,  10r6°  on  day  of  death. 

Post  mortem. — Lungs,  heart,  kidneys,  liver,  spleen,  all  healthy.  Brain  :  large 
quantity  of  clear  subarachnoid  fluid ;  thick  layer  of  lymph  adherent  to  base, 
and  under  surface  of  cerebellum.  No  meningitis  of  convexity.  No  inflamma- 
tion in  fissure  of  Sylvius  and  no  tubercles.     Great  brunt  of  disease  had  fallen 


1880— Medical.  237 

on  ventricles,  which  were  greatly  distended,  and  epeudyma  excessively  congested, 
innumerable  vessels  running  over  it.  They  contained  thick  viscid  lymph. 
Fourth  ventricle  contained  same  matter.  Fornix,  corpus  callosum,  &c,  all 
ploughed  up.  Brain  substance  very  vascular.  The  cord  between  dura  and  pia 
mater  covered  with  layer  of  thick  lymph.  Canal  and  substance  fairly  normal. 
No  bone  disease  or  other  cause  for  the  meningitis. 


X.— PLEURISY    WITH   EFFUSION. 

Twenty-five  cases  :  18  males  and  7  females.  In  10  the  effusion  was  on  the 
right  side,  in  13  on  the  left,  and  in  2  on  both.  In  15  cases  aspiration  was 
resorted  to  with  success,  8  oz.  being  the  smallest,  and  109  oz.  the  largest 
amount  withdrawn.  In  3  cases  the  operation  had  to  be  done  a  second  time,  and 
in  1  case  it  was  done  three  times.  In  1  case  both  pleurse  were  tapped,  in  the 
other  case  in  which  both  pleurae  were  affected  there  was  intense  inflammation 
with  effusion  of  plastic  lymph,  the  case  terminating  fatally.  With  this  excep- 
tion, and  1  other  case  in  which  there  was  a  suspicion  of  phthisis,  all  the  cases 
were  cured.  The  average  amount  of  fluid  withdrawn  at  each  tapping  was  43-7 
oz.     For  empyema,  vide  Special  Table. 


MEDICAL     REPORT. 

1881. 


By  GEORGE  GULLIVER,  M.A.,  M.B.  Oxon., 

MEDICAL   KEGISTRAK. 


PREFACE. 


The  same  general  plan  has  been  adopted  as  in  last  year's 
Report.  The  general  medical  statement,  the  general  table  of 
diseases,  the  table  of  infectious  cases  arising  in  the  hospital, 
and  the  tables  showing  the  complications  of  acute  rheumatism 
and  chorea,  are  all  precisely  similar  to  those  in  last  year's 
Report.  The  same  is  the  case  with  the  table  of  cases  of  ulcera- 
tive endocarditis  and  cerebral  haemorrhage  and  softening.  The 
cases  of  abdominal  aneurysm,  cerebral  tumour,  and  empyema, 
were  either  not  sufficiently  numerous  or  complete  to  warrant 
their  being  tabulated  this  year,  as  would  otherwise  have  been 
done ;  it  being  felt  that  the  adoption  of  a  uniform  series  of 
special  tables  by  successive  Registrars,  at  the  same  time  that  it 
would  greatly  enhance  the  value  of  the  Reports,  would  facilitate 
the  work  of  the  Registrar.  The  cases  of  intestinal  obstruction 
occurring  during  the  year  appeared  to  possess  several  points  of 
interest,  and  consequently  a  special  table  has  been  added  showing 
their  more  prominent  features. 


Table  I. — General  Medical  Statement. 

Number  of  Medical  Beds  ...                 ...                 ...                 ...                 ...     191 

Males.          Females.        Total. 

Number  of  patients  in  Medical  Wards,  Jan.  1st,  1881   ...     70     ...       87     ...     157 

» 

» 

admitted  during  the  year  1881      ...796     ...     892     ...1688 
Total                ...                 ...  866     ...     979     ...  1845 

>> 

n 

in  Medical  Wards,  Dec.  31st,  1881...     74     ...       90     ...     164 

>y 

>> 

treated  to  a  termination  during  1881  792     ...     889     ...  1681 

n 

» 

discharged  or  died  during  1881 : 

Males.          Females.          Total.        Rate  per  cent. 

Cured 

...     243     ...     340     ...     583     ...     3464 

Relieved 

...     320     ...     414     ...     734     ...     4366 

Unrelieved  or  other  causes  ...       37     ...       23     ...       60     ...       356 

Died 

...     192     ...     112     ...     304     ...     1814 

Total     ...  ...     792     ...     889     ...  1681     ...  100-00 

Average  number  of  days  of  each  patient's  stay  in  hospital— 35-7. 


240 


1881— Medical. 


£.2 


S-S 


■-1      s 

A 

-2  •  3 

•p_£CO 

O     Q     CJ 

g.5n0 

s  s'g*' 

<u  cS  ,p  ^  , 

<J   rH 


P  o 

o  a 


•+3    ^ 


cu  . 

cu  .-  ~- 

tc    ^    i 

rO      P      g 

O  nS    P 

gj    s    O 

^  ~p~  '!» 
o  S~ 


•2^ 
2  -^3ro 


u  -a 
cu   a 

>    cp 

©  p 

t    CU    cu 

^    P 

111 

"ft 


P. 2 

Ph3 


,0   o  A 


8  a  §  =* 

KH     O     0) 


CS 

CD    ca 

A  ^ 

CO 


s  I  a  8  if 


<£    co    ;-,  co 

-^  ■  -  .O  cfl 

ee  ."5   a  ca 

«h   t-   P  co 


.2  a 


«  "3 

P-2 


bo 
<i 

09  -MA0 

:    :      i-i         ; 

09-0S 

<N 

:  rH 

OS-Dt 

rH 

:  <-i  oo 

Ot'-OS 

;  rH 

r- 1 

:  rH 

O 

rH 

CO  ^  CM 

rH 

08-08 

i-l  rH 

:■* 

r-i 

:  r-< 

CO 

:  •>?  ^ 

og-oi 

rH 

rH   CO 

CO 
CO 

X>rH  *tf 

rH 

oi-s 

:  » 

rH  »rt      :      : 

rH 

us    :    ; 

9  wpan 

:  -* 

■  i— i 

:  *o 

:  n  i-h    : 

■<# 

i-i    :    : 

3  2 

So 

pi 

:  t- 

<N 

:  o 

-  rH 

<m    :    :    : 

■* 

00   rH  l> 

cq 

g 

rH   05 

i— 1 

rH  O 

rH 

:i>hh 

oo 

US 

00   O  rH 

r-l  i— 1 

•IB101 

rH  CO 
rH 

CO 

rH  O 

NI>HH 

Oi 
CJ 

CO    rH    00 
HHH 

N 

• 

m 

• 

w 

> 

W 

<1    ' 

a  •  *  * 

CO 

CO 

. 

u 

cu 

> 

c3  =*h 

{Rheumatis 
Nephritis 
Noma  . 
Typhus    . 

• 

la 
ttent 

las 

• 

O 

ENEKAL 

Rothelu 
Measles 

[c 
°C 
cS 
> 

P  5 
P-  CO 

"S 

CB 
43 

a 

Febricu 
Intermi 
Erysipe 

"a 

Cm 

O 

pmi^[Ji:0S 

M 

-isoj 

1881— Medical. 


211 


m  <o  a 
•&  S,ts 

.^a    to  _. 

g3  a 

go  g 

«  1 

en  — '    H 

>>  a  ■+» 

5,5!    i    « 

-  g  I  8 
s  S 'at 

o  o  53 


ei 


en    S 


O    Ct> 

<B  43   rH 


.a  += 


B  ^ 


tJD 


g    V  S 

>  o 

H      O  -B 

«  9  - 

Cy    CD  to 

B 


-B    5 


n3   g 


p^^     CO     _     j| 

In  CD  —  QJ 


IS  <u  a  2 

S  tj  a  t. , 

— '  a  -a  «  ■ 

_<  5  g  -° 

a  o  cj  o 

J*    ~  *>    to 
S  a        a> 

°  •-  „,  « 

°    =3  S    K 

><  2   oj 

X  rH  O  ,8 


5JS 


-a  S 


s.s 

a  o 

Jh     CO 

CD     to 

P-,  to 


&  a 


rP   ^ 


2fl        t 


<M                                                  ; 

r-t                       i-h    ;        : 

l-H                     :      ;  lO  •* 

CO                        rH 

CM                          :  CO         rH 

:             :  rH  ^  io 

i—l 

CO    rH 

Tfl 

rH 

rH          rH                        rH  i— 1 

:           cm    ;  i-h  io 

cc  <m  co          :  O     • 

CO                              ■  rH       T 

O              ;                            ;  CO 

r-i                   CM                       ;  CM   rH  rH 

CM 

imh     ■                  •  cm     •                           :    : 

co  rH     .         :     .     :         .                            .     . 

:          i-<             •    "    :    : 

rH                               .... 

•<* 

•  co  -#  oo    •                                                      ■     : 
:       t?          :         :     :     :     :     : 

rH                   rH                       J       ;      J       ; 

:    :  i-h    :         :  eo 

:             :    :     :  i-h 

;  CM  CO      ;            ;  rH      ;  rH      ; 

:    :        :  rH           cm             :    :    :  cm 

;  00  rH       ;          rH  tJI       ;       ;  r-t 

;  l-H          r-<       ;                 CO                 rH       ;       ;  Tfl 

IH 

;  cm  •*  cm       cm  cm     ■     -cm 
:  cm                            :     : 

cm  cm        :    :             :          i-h  i-h  i-h  -^ 

CM 

rH   O  CO  l-H           rH 

rH  rH  CM 

:  co         ;    ;           io             :  i-h  co  co 

CM  CM  l>      •            ; 

10        :        : 

:    :  i-h 

;  l-H              ;  rH                 XO                     :  rH  rH  rH 

rH                        l-H 

:  i-h    :    :        : 

:  <-< 

:    :        :    :            :            :    :  **    : 

o                : 

rH 

l      Z     •        00                        11            II                  I                  1      I  "^      • 

■*                                      r- 

•  its  cm    :      -<? 
:  *■»  rH    : 

rH  CM  CM          r- 

CM  rH             ;      •               CM                CM      :  CO  OS 

:    :          rH 

g  co 


o 

rH 

:  co  o  o  co 

00  ^ 

:  o    ;    ;  o 

CM 

:  co 

rH  CM 

CO 

:  co  io  co 

l-H 

rH 

rH  CO   lO  CM  CO 

in  cm 

■^l  O  rH  CM  J> 

rH 

CO 

CM  J> 

7-i  CM 

I-H 

CM   CO  rH   lO 
rH  t-i 

S  *  3 


i-2 
a  n 


.2  »  ^  °  2 


?,  B-a 


PhPh 


a    r= 

u    3 
<5  C72 


a  2-3 


a  tx  « 

2  «3  ^ 

Occhh  en 


S-3 

ao 


CX!  Ph 


a 
< 


2-S  «  fl 
S  &S.Sf> 

a  a  c  r- 

CJ     5-.  CD  .55 


242 


1881—  Medical. 


« 


M 

PS 

a 

fa 

p3 

A  doubtful  case. 

Congenital. 

Of  18  months'  duration ;  patient  had 

never  been  abroad;  both  legs  and 

one  arm  affected. 

There  was  early  renal  disease;  tra- 
cheotomy was  performed. 

Tracheotomy  in  3  cases,  2  children 
and  1  adult;  successful  in  the 
latter ;  1  case  probably  tubercular. 

Tracheotomy  performed  with  much 
benefit. 

Tracheotomy  was  performed ;  the 
foreign  body  subsequently  removed 
by  thyrotoray.  It  was  a  piece  of 
walnut  shell,  which  had  become 
impacted  during  an  epileptic  fit. 

A  single  large  ulcer  on  anterior  wall, 
probably  syphilitic. 

P 

fa 

a 

fa 

g 

(§| 

fa 

<M 

a 

:     :    :  "^    :>h     : 

:          H                 rH 

rg 

3 

fa 

lO  rH  rH      ;  rH             ; 

:      <n             :             : 

a 

<£)                     ;                    ;  rH                               rH 

S  2 

fc6™. 

-3  o 

fa 

o  -h 

O35MNUJIMN00  00                              -00              US              CO  «                          lO 
CO         NMHfflM-^iO                              .IN              r-l               CO  lO                          <N 

i-l                      rH 

60 

< 

09  mao 

rH       ; 

:                  i-i        ::            : 

09-09 

rH    ; 

rH 

:                 rH                 rH 

09-0^ 

rH   rH 

<M 

rH 

rH 

Ot-08 

i-l 

rH 

rH 

CO 

0S-0S 

"* 

:  i-1    : 

CO 

05-01     |           ^  "-1 

rH 

;  rH 

oi-s 

:    :  i-i 

9  *»p«n 

:  ih 

to 

a  S 

^ 

115HH 

iH 

Tjl  rH  rH 

<* 

*3    : 

rH 

s 

r-<     ::■*&:  i-i    ::    :                    1-100           1-1             ;  iH 

■PWL 

COrHiH^r-li-l'^i-li-l                               iH          (N                 rH                 <N  rH                               rH 

< 

fa 
P 

B                            °     u 
%     s                                S                            If 

5  £  "3                 h                          S  "1 .55                      n^d                      Jj 

°|     *  ■S-la-al       £g^   :l       a    .2^             § 

2  ja    «  es  a  oj  .5  e3  >>  2           -"J  h  a       a           a       t*>  g  bo                   * 

%£    ^wae^g      p    e    ^      o    £fe            5 

r-3                                                                                 l—l 
1— 1                                                                                >— 1 

1881—  Medical. 


243 


P^ 


.5  © 

.2  © 

b  o 

<D     *" 

.a    - 

-P    e. 

p<  5 

x.   o 

«M     > 

S  **j 

O  JP 

■*»  T 

•_2  2. 

fcc  o 

2  H 

s  .1 

-*J     u 

d  .o 

6r  ?, 

>»  p 

*  i£ 

T.  ~ 

S?  o 

B* 

&  **         l~ 


o 

o 

> 

N 

- 

- 

a 

- 

c 
a 

OD 

0 
oil 

2j 

- 

+j 

:. 

bo 

j* 

CD 

a 

Ml 

~ 

rH 

03 

.3 

H 

Pi 

O   r-j 

8  3 


.2      R-S 

Cm     .   *s 
5P«  <i 


cm    P- 

o  s 


EH 


01 

X   ",2 

©      M      P 

|  *  2  !3 

Pi  5S  a 

S  >>-2  2 


,  i—l    «  -w  +3    P< 


P        +i    3 

.SP     p  > 

2      0  * 

«        S  -i 

P      .13    * 

!2  -S  '" ' 

■S  »o  "  « 

a  S  ° 

©    2?    ■«  ' 
.  •    3    S«H' 


m3  .P   rH 


8g 


^  a  Sis 
^^  - 2 

ci    »    io    cS 


P  "S    ?    ©    o  "o 

.33  o>   t~>  o   P<t-s 

.   to  o   33^       m 

S  8  S,  S  a°  |  "g 

2-S  §  2  3  „      ' 

-I   §  M5         £   a, 

2  m         a>   ©   oo 

g    g  cj  ,_|  ,fi  ,P    C3 

3    9  eg        5»  ^   CD 


ad* 
3  — <    5S 

•  Pi  O 

£  *3  cm  *2 

g  -s  o  a 

S3«Hg« 


m  • 

O  03 

'£  3 

©  Q, 

a,  ^ 

I  3  0) 

03  U3 

be  g 


p^  8 
a  §^ 
Sag 

3  ..  -» 

,P      •"=*-! 

Cm     giJ 

■g  "^ 
O     Cj     03 

*  a  "3 


ift              rH              iH              tM         ct>                                        :           : 

:                  rH        : 

<M           sq            w            tji       i>                                        co 

<N 

co 

kO 

i-j               :       CD                                —I 

rH 

rH 

i-H 

:             •      co                           i> 

CM 

r-(           l-l 

1-H 

i—i 

cj     : 

co           co         :                           co 

CO 

O        rH                         co           : 

:  o 
.  i—i 

iM 

<N 

IM 

:  ■* 

.  i-H 

H 

ID 

-* 

rH 

•H 

•-1 

rH   00 

CD 

O 
rH 

eq 

cq 

CO 

oq 

CDI> 

rH 

CD 

CD 

i— 1 

eo 

-« 

cq 

rH 

"* 

rH 

to 

00 

rH 

CO 

CD 

rH 

<N 

C5 
rH 

O 

rH 

rH 

sq 

rH 

CO 

(M 

i> 

rH 

oq 

US 

rH 

Cf 

• 

oq 

rH 

—i  C 

i-i  oq 

H 

rH 

cc 

<M 

T? 

oq 

oq 

rH 

i— 

eq 

t> 

o 

O 
rH 

eo 

rH 

—4 

"* 

CO 

CO 

o  <?. 

(M  cr 

CO 

O 

CD 

1— 

CO 

rH 

CO 

ID 
rH 

CD 

rH 

"Cfl 

"o  c  a 

C  m3    O 


<o'p   * 

■g  g  a 


o 


Pi 
g 


«  M 


244 


1881—  Medical. 


CO 
W 

<! 

a 

w 
c4 

Probably  rheumatic. 

Anasarca ;    cystitis. 

1    case   fatal  from    cerebral   haemor- 
rhage;  in  this  also  recent  ulcera- 
tive endocarditis;   in  1  abscess  of 
brain,  which  had  burst  into  ventri- 
cles. 

In  1  adherent  pericardium ;  in  1  con- 
tracted  granular    kidneys;    in    1 
abdominal  aneurysm. 

In   1  phthisis ;    in   1  caries  of  spine 

and  amyloid  disease. 
4  fatal  from  compression  of  trachea ; 

in  1  also  aortic  regurgitation ;  in  1 

rupture   of   sac   into  pericardium ; 

2  of  the  cases  brought  in  dead. 
Fatal  from  rupture  of  sac. 

3 

Ph' 

:::i-h-cm                     ;      <m  -*             :oo:                 :        : 

.    .    :             :                         :      i-i                                               - 

a 

rH      ■                         CM        O  t-                 :  CO        00                   rH           ; 

:         :                             th                  ■ 

a  > 

a 

a 

fe 

l-H 

•    •  r-i                      :      *>  co           eo  ih       co 
:    :                        :      cm                  cm 

a 

:  i-i 

•    :                         :      cm                   rH 

:         r-l 

■a 

i 

ph 

rH      :      ; 

r-l 

a 

1  I 

tx  J, 

<<  o 

o 

:    :    :        :    :«r>                  o      -*  co            :  cm      cm              ua        : 

.  05                             CO         ^  "^                   •  ^         CO 

00  CO  00        "#  ©  CM                                  too             00  CM        cm                     :       <o 
coco           cm  cm  eo                      :      eo  eo           cmiooo                  .      i-h 

em 
<l 

09  J3A0 

09-0S 

;       :          rH       ;       ;                                   ;         i>  CM                 i-H   "#          rH 

:    :                     :      eo    :             :  eo      •<# 

09-0* 

:  i-< 

rid                             CMOSIO                "*  ©         CO 

— 1                               rH 

r-i 

0^08 

rH       ; 

:  cm                     :      coio          i-h  o      \a               ih         : 
i-h                   .-i                                  : 

08-02 

i-H    ; 

:    :                     •      eo  i>          ■*  cm      eo 
:    :                    .cm                  rH 

rH 

02-01 

:  rH                     ;      x>  rH             ;  co        : 

oi-s 

:    :                     :      rH    :             :  rH         : 

S  "Pan 

:<-i                     :        :    :            :    :        : 

*-<    J! 

s  I 

3  ° 
'A  o 

Ph 

a 

H  H       •          H       -^                                             OSl>                 COOiCO 

co                 cm                       : 

r-l 

:    :  H         :  rH  i-i                   cm      i>  co          *>i>      eo              i-i 

•      -                                                                                 WH                        rH          rH 

rH 

•wi 

r-lr-lrHr-li-IU3                               CM          CO  ©                 ©  CO          CO                        rH          CM 
J>  CM                  l-l  ■*           i-H 

co 

fa 

3 

IV.  Diseases  of  the  Oegans 

OF  ClECULATION. 

Pericarditis 

Palpitation  of  the  heart  . 
Angina  pectoris 
Fatty     degeneration     of 
heart    . 

Hypertrophy  of  heart 
Malformation  of  heart 

Ulcerative  endocarditis    . 
Chronic   valvular   disease 
of  heart 
.   fAortic  and  mitral 

-a  i 

a   |  Aortic  .         .         .         . 

<   L Mitral. 

Thoracic  aneurysm  . 
Abdominal  aneurysm 

"-5 

Ph 

I 


ta- 
rn 

K 
< 


1881—  Medical. 


245 


03    SR 
CO 


at   co 

-    a> 


3   o  1= 

°  "S  •" 

CD     S 

j»  o3  j 
«    b    u 

a  be  2 
£  a  3 
a  B  ° 

la"8 

5  '3  a 

09 

O   —    h^> 

-co  o  a 

»|  I 

«    fc  2 

■H«<H.S 


1     00     O 

>  Ph 

)  ;-. 

s   a  ?3 


T3    cd 


3  3 

CD    OS 
Pi 


60 13 

a  o 


•a  a  a  & 


o&SH 


a  >> 


to 


be  w   aJ   S  S 


43        ^ 

t2  "S  '-3 13 
a  o  -g 

CO   43     O 

05  a 

O  hH 


h     O     cj 

tjo  2 
o  2  ^ 


CD 
00 

a 

O     CO 

c  a 

a 
o 

o  P.M. 
floor  o: 
d  takei 

.g 

-a 

CD      . 

>  a 

P"     CD 

Ph  O 

03    « 

i>,Vg 
q3  a 
>  > 

a 

h 

o 

p              03 

a  ra 
cm  -H 

p  ,-,  -a 
-  5.2 

a 

4J 

*  § 

r>> 

Ph 

a 
o 

CD 

P 

tS 

a  ^-3 

a  « 

'Z'a 

•2  s 

on    2 

=4-1 

0 
a> 
Fh 

a 

V 

X 

09 

CD 

^<2  .« 
a  S  § 
a       a 

a  o  cj 

CO 

1 

•a 

05 

CD 
S-i 

.o 
CD 

CO 

CD 

.g 

43 

"a 

03 

03 

CO 

CJ 

a 

43 
O 

g£.g 

CD     CD    w 

**  5  of 

43      C      p 

03  M 

CD 

CD 

a 

a  "*  — 

u 

p  -a  o 

03 
"p. 

r=- 

B"d    0) 

>M 

a 

O  -£    3 

a 

33 

S  «  a 
<1 

:  i-i                         :             : 

CM 

:    :                       i — i          i—i 

CM 

CM                     i-l 

rH  CO                                    ;              CM 

ao 

■>* 

:    :                                     -# 

rH 

CO 

;               t— 1 

1-1 

:    :                        ■(>             : 

:  co  ■*  x> 

i— 1 

i— 1  i— 1  O  CO 

:    :                       t-             :              i-t    :    :  r-t    : 

:           <n 

;HtOt> 

:■* 


rH       ; 

:  rH    ;    :    ; 

rH 

:  <m     : 

rH 

CO 

:  ih    ;    ;    : 

CO 

H 

CO 

:  co     :  cm  rH 

rH 

:  HH  CM 

CM 

(M 

rH 

rH    CO   CM    rH    CO 

rH 

rH 

rH 

rH  CM  ■* 

rH 

O 
iH 

;(CHHt> 

rH 

rH 

rH 

i-l   HH   Tjl 

rH 

rH 

:  eo     :  ih  co 

•  co    : 

rH 

:  "-1 

CM 

rH 

rH  -# 

rH 

CM 

•  00  CO   <#  rH 
rH 

oq 

rH 

rH 

rH    O  CO 

■H 

00 

lO 

rH  rH       •  rH  CO 
rH 

CM 

rH 

CO 

CM 

N 

rH  <X>  J> 

rH  ■* 

CM 

i> 

rH   05  CO  O   "^ 
rH                 rH 

tP 

rH 

■* 

CM 

CO  CM  CO  o 

rH  rH 

<  CD 

fL,    rt  CO 

S  "  2  g 

w  °  °  2 
oq      t-  ^ 

«       P3<l 


w 

H 

■•/: 

B 

fc 
3 

h 

rl 

O 

M 

n 

n 

W 

*H 

< 

> 

.^-. 

w 

c/. 

H 

— 

2    o3    a    g  -- 

s  a  -S 

.  .  03    8j    03 


CD  CD 
-M  P< 
p     CO 


o 


o?3-J 

>>^    43   ^3 

k  t-  o3  ja 

-2    ?!    &  Ph 

«  S  ».-s 

co    CD    P    t- 
^rH     O     CD 


246 


1881—  Medical. 


^s 


w 

M 

-91 


REMARKS. 

In  2  intussusception,  1  cured ;  in 
1  strangulated  hernia  spontane- 
ously reduced,  but  producing  ente- 
ritis from  strangulation. 

Stricture  of  ascending  colon  in  1  ;  of 
rectum  in  5  ;  compression  of  rectum 
by  pelvic  growth  in  1;  chronic 
peritonitis  producing  stricture  of 
small  intestine  in  1 ;  in  2  no  P.M. 

Probably  traumatic ;  some  ribs  were 
fractured. 

1  probably  malignant. 

1  colloid. 

3   probably   malignant ;    in    1    con- 
genital hydrocele. 

Apparently  originating  in  intestine; 
common   duct  occluded,  and  bile- 
ducts  everywhere  greatly  dilated. 

Aspiration  in  both;  in  1  only  3  oz. 
of  pus. 

5 

fa 

*•    :              *>                              :    :  "-1    :        :    :  r-\ 

:           rn 

g 

co  <m                i— i                    i—i         ;  r-i  i— i     :         ;     : 

:          r-i 

a  > 

|3j 

l=< 

a 

i  "3 

& 

i— i 

H 

:  -* 

r-l              ;  i-H 

■<-<             : 

a 

T-l 

l-H 

<m    : 

"#              :  r-l 

n3 

5 
o 

fa 

"5    :            : 

S 

r-l  r-l                          ; 

:      co    : 

IN  r-l                   : 

S-3 

o 

13 
fa 

coco              eo                  <n        :    :    :    :        ::o            ••          •># 

rl                               (M                                                 CO                     .      • 

a  "5 

a2 

i^oo               co                     ■      ■"Jnoom      isfi    :          coco             : 

IffliH                      05                                          rt  M  ifl  ■*         H  N      .               (N  CO 

09  J8A0 

:    :    :    :         :    :  i-h          <n    :             ; 

bo 

<1 

09-oy 

Tft       ;                        r# 

r-i         :  i— i         :  rn 

<n    :             : 

os-ot 

-#  r-l                        CO 

:    :  cq  <m        :  i-i 

<N  r-l                     ; 

oj-os 

iH 

r-l 

:      n    : 

:  r-l               i-H 

Og-02 

rH 

l-H 

:  eo 

:      rn    : 

r-i    :             : 

05-01 

i-H 

i—l 

:  rn 

oi-s 

i-H  r-l 

*-*        :    : 

S  Mpufl 

<n  <n                                    i-H         :    : 

:  i"H        : 

i-H 

^   en 

■2  " 
3  ° 

^  o 

fa 

oo    ;               oo                      ._         :^hh         :  r-i 

1ft  pH                 r-l 

a 

lO  CO                        CM                               H          NHHil          MHri                 NH                 r-l 

•pra 

COCO                     O                           r-l<NU3<NiOeO<Nr-l              J>N               <n 

r-l                               r-l 

p4 

CO 

3 

VI.  Diseases  op  the  Diges- 
tive Organs — continued. 
Obstruction  of  the  bowels 
Acute  .         .         .         . 

Chronic   . 

Acute  peritonitis 

Chronic  peritonitis  . 
Tubercular  peritonitis 
Cancerous  peritonitis 
Ascites     . 

Catarrhal  jaundice    . 
Obstructive  j  aundice 
Malignant  disease  involv- 
ing common  bile-duct  . 

Gall-stones 
Abscess  of  liver 

Acute   yellow  atrophy  of 
liver     . 

1881— Medical. 


247 


p  >s  -■.  i*  "> 

ST -r;  tw  u  2 

—  "*  °  S  ft, 

o  «  S  ^  u 

s  s  ?  a  2 

5  £  g  <"£ 

5  —  «  c 


eo  «  o 


"ft.2  .2  So  3  .5 


m  ^  ^      ,jd 


ft" 


CO     <y 

*5 


•S-i  eJ 


•>   S   £  .2   § 

cu    —  -~    cu  ■—■ 


a>  <u  ri   s-   C    >■ 


o  .p 
2  * 


*  a, 


O    0) 
co    ft 


O    P    g  ,P 


2  rrt  ' 


2<£     >> 


■+2  "" 
^  P  M  • 
.  -f  ""    O 

r  a  3 . 

p 


53,0  s 

*     "     S  _5 

c  -c  .2  ^ 


tj  -° 


<J  J 


re  large  whit 
e    was    niixe 
al  change ;  ', 
anular ;    the 
in  2,  and  i 
mitral   vah 

« 
0 

ft 

a 

CU 

> 

P 
0 

2  we 
thei 
■stiti 
1    gi 
hisis 
the 

T3 
m 

Pi 

DD 

CO               ^      OJ      h!U 

co  .p  a  cj  ft  ° 

CJ 

03  •;-  .9    rt 

eg 

CI   .P                J-    rrt      CD 

1* 

0 

43 

_     O  r—   ->->  .P     CJ 

T*        ;i  P   0  p 

J             P     O     rl     S 

a; 

ri 

CD 

-3 

T3 

"3 

f  thef 
in    th 
tubal 
were 
was  fi 
compe 

cm  -u 

0 

00 

C8 

,s"Sj 

<( 

O 

Ph 

■*                        :             r-i        :                        :    : 

r-l 

■*                              : 

CM                                                                  CM          r-H                                          •  rH 

l-H 

CO                                             rH 
r-l 

«o                         : 

r-l                                   CM 

CO 
r-l 

10                           : 

:                       co 

CO  OS 
rH 

1-1                           ; 

r-l 

CM 

CM 

:*> 

Ci 

(M  <-< 

:  00 

t> 

r-l 

i-H 

CM 

CM  O 

1> 

rH 

r-l 

:                  :      co  qo                               : 

rH 

l-H 

^ 

rH 

TJH  x^ 

rH 

:      ■*  rH                               ; 

;                        rH                  :         :                           : 

>-h                 :        :    :                              : 

:                           :  rH                               : 

0 

r-l 

CM 

CM 

rH 

:  t^ 

.  1— 1 

!>. 

CM 

CM 

r-l 

CO  1- 

rH 

CD  10 

r-i 

K 


13 


"3 

2 

C3 
CU 

i 

0 

co  t3 

BU 

O 

on 

ASES     0 
NAEY   0 

conges 

C«I 

"2  "3 

^  p 

CD    M 
P     O 

CD     P 

»  Pi^ 

■2  ° 

,Q 

QpS 

p 

P   n 
0  ^3 

< 

<} 

<;  0 

a  >> 

a  i) 

-  p 


248 


1881—  Medical. 


< 


REMARKS. 

Possibly  abscess,  but  only  blood  came 

away  on  puncture. 
The  right  kidney  in  each  case. 
In  all  probably  due  to  calculus. 
(?)  Malignant  of  bladder. 

Of  base  of  brain. 

1  very  chronic  case  removed  by 
friends ;  in  2  no  P.M. ;  in  1  no 
tubercle  elsewhere,  but  bronchial 
glands  caseous. 

21  on  right  side,  13  on  left;  in  2 
both  sides  were  affected;  in  2 
there  was  epilepsy ;  in  1  post- 
hemiplegic chorea ;  in  1  hemiopia, 
and  in  1  monocular  diplopia. 

In  3  into  right,  in  2  into  left  corpus 
striatum ;  in  1  on  to  surface  of 
brain ;  in  6  there  were  contracted 
granular  kidneys,  and  in  1  valvular 
disease  of  heart. 

s 

fH 

:    :                 :                  w 

a 

r-l  co                   :                     -«*i 

id 

a  > 
t>.2 

fe 

§ 

•H 

P5J5 

Ph 

i—i      cm  co    : 

i> 

S 

:         :  oo    : 

73 
H 

3 
o 

Cm 

:         ;    :  i-t  ih 

a 

.ss- 

£  2 

S3-' 

so 

be™ 

*    ^? 

33-3 

►  cm 

«j  o 

"5 

:        :    :    :    :                      ©j>                :                  "* 
eo 

5  S 

oq      oo  co    :    •                       •  i>.             cm                   : 

to         tN  -<$      .      .                                    •  <M                     tH 

bo 

<1 

09  J3A0 

CO 

09-09 

<-*     : 

O                           i-l 

os-ot 

<-<         :    :    : 

r-i 

00                           (M 

0^-08 

Hrl     ! 

OJ                           CM 

os-os 

:        :  «a    : 

CO                           CM 

os-oi 

:        :    ;i-ih 

r-i 

01-9 

9  "PU{1 

:  m                 : 

»-     - 
o 

pi 

rH           N   WHH 

J>                            CO 

1-1 

s 

:        :  co    ;    :                       r-i  -#               oj 

H          NtOHH                                      r-l  t?                        CD                              i> 
•F}OX                                                                                                                                                    CO 

CO 

<J 

W 

CO 

I— 1 
Q 

VII.  Diseases    of    Genito- 

urinary   Organs — 

continued. 
Malignant  disease  of  kid- 
ney? 
Movable  kidney 
Pyelitis    .         .         .         . 
Hsematuria 
Incontinence  of  urine 

VIII.  Diseases  of  the  Ner- 

vous System. 
Simple  meningitis   . 
Tubercular  meningitis     . 

Hemiplegia 
Cerebral  haemorrhage 

1881 — Medical. 


249 


T3    fc*> 


4  a  * 

5-°  bDS 

>  c  «<-i  -9 

>  o   ^   o 


I  43  'O  'O     I-t 


,8   •-•    43      M      <"  03 

§  .,  o  a  >.  b  s 

t-i    >->43  -a  43  U3  u 

.8    J*    S    oS    S  -8  -3 

_    03   rH     8     t,     K  -H 


>>  a 

93 

3 
'5 

>> 

8 

-t3 

o 
gd 

& 

9 

eg 

.sJ 

a 

d 

-a 

o 

e3  o 

*<  8 

*°  a  2 

"-1  2  "S 

O  tn  ra 

O    60  »  U 

'"    fl  »  3 


,  43      U 

I  T3  «H    O 
03    o3    ej 

'Its 

1    03    u    fe 

i    fci    o 

,.8 


»     M     03 


99 


fc  fc 


;     -  03  43 


V»  8    a> 


M 

03     O 
»  °0  *3  43     93 

"5      CB    43      O      g 

'9rH     O    £^ 
ft         CfH   43     Q 


J  .8 

.a  2 

60-5  -g 


bC  9 


=«    83 


S3    §    » 

N   3-d 

.  "at,  u 
o?  * 
e3    & 


9  a 

-Sals. 


S>«  S-2 


5  2 


.J3     05     03 

..a -« 
ft,00- 

m    8    •» 

>>"*   cs 

o    -"Sd 

"c8.2  — 
^  '55    ft 

'|i  2 

^" 

C3     03     8 

21: 

+3  c8 

a 


T3    8 

2  m  "3  ft, 

"ft,  5  '»  JO 

m     m     O     OS 

o>  _a  43 

C.2JH 

...  ft  £-9 

■l3  2  « 

a;  1— I    a)    oj 

-8    —  >8      - 

.2  a 


•                        •      ■— '                    :                        :            ; 

<N                                      rH          r-|                                                                                                  . 

IN                                          |H                   rH 

CO                                   CO                Tp 

CO 

1-1 

HOI  00 

1-1 

<N 

•  10  <N 

:  ih 

rH 

:                       ih             :  in 

: 

:    :    :                         c 

• 

:                        :            :  >■•    :  i"<    :    :                              ■*    : 

l-H 

rH 

in    : 

ih  <n    : 

l-\ 

<n    ; 

<N 

1— 1 

in    :    : 

r-l 

t-l  iH 

iH 

^ 

1— 1 

<N 

<N 

rHCO-H 

CO  CO 

rH 

in 

IN 

CO 

O  05 
rH 

ih    ; 

*o  i> 

0    : 

r-l       ; 

CO     ; 

•             •                                   •                                         I                    t      '.       '. 

,   • 

CO 

iH 

IN 

CO 

iH  IN  r-l 

rH  OS  00 

0    : 

r-l      : 

co 

CO 

IN 

■*  iH       ; 

T-< 

ia  in 

Tjl 

r-l 

a 


.5  cs  &o 

a  «  .9  £  i^  ft.  §J 
*  -a   h,  00  "«   «  43 

k*  o7  »  §  §  p, £> 


«5  .T3 
03    03 

O    O 

r3  JS 


VOL.    XI. 


17 


250 


1881 — Medical. 


s 

8 
•<s> 

S 


pa 
< 
Eh 


CO 

M 

PS 

g 

s 

03 

In  4  fatal  cases  myelitis  with   sur- 
gical  kidneys,  and   in  1  of  them 
amyloid  disease  from  syphilis ;  in 
1  no  P.M. ;  of  non-fatal  cases,  2 
due  to  caries  of  spine ;  1  occurred 
during    the    course   of    secondary 
syphilis. 

Both  old  cases. 

In  1  also  bulbar  paralysis. 
In  1  there  was  Churcot's  disease    of 
shoulder-joiut. 

In  1  probably  primarily  cerebral,  and 
associated  with  epilepsy. 

In  1  associated  with  herpes,  and  pro- 
bably due  to  disease  of  spine. 

13° 

3 

fa 

!-"                                  :    :        :    :        : 

S 

-*                                  :    :        :    :        : 

03  T3 

fa 

3 

i  1* 

fa 

io                              i-h    :      i-i  cm      i— i 

■* 

a 

iO                                                     r-l  CM          MOO          -^Fl  CKI          rH  rH  rH  r-l       :  IN          CM  CO 

T3 

3 

N 

a 

Is- 

s  ° 

bL  >> 

>  <*. 

3 

o  •*? 

oo                               oooo      oo  ^      ©■*!<      co  cm  oo  ■<?  i>  <m      -*j<  oo 

O                                                    Ht»          1O00         ''JH          i*M          NH®          Htq 

be 

09  w^O 

:                                  :    :        :  >— '        : 

:  n 

CM 

09 -OS 

<n                               :    :       :  f*       : 

iH 

rH 

rH 

os-ot- 

CO                                                    H       I          HlO          N 

rH 

rH 

CM  CM 

ot-os 

tjH                                                    rl       ;          <N  <M          CM 

i-l 

M 

CM 

os-os 

1ft                                                        ;       ;          iH  rH          rH 

os-oi 

:                                  :    :        :    :        :  <n 

rH  iH 

oi-s 

r-4                                :  <m        :    :        : 

s  wpun 

s  £ 
SB'S 

fa 

CO                                                    rH       ;          rH  CM          rH 

CO 

Tfi 

s 

Ci                                                    HN          CO0O          -<?  <N          rH  rH  rH  rH  rH  N          CM  CO 

•pn°i 

»ft                                                    CM  CM          -^O          kft  CM          H  HHH^Ifl          <Mt* 
rH                                                                                r-l 

go 

•3 

w 

5 

M  §                                    .2           &                                S 

^t    .               H  .  .  1  .  .  •§  .    .  -g  g 

wl                                          .2  §               g                   §          .3 
^        .                            g       >,  ~    .  S4     "3 .3      .8  r  •«  .a  *  iP 

§1               i  i     |  zi  ||Si|l    ■  ■ 

«.           •                                          "£         c3    0         rt         a>    5        13   £<=w         £   2         rt 
co        r>*    _#                                     p         a_,  P         £.^jr— .         t-    O   o         —    3:        •*■* 
H  to  ^  -2                                   "  .2       .£    >^o         go        «   a°         g  B         O     • 
5b55o                               -w<u-S^3-«       a"       p.,2  .2       2  ,-.       >>  J 

B**f                1^1  fell    is    J|£  3|    II 

Pk                             «q      ^Ph      rn"      Qh5      PQOPh      P^M      Oh  cq 
i— i 

1881— Medical. 


251 


5  '-8  'x 

g  c8  <u 


5  a  is  2 


o    a 


^  o  d 


a 


o-s=  2 


o3   a>   a 
•r!  T3    » 


°  .X         g   <x>   o  iH 


.5-73 

a 
5  £ 


25h-3  g 


M  a 

ai  .a    to 

»-  =+H 

"  a,  =« 
2  a  u 


~CO 

«  a  §.s 


r3  .a 

o  3 


a  § 

a  2 

s  a 

=w  3 


a. 3 


,d   oj 

'S   «> 

&   > 

•2  " 

be  <u 

,2-d 

a  „ 


be  d 


oft 


fe  d 


ih                         : 

<n                        : 

i— i 

N 

■*                      i— i 

i-i 

i-<                                   CO 

I-l 

N 

riHHH 

<m    :  im  to    ■                           i-h  eo 

i— i 

N                          ia                     i— i 

m     :    ;    :nh           "*:«-<:: 

I-H 

<N                                      CO 

:::::.:          i-t    :    :    :  th                                  ; 

CO                                (N 

:    :    :  i-t    :                :  ih  i-*  ih                            ;    ; 

W5                                      CO 

:    :    :    ;nh           <n  r-i    ;  x> 

:  oq 

i-H                                         i-l                                  .-I 

i— 1      :      :  i— 1      ;      ;                <N  r-4      ;  O 

;  i-H 

i— 1  I— 1   r-i                       ;                  i— 1       :  I— 1   CO 

i-h    ; 

::::::             :    :  r-t    : 

i— i             ::::::             :    :    :    : 

£»                                         i-l 

IrlrlHrl     ;               CN  r-l  <N  CO 

i-l  CO 

CM  r-l  r-l  iH  CO  I-H 


CD  (M  CO  CD  (M 


go 
on   o 


a  t*  2S  .5  d  [». 

a^i-g-a^ 

•<  Ph  Ph  i-h  O  02 


K  3 


5    .S.S 


►4 


~  d 

fig 


O 


6 


w 


{Z5 

^  .J 

cs  fc 

h  «  2 

2°  * 
Q 


!►§> 
I 


252 


1881 — Medical 


^3 


>h 

h 
< 
Eh 


M 

s 

w 

OS 

Amputation  of  cervix  in  2. 

In  1  also  granular  os  and  vaginitis. 

In  2  retroflexion. 

1  was  an  epileptic. 

In  1  prolapsus,  in  2  stenosis  of  os. 
In  1  laceration  of  os. 
Retroflexion  in  1 ;  granular  os  in  1 ; 
endometritis  in  2. 

Cystitis  in  1. 

In  1  fatty  liver;   in  1  amyloid  dis- 
ease of  viscera. 
Removed. 
Growth  removed. 
In  fatal  case  also  pelvic  abscess. 

T3 

5 

ri 

:    :    :             :::::::::        :    :    :    :  <n 

i-l 

§ 

i-3 

Ph 

a 

,  "3 
ffij 

a 

-    -ih          ^H    :»o  co  ho    :m        :    •  oo    :    : 
:    .                       .         hn    .           :    :       :    : 

J> 

n3 

o 

fu 

r-irH;             :  ed  oq    :    :    :    :  o«i    ;      coeo-^ico:      r-i  •■*    ; 
:                           eo 

s 

:   :    :            :::::::::        :    :    :    :    :        :    :    : 

u 

MS- 

M 

bo? 

2  S" 
55 -a 
>■». 

«jj   o 

"« 

Cn 

13 

OlON              NNOONOOatOOOO         00  <N  00  01      :        NNN 
r-l                               H^HNNHHIMIS          iH  CO  <N  <N       •          lO  95  H 

83 

bB 
■5 

09  J3A0 

:    :    :            :    :    : «-(    :    :    :    :    :        :    :    :    :    : 

09-OS 

:    :    :.           ::::::  <n    :    :        :    :    :    :    : 

:  im 

09-(H> 

:::          <h    :    :  1-1    :  h  si    ;    ;        ;  i-h  ■*  r-i    : 

M  iffl 

Of-oS 

rHi-H      ;                <M  r-l      ;  i-l  rH  <M  •"#      ;i-l         NNMffiH         i-H  <M  r-l 

08-02 

•       ;  rH                 HHNNNOOONW          tH       -lOOi-H 

:    :                                          -j                             oq 

08-OT 

:::            :  «h        :    :    :  cq    :  ih        :    :    :  eo    : 

oi-s 

S  -tapnn 

a  « 

^H 

i-Hi-Ii-I                TjimNlDfflHONia         M»S<M  S5N         r-l  •<?  00 

g 

:    :    :             :::::::::        :    :    :    :    :        :    :    : 

-1«WL 

r-li-li-l                 ^MNlOMHONlfl          COM  NO!  N          rH  -^1  00 
i-l  (M                                      HM 

9  «     §           a 

2  w       ^3      h       ^ 

go 
GO 

3 

XI.  Diseases  of  the  Fe 
Organs    of    Ge] 

TION. 

1.  External  Generative  0 

— continued. 
Hematoma  of  labiu 
Abscess  of  labium 
Syphilitic  sore  of  la' 

2.  Uterus. 

Stenosis  of  os  . 
Elongation  of  cervix 
Laceration  of  cervix 
Prolapsus  uteri 
Anteversio  uteri 
Anteflexio  uteri 
Retroflexio  uteri 
Retroversio  uteri 
Subinvolutio  uteri 

Granular  os 
Endocervicitis . 
Endometritis  . 
Parametritis    . 
Pelvic  abscess  . 

Polypus  of  cervix 
Polypus  of  uterus 
Fibroid  of  uterus 

1881 — Medical. 


253 


254 


1881 — Medical 


a 

CD 

•A 

^5 

*    £ 

■Ss 

a 

•aJS 

.t* 

-a  g 

a-13 
5  <» 

^<1 

^       °  3 

-«si 

M'S 

e 

B  kC.                                     !>  t>   a?  co 

jo  p. 

oo^ 

lis 

E   E    h 

P5 

•S    OS                                                -S    «    *    M 

^  o                                       -§   o         bD 

•e  ^     « 

.£•«  a 

*  .5  a 

a  in  * 

°    -2   r2      » 

g  f>                               W  >  'S.  a 
Sflooooooosgo-t^ 

O       .2 

a    o    e8 

-*°  a 

g 'So  3  "a 

"gssis 

,a  o  o  o  S  -w 

<i>QflPOQQfli,fe<! 

c^  a 

Ofe 

<tj  E^  ft,  pc<  a  a 

r-<   i-H 
00  CO 
CO  00 

"3 

V  .d  X  *£  c>v^S  >>  S  t^d 

rH  r-H 

CO 

•-   E 

^1               N 

ia    0)    3      .3 

g   d   Mu+j   bo 

p3 

s-9  t  p,J  =«  *  5  v5  3  a  ® 

0J    cj    » 

J2   O-i 

a  a  a  a?  o  a 
h,  1-5  o  a  O  «sj 

zJootitid>d>did>tid>ti 

OQO 

oo 

OOOOOO 

M 

2» 

+* 

© 

o 

CD  ^    <M         lO  K5  w  w  to  ,.  ,.  ^ 

H^* 

^«5 

CO         CO  C5i  C75 

00  N  l»HH  H 

-2 

'E  *  S  'E  *E  "E  'C  "E  *E  **>  ^»« 

>   d   c 

r^=      »- 

b  &£?  t«  bis  b"o 

O 

p,  §  *  aaaaa  a  *  *  a 
<<h:g<l<|<l<l<|<|^0 

►2  /S  * 

kS  l3  a  a  s  3 

d 
a 

"Si's 

(4 

> 

o  o 

a  a 

•43 

03 

2"3oooooooooo 

oii  o 

o  o 

O   O   O   o   o   o 

R 

pjgiQBQOflQQQP 

a  co  q 

aa 

aaaaaa 

s 

T3 

^3 

•     • 

• 

"2^ 

£            3                      TO 

1      •  E  a*3     *  o.S     •     V     | 

^     S^O              OB'S 

•     a 

ct-.    m 

.9*. 

a 

a  S 

I      •           .   «    d 

0;     CD           ^3 

1  J:l  ll^S  g  |3 

a  o  _  o  ^  _  S..5<  > 

£8      ja 

^3 

a     CO       •            co 

5 

PftM^ESH^i 

^    a 

o 

i>a    ^^ 

«S 

CT5-<J<03COC<3CO(MCOt— 1    5   CO  O 

r-t  i-l  CO 

oo  co 

_    C3i  tJI  (M  W5  tM 

<1 

<N                                                           ^          CO 

CM 

M  i-H 

***  iH 

a) 

a'g^MsMNNMs'pqfH 

Pr  &  Em 

&I&3 

Pm'  g  g  p4  g  &J 

■a 

•     .           .     .  CO*        i-J     .  qJ 

**!  a  pu  «  a  „  „•  d  w  <  .  c5  e; 
HawM^sp^^co^ 

m  a  £ 

^a 

fe.  ^wa  _^ 

'3 

Kg'<i 

i-i<i 

1  fe  ^  ^  ^  2 
aWa 

i 


1881— Medical 


255 


T3 

p 

oe 

"3 

0 

a 

43 
CS 

£ 

"-3 

0) 

be 

-w 

>> 

O 

"3 

^IH 

a 

gg 

at 

P, 

a 

o 

& 

nd 

-a 

a 

o 

ci 

a 

«1 

a 

'ci 

2 

to 
OS 

BD 

'-3 

43 
43 

a 

0 

.     fc 

Jd 

s 

ED 

in  hospital 
This  case 

OD 

43 

O 

t3 
■I/ 
| 

'3 

s 

9 

a 

6C  •- 

CO      <U 

a 

0 

cu 
6C 

S    to 
■  03 
0}    0 

rd 

C^ 

r"     p4 

to  ^H 

line 

itto, 
itto. 

is  s 

rt    to 

-d    ° 

3  -a 

EG 

3 

0 

os   0   0 
&.-3    60 

&P« 

< 

^ 

0 

(M 

eo  (N  x>  us 

CO 

<N 

6  ^^J  -w 

0 

g 

> 

O)      rj      o      O 

a 

O 

QbOO 

1-5 

fe 

dddd 

d 

53 

CO          00  r-J 

00 

■■* 

ffq  05  rH  (M 

<N 

1-1 

6i>  ^»  6c  tib 

f-i 

43 

P    «    0    3 

3 

O 

u 

. 

<o 

> 

« 

'  «H      ' 

"E 

o 

-3 

o§  oo 

43 

O 
43 

S3  fl  S  S 

P* 

43 

OWflfl 

s 

P 

•III 

a 

1 

1 

H 

3 

pq 

OS  00  ■*  IM 

■* 

CO 

<M  Ol  CO 

<N 

CM 

&J  fe  Em  Cm 

&3 

s 

p^^  w'o 

I* 

h 

£ 

►4as^* 

M 

*-5 

p4 

256 


1881— Medical 


Table  IV. — Showing  the  relative  frequency  of  the  various  com- 
plications of  Acute  Rheumatism  in  the  first,  second,  and 
third,  or  later  attack, 


ACUTE  RHEUMATISM. 

Dis- 
charged. 

Died. 

T3 
B 

O 

o 

1 

— 

o 

:" 

Z> 
CI 

o 

T 
c 

M 

o 

i 

c 

i 

:- 

i 
c 

Per 

cent. 

M. 

F. 

M. 

F. 

Total  of  cases 

155 

80 

75 

1 

52 

70 

22 

8 

2 

1st  attack    . 

67 

34 

33 

1 

21: 

30 

7 

2 

1 

432 

2nd     „ 

55 

29 

26 

18 

23 

8 

5 

1 

355 

3rd 

33 

17 

16 

8 

17 

7 

1 

21-5 

Heart : 

Normal      . 

64 

41-5 

1st  attack     . 

34 

18 

16 

13 

14 

5 

1 

1 

53 

2nd     „ 

18 

10 

8 

5 

6 

3 

3 

1 

28 

3rd      „ 

Pericarditis 

12 
29 

6 

6 

1 

6 

5 

18-7 
18-7 

1st  attack     . 

13 

7 

6 

5 

6 

1 

1 

44-8 

2nd      „ 
3rd      „ 

Mitral  regurgitation . 
1st  attack     . 
2nd     „ 

10 
6 

67 
27 

27 

6 

4 

13 

13 

4 

2 

14 
14 

1 

4 

4 

13 

10 

4 
2 

n 

12 

2 

34-8 
206 

432 

403 
40-3 

2 
4 

1 

3rd      „ 

13 

4 

9 

5 

6 

1 

1 

19-4 

Mitral  obstruction     . 

5 

32 

1st  attack     . 

... 

2nd     „ 

3 

1 

2 

1 

1 

1 

60 

3rd      „ 

2 

2 

1 

1 

40 

Aortic  regurgitation . 
1st  attack     . 
2nd     „ 
3rd     „ 

Aortic  obstruction 

14 
2 
6 
6 

7 

2 
4 

2 

4 
2 

... 

2 
5 
3 

9 
142 

42-8 
42-8 

4-5 

1 
3 

1st  attack     . 
2nd     „ 
3rd      „ 

Pleuro-pneumonia 
1st  attack     . 
2nd     „ 
3rd      „ 

Tonsillitis 

1 
3 
3 

6 
1 
2 
3 

5 

2 

i 

2 

1 
3 
1 

1 
1 
1 

... 

2 
2 

3 

1 
1 

1 

1 
1 

14-2 

42-8 
42-8 

38 
16-7 
334 
50 

32 

1 

1st  attack     . 
2nd      „ 
3rd      „ 

3 
2 

2 

1 
2 

1 
1 

1 
1 

1 

60 

40 

1831— Medical 


257 


Table 

IV 

— continued. 

ACUTE  RHEUMATISM. 

"c3 

o 

Dis- 
charged. 

Died. 

S 
P 

c 

7 

o 
Ol 

o 

o 

'i 
o 

1 

o 

CO 

o 

J 

o 

-f 

c 

CO 

1 
© 

e 

CO 

> 

o 

Per 

cent. 

M. 

F. 

M. 

F. 

Acute  nephritis 
1st  attack     . 
2nd      „ 
3rd      „ 

Jaundice    .... 
1st  attack     . 
2nd     „ 
3rd      „ 

Urticaria  .... 
1st  attack    . 
2nd     „ 
3rd      „ 

Delirium  .... 
1st  attack     . 
2nd     „          .         .          . 
3rd      „         .          .         . 

1 
1 

1 

1 

3 
3 

2 
1 

1 

1 

1 

2 

1 

1 
1 

1 

•64 
100 

•64, 

100 

1-9 
100 

1-2 

50 

50 

... 

... 

... 

2 

1 

1 

1 

1 



Table  V. — Showing  the  causation  of  cases  of  Chorea,  the 
number  of  cases  which  were  unilateral  during  the  whole 
attack^  and  the  presence  or  absence  of  a  cardiac  murmur. 


CBOREA. 

'o 

Dis- 
charged. 

Died. 

= 
P 

C 
1 

o 

— 

i 

p 

X 

c 

c 

1 
o 

co 

5 

Per 
cent. 

M. 

F. 

M. 

F. 

Total  of  cases 

Cause  : 

I.  History  of  rheumatism  . 

(a)  Personal 

(b)  Family 

II.  Grave  nervous  shock 

Family      history     of 
nervous  disease 
Unilateral  duringwhole  period 

of  attack  . 
With  cardiac  murmur: 

14 

7 
3 
4 
6 

7 

1 

2 
2 

3 
3 

4 

4 
2 

2 

2 

2 

1 
1 

2 
2 

10 

3 

1 
2 
4 

5 

1 

1 
1 

1 
1 

3 

4 
1 
3 
1 

1 

1 
1 

10 

3 
2 

1 
4 

5 

1 

2 
2 

2 
2 

1 

50      ' 
43 
57 
44-5 

50 

7-1 

145 
100 

21-4 
100 

1 

1 

1st  attack 
2nd      „ 
3rd       „ 
(b)  Permanent 
1st  attack 
2nd      „ 
3rd       „ 

258 


1881—  Medical. 


■a 
a 

a 

'~     . 

p.-^ 
p.  3 

«  a 

1  2 
o 

a 

o 
P4 

Heart  weighed  14^  oz.     No 
patency    of    ductus    arte- 
riosus ;  no  perforation  of 
septa.        Both     ventricles 
hypertrophied  ;       auricles 
normal.   Mitral  valve  com- 
petent;   aortic    valve   ad- 
mitted free  regurgitation ; 
much  ulcerated  and  eroded, 
and   with   old   and  recent 
vegetations  attached.  Pul- 
monary  valve    competent. 
Circular  ulcer  on  one  flap. 
Behind    valve    the    conus 
was  constricted  for  about 
half  an  inch,  and  its  walls 
were     there     thick     and 
fibrous,  and  showed  some 
recent     ulceration.       Tri- 
cuspid valve  not  remark- 
able.    Lungs  contained  no 
infarcts.    Spleen  contained 
several  old  infarcts.     Kid- 
neys :     one    small    recent 
infarct.      Brain :    haemor- 
rhage   into    left    ventricle 
from     rupture    of     small 
aneurysmal     dilatation    of 
branch  of   posterior   cere- 
bral    artery    situated    at 

O 

a    . 
o  « 
53  a 

is 

o 
O 

June   15th. 
— Sp.    gr. 
1020,      no 
albumen. 
23rd.— Sp. 
gr.     1024, 
no      albu- 
men. 

Condition  of  heart 
and  circulation. 

Hypertrophied 
on   both    sides 
about    equally. 
Marked     thrill 
to  left  of  ster- 
num, over  pul- 
monary     area. 
Loud        rough 
systolic      mur- 
mur conducted 
to  left.     Softer 
diastolic    mur- 
mur heard  most 
plainly      about 
the   middle    of 
the      sternum. 
Right       radial 
pulse         much 
stronger     than 
left.    The  same 
signs  remained 
throughout. 

■n 
a 
a 

I    . 

O    oi 
P.S 

a 

On  admission  complains  of 
shortness  of   breath,    pain 
in  head,  and   occasionally 
in  ankles.  Has  some  cough  ; 
spits  blood  at  times.  Respi- 
ration    hurried  ;      pupils 
equal,    no     numbness     or 
paralysis ;     temp.    101-8°. 
June    28th. — Cough    very 
troublesome  ;     crepitation 
at    bases    of    lungs ;     no 
shivering ;  no  great  rise  of 
temperature.       30th. — No 
inequality  of  pupils ;  much 
cough ;  expectoration  scan- 
ty,    tinged     with     blood. 
Temperature     last     night 
102-8°.     July  1st.— Had  a 
convulsion,  became  uncon- 
scious, and  died  at  4  p.m. 
Temperature  in  the  morn- 
ing 103-8.° 

o 

§ 

o 
'> 

£ 

Has  never  had    acute 
rheumatism,      scarla- 
tina,   or    chorea.      Is 
married,    and    has    2 
children     alive      and 
well.  There  is  a  doubt- 
ful history  of  syphilis. 
Eighteen    years    ago, 
when  in  a  hospital  for 
a    miscarriage,    heart 
was      examined     and 
said    to    be    diseased. 
Since  then  has  broken 
down     much.        Out- 
patient of  this  hospital 
for    nearly    4    years. 
In-patient  last  Christ- 
mas; then  had  rigors 
with  very  high  tem- 
perature— once  106-5° 
— occasional  vomiting, 
and  much  pain  in  re- 
gion of  spleen. 

5 

"a 
>-> 

a 

a  irs 

a  r-l 

a 
o 

p. 

O 

Laun- 
dress, 
married 

XSSpUB 

'B|Mn;ni 

1S81— Medical.  259 


.a 

O 

a 

a>  .2 
"S  2 

peri 

oz. 

hied 

alve 

a 

'3  -a 

H»P.> 

a 

o 

03  T3 

S  K 

"S^-a 

,Q  J3 


§-3;S^£-n§i£-££^i2g£i;sS£'S£S| 


Hll^llll  11  ^slii  §  oifilil  bill 


a  =t!  aStu^^^S3-^^1"       a      ^T-i^  ^  a3  be 


flS5  53  .2  £*•"  s  B  *  ~  °  "*  a  a  -5  *>  g  ^  "S  *"  -3  u  >  -5  o  £  'S  ^  -g  3 
'§££lS^^a=-^S-|a§3"BggS|-stS.2§gl&o^§fra^ 

°frl^   o    «<<.S    O    oih   P«o^   «i    »   3    oS    bJO-3  .S-p    oH    55    CD  q3    u    P.  S  53  t3 


BQ 


^3    *"• 


a    • 


>-.cc  <m  53  m*  S 
-5      ©  -~  a  3 


(5«      »««    •?      5       i   gala's1*     *       a 

k*   »  E^   a   r   s       -n;:?;:5c3-T'bijjJU3S-i— -^joa 

pftSflsc^rtSsSss^KSHaftj 


J  -J  „  s  g^  ,  s  «  B, « ■"  s  g  s  s  »  *  s  »  »    s  "  _  „  a 


3  =£ 


i  §:, in .n^:i:|rii^^ii^is|;, 

<3^£ssS£s:a45S&3£8^S3a2p^Sa.s£i,5s$ES§.s 


o 


►>^_     »       /,      cO     i-      ~2    J-C     02     ?i     Qd   T5        *     _T     d       '         i      B)      •       i  BJ 

t'=iJ:b[2S«^a?g-=?  >> «  £  a  > 

^^^■^L^-'S^^SS^s  a 

.2  g  a  bt  a    .  be  s    .      IS  3  -a  a  -r;  -a  &^  2  3 


41 


260 


1881— Medical. 


ns  ■**  "-     . 

«  9  75  S 


?  &$ 


£i°*I73:3&P§W      -S 

a° 


os  =   u  i> 

fl    .    —i 
OS    beM 


5  S3 


3    +3      «H 


"I  S.SPH 

B        qn 
fl    O    Ph^j  • 

o  ffl  <3  a 
PQ 


■h   tod)  5 

JS  g  >  o 
2  a 


o-S  a 


,2    3T  be 
w    3    t 

.3    m    fl 

■g^'3 


S  p." 
°*  .*? 

2.2  S 

•">  *= 

b  .-p  a 


.s-g  a 


to   Jj   ai   a 

a  .5  £  a 


ja  <-  a  "  p<  D->o  3    .  a.<M  3  i 
3  too       <»!Z5<n  *i  a  to  £J  _o 

o      ^      hi   ,o«S   ,o-: 

A»  g  ||  ^  ,•  ^  |  ^  k-  o 

3    |  S  3  -B  t?   be3   e3  00   be  a 


;  a 

3 


_  ,3  r0J    3    $ 
.    -^  ^-<  fl    ^ 


O    3    & 

-      1-1 

ai  a      ^  » 


&  CO 


Cm  © 
i  o 


t*'3    S 
»3    s;    ^ 


0J    O    £;    B 


6  3 


Pm  £ 


in  a 

_   ►? 

II 

CO        tH 

3    3 


bC  B 

,3      co 


9lfl    P-+3 


8  be 


£  fl  n3 


03  ^ 


£g£. 


!_,  g  if  .a  g  j= 

*j    03  «4H  U3    a  05 


l^'Sfl    3*    §    p\2 
=3  J         -fl    £>,2    3    1 


3  3  fl  o  a   3 
"-1   <u   0)         Bo 

to    P<  O  .5   +j 
fl,M    «    3    ^fl 
— '         3    >  «B  .3  | 

g     O     CO  OJ     03 

°  §     g^     ^< 

S  -*>   be  £   i,   c3 

§  I *T  2  p- 

.„  ff   I.    &fl    « 

o)  «3  g  B  c 

rtio« 


w  =  ,3 


<U  2    s-    §    ^-S  SO 


•5  3 
3.2 


3    3 

2  53  ° 

3r*^ 
^   t-l     03 


3  -fl  a.: 


~  &a 


a  oo 


-3    C  •"  31  •■<         ••>    '• 

.u  §  '  §•«  -a  5 

«   03    ••»   *       .    »    Si] 

7C  o  fl   >  5T  03   5 
§S2c3«U3°, 

P§isi!^. 

I-    bcB^  o- 

3  g  3  2  's  fl  'S  53 
a  >  ^  Ph  o   u 


B,    r3      * 


U9   -^    B 


13  a 


eg  a 

be      ?J 


3  S  "S 

..a  o  ,3  -^ 

J       u   be^  « 


■S    °  fl  o  ' 
„  03  fl    A_, 

.S  a  ^ 


QJ      ^H 


p^  33 


JH^  2 


■£  a  i-h  73  p.  a  ^ 


1— I     >     CJ     0J 


S^.2f3 


U  -P   CO 

Ills 

fl   a   a>   03 


!  .2  o  53 

-3    fl,o3 


i«    0J  l-H 

a. 2 


03    «  J3 
3^    & 

coPh  ^ 

fl  — • 
o  eo 

O  iM 

bcrf, 


CP     0J      ■    fQ     c     oj 

'5    o'fl    «    2  3 
*t-c    03  ,3    S 


9  fl  i^.-e  .9  3  *a 


3    o    0J 
co  -<J    t< 


be  Pi  3 


Cu  fl  09    3  • 
a,    bp-S 

be  a  5  » 

fl   ee  'a  '3 
3   be  S   3 

O     0J     >.  fl 
f>-i^2    Qj    03 


.3  o 

Pi  C3 


5a 


•xsspae 


h5  o"^* 


]  881—  Medical. 


261 


•g  «  SP-S  2  -S  "8  to  § 

8  -3     r5     Jrr  C     O     I*  •{-  «H 

8,2  2  >m<*  - 


A    m^tt    i    h    to 


S3  .».a  ^3  "J  _ 

P<    S3 


o3   oo 


JJCd   oj    °   s 


!  S  * 


,5    Jl    O^J    o 


ID       . 


I     33  60   .« 

Woj  a)  _ 


o  "S 


2    *    to    >-» 

S-;  3   ffl 
,  a  o  c 


to 

B    43  -W 

a  "3  "-§  * 

B    33    B* 

d  -«  o  i2 

S  SIH  c3 

30  ^ 

fee  wrg  » 


>1?>-B'a'3     »     4>     03     fl     43    -W 


o-S  o 

55  §  .2     ' 


"5  i)      ° 

TJ         -£    43    ;r    d    d    60^ 

S      is  -«  "£  H  ?  os  2 

r#,E-iB<33drapT;t- 


^1-s§ 


"  a  - 

2W  „  p- 


goO 


aa      -Sg^Ss      S 

*  g*  b  „•  ;r.2  a  13 


.5  g  §  «  «>  •=  .2  2 

_b>l3    -3  "rt     B     fefir^J     03     43 


a°a 

S    co 
33     3 

8 1 

2  § 

P-C1-. 


fl    B 
33    O 


i        _     33  T3 

P-'.S  -a  "53 


•"T3 


M 

2  ^  a 

ftm  M 

m^2-B.5iSc33 

-§  ^  §>-§  ^  ..-a  ?5S 


as  "a  o 

a|S§« 

a    . 


rB      CO      O 


a  a 


a  ^ 


o  Ph 


t3 

Q3     ^     S'     33       . 

33  -a  co  g -a  d 
Ph 

1  43  --J 

.:  Bn  * 


P,B    a    rt  O 
£    O    33    o  ^    B    Bh 

Eh  *>      _«  g 


o  a> 


CO 

n     ;*  ^    d 


CO 


O  r3 


13 

33  -£  73     ® 


B  O 


2  fe  ^  • 

3  7*  a 


'  a  .a  «->  a:3  ^  rt 

J    a  •«    >    co  •£  g 

s  §  a  °  •-  b  _g  § 

'fs,|111l 

3.2    2^^    g    43 


§»   ei 


.2-1 


o  ^ 


J    3  -„ 

§  §  -  z  * 

JO   g   m   2   a 

B'«gdB>F_0 

I  *iH     d    O  33  •£  ^     O 

*      =«  -g  tM  a  o  a  a 
!  s  -2  «  g  £  -2,  .^  M 

'  .3  35  O    es    B     "  43 

-°  a*>  OT-  «  .2  * 


a  .2  .sp  g,  e  .sf jS  £  |  b  s  &  ^ 

■— J    co    !h  ^h  -u    ;-,  iJh  i— 'h^3H    to    o3 


'O  2 


CD  ' 


"3     43     rt     .•," 

2  a  -g  ^  o 


« 


3  £^  rt 

&     33     a^ 


IB*  'O 
d     43 

.2     >> 

■  43  r2  . 
a  ^  13 
«    03    33 

8    ^^2 

d  co  a 
ffl  8 

as""   S 

;  43  v3  a 

:  .a  Ph  cs 


t>     d     43     33        .     a    -*^     03 

"    t*  J3    t<    cr1  O    4) 

u  fee  43  sa 


§a 


a  -^  .jl,  -^  ^4  a  i— r 


as  43 


a  <H     43 


o3  eo 


03    ' 


-a  o 
Seh, 


3    OlH 

a"-5  ° 

43 


3  a  $ 
JSts  I 

5Ph  ftSP^S 


■"3  to. 


6X)  03 

a 


IS    co    g 


33    33 

-4J     -    -+J     ^ 


a  " 


2  a"- 
4>  S  *2 "» 


Si3  j  -* 

03    P    03 

?         r*  *&  ' 

>>      a  03 

^h  a  an 

03    o3    03  ^ 
!T     w     C^        . 


o  o  •-  as 

M.a 

o  a  — ■  43 
■^  a  ,33  jq 

-d  «<-  5j 


a  oi 


es  aO ' 


I     a 'a  a 
a  43  .a  ^  a  =«  §  § 

^aca-u,T3  oO  >•  43 


pq  to 


33  !>     >> 

h  >>     03 
3     \    g 

"5  °3 

j  ap5 


rt  V  aa 

.a  wa 


!H 


262 


1881 — Medical. 


■  ■a  eJ 
g.2^ 


a  S^  S  a 


SPis^ 


OJ      e2      —      -      ~ 

ft  bo      «  ° 

§ -g-a  as 

?  £       a 

t>     O     (D     03   c*h 


a  -2  6jd  y 


©  ;-<  43 

^■*  2  o 


O    rQ 

s  a 


-a 


a  -=  .jh  a  rj 
t,  o  ^  •-<  ,a 


•73    « 


-a  >-. 
.15  -a 


60 
a  is 

•3  a 


0,    s    «  .- 

-^  a  ^  " 


,  ^  a 


&•  § 


a   o>  a> 

■a)    a> 
obco 


©  ^ 
el 
S  J 


•n  a 


M^^ 


a  g 


a  _g  a  fcs 

■§  3  2  <u-3 
£  S  ^3  >  .2 

S»  8  2  J3 

s  »  s  « 

5P  5  °-2  . 

.5  a  <b  x  a 

43    09  J_3    CJ    Q 

§  si ..  S 

,  3  .2  =♦-.  '?-  ^ 


*     .  H3 


i>  *-«  J3 


+3    ..H 


a  a 


a  -w  ja 
o  es  ^ 


.2  o  2  U  g 

P        § 


a  a 


°1 
«  a 

«  9 


5a  g-d  « 

H    el  T3    t-^hH 
<u  J    el  -fi  H 


p£i 

<y-S 

a 

"?, 

S>§ 

c 


"W 


n3    el 

'w  a 


a  o  i,  "*  >>-a  >>t3 


^3 


a 

a 

o 

ft 

4J 

CJ 

trt 

0 

h 

a 

ft"^. 

a 

(B 

si 

a  -->  %  .g  a,  a  a, 


.a  >>t3    -  J, 

*  8  Sq  &»§ 


£.2-1 


lO 


Ui     "     O) 

lis* 


0J  s- 


\    u   «  ~ 

•a  43    !S     I     w 


oi    5    ffl        T3 

.. »  a  ^  «  . 

w  'zl  °1 

Sj,j  ft-a  r  a 

■S  "g    be  p    fee  g    JJ 

£  g-ns-s  a  s 


•"^5  -£     I     "" 

.  «  ^  *   '.  a 

,2  »H      ,a  o 

el    ^    es  ^3    '— 

9    2    oj        J"  S    O 
M  "55  ^    g"    fa 

>»•&,  2  -S  .2      -8 
a  ®  ,a  «  efi  -3 

°..     ^^Sbt 

_,   be        <u  •"   = 

«  »a 


l^llift 

o  43  p  n  i-i  a 
p  ,2       -:  ra  !^ 


,o  5 


>,  ft 
>-  a 
£  5 

•^   43 


a  -Q< 


•^  a  ^  ^  ^  r- 1  s»^ 

»'SB  *  a    •  * 
ft  ft     ■;  a  ^,r 

•5  g  -a  fe  J^  -  «  bp  __  43  §  ^  m 


,  'a  —  „ 

>  S  2  a -a  .2 

1  .£?  5  .2  S 

j  «  s?  «     :r 

a  -    ' 

a  "S  c 

i  "a  &  §  a  "a  S  J 

>  3      .«  «  ft  - 
j  S    •  >,  8  a;  2 
1  "  p  5  .s  ^  .2  §  "S  S  -a  .2  § 
=32  §  a  3'S5^£  §  SS 


a  2 


-S  2t3 
10  §1 

ft43     -{3       D-Jfl 

S  *  g  -a  .2  a 

o*1  ><  a  i<h 


2  ^  * 

B'Sa 

<v  a 

2  °  •— • 
a  a) 

2  " 

'>  2  a 
>.  w  o 

w  8  2 
>,bcg 

•a  >>a 

a   -  *- 
Son) 

r05  43     fe 


o 

a 

DQ 

43 

o 

^ 

a 

o 

^ 

i) 

*j 

o 

S 

Bl 

-« 

DQ 

< 

^   II     0) 


>-  s£  ,a  — 
^  'S  i  2 

el    —  -rx  ^h 


«2  2  S  o 


g    elfa 


.y 

el    .      el 

3? 

od 

a 

=*H      O 

a 

ago 
pita 
side 

43 

a) 

g- 

M    ei    3 


Eh '5 


I 


;» 


ft 


be-r; 
r2  'a 


.  io  Eh 


02 


1881— Medical. 


263 


3    to 


sw 


rfl    g 
.2    O 

r3        'H 

fl<2 
£  -£ 

-U     03 


.a  a 


-2£ 

•fl  «H  .3 


o 


B    >>  3    .. 

3   o   cd    3    fa 

B 

3 


•1 


°  -2  .2  -S.-0  £  6 

*<  s  -s  2P  o  «  fa 

cd  .5  B,  3    o"S  ■» 

^3  fa   rB  3  CD 

>,  2  e          =  fen  l-i 
fa  T 

s  s 


^ 


£~ 


.,5   Jj  0«'fc   » 

O    O    d^    P<  3   "S 


"    2    B    S    «         ®    S 


,fi.B 


fa-fl 


J  -3    «  _ 

o3  -s  "E  "5  -3  , 

■rj  jq  -fl    OS    3  £ 

K         3    fa    a?  si 


cfi  ^ 


•3  Si 


9  fe 


fa  *3  =4-1 

fa  fa 


S     £     "i'S     CD 
S  fa        „ 


CD     fl     CD     OT 


u 


3   cd 

w     --     w*j     H     iy  .     „ 

fl  oiriS  fl  rB  o3 
'gH'SoS^.gfl" 
£    Ph^)  ^  ,2    «   cu   «S 


«!* 


Bat-?, 


■a  os  1$p*  "3  E  S  -g 

A   S"fa53  sSS   p. 


T 

3 

& 

fa 

i>> 

-u 

a 

fa 
o 

-3 

p. 

fl 

Ph 

a 

H 

H 

39 

H 

3    S    * 


B.;fl 

s 

°    B 


llWs^^ 


j;    CD    .\« 
rB    fa    bD„p 


■O    BH 


O    3 
3  'g 


be 


9  Q 


bt-fl    I    •* 

fl    B     I    "3 


.3      •  "o    ■»  -u 


S.   3 


-3  ns 
a  °    3    >  rB" 
<D.=fa        .=    g"  s    =3    03    3  • 

CD     fe-  =     - 


3  g  c  b  ^ 
b-m *-  —  g 


!  T3    O 


-p  .; 


3   3 


s  g  s 


M      03 
-l     « 


3  §  ^  >•■  s  '3 

■SlS  s  *  S  tg  "H 

-5     <U  h-*  C5     (-J     O 

g  b  ^ 

fa  o.  3  ^ 


3   ^ 

.2  rH 

OS 


I  £  'B 

£     CD 


3  .2T-3 


B,  3 


B    JO 


>>s  >» 


B-fl^ 

S         -  be 

»    6C  3      . 

fcD  2    S'B-B 

5    fl   3»5.2 

■B  -3  .2  .B    cS  Q 


2  S"? 

3  >■  •— I 
03    CD  O 

■|S«    |do. 

3  ^      2-CX) 

'3      A  . 

-B    cd      •    3    3 

»^b  3  £  ?  «  S7  r  a  S  o3  «  s    ' 


B        -S° 


CD    b£ 


-    O    B  o 

?  -2  A«=s  S^ 
iaSg^^'2 


CD     CD     t^i  t/>     CT* 
O.— '     fa     "" 
CD 

-  > 


§  §^ 

°O-0    _  g    jj 

^-3  p,  3 

•"  3    B  -2         "^ 
"2    -  3    cj  u 

CD 


•»   J3    03    CD  ^B 


«       ^   a 

-    ■    ■    <3  _    CD    3 

g        P   3   5§  « 

co      -to  ,    fa    B 

U~  §  1  ^  V 

0- g 


DC 


00 


^      x    -J      1— i    O      r/_      O      CD 


S  fl 

-  fl, 

&* 

03    oj 

„  fl 

X-B 

8  S  3 


I S  "H  fee 


S^^ 


=5  .03    ^ 


a*  S 


3  B  £    <u 

A  3 

„  S  ;  «  o  v 

™     "     03     Oh  CD  _^ 

£  tn    fe  CD  -3 

^  ^  B,  3 


--.    ■"    o    55  -B 


A    3 


?3B 


B    to 


a    m  °  °  32  g 

S  §  a  fa  o|  | 

^  1  S  ^  1  a 

So  43  ?  c3  O  o 


?  ,-e     3  —  -*-■  8  a>  :2  -b 

falO  CDcDt»CD>S       ^ 

CD  ■-  8*3  -3  .a     fl  q^  .fl 

cs^3    S";*?    u  /-,   B    cd-3 


bu-3 


s  g 


"^      03      03   rfl    _J 


p< 

CD 

CO 


03     CD 

B--3 
A    B 


264 


1881— Medical. 


*  a1 
P<3 


-w  s  be 


8,2' 


,3  S)^0 

cs  -a  pd  2 


to    H 

CD  a 

S>pd 


ST3  « 
„_3  pd 
g 


:  o  § 

,2  -p>  a? 
->   d  a 

;  p=  •« 
!  sw 

•  g-d 

M^    . 

i  >>&(< 
'-d  o  d 

<pd  «l 


o3  ^3 
cd  13 


3  S 


"S  fc 


6~>=g 
03  ^ 


3 

«o  o  8 


,2  ^"Els 

•2  "«    p 

2  o    ^    i- 

"?  P<  O     O 


»-d  8 


^   es  =*-  ^3  a> 


60«l 

o  _■ 

si 


•d!  pd     bD-W 

-°       a  a 


H    CD 


O 


_  .d 


ao 


a  o  a 


3  p. «  -S 

S  o 

r-t    O  hr,  -PJ 

Softs 


3  a  '5 


is  1-5 


C    co    oj 

om  2 

O  PH    -pa 


3^0) 


CT*Pd    O 


03  «H 
a'       1,2 
■«    a 
2    fl    H    0) 

-w  .,=   -P> 

M  ^2  pa  _ 
I-6    -a 

cu  cd  J  5 
t.  fci  o  e8 
O  On  J 
o    o    o  += 


5^5 

•PS' 

00  i-pd 

CO  '2 

3   to  -d 

P-.2    P" 


-  a 
■d  «  o 

3     ®«M 

d  pd  TT    • 

13  ^  pd  Pd 

Id  o  § 


O    co    c3    P. 
-3    «    0)    O 


t,  u  a  t?  ^  u  c  _-i  i^o 
<»  =*-  <M  ^   g  _   £-£0 


s  g  a 


CO  O     ^ 


oj  ~d  p* 


to     tr,"^ 


-P  CO 
b      I 


a  ^  cd 

03    be— i 


)    o3  "  m     "*   U    to    rrt 


be  CO 


CD 


*a5saS 


o3   cd     .  r^  co 

!  —    g    M      .    ©  . 
i  .5  |   e-  P-  " 

s§.g 


bC-P    o 


d-a  =3  » 


S-h 


•3  co  a 

tOpSM 

§  a 

2   -=•        . 


.„-d    O  f  cT1 

g  &'-§  ©  g  a  -• 

a     H     U  r-l     §     P     3 

»  2  '&  A.S  ^  * 

CD    "    0)    "    •-     -  f-i 


CD 


°  2  & 


CD  [3  E"1 

d  J  d 

03    ¥ 


a  a 

al 


"3  ^ 
co  S  'd 


OgPtJ 

S  -S      -d  cd 


CD 


6cd 


a'73 

CD     <U 


3     m, 


••>    CO  "i  'T*     CO       . 

O  ^P    Ph  fi     I     o,.S 


^2     &.CO 


S  2  -d 

■B  °-2 
a  p^P 


-a  a>; 


■S-s  a 

CO      ** 

oi    O    „ 

•c  ^  J 

p   ci    s 


,scj  a  r-  pd  t3  ja 
o    .  E  a  a  -^  3  * 

U^  §dis  "  gW 


S^^^  I.  £-i  o?'.^?d  a 

-d  .£fp3    ShU    S«  ^csOcd 

m  SO  a  cq  .a  p.oq  n  .a  Phih  p= 


pd   a> 

CO   C(H 


pd    *  pd 


■d  ;: 


'W 


32 

d    d 

d  js 


6d        03 
°3   -PJ  ^p 

co  «a  a 


£■ 

pa  W 

CO 

S 

>>  '-^ 

d-o  2 

a  ojj 

**    t*  03 

Em 

o  "  be 
be  s  - 
.S  &  "3 

3-2  -§ 

fcr-i-d 


d  S  &  a 


^., 


O  ^3  •"  ro 


a  o  *  os  *d 


_co    >>  Vi  _o 


a  «h 
O  d 


cd  g 

3  'd 

fcn  «4  ^ 

C,J  c  co 

-    ®  t* 

*  pd  ^ 

--a  a 

bX)  03  03 


a  pa 
_  ■«)  pd 
p2      p- 


o  d  co 
•rt   03 
"P-H 


■d  o  >  * 


£pd 


a  a  ^>  &  o 
o  ^d  pd  o  a 

«    *    bD  Pi  cd 

cd  cd  *n     t; 

co    2    "  I-  ■    m 


>J  >>° 


•d     03     CD 


;-d -s  a  ■=«  gp=  be 


fc  •«    Cp 


g 


bc  g  ^  .-^  o  "S 
a^ps  &  Sp3  apa 


«d  g  be 


dpM 


a  2  beg 


g'd  g-d-g, 
cd       *-•  a  .pt 

co  CO  'd    o3    Pi 


o 


.  05  i 

i-s 


1881—  Medical. 


265 


si 


a  p  2 

a  8fl 
"  -*» 

o  g)*" 

t}  ~ 

Sri    a> 

P-I  —  s 

.2-2  « 
-5  £  $ 
2      £ 


■^  "£  -3 

°  £  2 


s  a 


s  P 
3,2 


60  S  ."£ 

§.SS 


S^<p  5 

~  T3  a> 

""     ~  ?  a> 

<«  a  «  a 

2-3  o  » 
§.2rd 

s  cs  "3  a 

J  3  45  P 


& 


i5o  g: 

a  a  -  £ ' 

.a  o  a  s 

o  Q     0,2 

^  .  'is  &  S 


^•2  •§  <§  § 

a  *;  c  t^  9 

£;    a>  -+j 


a 


-h'S'G,?' 


«     g, 


a  o  o- 


«M 


CJ 


p  IS  »  3 


o  ,a   a> 


■p  g'd 


w  s  a 

So  as  «      3  ^ 

p,      »  "  o  r2  S 

g  ts-e  £  m  § 

■a.2  a  «  o  o  g 


pC    a>    S 
•r   a>   a. 

£   3,^ 

1 95 
■13 

Is*    pi 


P=~ 


O    a> 


a 

O    r^      O 

-a  3,3 

%    9« 


c$    ci    ot 

3  3 'a 
££"$ 

■*■'  S-i 

a, 

-a  6c4h 
•-  ,p  c« 

a>    o3  ,3 
■+=  a  ^ 

s  a  § 

2.2  a 
p  2  o 


A  -a   S 

B      <T|      *> 

a)  a  _2 


a.   3 


-!3   si   B   a> 


3J    » 


£  3 


.5    Ph 

o3    o> 

2     &     ! 

p_  O    l 


5    «3 


^    -o    g    03    03 
fn    3 


03*  *8 


!.     g   ^h     P. 


O    V    ri  -P  'x    B 


Sea  n  oc  a 


n3  ,fl   o3   a.  i 


>.  g 


•  aa  =+h  a. 

*  o  O  > 

•a-a  o  h 

es    g  cs  a) 


5  3    . 
so-a 

3^3 
I8" 


5£ 


>  'aj 

«g    03 


J3  "2 


jj  a. 
as   tn 

g=2 
§-g 

la-a 


.    60 

a.s 


a.        g 

o  a>  w 


03 


BB 

-^  -» 

a  p 

o   © 

since  an 
typhoid 
years  ag 

o    OT 

a  s 

p^T^ 

a>  ^h 

>v.2 

a;    e3 

P.    s 

P 

3 

i 

> 

eu 

tH 
v. 

a 

ra 

^^ 

o 

93 

S 

o 

EH 

O 

3 

u 

^4 

«J 

o3 

-^ 

01 

S 

c3 

cd 

3 

<) 

°  l».  »  _: 

J  S3  "3 

u  >g  a  > 

a  S  .2P  o 

2?^p 

6  aa° 


Pi 


VOL.     XI. 


as 


2P--H 


18 


266 


1881—  Medical. 


"e 


> 

EH 


a 

to 

|£ 

o 

0 

o 

Malignant    stricture    of     rectum; 
perforation    of     caecum  ;     acute 
peritonitis;    no  old  ulceration  at 
point  of  perforation. 

Malignant  stricture  of  rectum  about 
4  inches  from  anus;  perforation 
of  transverse  colon,  apparently 
determined  by  a  sharp  piece  of 
mutton  bone,  which  was  retained 
in  colon  by  the  stricture,  and  had 
much  excoriated  the  mucous  mem- 
brane ;  acute  peritonitis ;  no  old 
ulceration  at  point  of  perforation. 

Stricture  and  ulceration  of  sigmoid 
flexure  from  new  growth.  Per- 
foration of  sigmoid  flexure  just 
below  ulcer — ?  from  use  of  enema 
tube — acute  peritonitis. 

Stricture  of  rectum,  consisting  of 
ulcerated  new   growth,  4   inches 
above  rectum ;    acute   peritonitis 
originating  in   neighbourhood  of 
wound. 

"a 
1 

H 
H 

Enemata,  &c. 

Enemata  given  with  much 
relief ;    died    eventually 
from       perforation      of 
bowel. 

None;  patient  was  mori- 
bund on  admission. 

Left     lumbar     colotomy 
commenced,    but    aban- 
doned.     Littre's   opera- 
tion performed  at  same 
time  on  right  side,  but 
bowel    not    opened    till 
following  dny,  three  days 
after  admission. 

c  a 

o  o 

Three  weeks. 
Seventeen  days. 

Gradual  onset  since 
May. 

Six    months;  gra- 
dual onset. 

a 
o 

§ 

.a 
o 

o 

CD 

3 

ft 

Stricture  of  rectum. 
Stricture  of  rectum. 

Stricture  of  rectum. 
Stricture  of  rectum. 

o 

Q 

Oct.  20 
June  17 

Nov.  24 
Feb.  21 

09 
bO 

1 
S 

II                                    II 

a 

i 

■a 

Oct.  12 
May  14 

Nov.  24 
Feb. 10 

Initials, 

age, 
and  sex. 

S.  H., 

50, 
F. 

M.  B., 
53, 
F. 

M.A.H., 

47, 

F. 

M.  H., 
59, 
F. 

1881—  Medical. 


267 


o«o  gft  fe  £  -2  -3  a 


u 

a 

-to 

o9 

a 

cum 
sted 
was 

'E 

OD 

+3 

a 
s 

till 
d  he 
from 

P 
-w 

s 

3  M-3 

st) 

~v  w  '"3 

o 

o 

be 

a 

-a  ^ 

> 

o 

a 

to 

be  u 

O 

09 
CO 

5~  « 

'5 

a  P  -• 
•a   u  jq 

■C   o~ 

00 

c 

u 

8  s-.*3 

-u 

o 

a 

03 

a 
>  fl  a 

O    «    d 

a 

a 

£g    . 

*" 

~- 

c  '•«  ^ 

ufl 

ofl 

Tl 

2  2"? 

=   13     OT 

OJ 

if- 

^>  a  a 

oS 

a 

3  c2  •£ 

Do,* 

~ 

£  a  S  bs  «  3 

ft  o  g  J  |  P 

o  =s  *   S  a 

•g    ^3     «     S  «H 

■*3  "3  ^  a      "3 

to  ;£:   o   <u  ^  J; 

<t-  ^  OB  03  "-1       • 

5  o  u  a       tCH 

•Si  tig 

S  rt  ». -0 


a   «  _r  a  t=   a 
'5    a,  °    o    a    ?    S  jq 


o    ^^ 
w    aj    qb 


'Si)'*3 

a  o 


5 


CO 


TO      ^ 

^>  OB 

*  s  a  §  *  § 

"  3  2  §•£  a 


°y 


'  --K 


a   ti  a  ° 
a 


ea  -it  tu   _,   ^ 

,£8  ja  ft  ."E  "S  2  9 
•r  &  3  &  p,"2  '-3 


«h  a,  a  a 
-  5  a  o3  o8  ,a  si 
a  2  ^-c  a      ^ts 

tu   co  a; 

^        «"S  « 
aB   a; 


.^  *a  a  ~!3.  "S  ^8-7-!  a  ^  _ 
^.bcogol^aag-fl- 

9jtp'to!HaaBtSo3«4H.a 
M  


a 


OB     >j 

«     OS 

a  ^ 


03    0> 
T3     ft 

<-*  a 


5' 


o8  a  u     . 

u  a  aB   co 

b£  ^  >  ^ 

...  >*  as    a; 

to  x    a> 

5    43     £     & 

a  g  o  o> 
o  a  a   a) 

ao^ 

a>  —I   fl  *3 

2  S  §  u 

J2   ~    ~S   -O 


I 


R^3 

aB   >j 

fcl    co      . 

°  a   " 


a  o 


rt  -a  a  a 

aB  -» 

^  a  -■   <u 

.2   u  be 

■S  1  2  > 


13  4IP 

+>"  J    to 

"  a  -a  o  a    • 
s  .2  a  cs  ^3 

a  —    «rrt       a 
-S  °  5       ob  be 

"E  —  a  ^^3  3 

M  2  S  >  o  i, 


^ 


Ph 

<5 


W  in  l 


5£f^ 


SPECIAL   ANALYSES   AND   ABSTRACTS. 


I.— MYXCEDEMA. 

Two  cases,  both  females. 

Case  1. — J.  L — ,  set.  38,  admitted  October  2nd.     Discharged  December  4th. 

Family  history. — Father  died,  set.  46,  from  the  effects  of  drink.  Mother  and 
a  brother  and  sister  died  of  consumption.  Her  one  child  died  of  water  on  the 
brain. 

Previous  history. — Had  usual  diseases  of  childhood,  also  typhus  fever  and 
rheumatic  fever. 

Present  illness. — In  1869  first  began  to  feel  tottery  on  her  legs  with  shooting 
pains  in  all  the  joints,  especially  in  right  arm,  the  hand  pitting  on  pressure. 
This  followed  by  pains  in  shins.  Then  became  extremely  nervous,  and  fell  on 
attempting  to  walk.  Lost  her  hair  a  good  deal.  Eyelids  became  puffy.  Slow- 
ness of  speech  came  on.  Became  deaf  in  right  ear.  Memory  is  good.  Cata- 
menia  irregular. 

State  on  admission. — Has  recently  had  a  bad  flooding,  and  breath  is  now  very 
short,  and  she  is  very  weak.  She  is  rather  stout.  Complexion  waxy  and 
translucent,  with  a  flush  on  either  cheek.  Eyelids  thick  and  drooping ;  eye- 
brows raised ;  eyeballs  rather  prominent ;  pupils  equal.  Skin  dry  and  rough, 
elastic  to  touch •  no  pitting  anywhere.  Sight  good •  taste  good ;  is  a  little 
deaf.  Speech  remarkably  slow  and  deliberate.  Hands  spade-like.  Thyroid 
gland  cannot  be  felt.  No  lumps  above  clavicles.  Feels  listless  and  apathetic. 
Superficial  and  deep  reflexes  normal.  Temp.  97*4°.  Urine  clear,  sp.  gr.  1015, 
?  trace  of  albumen. 

During  her  stay  in  hospital  patient  regained  some  strength,  but  underwent  no 
important  change.  The  average  amount  of  urine  passed  in  the  twenty-four 
hours  was  45*7  oz.,  as  estimated  from  twenty-five  observations;  its  specific 
gravity,  as  estimated  from  eight  observations,  was  1014'5.  The  daily  average  of 
urea,  as  estimated  from  eleven  observations,  was  213-19  grs.  It  was  noted  to 
contain  a  trace  of  albumen  on  three  occasions. 

The  temperature  was  taken  seventy-one  times,  with  few  exceptions,  morning 
and  evening  daily.  It  only  reached  normal  sixteen  times,  and  was  never  above 
98-6°.     On  nineteen  occasions  it  was  below  97°. 

Case  2.— H.  B— ,  set.  36,  admitted  September  30th.     Died  October  6th. 

This  case  was  in  hospital  in  1879.  For  abstract  of  history  and  condition  of 
patient  at  that  time  vide  Table  VIII  on  p.  388,  vol.  x. 


1881—  Medical.  269 

No  notes  of  history  taken  this  time. 

State  on  admission. — Typical  features  of  a  case  of  myxoedema.  Signs  of 
pneumonia  at  left  back.  First  sound  of  heart  inaudible,  second  clear  and  sharp. 
Pulse  72.  No  ascites.  Tongue  moist  and  pale.  Bowels  regular.  Urine,  sp.  gr. 
1020,  no  albumen.     Catamenia  absent  for  three  months.     Temp.  97*4°. 

October  2nd. — Mind  is  wandering.  Knows  she  is  in  St.  Thomas's  Hospital, 
but  objects  to  having  "  no  bed  to  lie  on."  Passed  no  urine  yesterday  nor  during 
night.     Bowels  open  twice.     23  oz.  of  urine  drawn  off,  sp.  gr.  1020,  no  albumen. 

3rd. — Mind  is  clearer. 

6th. — Has  continued  to  wander,  and  is  very  drowsy.  Evacuations  passed  in 
bed.     Died  quietly. 

Temp.,  September  30th,  2  p.m.,  97  4°;  8  p.m.,  96-2°.  October  1st,  a.m., 
94-8°;  p.m.  95'60.  2nd,  a.m.,  95-4°;  p.m.  96°.  3rd,  a.m.,  95°.  4th,  a.m.,  94°; 
p.m.,  94°.     5th,  a.m.,  94°  ;  p.m.,  94°.     6th,  a.m.,  94°. 

Post-mortem. — Body  well  nourished.  Skin  very  pale.  Peritoneum  contained 
a  pint  and  a  half  of  clear  serum.  Parts  of  the  membrane  were  very  cedematous. 
Pericardium  was  completely  distended  with  pale  serum.  Left  pleura  adherent ; 
right  partially  so,  and  contained  half  piut  of  serum.  Heart  7i  oz. ;  valves 
normal.  Lungs :  left  completely  collapsed,  and  the  whole  organ  sinks  in  water. 
Partial  collapse  of  right.  Liver  anaemic.  Kidneys  sublobulattd,  elongated,  and 
abnormally  firm.  Capsule  strips  off  abnormally  readily.  On  section  organs 
presented  a  uniform  homogeneous  glistening  aspect.  No  wasting  of  cortex. 
Spleen  apparently  normal.  Intestines  normal.  Brain  45  oz.,  somewhat  anasmic, 
but  otherwise  natural.  Uterus  large,  but  normal.  Thyroid  gland  represented 
by  two  little  yellowish-white  masses,  forming  together  a  mass  about  the  size  of 
the  last  joint  of  the  little  finger. 


II.— SCORBUTUS. 

One  case,  J.  W — ,  sat.  48,  metal-worker,  admitted  April  27th.  Died 
May  4th. 

Family  history. — Good.  Mother  had  an  attack  of  purpura,  from  which  she 
recovered. 

Previous  history. — Good. 

Present  illness. — Since  beginning  of  March  says  he  has  been  living  on  bread 
and  meat  without  vegetables.  Four  days  before  admission  felt  chilly  and  ill ; 
on  subsequent  day  left  foot  began  to  swell,  then  right  knee,  and  arms  and  hips. 

State  on  admission. — Fairly  nourished.  Breath  foul,  gums  swollen,  with  a 
few  small  ulcers  on  them.  Fauces  swollen  ;  slough  on  right  side.  Tongue  red, 
and  coated  and  swollen.  Glands  under  jaw  swollen  and  tender.  Appetite 
fair;  is  very  thirsty;  bowels  open.  Heart  and  lungs  normal.  Urine  1030, 
no  albumen.  Temp.  100°.  Has  petechial  spots  over  right  elbow-joint,  pain 
and  tenderness  in  shoulder  and  elbow.  Below  knees  on  both  legs,  which  are 
swollen,  is  an  abundant  petechial  rash  and  some  general  bluish  discoloration  ; 
no  swellings  in  popliteal  spaces ;  no  articular  swellings,  but  pain  in  joints. 
Ordered  Mist.  Pot.  Citr.  3j,  4tis  horis. 


270  1881— Medical. 

April  30th. — Not  so  well.  Temp,  bas  risen  to  103°.  More  bruise-like 
discoloration,  with  swelling  on  dorsum  of  each  foot  and  over  right  olecranon. 
Throat  very  painful. 

May  2nd. — Patch  of  extravasation  over  sacrum,  one  on  cheek,  and  more  on 
legs  and  arms.  Left  forefinger  red  and  swollen.  Ordered  Liq.  Ferri  Perchlor. 
mxv,  Spirit.  Chlorof.  *ixv,  Aq.  ad  §j,  t.  d.  s.,  wine  $x. 

3rd.  -Extravasation  of  blood  beneath  prepuce.  A  few  spots  of  blood  in 
motion. 

4th. — Very  much  worse.  Very  livid,  and  extravasations  have  increased. 
Pulse  126 ;  temp.  100-8°.  In  the  afternoon  he  became  delirious  and  died,  some 
blood  being  passed  in  the  urine  just  before  death. 

Post-mortem. —  Abundant  subcutaneous  haemorrhages  as  in  life.  Peritoneum 
contained  a  few  ounces  of  bloody  serum ;  considerable  patches  of  extravasation 
between  layers  of  mesentery.  Pleurae  and  pericardium  normal;  no  extravasa- 
tion beneath  them.  Lungs  cedematous.  Heart :  left  ventricle  firmly  con- 
tracted and  empty,  right  contained  some  recent  clot.  Liver  appears  swollen; 
here  and  there  in  substance  some  patches  of  extravasation.  Spleen  :  a  patch  of 
extravasation  beneath  capsule.  Kidneys  normal.  Intestines :  some  petechial 
haemorrhage  in  patches  beneath  mucous  membrane  of  small  intestine ;  Peyer's 
patches  in  lower  part  were  swollen,  and  the  lowest  was  ulcerated;  in  the 
caecum  was  a  patch,  where  there  was  a  considerable  amount  of  clot  beneath 
mucous  membrane,  which  itself  appeared  black  and  gangrenous  and  about  to 
slough ;  a  few  inches  lower  down  was  a  patch,  about  two  inches  long,  involving 
the  whole  circumference  of  the  bowel,  where  there  was  the  same  condition,  and 
a  large  clot  beneath  peritoneum  corresponding  to  it.  Stomach  :  a  few  small 
submucous  extravasations.  The  tonsils  and  mucous  membrane  around  gan- 
grenous. Larynx  :  extravasations  here  and  there  beneath  its  mucous  mem- 
brane. Joints  normal.  There  were  no  clots  between  the  muscles  of  legs,  the 
extravasation  being  almost  entirely  into  subcutaneous  tissue. 


III.— ANEMIA. 

Fifteen  cases  :  3  males,  12  females.  1  case  pernicious  and  fatal ;  in  1  probably 
renal  disease ;  in  1  possibly  Addison's  disease. 

Abstract  of  fatal  case. — E.  T — ,  aet.  50,  female,  married,  admitted  November 
16th,  1880.     Died  February  3rd,  1881. 

Family  history. — Father  died  at  73.  Mother  died  at  climacteric  period.  Has 
had  five  sisters ;  only  one  is  living.  One  died  of  post-partum  haemorrhage  and 
three  at  climacteric  period.  Has  had  five  children  and  four  miscarriages.  No 
certain  evidence  of  syphilis. 

Previous  history. — Never  very  healthy.  Usual  diseases  of  childhood.  Rheu- 
matic fever  twelve  years  ago.  Chest  was  affected  then,  and  has  suffered  from 
palpitation  on  exertion  since.  Catamenia  were  formerly  too  frequent,  but  they 
have  not  appeared  for  four  years.  Confinements  were  troublesome,  and  had 
haemorrhage  after  two. 

Present  illness. — Has  been  coming  on  gradually  for  four  or  five  months,  and 


1881—  Medical.  271 

for  the  last  ten  weeks  she  has  taken  to  her  bed.  Commenced  with  weakness 
and  vague  pains  in  limbs,  which  have  been  increasing.  At  same  time  throat 
and  gums  have  been  sore,  and  she  has  been  spitting  blood  during  her  whole 
illness.     Has  not  herself  noticed  any  increased  sallowness  of  her  complexion. 

State  on  admission. — Well  nourished  ;  intensely  anaemic  ;  conjunctivae  slightly 
yellow ;  mucous  membrane  of  mouth  pale ;  gums  much  swollen  ;  teeth  tender. 
Spits  blood  from  time  to  time.  Lungs  emphysematous.  Heart:  murmur  all 
over  prsecordium,  systolic  and  loudest  at  base.  No  evidence  of  hypertrophy. 
Pulse  84,  weak,  and  compressible.  Venous  hum  heard  on  both  sides  of  neck. 
Abdomen  flaccid.  Liver  can  be  felt  below  ribs.  Spleen  enlarged  and  palpable 
below  ribs.  No  glandular  enlargement  anywhere.  Temp.  99*4°.  Urine  1020, 
lithates,  no  albumen.     Ordered  wine  and  a  mixture  containing  iron. 

During  her  stay  in  hospital  she  became  gradually  weaker;  had  delusions 
from  time  to  time ;  was  constantly  troubled  with  a  hacking  cough,  and  expecto- 
rated blood,  most  probably  from  gums.  The  circulation  became  weaker,  and  the 
blood  on  examination  was  found  to  be  somewhat  deficient  in  the  number  of  the 
red  corpuscles,  which  were  paler  than  usual,  did  not  run  into  rouleaux,  but 
remained  heaped  in  irregular  masses.  They  were  very  pale  in  colour,  very  few 
were  well  formed,  many  tailed.  Her  appetite  failed,  and  towards  the  last  she 
suffered  from  vomiting.  Her  temperature  was  almost  always  at  some  time 
during  the  day  above  the  normal  till  the  last  two  days,  when  it  was  subnormal. 
The  urine  was  examined  on  seven  occasions,  and  was  never  found  to  contain 
albumen. 

Post-mortem. —  Body  fairly  nourished  ;  no  oedema ;  a  thick  layer  of  bright 
yellow  subcutaneous  fat.  Mesentery  loaded  with  fat  of  a  bright  yellow 
colour,  and  between  layers  of  omentum  there  was  a  thick  uniform  layer.  No 
ascites,  or  fluid  in  pericardium  or  pleurae.  Walls  of  heart  loaded  with  fat ; 
organ  somewhat  hypertrophied ;  valves  normal ;  substance,  especially  that  of 
left  ventricle,  remarkably  fatty;  cavities  contained  no  clot,  but  only  watery 
claret-coloured  blood.  Elsewhere  in  vessels  the  same  kind  of  blood,  and  a  few 
small  shreds  of  clot.  Lungs  cedematous.  Liver  flabby  and  wasted.  Spleen 
rather  large  and  soft.  Kidneys  showed  early  interstitial  change,  with  a  few 
cysts  and  granules  of  urate  of  soda.  Brain  substance  very  pale,  and  convolu- 
tions shrunken  and  wasted.     Uterus  normal. 

IV.— GENERAL  TUBERCULOSIS. 
Nine  cases  fatal :  4  males  and  5  females. 

Case  1. — Male,  aet.  12.  Had  symptoms  of  progressive  wasting,  without  much 
fever. 

Post-mortem. — Mediastinal  and  mesenteric  glands  caseous;  tubercle  between 
layers  of  pericardium,  which  were  adherent ;  tubercle  in  lungs,  and  also  caseous 
pneumonia.  There  was  also  an  ulcer  in  stomach,  which  had  perforated.  No 
tubercle  in  intestines,  liver,  spleen,  kidneys,  or  brain. 

Case  2. — Male,  aet.  2.  Died  on  day  of  admission  with  symptoms  of  meningitis 
and  hyperpyrexia.     Temp,  just  before  death  110°. 

Post-mortem. — Tubercular  meningitis  and  miliary  tubercles  of  lungs  and  pleura;. 


272  1881— Medical. 

Case  3. — Male,  set.  4.  Admitted  for  empyema,  which  was  tapped,  and  suppu- 
ration in  elbow-joint,  which  was  opened.  Appeared  to  improve  for  a  time,  but 
then  got  worse,  and  eventually  died  with  symptoms  of  meningitis. 

Post-mortem. — Tubercular  meningitis,  and  miliary  tubercles  of  lungs,  liver,  and 
spleen ;  also  some  pus  in  left  pleura. 

Case  4. — Male,  set.  2.  Symptoms  of  meningitis.  Very  chronic  case.  One 
month  in  hospital. 

Post-mortem. — Tubercular  masses  in  brain;  meningitis;  miliary  tubercles  of 
lungs. 

Case  5. — Female,  set.  23.  Very  well  nourished.  Admitted  with  symptoms  of 
acute  fever.  The  temperature  was  very  high  throughout,  and  reached  107° 
before  death. 

Post-mortem. — Miliary  tubercles  of  pleurae,  lungs,  peritoneum,  and  kidneys. 
No  tubercle  of  brain,  but  numerous  small,  probably  perivascular,  hsemorrhages. 

Case  6. — Female,  set.  9.     Symptoms  of  meningitis. 

Post-mortem, — Miliary  tubercle  in  pia  mater  of  brain  and  cord,  peritoneum 
pleurae,  and  lungs. 

Case  7. — Female,  set.  29.     Symptoms  of  meningitis. 

Post-mortem. — Tubercle  of  pia  mater  of  brain  and  cord,  peritoneum,  pleurae, 
and  lungs. 

Case  8. — Female,  set.  17  months.     Symptoms  of  progressive  emaciation. 
Post-mortem. — Tubercle  of  lungs,  bronchial  glands,  thymus,  liver,  and  spleen. 

Case  9. — Female,  set.  34.  Rapid  wasting,  with  fever.  Signs  of  pleurisy  and 
peritonitis.     No  post-mortem. 


V.— MALIGNANT  DISEASE  (GENERAL). 

Fifteen  cases :  6  males  and  9  females.     5  males  and  4  females  died. 

Case  1. — Male,  set.  42.  Died.  Right  testicle  had  been  enlarged  for  eight 
years.  Had  been  ill  for  four  or  five  months  with  cough  and  dyspnoea.  Signs  of 
tumour  of  chest. 

Post-mortem. — Sarcoma  of  right  testicle,  of  lumbar  and  mediastinal  glands, 
extending  backwards  through  intervertebral  foramina  into  spinal  canal,  but  with- 
out injuring  the  cord;  also  sarcoma  of  lungs. 

Case  2. — Male,  set.  23.  Died.  Right  testicle  removed  five  months  before  for 
cystic  sarcoma.  Ill  for  a  month  with  dyspnoea.  Fluid  in  pleurae.  Large  quan- 
tities of  blood-stained  serum  removed  on  two  occasions  by  aspirator. 

Post-mortem. — Sarcoma  of  liver,  spleen,  kidneys,  left  supra-renal,  lungs,  pleurae, 
and  mediastinal  glands;  also  a  mass  in  posterior  part  of  right  frontal  lobe  of  brain. 

Case  3. — Female,  set.  54.  Died.  Scirrhus  of  right  mamma.  Signs  of  intra- 
thoracic tumour  and  enlarged  liver. 

Post-mortem. — Scirrhus  of  right  mamma,  lungs,  and  liver. 


1881 — Medical  273 

Case  4. — Female,  set.  56.  Died.  Scirrhous  tumour  in  left  mamma.  Suffered 
from  ascites  and  chest  mischief. 

Post-mortem. — Scirrhus  of  left  mamma,  pleura?,  liver,  and  retro-peritoneal 
glands. 

CASE  5. — Female,  set.  46.  Discharged.  Left  mamma  excised  nine  months 
ago.     Symptoms  of  intra-thoracic  growth. 

Case  6. — Female,  set.  48.  Discharged.  Left  mamma  removed  three  years 
ago.     Symptoms  of  intra-thoracic  tumour. 

Case  7. — Female,  set.  28.  Discharged.  Scirrhous  tumours  in  both  mammae, 
skin,  orbit,  abdomen,  and  thorax.  A  very  chronic  case.  Symptoms  those  of 
progressive  weakness  and  emaciation. 

Case  8. — Female,  set.  64.  Discharged.  Melanotic  sarcomata  in  skin,  most 
abundant  on  abdomen.     Had  ascites,  probably  due  to  growth  in  abdomen. 

Case  9. — Female,  ajt.  30.   Died.    Symptoms  those  of  intra-thoracic  tumour,  &c. 

Post-mortem. — Sarcomata  of  periosteum  of  left  clavicle  and  scalp,  of  retro- 
peritoneal and  mediastinal  glands,  and  of  liver. 

Case  10. — Male,  set.  24.  Discharged.  Numerous  subcutaneous  tumours,  one 
of  which  was  excised,  and  found  to  have  the  structure  of  a  sarcoma.  Skin  of  left 
leg  much  thickened,  as  in  elephantiasis,  probably  from  lymphatic  obstruction.  A 
very  chronic  case. 

Case  11. — Male,  set.  10.  Died.  Right  leg  removed  for  sarcoma  one  year 
before.     Symptoms  of  intra-thoracic  tumour. 

Post-mortem. — Right  pleura  entirely  occupied  by  soft,  partly  cystic,  new 
growth;  left  also,  to  some  extent,  invaded.     Abdominal  organs  free  from  disease. 

Case  12. — Female,  set.  28.  Died.  Symptoms  those  of  new  growth  in  peritoneum. 

Post-mortem. — Malignant  disease  of  right  ovary,  liver,  retro-peritoneal  glands, 
and  lungs.  Microscopically  examined,  the  growth  proved  to  be  epithelioma ;  in 
what  organ  it  originated  there  was  nothing  to  show. 

Case  13. — Male,  set.  48.  Died.  Symptoms  of  emaciation  and  great  constrict- 
ing pain  in  abdomen.     Paraplegia  set  in  suddenly  in  hospital. 

Post-mortem. — Malignant  disease  of  right  lung,  liver,  pancreas,  and  glands  of 
cceliac  axis,  involving  intercostal  nerves  and  invading  spinal  canal,  as  in  the  first 
case,  but  also  producing  softening  of  the  spinal  cord  from  pressure. 

Case  14. — Male,  set.  38.  Died.  Symptoms  of  emaciation,  great  pain  in  back 
and  epigastrium,  and  radiating  round  chest. 

Post-mortem. — Malignant  disease  of  peritoneum,  omentum,  liver,  pancreas,  and 
retro-peritoneal  glands  surrounding  and  implicating  intercostal  and  lumbar 
nerves,  but  not  invading  spinal  canal. 

The  last  case  was  a  readmission. 


VI.— ERYTHEMA. 

Seven  cases :  1  male  and  6  females.     Youngest  10,  oldest  35.     One  was  a  case 
of  erythema  papulatum;  the  rest  were  cases  of  erythema  nodosum.     In  all  the 
VOL.  XI.  19 


274  1881 — Medical 

cases  there  was  more  or  less  fever,  the  highest  temperature  noted  heing  10460. 
In  the  case  of  erythema  papulatum  the  eruption  was  in  the  arms  and  legs.  In 
two  cases  of  erythema  nodosum  the  eruption  was  only  on  the  legs  helow  the 
knees;  in  two  it  was  on  the  thighs  and  buttocks  as  well;  in  four  the  arms  were 
also  affected ;  and  in  one  case  a  spot  or  two  appeared  on  the  face.  In  one  case 
there  had  been  tonsillitis  just  before  admission,  and  in  two  there  was  a  family  or 
personal  history  of  acute  rheumatism. 

VII.— BRONCHIECTASIS. 

Three  cases :  2  males,  1  female.  In  one  male  there  was  uniform  dilatation  and 
thickening  of  bronchi  in  both  lungs;  in  the  other  the  dilatation  was  uniform, 
but  confined  to  the  base  of  the  left  lung. 

Case  3. — Female,  set.  32.  History  of  winter  cough  for  years.  Rheumatic 
fever  six  years  ago.  Has  been  much  worse  for  the  last  fortnight,  having  had 
shivering,  vomiting,  and  cough. 

On  admission  fairly  nourished,  cyanotic,  with  slight  clubbing  of  finger  ends ; 
legs  oedeniatous ;  cough,  with  muco-purulent  expectoration.  Left  side  contracted, 
and  heart  appears  pulled  over  to  same  side.  Right  side  hyper-resonant,  with 
copious  moist  rales.  Left  side  somewhat  less  resonant  than  right,  but  nowhere 
actually  dull  except  over  a  patch  in  mammary  region,  where  there  is  tubular 
breathing  and  bronchophony.  Elsewhere  on  left  side  rhonchal  fremitus,  marked 
with  loud,  cooing,  inspiratory  rhonchi.  Temperature  99'4°.  Urine:  sp.  gr.  1023, 
acid,  much  albumen.  Till  time  of  death,  about  five  weeks  after  admission,  cough 
remained  bad,  with  copious  muco-purulent  expectoration.  (Edema  of  legs  remained, 
and  a  purpuric  rash  appeared  on  them.  She  had  sickness  and  diarrhoea  at  times. 
The  average  quantity  of  urine  passed  in  the  twenty-four  hours  was  22  ounces. 

Post-mortem. — Slight  deposit  of  lymph  on  pericardium.  Left  pleura  adherent 
throughout,  but  not  materially  thickened.  A  few  adhesions  at  right  apex.  Heart 
normal,  displaced  towards  left;  weight  8  ounces.  Anterior  border  of  right  lung 
very  emphysematous,  and  projected  one  and  a  half  inches  beyond  median  line; 
bronchi  not  dilated,  simply  congested.  Left  lung  much  contracted ;  a  patch  of 
grey  hepatisation  in  lower  part  of  upper  lobe.  Scattered  fairly  uniformly  through- 
out whole  organ  were  numerous  cavities,  from  a  quarter  to  three  quarters  of  an 
inch  in  diameter,  which  proved  to  be  dilatations  of  bronchial  tubes.  They  were 
lined  with  thin  shining  mucous  membrane.  The  lung  tissue  between  the  cavities 
was  somewhat  congested,  but  crepitant,  and  free  from  fibroid  change.  No  tubercle 
anywhere.  Intestines  and  larynx  not  ulcerated.  Liver  and  spleen  congested. 
Kidneys  and  intestines  typically  amyloid. 

VIII.— ELEPHANTIASIS. 

One  case,  female,  set.  36,  relieved. 
Fn-'iiily  history. — Good. 

Previous  history. — Not  remarkable.  When  fifteen  had  ague  in  Kent.  Has 
got  much  stouter  in  the  last  three  or  four  years. 


1881 — Medical.  275 

Present  illness. — Seventeen  months  ago  was  attacked  with  vomiting,  rigors, 
and  fever,  followed  by  swelling  of  right  great  toe,  attended  by  great  pain. 
Whole  foot  and  ankle  also  became  affected,  then  also  right  hand,  wrist,  and 
forearm.  The  attack  lasted  four  days,  and  was  followed  by  desquamation. 
Another  attack,  in  which  the  same  parts  were  affected,  occurred  six  weeks 
later.  The  swelling  did  not  disappear,  but  somewhat  subsided-  between  the 
attacks.  Since  then  she  has  had  eight  similar  attacks,  and  though  the  erysipelas 
attacked  no  other  parts,  the  enlargement  has  affected  the  left  leg  especially,  and 
the  left  arm  in  a  less  degree. 

State  on  admission  and  progress. — Stout,  florid,  and  healthy  looking.  Both 
legs  enormously  enlarged.  Right  measures  twenty-three  inches  in  circum- 
ference four  inches  above  ankle,  left  sixteen  inches.  Skin  does  not  pit;  is 
brawny,  coarse,  with  an  ichthyotic,  and  in  some  parts  a  tuberculated,  character. 
There  is  a  tight  constriction  at  ankle,  giving  somewhat  the  appearance  of 
Tui'kish  trowsers.  Similar  condition  of  arms,  right  being  larger  than  left. 
Sensation  impaired  over  affected  parts.  Urine  and  temperature  normal.  Faint 
systolic  murmur  at  apex  of  heart.  Weighs  seventeen  stone.  Had  one  well- 
pronounced  attack  of  erysipelas  shortly  after  admission,  which  lasted  for  three 
days.  With  this  exception  during  a  two  months'  stay  she  enjoyed  good  health. 
The  blood  and  urine  were  repeatedly  examined  for  filariae,  but  none  were  found. 
She  was  treated  with  Martin's  bandages  with  the  effect  of  somewhat  reducing 
the  swelling. 


IX.— ACUTE   YELLOW   ATROPHY   OF   LIVER. 

Two  cases :  1  male,  1  female. 

Case  1. — Male,  set.  2J,  admitted  April  5th.  Died  April  6th.  Jaundice  has 
been  coming  on  gradually  for  three  weeks  ;  has  become  duller  during  last  week  ; 
has  been  restless  and  fretful.  For  last  week  has  often  been  sick.  For  two  or 
three  days  has  had  nervous  twitchings.     Motions  clay  coloured,  offensive. 

State  on  admission  and  progress. — Well  nourished ;  is  deeply  jaundiced ; 
frequent  convulsions;  vomits  frequently.  The  vomit  has  the  character  of  coffee 
grounds.  Abdomen  rather  distended.  Liver  not  felt  below  ribs.  Dulness 
measures  only  one  and  a  quarter  inches  in  nipple  line.  Pulse  112;  resp.  52, 
shallow,  and  hurried;  temp.  98'2°  in  rectum.  In  the  evening  there  was  hic- 
cough and  the  vomiting,  and  convulsious  continued.  Water  was  drawn  off  by 
catheter,  but  no  record  was  kept  of  its  characters.  Died  early  the  succeeding 
morning. 

Post-mortem. — Body  and  tissues  deeply  bile  stained  ;  a  few  punctiform  haemor- 
rhages beneath  serous  membranes.  Liver  weighed  10J  oz.,  shrunken,  and 
flabby.  On  section  much  mottled,  in  some  parts  orange,  in  some  pale  straw 
coloured,  and  in  others  green.  On  microscopical  examination  showed  the 
characters  of  acute  yellow  atrophy. 

Case  2.—  Female,  ajt.  36,  admitted  May  18th.     Died  May  25th. 

Family  and  previous  history. — Nothing  remarkable  in  either. 

Present   illness. — Began   three  weeks   before   admission   with  headache  and 


276  1881 — Medical. 

vomiting,  accompanied  by  jaundice.  Has  been  gradually  getting  weaker,  and 
has  now  for  a  day  or  two  been  unconscious.  Has  been  married  three  months, 
and  is  said  to  be  pregnant.     Had  children  before  her  marriage. 

State  on  admission. — Rather  thin  ;  deeply  jaundiced  ;  is  very  restless ;  keeps 
writhing  about  and  moaning ;  answers  unintelligibly  when  spoken  to.  Respira- 
tions constantly  interrupted  by  sighing  and  groaning.  Heart  normal.  Pulse 
104.  Tongue  dry  and  brown ;  sordes  on  lips  and  teeth.  Abdomen  not 
distended.  Liver  dulness  measures  three  and  a  quarter  inches  in  nipple  line. 
Temp.  97'4°.     Urine,  sp.  gr.  1012,  albuminous,  contains  bile  pigment. 

April  20th. — Has  remained  unconscious  and  very  restless ;  skin  of  a  more 
dusky  colour.  No  vomiting  since  admission  j  bowels  have  not  been  open. 
Temp.  98'2°.     Urine,  sp.  gr.  1012,  bile  pigment,  no  albumen. 

21st. — Better;  talks  sensibly;  jaundice  less  marked ;  passes  urine  voluntarily ; 
no  action  of  bowels.     Temp.,  p.m.,  100°. 

24th. — Has  been  getting  worse ;  more  delirious ;  weaker ;  jaundice  more 
intense.  Liver  dulness  measures  only  two  and  a  half  inches.  Temperature  has 
been  as  high  as  102°.     Bowels  open  ;  motion  pale  brown. 

25th. — Gradually  sank  and  died.  Temp.  106'2°  just  before  death.  No  note 
made  of  leucin  and  tyrosin  in  the  urine.     There  were  no  haemorrhages  noted. 

Post-mortem. — No  haemorrhages  anywhere ;  tissues  much  bile  stained.  Lungs 
congested  in  dependent  parts.  Liver  weighed  2  lb.  2£  oz. ;  much  wasted ;  very 
thin  and  flabby ;  surface  smooth.  On  section,  of  a  pale  greenish-yellow  colour, 
with  paler  streaks  between  lobules.  Spleen  small.  Kidneys  flabby.  Cortex 
swollen  and  bile  stained ;  medullary  rays  of  a  rather  bright  red  colour.  Brain 
congested.     Uterus  showed  no  evidence  of  pregnancy  or  recent  abortion. 


SURGICAL    REPORT. 

1880. 

By  HENRY   PERCY   POTTER,  F.R.C.S. 


General  Statement. 

Number  of  surgical  beds 

„         of  patients  in  hospital  January  1st,  1880 


208  \Pe 


241 

Males       112 
Females     96 


Males     1350 


r 
„         admitted  during  the  year  1880     .  2299  j  Females  949 


Total , 


2507 


in  hospital  December  31st,  1880  .     234-^  i,      , ,      -,qk 
treated  to  a  termination  during  the  year  1880     .  2273 


Total. 

Males. 

Females 

Discharged  cured 

.      1747 

..       1039 

708 

„           relieved     . 

332 

198 

134 

„           unrelieved         . 

52 

22 

30 

Died 

142 

94 

48 

2273 

..       1353 

920 

Average  number  of  deaths  6*2  per  cent. 
„  ,,  days  in  hospital  32. 


Average  number  of  surgical  deaths  since  the  opening  of  the  New 
Hospital  in  1871.1 


1871-72       . 

.    7-7 

per 

cent. 

1876-77       . 

.     7-5  per  cent 

1872-73       . 

.    85 

j> 

1877-78       . 

.    77        „ 

1873-74       . 

.     91 

» 

1878-79       . 

.    6.0        „ 

1874-75      . 

.     8-7 

>> 

1879-80      . 

•     6-2 

1875-76      . 

.     66 

>> 

The  above  list  includes  many  cases  brought  into  the  hospital  dead  or  dying. 
VOL.  XI.  20 


278 


1880 — Surgical. 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


DISEASE. 


Genekal  Diseases. 
Erysipelas  (arising) 

„     (admitted  as  such)  . 

Pyaemia  (arising) 

„     (admitted  as  such)  . 
Syphilis — 

1.  Primary,  by — 
a.  Indurated  sore     . 

2.  Secondary,  by — 

a.  Condylomata 

b.  Eruptions     . 

c.  Ulceration  of  tongue    . 

d.  „  throat     . 

e.  „  cornea    . 

Local  Diseases. 
Tttmoues. 
Carcinomata — 
Scirrhus  of — 

a.  Breast 

b.  „     (recurrent) 

c.  Glands 

d.  Rectum 
Encephaloid  of — 

Bladder 
Colloid  of — 

Rectum 
Epithelioma  of — 

a.  Tongue 

b.  Lip     . 

c.  Mouth 

d.  Vulva  and  penis 

e.  Scrotum 

f.  Anus  and  rectum 

g.  Lower  extremity 
h.  Inguinal  glands 
j.  Submaxillary  glands 

Sarcomata — 

1.  Spindle-celled. 

a.  Upper  jaw 

b.  Lower  jaw 

c.  Mamma. 

d.  Scapula  . 

e.  Thigh     . 


1880 — Surgical. 


279 


Classes,  according  to  authorised  Nomenclature. 


Duration  of  residence. 

i 

Result. 

Remarks. 

s.  Dvn. 

4  5-13 

L    13 

5  19 

1 

\   7 

11 

5 

3 

!    o 
1 

1 

2 

Wks 
2-4 

6 
19 

5 

9 
5 

i 
l 

6 

5 
4 

3 
2 
1 

i 

1 
1 

2 
1 

i 

Mts. 
1-2 

9 
9 

9 

13 

15 

1 

11 
1 

1 

5 

1 
1 
1 

1 

2 
2 

Mts. 
2-4 

4 
3 

5 

6 
10 

i 

1 
1 

i 
l 

l 

Mts. 
4-6 

1 
1 

i 
l 

Mts. 
6-9 

2 
1 

Mts 
9-12 

1 

i 

1 

C. 

32 
19 

18 

32 

31 

1 

1 

1 

15 

1 

3 

8 
4 

2 
1 
1 
1 

2 
1 
1 
2 

2 

R. 

5 

2 

1 

5 

8 

U. 

1 
1 

D. 

1 
6 

1 

See  Special  Table  III. 

4  died  of  visceral  disease,  1  from  post-pharyngeal 
abscess,  1  from  exhaustion  and  disease  of  elbow. 

With   warts   2,  psoriasis  5,    gonorrhoea  5,  sore- 
throat  2,  bubo  1. 
4  combined  with  other  secomlary  symptoms. 
Chiefly  psoriasis  and  roseola. 
With  rupial  eruption. 

With  iritis. 

2  died  suddenly :  1  with  cardiac  disease,  1  from 

?  acute  septicaemia. 
Primary  amputation  8  and  13  months  previously. 
Death  from  general  infection  of  carcinoma. 
2  ?  scirrhus,  2  colotomy. 

With  large  ischio-rectal  abscess. 

2  recurrent,  3  Langenbeck's  operation,  death. 

2  recurrent,  in  5  operation. 

Neither  operated  upon. 

1  involving  os,  3  removed. 

Recurrent. 

1  died  suddenly  whilst  under  ether. 

1  following  scar  or'  burn,  1  connected  with  ulcers. 

Too  extensive  for  operation. 

Following  removal  of  tongue. 

1  extending  deeply  into  zygomatic  fossa,  1  operation. 
Osteo-sarcoma. 

Recurrent. 

Amputation  of  thigh  in  2. 

1 
1 

1 
1 

1 

4 

1 

1 
2 

1 
2 
1 
1 

2 

i 

3 
1 
1 
3 
1 

1 

2 
2 

1 

1 

1 
2 

1 
1 

2 

280 


1880 — Surgical. 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


Sex. 

Age. 

Duration  before  admission. 

DISEASE. 

M. 

v.  ■ 

1 

1- 

3 

5-10 

-20 

-30 

HtO 

-50 

-60 

So 
< 

Dys 
1-4 

Dys. 
5-18 

Wks 
2-4 

Mts. 
1-2 

Mts. 
2-6 

Mts. 
6-12 

'3 
o 

3 

i  -3 

Local  Diseases — 
Tumours. 
Sarcomata — - 

1.  Spindle  -  cell 

tinued. 
/.Fibula    . 
g.  Multiple 

2.  Round-cellec 

a.  Upper  jav 
o.  Miimma  . 

c.  Parotid  . 

d.  Groin  (m 

e.  Face 

g.  Testis 

3.  Myeloid. 

Lower  jaw 
Sarco-rayxoma  . 
Myxoma    . 
Adenoma — 

Mamma          . 
Enchondroina 
Fibroma    . 
Lipoma 
Lymphoma 
Neuroma  . 
Angioma    . 
Nsevus  vascular 
Rodent  ulcer 
Lupus 
Polypus     . 
Exostosis   . 
Gumma 
Papilloma  . 
Molluscum 
Doubtful    . 
Cystic — 

a.  Ovarian 

b.  Sebaceous 

c.  Simple . 

d.  Hydatid 

Nervous  System 

Tetanus  (arising' 

„     (admitted 

continued. 
ed  —  con- 

I. 

V 

elanotic)    . 

s 

as  such) 

1 
1 

1 

2 

1 

i 

l 

2 

1 
1 

1 
1 
1 
1 
6 

1 

2 
1 

1 

1 

1 

1 

2 
2 
1 
2 
1 

1 

2 

1 

9 
3 
8 
6 
4 

"i 

4 
3 
3 
1 

i 

2 

1 

2 

23 

2 

1 

1 
1 

2 

1 

1 

2 
1 

1 
1 

1 

5 

1 
1 

"i 

3 
1 

i 
l 

2 

i 
l 

2 

1 

1 

1 

1 
2 

4 

1 

2 

1 

4 

1 
1 

1 

1 

2 

i 

2 
1 

3 

i 

6 
2 

1 
2 

1 

1 
1 

1 

1 
1 

1 

2 
3 

2 

2 

1 

1 

4 
1 
1 

1 
1 

2 

1 
1 
1 

1 
2 

5 
1 
1 

1 
1 

1 
1 

1 

2 
2 

2 

2 

1 

1 

1 
1 

2 

i 
i 

i 
l 
l 

1 
1 
1 

2 
2 

1 
1 

1 
4 

1 

1 

1 

1 
1 

2 
1 

2 

1 

2 
1 
2 
1 
1 

1 
3 

2 

4 
3 
4 
7 
2 

5 

4 
3 
4 

1 
2 
1 

2 
2 

16 

4 
3 

1 

... 
"2 

"i 

1 

1880 — Surgical. 


281 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 

Result 

Dye. 

5-13 

Wks 
2-4 

i 

Mts. 
1-2 

i 

Mts. 
2-4 

1 

Mts. 
4-6 

Mts. 
6-9 

Mts. 
9-12 

c. 

1 

R. 

u. 

D. 

2 

i 

1 

1 

i 
i 

i 

l 

l 

2 

1 

2 

1 
1 

1 

2 

1 

1 
1 

1 

1 
1 

1 

2 

1 
1 

i 

3 

2 

1 

5 

2 

8 

1 

3 

3 

5 

3 
3 

1 

3 

1 

1 

3 

4 

2 

4 

1 
4 

2 

8 
3 

7 

1 
1 
1 

1 

3 

2 
1 

3 

2 
3 
2 
1 
2 

] 

3 
3 

1 
2 
1 
5 

1 
1 
3 

2 

1 
2 

... 

1 

2 
1 

1 

1 

1 

1 

1 

3 

3 

15 

2 

11 

4 

4 

4 

1 

3 

2 

1 

1 

4 
3 

1 

1 

1 

2 

1 

2 

Remarks. 


Removal,  haemorrhage,  amputation  of  thigh. 

1  in  axillae,  neck,  thigh,  chest,  and  back,  liver,  &c. 

1  in  brain,  chest,  neck,  and  abdomen. 
Too  extensive  for  operation. 

Both  removed. 
Primary. 

1  of  lower  eyelid,  3  of  cheek  or  upper  jaw. 
Removed. 

Cystic,  castration. 

Thrice  recurrent,  removal  of  lower  jaw. 
Of  mamma,  parotid,  and  finger. 
Of  neck  and  thigh. 

8  removed. 

3  parotid  (cystic). 

2  epulis  of  upper  jaw,  1  of  knee,  5  uterine. 
Of  axilla,  back,  loin,  arm,  thigh,  and  neck. 
Of  axilla,  groin,  and  neck. 

Following  wound  of  finger. 
All  removed. 

3  of  head,  1  of  back. 
Of  head  and  face. 

1  treated  with  thermo-cautere. 

Rectum. 

Of  tibia. 

Of  tongue,  face,  neck,  shoulder,  calf. 

Of  vulva  and  clitoris. 

1  general,  1  of  ear. 


15  antiseptic  ovariotomy. 
Of  neck  and  scalp ;   1  dermoid  on  orbit. 
Of  thigh  and  forehead,  both  removed;  1  of  sper- 
matic cord,  tapped. 
Removed  antiseptically  from  thigh. 


I  Sec  Tetanus  (Summary  of  Diseases),  p.  (316)  ?. 


282 


1880 — Surgical. 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


DISEASE. 

Sex. 

Age.                                         Duration  before  admission. 

M. 

3 
1 
2 

7 

8 

7 
1 
1 

i 

l 

22 
4 
2 

11 

i 

IS 

9 
2 

1 
3 

2 
1 

F. 

2 
3 
3 

5 
4 
1 

7 
2 

1 
1 
1 

1 

15 
5 

5 

1 

2 
1 
2 

2 

2 

7 

-3  in 

5 

2 
1 

i 
i 

2 

1 
2 

5-10 

i 

-20 

1 

5 

2 

2 
1 

1 

2 

i 

4 

-30 

2 

4 

1 

3 
2 
1 
4 
1 

3 
1 
1 

2 
1 

6 
1 
1 

2 
1 

1 

-40 

3 

2 

3 

3 

2 
1 

1 

1 

4 

1 
1 

4 
3 

2 
1 

-50 

i 
i 

2 

1 
1 

1 

5 
6 

3 
1 
1 

1 
8 

4 

1 

1 
1 

-60 

2 
1 

4 
5 

2 

1 

1 

2 
2 

1 

3  O 
_S  SO 

1 

8 
3 

4 

2 
1 

2 

Dys. 
1-4 

2 
10 

7 

1 
1 

1 

21 

16 

6 

2 
2 

i 

Dvs. 
5-13 

3 

1 
3 

2 
3 
1 

2 
1 

1 

Wks 
2-4 

5 

1 
2 
1 

2 

1 
2 

Mts. 
1-2 

5 
1 

7 
1 
1 

4 
1 

Mts. 
2-6 

2 

1 

4 
1 

1 

Mts 
6-12 

1 

2 
1 
2 

i 

s 

o 

G 

1 
3 

5 
1 

3 

2 
1 

5 

"i 

2 

2 
1 

i 

11 

3 

"i 

"j 

Circulatory  System. 
Aneurism     . 

Varicose  veins      .                   . 
Phlebitis      . 
Haemorrhage 

Epistaxis     . 

Glandular  System. 
Adenitis  (acute)  . 
„       (chronic) 
Angeioleucitis 
Mammary  abscess 
Enlarged  tonsils  . 
Enlarged  thyroid 

Respiratory  System. 
Aphonia       . 
Diphtheria  . 
Empyaema 
Dyspnoea     . 

Digestive  System. 
Intestine — 
Strangulated  hernia — 

a.  Inguinal 

b.  Femoral 

c.  Umbilical     . 
Herniae — 

a.  Inguinal 

b.  Femoral 

c.  Umbilical     . 

d.  Ventral 
Fistula  in  ano    . 

»     hypogastric  . 
Haemorrhoids     . 

Prolapsus  ani     . 

Stricture  of  rectum    . 
Ulcer  and  fissure  of  rectum 
Ulcer  of  tongue  and  mouth 
Intussusception 
Obstruction  of  intestine     . 

1880 — Surgical. 


283 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 

1 

Etesult. 

i, 

1 

1 

Dys. 
>-13 

i 

5 

4 

4 
2 

2 

1 

2 

4 
2 

4 
2 

1 

8 

5 

1 

1 
2 
1 

Wks 
2-4 

1 
1 
4 
3 

1 
1 
1 
1 

1 

1 
1 

4 

4 

1 
2 

1 

5 
1 

4 

2 
2 

Mts 
1-2 

1 
1 

"2 
4 

4 
9 

1 

2 
1 

2 

4 

Mts 
2-1 

1 
1 

i 

i 

1 

1 
1 

1 

Mts. 
4-6 

Mts. 
6-9 

Mts. 
9-12 

11 

c. 

2 

1 

5 

10 

7 

9 
4 

2 
6 

2 

18 

17 
2 

6 
3 

20 

10 
1 

8 
1 

1 

R. 

1 
2 

V. 

D. 

J 

1 

G 
1 

1 

3 
1 

i 

1 
1 

3 

1 
5 

6 

4 

1 

2 

1 

1 
1 

1 

5 
2 

1 

1 
1 

3 

2 

1 

1 
1 

5 

2 
4 

"i 

i 
2 

Remarks. 


2  popliteal,  ligature  of  femoral;  1  innominate. 

1  complicated  with  abscess,  1  ligature. 

Of  lower  extremity. 

4  from  varicose  veins,  1  from  hand,  scalp,  and 
rectum  after  wound,  1  from  gums  in  a  subject  of 
haeinorrhagie  diathesis,  2  after  tooth  extraction. 

In  3  plugging  of  nares. 


2  inguinal,  2  axillary,  1  popliteal,  the  rest  cervical. 
1  elbow,  1  axillary,  the  rest  cervical. 
Of  arm  and  leg. 


Cystic. 


Hysterical. 

Tracheotomy. 

Pressure  of  aneurism,  tracheotomy. 


5  See  Special  Table — Hernia,  p.  (328  ?  et  seq.). 


3  inflamed,  5  irreducible. 
All  uncomplicated. 
No  operation,  exhaustion. 
Epiplocele. 

7  complete,  18  operated  upon. 
?  origin,  unconnected  with  intestine. 
3    complicated    with    prolapsus,    1    with    vesical 
catarrh;  4  ligatured. 

1  with  prolapsus  uteri,  1  with  congenital  scrotal 
hernia. 

Syphilitic. 

2  with  haemorrhoids,  2  division,  2  forcible  dilatation. 
Death  due  to  acute  bronchitis. 

Abdominal  section. 

?  nature;  r.  lumbar,  colotomy. 


284 

Table 

] 

1880- 
-Abstraci 

-Surgical 
,  showing 

Diseases 

,  Injuries 

,  tyc,  in 

DISEASE. 

Sex. 

Age. 

Duration  before  admission. 

M. 

3 

2 

5 

1 

2 

1C 

1 

6 

11 

3 
32 

20 

3 

li 
2 
2 

3 

1 

... 

F. 

6 
4 

1 

2 

1 

... 
.. 
1 

3! 
33 

5 
9 
9 

u 

"2'n 
P 

2 

1 
3 

1 
1 

5-10 

4 
1 

1 
1 

i 
l 

-20 

i 

3 

1 

2 

1 

1 
1 

18 
24 

5 

7 
5 

-30 

1 

1 
1 

2 
1 

3 

1 

8 

6 

1 
2 

i 
n 

9 

1 

1 

4 

-40 

1 

2 
1 

3 
1 

1 
1 

10 
5 

1 

4 

1 

i 
i 

-50 
1 

3 

1 

i 

9 
3 

i 
l 

i 

-60 
1 

1 

1 
1 

1 
3 

1 
2 

1 

g  so 
«! 

1 
1 

1 
3 

4 

i 

Dys. 
1-4 

18 
2 

i 

1 

1 

4 

1 

Dys. 
5-13 

1 
1 

1 
1 

1 
9 

4 

4 

Wks 

2-4 

1 
1 

"i 

12 

7 

2 

1 

Mts. 
1-2 

1 

1 

1 

2 
2 

1 

1 
9 

2 

1 
1 

Mts. 
2-6 

1 
2 

*2 

1 
1 

*5 

7 
3 

3 
1 
1 

Mts. 
6-12 

1 

1 

4 
1 

1 

o 
5 

1 

4 

1 
1 

7 

3 

4 

1 

3 

7 

1 
30 

i 

1 
1 

3  = 

2 

1 
2 

1 
2 

i 

i 

i 

6 
2 

"i 

Genito-Urinary  Syst 
Testicle — 
Orchitis  (chronic) 

Epididymis — 
Epididymitis 

Scrotum,  Sfc. — 
Hydrocele . 

Hematocele 

Varicocele . 
Phimosis 
Paraphimosis 
Rupture  of  perineum 
Displacement  of  uteru 

Vesico-vaginal  fistula 

Bladder — 
Cystitis 
Calculus     . 

Urethra — 
Calculus    . 
Stricture   . 

Retention . 

Extravasation  of  urii 
Urinary  fistula  . 
Perineal  abscess 
Hematuria 
Dysuria 

Other  Affections  of( 
rative  Organs. 
Gonorrhoea 
Soft  sore  . 

~S\  arts 

Labial  abscess,  &c. 

Bubo 

EM. 

S 

ie 

jENE- 

Surgical — 1880. 


285 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 

.Result. 

Remarks. 

3. 
4 

Dys. 
5-13 

Wks 
2-4 

Mts. 
1-2 

Mis. 
2-4 

Mts. 
4-6 

Mts. 
6-9 

Mts. 

a-is 

x>  C 
o  a 

<  a 

C. 

R. 

U. 

D. 

L 

1 
1 
1 

3 

1 

"i 

3 
1 

2 

2 

1 

2 
3 

i 

1 

1 
1 

2 

i 
l 

3 

1 

19 

8 

2 
3 

2 

17 
12 

1 
3 

4 

1 

3 

1 
2 
2 

3 

1 

2 
6 

7 
1 

3 

1 

14 
15 

3 

4 
2 

2 

2 
1 

3 
2 

2 

4 
5 

1 

i 

1 
1 

2 

i 
i 
i 

1 

2 
1 

4 

1 
2 
9 
1 
3 

1 

7 
9 

3 

25 

1G 
1 

g 

2 

2 

1 

37 
3fi 

1 
1 

1 

2  syphilitic,  1  malignant. 

Tubercular. 

1  double,  4  radical  cure :  2  injected,  2  laid  freely 
open  by  Volckmann's  method. 

Veins  included  in  sutures. 
9  circumcision. 
With  soft  sores. 
In  4  operation. 

1  prolapsus  after  rupture  of  perinseum,  2  retro- 
version. 

5  vesical  catarrh,  3  subacute. 
Death,  set.  83,  broncho-pneumonia;  6  lithotomy, 
2  lithotrity,  1  Clover's  injection,  2  ?  calculus. 

All  extracted,  1  with  three  calculi. 

5  internal  urethrotomy,  1  cystotomy,  3  perineal 

section;  deaths  due  to  cystitis  and  bronchitis. 
In  2    perineal  section,  1    aspiration;    1  died  of 

cystitis  and  uraemia,  1  of  acute  blood  poisoning. 
Deaths,  uraemia  and  cystitis. 
Perineal,  1  cauterized,  3  perineal  section. 
Complicated  with  hernia  and  haemorrhoids. 
1  after  old  lithotomy,  1  ?  ruptured. 
Renal. 

7  with  bubo,  3  phagedenic,  1  with  gonorrhoeal 
rheumatism. 

1  virulent,  4  with  syphilis. 

3 

1 

3 

3 
1 

3 

1 
2 

1 

8 

1 

-1 

2 

3 
2 

2 

1 

■-> 

1 

2 

6 

8 
9 

1 

1 

286 


1880— Surgical. 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


DISEASE. 

Sex. 

Age. 

Duration  before  admission. 

j. 

o        , 

M 

F 

■=io 

5-10 

-9,0 

-Rfl 

-40 

-so 

-fin 

>  n 

Dys 

Dvs. 

Wks 

Mts 

Mts 

Mis 

o       **  •- 

3 

< 

JW 

6-13 

ii-4 

1-i! 

2-6 

6-li. 

6    Se 

Diseases    of    Locojiotobi 

System. 

Bo  ties — 

Periostitis  of — 

a.  Ilium  . 

1 

1 

b.  Femur  (acute) 

4 

... 

2 

1 

1 

1 

?, 

1 

c.  Tibia  (acute) 

1 

1 

1 

,,      (chronic)    . 

y 

1 

1 

1 

3 

d.  Fibula 

l 

i 

2 

1 

1 

e.  Ulna  (acute) 

l 

1 

1 

f.  Scapula 

l 

1 

1 

g.  Ribs  (acute) 

i 

1 

...     ! 

Ostitis  of — 

a.  Tibia  . 

l 

l 

1 

1 

1 

J 

b.  Superior  maxilla . 

l 

1 

1 

Necrosis  of — 

a.  Nares .... 

l 

1 

1 

b.  Skull  . 

i 

1 

1 

c.  Superior  maxilla . 

i 

l 

1 

1 

1 

1 

d.  Inferior  maxilla  . 

5 

1 

1 

?, 

1 

2 

3  ... 
1  ... 
1 

e.  Clavicle 

... 

i 

1 

f.  Radius 

i 

1 

g.  Metacarpal  bone,  &c.  . 

i 

i 

1 

1 

1 

1  ... 

2  1 

h.  Ribs    . 

l 

2 

2 

1 

j.  Ilium  . 

3 

i 

1 

1 

1 

2   ... 

4    ... 

Jc.  Femur 

5 

l 

2 

2 

1 

I.  Tibia  . 

7 

4 

3 

6 

1 

1 

1 

a 

?, 

1 

2     3 

m.  Os  calcis,  &c. 

4 

1 

i 

2 

1 

1 

1 

?, 

2   .. 

Caries  of — 

a.  Temporal  bone    . 

1 

1 

1 

b.  Metacarpus. 

1 

1 

l 

1 

1 

1 

c.  Finger 

1 

1 

d.  Femur 

1 

1 

i 

e.  Tibia  .         .         .         . 

1 

1 

i 

f.  Tarsus 

8 

1 

l 

3 

3 

1 

1 

1 

i 

1 

4     2 

g.  Metatarsus . 

1 

1 

]    ...L 

Joints — 

Shoulder — 

a.  Incipient     . 

2 

1 

2 

1 

3 

b.  Chronic 

2 

2 

-i ::: 

c.  Anchylosis  . 

1 

1 

1 

Elbow — 

h 

Chronic   .        .         .        . 

9 

6 

l 

1 

4 

5 

4 

... 

2 

3 

3 

i 

6     lj 

1880— Surgical. 


287 


Classes,  according  to  authorised  Nomenclature — continued. 


Duratioi 

of  residence. 

Result 

Remarks. 

Dvs. 
5-13 

Wks 
2-4 

Mts. 
1-2 

Mts. 
2-4 

Mts 
4-6 

Mts 
6-9 

Mis. 
B-12 

S)  re' 

c 

R. 

U. 

D. 

1 
1 

1 

i 

*4 

i 

i 
l 

i 

i 
l 

4 

2 

1 
2 

i 
l 

i 
l 
l 
l 

l 

l 
l 

5 

1 

2 
1 

2 

1 

1 

i 

i 

2 

3 
1 

1 

i 
i 

i 

3 

1 
1 

i 

2 
2 

2 

1 
3 

1 

"i 
i 

1 

2  syphilitic. 

Syphilitic. 

Of  base. 

1  with  suppuration  of  antrum. 
In  2  sequestrotomy. 

Lower  third. 

In  all  bone  removed. 

2  of  ilium,  1  of  pubes. 

1  necrosis  of  stump,  3  sequestrotomy,  1  amputa- 
tion of  thigh. 
1  died  of  lardaceous  disease. 

1  extirpation  of  os  calcis. 

Amputation. 

2  Syme's  amputation,  1  excision  of  os  calcis. 

1  excision. 

Fatal  case :  pneumonia. 

3  excision,  2  partial. 

4 

1 
1 

1 
2 
1 
1 
1 

1 

2 
1 
1 

2 
3 

2 

5 
5 

1 

2 
1 

1 
1 
7 
1 

2 
9 

1 
2 

i 

... 

i 

1 

1 

1 

1 

4 

l 

1 

i 

i 
l 

i 

3 
3 

5 

1 

3 

i 

3 

2 

1 
1 
1 

6 

1 

288 


1880 — Surgical. 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


DISEASE. 

Sex.                               Age. 

Duration  before  admission. 

M. 

F.  |"> 

p 

5-10 

-20 

-30 

-40 

-50 

-60 

Dys. 
1-4 

Dys. 
5-13 

Wks 
2-4 

Mrs. 
1-2 

Mts 
2-6 

Mts 
6-12 

'3 
1 

i  - 

Diseases    of    Locomotory 
System — continued. 
Joints — 
Wrist        . 
Sacro-iliac 
Hip- 

a.  Incipient     . 

b.  Chronic 

c.  Old  excision  readmitted 

d.  Chronic  osteo-arthritis 

e.  Anchylosis  . 
Knee — 

a.  Incipient     . 

b.  Chronic 

c.  Old  excision  readmitted 

d.  Chronic  osteo-arthritis 

e.  Anchylosis  . 

f.  Loose  cartilage    . 
Ankle — 

a.  Incipient     . 

b.  Chronic 
Tarsus        . 
Metatarsus 

Spine — 
Pott's  curvature 

Caries  without  curvature  . 
Lateral  curvature 

Deformities. 
Talipes — 

a.  Equino-varus 

b.  Varus    . 

c.  Equinus 

d.  Valgus 

e.  Calcaneus 

/.  Clavus  . 
Deformity  of  face 

„             palate    . 

„             thigh 

3 

1 

14 

11 
2 
1 

1 

11 

20 

1 
2 

1 
1 

1 
1 

1 

10 

5 
1 

3 

2 
3 
4 

i 
l 

l 

1 

12 
1(3 

2 

12 
21 

8 
1 

2 
3 
1 
1 

3 

1 

5 

1 

2 

"} 

1 

2 

... 

6 

7 

3 

7 

1 

6 

2 
2 

9 

11 

3 

2 
11 

i 
1 

2 

1 

1 

1 
3 
1 

i 

i 

10 
9 

1 

i 

6 
3 

2 
1 

1 

4 

1 
5 

1 

1 

7 
1 

1 
1 

1 

1 
2 

1 

5 
11 

2 
2 
1 
1 

1 

2 

2 

3 

7 

2 
1 

1 
1 

1 

1 
1 

1 

i 

2 

2 

2 
1 

1 

1 
1 

2 
2 

4 

1 

2 

2 
1 

i 

5 
4 

1 

1 

10 

4 

8 
2 

3 
1 

1 
1 

2 
1 

1 

3 

4 
1 

2 

4 

1 
1 

1 
1 

1 
1 

1 
2 

2 

22 
3 
1 
1 

1 

33 

1 
1 
1 

3 

1 

12 

1 

6 

4 

4 
3 
6 
1 

1 
1 
1 

1 

1 

2 
2 

1 

1880 — Surgical. 


289 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 

Result. 

Remarks. 

Dvs. 
6-13 

1 
1 

3 

2 
4 

i 
i 

2 

1 
2 

"i 

2 

... 
... 

Wks 
2-4 

2 

4 
8 

i 

6 
14 

i 

2 
1 
1 
1 

4 

i 

3 

3 
1 
1 

1 

"i 

i 

... 

Mts 
1-2 

1 

5 
3 
3 

9 

8 

i 
i 
l 

4 

1 
1 

1 
1 
3 

1 

1 

Mts. 
2-4 

1 

4 

1 

4 
8 

i 

i 
l 

2 

l 
i 

l 

Mts 
4-6 

2 
5 

4 

1 
1 
1 

1 
1 

1 

Mts. 
6-9 

5 
5 

1 

1 

1 
1 

Mts. 
9-12 

3 
3 

1 

?S3 
o  o 
J=  ;►. 

1 
1 

C. 

1 

10 

11 

2 

1 

10 
22 

1 
2 
1 
1 

1 

4 

1 

7 

4 
2 

3 

2 
1 

1 

3 

R. 

3 
1 

In 

11 

2 

u. 
1 

D. 

5 

2 

All  synovial. 

Of  the  fatal  cases  1  excision. 

Fatal  cases  :  tuberculosis  and  amyloid  disease. 

With  anchylosis. 

All  synovial;  2  gonorrhoeal  rheumatism,  1  acute 

suppurative  synovitis. 
8  excision,  3  amputation  of  thigh.     Fatal  cases : 

1  of  collapse  after  incision,  1  of  haemorrhage 

after  excision. 

2  hydrops  articuli,  1  excision  of  knee. 
1  partial  excision,  1  forcible  flexion. 
Cyst  of  synovial  membrane  removed. 

Synovial  disease ;  1  gonorrhoeal  rheumatism. 
1  Syme's  amputation,  1  incision. 
Chronic  synovitis. 

1  amputation,  1  excision. 

7  psoas  abscess,  1  double  psoas,  1  gluteal,  1  iliac 
abscess. 

2  lumbar,  1  gluteal,  1  psoas,  1  cervical  abscess. 

4  tenotomy,  1  of  which  Syme's  amputation  was 
performed  on  account  of  extreme  atrophy  of  leg. 

Tenotomy  in  2. 

1  infantile  paralysis. 

4  tenotomy. 

Contraction  of  plantar  fascia  after  infantile  para- 
lysis, with  displacement  of  os  calcis. 

Division  of  plantar  fascia. 

1  following  bullet  wound,  2  after  lupus  of  nose. 

Syphilitic  aperture. 

After  burn. 

1 

4 

17 

2 

3 
1 

2 

1 

1 

7 

1 

4 

1 

2 
2 

7 
1 

1 

1 

1 
1 

290 

Tabli 

i    I.- 

1 880 — Surgical. 
—Abstract,  showing  D 

iseases,  Injuria 

;$ 

d 

m 

DISEASE. 

Sex. 

Age. 

Duration  before  admission. 

M. 

F. 

2 

4 

7 

10 

1 

2 
9 

2 

] 

2 

3 
3 
5 

1 

1 

9 
] 

4 
2 
4 
1 

1 

u 

■5 

1 

1 

6 

14 

5 
5 
4 
1 

2 

3 

2 

2 
2 

1 

5-10 

1 

2 
10 

i 
l 

l 

l 
l 

] 

3 

-20 

2 

3 
1 
3 
1 

4 

2 
1 
1 

2 
5 

2 
4 

2 
1 

-30 

1 
1 

1 

3 
2 
3 

1 
1 

2 
3 
1 

3 

2 

1 

-40 
1 

i 
i 

4 

2 

1 

-50 
1 

1 

1 
1 

] 
3 

1 

... 

-60 

1 
3 

< 

l 

l 
l 

l 

Dys. 
1-4 

2 
4 
1 

4 

4 

1 

i 
l 

Dys 
5-13 

1 
3 

3 

6 
1 

1 

4 

Wks 
2-4 

2 

1 

1 
3 
1 

1 

4 

3 

... 

Mts 
1-2 

5 

3 

1 

i 

Mts 
2-6 

1 

1 

1 

1 

1 
2 

Mts 

6-ia 

2 

1 

I  1 

3 

9 
23 

1 
2 

11 
5 
4 
1 

2 

2 
4 
1 

1 

... 

2 

Deformities — continui 
Deformity   of    knee 

excision 
Deformity  of  leg 

„            forearm 
Curved  tibia 
Genu  valgum 

„     varum 
Infantile  paralysis 

Malformations. 
Cleft  palate 
Harelip,  single     . 
„         double . 
Ear      . 

Hand  . 

Toe     . 

Extroversio  vesicae 
Branchial  fistula  (pate 

Appendages  to  Muse 

System. 
Bursa  prepatellaris,  en! 
inf 
„            suppui 
Bursa  olecranon.suppu 
Ganglion  of  wrist 
Thaecal  abscess    . 

Cellular  Tissue. 
Inflammation 
Cellulitis 
Anthrax 
Abscess — 

a.  Neck  and  Face 

b.  Shoulder 

c.  Arm  and  hand 

d.  Chest    . 

e.  Abdominal  walls   . 
f.   Lumbar 

t;.  Gluteal 

after 
nt)    . 

3ULAR 

argecl 
.amed 
•ating 
•a  ting 

1 
1 
2 
2 
18 

2 

9 
2 

2 

1 

1 

4 
1 

2 
6 
1 

1 
1 

7 

10 

1 

3 

4 
1 
1 
8 
1 

1 880 —  Surgical. 


291 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 

Result. 

Remarks. 

>VS. 
1-4 

1 

2 

1 

1 
2 

"i 
l 

2 
2 

1 
1 

Dys. 
5-18 

2 

2 
1 

1 
2 
3 
1 

1 

3 

7 

5 

3 
1 

i 

Wks 
2-4 

6 
1 

3 
1 
2 

1 

1 
2 

4 

1 
1 

3 

6 

"i 

4 

1 

Mts. 
1-8 

1 
4 
6 

2 
2 
2 

2 
1 
1 

1 
1 

4 

1 
3 

2 
2 

Mts. 
2-4 

1 

5 

12 

1 
2 

i 

i 

i 
i 

Mts 
4-6 

1 

2 
3 

1 

2 

1 

Mts. 
6-9 

i 

Mts. 
9-12 

>  5 
«*1  ed 

C. 

3 

2 

3 

17 

1 

1 

8 
4 
3 

1 

2 
1 

1 

2 

5 
11 
1 
2 
1 

8 

Ki 

1 

4 

2 
7 
1 
1 
2 

R. 

U. 

D. 

Subcutaneous  section  above  condyles  in  two  cases. 

1  resection,  1  forcible  straightening. 
6  osteotomy,  2  bilateral. 
16  subcutaneous  osteotomy. 
Osteotomy. 
Amputation  in  1. 

9  operated  upon. 

Death :  pleuropneumonia. 

Ill  developed,  and  upper  part  of  prima  deflected 

downwards. 
Fingers  coherent,  supernuniary  thumb. 
Hammer  toe. 
3  operated  upon. 
Sinus  in  neck. 

1  removed,  1  tapped. 
1  freely  incised. 

Of  arm,  leg,  thigh,  foot,  and  penis. 

Death  from  septicaemia  and  gangrene  of  lungs. 

Of  hand  and  back. 

Fatal  case :  cystitis,  pyelitis,  &c. 

Free  incision  in  2. 

Acute  peritonitis,  pneumonia. 

1 
2 

5 
9 

2 
1 

2 

... 

1 
2 

1 

1 
1 

1 

1 

2 

1 

1 

1 
1 

2 

2 

1 

1 

1 

1 

2 

292 

Table 

I 

1880- 
-Abstract 

-Surgical 
,  showing 

Diseases,  Injuries 

,*r 

?•> 

ira 

DISEASE. 

Sex. 

Age. 

Duration  before  admission. 

M. 

F 

a10 
3 

5-10 

-20 

-30 

-40 

-50 

-60 

>  ~ 
S5 

2 
2 

Dya 

1-4 

1 

4 

Dys. 
5-13 

1 

2 
1 

i 

l 
l 

l 

Wks 
2^ 

"i 

2 

1 
i 

i 

2 

2 

i 

2 

Mts. 
1-2 

1 
I 
2 
2 
1 

i 

i 
l 

2 
2 

i 

Mts. 

2-6 

1 
1 

i 

l 

l 

"4 
4 
1 

1 

Mts 
6-12 

i 

1 

2 
2 

£ 
0 

1 

2 
1 
1 
1 

1 

1 
1 
6 
2 

3 

3 
5 

|1 

i 

"1 

1 

1 

1 

2 

4 

Cellular  Tissue- 

Abscess — 

h.  Ischio-rectal . 

j.   Hip       . 

k.  Thigh  . 

1.    Knee     . 

m.  Leg 

n.  Foot 
Sinus  . 

Cutaneous  Syste 

Ulcer  of — 

a.  Scalp     . 

b.  Face 

c.  Arm 

d.  Thigh  . 

e.  Leg 

/.   Foot      . 
Onychia 

Eruption  on  hanc 
Noma  ani    . 
Gangrene    . 
Ingrowing  toe-ns 
Eczema 

Miscellanea. 
Medical  cases 
Trivial 

—coni 

M. 

1 
ill 

inued 

3 
] 
6 

a 

5 
4 

1 

2 
1 
] 

2 
11 

7 

l 

2 

i 

2 

5 
10 

i 

3 

1 

1 

3 

1 

2 

1 
5 
6 

1 

1 
1 

3 

4 

1 
1 

i 

i 

2 

i 
l 

i 
i 
i 

3 

2 

4 

4 
1 

4 

1 
1 

i 

2 

1 

2 
1 

2 

i 
l 

i 

l 
l 

4 
2 

1 

1 
2 

3 

4 

1 
2 

2 

1 
4 
2 

1 
1 

1 

1 
2 

2 

1 

1 
1 

"i 
l 

4 
4 

1 

1 
1 

1880 — Surgical. 


293 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 


Result. 


Wks  Mts 
%A    1-i 


Mts 

■:-i 


Mts.  Mts.  Mts. 
4-6   6-9  9-12  Ja  P. 


Remarks. 


Periarticular. 
3  traumatic. 
Incision  in  all. 


2  suppuration  over  extensors,  2  sloughing. 
Of  mamma,  knee,  thigh,  and  abdomen;  the  latter 
after  hydatid  of  liver. 


2  syphilitic  of  scalp,  1  following  angioma. 
1  each  ?  syphilitic  of  chin,  of  lip,  of  cheek. 
Syphilitic. 

1  syphilitic,  1  of  stump,  1  after  burn. 

2  of  stump,  1  elephantiasis,  in  1  amputation. 

3  perforating. 
Syphilitic  of  toe. 
Psoriasis,  vesication. 
After  measles. 

General  atheroma,  cystitis,  and  pyelitis. 

Excision. 

1  each  general,  of  stump,  of  leg. 


Fatal    cases :    dysentery   with    hepatic    abscess  j 

omental  hydatids,  abdominal  section. 
Death  :  chronic  otitis,  meningitis. 


VOL.   XI. 


21 


294 


1880 — Surgical. 


Table  II.— 


INJURIES. 


Sex. 


Genebal  Injttbies. 
Burns 
Scalds 


Local  Injttbies. 

Injuries  of  the  head — 
Scalp  wound 

Soilp  contusion 
Wound  of  artery 
Fracture  of  vault 

„  base 

Concussion 

Injuries  of  the  face — 
Wound 

„         of  artery 
Contusion     . 

Fracture  of — 
Superior  maxilla 
Inferior  maxilla  . 

Malar 
Nasal 

Injuries  of  the  eye — 
Wound  of  globe . 
Contusion  of  lids 

Injuries  of  the  necJc — 
Wound 
Sprain 

Injuries  of  the  chest  — 
Wound 
Contusion   . 
Fracture  of  rib  . 

Injuries  of  the  back — 
Wound 
Contusion,  &c.    . 


47 


14 


14     19    11   11 
12      11     18      3 


5-10 


-80 


4      1 
1      1 


17 


2     1 


-60 


Duration  before  admission. 


.so    a  S 


Ilrs. 
1-6 


[Irs 

7-12 


Dvs. 
1-3 


Dys. 
3-6 


1880—  Surgical 


295 


Injuries. 


Duration  of  residence. 


.  Dys. 

:   O-lO 


12 


23 


ttks 


13 


L0 


Mts 
2-4 


Mta 

-Id 


Mts. 
6-9 


Mt 
9-1S 


Result. 


C.    R.  U.  D 


Remarks. 


Deaths ;  9  under  8  years  of  age ;  collapse. 
1  of  oesophagus,  1  of  pharynx  in  which  trache- 
otomy was  done. 


8  bone  bare,  1  delirium  tremens,  1   died  lacera- 
tion of  brain. 
2  with  haeinutoma. 
Of  anterior  temporal. 

6  trephined,  1  death  from  gun-shot  wound. 
5  ?  fracture,  1  gun-shot  wound. 
Death  :  laceration  of  brain,  hemorrhage. 


1   complicated  with  erysipelas,   1   with  delirium 

tremens. 
Of  facial. 


In  1  fracture  of  superior  maxilla,  1  bilateral,  1  at 

symphysis. 
Compound  depressed. 
With  contusion  of  forearm. 


3  extirpation. 


All  self-inflicted,  2  into  air  passages. 
One  of  8  months'  standing. 


1  gun-shot,  1  by  needle,  1  stab,  3  penetrating. 

None  severe. 

4  emphysema,  3  haemoptysis,  1  rupture  liver,  2 
hsematuria,  1  rupture  diaphragm,  &c,  1  perito- 
nitis. 

1  incised,  1  punctured. 

3  sprained. 


296 


1880— Surgical. 


Table 

II- 

INJURIES. 

Sex. 

Ages. 

Duration  before  admission. 

M. 

P. 

C 

4 
1 

2 

"l 

2 
1 

i 

5-10 
10 

i 

3 
3 
1 

1 
3 

1 

-20 
3 

3 
2 

i 

1 
2 
1 

4 
5 
3 

i 

1 
1 

2 
1 

1 

i 

i 

-30 

1 
1 

7 
1 

i 
i 

3 
2 

1 

4 
1 

i 
l 

-40 
1 

2 

1 
2 

2 
2 
3 

4 
2 

3 

1 
2 

-50 

1 

2 
1 

2 

1 

4 
1 
1 
1 

1 

2 

-60 

1 

1 
1 

"i 
i 

l 
i 

i 
l 

i 

o  o 

.=  SO 

1 

1 
1 

1 

2 

1 

15 
1 

2 
1 

5 
1 
1 
5 
2 
1 

9 
9 

7 

1 
1 
1 

1 
1 
1 

6 
3 
3 
5 

3 

4 
1 

His. 
1-6 

1 

7 
3 

2 

3 

2 
2 

1 

2 

2 

2 

Hrs. 
7-12 

1 

Hrs. 
13- 

24 

1 

Dys. 
1-3 

1 

i 

2 

Dys 
3-6 

1 

1 

1 
1 

1 

2 
1 

i 
i 

i 
l 

2 

it 

4 

2 
"2 

Local  Injuries — 

continued. 
Injuries  of  the  spine — 
Fracture     . 

Dislocation 

Concussion 
Injuries    of  the    abdo- 
men— 

Contusion  . 

Wound 
Injuries  of  the  pelvis — 

Contusion  . 

Wound 

Fracture     . 
Wound  of  groin   . 
Contusion  of  labium     . 
Rupture  of  urethra 
Wound  of  scrotum 
Hematocele 

Upper  Extremity. 
Wounds  of — 

a.  Arm 

b.  Hand     . 

c.  Artery  . 
Contusion  of — 

o.  Shoulder 

b.  Elbow    . 

c.  Arm 
Dislocation  of — 

a.  Scapula  from  clavicle 

b.  Humerus 

c.  Forearm 

d.  Phalanx 
Fracture  of — 

a.  Clavicle . 

b.  Scapula  . 

c.  Humerus,  simple 

,,      comminuted 
,,          compound 

comminuted 
„      ununited     . 

d.  Radius    . 

e.  Ulna 

2 
2 
1 

24 
1 

3 
1 

5 
1 

"h 

2 
1 

7 

10 

6 

1 
1 
1 

1 
1 
2 
2 

6 
3 

6 
6 

4 

2 

3 

... 

2 

5 

2 

1 

i 

8 
3 
6 

i 

1 

3 

2 
1 

i 

1 

1880 — Surgical 


297 


continued. 


Duration  of  residence. 


Wks 

2-4 


Mts 
2-4 


Mts 
4-li 


Mts. 
6-9 


Result. 


C.  R.  U.  D 


Remarks. 


12 


1  old  case,  1  of  dorso-lumbar  region,  cured ;  1  of 
lower  cervical,  1  of  upper  dorsal,  both  died. 

1  rotatory  displacement  of  lower  cervical,  1  dis 
placement  of  1st  dorsal. 

of  cervico-dorsal  region. 


Fatal  cases  :  rupture  of  liver,  acute  peritonitis. 


1  large  contusion  of  buttock. 

Of  buttock. 

Deaths  :  rupture  of  kidney,  pneumothorax,  shock. 

Followed  by  sloughing. 
Traumatic,  in  2  perineal  section. 


3  amputated,  4  incised,  the  rest  lacerated. 

3  amputation  of  fingers. 

6  of  radial  at  wrist,  6  of  palmar  arch. 


Haematoma. 


?  Of  long  duration  ;  downwards. 
Reduced  by  manipulation. 
Of  head  of  radius  backwards,  of  both  bones. 
1  of  1st  phalanx  backwards,  removal  of  head  of 
metacarpal  bone,  1  compound  of  middle  phalanx. 
4  comminuted,  1  incomplete. 
1  of  body,  1  lower  angle,  1  vertebral  border. 
1  separation  of  lower  epiphysis,  1  intracapsular. 
1  fracture  of  neck  of  humerus,  with  dislocation. 

3  into  elbow,  1  followed  by  excision. 

Both  operated  upon. 

1  double  Collis. 

Also  of  internal  condyle. 


298 


1880 — Surgical. 


Table  II— 


Sex. 

Ages. 

Duration  before  admission. 

INJURIES. 

<o 

M. 

F.      a  "'1 5-10  -20 

-30   -40   -50 

-60 

> 
30 

-  so 

3  1 

a  £ 

Hrs. 
1-6 

Hrs. 

7-12 

tirs. 
13- 

Dys. 
1-3 

Dys. 
3-6 

0  C' 

"H 

3 

<* 

=  * 

24 

<t 

II 

JPPER  EXTREMITY — 

continued. 

f.  Radius  and  ulna 

1 

... 

1 

1 

Forearm,  com  p.    . 

2 

i 

1 

2 

Ditto,  compound 

and  comminuted 

2 

2 

2 

1 

1 

3 

1 

Ditto,  ununited . 

3 

3 

3 

Ditto,       vicious 

union 

1 

1 

1 

g.  Fingers,    compound 

comminuted 

7 

1 

l 

3 

2 

5 

1 

1 

Synovitis    (traumatic) 

of  shoulder 

1 

1 

Lower  Extremity. 

Wounds  of — 

a.  Thigh     . 

4 

2 

1 

1 

... 

2 

1 

1 

b.  Leg 

9 

2 

"i 

2 

1 

3 

1 

6 

1 

1 

3 

c.  Knee 

6 

3 

2 

2 

1 

1 

1 

1 

1 

6 

1 

1 

1 

d.  Foot 

7 

2 

2 

2 

2 

1 

2 

5 

1 

3 

Contusion  of — 

a.  Hip 

3 

1 

1 

1 

1 

1 

3 

1 

b.  Thigh    . 

6 

2 

3 

1 

4 

1 

1 

c.  Leg 

16 

i 

4 

i 

6 

4 

1 

1 

10 

3 

2 

2 

d.  Foot 

8 

3 

2 

i 

2 

2 

2 

i 

1 

8 

1 

1 

1 

Dislocation  of — 

a.  Femur    . 

4 

1 

1 

2 

1 

2 

1 

b.  Patella  . 

1 

i 

1 

i 

1 

1 

c.  Semilunar  cartilage 

of  knee 

3 

3 

2 

1 

d.  Leg 

1 

i 

1 

e.  Foot 

2 

i 

i 

2 

f.  Astragalus 

1 

1 

1 

Fracture  of  femur — 

a.  Simple  . 

22 

15 

7 

8 

2 

1 

5 

3 

2 

9 

24 

8 

2 

3 

b.  Compound 

1 

1 

1 

c.  Comminuted  . 

3 

i 

1 

1 

3 

d.  Comp.  comminuted 

2 

,,, 

1 

1 

2 

Fracture  of  patella 

8 

4 

2 

6 

4 

6 

2 

1 

1 

2 

Fracture  of  tibia — 

a.  Simple  . 

21 

4 

3 

6 

4 

3 

4 

3 

2 

19 

3 

1 

1 

1 

b.  Compound 

2 

1 

1 

2 

c.  Comp.  andcommin 

1 

1 

1 

d.  Ununited 

1 

i 

]880 — Surgical. 


299 


continued. 


Duration  of  residence. 

Result. 

Djs. 
1-1 

1 
1 

1 

2 
1 

Dys. 
5-13 

Wks 

2-4 

Mis. 
1-2 

Mts. 
2-4 

Mts. 
4-6 

Mts 
6-9 

Mts. 
9-12 

C. 

R. 

u. 

D. 

Remarks. 

1 
1 

2 
1 

1 

1 
3 

4 

1 
2 
8 
1 

2 

1 

1 

2 

1 

7 

"i 

1 
1 

4 

1 
2 
1 
3 

1 
1 
2 
2 

1 

1 

"i 
l 

3 

3 

14 

1 

1 
1 

6 
1 

2 

3 
1 

1 

21 

2 

1 
8 

1 

1 

1 
2 

8 

i 
l 

2 
1 

i 

i 

1 

1 

1 
2 

2 

1 
7 

1 

2 

11 

S 

9 

3 

6 

16 

11 

1 

1 

2 
1 
2 

1 

31 

1 

2 

1 

12 

L8 

2 

1 

With  dislocation  of  inferior  rad-ulnar  artic. 

1  with  simple  fracture  humerus. 

Amputation  in  3  cases. 
Same  patient. 

Forcible  re-fracture. 

1 
3 

1 

In  6  amputation  of  fingers. 

2 

2  shock,  1  in  amputation. 

In  1  bare  bone,  1  amputated. 

4  into  joint.     Death  :  collapse. 

1  amputated,  1  from  needle  which  was  extracted. 

3  haematoina. 

2 

1 

2 
3 

1 

7 
5 

1 

4  haematoina,  1  with  fractured  rib. 
2  hffiinatoina  of  foot. 

2 

1 

3 

1 

1  recent,  2  congenital,  1  of  long  duration. 
1  recent,  1  since  infancy ;  outwards. 

1  internal  cartilage,  1  external,  1  not  reported. 
Inwards. 

1  inwards,  1  backwards,  both  with  fracture    of 

malleoli. 

1 

1 

2 

4  extracapsular,  3  intracapsular,  rest  of  shaft  de- 
layed union. 

i 

2 

6 

1 
1 

3  fractured  the  second  time,  1  vertical,  rest  trans- 
verse. 

Chiefly  lower  third. 
1  into  ankle-joint. 
Acute  septicemia. 

1 

300 


1 880— Surgical. 


Table  II— 


INJURIES. 

Sex. 

Ages. 

Duration  before  admission. 

M. 

F. 

10 
1 

15 
2 
3 

1 

i 

"7 
4 

1 

16 

3 

873 

a"3  S 

3 

-10 

1 

2 
1 

1 
3 

-20 

5 
1 

5 
3 
1 

1 

1 

1 
10 

1 

-30 

9 
1 

8 
3 

i 

2 
2 

i 

"7 

7 

-40 

15 
1 

9 

1 
1 

5 

6 
1 

-50 

9 
1 

8 

1 

1 

1 

1 

4 

1 
1 

-60 

7 

11 

4 

i 
1 
1 

1 
1 

So 
a  <o 
<i 

1 

4 
2 

i 
i 

1 

M  1* 

"2  2 
5~ 

29 
3 

31 

7 
2 

8 

3 
3 

1 
3 

1 

21 

5 
1 

1 

Hrs. 
1-6 

6 
1 

10 
3 
1 

1 
3 

1 

Hrs. 
7-12 

1 
2 

Hrs. 
13- 

24 

Dys. 
1-3 

3 

1 

1 
2 

Dys. 
3-6 

1 

i 

1 
1 

0  s- 

1 
i 

3° 

25  0. 

7 

8 
2 

1 

1 

1 
2 

2 

LOWEE   EXTEEMITY — 
continued. 
Fracture  of  fibula — 

a.  Simple  . 

b.  Compound 

Fracture  of  tibia  and 
fibula — 

a.  Simple  . 

b.  Compound 

c.  Comminuted  . 

d.  Corup.  comminuted 

Fracture  of   bones  of 
foot— 

a.  Simple  . 

b.  Compound 

c.  Comminuted  . 

d.  Comp.  comminuted 

Synovitis  {traumatic) — 

a.  Hip 

b.  Knee 

c.  Ankle     . 

Rupture  of  ligamentum 
patellae   . 

General  contusions 

Fracture   through    site 
of  excision  of  knee . 

Ophthalmic  cases,  &c. 
not      included      in 
above  report  . 

Brought     in     dead    oi 
dying      . 

Total       . 

37 
3 

35 

10 
2 

7 

2 

4 
1 
4 

3 

23 

6 

2 
1 

20 

6 

140C 

2273 

1880— Surgical. 


301 


continued. 


Duration  of  residence. 


Dys. 
-13 


W"ks 
2-4 


20 


Mts.  Mts. 
1-2   2-4 


Mts 
4-6 


Mts. 
6-9 


Mts. 
9-12 


Result. 


C.  R.  U.  D 


13 


27 


Remarks. 


2273 


1   with  delirium  tremens,  1   with  outer  displace- 
ment of  foot. 
All  at  lower  fourth. 


1  with  haematoma,  2  with  delirium,  1  fractured 
rib,  4  displacement  of  foot,  3  delayed  union. 

2  amputation  of  leg. 

Fatal  cases  :  collapse,  abscess  of  brain,  secondary 
haemorrhage.     In  6  amputation. 


2  of  phalanx,  1  metatarsal. 

Phalanges. 

Astragalus  and  dislocation  forwards  and  outwards. 

All  primary  amputation. 


1  fracture  of  3rd  rib,  1  followed  by  suppuration 
of  joint. 


Followed  by  erysipelas. 


= /Diseases...     980 
\  Injuries...     767 


E. 

v. 

D. 

278    . 

,    45     . 

.     87 

54     . 

.       7     . 

.     65 

302 


1880— Surgical, 


Table  III.- 


SURGICAL  OPERATIONS. 

Sex. 

A% 

es. 

U 

« 

M. 

P. 

1- 
p 

5-10 

-20 

-30 

-10 

-50 

-60 

So 

Removal  of  Tumours  and  Growths. 

Amputation  of  breast         . 

30 

1 

... 

5 

4 

2 

11 

4 

3 

Removal  of  axillary  glands 

3 

1 

2 

For  epithelioma  of  tongue 

9 

1 

i 

5 

3 

1 

„           of  lower  lip 

5 

... 

l 

2 

2 

„           of  vulva  . 

2 

2 

„           of  anus    . 

i 

i 

... 

... 

„           of  rectum 

i 

i 

2 

... 

... 

„           of  thigh  . 

3 

3 

... 

„           of  scrotum  and  penis 

2 

1 

] 

„           of  glands 

1 

1 

For  sarcoma  of  leg  .         .         .         . 

2 

i 

2 

•  <• 

1 

„           of  thigh        . 

1 

l 

1 

i 

..« 

„           of  groin         . 

l 

i 

,           of  face  . 

i 

2 

2 

i 

,           of  jaw            . 

4 

... 

2 

i 

1 

"•• 

,           of  parotid     . 

3 

i 

i 

1 

... 

,           of  scapula     . 

i 

1 

2 

,           of  hand          . 

l 

i 

... 

,           of  testis                   . 

l 

l 

For  enchondroma  of  parotid 

3 

i 

i 

"i 

For  myxoma     ...... 

i 

1 

i 

i 

For  fibroma       ...... 

2 

i 

l 

For  lipoma 

2 

6 

1 

l 

3 

i 

i 

For  lymphoma.         . 

1 

3 

i 

3 

For  angioma     ...... 

1 

5 

2 

3 

l 

1 

For  nsevus  vascularis         . 

4 

1 

For  rodent  ulcer        . 

i 

2 

i 

"2 

For  lupus          ...... 

l 

2 

i 

2 

For  polypus      ...... 

1 

i 

•  •• 

For  exostosis     ...... 

l 

1 

2 

>  .• 

For  molluscum          . 

l 

1 

i 

For  cystic  disease  of  ovary  (ovariotomy)    . 

15 

i 

3 

"4 

4 

2 

i 

For  fibroid  disease  of  uterus  (abdominal 

section) 

2 

1 

1 

For  sebaceous  tumour       . 

2 

2 

*2 

1 

1 

.  *  ■ 

For  hydatid  cyst       . 

1 

1 

For  simple  cyst          . 

1 

3 

i 

1 

2 

... 

For  enlarged  bursa  patellae 

2 

l 

i 

.  •• 

For  ulcer  following  angioma     . 

1 

l 

... 

For  pa 

ipilloma           . 

2 

... 

... 

2 

1880 — Surgical. 


303 


Surgical  Operations. 


Duration  of  residence  after  operation. 


Dys. 
18 


Wks  Mts. 
2-4    1-2 


16 


10 


Mts 
2-4 


Mts. 
4-6 


Mts 
6-9 


Mts 
9-12 


Result. 


C.     R.  U.  D 


Remarks. 


17  for  primary  scirrhus,  1  recurrent,  4  sarcoma, 
8  adenoma. 

Scirrhous  infiltration. 

5  renewed  with  ecraseur,  3  Langenbeck's  opera- 
tion. 

4  removed  by  V-shaped  incision,  1  recurrent  and 
treated  with  actual  cautery. 

Removed  with  knife. 
Died  suddenly  during  operation. 
3  operations  on  same  patient  for  recurrence  in- 
volving scar  of  burn. 
1  recurrent,  both  removed. 
Inguinal  region. 
1  subsequent  amputation  for  haemorrhage. 

Melanotic. 

1  epulis  :  osteo-sarcoma. 
1  myxoiua-sarcoma. 
Both  recurrent. 
Myxoma -sarcoma. 
Castration. 

1  of  thigh,  1  of  leg. 

Opulis  of  upper  jaw. 

Of  neck,  back,  loin,  thigh,  and  axilla. 

Of  neck,  groin,  and  axilla. 

Of  neck,  thigh,  heel,  back,  and  genitals. 

Of  scalp,  leg,  back,  and  face. 

Removal  by  excision. 

Thermo- cautere. 

Rectum. 

Of  tibia  and  great  toe. 

Molluscum  tibrosum. 

1  incomplete  ovariotomy. 

Removal  of  uterus. 

Pedunculated  of  thigh. 

2  removed,  2  paracentesis. 


Of  external  genitals  j  removed  with  knife. 


304 


1880—  Surgical. 


Table  III- 


Sex. 

Ages. 

SURGICAL  OPERATIONS. 

M. 

F. 

P 

5-10 

-20 

-30 

-40 

-50 

-60 

0 
> 

oc 

Ciectjlatoby  System. 

Ligature  of  artery    .... 
Obliteration  of  varicose  veins    . 
Plugging  nares  for  epistaxis 

Rebpibatoey  System. 

Tracheotomy 

Digestive  System. 

Excision  of  tonsils    .... 
Strangulated  inguinal  hernia    . 

„             femoral  hernia     . 

„             umbilical  hernia . 
Division  of  fistula  in  ano  . 
Removal  of  haemorrhoids  . 
Division  of  stricture  of  rectum          , 
Fissure  of  anus 

Colotomy ..... 
Abdominal   section   for  stricture  of 
turn  (1),  and  intussusception  (2),  < 

Genito-ubinaby  System. 

Hydrocele  tapping,  with  or  without 
tion  of  tunica  vaginalis 

Varicocele         .... 
Hematocele      .... 
Circumcision     .... 
Ruptured  perineum  . 
Paracentesis  of  ovarian  cyst 
Lithotomy  (lateral)  . 
Lithotrity          .... 
Urethral  calculus 

Calculus  removed  by  Clover's  inject) 
Internal  urethrotomy 
Cystotomy         .... 
Perineal  section 

rec- 
fcc.     . 

injec- 
)r 

i 

3 

7 

i'6 

i 
i 

18 
4 

i 

3 

4 

4 

2 

1 

14 

*6 
2 
3 
1 
7 
1 
13 

1 

1 

14 
2 
2 

2 

5 

"4 
3 

3 
2 

i 

i 

2 

"4 
i 

"i 

2 

1 

i 
"2 

1 

1 
3 

i 

... 

i 
1 

is 

1 
1 
1 

1 

1 
1 

i 

"i 
3 

"2 

2 

"2 

1 

3 

"4 
2 
1 
2 

1 

2 
2 
1 
1 

3 
1 
3 

1 

i 
5 

"7 

i 
1 

2 

"i 
i 

i 
3 

i 

2 

"i 
1 

2 

1 

i 
1 

1 

"3 

i 

"7 
3 
3 
1 

continued. 

1880- 

Surgical.                                       805 

Duration  of  residence  after  operation. 

Result. 

Remarks. 

on 

Ovs. 7 

i-iu 

iVks 
2-4 

Mts. 
1-2 

Mts. 

2-4 

Mts. 
4-6 

Mta.l 
6-9 

Mts. 
9-12 

2  u 

C. 

E. 

u. 

D. 

1 
1 

i 
l 

4 
1 

i 
l 

2 

i 
l 
l 
l 
l 

2 
2 

i 
l 

l 

l 

2 

5 

9 
3 

i 

2 

2 

3 
1 
1 

i 

4 
2 

1 

1 

"i 

8 

3 

4 
?1 

1 

1 
3 
3 

5 
1 

4 

1 

i 

2 

"2 

i 

i 

1 

1 
4 

... 

2 
3 

1 

1 

5 

13 

20 

4 

6 
1 

4 

2 

1 

14 

3 

5 
2 
3 
1 
7 
1 
10 

1 

1 

Of  common  carotid,  2  of  femoral. 

2  tetanus,   2    diphtheria,    1    haemorrhage    into 
glottis,     scald     of      throat,     1     erysipelatous 
oedema  of  neck,  1  aneurism  of  aorta. 

In  2  sac  unopened."!  a             .  ,  ^  , .         ,oooN 
In  5  sac  opened.       L  See/Pecial  T^le,  p  (328) 
c                      et  seq. 

8  complete. 
4  ligatured. 

3  division,  3  forcible  dilatation. 

2  for  stricture  of  rectum,  1  ?  nature. 

Peritonitis. 

2  injected,  2  sac  layed  freely  open  on  Volck- 
mann's  principal,  and  tunica  vaginalis  stitched 
to  opposed  skin  and  edges  sutured  together. 
Antiseptics. 

Wire  sutures  and  pins  behind  veins. 
Volckmann's  operation. 
For  phimosis. 

1  died  suddenly  with  pleurisy. 
Fatal  case  :  broncho-pneumonia. 

In  2  meatus  slit  up  and  calculus  removed. 

4  small  stones. 

For  stricture  at  membrano-bulbous  portion. 
For  haemorrhage  after  internal  urethrotomy. 

3  for    stricture,    1    haemorrhage  into   bladder, 
3    for   retention,    2    for    fistula?,  2  ruptured 
urethra,  1  extravasation. 

5 

4 

1 
3 

? 

7 

5 

1 
3 

4 
1 

i 

1 
1 

1 
1 

4 

"i 
i 

1 
2 

1 
1 

l 

• 

306 


1880 — Surgical. 


Table  III— 


SURGICAL  OPERATIONS. 

Sex. 

Ages. 

H 

a 

M. 

F. 

^3 

5-10 

-20 

-30 

-40 

-50 

-60 

oo 

Genitourinary  System — continued. 

Cauterization  of  fistula     . 

1 

1 

Aspiration  of  bladder         . 

1 

i 

Warts  (removal  of)            . 

1 

3 

3 

i 

Vesico- vaginal  fistula        . 

1 

i 

Castration         ...... 

i 

l 

Locomotory  System,  &c. 

Removal  of  necrosed  bone  for  disease  of — 

a.  Upper  jaw         . 

l 

1 

1 

1 

b.  Lower  jaw        . 

2 

1 

i 

c.  Humerus ...... 

1 

i 

i 

l 

d.  Metacarpus       .         .         .         .         . 

l 

i 

e.  Clavicle    ...... 

l 

... 

i 

f.  Femur 

5 

2 

3 

g.  Tibia 

7 

4 

2 

6 

i 

1 

i 

h.  Os  calcis  ...... 

3 

2 

1 

j.   Radius      ...... 

1 

k.  Ribs          ...... 

i 

2 

2 

i 

Caries  of — 

a.  Humerus  ...... 

2 

1 

l 

b.  Metacarpus       . 

1 

i 

c.   Femur      ...... 

i 

i 

d.  Tarsus      ...... 

i 

e.  Tibia 

l 

i 

f.   Metatarsus 

l 

l 

Excision  of — 

a.  Lower  jaw        . 

1 

l 

b.   Slioulder  ...... 

i 

1 

2 

c.  Metacarpal  bone       . 

i 

i 

d.  Elbow 

3 

1 

i 

1 

i 

i 

e.  Hip 

11 

6 

6 

9 

l 

1 

/.   Knee 

3 

7 

3 

l 

3 

3 

g.  Os  calcis  ...... 

2 

2 

h.  Metatarso-phalangeal-joint 

1 

i 

i 

"i 

Tenotomy  of  biceps  femoris 

1 

l 

„           for  club-foot     .         .         .         . 

7 

5 

3 

4 

5 

For  ununited  fracture  of  humerus     . 

2 

... 

2 

Resection  of  radius  . 

i 

i 

Subcutaneous  division  of  femur 

17 

n 

10 

13 

5 

„                 „        of  tibia  . 

3 

6 

5 

2 

2 

... 

continued. 

1880 

— Surgical.                                      307 

Duration  of  residence  after  operation. 

Result. 

Remarks. 

1 

Dvs. 
>-lo 

1 
1 

2 

i 
i 

(Vks 
2-4 

1 
1 
3 

1 
1 

"i 
i 
i 

2 
6 

i 

Mts. 

1-2 

1 
1 
1 

1 

i 
i 

3 

3 

i 

1 

1 

1 
i 

i 

2 

l 
l 

l 

5 
1 

10 
2 

Mts. 
2^ 

i 

5 
1 

1 

i 

"i 

6 
3 

1 
15 

4 

VIis.j 
4-6 

2 

2 

1 
1 

i 

4 

4 
1 

3 

3 

Vtts.l 
6-9 

i 

"4 

Vlts. 

J-18 

2 
1 

3? 

C. 

1 

4 
1 
1 

2 
1 

1 
1 
2 
8 
2 

3 

1 
1 
1 
1 

1 

1 

i 
1 
4 
9 

9 
2 

8 

1 
1 

28 

6 

R.  U 

.  D. 

Fistula  in  pernico. 

Retention. 

Excision. 

Sarcoma  of  testis. 

1  subsequent  excision  of  humerus. 

1  necrosis  of  stump. 

1  whole  of  shaft  removed. 

1  subsequent  excision. 

1  subsequent  excision. 
Of  trochanter  major. 

Sarcoma  of  jaw. 

Died  of  pneumonia. 

Head  of  bone  removed  for  dislocation. 

3  disease,  1  injury. 

1  died  of  tubercular  meningitis,  1  of  haemorrhage, 

1  of  collapse. 
1  partial  excision.     Death  :  haemorrhage. 

1  necrosis,  1  caries. 
Caries. 

Contraction  of  knee,  amyloid  disease. 
Of    tendo-Achillis   5,    of    tibial    tendons   3,   of 
peronei  3,  of  plantar  fascia  1. 

For  deformity  after  fracture. 

2  deformity  after  excision,  24  genu  valgum,  1 
genu  varum,  1  deformity  of  knee. 

For  curved  rachitic  tibiae  and  malposition  after 
fracture. 

:; 

i 

1.. 

1  ,, 
2.. 

3. 

2. 
1. 
1  . 

1. 

.  i 

1 
1 

5. 

1 

..    3 

1 

" 

2. 

4. 

1 

... 

3. 

308 


1880— Surgical. 


Table  III- 


Sex. 

Ages. 

M. 
12 

i 
l 
l 

3 
1 
1 
1 
1 

2 

1 
1 

2 
1 
9 

4 

9 
2 

2 

1 
1 
1 
1 

1 

2 
2 

5 

2 
2 
1 

P. 

6 

2 
1 

"i 

4 

1 

2 

2 
1 

2 

1 
1 

1 

5 

2 

1 
2 
2 

"O  in 
S3 

13 
1 

i 
i 

"i 

i 

i 

l 
l 

i 

5-10 
11 

i 
i 

i 
i 

i 

2 

2 

-20 

3 
1 

i 

i 
l 

i 

i 

i 

2 
4 

4 
1 

i 
i 

2 

"2 

-SO 

1 

1 

i 
1 

2 
i 

1 
1 

2 
2 

i 
2 

1 

1 
2 
1 

i 

-4,0 

1 
i 

i 

1 

4 

1 

1 
1 

2 

1 

-50 
1 

1 

i 
i 
1 

1 

1 

-60 

i 

1 
i 

1 
1 
1 

h 
< 

: 

i 

1 

] 

Locomotoey  System — oonti 
Incisions  (major) 

Forcible  movement  of  join 
Forcible  straightening  of 
Scraping  interior  of  knee- 
Removal  of  loose  cartilage 
„         foreign  body  f  re 
Aspiration 

Ununited  fracture  of  fore 
„               „            tibia 
Ganglion  of  wrist  (compo 
Ligature  of  radial  artery 
Reduction  of  dislocation— 

Of  humerus  . 

Of  forearm  . 

Of  astragalus 

Of  foot 
Refracture  of  forearm 

Primary  amputation. 
Of  upper  arm   . 
Of  forearm 
Of  finger . 
Of  thigh  . 

Of  leg       . 
Of  foot     . 
Of  toe 

Secondary  amputation. 
Of  upper  arm    .         . 
Of  fiuger 
Of  leg       . 
Of  foot     . 

Of  thigh  . 

Amputation  for  disease. 
Of  upper  arm    . 

Of  fingers 

Of  thigh  . 

Of  leg       . 
Of  foot     . 
Of  toe       . 

tued. 

ts      . 
flexor  tend 
joint 
from  kne< 
m  wrist,  fo 

irm  . 

mi)'. 

ons    . 
ot,&c. 

1880— Surgical 


309 


continued. 


Duration  of  residence  after  operation.  Result 


ffka 
3-4 


Mts.  Mts.'sita.|Mts.  Mts.  f  \ 
1-2    2-4  i  4-6    6-9  9-12-3  I 


15 


Remarks. 


Periostitis  of  femur,  dislocation  of  shoulder  and 

knee,  lumbar  abscess,  calf,  &c. 
Anchylosis  of  knee  and  shoulder. 
Of  hand. 
Disease  of  knee. 
?  Cyst  of  synovial  membrane. 
Point  of  bradawl  from  wrist,  needle  from  foot. 
Gluteal,  lumbar  abscess,  &c. 
Resection. 
Seton  introduced. 
Opened  freely  antiseptically. 


1  with  fracture  of  astragalus. 
With  fracture  of  astragalus. 
Vicious  union. 


2  laceration,  2  compound  comminuted  fracture. 
Compound  comminuted  fracture. 

3  lacerated,  6  fractured. 

1  compound  comminuted  fracture,  1  simple  of 
femur  into  joint,  3  smash  of  leg,  1  laceration 
of  thigh. 

2  laceration,  5  smash  of  leg,  2  smash  of  foot. 
1  Hey's,  1  Syme's  amputation. 

Smash. 


18  days  after  lacerated  wound. 
5  days  after  lacerated  wound. 
Septicaemia,  empyema. 
Syme's    amputation   4   months 

amputation  of  foot. 
9  days  after  primary  amputation  of  foot,  1 

gangrene. 


after    primary 
for 


VOL.    XI. 


Disease   of   elbow,  1  reamputation   for   conical 

stump. 
1  supernumary  thumb,  2  cellulitis,   2  caries,  1 

necrosis. 
1  sarcoma  of  fibula,  2  of  femur,  1  necrosis  of 

femur,  3  dislocation  of  knee. 

1  infantile  paralysis,  2  sloughing. 
Disease  of  tarsus  and  ankle,  talipes. 

2  "  hammer  toe,"  1  caries. 


22 


310 


1880— Surgical. 


Table  III— 


Sex. 

Ages. 

SURGICAL  OPERATIONS. 

Fh 

<D 

M. 

F. 

■8- 

5-10 

-20 

-30  |  -40 

-50 

-60 

.gto 

< 

Reparative  and  Plastic  Opebations. 

Face,  deformity  of 

1 

3 

... 

1 

3 

... 

... 

... 

Thigh           „            

Cleft-palate 

Harelip     ....... 

1 

9 

7 

2 

7 

2 
13 

3 

"5 

i 
1 

1 

... 

Extroversio  vesicae 

5 

3 

2 

... 

... 

... 

... 

Miscellanea. 

Trephining  skull       . 

5 

2 

2 

1 

... 

Extirpation  of  eyeball       . 
Excision  of  in-growing  toe-nail 

3 

"i 

... 

1 

1 

1 

1 

Hare-pin  extracted  from  bladder 

l 

... 

1 

Removal  of  needle  from  hand  . 

l 

1 

... 

Total                              i 

338 

251 

' v 

589 

1 880 — Surgical. 


311 


continued. 


Duration  of  residence  after  operation. 

Result. 

Remarks. 

U  <o  1 

1^6-10 

Wks 
2-4 

Mts. 
1-2 

Mts. 
2-4 

Mts.  Mts. 
4-6;  6-9 

Mts 
9-12 

C. 

ft. 

u. 

D. 

i 

7 
2 

i 

3 
2 

1 

3 
3 

1 
1 
1 

3 

1 

5 
1 
3 

3 

2 
2 

2 

8 

13 

1 

3 

3 

1 
1 
1 

462 

v. 

2 

1 
3 

4 

1 

2 

1  restoration  of  lower  lid,  3  deformity  of  nose 

following  lupus. 
After  burn. 

In  1  snout  merely  removed. 

4   comminuted  fracture  of  vault,  1  wound    by 

bullet. 
Wound  of  eye. 

71 

— 

56 

589 

SUMMARY   OF   DISEASES. 


GENERAL   DISEASES. 


Erysipelas  (arising). — C.  32,  R.  5,  D.  1.  Arising  in  the  surgical  wards  of  the 
hospital  38  cases;  males  24,  females  14;  mostly  following  operation.  Average 
duration  of  erysipelas  13  days.  Death  due  to  exhaustion  following  severe 
erysipelas  of  trunk  after  general  contusions. 

Erysipelas  (admitted  as  such). — C.  49,  R.  2,  D.  6.  57  cases;  of  these  18  of 
scalp  and  face;  16  of  upper  extremity;  23  of  lower  extremity;  2  vaccino- 
erysipelas. 

Pycemia  (arising). — No  case  of  pyaemia  arose  in  the  wards  during  the  year. 

Pycemia  (admitted  as  such). — D.  1.  Male.  Admitted  with  erysipelas  of  leg, 
disorganisation  of  ankle-joint;  acute  blood  poisoning.  Died  on  third  day. 
P.M. — In  upper  part  of  left  lung  two  or  three  small  wedge-shaped  patches  of 
consolidation  containing  semi-purulent  matter.  Suppuration  in  ankle  and  both 
knees. 

Syphilis — 

1.  Primary  by — 

a.  Indurated  or  primary  chancre. — Males  2,  females  18.  C.  18,  R.  1,  U.  1. 
Females  admitted  chiefly  for  primary  sore ;  most  with  some  venereal  complica- 
tion ;  6  with  marked  induration ;  11  with  inguinal  adenopathy. 

2.  Secondary  by — 

a.  Condylomata. — Males  2,  females  36.  C.  32,  R.  5,  U.  1.  Associated  with 
vaginal  discharge  in  12,  sores  in  6,  sore  throat  7,  warts  3,  psoriasis  4,  eczema  1, 
buboes  2. 

b.  Eruptions. — Male  4,  female  38.  C.  34,  R.  8.  Psoriasis  26 ;  roseola  7 ; 
rupia  6;  eczema  6;  lichen  2  ;  with  sore  4;  warts  2;  vaginal  discharge  11. 

c.  Ulceration  of  tongue.  Female  1.  C.  1.  With  sore,  rupia,  inguinal 
glandular  enlargement,  and  vaginal  discharge. 

d.  Ulceration  of  throat. — Female  1.  C.  1.  Also  of  upper  lip  eight  months 
after  primary  sore  ;  psoriasis,  prurigo. 

e.  Ulceration  of  cornea. — Female  1.     C.  1.     With  iritis  and  conjunctivitis. 


1880 — Surgical.  313 

LOCAL  DISEASES. 

TUMOURS. 

Carcinomata. 
Scirrhus  of — 

a.  Breast. — Females  22.  C.  15,  E.  1,  U.  4,  D.  2.  4  too  far  advanced  for 
operation ;  in  8  cervical  or  axillary  glandular  infiltration ;  amputation  (partial 
or  complete)  in  17.  Deaths — acute  septicaemia  with  fibroid  phthisis ;  large,  flabby, 
fatty  heart,  weighing  1  lb.  2  oz. 

b.  Breast  (recurrent). — C.  1,  U.  1.  Primary  amputation  8  months  previous  to 
admission  and  13  months;  recurrence  6  and  5  months.     Operation  in  1. 

c.  Glands. — C.  3,  U.  1,  D.  1.  4  axillary;  1  submaxillary;  3  primary; 
2  secondary.  In  2  mamma  amputated  6  months  before  admission  ;  in  3  removal 
of  glands. 

d.  Rectum. — Male  4,  female  2.  R.  1,  U.  2,  D.  3.  In  2  nature  of  tumour 
uncertain ;  1  left,  1  right  lumbar  colotomy ;  1  abdominal  section  without 
opening  colon  ;  1  division  of  stricture ;  1  refused  colotomy. 

Encephaloid  of — 

Bladder. — Male  1.  D.  1.  Cystitis  and  haemorrhage  from  bladder.  Tumour 
readily  felt  per  rectum.  P.M. — Medullary  cancer  of  bladder;  granular  con- 
tracted kidneys. 

Colloid  of— 

Rectum. — Female  1.  D.  1.  Large  gluteal  and  ischio-rectal  abscess ;  loss  of 
power  over  sphincter.  P.M. — Colloid  cancer  of  rectum  and  pelvis,  originating 
on  the  left  and  anterior  sides  of  rectum,  extending  through  sciatic  notches  to 
nates.  Thrombosis  of  veins  of  lower  extremities.  No  infiltration  of  glands  of 
pelvis  or  abdomen. 

Epithelioma  of — 

a.  Tongue.— Males  12,  female  1.  C.  8,  R.  1,  U.  1,  D.  3.  6  with  glandular 
infiltration;  excision  in  8 ;  1  complicated  with  erysipelas;  1  with  pleurisy; 
1  haemorrhage  after  digital  examination ;  ligature  of  common  carotid  above 
omo-hyoid;  asthenia;  death;  1  died  after  Langenbeck's  operation.  P.M. — 
Cirrhosis  of  liver ;  granular  contracted  kidneys. 

b.  Hip. — Males  7.  C.  4,  R.  1,  U.  2.  5  cases  operated  upon.  In  5  sub- 
maxillary glandular  enlargement;  1  followed  by  erysipelas. 

c.  Mouth. — Males  2.  U.  1,  D.  1.  Both  too  extensive  for  operation.  P.M. — 
Glands  enlarged  with  new  growth.  Tumour  involving  larger  portion  of  inferior 
maxillary  bone,  extending  into  neck.  Tongue  also  partially  involved.  No 
affection  of  oesophagus  or  larynx. 

d.  Vulva  and  penis. — Male  1,  females  3.  C.  2,  R.  1,  U.  1.  2  excision  of 
growth  from  vulva ;  1  amputation  of  penis ;  1  uterus  involved  and  fixed ;  in 
1  glandular  enlargement,  and  too  far  advanced  for  operating  upon. 

e.  Scrotum. — C.   1.     Recurrent  epithelioma  of   perineum  in  connection  with 


314  1880 — Surgical. 

wound  of  old  operation  for  stricture  (perineal  section).     Removal  of  mass  with 
knife. 

f.  Anus  and  rectum. — Males  3,  female  1.  C.  1,  R.  1,  U.  1,  D.  1.  1  with 
fistula  ;  1  with  haemorrhoids  ;  2  growth  removed  by  incision  ;  rest  relieved  with 
suppositories.  P.M. — Death  from  ether  inhalation,  general  pleuritic  adhesions, 
oedema  of  right  lung,  ?  epithelioma,  or  scirrhus  of  rectum. 

g.  Lower  extremity. — Males  2.  C.  1,  D.  1.  1  infiltration  of  scar  of  burn 
operated  upon  three  times  ;  1  epithelioma  of  ulcers  of  legs.  P.M.  — Bronchitis  ; 
cardiac  disease. 

h  and  j.  Inguinal  and  submaxillary  glands. — Males  5.  R.  4,  U.  1.  All 
secondary  ;  3  following  removal  of  tongue  ;  2  of  penis  ;  1  operation,  inguinal. 

Sarcomata. 

1.  Spindle- celled — 

a.  Upper  jaw. — C.  2,  R.  1,  U.  2.  4  too  extensive  for  operation  ;  1  recurrent; 
1  involving  zygomatic  fossa;  in  1  partial  removal  of  palate;  cavity  of  antrum 
exposed. 

b.  Lower  jaw. — C.  1.  Osteo-sarcomatous  epulis  removed  with  knife,  chisel, 
and  gouge. 

c.  Mamma.— C.  1.     Suppurating  signs  of  recurrence  before  discharged. 

d.  Scapula. —  C.  2.  Both  recurrent  after  removal.  1  size  of  walnut  over 
scapula  ;  1  4  x  3  J,  loosely  attached  to  dorsum  scapula? ;  2  removed. 

e.  Thigh. — C.  2,  U.  2.  1  ?  sarcoma ;  1  refused  operation ;  amputation  of 
thigh  in  2 ;  1,  set.  6,  circumference  of  knee  17i. 

f.  Leg. — C.  1.  Removed  with  greater  part  of  fibula;  recurrence  6  weeks 
after ;  again  removed ;  in  5  days  secondary  haemorrhage  and  amputation  of 
thigh. 

g.  Multiple. — D.  2.  Duration  18  months  and  2  years.  In  both  cases  general 
disseminated  masses  of  new  growth. 

2.  Mound-celled — 

a.  Upper  jaw. — U.  1.  Ulcerating  round-celled  sarcoma  of  left  cheek;  palate 
and  nares  involved.     No  relief  from  chian  turpentine. 

b.  Mamma. — C.  1,  U.  1.  1  in  child  of  three  months  old;  brawny  tense 
growth,  3£  x  3£,  not  suitable  for  operation ;  1  removed. 

c.  Parotid. — C.  2.  1  recurrent.  Both  removed  with  knife  without  much 
haemorrhage. 

d  Groin. — C.  1.  Hard  movable  swelling  below  Poupart's  ligament  sug- 
gesting omental  hernia;  lumbar  glandular  enlargement;  one  third  of  tumour 
melanotic. 

e.  Face. —  C.  1,  U.  2,  D.  1.     1  melanotic  of  lower  eyelid  removed  with  scissors; 

1  electrolysis  employed   with  effect ;    2,   same    patient,  recurrent  extensive 

round-celled.      P.M. — Blocking  by  new  growth  of  left  internal  jugular  vein 

innominate  and  superior  cava,  also  projecting  freely  into  right  auricle;  slight 

coduraa  <>f  upper  extremities. 


1880 — Surgical.  315 

/.  Leg. — C.  1.     Removed  with  knife  (subsequent  recurrence). 

g.  Testis. — C.  1.  5  years'  duration ;  rapid  increase  3  months.  Cystic  with 
sarcomatous  growth  from  interior. 

3.  Myeloid. — R.  1.  Right  half  of  lower  jaw  removed  before  admission  ; 
operated  upoii  three  times ;  left  half  removed. 

Cystic — 

Ovary.— C.  11,  R.  4,  U.  4,  D.  4. 

Cases  in  which  ovariotomy  was  performed  15.     C.  11,  R.  1,  D.  3. 

Case  1. — E.  H.,  set.  18,  single.  Double  ovarian  disease.  Previous  para- 
centesis ;  fluid  highly  albuminous.  Tumour  movable,  and  at  first  thought  to 
be  connected  with  omentum.  Chiefly  unilocular  of  left  side;  long  pedicle;  no 
adhesions;  commencing  suppuration  in  interior.  Cyst  of  right  side  (3  chief 
cysts),  lying  in  right  iliac  fossa,  contained  traces  of  teeth  and  hair.  Healed  by 
first  intention.     Cured. 

Case  2. — E.  D.,  set.  24,  married.  Suckling  child  of  4  months  old.  Tumour 
noticed  2  months  after  confinement.  Catamenia  always  regular.  Paracentesis ; 
11  pints  of  fluid.  Cyst  multilocular;  right  ovary.  One  large  cyst  contained 
thin  fluid,  another  more  solid  and  cheesy.  Pedicle  2£  inches  broad,  tied  with 
silk.     Cured. 

Case  3. — F.  S.,  set.  30,  single.  Duration  2  years.  Amenorrhcea  6  months. 
Fluid  gelatinous;  a  good  deal  of  solid  material  in  cyst.  Multilocular;  right 
ovary.     Pedicle  tied  and  returned.     Cured. 

Case  4. — A.  B.,  set.  31,  married.  Double  ovarian  disease.  Duration  4  years. 
Catamenia  regular.  Larger  cyst  on  right  side,  and  chiefly  unilocular ;  left 
2  cysts.     Pedicles  ligatured.     Cured. 

Case  5. — E.  W.,  set.  37,  married.  Duration  1  year.  Catamenia  regular  till 
6  niunths  before  admission ;  sanguineous  discharge  since.  Cyst  adherent  to 
liver,  omentum,  and  transverse  col.m.  Some  ascitic  fluid.  Right  ovary.  11  liga- 
tures.    Highest  temperature  99*6°.     Cured. 

Case  6. — H.  0.,  set.  39,  married.  Duration  1^  year.  Noticed  after  confine- 
ment.    Catamenia  regular.     Right  ovary.     Scarcely  any  adhesions.     Cured. 

Case  7. — S.  J.,  set.  40.  Duration  6  months.  Menorrhagia.  Dark  straw- 
coloured  fluid.     Right  ovary.     Cyst  the  size  of  a  man's  fist  on  left  side.     Cured. 

Case  8. — J.  A.,  set.  44.  Duration  10  months.  No  adhesions ;  multilocular 
right  ovary.  Temp,  never  above  100'8°.  Discharged  cured  5  weeks  after 
operation. 

Case  9. — M.  A.  H.,  set.  59,  married.  Duration  13  months;  previous  para- 
centesis. Operation  uncomplicated,  slightly  adherent  to  walls.  Discharged  in 
one  mouth.     Cured. 

Case  10. — M.  W.,  set.  47,  single.  Duration  ?  2%  years.  Paracentesis  2  years 
ago.  Fluid  clear,  almost  like  water,  containing  excess  of  chlorides.  Left  ovary 
involved ;  no  adhesions.     Discharged  in  36  days.     Cured. 

Case  11. — S.  C,  set.  60,  married.  Duration  11  months.  Cyst  rotten,  burst, 
and  fluid  escaped  into  peritoneal  cavity.  Adhesions.  Cyst  multilocular  and 
contained  gelatinous  material.     Cured. 

Case  12.— M.  A.  R.,  set.  69.      Duration  1  year.     Operation  abandoned  on 


316  1880 — Surgical. 

account  of  adhesions ;  cyst  stitched  to  abdominal  wound;  16  pints  fluid  removed. 
Incomplete  ovariotomy.     Relieved. 

Case  13. — H.  D.,  set.  49,  single.  Duration  5  months;  no  catamenia  since 
first  appearance.  Broad  ligament  cyst;  a  quantity  of  solid  material.  Multi- 
locular.  Right  ovary.  Pedicle  short,  5  ligatures  placed  upon  it.  Only  slight 
adhesions  anteriorly  and  in  the  pelvis.  Died  7  days  after  operation  from  acute 
peritonitis. 

Case  14. — F.  F.,  set.  47,  widow.  Duration  4  months.  Cyst  multilocular, 
burst  in  peritoneal  cavity.  Left  ovary.  Died  7  days  after  operation  from 
pneumonia. 

Case  15. — R.  W.,  set.  58,  married.  Duration  10  years.  A  great  number  of 
adhesions  around  cyst.     Died  2  days  after  operation  from  exhaustion. 

Fibroid  disease  of  uterus. — C.  1,  D.  1.     Abdominal  section  in  both. 

Case  1. — S.  H.,  set.  51,  married.  Constant  purulent  or  sanguineous  discharge. 
Uterus  measures  5£  inches  vertically.  Uterus  removed  with  fibroid  tumour 
under  antiseptic  precautions.  Tumour  transfixed  with  needle  1^  inch  ahove  os 
uteri,  and  thread  tied  on  either  side.  Discharged  in  less  than  a  month  after 
operation. 

Case  2. — M.  A.  W.,  set.  48,  widow.  Tumour  4>i  years.  Catamenia  regular. 
Removal  of  portion  of  uterus  and  Fallopian  tubes.  Little  if  any  peritonitis. 
Died  5  days  after  operation  from  haemorrhage  into  abdominal  cavity. 


NERVOUS   SYSTEM. 

Tetanus  (arising). — D.  1.  Recurrent  tumour  of  leg  (sarcoma);  ulcerating. 
Three  weeks  after  admission  complained  of  stiffness  of  neck  followed  by  all  the 
symptoms  of  tetanus.  Much  improvement  under  chloral,  but  died  suddenly 
during  a  spasm  on  11th  day  of  tetanus. 

Tetanus  (admitted  with). — C.  2,  D.  2.  1  patient  admitted  with  trismus  of 
2  days'  duration  following  lacerated  wound  of  thumb,  which  lasted  but  4  days. 
1  lacerated  wound  of  pinna  9  days  before  admission.  Trismus  6  days.  Chloral 
hydrate,  9j,  4tis  horis.  Went  out  in  a  month.  Cured.  1  wound  of  foot  6  clays. 
Tetanus  16  hours.  Inhalation  of  chloroform.  Tracheotomy.  Died  during 
severe  spasm.  1  wound  of  foot  with  pickaxe.  Wound  healed.  Tracheotomy. 
Chloroform.     Died  on  2nd  day  after  admission. 


CIRCULATORY   SYSTEM. 

Aneurism. — C.  2,  R.  1.  1.  Male,  set.  39,  messenger.  Popliteal  aneurism 
6  months.  Subject  to  rheumatism  and  gout.  Never  syphilis.  Digital  com- 
pression employed  under  the  influence  of  morphia  on  and  off  for  six  days.  Leg 
then  flexed,  elevated,  and  bandaged.  A  fortnight  after  ligature  of  femoral  at 
apex  of  Scarpa's  triangle.     Cured. 


1880 — Surgical.  317 

2.  Male,  set.  39,  tailor.  Popliteal  aneurism  6  months.  Said  to  be  abstemious, 
and  no  history  of  syphilis.     Ligature  of  femoral  at  Scarpa's  triangle. 

3.  Male,  ajt.  39.  Aneurism  of  innominate  artery.  Probable  duration  2  years. 
Syphilis  18  years  ago.  Pulsating  swelling  which  pushed  right  sterno-clavicular 
articulation  forward,  subsided  somewhat  under  iodide  of  potassium.     Relieved. 


DIGESTIVE   SYSTEM. 

Hernia. — (See  Special  Table,  Hernia.) 

Fistula  in  ano. — C.  20.  All  but  two  operated  upon.  2  double  fistula;  j  1  had 
also  perineal  fistula  with  stricture ;  1  had  haemorrhoids  ;  4  with  family  history 
of  phthisis  ;  3  with  personal  history  of  same. 

Hemorrhoids. — C.  10,  R.  1.  5  internal,  3  external,  3  internal  and  external ; 
4  with  haBinorrhage. 

Stricture  of  rectum. — R.  2.  Females.  Syphilitic.  About  2  years'  duration. 
1  3 \  inches  from  verge  of  anus  much  relieved  by  division  with  knife  under  ether 
and  dilatation  with  bougies  smeared  with  Ung.  Hyd.  1  dilated  with  bougies. 
Pot.  iod.  given.     Much  relieved. 

Intussusception. — Males  2.  D.  2.  In  both  abdominal  section.  Both  aged 
3  months.  In  1  abdominal  pain  3  days.  Blood  and  mucus  from  bowel  before 
admission.  Obstruction  3  days  with  vomiting.  Incision  in  median  line  to 
relieve  invagination  which  was  found,  but  not  returned ;  afterwards  insufflation 
and  copious  injections.  Died  3  hours  after.  P.M. — Small  intestine  found 
stitched  to  wound  forming  artificial  anus.  Small  intestine  invaginated  into 
transverse  colon  near  splenic  flexure,  in  fact,  extending  down  descending  colon 
to  neighbourhood  of  anus.  Gut  even  post-mortem  was  quite  irreducible,  and 
intussusception  found  to  commence  at  ileo-csecal  valve.     No  peritonitis. 

1  with  umbilical  hernia  and  intussusception;  protrusion  of  vitelline  duct. 
Abdominal  section  not  followed  by  relief.  P.M. — The  condition  of  things  very 
curious.  (1.)  A  solid-looking  fleshy  mass  covered  with  membrane,  looking  like 
mucus  membrane,  projected  from  gut  to  the  size  of  a  bean.  This  was  attached 
at  right  angles  to  the  bowel  by  a  short  pedicle.  (2.)  The  pedicle  joined  a  piece 
of  bowel  about  1J  inches  long,  at  each  end  of  which  was  an  orifice  with  thick- 
ened edges,  just  like  the  ends  with  intussuscepted  gut.  The  membrane  covering 
this  \\  inches  of  bowel  looked  like  mucous  membrane.  (3.)  Behind  a  loop  of 
intestine  passed  into  this  portion,  and  was  evidently  intussuscepted.  Recent 
acute  peritonitis. 

Obstruction  of  bowels. — Male,  set.  60,  shoemaker.  Frequent  and  prolonged 
attacks  of  constipation,  causing  much  trouble  ten  months  before  admission,  with 
retching,  constipation,  pains,  and  flatulence.  Fsecal  vomiting  and  muco- 
sanguineous  discharge  from  rectum.  Bowels  acted  slightly  after  enemata. 
Condition  on  admission  : — Emaciation,  constipation,  pain,  tympanites.  Relieved 
temporally  by  enemata  and  01.  Ricini.     Right  lumbar  colotomy.     Cured. 


318  1880 — Surgical, 


GENITO-  URINARY   SYSTEM. 

Hydrocele. — C.  4,  D.  1.  4  tapped  previously.  In  2  iodine  injected;  1  fol- 
lowed by  much  inflammatory  thickening ;  1  very  large  hydrocele  tapped ; 
\\  gallons  fluid  evacuated,  then  freely  opened  under  antiseptic  spray;  tunica 
vaginalis    and    testis    removed;    pericarditis,    endocarditis,   pleurisy.      Death. 

1  double  hydrocele;  sacis  opened;  tunica  vaginalis  sutured  with  carbolic  to 
opposed  skin ;  1  hydrocele  of  cord  with  undescended  testis. 

Hcematocele. — C.  1.  Before  admission  tapped  4  times  in  6  months.  No  relief 
from  ice  and  suspensory.     Slit  up  and  tunica  vaginalis  sewed  to  skin. 

Cystitis. — C.  7,  R.  1.  5  cases  of  vesical  catarrh,  chiefly  due  to  morbid 
products  in  urine.     1  acute ;    1  subacute ;    1  tubercular ;   2  due  to  calculus ; 

2  with  hsematuria. 

Calculus  vesicae. — Males  11,  female  1.     C.  9,  R.  2,  D.  1.     1  female,  ?  calculus. 

2  males,  ?  calculus.  Lateral  lithotomy  in  6  males.  1  stone  size  of  flattened 
pigeon's  egg;  1  size  of  marble.  Calculi  the  following  dimensions: — 1^  x  Ig  x  f  in.; 
1|  x  13;  1  x  |;  2£  x  1£  x  1.  Stricture  of  urethra  in  2  cases;  cystitis  in  2;  enlarged 
prostate  in  1;  prolapsus  ani  and  phimosis  1 ;  5  uiic  acid  and  phosphates;  1  uric 
acid  and  oxalates  ;  lithotrity  in  2  males ;  1  had  4  calculi,  1  of  which  was  crushed, 

3  removed  by  Bigelow's  apparatus ;  1  c;ise  of  lithotrity,  oxalate  of  lime  and  uric 
acid,  4  previous  sittings ;  fragment  removed  with  Clover's  injector. 

Calculus  of  urethra. — C.  3.  All  simple  extraction.  1  previous  passage  of 
calculus  size  of  cherry-stone ;  3  removed  from  one  patient.  In  2  meatus  had  to 
be  slit  up  ;  3  cases  of  phosphates  ;  1  urate  of  ammonia. 

Stricture  of  urethra. — C.  25,  R.  4,  D.  3.  Causes. — Traumatic  3 ;  following 
gonorrhoea  18.  Complications. — 3  retention  of  urine;  1  each  cystitis,  anal 
fistula,  rigors,  phimosis ;  2  perineal  fistula.  Treatment. — Continuous  dilatation 
8;  gradual  12;  perineal  section  2;  internal  urethrotomy  8;  Holt's  dilatation  1; 
cystotomy  1.  Fatal  cases. — 1,  set.  73,  double  stricture,  dysuria.  No  catheter 
passed.  Perineal  puncture.  Wound  of  bulb  followed  by  venous  baiinorrhage. 
Cystitis;  exhaustion.  P.M. — Prostatic  abscess ;  chronic  bronchitis;  cirrhosis  of 
kidneys ;  cystitis.  1,  set.  45,  traumatic  stricture ;  suppression ;  uraemia.  P.M. 
— Granular  contracted  kidney  ;  cystitis ;  no  pyelitis.  1,  set.  74,  foetid  urine 
dribbling  from  urethra  ;  cystitis.     P.M. — Bronchitis. 

Retention. — C.  16,  R.  2,  D.  2.  4  with  enlarged  prostate,  the  rest  with  stric- 
ture ;  1  with  gonorrhoea ;  1  with  perineal  abscess  and  extravasation.  Treat- 
ment.— Perineal  section  4;  bath  4;  catheter  10;  aspiration  of  bladder  above 
pubes  1 ;  tapping  of  rectum  1.  Fatal  cases. — 1,  sot.  33,  admitted  for  retention 
with  stricture.  Catheters  passed.  P.M. — Cystitis;  suppurative  nephritis; 
pyelitis;  surgical  kidney  ;  phthisis.  1, set.  70, retention  with  enlarged  prostate ; 
rigors ;  prostatic  abscess.     P.M. — Cystitis. 

Extravasation  of  urine. — C.  1,  D.  2.  1  admitted  with  impacted  urethral 
calculi ;  stone  came  away,  and  4  days  after  extravasation  of  urine  appeared ; 
incisions ;    slight  tetany ;    circumcision.     1   with  scrotum  the  size  of  a  large 


1880 — Surgical.  319 

cocoa-nut,  brawny,  with  several  sinuses,  discharging  pus.  Perineal  section. 
Incisions  into  scrotum ;  large  quantity  of  pus  evacuated ;  uraeinia.  P.M. — 
Stricture  of  urethra,  cystitis,  atrophy,  and  inflammation  of  kidneys.  1  self-made 
false  passage ;  extravasation  into  perineum ;  suppression  of  urine ;  delirium ; 
uraemia.     P.M. — Pleuritis  ;  peritonitis. 

Urinary  fistula. — C.  9,  D.  1.  All  with  stricture;  all  perineal;  1  also  scrotal; 
3  multiple  fistula? ;  5  treated  by  catheter ;  3  perineal  section ;  1  Holt's  dilator ; 
1  thermo-cautere ;  1  followed  by  erysipelas.  Fatal  case. — Deformity  of  scrotum. 
Fistula?,  1  above  pubes  and  others  of  scrotum ;  inflammatory  induration  of  peri- 
neum ;  perineal  section;  suppression  of  urine;  uraemia;  diarrhoea.  P.M. — 
Pelvic  and  perineal  cellulitis;  acute  peritonitis;  cystitis. 

Gonorrhoea. — C.  37,  P.  2.  Complications,  Sfc. — Sores  (soft  and  hard)  8; 
warts  4;  condylomata  1;  bubo  1;  excoriations  5;  psoriasis  and  other  eruptions 
6;  oedema  of  vulva  1 ;  fistula  2  ;  haemorrhoids  1. 


DISEASES   OF   LOCOMOTORY   SYSTEM. 

Periostitis  and  ostitis. — C.  12,  R.  5. 

Necrosis  and  caries. — C.  35,  R.  20.     No  cases  of  special  interest. 

Fatal  case. — Male,  aet.  20.  Chronic  inflammation  leading  to  necrosis  of  tibia 
4  years.  Pieces  of  bone  have  come  away  on  different  occasions.  On  admission 
several  sinuses  discharging  over  skin ;  sequestrotomy,  followed  in  3  weeks  by 
diarrhoea,  vomiting,  and  exhaustion.  P.M. — Large  amvloid  liver  encroaching  on 
thoracic  cavity;  spleen  waxy  and  received  into  a  hollow  of  left  lobe  of  liver; 
kidneys  and  intestines  likewise  amyloid. 

Of  shoulder. — C.  2,  R.  3,  D.  1.  4  cases  of  atrophy  of  shoulder  muscles; 
1  with  severe  and  persistent  neuralgia;  1  subarticular  caries  of  head  of  humerus 
in  which  excision  was  performed ;  2  anchylosis ;  in  1  forcible  movement  under 
chloroform  employed. 

Fatal  case. — Female,  aet.  25.  Disease  following  injury  of  shoulder  of  12 
months'  duration.  Partial  excision  9  months  before  admission.  Excision  of 
bone  completed.     Double  pneumonia  ;  temp.  105°  before  death. 

Of  elbow. — C.  9,  R.  6.  1  following  fracture ;  1  dislocation ;  5  synovial ; 
3  suppurative  synovial ;  2  anchylosis ;  1  caries ;  2  necrosis.  In  3  excision ; 
1  amputation  of  upper  arm  ;  1  sequestrotomy,  the  sequestrum  being  at  junction 
of  epiphysis  and  shaft. 

Of  hip.—C.  27,  R.  26,  U.  1,  D.  7.  Incipient  26;  chronic  30;  old  excision 
readmitted  4 ;  chronic  osteo-arthritis  1  ;  anchylosis  1  ;  excision  of  hip  17,  1  of 
which  was  dou'ole ;  abscess  of  hip  or  thigh  14;  iliac  3  ;  in  2  disease  double; 
with  disease  of  ilium  2;  pathological  dislocation  2;  followed  by  erysipelas  4; 
1  disease  localised  between  upper  epiphysis  and  diaphysis ;  1  with  necrosis  of 
femur. 

Fatal  cases. — Male,  aet.  9.     Disease  1   year ;    also  of  pelvis ;    excision ;  anti- 


320  1880 — Surgical. 

septic  acetabulum  extensively  diseased;  acute  nephritis;  suppression;  albumi- 
nuria; delirium.     No  post-mortem. 

Male,  ait.  14.  Duration  6  months.  Struma;  abscess  of  thigh;  diarrhoea; 
delirium  ;  tubercular  meningitis.     No  post-mortem. 

Female,  set.  3.  Disease  of  both  hips  5  months.  Abscess  of  hip  ;  antiseptics  ; 
carbolic  poisoning.  Death  after  exhaustion  and  great  wasting.  P.M. — Tuber- 
cular disease  of  lungs. 

Male,  set.  9.  Disease  10  months.  Abscess  of  thigh ;  aspiration.  P.M. — 
Pulmonary  phthisis. 

Female,  set.  10.  Incipient  disease  3  weeks.  Acute  necrosis  of  epiphysis ; 
excision ;  hsemorrhage.     P.M. — Iliac  abscess ;  disease  of  mitral  valve. 

Male,  aat.  8.  Duration  8  months.  Iliac  abscess  opened;  excision;  caries  of 
head ;  sequestrum  of  acetabulum  ;  collapse. 

Male,  set.  7.  Disease  of  hip  and  ilium  6  months.  Sinuses  opened  up ;  no 
bone  removed.     P.M. — Phthisis;  amyloid  disease  of  intestines; 

Of  Jcnee. — C.  46,  P.  25,  D.  2.  Incipient  33 ;  chronic  41 ;  old  excision  read- 
mitted 1 ;  chronic  osteo-arthritis  5  ;  anchylosis  2  ;  loose  cartilage  1 ;  excision  of 
knee  10,  1  of  which  proved  fatal ;  amputation  of  thigh  3 ;  subcutaneous  divi- 
sion tibia  1 ;  simple  synovial  disease  17 ;  suppurative  synovial  11 ;  disease  of 
joint  surfaces  with  abscess  6 ;  double  syphilitic  disease  1 ;  with  displacement 
backwards  and  outwards  of  tibia  4;  gonorrhceal  rheumatism  2;  hydrops  articuli 
2 ;  congenital  dislocation  of  hip  1 ;  with  lengthening  of  femur  1 ;  followed  by 
erysipelas  1. 

Fatal  cases. — Female,  set.  28.  Disease  of  knee  4  years.  Fixation  of  knee ; 
nocturnal  pain;  excision;  haemorrhage;  collapse;  transfusion.  P.M. — Organs 
healthy. 

Male,  set.  2.  Abscess  of  knee  opened  under  antiseptic  spray  1  day  before 
admission.     Vomiting  and  black  urine.     Died  of  collapse  and  carbolic  poisoning. 

Of  ankle. — C.  5,  R.  2.  Gonorrhceal  arthritis  1 ;  simple  synovial  2 ;  suppura- 
tive 3;  in  1  Syme's  amputation. 

Genu  valgum. — C.  17,  R.  9,  U.  2.  Subcutaneous  osteotomy  in  16 ;  genu 
valgum  duplex  14 ;  well-marked  rickets  15 ;  with  genu  varum  on  opposite 
side  2. 


SUMMARY   OF  INJURIES. 


GENERAL   INJURIES. 

Burns.— Males  14,  females  19.     C.  19,  D.  14.     Of  face  and  head  8 ;  of  chest 
6 ;  of  back  2  ;  of  abdomen  2 ;  of  upper  extremity  9 ;  of  lower  extremity  2 
general  5.     Complications.— \  with  pneumonia  and  bronchitis;    1  erysipelas 
1  delirium  tremens.     Treatment. — Carron  oil  18 ;  carbolic  oil  3 ;  olive  oil  2 
acetic  acid  and  whiting  6  ,•  vaseline  and  salicylic  acid  5 ;  saturated  solution  of 
bicarbonate  of  soda  2.     Most  of  the  2nd  and  3rd  degree ;  2  of  the  4th ;  1  of 
the  5th. 

Fatal  cases. — Collapse  11 ;  exhaustion  2  ;  delirium  ?  ;  meningitis  1. 

Scalds.— Males  12,  females  11.  C.  18,  R.  1,  D.  4.  Of  head  and  neck  4;  of 
chest  6 ;  of  back  2 ;  of  abdomen  2 ;  of  throat  2 ;  upper  extremity  2 ;  lower 
extremity  2.  Treatment. — Carron  oil  10 ;  acetic  acid  and  whiting  3  ;  bicarbonate 
of  soda  2 ;  carbolic,  olive  oil,  cotton  wool,  each  2. 

Fatal  cases. — 3  collapse ;  1  suppuration  and  exhaustion. 


LOCAL   INJURIES. 

HEAD. 

Scalp  wound. — Males  47,  females  13.  C.  59,  D.  1.  Complications. — Bleeding 
from  ear  2 ;  concussion  12 ;  haemorrhage  3 ;  erysipelas  3 ;  delirium  tremens, 
hsematoma,  contusion  of  wrist  and  shoulder,  cf  each  1.  Extensive  wounds  with 
stripping  of  periosteum  3,  treated  with  success  antiseptically. 

Fatal  case. — Male,  aet.  52.  Fell  40  ft.  from  scaffolding ;  insensible  on  admis- 
sion ;  right  pupil  dilated ;  bleeding  from  right  ear ;  paralysis  right  facial ; 
breathing  stertorous;  Collis  fracture.  Lived  36  hours.  P.M. — Laceration  of 
brain,  both  tempero-sphenoidal  lobes  and  corpus  callosum ;  no  haemorrhage  into 
ventricles ;  fracture  of  6th  and  7th  left  costal  cartilages  without  displacement ; 
hsemothorax. 

Fracture  of  vault  of  skull— Males  19,  female  1.     C.  15,  U.  2,  D.  3.     Com- 


322  1880 — Surgical. 

pound  fracture  without  depression,  without  head  symptoms,  1 ;  compound 
depressed  2;  simple  depressed  7,  pressure  of  occipital  followed  by  epileptiform 
seizures  ;  fissure  of  frontal  with  lacerated  wound  of  scalp  2. 

Other  cases.— Male,  set.  11.  Fell  from  horse,  and  probably  kicked  by  it. 
When  admitted,  insensible,  much  vomiting,  collapse;  consciousness  returned 
soon  after  admission.  Compound  and  depressed  fracture  of  skull  in  occipito- 
parietal region,  without  injury  to  dura  mater.  Trephine;  elevation  of  larger 
fragment  not  removed,  a  small,  loose  piece  of  bone  from  outer  table  taken  away, 
and  small  fragments  from  inner  table.     Discharged  46th  day,  cured. 

Male,  set.  13.  Kicked  by  a  horse  in  parieto-occipital  region.  No  head  sym- 
ptoms. Depression  J  in.  deep  over  surface  of  3  in.  Trephine  and  elevation. 
Discharged  52nd  day,  cured. 

Male,  set.  30.  Large  cog-wheel  fell  upon  head.  Compound  comminuted  frac- 
ture of  left  parieto-occipital  region,  depression  \  in. ;  paralysis  of  right  arm. 
Trephine;  elevation  of  fragments  ;  piece  of  bone  larger  than  a  shilling  removed. 
Some  brain  matter  escaped  next  day.  Aphasia.  This  and  paralysis  improved 
before  the  patient  was  discharged  on  53rd  day,  cured. 

Male,  set.  34.  Deal  board  fell  upon  head.  Compound  and  comminuted 
depressed  fracture  of  left  side  frontal  bone,  scalp  wound  extensive,  no  loss  of 
consciousness;  vomiting;  no  paralysis.  Trephine;  elevation  of  four  or  five 
depressed  fragments.     Discharged  69th  day,  cured. 

The  above  operations  antiseptic. 

Fatal  cases. — Male,  set.  25.  Fell  down  fifty  stone  steps.  Effusion  beneath 
left  side  of  scalp ;  right  hemiplegia ;  contracted  right  pupil.  Trephine ;  no 
extravasation  of  blood  to  be  seen  either  external  or  beneath  dura  mater.  P.M. 
— Extensive  effusion  of  blood  over  whole  of  posterior  surface  of  skull  and  left 
lateral  region.  Two  fractures  of  skull,  one  along  occipital  bone  vertically 
ceasing  just  at  foramen  magnum.  The  other  divided  left  temporal  bone  in  its 
squamous  portion,  parallel  with  and  anterior  to  petrosal  part.  Clotted  blood 
over  left  cerebral  hemisphere  ;  this  continued  about  region  of  angular  convolu- 
tion, also  both  temporo-spheroidal  and  anterior  lobes. 

Male,  set.  56.  Self-inflicted  gun-shot  wound  over  upper  part  of  temporo- 
occipital  region.  Trephine ;  three  fragments  of  bone  removed ;  deep,  scarcely 
stertorous  respiration.  Lived  3  days.  P.M. — Laceration  of  parietal  lobe  just 
above  fissure  of  Sylvius,  entering  through  right  ascending  parietal  convolution. 
Bullet  found  in  right  lateral  ventricle. 

Male,  set.  68.  Fell  from  cab  and  struck  head.  Fracture  of  vault  of  skull. 
Died  on  3rd  day,  comatose.  Fracture  of  6th  and  7th  left  ribs.  On  admission 
semiconscious,  irritable,  unwilling  to  be  moved ;  breathing  stertorous  and 
rattling.     General  convulsions,  especially  of  right  side  of  face.     No.  P.M. 

Fracture  of  base  of  skull. — Males  16.  C.  10,  D.  6.  5  fracture;  4  bleeding 
from  ear  ;  3  also  from  nostril ;  1  with  subconjunctival  haemorrhage  and  vomiting; 
1  complicated  with  fracture  of  tibia. 

Other  cases. — Male,  set.  15.  Knocked  by  horse  and  cart.  Conscious  on 
admission,  vomiting.  One  hour  after  admission  stertorous  breathing  lasting  ten 
minutes,  bleeding  and  watery  fluid  from  left  ear;  no  paralysis.  Followed  by 
abscess  over  mastoid  process.     Cured. 


1880— Surgical.  323 

Male,  set.  27.  Fall  of  7  feet.  Unconscious  ;  bleeding  from  right  ear ;  serous 
discharge  from  both  ;  vomiting  of  blood  ;  facial  paralysis.     Cured. 

Male,  set.  29.  Fall  down  flight  of  steps ;  found  insensible  in  an  area.  Un- 
conscious ;  twitchings ;  bleeding  from  left  ear ;  no  paralysis  of  limbs  or  face ; 
left  internal  strabismus ;  pupils  equal ;  diplopia.  On  14th  day  aphasia  and  left 
facial  paralysis,  which  existed  on  36th  day,  when  patient  was  discharged,  cured. 

Male,  set.  36.  Thrown  from  horse.  Insensible  on  admission ;  pupils  equal ; 
no  paralysis ;  ?  escape  of  brain  matter  from  left  auditory  meatus.  On  13th  day 
right  facial  paralysis  noticed.     Cured. 

Fatal  cases. — Male,  set.  50.  Thrown  off  cab.  Insensible  ;  right  facial  para- 
lysis. Lived  but  a  few  hours.  P.M. — Fracture  of  base  of  skull ;  cerebral 
hsemorrhage. 

Male,  set.  54.  Fall  from  ladder.  Insensible ;  no  paralysis ;  no  external 
bleeding.  Lived  10  hours.  P.M. — Fracture  comminuted  into  foramen  mag- 
num ;  contusion  of  cerebellum  and  left  frontal  lobe ;  effusion  of  blood  over  left 
hemisphere. 

Male,  set.  18.  Knocked  down  by  cab.  Unconscious ;  restless ;  vomiting ; 
bleeding  from  left  ear.  P.M. — Separation  of  lamboidal  suture  ;  cracks  extend- 
ing forward  from  this  for  about  3  in.,  involving  only  inner  table;  laceration  of 
left  temporo-sphenoidal  lobe. 

Male,  set.  33.  Fell  50  ft.  from  ladder.  Unconscious  ;  stertorous  breathing  ; 
no  paralysis;  bleeding  from  right  ear,  nose,  and  mouth.  P.M. — Comminuted 
fracture  of  sphenoid,  traversing  petrous  bone ;  contusion  of  frontal  lobes. 

Male,  set.  36.  Self-inflicted  gun-shot  wound  of  head.  Lived  20  minutes. 
Bullet  entered  head  above  right  tragus.  P.M. — Course  of  bullet  through 
external  auditory  meatus,  striking  temporo-sphenoidal  lobe ;  found  embedded  in 
left  portal  lobe,  and  flattened  out  into  quite  a  thin  plate. 

Male,  set.  36.  Fell  while  running.  Unconscious ;  bleeding  from  left  ear  and 
nose  ;  restless.  P.M. — Effusion  from  middle  meningeal  artery ;  fracture  of  occi- 
pital, temporal,  and  sphenoid  bones ;  contusion  of  right  temporo-sphenoidal  lobe. 

Concussion. — Males  41,  females  19.  C.  57,  R.  2,  D.  1.  Complications. — 
Bleeding  from  ear  6;  from  nares  2;  facial  paralysis  4;  scalp  wound  10;  hsema- 
toma  of  scalp  4 ;  of  thigh  3 ;  contusion  of  scalp  2  ;  1  followed  by  dementia ;  1 
pneumonia ;  b  hypersesthesia  of  spinal  accessory ;  1  erysipelas. 

Fatal  case. — Male,  set.  48.  ?  Nature  of  accident.  Lived  5  hours ;  much 
swelling  of  left  parieto-occipital  region ;  unconscious  ;  pupils  equal,  dilated ; 
stertor;  lividity.  P.M. — Laceration  of  frontal  and  parietal  lobes,  corpus  stria- 
tum and  optic  thalami ;  blood  extravasation  into  lateral  ventricles. 

Injury  to  eyeball. — Males  4,  female  1.  C.  5.  Primary  extirpation  of  globe  in 
3,  all  due  to  direct  blow  ;  total  loss  of  vision. 


INJURIES  OF  CHEST,  SPINE,  AND  PELVIS. 

Fracture   of  ribs. — Males    22,  females    5.     C.   23,  D.  4.     Direct  injury  10 ; 
indirect  6;  comminuted  1;  at  junction  of  costal  cartilage  3;  1  with  depression 


324  1880  —  Surgical. 

below  rib.     Complications. — Empbysema  4 ;  haemoptysis  3  ;  haeinaturia  2  ;  bron- 
chitis 3  ;  collapse  2  ;  pleurisy  2  ;  fracture  of  clavicle  1. 

Fatal  cases. — Female,  set.  17.  Run  over  by  a  van.  Peritonitis;  collapse; 
bronchitis  ;  pleurisy ;  foetid  pus  evacuated  from  right  loin.  P.M.— Fracture  of 
last  rib ;  lumbar  and  iliac  abscesses. 

Male,  set.  40.  Run  over.  Collapse;  delirium.  P.M. — Pleurisy;  fracture  of 
7th  and  8th  ribs ;  rupture  of  diaphragm,  liver,  and  right  kidney. 

Male,  eet.  4.  Run  over.  Haernatura;  collapse.  P.M. — Rupture  of  perito- 
neum, liver,  and  right  kidney  ;  fracture  of  10th,  11th,  and  12th  ribs. 

Male,  eet.  28.  Run  over.  Collapse;  internal  haemorrhage.  P.M. — Serous 
effusion  into  peritoneal  cavity  ;  rupture  of  liver  ;  fracture  of  9th,  10th,  and  11th 
ribs  ;  contusion  of  right  forearm. 

Fracture  of  spinal  column. — Males  2,  females  2.  C.  2,  D.  2.  Female,  aet.  18. 
Fell  from  fourth  story  of  house.  Prominence  in  dorso  lumbar  region  about 
5x5  (haematoma)  ;  haematuria ;  albuminuria ;  pains  in  lower  extremities ;  no 
loss  of  motion  or  sensation  ;  application  of  plaster-of- Paris  splint  enclosing  whole 
trunk. 

The  above  case  readmitted  for  application  of  felt  jacket. 

Male,  set.  31.  Fracture  of  lower  cervical  vertebrae  whilst  diving.  Anaesthesia 
and  paralysis  of  whole  of  lower  part  of  body.     No.  P.M. 

Male,  aet.  20.  Fell  from  scaffolding  35  ft.  Anaesthesia  below  first  rib  ;  loss  of 
motion  and  sensation  of  legs;  retention  of  urine;  sensation  of  "pins  and 
needles"  down  thighs  and  legs;  spinal  irritation.  P:M. — Fracture  of  7th 
cervical  vertebra ;  considerable  haemorrhage  into  the  canal  and  outside  the  dura 
mater ;  pressure  on  cord. 

Dislocation  of  spine. — Males  2.  C.  2.  Male,  aet.  22.  Fell  down  stairs, 
striking  top  of  head.  Partial  paralysis  of  right  leg  and  arm  and  partial 
anaesthesia ;  retention ;  deficient  movement  of  chest  walls ;  rotatory  displace- 
ment of  lower  cervical  vertebra.  Plaster-of- Paris  splint  applied  supporting  head 
and  extending  down  back. 

Male,  aet.  44.  Truss  of  straw  fell  upon  patient.  Evident  displacement  of 
first  dorsal  vertebra.     Discharged  7th  day,  cured. 

Fracture  of  pelvis. — Cases  discharged  cured.  Male,  aet.  57.  Fell  from  roof 
25  ft.,  flat  on  back.  Fracture  of  rib  with  emphysema ;  fracture  of  left  side  of 
pelvis.] 

Male,  aet.  38.     Run  over.     Fracture  of  ischium ;  haematuria. 

Male,  aet.  24.  Brick  wall  fell  12  ft.  upon  patient.  Fracture  outside  sacro- 
iliac synchondrosis,  and  extending  to  ramus  of  pubes ;  retention.  Plaster-of- 
Paris  jacket,  including  trunk  and  thighs. 

Fatal  cases. — Male,  ?  aet.  20.  Nature  of  accident  unknown.  P.M. — Fracture 
of  6th,  7th,  8th,  and  9th  ribs,  with  laceration  of  visceral  pleura ;  rupture  of  lung 
and  kidney  ;  haemo-pneumothorax  ;  fracture  of  iliac  bone  and  sacrum. 

Male,  aet.  7.  Run  over  by  cart.  Collapse;  vomiting;  restless.  P.M. — Frac- 
ture right  across  pubic  crest  on  left  side,  and  separating  left  ilium  from  sacrum ; 
much  subperitoneal  extravasated  blood  in  pelvis ;  suddenly  produced  hernia  of 
fundus  of  bladder. 


1880 — Surgical.  325 


INJURIES  OF  THE  UPPER  EXTREMITIES. 

Wounds. — M.  23,  F.  17,  C.  40.  1  into  elbow-joint;  1  caused  by  bradawl, 
which  was  found  beneath  flexor  subluni  tendons  at  wrist;  2  by  glass;  1  by 
needle;  1  by  bullet;  1  snakebite  (English  viper),  with  vomiting  and  much 
effusion  ;  1  complicated  with  fracture  of  ribs;  2  with  haemorrhage  ;  amputation 
of  arm  3 ;  of  fingers  3. 

Fracture  of  humerus  (simple  and  comminuted). — C.  13,  R.  2.  By  direct 
violence  8;  indirect  7;  at  upper  third  5;  middle  third  4;  lower  third  6;  of 
internal  condyle  1 ;  of  external  condyle  1 ;  intracapsular  1 ;  longitudinal  into 
elbow  1 ;  with  synovitis  of  elbow,  hsematoma,  wound  of  scalp,  of  each  1. 

Fracture  of  humerus  (compound). — C.  4.  1  at  middle,  3  at  lower  end ;  1  with 
crushing  of  ulnar  nerve  (failure  of  attempt  at  artificial  union) ;  1  removal  of 
internal  condyle ;  1  of  external  and  capitellum ;  1  excision  and  removal  of 
fragments. 


INJURIES  OF  THE  LOWER  EXTREMITIES. 

Dislocation  of  femur. — M.  4,  C.  1,  U.  3.  1,  set.  10,  single  congenital  disloca- 
tion on  dorsum ;  1,  set.  5,  double  congenital,  with  much  lordosis ;  1  set.  23, 
dislocation  on  dorsum  of  15  years'  standing;  2|  in.  shortening;  fair  amount  of 
flexion  and  extension ;  1  recent,  dorsal,  produced  by  forcible  abduction ;  reduction 
without  ansesthetic. 

Dislocation  of  patella. — C.  1,  U.  1.  In  1  direct  violence  to  knee,  admitted 
with  traumatic  synovitis,  dislocation  outward,  reduction ;  in  1  history  of  obscure 
injury  in  infancy  ;  outward  ;  no  treatment. 

Dislocation  of  semilunar  cartilage. — C.  2,  R.  1.  In  2  direct,  in  1  indirect 
violence  ;  2  internal  cartilage,  1  external. 

Dislocation  of  foot. — C.  2.  Both  produced  by  twist  of  foot.  1  inwards,  with 
?  fracture  of  astragalus;  ether  given;  reduction  of  dislocation;  plaster  splint 
applied.     1  backwards,  with  fracture  of  both  malleoli. 

Dislocation  of  astragalus. — C.  1.  Twisted  foot ;  rotation  of  astragalus  on 
antero-posterior  axis  outwards,  and  dislocation  of  bone  outwards ;  head  of  bone 
detached  from  scaphoid  and  superior  surface  looks  outwards ;  no  fracture  of 
external  malleolus.     Reduction  under  chloroform  ;  plaster  splint. 

Fracture  of  femur  (simple). — C.  34,  R.  1,  D.  2.  Of  shaft  30 ;  extracapsular  4, 
of  which  1  was  long  standing,  and  in  another  the  opposite  femur  fractured 
2  years  previously;  fragilitas  ossium  in  2,  with  delayed  union;  by  indirect 
violence  20,  by  direct  17;  into  knee-joint  3;  1  with  fracture  of  ilium  and  con- 
cussion; 1  with  delirium  tremens;  1  followed  by  necrosis  of  shaft  at  seat  of 
fracture. 

Fatal  cases. — Male,  set.  8.     Accident  caused  by  traction  engine.     Fracture  of 
VOL.  XI.  23 


326  1880 — Surgical. 

femur  into  knee-joint;   laceration  of  thigh;  collapse.     Primary  amputation  of 
thigh  at  upper  third.     Lived  4  hours. 

Male,  set.  76.  Fell  down  flight  of  stairs.  Fracture  at  junction  of  upper  and 
middle  thirds.  Plaster  splint  applied.  Bedsores.  Lived  1  month.  P.M. — 
Chronic  gout  and  rheumatic  arthritis;  contracted  kidney. 

Compound  fracture. — C.  1.  Direct  from  kick  of  horse.  Remained  in  hospital 
15  months  for  delay  in  union. 

Comminuted  fracture. — C.  2,  D.  1.  All  by  direct  violence  to  shaft,  2  at  lower 
third,  1  middle.     Delirium  tremens.     P.M. — Cirrhosis  of  kidneys  and  liver. 

Compound  and  comminuted. — C.  1,  D.  1.  1  at  upper  third,  1  at  lower  into 
knee-joint.     Primary  amputation  in  1 — death  from  collapse. 

Fracture  of  patella. — C.  12.  In  4  history  of  direct  violence,  the  rest  by 
muscular  action,  1  vertical. 

Fracture  of  tibia. — C.  22,  R.  6,  D.  1.  Direct  violence  6,  indirect  20,  spon- 
taneous 1.  At  middle  third  9,  lower  third  20,  greenstick  1 ;  2  compound,  1  into 
ankle,  1  compound  and  comminuted,  1  ununited  ;  3  transverse  of  shaft. 

Fatal  case. — Male,  set.  42.  Fell  from  a  ladder.  About  two  inches  of  bone 
was  protruding,  and  a  small  loose  fragment  removed.  Internal  saphenous  vein 
wounded,  this  divided  and  tied  at  both  ends.  Delirium ;  septicaemia ;  no  rigor. 
P.M. — Suppuration  of  soft  parts  about  fracture ;  femoral  glands  hypersemic  and 
enlarged.     No  evidence  of  pysemia. 

Fracture  of  fibula. — C.  38,  R.  13.  Those  relieved  only  retained  in  hospital  for 
a  few  days.  All  at  lower  fourth  of  shaft.  By  indirect  violence  (twist  of  foot, 
&c),  47 ;  by  direct  violence  4 ;  1  of  3  weeks'  duration ;  5  ?  fracture ;  2  with 
delirium  tremens ;  4  compound  at  lower  third.  Lateral  or  antero-postei'ior 
plaster  of  Paris  splints  in  all  cases. 

Fracture  of  tibia  and  fibula. — C.  67,  R.  3,  D.  4.  At  upper  third  of  shaft  5  ; 
at  middle  third  11 ;  at  lower  third  58.  By  indirect  violence  53  ;  by  direct 
violence  21 ;  1  second  time  of  fracture ;  2  followed  by  necrosis ;  1  into  knee- 
joint  ;  12  coinpouud,  2  comminuted ;  10  compound  and  comminuted,  1  case 
being  of  both  legs. 

Fatal  cases. — Male,  set.  15.  Compound  fracture  by  indirect  violence  at  junc- 
tion of  lower  and  middle  thirds  of  both  bones.  Dressed  antiseptically  ;  sloughing 
and  deep  suppuration.  Secondary  amputation.  Suppuration  of  knee-joint; 
rigors;  septicsemia.  P.M. — Empyaema  ;  incipient  pneumonia,  right  base ;  small 
abscess  over  symphysis  pubis. 

Female,  set.  61.  Smash  of  leg  by  tramcar.  Lived  24  hours.  Collapse;  pri- 
mary amputation  above  knee.     P.M. — Granular  contracted  kidneys. 

Male,  set.  20.  Railway  accident.  Primary  amputation  below  knee ;  secondary 
haemorrhage ;  collapse. 

Male,  set.  62.  Run  over  by  'bus.  Smashed  leg,  loose  fragments  removed. 
Delirium  tremens  ;  erysipelas  of  face.  P.M. — Abscess,  size  of  orange,  right  side 
of  brain. 

Fracture  of  bones  of  foot.—  C.  10,  D.  1.  Fatal  case. — Female,  set.  65.  Run 
over  by  brougham  ;  compound  and  comminuted  fracture  of  foot,  with  laceration. 


1880— Surgical.  327 

Primary  amputation  of  leg  at  lower  third;  sloughing;  haemorrhage.  Secondary 
amputation  of  thigh;  extensive  atheroma  of  vessels;  sloughing  of  flaps.  P.M. 
— Fracture  of  2nd,  3rd,  4th,  5th,  6th,  7th  ribs;  6th  projecting  into  pleural  cavity; 
acute  pleurisy. 

Synovitis,  acute  traumatic,  of  hip,  knee,  and  ankle. — C.  42,  R.  1. 

General  contusions. — D.  1.  Male,  set.  64.  Fell  down  stairs  3  days  before 
admission ;  old  disease  of  left  leg.  Erysipelas  ;  ?  paraplegia ;  sloughing  ulcers 
over  sacrum,  both  hips,  heels,  and  leg ;  exhaustion.  P.M. — Chronic  ostitis  of 
left  tibia ;  bedsores. 


328 


Special  Tables. 


t 

8, 


ffl 
< 
E- 

< 
o 

- 

CO 


53 
S 

s 


1 

Scrotal.     Symptoms  not  urgent. 

Vomiting  and  abdominal  pain. 

Sac  tapped  day  after  admission,  followed  by 
relief.  Three  days  after  symptoms  of 
peritonitis  appeared ;  the  sac  was  then 
opened,  and  intestine,  which  was  in  a  re- 
coverable condition,  returned,  and  some 
omentum,  which  was  thickened,  removed. 
The  abdomen  was  punctured,  and  fetid 
gas  allowed  to  escape  from  intestine.  Died 
night  of  operation.  P.M.— Gangrene  of 
intestine;  some  small  ulcers  not  perfora- 
ting into  peritoneal  cavity.  Extensive 
peritonitis. 

Stercoraceous  vomiting  three  days.     P.M. — 
Peritonitis ;  fatty  heart  and  liver.     Hernia 
of  opposite  side. 

Abdominal  tenderness,  vomiting,  tension  of 
sac. 

"3 

dddfi                                     dfio'd 

3 

CO 

CD 

a 

o                                                            * 

3                                       s 

in?                     tin 

8                                         "S 

"3 

1 

c«    to         S3                                                                   a 

u'S  e  «                                                          cu  ct>             a> 

rt^H    O                                                                                 h- 1    O                 M 

JJ               eS                                                                        as 
"               00                                                                           00 

o.3 
S3  P 

S  § 
Pi 

05                                                                                                                           W                              00 

S-     O)     fci     W                                                                                                  t-     M                      Si 

p    >s  3    £>                                                                          3    t->               S3      , 
OcSOJS                                                                  ocsoS 
,0  rQ  ,-  T3                                                                     ,q  ns              ,fl 

>*Tf  Hl>                                                                     H«CO              •<?  •<? 

c 

o 

q 

£  2  £                                                §"     £ 

Ctf    g    ca      "                                                                             «     -  O          a,      - 

611 

<5 

»OHO                                                                     CD  X>              X>  00 

CO 

a  a  a  a                           a  a      a  a 

g 

p. 
g 

o 

o 

CI,         J-i                                                                            jj 

a  a  »i  s,                                                9    .      hti 

o   o   e   QD                                                            ^r-              cu<u 
9   «    13   o                                                                      2  .2                9   <v 

»     B     O     It                                                                                                  S  "o                      O'rf 

6 

rtHM^f                                                                     ift  CO              J>  00 

Special  Tables. 


329 


tc 


OJflu 

1*3 1  I525 

■«  is  ^    ^ 

a  is  -r  <i>  o 
•3  "8  s  -m  - 


.5   « 


,21 


w 


2  «  a 

53    S    ?. 


9.1 


g  be 

O    53 


Dh  tH   p,  2  as 


5  n    „ 

6D        S 

53  s  g 


rrj  T3 

1.2 

o  a 

O    eS 


S     £     5     5 


Sft,     4) 

^  o  2 

o     £ 


3 

bo 

a 
S 


,3 

bO 


qq 


o 

o 


75, 

'<3 


h J 


ev"?>'* 

1'E  ■ 

>  "£  '-3 

2   a  'a 

g°  § 

a  !.'S 


O    F  -3 

a>  'S   53 

■■-So 

bo.£ 


be  S  , 


o     oo    a 


d     d     uQ     d     #     Pn'dddd     P 


w 


I       I 


I    I 


«        CO 


»ri  a> 

3 

53    bO 

U 

Pi 

is  g  1 

i 

"    C3 

•J 
3 

j3     oj 

H 

P4    .O- 

5? 


fr 

TJ 


„  53 


o 

r-l 

U3 

"* 

1> 

<N 

<M 

o 

lO^O 

HH   M 

<N 

o 

a 

CD 

o 

OS  lO 
i-l  vO 

o 

CO 
CD 

CO 

©5 

CO 

O  "*   CO  C5  r-l 
lO  <M  •*  ■■#  X> 

CO 

i— i 

fe 

S 

SS 

a 

a 

a 

aS 

a 

a 

aaSaa 

3 

S 

SB      .    ti 

Oft      ^ 

O     in  r-J 


£ 

O 

W 

£ 

J 

o 

cS 

Od     a 

o 

a 
i—t 

OS 

o 

r-l 

H  <N 

CO 

-* 

«5 

coi> 

ao 

OS 

OHNW* 
iM  <M  iM  <M  (M 

CO 

330 


Special  Tables. 


a  .^t3  +3  v„  a 


M£ 


»  is  « 


o 

S    Ph'1=    cs 
*  ^a  .2   a 

>-<  <u  q  a 


,*e 


o  2   «  §f>*  "^  a 
-  00  t~.g      =  Ph  S 


S  ^=5 


S    6t 


«B  -w   as 
_    w    t-i 

S  ^  a 
P  P.  &. 

2^°g|a$5^ 

&J3 §££2 ' 


93 


13 


g  ^02  -g  .3  fc  'S  -3 


CD     rZ* 

J3  13 


S9^ 

O     00 

«  a  a 

OJ    g  .0 

a      ■« 

■-3-  a 

S   «   <u 

-^  *o  °< 

a  sc  ° 


> 

a"8^      g 
o  00  «2  00  a 

eS    3  13  • s    3 

g  a  5  a  a 

g  « .a  o  2 

§3  KQ  .-£  a 

-S  to1-1  -n  § 

00  a    .  a)     , 

S°  tag,  :rS 

a  a  o  «J  o  : 

§    SB  O  O  -J 

>  HI 


Ph 


t-> 

ed 

«H 

ts 

0 

ri 

OJ 

bo 

^  T3 

eB 

O 

<L>    CD 

T) 

s-   -u 

3  a 

6t«H    o>  13 

13 

3  oa  « 

um 
kle 

oget 
mov 

3 

a 
.2 

e  omenl 
11   knuc 
ought  t 
ntum  r« 

a 

a 

a 

a 

M 

a 

C3 

§  s-°  a 

13 

00 

CQ  02        O 

«* 

d« 


OOP 


OO       OOOO       OOPh       OOO 


to 

8 

tC3 


M 

o 

W 

Ph 

w 


13 

2^ 
a  a> 
ai  a 

2  a< 


dB 


1   © 

I      CD 


W 


0 

a, 

a 

0 

0 

Ch 
CO 

H-> 

a 

a 

w 

w 


a 

00    o 

•a  « 


00      ^H 

>>    3  GO 

03    O  >> 

13  ^3  sS 


-  3  ^    S 
£  0    0)    O 

»#  co  p  co 

&8 

13    P 

CO  iH 

co  co  co 

i^-S 


o  •* 

CO  CO 


£a 

-&  co 


>->      a  >j 

.-I  CO  C5  co 


as&; 


Ph  Ph      Ph'  Ph  Ph  Ph      Ph  Ph  Ph      Ph  §  Ph 


13     H 
j-1    03 


Blacksm 

Tailor 

Married 

s  : 

Widow 

Single 
Married 

s  s  : 

Smith 
Single 

CM  CO  CO 

IN  CO 

co  co 

Tp  \o  CO  t^ 

co  co  co  co 

00  OS  Q 
CO  CO  ^ 

HNM 

Special  Tables. 


331 


.2     A 


a 

Q 

a 

p 

> 

a 

>> 

a 

+j 

a> 

■d 

0) 

3 
0) 

5 
o 

45 

0/ 

* 

o 

CB 

r3 

bi 

p 

s 

a 

1 — I 

s 

43 

o 

« 

a 

3 

s 

p 

S3 

H 

"3 

H 

■ 

J    3 

3 

-4-< 

13 
03 

O 

- 

P 

2 

?3 

«H 

a 

o 

§      .5 

«  o  .2* 
gS  a 
g  2  >» 

£  a>  S3 
<o   O-c  os 

*°f 

0)     CL 

1  >,§ 


«H    2   9 

2  &b  « 

a.sg. 


•si "S    -eas 


iS     i     S 


PnfV 


S   >».! 


.«  3     I*     **»    <U     -3 

P  4J  Sp      •" 

3    3    o3    £    o> 


~  s 

S  oj  .,  a>  ~  g  is 

"     °  S   43   5  ^     (-, 

>■"  CG  g   «-   oj        J3 

>  « j             >» 

•  >?t  a  .2  « 

■  "B   2  3        -2  -3    «S 

rl      Oi      O  **      ~      t«       3    ^7" 


o 

03    ° 

'a  a 


O  ,q 


S  a 


a  gfe 


0) 

O 

a 

sa 

»d 

-r* 

3 

| 

3 

s 

M 

3 

9 

-H 

fc 

c 

gc 

>>  On 

n* 


3  8  g      .!!<! 


r£     _     «     • 

«  a  >  a 
!  2  §  <= 

M      «    43 

oa  -a  "H  ,-T 
»  ft  ■" 
feja      a 

m  a  ip  a 

®  S  ° 

o  -S  «a  "S 


ooo 


«p 


OK 


M 


5  & 


H  g 


W 


oj  13 

c  2 
a>  a 

&  « 
O    Ph 

a  © 
a  o 

CD 


S        3 

•?»      a 

►o     — 


*  in 

S  §.2 

"-"Op, 
oj   * 


3  . 


r3 

13 

oso»o 

io 

CO 

(N  rH 

rH 

^ 

©S" 

E 

0! 

a  >>0 

N  "?  rH 

o 

>» 

.a 

"SI 

i-H 

O 

1-1 

co  co  10 

oo 

e»s 

CM  •*  tJI 

■* 

CO 

fe  Ph  Pm 

fR 

fe 

■* 


fe 


S 


a 


M       13 

.2     S 


I.S 

"9  S 


i      H 
I      OJ 


Ph>< 


§S  a 


fe'a 


a 
S 

a 

bO 


o 


SPECIAL   TABLE   II.— ERYSIPELAS. 

(Developed  in  Hospital.) 


1.  Male,  set.  36.     Kecurrent  epithelioma  of  lip.     2  days  after  application  of 
galvanic  cautery.     Duration  7  days.     Relieved. 

2.  Female,  set.  19.     Sarcoma  of  lower  jaw.     15  days  after  second  operation. 
Lasted  8  days.     Relieved. 

3.  Female,  set.  65.     Lipoma  of  neck.     3  days  after  removal.     5  days'  dura- 
tion.    Cured. 

4.  Female,  set.  23.     Lupus  of  nose.      Appeared  without  any  exciting  cause. 
Erythema  disappeared  in  2  days.     Cured. 

5.  Male,  set.  40.     Sebaceous  tumour  of  neck.     11  days  after  operation.     Lasted 

13  days.     Cured. 

6.  Male,  set.  33.     Perineal  fistula.     6    days  after  perineal  section.     Lasted 
7  days.     Cured. 

7.  Male,  set.  16.     Necrosis  of  superior  maxilla.     Appeared  in  connection  with 
sinus  of  cheek.     Lasted  about  a  week.     Cured. 

8.  Male,  set.  32.     Necrosis  of  femur.     Appeared  day  after  probing.     Has  had 
several  previous  attacks.     Cured. 

9.  Male,  set.  25.     Necrosis  of  os  calcis.     10th  day  after  incision.     Duration 
18  days.     Cured. 

10.  Male,  set.  13.     Caries  of  temporal  bone.     Erysipelas  of  face.     Duration  a 
week.     Cured. 

11.  Male,  set.  6.     Disease  of  hip.     6  days  after  excision.     Lasted  14  days. 
Cured. 

12.  Female,  set.  19.     Disease  of  hip.     In  connection  with  abscess  of  thigh. 
Duration  3  weeks.     Cured. 

13.  Female,  set.  35.      Disease  of  knee.     20  days  after  excision.     Duration 

14  days.     Cured. 

14.  Male,   set.   26.      Caries  of  metatarso-phalangeal  joint.      1    month  after 
sequestrotomy.     Lasted  24  days.     Cured. 

15.  Female,   set.   26.      Deformity   of  nose.      Plastic   operation,   followed  in 
4  days  by  erysipelas.     Lasted  7  days.     Cured. 

16.  Male,  set.  1£.     Abscess  of  hip.     After  incision.    Duration  5  days.     Cured* 

17.  Male,  set.  32.     Abscess  of  thigh.     One  week  after  incision.     Cured. 

18.  Male,  set.  30.      Abscess  of  foot.      Following   incision  of  arm.      Lasted 
4  weeks.     Cured. 


1880—  Surgical.  333 

19.  Male,  set.  32.     Lacerated  wound  of  scalp.     6  days  after  admission.     Dura- 
tion 20  days.     Cured. 

20.  Female,  set.   65.      Lacerated   wound  of  scalp.      17  days  after  accident. 
Lasted  2  weeks.     Cured. 

21.  Male,   set.   58.      Wound  of  face.     11    days   after  admission.      Duration 
18  days.     Cured. 

22.  Male,  set.  38.     Scalp  wound,  followed  in  9  days  by  erysipelas.     Lasted 
10  days.     Cured. 

23.  Female,  set  5.     Needle  wound  of  foot.     1  month  after  admission.     Dura- 
tion 14  days.     Cured. 

24.  Male,  set.  35.     Compound  comminuted  fracture  of  both  legs.     Erysipelas 
after  amputation.     Lasted  17  days.     Cured. 

25.  Male,  set.  64.     General  contusions.      Erysipelas  of   trunk.      Died  from 
sloughing  and  exhaustion. 

26.  Female,  set.  39.     Scirrhus  of  mamma.     Excision  of  breast;    antiseptic. 
Cured. 

27.  Female,  set.  43.     Scirrhus  of  mamma.     Excision  of  breast,  followed  two 
days  after  by  erysipelas,  lasting  10  days.     Cured. 

28.  Male,  set.  44.     Epithelioma  of  tongue.     Partial  excision.     Three  months 
after  erysipelas  developed.     Went  out  cured. 

29.  Male,  set.   10   months.      Lipoma   of  arm.     Removed.      Lasted   7   days. 
Cured. 

30.  Female,  set.  43.     Ostitis  of  tibia.     Erysipelas  after  probing.     Cured. 

31.  Male,  set.  19.     Acute  necrosis  of  left  tibia.     Lasted  3  weeks.     Relieved. 

32.  Male,  set.  5.     Necrosis  of  os  calcis.    Sequestrotomy,  followed  in  20  days  by 
erysipelas.     Cured. 

33.  Male,  set.  7.     Disease  of  hip.     Erysipelas  2  months  after  excision,  lasting 
23  days.     Relieved. 

34.  Male,  set.    10.      Disease   of   hip.      Erysipelas   3   months   after  excision. 
Relieved. 

35.  Female,  set.  31.     Contracted  flexor  tendons  of  hand.     Forcible  straight- 
ening of  fingers,  with  rupture  of  skin.     Erysipelas  26  days  after.     Cured. 

36.  Male,    set.   38.      Wound  of   forehead.      Delirium   tremens.      Erysipelas 
5  days  after  wound.     Cured. 

37.  Female,  set.  25.     Wound  of  forehead  and  ?  fracture  of  superior  maxilla. 
Lasted  4  days.     Cured. 

38.  Female,  set.  13.     Compound  comminuted  fracture  of  leg.     Sequestrotomy, 
followed  by  erysipelas  one  month  after,  lasting  three  weeks.     Cured. 


SURGICAL    REPORT. 

1881. 

By  WILLIAM  HENRY  BATTLE,  F.E.C.S. 


General  Statement. 


Number  of  surgical  beds 241 

234f  Males     129 
\  Females  105 
„„*/ Males      123 
**'  \  Females  104 
„  „        treated  to  a  termination  during  tbe  year  1881     .  2329 

Total.  Malea.  Females. 

Discharged  cured    ....       1457         ...         897         ...         560 


of  patients  in  hospital  January  1st,  1881     . 
„  „         December  31st,  1881 


relieved 
unrelieved 


Died 


662 

47 

163 

2329 


439 

14 

114 

1464 


223 
33 
49 

865 


Average  number  of  deaths  6*9  per  cent. 
„  „  days  in  hospital  37. 


Average  number  of  surgical  deaths  since  the  opening  of  the  new 
Hospital  in  1871.1 

1871-72  .  .  77  per  cent. 

1872-73  .  .  85 

1873-74  .  .  91 

1874-75  .  .  8-7 

1875-76  .  .  66        „ 

1  The  above  list  includes  many  cases  brought  into  the  hospital  dead  or  dying. 


1876-77 

.    7*5  per  cent. 

1877-78 

.    7-7        „ 

1878-79 

•    60        „ 

1879-80 

.    62        „ 

1880-81 

.    69        „ 

336 


1881 — Surgical. 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


DISEASE. 

o 

Sex. 

Age. 

Duration  before  admission. 

If. 

P. 

fr4 

s 

a- 

3 

5-10 

-20 

-30 

-40 

-50 

-60 

oo 

Dys. 
1-4 

Dys. 
5-13 

ffks 
2-4 

Mts. 
1-2 

Mts. 
2-6 

Mts 
6-12 

1 

1 

5 

2 
2 

"i 
1 

i 

i 
1 

'5 
0    ^ 

5    ; 

0    < 

6 
21 

i 

3 

4 

2 

3 

1 

1 

"1 

1 

General  Diseases. 
Erysipelas  (arising) 

Do.  (admitted  as  such)  . 

Pysemia  (arising) 

Do.  (admitted  with  it)   . 
Syphilis — 

1.  Primary,  by — 

Indurated  sore 

2.  Secondary 

3.  Tertiary    . 

4.  Congenital 

Local  Diseases. 
Tumours. 
Carcinomata — 
Scirrhus  of — 

a.  Breast    . 

b.  Do.  (recurrent) 

c.  Axillary  glands 

d.  Rectum  . 
Encephaloid  of — 

a.  Breast    . 

b.  Do.  (recurrent) 
Epithelioma  of — 

a.  Tongue  . 

b.  Lip 

c.  Mouth     . 

d.  Nose 

e.  Lower  extremity 
/.  Glands    . 

g.  (Esophagus 
h.  Rectum  . 
i.  Genitals . 
Sarcomata — 

a.  Palate     . 

b.  Upper  jaw 

c.  Lower  jaw 

d.  Frontal  . 

e .  Neck 

/.  Chest-wall 
g.  Parotid  region 
h.  Breast     . 

Vo 

59 

2 
3 

45 
5 
1 

38 

2 
4 
4 

1 
1 

11 

7 
4 
2 
3 
3 
1 
4 
3 

2 
2 
2 
1 
2 
1 
3 
1 

21 

52 

2 

2 

i 

3 

3 

11 

7 
4 
2 
3 
3 

3 

2 

2 
2 

1 

1 

11 
17 

i 

6 

13 
2 
1 

38 

2 
4 

1 

1 

1 

1 

1 
1 

2 

1 
1 

1 
2 
1 

5 

5 

i 

2 
5 
1 

5 
6 
1 

3 

28 

2 

11 

17 
1 

4 
15 

4 

1 
1 

i 

l 

l 
l 
l 

4 
8 

1 
2 

1 

8 
1 

1 
1 

"i 

i 

i 

6 

18 

15 

1 

4 
1 

1 
1 

4 
2 
2 

1 

"i 

i 
i 

i 

2 

7 

i 

5 

4 
2 
1 

1 
1 

1 
1 

1 

2 

3 
1 

9 
"2 

3 
3 

2 

1 
2 

1 

i 

2 

29 

32 

1 
1 

5 

3 

5 

2 

3 
1 

1 

3 

10 

3 
1 

2 

1 
1 

1 

1 

17 
2 

6 

2 
2 
3 

1 

6 
1 

4 

1 
3 
1 

i 
i 

1 

2 

1 

Classes, 

1881—  Surgical.                                  337 
according  to  authorised  Nomenclature. 

Duration  of  residence. 

Result. 

.Remarks. 

s.  Dys. 
4  5-13 

Wks 
2-4 

Mts. 
1-2 

Mts. 

2-4 

Mts. 
4-6 

Mts. 

6-9 

Mts. 
9-12 

O   o 

C. 

11. 

U. 

D. 

.      6 
5   26 

2  "i 

.     2 

.      1 

3  2 

.'.      2 
1      1 

1  3 
..      2 

2  ... 

..    i 

..  "i 
..    i 

i  ... 

8 
20 

3 

7 
1 

13 
1 

i 

5 
5 
1 
2 

2 
1 
2 

2 
2 

10 

15 
2 

2 

19 

2 

1 

19 

2 

1 

1 

2 

1 
1 

2 

2 
1 

1 

1 

1 

4 
2 

1 

10 

i 

i 

l 

i 

l 

5 
1 

1 

6 

i 

1 
1 

1 

1 

1 

1 

i 

27 
63 

4 

33 

4 

28 

2 
3 

1 

1 

2 

6 

1 
2 

i 
1 

1 

2 

4 

12 

1 

4 

3 

6 

6 

2 
3 

1 

3 

Fatal  cases :  sarcoma  of  neck,  epithelioma  of  jaw, 
excision  of  hip,  dislocation  of  shoulder,  necrosis 
of  os  calcis,  burn. 

1  vaccino-erysipelas,     1    coma,    1    convulsions, 
3  cellulo-cutaneous. 

Vide  Special  Table — Pyaemia. 
Ditto. 

Eruptions  in  4,  haemorrhage  iu  1. 
Vide  General  Summary. 
Ulceration  of  palate,  leg,  nose  2,  penis. 
Marasmus,  convulsions. 

In  4  ulceration  of  skin  over  tumour,  1   cystic. 

See  General  Summary. 
In  cicatrix  of  operation. 
Removal  in  3. 
Deaths  :  1  after  colotomy,  1  peritonitis. 

Amputation. 

In  cicatrix  of  operation. 

2  of  upper  lip. 

Amputation  of  leg  1,  toe  1,  scraping  1. 
Inguinal  2,  axillary  1. 

Colotomy  1,  of  anus  1. 
Vulva  1,  perinaeuin  1,  penis  1. 

Both  recurrent. 
No  operation. 
Epulis. 

1  primary  of  glands,  1  recurrent. 

Melanotic  1 ;  readmission  1,  convulsions. 

Amputation. 

1 
1 

1 

2 

6 

1 
3 
1 
2 
1 

3 
1 

1 

2 
1 
1 

2 

2 

1 
1 
1 

1 

1 

1 

1 

i 

i 

i 

i 

338 


1881 — Surgical. 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


DI8EA.SE. 


Local  Diseases. 

Tumoues. 
Sarcomata — continued. 

i   Testis 

Jc.  Lower  extremity 

I.  Rectum  . 
Adenoma — 

Breast 
Lipoma    . 

Papilloma 

Angioma 

Exostosis 

Neuroma 

Fibroma 

Myo-fibromata 

Molluscum 

N»vus  vascularis 

Glandular 

Polypus 

Rodent  ulcer    . 

Lupus 

Keloid      . 

Cystic — 

a.  Ovarian    . 

b.  Sebaceous 

c.  Dermoid    . 

d.  Hydatid   . 

e.  Other  cysts 


Nebvotjs  System. 
Tetanus  ( admitted  as  such) 
Meningitis 
Paralysis  of  ulnar  nerve  . 
Hypersesthesia  of  cicatrix 
Infantile  paralysis    . 


Cibcttla.tory  System 
Aneurism 
Varicose  veins 
Phlebitis 

Thrombosis  of  vein 
Haemorrhage   . 
Gangrene 


18 


Sex. 


1  ... 

6   6 


4|  2 

1 

1 


5-10 


-2d 


-80 


-40 


-5d 


-60 


Dts 
1-4 


Duration  before  admission. 


Dys. 
5-13 


Wks 
2-4 


Mts 
l-S 


Mts 
2-6 


Mts. 
6-12 


1881— Surgical. 


339 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 


Wks  Mts. 
i-A   1-2 


Mt 


3 
1 
2 
2 
2      2 


Mts. 
4-6 


Mts. 
6-9 


Mts. 
9-12 


Result. 


Remarks. 


Castration,  1  peritonitis. 

2  of  femur,  amputation,  died;  deposit  in  lungs. 

Completely  surrounding  canal. 

Excision  8,  cystic  2. 

Multiple  2,  hip  1,  shoulder  3,  forehead  1,  chest  2, 

arm  1,  back  2. 
Congenital  of  scalp. 
Cheek. 

Subungual  of  toe  2,  humerus  2,  tibia  1. 
Both  on  branches  of  ulnar  nerve. 
Removed. 
Removal  2. 
Hairy  and  pigmented. 
Nose,  chest,  finger,  lip. 
Neck  3,  axilla  1. 
Associated  with  fissure. 
Forehead,  scalp,  face;  2  recurrent. 
Face  and  nose,  nose,  under  jaw  and  over  clavicle. 


Ovariotomy  in  17,  of  whom  4  died. 
Arm  1,  neck  1. 

Of  liver,  paracentesis  and  abdominal  section. 
Of  spermatic  cord  3,  congenital  of  chest-wall  1, 
behind  angle  of  jaw  1,  front  of  neck  1. 


Punctured  wound  of  foot,  contused  wounds  of  face. 

Subacute. 

Excision  of  cicatrix. 

After  excision  of  shoulder,  amputation  of  breast. 

Amputation  of  leg  1. 


Groin  1,  axillary  1. 

Excision  of  part  of  vein  1. 

Varicose  veins  2. 

Varicose  veins  1,  anaemia  1,  both  legs  affected. 

Epistaxi<  4,  varicose  ulcer  1,  after  circumcision,  1, 

Toes  3,  finger  2,  penis  1. 


340 


1881 — Surgical. 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


o 

Sex.  |                            Age. 

Duration  before  admission. 

DISEASE. 

M. 

F. 

P 

5-10 

-20 

-30 

-40 

-50 

-60 

§0 

~  so 

"1 

Dys. 
1-4 

Dys. 
5-13 

Wks 
2-4 

Mts 
1-2 

Mts. 
2-6 

Mts. 
6-12 

g    1 
0    « 

Glandular  System. 
Inflammation  . 
Abscess    . 
Angeioleucitis  . 
Caseous  degeneratio 
Mammary  suppurat 

Diseases    of     Due 

Glands. 
Bronchocele     . 

Respiratory  Syste] 
Diphtheria 
Foreign  body  . 

Digestive  System. 
Cancrum  oris   . 
Acute  glossitis. 
Tonsillitis 
Abscess  of  fauces 
(Esophageal  strictui 
Strangulated  hernia 

a.  Inguinal  . 

b.  Femoral    . 

c.  Umbilical 
Herniae — 

Inguinal,  irreduci 
incarcei 

Femoral,  irreduci 

Umbilical,  irreduc 

Ventral 
Intestinal  obstructic 
Peritonitis 
Fistula  in  ano . 
Hemorrhoids  . 
Ulcer  of  rectum 
Stricture  of  rectum 

Genito-urinary  Sy 
Phimosis 
Paraphimosis   . 
Hydrocele 

Do.,  suppuration 

n 

on     . 

TLES3 

a. 

e 

ble    . 
ated. 
ble     . 
ible  . 

n 

STEM. 
3f       .' 

2 

12 

10 

4 

3 

3 

1 
2 

1 
1 
2 
3 

1 

27 

13 

2 

6 

1 
4 
2 
1 
4 
2 
22 
14 
3 
5 

7 
1 
4 
1 

1 
3 
g 
3 

1 

2 

1 
1 
1 
2 

27 
4 
1 

6 

1 

1 

1 

14 

11 

3 

7 
] 
4 

1 

1 
9 
1 
1 
3 

2 
1 

1 

1 
1 

9 

1 

i 

3 
2 
1 
3 
1 
8 
3 

5 

2 

i 

1 

1 

... 
5 

1 
1 

i 
1 

i 
1 

3 
1 
1 

1 
1 
1 

1 

1 

i 

4 

i 
3 

1 
4 
2 

3 

2 
2 

1 
1 

i 

i 

5 

i 
1 

1 
1 

1 
2 

4 
1 

2 

"i 

7 
3 

2 

i 

4 
5 
1 
1 

2 

1 
1 
1 

9 
5 
1 

2 
1 
1 

1 
2 

"7 
5 
1 
2 

i 

i 

1 
1 

1 

'4 

1 

1 

3 

4 
1 

1 
2 

2 
1 

i 

4 

2 

1 
1 
2 

26 

11 

1 

1 

1 
2 

1 
1 

i 

3 

1 

1 

i 
1 

1 
1 
1 

1 

2 
i 

*6 
4 

2 
1 

1 
1 

i 

1 

1 

i 
1 

1 

i 

1 

i 
3 

1 

3 
1 

3 

i 

2 
1 

3 

3 
1 
1 
2 
1 

13 
13 

2 
2 

7 
4 

1881 — Surgical. 


341 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 


Wks  Mts.  Mts. 
2-4    1-2    2-4 


Mts. 
4-6 


Mts 
8  -',) 


Mts 
9-12 


Result. 


C.   R.  U.  D 


Remarks. 


Axilla  4,  groin  3,  popliteal  2,  cervical  3. 

Leg  5,  arm  5. 

Struma. 

Acute  abscess  1,  chronic  1,  sinuses  1. 


Excision  of  thyroid  1. 


Tracheotomy. 

Tracheotomy  1,  laryngotomy  1. 


Incisions. 

Each  subject  to  itj  1  rheumatism. 
Post-pharyngeal,  soft  palate,  tonsil. 
Simple  fibrous. 

Vide  Special  Table — Hernia. 

Taxis  1,  operation  1. 

Painters'  colic  1,  omental  1. 

Operation  1. 

Fatal  case :  internal  strangulation  by  band. 

Ten  years  after  ovariotomy. 

Vide  General  Summary  of  Diseases. 

Perforation  of  simple  ulcer  1,  typhoid  ulcer  1. 

Fatal  case :  phthisis. 

Complicated  by  fissure  1. 

Haemorrhage  1. 


Circumcision  6,  congenital  5. 
Incisions. 


Incision. 


VOL.  XI. 


24 


342 

1881- 

■Surgical, 

Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 

DISEASE. 

Sex. 

Ages. 

Duration  before  admission. 

u        1 

i 

'5     S 
g     « 

5    a 

0 

o 

M. 

F. 

2  m 

3 

5-10 

-20 

-30 

-40 

-50 

-60 

So 

fl  CO 

< 

Dys. 
1-4 

Uys. 
5-13 

Wks 
2-4 

Mts. 
1-2 

Mts. 
2-6 

Mts. 
6-12 

Genito-Ubinaey  System 

— continued. 

Varicocele 

2 

2 

1 

1 

1 

1 

Epidymitis  acute 

3 

3 

3 

1 

1 

1 

Do.,  tubercular     . 

■1 

4 

1 

3 

1 

T 

Undescended  testis  . 

1 

1 

1 

... 

1 

Syphilitic  testis 

1 

1 

1 

1 

Vulvitis   .... 

2 

2 

1 

1 

g 

Ulcer  of  vulva 

1 

1 

1 

1 

... 

Abscess  of  labium     . 

5 

B 

3 

?, 

s 

2 

...    . 

Rupture  of  perinamm 

3 

3 

1 

2 

3 

Vesico-vaginal  fistula 

1 

] 

1 

1 

Vesical  irritation 

2 

2 

?, 

1 

Atony  of  bladder 

3 

3 

1 

?, 

9 

1 

Cystitis    .... 

3 

2 

1 

1 

?, 

1 

1 

■ 

Ulceration  of  bladder 

1 

1 

1 

1 
o 

Malignant  disease  of  do.  . 

2 

2 

?, 

Hsematuria 

1 

1 

1 

1 
lfi     1 

Stricture  of  urethra 

24 

24 

1 

10 

7 

2 

4 

1 

1 

3 

2 

Retention  of  urine    . 

16 

L6 

1 

3 

5 

?, 

?, 

ft 

15 

1 

Perineal  abscess 

4 

4 

9, 

1 

1 

3 

1 

... 

Extravasation  of  urine     . 

2 

g 

1 

1 

^ 

Urinary  fistula 

•1 

1 

2 

1 

1 

1 

1 

2 

Abscess  of  prostate  . 

1 

1 

1 

1 

Hydronephrosis 

•1 

1 

4 

1 

o 

1 

Calculus — 

1.  Kidney    . 

1 

1 

1 

1 
1 

2.  Bladder  . 

3 

2 

1 

1 

1 

1 

1 

3.  Urethra  . 

1 

1 

1 

1 

Other     Aeeections     oi 

Generative  Organs 

Gonorrhoea 

ac 

1 

U 

13 

7 

3 

fi 

4 

fi 

Soft  sore . 

24 

6 

18 

1 

12 

11 

1 

4 

3 

q 

3 

1 

Warts      . 

2 

2 

1 

1 

1 

1 

... 

Diseases  op  Bones. 

Rachitis  . 

1 

1 

1 

1 

Periostitis  of — 

a.  Femur,  acute  . 

1 

1 

1 

1 

chronic 

2 

2 

?, 

.  * . 

\ 

■■ . 

1 

b.  Tibia,  acute 

4 

3 

1 

1 

1 

1 

1 

1 

9, 

chronic  . 

4 

2 

2 

1 

?, 

1 

l 

1 

2 

Ostitis      ,         , 

2 

1 

1 

... 

... 

1 

1 

... 

1 

... 

... 

1 

1881 — Surgical. 


343 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence.                        Result. 

3     l>\s 

1  5-15 

Wks 

Mts 

Mts 
3-4 

Mts 
4-( 

Mts 
6-i 

Mts 
9-1' 

;  1 1  c.  r 

Remarks. 
.  U.  D. 

"2 
2 

... 

1 

4 

2 

2 

1 

"7 
6 
2 

i 

■1 

3 
1 

1 

1 

\    2 
1    1 

1 
1 
1 

i 
1 
1 

i 
1 

2 
1 
5 
4 
2 

i 

i 

2 
1 

4 
7 
1 

2 
2 

1 
1 

i 

2 

1 

"i 

8 
1 

1 
3 
1 

i 

5 

8 

"l 
1 

1 

1 

3 
1 

5 

4 

1 

1 

1 

2 
1 

2 
2 

... 

1 

...       1     1 

,.,     2   1 

3 

...     1 

1 

...     1... 
...     5... 

3 

1 

2 

3 

1 

1 

1 

1 
...  15   6 
...  16 

3   1 
...     2 

3 

...     1 
...     1   3 

...     1 
...     2 

...  17   3 
...  20   4 
...     2... 

...     1 

2 
...     2   1 

...     1    1 

Operation  1. 

Gonorrhoea  3, 1  with  orchitis  and  acute  hydrocele. 
...    1  Abscess  in  3,  tubercular  pyelitis  1. 

..  Groin,  painful;  castration. 
Double;  castration  right  side. 

Traumatic. 
...    .    Traumatic  1,  ?  gonorrhoea  2. 

.    Traumatic  2,  parturition  1. 
Second  child,  forceps. 

...    2  Uraemia  1,  surgical  kidneys  1. 
...    1  Surgical  kidneys. 
...    3 

...    1 

..  Perineal  fistula  and  retention. 
...  Result  of  injury,  1  readmitted  twice. 

...     .  Nephrotomy. 

1  Lithotomy  2,  dilatation  of  urethra  1. 
,,.  External  urethrotomy. 

7  warts,  1  stricture. 

3  phagedamic.    9  bubo,  13  gonorrhoea." 

Phimosis  1,  pariphimosis  1. 

...    1  Amputation  1.     Died:  pyaemia  1. 

All  syphilitic. 

1  chronic,  1  subacute. 

344 

1881— 

Surgical. 

Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 

s 

ex.                                Ages. 

Duration  before  admission. 

DISEASE.                    j 

|  M 

.  F.i- 

5-10 

-20 

-30 

-40 

-50 

-60 

lo 

a  so 

Dys. 
1-4 

Dys. 
>-13 

Wks 
?.-4 

Vtts. 
1-9. 

VI  ts. 

ilts. 

i-lfl 

'3     f. 

H 

u> 

< 

o    ■<■ 

Diseases   of  Bone — con-\ 

tinned. 

Osteomyelitis  .         .         .    1 

L 

1 

1 

Abscess  of  femur      .         .    1  .. 

.    1   ... 

1 

1    . 

,,            tibia        .         .    2 

1    1   ... 

2 

2    . 

Necrosis  of — 

a.  Frontal     .         .         .2 

1 

1 

1 

2 

b.  Jaw           .         .         .3 

1    2     1 

2 

1 

1 

1    . 

c.  Humerus .         .         .1 

1 

i 

1    . 

d.  Ulna         .         .         .2 

2 

2 

2 

... 

e.  Femur      .         .         .    7 

6    1  ... 

l 

3 

2 

1 

1 

6    . 

/.  Tibia        .         .         .10 

9    1  ... 

l 

5 

1 

1 

1 

1 

1 

2 

1 

G    . 

g.  Fibula      .         .         .!  1 

1...     1 

1    . 

h.  Bones  of  foot  .         .    9 

4    5     1 

5 

2 

1 

1 

3 

3 

2    . 

Caries — 

a.  Radius     .         .         .1 

1...     1 

1 

b.  Rib  .         .         .         .2 

1    1  ... 

2 

1 

1    J 

c.  Pelvic  bones      .         .    2 

2 

2 

2 

d.  Tibia        .         .         .3 

1    2  ... 

2 

1 

3 

e.  Mastoid  cells    .         .    3 

3...     1 

1 

1 

3 

f.  Tarsus       .         .         .5 

4    1  ... 

1 

2 

1 

1 

1 

4 

g.  Carpus     .         .         .2 

1    1  ... 

1 

1 

1 

1    . 

Diseases  op  Joints. 

Shoulder — 

a.  Chronic    .         .         .7 

2    5  ... 

3 

3 

1 

3 

4   . 

b.  Hysterical         .         .    1  . 

.    1  ... 

1 

1    . 

Elbow — 

a.  Chronic    .         .         .    2  . 

..    2  ... 

2 

1 

1 

b.  Anchylosis         .         .    3 

1    2  ... 

2 

1 

1 

2 

Wrist       ....    5 

5 

2 

1 

2 

2 

1 

2 

Sacro-iliac        .         .         .    1  . 

..    1  ... 

1 

1 

Hip— 

a.  Incipient          .         .  27 1 

413    5 

4 

16 

1 

1 

1 

3 

1 

5 

10 

4 

3 

b.  Chronic    .          .          .  34  2 

113  11 

11 

1 

4 

1 

1 

2 

7 

6 

18 

c.  Anchylosis        .         .    4 

2   2  ... 

1 

3 

4 

d.  Old  excision     .         .    1 

1 

i 

1 

e.   Rheumatoid     .         .    2 

1    1  ... 

1 

1 

1 

f.  Hysteria  .         .         .    1  . 

..    1  ... 

1 

i 

Knee — 

a.  Incipient          .         .  14 

9   5    4 

3 

3 

3 

1 

2 

4 

2 

5 

1 

b.  Chronic    .         .          .38: 

!612    1 

12 

10 

6 

4 

3 

1 

1 

2 

4 

32 

c.  Anchylosis        .         .    4 

1    2  ... 

1 

1 

2 

-4 

d.  Old  excision     .         .    2 

1    1  ... 

1 

1 

1 

1 

e.  Rheumatoid     .         .    6 

3    3  ... 

1 

1 

1 

3 

1 

2 

1 

2 

f.  Hysteria  .         .         .1 

..    1  ... 

1 

1 

g.  Loose  bodies    .         .    3 

2    1   ... 

i 

1 

1 

1 

1 

1 

1881 — Surgical, 


315 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 

Result 

I.  Dys. 

Wka 

Mts 

Mts 

Mts. 

Mts. 

Mts. 

gg 

1  5-J3 

2-4 

1-2 

2-4 

4-6 

6-9 

9-12 

5  £ 

0. 

R. 

U. 

D 

1 

2 
1 

1 
1 

2 

1 

1 

2 

2 

1 

1 

1 

2 

] 

2 
2 

2 
2 
2 

i 

3 

2 

i 

2 

2 
7 

7 

3 

i 

3 

4 

i 
i 

... 

... 

1 

8 

1 

l 

1 

1 

1 

l 

3 

1 

1 
2 

2 
1 
1 

2 

1 
1 

1 

3 
1 

2 
1 

1 
1 

2 

2 

1 

1 
1 

1 

2 

2 

2 

3 

2 

7 
1 

3 

1 

3 
1 

1 

3 

2 
1 

1 

1 

11 

8 

4 

1 

1 

23 

4 

3 

4 

6 

9 

8 

3 

16 

14 

1 

1 

i 

3 

2 
1 

2 

2 

1 

... 

... 

2 

1 

i     2 

4 

2 

4 

6 

7 

1 

.     4 

4 

i 

11 

4 

12 

4 
1 

2 

1G 
1 

10 
4 

1 

3 

3 

i 

2 

..■ 

1 

5 

1 

l 

1 

1 

... 

■m 

1 

2 

1 

Remarks. 


Femur;  pyaemia. 


Syphilitic. 

Lower  jaw  1,  upper  1. 

Olecranon,  with  suppuration  of  joiut,  1. 
Stump  1. 
Amputation  1. 

Os  calcis  4,  erysipelas  1. 

Strumous ;  double. 


Abscesses. 

Double  1,  Syme's  amputation  1. 

llemoval  of  bones  1. 


1  traumatic. 

Causes :  fracture  into  joint,  dislocation,  disease. 

Amputation  2,  gouty  1. 


1  typhoid  fever. 

Tubercle  2,  phthisis  1,  amyloid  degeneration. 

Osteotomy  2. 

Rheumatism  1,  rheumatoid  arthritis  1. 


Puerperal  1. 


Amputation  1. 

Rheumatism  1,  rheumatoid  arthritis  5. 

Knee  and  ankle. 

Removal  2. 


346 


1881— Surgical. 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


DISEASE. 

Sex. 

Ages. 

Duration  before  admission. 

M. 

F. 

u 

a"5 

5-10 

-20 

-30 

-40 

-50 

-60 

93 

Dys. 
1-4 

Dys. 
5-13 

Wks 
2-4 

Mts. 
1-2 

Mts. 
2-6 

Mts. 
6-12 

1    S 

0    ^ 

Diseases  of  Joints — con- 
tinued. 
Ankle — 

a.  Chronic    . 

b.  Gonorrheal  arthritis 

c.  Old  excision     . 
Foot        . 

6 

1 
1 
4 

3 
1 

1 

4 

3 

3 

2 
1 
1 
1 

1 
1 

2 

1 

i 

2 

1 
1 

... 

4    ., 
2    .. 

Diseases  of  Spine. 
Spinal  weakness 
Pott's  curvature 

1 

17 

1 

10 

"7 

"4 

1 
6 

2 

4 

1 

2 

7 

6 

1  .. 

2  .. 

Lateral  curvature     . 
Coccydynia 
Spondylolisthesis 
Hysterical 

2 
1 

1 
1 

... 

2 
1 
] 
1 

... 

2 

i 
1 

1 

2    .. 
1    .. 
1    .. 
1    ., 

Defoemities. 
Talipes — 

a.  Equino-varus     . 

b.  Varus 

c.  Equinus     . 

d.  Valgus 

e.  Cavus 
Torticollis 
Genu  valgum  . 

0 
6 

9 
4 
1 
4 

7 

G 
4 
4 
2 

4 

4 

3 

2 
5 
2 
1 

3 

5 
3 
1 

1 

1 

7 

2 

3 

2 
1 

2 
1 
2 
6 

2 
1 

1 

1 
1 

9    ., 
6   . 
9   . 
2    . 
1    . 

Genu  varum    . 
Curved  tibise    . 

3 
5 

2 
4 

1 

1 

"4 

1 
1 

2 

1 
1 

2    . 
4    . 

Deformity  of— 

a.  Nose. 

b.  Lower  extremity 

4 
3 

2 
1 

2 
2 

i 

3 

1 
1 

1 

1 

4    . 
2    . 

c.  After  burn 

d.  Upper  extremity 

2 

4 

1 

1 

4 

2 
2 

1 

1 

2 

1 

1 

1    . 
1    . 

Malfoemations. 

a.  Cleft  palate 

b.  Harelip  and  cleft  pa- 

late 

12 
8 

5 
5 

7 

3 

1 

6 

5 
1 

3 

3 
1 

12    . 
8    . 

1881 — Surgical. 


347 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 

Result. 

Remarks. 

1.  Dys. 

46-13 

"i 
l 

3 

2 
3 

2 
1 

"2 
2 

Wks 
2-4 

3 

3 

1 

3 
3 

1 
1 

1 

1 
2 

Mts. 
1-2 

2 
"3 

6 

i 
1 

5 

3 
2 

i 
1 

1 
1 

1 

8 
2 

Mts. 
2-4 

1 

1 

1 

1 
1 

2 
2 
2 

"i 

2 

2 

"i 
1 

2 

2 

Mts. 
4-C 

i 

1 

2 

1 

Mts. 
6-9 

1 

2 

1 
1 

Mts. 
9-12 

"i 
1 

si 
1 

C. 

1 
1 

1 
3 

5 
2 
3 

2 

4 

2 
3 

1 
1 

2 

1 

10 
2 

ft. 
5 

U. 

1). 

Syme's  amputation  1,  excision  1. 
Suppuration  round  joint. 
Amputation. 

Metatarsophalangeal  joint  2,  gout  1,  gouty  ulcer- 
ation of  big  toe-joint  1. 

Epileptic. 

Paraplegia  2.    Abscesses,  psoas  4,  lumbar  4,  cer- 
vical 2. 
1  readmission. 
?  Hysterical. 

Also  clavus  1,  measles  1. 
Also  clavus  1. 
Right  3,  left  3,  double  3. 
Rheumatism  1,  genu  valgum  1. 

Left  1,  right  3. 

Left  1,  right  2,  double  4,  subcutaneous  osteo- 
tomy 5. 
Left  2,  double  1. 
Osteotomy  3,  measles  1. 

Rhinoplastic  operation  4. 

Chronic  spinal  disease;  after  excision  of  ankle; 

toe. 
Foot  1,  chest  and  arm  1. 
After  fracture  3,  after  injury  to  finger  1. 

Soft  palate  5,  hard  palate  2,  involving  both  5. 

Double  with  complete  cleft  2,  single  with  com- 
plete cleft  5,  single  with   incomplete  cleft  1, 
operation  on  lip  5. 

1 

1 
17 

2 

1 
1 
1 

4 

4 
6 
4 
1 
2 
3 

1 
1 

3 

2 

1 

3 
4 

2 

2 

348 

Table  I.- 

1881 — Surgical. 

—Abstract,  showing  Diseases,  Inju 

nes 

>% 

c, 

in 

DISEASE. 

o 
H 

Sex. 

Ages. 

Duration  before  admission. 

M. 

F. 

a"5 

P 

5-10 

-20 

-30 

-40 

-50 

-60 

1 
1 

i 

0 

§0 

< 

1 
1 

1 

i 
i 

Dys 
1-4 

1 
1 

3 

6 

1 

i 

Dys. 
5-13 

1 

10 

1 

1 

"i 

i 
3 

1 
5 
1 

2 

Wks 

2-4 

12 
1 

2 

1 
1 

1 

i 

2 

4 
3 

Mts. 
1-2 

1 
1 

3 

Mts. 
2-6 

i 

2 

1 
i 

i 
1 
1 

i 

Mts. 
6-12 

2 

'a     S I 

0 

-     0 
5   **'" 

I, 

2    •• 

1    .. 

1    .. 

1    ., 
1    » 



1    .. 


=.  :■ 









Malformations  —  c 
tinned. 

c.  Of  rectum 

d.  Epispadias 

e.  Extroversio  vesi 

Appendages    to    M 
lae  System. 
Tenosynovitis  . 
Thecal  suppuration 
Ganglion 

Bursa? — 

1.  Inflammation — 

Bursa  prepate 

2.  Suppuration — 

a.  Over    trocl 

major 

b.  Bursa     pre 

laris 
e.  Over  foot 

3.  Enlargement — 

a.  Over  acrom 

b.  Under  psoa 

c.  Prepatellar 

d.  Over  foot 

Celltjlae  Tissue. 
Inflammation  . 
Sinus 
Abscess — 

a.  Neck 

b.  Scalp 

c.  Shoulder    . 

d.  Arm  . 

e.  Thoracic  walls 

f.  Lumbar     . 

g.  Abdominal 
h.  Perineal     . 
i.    Ischio-rectal 
Jc.  Buttock     . 
1.   Thigh 

m.  Leg  . 
n.  Stump 

on- 

ca3     . 

uscu- 

.laris 
tantei 
patel- 

ion    . 

s 

2 

1 

2 

1 

3 
3 

5 

3 

28 
1 

1 

1 

1 

1 
2 

2 
1 
2 
3 
2 
1 
1 
1 
4 
A 

17 
6 
3 

2 
1 
2 

1 
3 

2 

1 

1 

10 

] 

1 
1 

1 

1 

2 
1 

2 
2 

1 

1 
4 

3 

12 

5 

3 

1 

4 

2 
IS 

3 
1 

2 

1 
2 

1 

1 
5 
1 

2 
1 
2 

1 
"2 

i 

1 

"5 
2 

3 

1 

1 
1 
1 

1 
1 
3 

4 
2 

8 
1 

1 

I 
2 

"i 

i 

... 

1 
10 

2 
1 

1 
1 
2 
3 

i 
1 

5 

1 
1 

i 

"2 

1 
2 

1 

i 

2 
1 

2 

1 

1881— Surgical. 


349 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 

Result. 

Remarks. 

s.lDva 
-1  5-18 

Wks 
2-4 

Mts. 
1-2 

Mts. 
2-4 

Mts. 
4-6 

Mts. 
6-9 

Mts. 
9-12 

o  <u 

C. 

R. 

U. 

D. 

i  ... 

.      4 

1    11 

.      1 
.      1 
.      1 

'!    i 

..      2 
..      1 

.'.    i 
..    l 

.'.    i 

..      2 
..      1 
..      3 
..      1 
..      1 

1 

3 
3 

1 

12 

1 
1 

2 
2 

1 
1 
5 
3 
1 

1 
1 

4 
1 

1 

1 
1 

i 
l 

i 

5 

i 

1 

2 

1 
1 

2 

1 
1 

2 

i 

... 
1 

... 

1 

1 
3 

2 

5 

3 

27 
1 

4 
1 

2 

2 
1 
2 
1 

2 

1 

1 
2 
L6 

5 

3 

1 

1 

2 

Communication  with  bladder  1,  urethra  1. 
Amputation  2. 

Vide  Special  Table — Pyaemia. 

1  over  patella,  1  connected  with  costal  cartilage. 

Struma  2. 

Chronic  tubular  nephritis. 
5  months  after  ovariotomy. 
Also  disease  of  knee,  peritonitis. 

Amyloid  degeneration  1. 

1 

1 

1 

1 

1 

2 

1 

3 
1 
1 

1 
"l 

1 

350 


1881 — Surgical, 


Table  I. — Abstract,  showing  Diseases,  Injuries,  fyc,  in 


Sex. 

I  ML  F 

-t 

Ages. 

Duration  before  admission. 

DISEASE. 

E 

*-< 

5-10 

-20 

-30 

-40 

-50 

-60 

0> 

So 
0  «o 
a) 

Dys. 
1-4 

Dys. 
i-13 

Wks 
2-4 

VI  ts. 
1-2 

Sits. 

2-6 

Mts. 
5-12 

1 
0 

0 

0  ■■ 

O 

] 

Cellular    Tis 
tinued. 

Cellulitis — 

a.  Hand  and 

b.  Arm  . 

c.  Chest 

d.  Leg  . 

e.  Foot  . 

f.  Pelvic 

Carbuncle — 

a.  Chest 

b.  Neck. 

c.  Side  . 
(/.  Back 

e.  Shoulder 

f.  Hip  . 

Gumma  . 
Conical  stump 

Cutaneous  Sy 

Ulcer — 

a.  Neck 

b.  Chest 

c.  Arm  . 

d.  Leg  . 

e.  Stump 

/.  Over  knee 

g.  Foot  . 

Acute  dermati 
Eczema    . 
Scleroderma 
Hypertrophy  < 

SUE  —  cow- 
forearm     .  1 

3TEM. 

/is 

)f  nails 

111.. 
5    5.. 

1  1.. 
4   2 

2  2 
1  ... 

3... 
1    1 

1    1. 

1... 

4    1 
1   1. 

1... 
3... 
1    1 
2314 
1... 

3  1 
3    3. 

1    1 
3... 
1... 
1... 

.     1 

2  "i 
1   1 

7  ... 

3  ... 

i !!! 
3  ... 

i ... 

3  ... 

1  ... 
9  ... 

1  ... 

2  ... 

3  ... 
1  ... 

i 

i 
l 

2 

i 

i 

2 

"2 
1 

1 

5 
1 

"4 
2 

i 

7 

2 

1 

1 
2 

i 
"i 

1 
2 

1 
"e 

2 

1 

3 

2 
1 

"i 

6 

1 

1 

1 
2 

1 

i 

2 
1 

1 

i 

i 
i 

i 
i 

6 
2 
1 
2 

2 

i 

5 
2 

1 
1 

1 

1 

i 
1 

1 

i 
1 
1 

1 

1 

3 
1 

1 
1 

2 

i 

1 

"2 
1 

1 

1 
1 

*5 

2 
1 

2 

1 

1 

"4 

"i 
2 

1 

1 

i 
11 

i 

i 
1 

1881 — Surgical, 


351 


Classes,  according  to  authorised  Nomenclature — continued. 


Duration  of  residence. 


Ilvs. 
5-513 


Wks 

2-1 


Bits. 

1-2 


Mts 
3-4 


Mts 

4-fi 


Mts. 
6-9 


Mts, 
9-12 


Result. 


Remarks. 


Exhaustion;  fatty  degeneration  of  viscera. 
Amyloid  disease  2,  medical  1. 


Pysemia  1,  admitted  with  erysipelas  1. 
Paraplegia  1. 


Below  knee. 


After  application  of  acid. 
Sternum  1,  over  breast  1. 
After  burn  1,  self-inflicted  1. 
Both  legs  5,  amputation  2. 
After  amputation  for  infantile  paralysis. 
All  syphilitic. 

Fatal  case;  perforating  ulcer  with  diabetes  and 
albuminuria. 

Scalp  1,  legs  2. 

Syphilitic. 

Hysteria. 


352 


1881— Surgical. 


Table  II.— 


INJURIES. 

Sex. 

AgeB. 

Duration  before  admission. 

Id 
o 

M. 

F. 

1- 

5-10 

-20] 

-30 

-40 

-50 

-60 

So 
a® 
<1 

S  3 
5  0 

Hrs. 
1-6 

Hrs. 
7-12 

Hrs. 
13- 

24 

Dys. 
1-3 

Dys. 
3-6 

^2 

2i 

General  Injuries. 
Frostbite  . 
Barns 
Scalds 

General  Contusions  . 

Local  Injuries. 

Injuries  of  the  head — 
Scalp  wounds    . 
Concussion 
Fract.  of  vault,  simple 
„      compound 
„      com.  depressed 
„      of  base   . 

Injuries  of  the  face — 

Wounds    . 

Contusions 
Wound  of  tongue 

Fracture  of — 
Superior  maxilla 
Inferior  maxilla 

Dislocation  of — 
Inferior  maxilla 

Injuries  of  the  eye — 
Wound  of  eyelid 
Injury  to  eyeball 

Injuries  of  the  ear— 
Foreign  body    . 

Injuries  of  the  necTc — 
Wound  of 
Sprain  of 

Injuries  of  the  chest — 
Wound  of 
Contusion  of     . 

Fracture  of  ribs. 
„             sternum  . 

1 

43 
34 

15 

34 

59 

4 

2 

2 

14 

14 
6 
1 

4 
1 

1 

1 
2 

1 

10 
1 

3 

13 

41 
2 

25 
19 

11 

30 

51 

1 

2 

2 

13 

10 
2 
1 

4 
1 

1 

1 
1 

1 

6 
1 

3 

9 

33 

2 

1 
18 
15 

4 

4 
8 
3 

i 

4 

4 

1 

4 

4 

8 

15 
22 

3 

4 

7 
2 

4 
2 
1 

1 

1 

1 

"3 
1   I 

! '" 

"5 
3 

4 

3 

11 

1 

3 

1 
1 

1 

ii 
4 

3 

16 

i 

1 
1 

1 
1 
2 

6 
3 

3 

5 

7 

1 
1 

5 

2 

1 
4 
3 

2 

1 

2 

8 
7 
1 

"3 

3 

3 
1 

5 

1 
1 
5 

2 

1 
3 

1 

3 
6 

1 

1 
1 

1 

1 
1 

2 
15 

2 

4 
3 

1 
3 

4 

1 

1 
12 

1 

1 

4 

2 

2 

i 
3 

2 
3 

4 

11 

31 

1 

1 

4 
2 

2 
1 

5 

1 
1 
9 
1 

27 
18 

11 

18 

20 

2 

2 

2 

11 

9 
3 
1 

2 

1 
2 

3 

2 

4 

16 

1 

6 

2 

2 
5 

1 

1 

2 
5 

1 
2 

1 

1 
3 

1 

2 

2 
2 

1 
5 

1 
2 
1 

i 
1 

1 
1 

1 
"i 

r 

1881 — Surgical. 


353 


Injuries. 


Duration  of  residence. 

Result. 

Remarks. 

s.  Dys. 
1  5-13 

Wks! 

2-1 

Mts. 
1-2 

Uts. 
2-4 

Mts 
4-6 

Mts. 
6-9 

Mts. 
9-12 

>  3 

O   0} 

<  * 

C. 

R. 

u. 

i) 

i  "e 

1     8 
t     5 

)     8 
t   21 

I      1 
.      2 

I     1 

i     5 
I     2 

1 
.      1 

.      1 

.      ] 

.      1 
1.      1 

.      2 
I     2 
I  20 
.     1 

9 
11 

6 

15 

y 
i 

2 

3 
1 

3 

1 

5 
1 

1 
2 
8 

"i 
2 

1 

4 

1 
2 

1 

1 

1 

1 

11 

2 

1 
1 

1 

2 

"i 

i 

i 

... 

1 

19 

24 

14 

30 
54 

1 
2 

5 

13 
5 
1 

3 

1 

1 

2 

8 
1 

2 

12 

18 

91 

2  died  under  12  hours. 
1  died  bullet  wound. 
Trephining  in  each. 
5  lived  under  12  hours. 

All  compound,  1  fracture  of  inf.  maxilla. 

Bilateral,  20  days. 

Incised. 

1  excision  for  rupture  of  globe,  1  prolapse  of  iris. 

Penetrating  air  passages  5,  suicidal  8. 
?  Displacement  of  tendon. 

All  penetrating,  punctured  2,  bullet  1. 
Haemoptysis  2,  emphysema  2,  pleurisy  1. 

Pneumonia  1. 

10 

7 

] 

4 
5 
1 

14 
3 

3 

1 

1 

9 

i 

1 
1 

1 
1 

1 

1 

1 

21 

2 

1 

354 


1881—  Surgical, 


Table  II— 


INJURIES. 


Local  Injuries — 
continued. 
Injuries  of  the  oach- 
Contusion  of     . 
Sprain  of. 

Injuries  of  the  spine- 
Concussion  of  . 
Fracture  of 

Injuries  of  the  abdo- 
men— 
Contusion  of     . 
Wound  of  . 

Injuries  of  the  pelvis — 
Contusion  of     . 
Fractures  of 
Contusion  of  buttock 
Wound  of  „ 

Contusion  of  groin 

„  perina3um 

Wound  of  „ 

Contusion  of  genitals 
Wound  of  „ 

Upper  Extremity. 
Wounds   . 
Contusions 
Wound  of  artery 

Dislocation  of — 
Clavicle  from  stern.  . 

Humerus   .        . 

Carpus 

Finger 

Fracture  of — 
Clavicle    . 
Acromion. 
Humerus — 

Simple  . 

Compound     . 

Comp.  comminuted 
Radius  and  ulna — 

Compound     . 

Ununited 


Sex. 


M.     F. 


21 


-20    -30 


1 

1       1 
3 


1    ...      1    .. 

1    . 


-5(i 


Duration  before  admission. 


&5 


Era 

1-6 


Hrs 

7-12 


1881 — Surgical. 


355 


continued. 


Duration  of  residence. 


Dvs. 
5-13 


Wks  Mts. 
4    1-2 


Mts 

:-4 


5ItB. 

4-G 


\lt.s 

6-9 


Mts 
9-12 


Result. 


20 


Remarks. 


1  died  3  hours  after  admission,  1  lived  24  hours, 
both  cervical. 


See  General  Summary. 
Suicidal,  peritonitis. 


Shock. 

See  General  Summary. 

1  hajmatotna. 
Haemorrhage  from  urethra. 

Followed  by  hematocele  and  epididymis 


3  amputation  of  fingers,  1  cellulitis. 

4  hsematoma,  2  severe. 


1  contusion  of  back,  1  abdominal  injury,  1  frac 

ture  of  ribs. 
All  subcoracoid. 
Double. 
Metacarpophalangeal  joint,  compound. 


1  fracture  of  ribs,  1  injury  to  chest. 
Contusion. 

1  spontaneous  ?  tumour,  1  impacted. 
D.  T.  1. 

2  amputation. 


356 


1881— Surgical, 


Table  II— 


INJURIES. 


Upper  Extremity — 
continued. 
Fracture  of — 
Radius,  simple  . 
Ulna 

Hand     and     fingers 
comp.  and  coram.  . 


Lower  Extremity. 

Wounds  of — 
Thigh 
Leg . 
Knee 
Foot 

Contusion  of — 
Hip. 

Thigh 
Leg  . 
Foot 


Dislocation  of — 
Femur 

Head  of  fibula 
Astragalus 
Foot 
Toe  . 


Fracture  of  femur — 
Simple 

Comminuted     . 

Compound 

Comp.  comminuted  . 

Neck  of  femur  . 

Fracture  of  tibia — 
Simple 
Compound 
Comminuted     . 
Comp.  comminuted  . 

Fracture  of  fibula — 
Simple 

With      rupture      of 
int1.  lat1.  lig. 


Sex. 


-10 


-20 


10 


-SO 


-40   -50 


-(,0 


-2J 


Duration  before  admission. 


Ilrs. 
1-6 


Hrs. 
7-12 


3() 


1881 — Surgical. 


357 


continued. 


Duration  of  residence. 


Dys.  Wks 
S-18   2-4 


Mts 
1-2 


3 
1 

16 


10 


22     6 

13 


Mts 
U-4 


2S 


Mis 
4-6 


Mrs 
6-8 


Mts.  >  S 
9-12  3  t. 


Result. 


C.    R.  U.  D 


14 


10 


2.3 


Remarks. 


Double  Colles'  concussion. 

3  olecranon,  1  ununited  cured  by  operation. 

Amputation  fingers  7,  amputation  arm  2,  tendon 
torn  out  1. 


1  gunshot,  1  D.  T. 
Needle  lodged  2,  glass  1. 

Rheumatoid  arthritis  1. 

1  D.  T. 

Hffiinatoina  4,  followed  by  slough  3. 


VOL.  XI. 


1  pubic,  2  ?  congenital. 
Forwards. 

Partial,  backwards. 


D.  pulmonary  embolism,  hypostatic  congestion 

delirium. 
1  scalp  wound. 

Fracture  of  other  leg,  gangrene. 
Amputation  of  thigh  2,  shock,  1  D. 
1  with  fracture  of  radius. 


Ununited  3. 

Erysipelas  1,  D.  T.  1. 

Upper  third. 

Secondary  amputation  1,  fracture  of  ribs  1. 


Dislocation  of  foot  2,  synovitis  knee  1. 
Geueral  contusions  1. 

25 


358 

1881— 

Surgical. 

Table 

II- 

INJURIES. 

Sex. 

Ages. 

Duration  before  admission. 

M. 

F.    " 

3 

i-10 

-20 

-80 

-40   -50 

-60 

0 
<4 

3*3 

3_ 

Hrs  'Hrs. 
1-6|7-12 

Hrs. 
13- 
24 

Dvs.'Dys. 
1-3    3-6 

1 1- 

—  — 

Lower  Extremity — 
continued. 
Fracture  of  tibia  and 
fibula — 
Simple 

Comminuted     . 

Compound 

Comp.  comminuted   . 

Fracture  of  patella 
Rupture  of  tendon 
Fracture  of— 
Astragalus 
Os  calcis  . 
Bones  of  foot — 
Simple 
Compound     . 

Joints. 
Wound  of — 
Knee 

Thumb      . 

Synovitis  {traumatic)- 
Wrist 

Hip  . 

Knee 
Ankle 
Medical     . 

Ophthalmic 
Trivial  cases 

Ophthalmic  cases,  &c, 
not  included  in 
above  report. 

Brought  in  dead  or 
dying    . 

Total 

67 

3 
13 

9 

19 
1 

1 
3 

5 
4 

4 
2 

1 

2 
30 

8 
12 

2 
25 

235 
13 

(35 
Ol 

00 

52 

3 

10 
9 

12 
1 

1 
3 

5 
4 

3 
2 

1 

2 

24 
6 
9 

2 
13 

122 
11 

CO 

15 
3 

7 

1 

"*6 
2 
3 

12 

113 

2 

us 

CO 

5 

4 

2 

i 

5 
1 

1 

1 
2 

1 

1 

7 
1 

1 
1 

1 

6 
1 
1 

1 

7 

3 

7 

2 
3 

2 
1 

6 
3 

7 

20 

3 
3 

4 
2 

"7 
2 
1 

13 

3 

1 

3 

1 

1 

1 

1 

1 

1 

"i 

i 

8 
2 
1 
3 

1 

1 
2 

1 

2 

1 

1 
1 

2 

"i 
i 

10 

4 
3 

2 

1 
2 

2 

3 

1 
2 

"4 
2 

1 

49 

3 

8 
5 

16 
1 

i 

3 
1 

3 

1 

1 

13 

5 

1 
"i 

2 

1 

i 
1 

9 
1 

1 

1 

4 

3. 

1! 
11. 

1881 — Surgical. 


359 


continued. 


Duration  of  residence. 


Wk 
2-4 


Mrs 
1-2 


Mts.lMts.  Mts. 
2^1   4-6,  6-9 


11 


Result. 


120 


U. 


18 


2329 


Remarks. 


1  dislocation  of  head  of  fibula  and  rupture  of 
quadriceps  tendon,  2  delayed  union. 

Into  ankle  joint  1. 

Primary  amputation  3,  pyaemia  after  amputation 

1,  both  legs,  D.  shock  1. 
Muscular  action  18,  direct  violence  1. 
Pain  in  joint  for  14  days  before  rupture. 


Compound  1. 


Amputation  of  leg  (double)  1,  Syme's  1,  amputa- 
tion of  toe  1. 


Needle  1,  lacerated   and  contused  1,  incised  1 
punctured  1. 


With  rupture  of  tendons  of  forearm  and  contu 
sion. 

Rheumatoid  arthritis  1. 

Followed  by  suppuration  1,  wound  over  joint  2. 

Rupture  of  ligament  1. 

Enteric  fever  1,  rheumatism  2,  gout,  jaundice, 
hemiplegia,  hysteria,  suppression  of  urine: 
ascites,  oedema  of  lower  extremities,  &c. 

Alcoholism,  senectus,  old  amputation,  for  read- 
justment of  splints,  &c. 


360 

1881 

— Surgical. 

Table 

III 

SURGICAL  OPERATIONS. 

Sex. 

Ages. 

M. 

F. 

5-10 

-20 

-30 

-40 

-50 

-60 

< 

Removal  of  Tum 

Amputation  of 

Ditto  with  rem 

Removal  of  rec 

„            axi 

For  epitheliorn; 
)> 

For  sarcoma  of 
i> 

For  adenoma  o 
For  lipoma 
For  papilloma 
For  fibroma 
For  angioma 
For  exostosis 
For  lymphoma 
For  molluscum 
For  nsevus  vas< 
For  rodent  ulc 
For  lupus 
For  keloid 
For  myofibrom 
For  cystic  disc 
For  sebaceous 
For  various  cy 

For  polypus  of 

ClECTJLATOEY    SYS 

Ligature  of  su 
„           ex 

,,                CO 

ra 
ul 

PO 

lir 
Obliteration  oi 

DUES  AND  GEOWTHS. 

breast 

oval  of  glands    . 

urrent  growth   . 

lary  glands 

uinal  glands 

i  of  tongue 

lip       .         .         . 
mouth 
genitals 

lower  extremity  . 
palate 

jaw  .         .  _      . 
parotid  region  . 
testes 

lower  extremity 
F breast 

mlaris 

3T 

a  of  uterus 
ase  of  ovary 

3ysts  . 
<ts 

rectum 

STEM. 

bclavian  artery  . 
iernal  iliac          . 
muion  carotid    . 

iial    . 
aar     . 
pi  i  teal 
igual 

varicose  veins  . 

4 

7 
2 
1 

4 

2 
2 

4 
2 

i 

"i 
i 

i 

4 

"i 

i 

3 
3 
1 
1 

1 

24 

10 

3 

3 

2 

1 

i 
i 
i 

4 
8 
8 
1 
2 
1 
2 
3 
1 
4 
2 
2 

2 

17 
2 
2 

1 
1 

i 
1 

4 

i 

1 

i 

i 

i 
i 

3 

l 
l 

i 

l 
l 

i 

5 
2 
1 

1 

2 

1 

5 
1 
1 

1 

1 
2 

1 

5 
2 

1 

2 
1 

i 

3 
5 

i 
i 

2 
4 

1 

i 

l 
l 
l 
l 

7 
6 
2 
3 

i 

2 

4 
1 

i 

2 
2 
2 

2 

*5 

1 
2 

5 
1 

2 

2 

1 

i 

i 

3 

i 
i 

7 
1 

2 
1 
3| 

i 

2 

2 

1 
ll 

Surgical  Operations. 

1881— Surgical.                                 361 

Duration  of  residence  after  operation. 

Result. 

Remarks. 

■a  *' 

"l 

i 

i 

i 

'2 
2 
1 

1 

Ovs 
5-13 

i 

6 

2 

1 

3 
5 

2 

2 
1 

i 

1 

i 

2 

1 
1 

1 

2 

Wks 
2-4 

17 
5 
2 
2 
2 
2 
1 

2 

1 
1 

1 
1 

5 

5 
1 
1 
1 
1 
2 

3 
2 

2 

4 
3 

i 

1 

i 
1 

1 

Mts. 
1-2 

Mts.'Mrs. 
2-4   4-6 

Mts. 
6-9 

Mts.'|  i 
9-12  -5  >. 

C.  R. 

u. 

D 

7 
5 
1 

1 

1 

1 
2 

1 

1 

6 
2 

i 

2 

2 

1 

3 

1 

1 
1 

I 

i 

1 

24 

7 
3 

3 

2 

2 

7 

Haemorrhage  1,  internal  deposit  1. 

Breast. 

Scirrhus. 

Secondary  to  epithelioma  of  penis. 

Haemorrhage. 

Upper  lip  1. 

Same  case ;  died  after  removal  of  tongue. 

Anus  and  vulva  1,  amputation  penis  1. 

Same  case,  scraped.  (See  Amputation  for  Disease). 

Recurrent ;  soft  palate. 

Upper  jaw  1,  lower  2. 

Extension  of  growth  to  meninges  ;  convulsions. 

Peritonitis. 

2  cases,  each  2  operations. 

Congenital  of  scalp. 

Cheek ;  excision. 
Toes  2,  humerus  1. 

Hairy  and  pigmented. 

Nose,  2  operations  by  electrolysis  ;  ditto  finger  1. 

Caustics  1,  excision  2,  plastic  operation  in  1. 

Scraping,  caustics. 

Excision. 

All  antiseptic  precautions. 
Arm  1,  neck  1. 

Hydatid   of    liver   1,   dermoid    1,    of   chest    1, 
neck  1,  spermatic  cord  2. 

3rd  part ;  aneurism. 

Aneurism  in  groin. 

Followed  by  suppuration  of  vitreous  on  same 

side,  secondary  haemorrhage,  and  ligature  of 

lingual  artery  in  the  wound. 
Wound  2,  after  burn  1. 
Wound  3,  after  burn  1. 
Secondary  haemorrhage  after  amputation. 
Secondary  haemorrhage,  wound.  {Vide  Common 

Carotid). 
Excision  1,  ligature  1. 

1 

2 

1 

1 

1 

1 
2 

2 
8 
12 
1 
4 
1 
3 
3 
1 
2 
3 

1 

13 

2 
6 

1 

1 
1 

2 
2 
1 

2 

1 
1 

4 

1 

1 

1 
2 

1 
1 

3 

2 

2 

4 

1 

1 

2 

1 

362 


1 881— Surgical. 


Table  III— 


SURGICAL  OPERATIONS. 


Sex. 


M. 


5-10 


-30 


Cibculatoby  System — continued. 
Plugging  nares  for  epistaxis  . 
Venesection      .... 


Respieatoby  System. 
Tracheotomy    . 

Laryngotomy  . 

Ductless  Glands. 
Removal  of  thyroid 


Digestive  System. 
Excision  of  tonsils    . 
Strangulated  inguinal  hernia  . 
„  femoral  hernia    . 

„  umbilical  hernia 

Abdominal  section  . 

Artificial  anus 

Imperforate  anus 

Division  of  fistula  in  ano 

Removal  of  haemorrhoids  . 

Fissure  of  anus 

Division  of  stricture  of  rectum 


Genito-tteinaby  System. 
For  phimosis    . 

For  paraphimosis     . 
For  hydrocele  . 

For  varicocele  . 
For  ruptured  perinaeum    . 
For  removal  of  warts 
Puncture  ahove  pubes 
Internal  urethrotomy 
Perineal  section 

„        puncture    . 
Extraction  of  foreign  body 
Calculus  of  bladder 
„  urethra 

„  kidney  . 

Castration 


2       1 

4       1 


5 

4 

10 


continued. 

1881— Surgical                                 363 

Duration  of  residence  after  operation. 

Result. 

Remarks. 

>. 

•* 
1 

5 

1 

1 

5 
3 

2 

i 

i 

2 

i 

i 
i 

Dvs. 
5-13 

Wks 
2-4 

Mts. 
1-2 

Mts 
2-4 

Mts. 
4-6 

Mts. 
6-9 

Mts. 
9-12 

>  <3 

C 

li. 

u. 

D. 

1 

1 

2 
1 

8 
7 

5 

2 
2 

2 

5 
2 

i 

1 
2 

*6 

4 
1 

1 
1 
8 
6 
1 

4 

3 

1 

4 
1 
1 

2 
1 
1 

1 

i 

1 

3 
4 
3 

2 

4 
1 
1 

1 

2 

1 

2 
5 

2 
1 

1 

1 
2 

i 

3 

1 
1 

2 
5 

2 

1 

2 

1 
2 

1 

3 

4 

1 

3 
10 
9 
1 
1 

1 

i<; 

13 

l 

2 

11 

2 
4 

1 

"8 

"s 

3 
2 
1 
2 
1 
1 
1 

In  2  cases  of  fractured  skull,  performed  twice 
with  relief,  1  before  removal  of  thyroid. 

Bronchocele    1,   punctured   wounds  trachea    1, 

scald  1. 
Fish  bone. 

Vide  Tracheotomy  and  Venesection. 

1  also  operation  for  cleft  palate. 
Extraperitoneal  2. 
Erysipelas  1. 

1  exploratory,  afterwards  colotomy ;  2  extension 

of  hernial  incision,  ultimately  fatal. 
Colotomy  5,  Littre's  operation  2. 
Afterwards  Littre's  operation. 
1  operation  for  lipoma. 
Clamp  and  cautery  11,  ligature  2. 
1  also  operation  for  haemorrhoids. 

Circumcision  9,  incision  2,  before  application 
of  caustic  to  sore. 

Also  for  warts. 

Tapping  with  injection  of  iodine  3,  simple  tap- 
ping 3,  incision  1,  1  two  tappings. 

5  two  operations,  1  also  circumcision. 
5  in  same  patient. 

1  also  extraction  of  foreign  body. 

2  for  extravasation  of  urine. 
After  suprapubic  puncture. 
Guide  of  urethrotome. 

Lateral  lithotomy  2,  dilatation  of  urethra  1. 
Perineal  section. 
Nephrotomy. 

1  also  operation  for  hernia,  sarcoma  2,  painful 
retained  testis  1,  syphilitic  testis  1. 

3 

2 
1 

1 

8 
5 

1 
3 

2 

2 

2 
3 

1 
1 

3 

3 
5 
6 

1 

i 

2 

1 

1 

2 

2 

364                                  1881— Surgical. 

Table  III— 

SURGICAL  OPERATIONS. 

Sex. 

Ages. 

53 

V 

M. 

F. 

-3 

a  "= 

5-10 

-20 

-30 

-40 

-50 

-60 

4 

Locomotoky  System. 

Subcutaneous  division  of  femur 

4 

6 

1 

7 

2 

h                 >,             tibia 

3 

3 

5 

1 

Trephining  of  skull 

2 

i 

i 

„            femur 

1 

i 

„            tibia 

1 

... 

i 

Linear  osteotomy     .... 

1 

1 

2 

For  ununited  fracture 

2 

1 

i 

Excision  of  portion  of  rib 

1 

1 

Removal  of  bone  in  compound  fracture 

5 

i 

3 

i 

Removal  of  necrosed  bone  from — 

Jaw  ...... 

2 

1 

1 

1 

1 

Humerus  ..... 

2 

i 

"i 

Ulna 

1 

i 

Ilium         ..... 

1 

1 

Femur      ...... 

4 

3 

i 

2 

4 

Tibia        ....:. 

15 

2 

7 

1 

i 

2 

2 

Fibula 

1 

1 

Os  calcis  ...... 

2 

2 

1 

2 

1 

Other  bones  of  foot .... 

2 

3 

i 

3 

1 

Caries  of — 

Tarsus      ...... 

1 

1 

Carpus      ...... 

1 

i 

Other  bones      ..... 

2 

2 

i 

2 

1 

Excision  of — 

Elbow 

1 

1 

Hip 

7 

"i 

"5 

3 

4 

2 

Knee 

4 

i 

1 

3 

1 

Ankle        ...... 

1 

1 

Forcible  flexion  of  knee    .... 

1 

i 

2 

Incision  into  hip-joint      .... 

1 

1 

„            knee    ..... 

2 

3 

3 

i 

i 

... 

Removal  of  loose  bodies  .... 

1 

1 

1 

1 

Scraping  ot  shoulder-joint 

1 

1 

2 

„          knee      ..... 

1 

1 

i 

1 

„          ankle     ..... 

1 

i 

Tapping  in  disease  of  hip 

io 

3 

2 

i 

,,            „              knee 

5 

2 

1 

2 

1 

3 

For  ganglion  of  wrist        .... 

1 

2 

2 

1 

Reduction  of  dislocation — 

Of  lower  jaw          ..... 

1 

1 

Of  humerus            ..... 

2 

2 

i 

... 

3 

Of  carpus     ...... 

2 

2 

... 

Of  femur      ...... 

2 

2 

Of  head  of  fibula 

2 

2 

... 

Of  astragalus         ..... 

1 

1 

... 

... 

Amputation  of  fingers       .... 

27 

1 

5 

5 

"5 

6 

3 

3  1 

"i 

1881 — Surgical. 


365 


continued. 


Duration  of  residence  after  operation. 

Result. 

Remarks. 

»>  Dys 
a  6-13 

* 

i  "... 

L    ... 

1    1 

L     1 

i    i 
i 

i 
i 

i 
l 

2 
2 
1 
1 

8 

Wks 
2-1 

i 
l 

"i 

i 

3 

2 

1 

2 
1 

11 

Mts. 
1-2 

3 

3 

1 

1 

1 

1 
1 

i 

2 

2 

2 

i 
l 

"i 

i 

2 

1 
1 
3 

2 

1 
6 

Mts 
2-4 

7 
2 

1 

i 

i 

2 
4 

1 

i 

i 

2 

1 
3 
2 

4 

i 

5 

i 

Mts. 
4-6 

"i 

i 
l 

l 

3 
1 
1 

1 

2 

3 
2 

Mts. 
6-9 

1 

1 
1 

"i 

i 

i 

Mts. 
9-12 

2 

5    03 

1 

2 

C. 

H 

4 
2 

1 
1 
1 

1 

2 
1 
1 

1 
4 
9 
1 

3 
4 

2 

1 

10 

4 

1 

i 

2 

3 

3 

2 

1 
2 

2 

2 
1 

K. 

U. 

D. 

Neck  1,   below    trochanter   major  1,  for   genu 

valgum  5  (double  1),  varum  3. 
Also  of  femur  1,  double  2,  circumcision  1. 
Depressed  fracture  of  vault. 
Osteomyelitis. 
Chronic  abscess. 
Tibia  for  ?  ostitis,  ostitis  ulna. 

Empyema  and  spinal  disease. 
Skull  2. 

1  two  operations. 

2  cases  two  operations,  1  case  four  operations. 

Erysipelas  and  miscarriage  1. 

1  also  necrosis  of  humerus. 

Ulna  1,  tibia  3,  1  two  operations. 

Partial. 

Aspiration  in  2. 
Died  of  shock. 

Afterwards  excision,  acute. 

Suppuration  in  joint;    1  died  after  sequestro- 

tomy. 
Knee. 

Afterwards  excision  1,  amputation  1. 
Scarlatina. 

2  aspirated  three  times,  1  twice. 
Aspirated  twice  1,  refused  amputation  1. 
Compound  1,  removal  1. 

Bilateral. 

Double. 

Primary  and  secondary. 

2 

1 
2 

1 
1 

1 

1 

2 

2 
6 

1 

i 

l 

i 

2 

1 

1 

3 
1 

2 

1 
2 

2 

2 
2 
1 
7 
4 
1 

1 

1 

24 

4 

366 


1881 — Surgical. 


Table  III— 


Sex. 

Ages . 

SURGICAL  OPERATIONS. 

M. 

F. 

u 

T3 
[JU5 

1= 

5-10 

-20 

-80 

-40 

-50 

-60     J 

<3 

LOCOMOTOBY   SYS 

Primary  amputat 
Of  arm     . 
Of  thigh . 
Of  leg      . 
Of  foot    . 

Secondary  amput 
Of  thigh  . 
Of  leg      . 

Amputation  for  t 
Of  forearm 
Of  fingers 
Of  thigh  . 
Of  leg      . 
Of  foot    . 
Of  toes     . 

Repabative  Ope] 
For  cicatrix  of 
For  harelip 
For  cleft  palat 
For  extroversic 
Plastic 

For  reunion  of 

Tenotomy  for  c 

t 

i 

Miscellaneous. 
For  conical  stu 
Excision  painfi 
Extirpation  of 
For  enlarged  b 
For  removal  of 
Paracentesis  of 

» 

Incision  for  ab 
1 

rEM— 
ion. 

ation 
'iseas 

SATIC 

burn 

n  of 

nervt 
lub-f 
orticc 
eforn 

mp 
1  cicE 

eyeba 

arsa 

forei 

abdo 

cbes 

kidn 

lom'u 

'otal . 

-cont 

e. 

NS. 
bladd 

DOt 

iiis 

lity 

ttrix . 
11 

gn  be 
men  . 
t 
ey     . 

lal  ab 

'nued 

er 

dies 
scess 

4 
5 
6 
1 

2 

4 

2 
6 
6 
2 
1 
5 

1 
4 
5 
4 
6 
1 
13 
4 
3 

1 
1 
1 
3 

4 
1 

12 

404 

« , 

6( 

1 

9 
2 
1 

4 

3 

10 

2 

9 

i 

1 

2 
2 
3 

2 

6 

261 

i ' 

55 

i 

5 
5 

4 
*9 

i 

1 

2 
1 

i 

6 

8 
3 

i 

3 

3 
1 
3 

2 

2 
4 
1 
1 
1 

3 

4 

5 
1 

1 

2 

2 
1 

1 
1 

1 

1 
2 
5 
1 

"l 
6 

i 

1 

2 
1 

2 

2 

i 

3 
1 

i 

3 
1 

"i 

i 

3 
2 

i 

i 

i 

i 

i 

3 
1 

i 

i 

1          .. 
1          .. 

i    ." 
i    .. 

i    !i 

l    .. 

1881 — Surgical. 


367 


continued. 


Miration  of  residence  after  operation. 

Result 

Dvs 

5-18 

Wks 

2-4 

Mts. 
1-2 

Mts. 
2-4 

Mts 
'1-6 

Mts 
6-9 

Mts. 
9-12 

Si 

0  w 

<  - 

c. 

a. 

u 

1). 

3 

"i 

"4 

i 

5 
1 

i 
3 

2 
1 

1 

1 

2 
3 
1 

i 

2 

1 

"5 

2 

"9 
1 
1 

1 
1 

2 
1 
1 
1 

2 
1 
2 

2 

13 

2 

i 

'5 
2 
2 

5 

2 

2 
1 

2 

1 
2 

1 

1 

1 

2 

i 

2 
4 
2 
1 
1 
2 
1 
3 

1 
i 

6 

3 

2 
1 

i 

i 

1 
i 
i 

i 
3 

1 

1 
1 

1 

1 

1 

3 

1 
5 

1 

1 

3 

2 
7 
13 
3 
2 
5 

2 

6 

11 

4 
1 

14 
3 
2 

1 

2 
2 
6 

1 

6 

0 
ire 

-7< 

i 

1 

4 

1 

1 

1 

2 

3 

4 
4 

4 

1 

8 
1 

2 

1 

3 

3 
2 

11 

1 

0 
ire 
H 

CO 

; 

665 

Remarks. 


1  double  amputation  and  reamputation. 
Pirogoff. 


After  amputation  of  leg  1. 

Also  amputation  of  thigh,  1  reamputation. 


Disease  of  wrist  2. 

Gangrene  lt  erysipelas  1. 

Sarcoma  of  fe\nur  2. 

Epithelioma  of  leg  1,  disease  of  ankle  1. 

Syme's  amputation. 


In  1  four  operations. 
Also  operation  on  palate  2. 
1  excision  tonsils,  1  harelip. 

4  operations,  same  child. 

5  rhinoplasty,  2  two  operations. 
Ulnar. 

6  cases,  two  operations  each. 
1  case  two  operations. 
Tendo-Achill.  3,  ext.  long,  pollic.  1. 


Ruptured  globe  1,  burn  1. 
Incision  1,  tapping  2,  removal  2. 
Bullet  2,  needle  2,  glass  1,  shot  1. 
Sciirhus;  ascites,  1  case  three  tappings. 
Ultimately  died,  sarcoma  of  lung. 
Tapped  eight  times  1,  others  readmissions  of  a 
case,  each  for  hydronephrosis. 


SUMMARY   OF   DISEASES. 


GENERAL  DISEASES. 


Erysipelas  (arising). — 35.  C.  27,  R.  2,  D.  6.  33  cases  arose  in  the  wards,  of 
which  21  were  males,  12  females ;  2  cases  of  facial  erysipelas  occurred  in  nurses 
(see  Special  Table  III. — Erysipelas). 

Erysipelas  (admitted  as  such).— 69.  C.  63,  D.  6.  52  males,  17  females;  of 
these  5  were  cellulo-cutaneous,  and  3  died ;  2  cases  were  followed  by  multiple 
subcutaneous  abscesses,  in  one  of  which  the  eruption  wandered  all  over  the 
trunk  and  extremities  ;  both  recovered. 

Pymmia. — (See  Special  Table  II.— Pyaemia.) 
Syphilis — 

1.  Primary  by — 

a.  Indurated  cliancre. — Males  2,  females  6.  C.  4,  R.  4.  With  eruption  4  ; 
gonorrhoea  5  ;  warts  1 ;  1  admitted  for  haemorrhage  from  sloughing  sore,  which 
afterwards  became  indurated. 

2.  Secondary. — C.  33,  R.  12.  Males  2,  females  43.  Manifested  by  the  following 
symptoms — Condylomata  16 ;  ulceration   of  tonsils  14 ;    fissures  of  tongue   1 
lips  1 ;    anus  1 ;    sores   about   genitals   20 ;    Eruptions  :  acne   2 ;    psoriasis   14 
lichen  1;  rupia  2;  other  varieties  10;  iritis  2;  conjunctivitis  2.  Complications 
gonorrhoea  36 ;    oedema  of  labia  12 ;  warts   5  ;    buboes  2 ;    marked  glandular 
enlargement  9 ;  tonsillitis  3;   abscesses  2;    anaemia  1 ;  hysteria  1;  ptyalism  1 ; 
haemorrhoids  5  ;  scabies  5. 

2.  Tertiary. — C.  4,  R.  1.  Males  3,  females  2.  Males,  1  ulceration  of  glans 
penis,  readmitted,  1  ulceration  of  nose  and  face.  Females,  1  ulceration  of  hard 
palate  and  calf  of  leg,  1  ulceration  of  nose  and  tongue. 

LOCAL   DISEASES. 

TUMOURS. 

Carcinomata. 

Scirrhus  of — 

a.  Breast. — C.  28,  R.  4,  U.  3,  D.  3.  3  refused  operation ;  4  disease  too  exten- 
sive; in  5  family  history  of  cancer;  1  of  phthisis;  ?  cause,  injury  to  breast  in 


1881 — Surgical.  369 

6 ;  gathered  nipple  1 ;  abscess  of  breast  6 ;  1  preceded,  for  eighteen  years,  by 
discharge  from  nipple ;  parturition  1 ;  in  this  case  there  was  internal  deposit, 
ascites.  Breast  only  affected  in  22,  remainder  some  glandular  enlargement.  Of 
fatal  cases  after  operation,  1  haemorrhage,  1  internal  deposit,  in  each  glandular 
affection. 

b.  Breast  (recurrent). — C.  2.  Recurred  in  cicatrix — period  between  operation 
and  recurrence  of  growth,  set.  33,  2  months ;  set.  50,  18  months ;  in  this  case 
the  axillary  glands  had  been  removed  twice  during  period  of  2  years. 

c  Axillary  glands. — C.  3,  R.  1.  1  ait.  48,  free  from  disease  2  months.  1 
set.  49,  free  6  months.  Glands  not  affected  before  first  operation  in  either.  2 
set.  50,  recurrent. 

d.  Rectum. — R.  1,  U.  1,  D.  2.  In  2  colotomy  was  performed,  affording  much 
relief;  1  died  of  peritonitis,  fx'om  ulceration  above  stricture;  1  relieved  by 
morphia. 

Encephaloid. — C.  2. 

Breast. — No  history  of  cancer;  growth  4  months;  fungating;  no  involve- 
ment of  glands;  removal;  readmitted  a  month  afterwards  for  recurrence  in 
cicatrix  of  14  days'  growth ;  removal. 

Epithelioma. 

a.  Tongue. — C.  2,  R.  6,  U.  2,  D  1.  1  recurrent ;  1  involved  lower  lip,  and 
was  too  extensive  for  removal ;  1  floor  of  mouth  involved,  here  anterior  portion  of 
inferior  maxilla  removed  with  anterior  two  thirds  of  tongue;  died  4  days 
afterwards  from  haemorrhage  ;  4  cases  growth  removed  with  galvano- cautery  ;  in 
8  distinct  enlargement  of  submaxillary  glands. 

b.  Lip. — C.  6,  R.  1.  Removal  in  each  case;  slight  glandular  enlargement  in 
1;  recurrent  2,  one  of  upper  lip,  involving  whole  lip,  alse  of  nose  and  cheek, 
16  mouths'  growth  ;  extensive  lupoid  scars  of  face.  Disease  of  lower  lip  treated 
by  usual  V-shaped  incision. 

c.  Mouth. — -R.  3,  D.  1.  Hard  palate  1,  refused  operation ;  lower  jaw  and 
cheek  3;  1  recurrent,  5  months;  1st  operation,  removal  of  part  of  inferior 
maxilla  ;  2nd,  removal  of  anterior  two  thirds  of  tongue  and  scraping  of  recurrent 
growth,  erysipelas ;  died  after  residence  8  months. 

d.  Nose. — R.  1,  D.  1.  Commenced  2  years  before;  readmission;  died  25 
days ;  nasal,  ethmoid,  and  superior  maxilla  affected ;  cystic  kidneys ;  valvular 
disease  of  heart. 

e.  Lotver  extremity. — C.  1,  R.  2.  Recurrent  2  ;  1,  8  months,  of  thigh,  exten- 
sive, treated  by  scraping  ;  1,  after  removal  of  little  toe,  2  months;  1,  8  months, 
ulceration  of  leg,  amputation  below  knee,  enlargement  of  gland  in  groin,  which 
he  refused  to  have  removed. 

/.  Glands. — C.  2,  R.  1.  Axillary  enlargement  2  months,  a  growth  removed 
from  forearm  in  position  of  old  scar  5  months  ago  ;  marked  cachexia  ;  extensive 
involvement  of  axilla ;  2,  same  patient,  right  groin  after  removal  of  epithelioma 
of  penis,  each  time  one  gland  removed  of  2  and  3  months'  growth  respectively. 


370  1881— Surgical. 

g.  (Esophagus. — D.  1.  Female,  set.  46 ;  5  months,  dysphagia,  loss  of  flesh ; 
nutritive  enemata.     Communicated  with  trachea  hy  a  small  aperture. 

h.  Rectum. — R.  3,  U.  1.  Anus  chiefly  involved  and  ascites  1 ;  in  1  growth 
presented  microscopical  characters  of  cylindroma  j  1  colotomy. 

i.  Genitals. — C.  1,  R.  1,  D.  1.  Mt.  48,  penis,  removed  by  knife  and  galvano- 
cautery.  Mt.  64,  commenced  in  perineal  fistula  and  involved  genital  organs 
partially  ;  removed  twice  before,  now  too  extensive.  Mt.  38  ;  12  months,  vulva 
and  perinseum,  greater  part  removed  by  knife,  haemorrhage  controlled  by 
ligature  and  thermo-cautery. 

Sarcomata. 

a.  Palate. — C.  1,  R.  1.  Females,  each  recurrent,  one  myeloid  after  removal 
4J  years  previously,  the  other,  spindle-celled  of  soft  palate,  after  removal  18 
months  before ;  removed. 

b.  Upper  jaio. — U.  1,  D.  1.  Males,  set.  63,  commenced  with  discharge  from 
nostril  3|  monthsbefore  ;  exophthalmos  and  much  swelling  of  right  side  of  face, 
with  large  opening  in  right  molar  region  of  mouth,  too  extensive  for  operation ; 
died.  Mt.  58,  commenced  with  obstruction  of  left  nasal  duct;  slight  exophthal- 
mos, lachrymation,  swelling  below  eye  ;  operation  not  recommended. 

c.  Lower  jaw. — C.  2.  Males,  set.  7  and  11.  Small  myeloid  epulis  in  each  j 
removed. 

d.  Frontal. — R.  1.  Female,  set.  40,  16  months'  duration;  large  growth 
fungating  through  two  small  openings;  no  operation. 

e.  Neck. — R.  1,  D.  1.  Male,  set.  27,  began  as  glandular  painful  enlargement 
after  sore  throat ;  when  admitted  involved  most  of  left  side  of  neck,  suppuration, 
incision,  ultimately  formed  large  fungating  sore.  Had  attack  of  erysipelas, 
recovered  from  that,  but  died  from  exhaustion.  Female,  set.  34,  removed  5 
months  before,  recurrent  in  cicatrix  and  glands,  ulceration  over  mid  line  of  neck, 
from  which  occasional  hsemorrhage ;  growth  large ;  relieved. 

/.   Chest  wall. — U.  1.     Female,  7  months'  growth,  under  right  scapula. 

g.  Parotid  region. — R.  2,  D.  1.  Female,  set.  44,  sarcoma  of  parotid  region 
removed  13  months;  small  fungating  growth  from  right  ear.  Readmitted; 
growth  partly  rexoved  ;  died  from  convulsions,  due  to  growth  in  dura  mater  3 
weeks  afterwards.  Male,  set.  27,  melanotic,  commencing  after  removal  of 
growth  from  forehead  4  months  previously ;  extensive,  with  facial  paralysis  and 
deafness. 

h.  Breast. — C.  1.     Fasciculated  sarcoma ;  6  months'  growth  ;  amputation. 

i.  Testis. — R.  1,  D.  1.  Mt.  23,  R. ;  castration;  tumour  partly  cystic,  com- 
posed of  small  round  cells ;  afterwards  readmitted  to  medical  side  with  recurrent 
growths  in  lungs.  Mt.  36,  D.;  8  mouths'  growth  iu  retained  testis,  right  groi^ 
sac  of  hernia  opened  during  removal,  peritonitis,  growth  round  cells,  fairly  uni- 
form in  size. 

k.  Lower  extremity. — C.  2,  R.  1,  D.  2.  All  females.  Mt.  35,  amputation  of 
thigh  for  disease  of  lower  end  of  femur,  18  months'  duration,  recurred  in  stump 


1881—  Surgical.  371 

and  lungs ;  round-celled.  iEt.  17,  periosteal  growth  lower  end  of  femur,  3 
months  ;  amputation  of  thigh  ;  recurrence  in  lungs ;  round-celled  growth.  iEt.  44, 
recurrent  growth  ;  two  operations  previously  ;  removed ;  found  to  be  adherent  to 
sheath  of  femoral  artery ;  structure  round-celled  with  a  few  spindle  cells. 
iEt.  65,  small  round-celled  growth  affecting  leg;  recurrent;  commencing  2£ 
years  before  as  primary  cutaneous  growth  ;  removed;  three  attacks  of  erysipelas. 
-33t.  42,  negress ;  size  of  hen's  egg ;  front  of  thigh ;  cutaneous  growth ;  re- 
moval; spindle-celled. 

I.  Rectum. — Male,  set.  23,  R.  4 — 5  months ;  increasing  difficulty  in  defalca- 
tion ;  growth  surrounding  rectum  ;  firm ;  no  ulceration. 

Cystic  of — 

Ovary. — C.  12,  R.  2,  D.  4.     In  17  ovariotomy  was  performed. 

Case  1. — Mt.  43, married.  Increase  in  size  of  abdomen  18  months  to  2  years; 
pain  in  left  side ;  multilocular  tumour ;  knuckle  of  intestine  adherent  to  fundus 
of  cyst ;  temperature  at  4  a.m.  next  morning  101°,  but  soon  became  and  continued 
normal.     Discharged  23  days  after  operation. 

Case  2. — iEt.  58,  single.  6th  admission;  tapped  each  time;  multilocular 
tumour  without  adhesions;  no  bad  symptoms.  Discharged  48  days  after 
operation. 

Case  3. — iEt.  25,  single.  Gradual  painless  enlargement  of  abdomen ;  12 
months.  One  severe  attack  of  abdominal  pain  without  vomiting;  large  uni- 
locular cyst  containing  17  pints  dark  greenish  fluid ;  one  adhesion ;  vomiting  for 
2  days;  no  other  bad  symptom.     Discharged  26  days  after  operation. 

Case  4. — iEt.  33,  married.  Youngest  child  3  months  old ;  noticed  that  abdo- 
men was  larger  12  months  ago.  One  attack  of  severe  pain  in  abdomen  with 
vomiting.  Wall  of  cyst  adherent  all  round,  and  after  contents  evacuated  part 
removed,  but  the  adhesions  in  pelvis  too  intimate  to  allow  of  separation  ;  neither 
pedicle  nor  ovary  removed ;  bone  drainage  ;  fluid  in  cyst  of  consistency  of  treacle, 
brownish  colour,  very  offensive.     Discharged  101  days  after  operation. 

Case  5. — iEt.  46,  married.  Growth  2  years.  Comparatively  painless;  con- 
siderable stretching  of  abdominal  walls  between  umbilicus  and  ensiform  cartilage; 
40  days  before  operation  a  few  ounces  of  ascitic  fluid  drawn  off.  Solid  tumour 
conuected  with  right  ovary ;  ascites  ;  left  ovary  found  diseased  and  removed. 
Discharged  66  days  after  operation. 

Case  6. — iEt.  40,  married.  2  years' growth.  3  attacks  of  abdominal  pain; 
multilocular  cyst  with  much  solid  matter.     Discharged  27  days  after  operation. 

Case  7. — iEt.  50,  married.  5  years'  painless  growth.  Great  distension  of 
abdomen ;  a  little  free  fluid  ;  unilocular  cyst  containing  16  pints  fluid,  adherent 
to  wall  in  front  and  intestine  above  and  behind  j  adhesions  recent ;  left  ovary 
affected.     Discharged  32  days  after  operation. 

Case  8. — iEt.  30,  single.  Increase  in  girth  noticed  6  months.  Cyst  uni- 
locular ;  no  adhesions ;  13£  pints  fluid.     Discharged  31  days  after  operation. 

Case  9. — iEt.  42,  married.    Enlargement  of  abdomen  noticed  10  weeks.    Uni- 


372  1881 — Surgical. 

locular  cyst  connected  with  left  ovary,  22|  pints  of  fluid ;  adhesions  to  omentum, 
Fallopian  tuhe,  and  recent  to  wall.     Discharged  30  days  after  operation. 

Case  10. — Mt.  25,  single.  6  years.  Multilocular  cyst ;  Fallopian  tuhe  of 
opposite  ovary  adherent.     Left  hospital  40  days  after  operation. 

Case  11. — Mt.  30,  married.  9  months.  Unilocular  cyst  connected  with  right 
ovary,  very  extensive  and  vascular  adhesions  all  round;  23  days  afterwards  17 
ounces  of  offensive  pus  removed  by  aspirator  from  abscess  above  right  Poupart's 
ligament  no  further  trouble.     Left  hospital  44  days  after  operation. 

Case  12. — Mt.  32,  married.  6 — 7  months.  Some  thick  yellow  viscid  fluid 
in  peritoneal  cavity  ;  multilocular  cyst ;  left  ovary  ;  pedicle  long  and  very  soft, 
much  solid  matter.     Discharged  40  days  after  operation. 

Case  13. — Mt.  25,  married.  Growth  3  years.  Admitted  once  for  peritonitis  ; 
adherent  solid  tumour  connected  with  right  ovary  ;  several  adhesions,  some  pain  ; 
pedicle  found  twisted.     Discharged  34  days  after  operation. 

Relieved. — Mt.  25.  3  years'  growth.  2  children  since  first  noticed.  Ad- 
mitted with  peritonitis  and  anaemia ;  was  in  hospital  10  days ;  afterwards  re- 
admitted and  successfully  operated  upon.     See  No.  13. 

Mt.  28.  3  months.  Malignant;  general  of  abdomen;  jaundice.  To  Medical 
Ward. 

Fatal  cases. 

Case  1. — Mt.  43,  widow.  14 — 15  months.  Had  been  tapped  once.  Multi- 
locular but  extremely  adherent,  so  that  cyst  wall  was  left  in  several  places, 
especially  in  hepatic  region  ;  lived  5  days.     P.M. — Extensive  peritonitis. 

Case  2. — Mt.  54,  single.  2  years.  Multilocular  cyst  apparently  connected 
with  right  ovary,  but  parts  much  matted  together  ;  pedicle  long  and  twisted  ; 
some  discoloration  of  adjacent  parts  of  tumour ;  lived  9  days.  P.M. — Peri- 
tonitis, about  2  ounces  of  pus  in  Douglas's  pouch  surrounding  ligatured  pedicle. 

Case  3. — Mt.  54,  married.  4  months.  (Edema  of  lower  extremities ;  cyst 
unilocular,  very  adherent  to  posterior  wall  of  bladder  and  fuudus  uteri ;  dis- 
sected off  bladder  and  removed  with  body  of  uterus  ;  ligatures  having  been 
applied  just  above  cervix,  both  ovaries  removed ;  lived  2  days.  P.M. — Con- 
tracted granular  kidneys;  cardiac  hypertrophy. 

Case  4. — ^Et.  42,  married.  4  months.  Dyspnoea  and  cough ;  occasional 
vomiting  ;  immense  distension  of  abdomen  ;  trace  of  albumen  in  urine ;  tapped, 
11  pints  fluid  removed,  yellow  and  turbid ;  6  pints  of  fluid  found  in  peritoneal 
cavity,  and  a  large  cancerous  mass  growing  in  connection  with  omentum ; 
drainage  tube  inserted  and  wound  closed ;  died  next  evening. 

Each  operation  carried  out  with  antiseptic  precautions. 
Myofibroma. 

Of  Uterus.— K.  1,  D.  2. 

R.,  set.  45,  single.  9  years.  Size  of  cocoa  nut ;  diarrhoea  j  removal  not 
recommended. 


1881— Surgical.  373 

D.,  aat.  40,  married.  2  years.  Interfering  with  respiration ;  oedema  of  right 
leg ;  large  intramural  fibroid  removed  with  body  of  uterus  and  ovaries,  which 
were  slightly  enlarged  and  cystic ;  did  not  recover  from  shock  of  operation ; 
lived  3  days.  P.M. — Slight  localised  peritonitis,  and  about  6  ounces  blood-stained 
serum  in  cavity  of  pelvis. 

Mi.  39,  single.  6  years.  Much  abdominal  tenderness  ;  very  adherent ;  tumour, 
which  was  large  and  very  vascular,  removed  with  right  ovary  and  upper  part  of 
uterus  above  a  double  ligature  of  silk ;  a  small  fibroid  removed  from  posterior 
part  of  stump,  ligatures  again  applied  and  stump  seared  with  cautery ;  left 
ovary  also  removed ;  lived  about  16  hours  after  operation.  P.M.— Peritoneal 
cavity  contained  about  a  pint  of  fluid  blood. 


NERVOUS  SYSTEM. 

Tetanus  (admitted  as  such). — D.  2.  Male,  ait.  18.  Punctured  wound  of  foot ; 
6  days.  Stiffness  of  neck  and  jaw,  with  difficulty  in  swallowing,  and  some 
spasm.  24  hours.  Profuse  perspirations,  thirst,  restlessness  ;  healthy  purulent 
discharge  from  the  wound ;  some  severe  spasms  with  opisthotonos.  Morphia,  sub- 
cutaneously  at  first,  but  for  last  7  hours  chloroform  inhalation.  Temperature 
before  death  106-3°,  20  minutes  after  108-2°. 

Male,  set.  61.  Contused  wound  of  nose  and  contusion  of  head;  8  days.  Stiff- 
ness of  neck  and  jaw,  with  difficulty  in  swallowing ;  dyspnoea  and  occasional 
spasm.  Bromide  of  potassium  ordered,  discontinued  next  day ;  nutrient  enemata. 
Spasms  increased  and  laryngotomy  performed,  but  patient  died  about  15  minutes 
afterwards,  having  lived  4  days  after  first  appearance  of  symptoms.  P.M. — 
Nothing  remarkable  in  either  case. 


CIRCULATORY  SYSTEM. 

Aneurism. — Male,  mt.  56.  3  months'  swelling  in  left  groin.  No  history  of 
syphilis,  but  10 — 15  years  ago  sore  on  penis  with  suppurating  bubo.  Aneurism 
large,  under  and  above  Poupart's  ligament ;  skin  red  and  coverings  apparently 
thin,  extending  upwards  to  4  inches  from  umbilicus.  Also  a  small  aneurismal 
swelling  in  right  groin.  No  arcus  senilis  but  radials  tortuous  and  hard ;  external 
iliac  ligatured  with  tendon  from  Kangaroo  tail,  about  1  inch  above  aneurism ; 
pulsation  ceased  at  once.  Dressed  twice,  antiseptics  discontinued  18  days  after- 
wards. Slow  consolidation  with  puckering  of  skin  over  it.  Aneurism  in  right 
groin  slightly  larger. 

Female,  set.  69.  10  months'  swelling  below  left  clavicle ;  involuntary  rhythmical 
movement  of  right  arm  for  last  7  years,  but  not  obliged  to  use  left  arm  much 
more  in  her  work.  Size  of  a  small  orange,  junction  of  mid  one-third  with  outer 
one-third  clavicle.  Slight  arcus  senilis;  ligature  of  third  part  of  subclavian 
artery  with  catgut ;  next  day  pulsation  in  radial.     Antiseptics  discontinued  on 

vol.  xi.  26 


374  1881— Surgical. 

10th  day.  Tumour  gradually  became  smaller  and  harder,  but  faint  pulsation  could 
be  felt  in  it  when  discharged  63  days  after  operation. 


DIGESTIVE  SYSTEM. 

Hernia, — (See  Special  Table  I,  Hernia.) 

Fistula  in  ano. — C.  15,  R.  4,  U.  2,  D.  1.  In  9  history  of  previous  fistula,  3 
family  history  of  phthisis,  4  symptoms  of  phthisis,  1  died,  ulceration  of  larynx 
and  intestines,  and  cavities  in  lungs  ;  4  abscesses  incised,  hamiorrhoids  in  2  ;  16 
fistula  divided. 

Obstruction  of  bowels. — C.  3,  D.  1.  Female,  set.  50.  4  days'  constipation,  abdo- 
minal pain  and  vomiting  ;  enemata  and  purgatives.  Female,  set.  52.  5  days  before 
relieved  by  enema;  vomiting;  ring  of  new  growth  surrounding  upper  part  of 
rectum ;  colotomy ;  fseces  discharged  through  wound  in  loin.  Female,  a3t.  42. 
Constipation  14  days,  more  recently  vomiting  and  much  griping  pain,  followed  by 
distension  of  abdomen.  Some  ascites ;  marked  distension ;  enemata  without 
effect.  Abdominal  section  proved  existence  of  annular  stricture  of  sigmoid 
flexure  and  peritonitis ;  incision  made  in  loin  and  intestine  joined  to  wound  above 
stricture.  Gut  opened  next  day,  no  bad  symptom.  When  discharged,  52  days 
afterwards,  was  passing  motions  by  rectum,  and  wound  in  loin  almost  healed. 

Fatal  case. — Male,  a)t.  8.  10  days  before  admission  fell  downstairs.  7  days' 
severe  epigastric  pain  with  vomiting  ;  4  days'  constipation.  Admitted  with  dis- 
tension of  abdomen,  marked  peristaltic  action  of  intestines  and  vomiting ; 
enemata  returned  unchanged.  Treated  by  opium,  ultimately  abdominal  section 
performed.  Some  adhesions  broken  down ;  intestines  congested  and  much  dis- 
tended ;  punctured  with  fine  trochar.  P.M. — In  addition  to  marks  of  constriction 
produced  by  bands  mentioned  above,  a  constriction  38  inches  above  ilio  csecal 
valve,  possibly  result  of  old  intussusception  followed  by  sloughing. 


GENITO. URINARY  SYSTEM. 

Hydrocele. — C.  4.  2  left,  2  right.  The  present  collection  of  fluid  in  exis- 
tence 5,  10,  15,  and  36  months  respectively.  1  had  been  tapped  once  before,  and 
1  nine  times.  Treatment. — 1  tapping  only,  3  tapping  and  injection  of  iodine;  in 
1  the  injection  was  followed  by  rigors  and  reaccumulation  of  fluid,  but  this  was 
relieved  by  a  second  tapping  without  injection. 

The  case  of  suppuration  of  hydrocele  was  tapped  in  Out-patient  department 
4  days  before,  and  injured  himself  whilst  at  work.     Cured  by  free  incision. 

Fpididym  itis— 

a.  Acute. — C.  2,  R.  1.  1  admitted  with  gonorrhoea;  2  discharge  recommenced 
after  admission;  1  with  orchitis  and  ac.  hydrocele,  relieved  by  puncture. 

/3-  Tubercular.— R.  3,  D.  1.  In  none  family  history  of  phthisis.  3  occurred  on 
right  side,  and  in  each  there  was  abscess.    1  double,  admitted  with  incontinence 


1881— Surgical.  375 

of  urine,  which  contained  pus  and  blood ;  vomiting  and  great  general  depression. 
P.M. — Advanced  strumous  pyelonephritis. 

Calculus  vesica. — C.  2,  D.  1.  Male,  sat.  7.  No  history  could  be  obtained. 
Extracted  by  lateral  lithotomy,  large  uric  acid  stone ;  some  haemorrhage  after 
operation,  easily  controlled.  Female,  set.  44.  Symptoms  2  years  ;  kept  bed  for  6 
months  on  account  of  pain  on  movement ;  operation  16  years  ago  for  lacerated 
perinsBum  ;  small  rounded  particles  of  phosphates  adhering  and  forming  large  cal- 
culus ;  no  nucleus  discovered ;  extracted  through  dilated  urethra.  Fatal  case- 
Male,  set.  36.  Commenced  9  months  ago  suddenly.  Cystitis  and  great  pain  with 
dry,  brown  tongue ;  calculus  1£  x  £  inch,  extracted  by  lateral  lithotomy  ;  lived 
4  days.     P.M. — Cystitis,  enlarged  prostate,  surgical  kidneys. 

Retention  of  urine. — C.  16.  11  result  of  stricture,  4  result  of  spasm  in  inflam- 
matory condition  of  urethra,  usually  brought  on  by  drink ;  1  enlarged  pros- 
tate. Treatment. — Warm  bath  and  opium  primarily  in  6,  in  4  of  which 
catheterisrn  afterwards  employed ;  8  catheterism  only ;  tapping  above  pubes  1, 
perinoeal  puncture  1. 

Stricture  of  Urethra. — C.  15,  R.  6,  D.  3.  Gonorrhoea  probable  cause  in  20, 
but  strongly  denied  in  2;  injury  to  perinseum  3  ;  ascribed  to  cold  1.  Complica- 
tions.— Cystitis  2  ;  oedema  of  genitals  1 ;  scrotal  abscess  1 ;  extravasation  and 
perineal  fistula  1 ;  perineal  fistula  1 ;  adherent  prepuce  1 ;  haemorrhage  from 
urethra  1 ;  retention  of  urine  1 ;  foreign  body  in  bladder  1 ;  rheumatism  1. 
Treatment. — Interrupted  dilatation  11 ;  continuous  dilatation  3 ;  internal  ure- 
throtomy 5 ;  external  urethrotomy  3 ;  perineal  puncture  2 ;  incision  of  meatus 
1.  Fatal  cases. — Cystitis  and  surgical  kidneys  2;  1  valvular  stricture  of 
urethra,  also  contraction  of  meatus,  requiring  incision,  followed  by  rigors  and 
suppression  of  urine.     P.M. — Cystitis,  congestion  of  kidneys. 

Hydronephrosis. — C.  1,  E.  3.  C,  Male,  at.  12.  Hematuria  after  abdominal 
injury  5  weeks  before,  left  side ;  tapped  8  times,  and  from  38  to  80  ounces  of  urine 
drawn  off  at  each  tapping.  R.,  male  set.  6.  4  months  before  abdominal  injury, 
followed  by  hematuria  ;  fluctuating  swelling  in  left  loin.  Tapped  twice,  37  and 
30  ounces  drawn  off;  the  fluid  consisted  of  changed  blood  and.urine.  Readmitted 
twice  during  year,  and  clear  fluid  drawn  off  on  each  occasion,  20  and  25  ounces 
respectively. 

Calculus  of  kidney. — Female,  a)t.  39.  12 — 13  years' nephralgia,  right  side  ;  15 
months'  abscess  broke  in  right  loin  leaving  sinus,  which  is  still  discharging; 
several  small  calculi  passed  from  tins  7  weeks  since.  Calculus  felt  in  sinus; 
incision  made  in  loin  and  a  stone,  which  had  advanced  some  distance  from 
kidney,  extracted ;  nothing  found  in  pelvis  of  kidney.  Convalescence  retarded 
by  double  pneumonia  a  month  after  opci'ation. 

Gonorrhoea. — Male  1,  Female  19.  C.  17,  R.  3.  Complications. — Stricture  of 
urethra  1 ;  bubo  3  ;  sloughing  bubo  1 ;  warts  7 ;  labial  abscess  2 ;  rheumatism  1 ; 
haemorrhoids  1 ;  enlarged  tonsils  1. 

Soft  Sore. — Male  6,  Female  18.  C.  20,  R.  4.  Complications. — Males,  phimosis 
2;  paraphimosis  1 ;  3 phagedenic;  2  with  severe  haemorrhage.     Females,  vaginal 


376  1881— Surgical. 

discharge  13 ;  bubo  9 ;  warts  4 ;  vulval  oedema  1 ;  haemorrhoids  2 ;  fissure  of 
anus  1 ;  erythema  nodosum  1 ;  scabies  8 ;  vascular  growth  of  meatus  urinarius 
1  ;  anaemia  2 ;  pneumonia  X ;  congenital  absence  of  vagina  1,  readmitted. 


DISEASES  OF  LOCOMOTORY  SYSTEM. 

Of  hip  -joint. —Males  39,  females  30.  C.  41,  R.  24,  D.  4.  Incipient  (1st 
stage)  27 ;  2nd  and  3rd  stages  35 ;  old  excision  1 ;  anchylosis  4,  in  2  subcutaneous 
osteotomy  performed ;  rheumatism  1;  hysterical  1.  Excision  of  joint  in  14  j 
incision  of  joint  in  1  acute  case;  incision  of  abscess  16 ;  aspiration  of  abscess  4  j 
disease  of  both  hips  1 ;  disease  of  tarsus  1,  of  pelvis  1.  Erysipelas  developed  in 
3  ;  measles  1  ;  scarlatina  1 ;  typhoid  fever  1. 

Fatal  cases. — Male,  aet.  7.  Hip  disease  3  months.  Symptoms  slight,  free  and 
painless  movement  of  joint ;  abscess  formed  outer  side  of  thigh ;  dilated  and 
fixed  pupils;  nystagmus;  hands  very  tremulous ;  hectic;  optic  neuritis ;  emacia- 
tion ;  abscess  inner  side  of  thigh ;  bedsores.  P.M. — 2  tubercular  masses  in  dura 
mater  at  base  of  brain,  each  the  size  of  a  walnut ;  three  or  four  small  tubercular 
masses  in  lungs. 

Female,  aet.  6.  Hip  disease  14  days.  Rigidity ;  flexion ;  starting  at  night. 
Examined  under  chloroform.  Grating  in  joint;  excision,  opening  communicating 
with  interior  of  pelvis  ;  head  of  femur  absorbed ;  wound  healed.  Optic  neuritis; 
nystagmus ;  dilated  and  fixed  pupils ;  tremulous  movements  of  hands  j  hemi- 
plegia following  slight  convulsion ;  emaciation.     No  post  mortem. 

Female,  aet.  26.  Symptoms  referred  to  left  hip  after  enteric  fever.  7  months ; 
extreme  tenderness,  fluctuation,  some  displacement.  Excision ;  wound  almost 
closed,  then  discharge  increased;  diarrhoea;  troublesome  cough  ;  night  sweats; 
dyspnoea ;  signs  of  cavity  at  left  apex ;  exhaustion.     No  post  mortem. 

Female,  aet.  19.  Pain  in  hipjand  groin  after  falling  on  hip.  18  months.  Fulness 
in  groin  and  starting  at  night ;  abscess  opened,  excision ;  erysipelas ;  abscess 
opened  in  groin  ;  loss  of  appetite.  Placed  on  water  bed.  Thin  purulent  discharge 
from  sinuses ;  2nd  attack  of  erysipelas ;  bedsores ;  great  emaciation.  P.M. — At 
apex  of  each  lung  contraction  of  fibroid  material  around  small  caseous  masses ;  a 
few  scattered  tubercles ;  amyloid  disease  of  abdominal  organs. 

Of  lcnee- joint.— Males  42,  females  26.  C.  27,  R.  37,  D.  4.  Incipient  14  j 
chronic  54;  old  excision  2;  fibrous  anchylosis  4;  loose  bodies  3;  extracted  2; 
after  confinement  1 ;  rheumatism  1 ;  rheumatoid  arthritis  5 ;  admitted  with 
suppuration  of  joint  7 ;  in  1  disease  of  shoulder;  1  of  os  calcis ;  1  compound 
ganglion  of  wrist ;  1  bursal  enlargement  over  hip ;  contracted  erysipelas  2 ; 
measles  1. 

Fatal  cases. — Female,  set.  14.  3  years'  pain,  7  mouths'  swelling,  wearing  splint  5 
months.  63  days  after  admission  joint  excised.  Tubercular  disease  of  synovial 
membrane;  slight  hajmorrhage  after  return  to  bed,  but  patient  never  rallied  from 
shock  and  died  same  day.     P.M. — Tuberculosis  of  left  lung  and  liver. 


1881— Surgical.  377 

Female,  set.  38.  Injured  knee  after  a  long  illness,  nature  of  which  doubtful.  5 
weeks'  gradual  swelling  and  much  pain;  incision  into  abscesses ;  bedsores ;  typhoid 
condition;  offensive  discharge;  exhaustion.     No  post  mortem. 

Female,  set.  10  mouths.  3  weeks.  Incisions  and  drainage  tube  passed  across 
joint ;  stomatitis  ;  diarrhoea ;  purpuric  spots.  Lower  end  of  diaphysis  of  femur 
removed  ;  exhaustion.     No  post  mortem. 

Male,  sot.  50.  Pain  iu  knee  7  weeks ;  4  weeks'  pain  in  whole  leg ;  restless 
nights  ;  swelling  of  leg  from  thigh  to  ankle  ;  oedema  ;  delirium  ;  incisions ;  pro* 
fuse  discharge  ;  slight  rigors ;  bedsores ;  exhaustion ;  in  hospital  9  days.  No 
post  mortem. 

Of  ankle-joint. — Males  5,  females  3.  C.  5,  R.  3.  1  gonorrhcoal  synovitis  with 
suppuration  round  joint ;  1  excision,  symptoms  of  phthisis  developed  and  leg 
amputated  on  readmission;  1,  aet.  56,  S vine's  amputation  ;  1  incision  outer  side 
of  joint,  removal  of  sequestrum  from  upper  surface  of  astragalus,  and  joint 
scraped  ;  3  plaster-of- Paris  splints  applied. 


SUMMARY  OF  INJURIES. 


GENERAL  INJURIES. 


Frostbite. — Female,  set.  4.  Suffering  from  chilblains ;  out  during  heavy  storm 
of  snow  in  February,  and  exposed  all  night  to  cold,  2  weeks  before  admission. 
Both  feet  affected,  left  more  than  right ;  sloughing  of  toes  and  gradual  removal 
of  bones. 

Burns.— Males  25,  females  18.  C.  19,  R.  10,  D.  14.  General  18;  face  and 
head  2 ;  face  and  upper  extremities  7 ;  upper  extremities  8 ;  lower  extremities  2  ; 
chest  6.  Of  these  5  epileptic ;  7  caused  by  night-dress  catching  fire ;  3  gas 
explosions ;  1  ether  explosion.  1  erysipelas ;  2  haemorrhage,  in  1,  set.  21, 
sloughing  of  tendons  of  forearm,  14th  day  haemorrhage  from  ulnar  artery,  16th 
from  radial :  in  each  case  requiring  double  ligature ;  1  charring  of  fingers ;  1  of 
eye,  suppuration.  Treatment. — Carron  oil  16;  terebine  and  oil  13;  Cat. 
Lini  2 ;  acetic  aci  d  and  whiting  7 ;  almond  oil  1 ;  carbolic  oil  2 ;  saturated 
solution  of  bicarbonate  of  soda  1.    2  died  from  collapse  before  special  treatment. 

Fatal  cases. — Males  6,  females  8.  5  collapse,  in  1  also  vomiting  and  diarrhoea ; 
1  congestion  of  lungs ;  1  erysipelas ;  shock  1 ;  convulsions  2,  in  1  temperature 
of  107'2°;  exhaustion  2,  1  from  haemorrhage  and  diarrhoea;  exhaustion  and 
shock  2 ;  chorea  and  shock  1. 

Scalds. — Males  19,  females  15.  C.  24,  R.  7,  D.  3.  General  2;  face,  arm,  and 
trunk  2  ;  face  and  arm  1 ;  face  and  head  or  neck  7 ;  fauces  3,  requiring  trache- 
otomy 1 ;  chest  1 ;  lower  extremities  15  ;  arms  and  trunk  3. 

Fatal  cases. — Males  3.  All  under  2  years  of  age ;  2  within  24  hours ;  1  shock. 
1  convulsions,  1  within  48  hours5  shock.  Treatment. — As  primary  application : 
Carron  oil  22;  almond  oil  1;  terebine  and  oil  6;  acetic  acid  and  whiting  1 ; 
carbolic  oil  1 ;  in  3  steam  kettle  used. 


LOCAL  INJURIES. 

HEAD. 

Scalp  wound. — Males  30,  females  4.  C.  30,  R.  4.  Exposed  bone  in  6.  Com- 
plications.— Slight  concussion  4;  division  of  temporal  artery  1;  wound  of  face 
1,  of  leg  1 ;  sprain  of  ankle  1 ;  contusion  of  face  5,  of  thigh  1,  chest  2,  abdomen 
1 ;  followed  by  aphasia  1 ;  by  dilatation  of  pupil  1 ;  by  suppuration  2 ;  erysipelas 
3.     Majority  treated  antiseptically. 


1881— Surgical.  379 

Concussion. — Males  51,  females  8.  C.  54,  It.  5.  Complications. — Bleeding 
from  ear  3  ;  epistaxis  9 ;  facial  paralysis  1 ;  impairment  of  vision  1 ;  subconjunc- 
tival ccchymosis  4  ;  aphasia  1;  probable  laceration  of  brain  1;  temporary  inequality 
of  pupils  3  ;  shock  1 ;  retention  of  urine  1.  Fractures,  2  radius  and  ulna ;  ulna 
1 ;  Colles'  2  j  clavicle  1 ;  inferior  maxilla  1.  Wounds  of  face  3 ;  scalp  11 ;  thigh  1 ; 
side  1.  Contusions,  general  1 ;  face  4 ;  scalp  6 ;  head  2.  1  male,  set.  40, 
found  unconscious  8  hours  before  admission.  Contusions  of  head ;  quite  insen- 
sible; very  irritable;  on  4th  day  over  40  convulsive  seizures,  lasting  about  30 
hours;  gradual  recovery  of  Consciousness,  memory.  Much  headache,  relieved  by 
Liq.  Hyd.  Perchl.  Residence  69  days;  C.  Male,  set.  56,  liable  to  attacks  of 
speechlessness ;  slight  attack  of  right  hemiplegia  12  months  ago ;  contusion  of 
right  parietal ;  speechless ;  able  to  write  name  and  address ;  no  paralysis  evident. 
In  2  days  left  facial  paralysis  and  drowsiness ;  gradual  improvement ;  highest 
temperature  100'8°.     Residence  28  days. 

Fracture  of  vault  of  skull. — Simple. — Male  1,  females  3.  R.  1,  D.  3. 
Relieved. — Male,  set.  3.  Depressed  fracture  of  parietal;  5  months;  suffering 
from  headache. 

Fatal  cases. — Female,  set.  9  months.  Mother  fell  downstairs  with  child  in 
her  arms.  Gradual  loss  of  consciousness  ;  vomiting.  Admitted  insensible  ;  eye3 
strongly  turned  to  right ;  cold ;  fracture  felt  on  right  side  of  skull,  soon  oblite- 
rated by  swelling  produced  by  blood  effusion  ;  convulsive  movements  ;  stertor  J 
severe  convulsion.  P.M. — Separation  of  squamous  portion  of  temporal  bone  from 
its  attachments  and  fracture  of  it ;  laceration  of  brain ;  effusion  of  blood  under 
scalp,  and  over  surface  of  brain  from  base  to  vertex. 

Female,  set.  8.  Knocked  down  and  run  over  by  a  light  cart.  Was  unconscious 
for  1|  hour ;  epistaxis  ;  admitted  conscious ;  contusions  and  abrasions  of  f acej 
also  slight  wound  near  left  temple;  no  visible  contusion  of  abdomen,  but  severe 
pain  in  left  side  when  moved  At  2  a.m.  next  day  slight  convulsive  seizure, 
followed  by  gradual  loss  of  consciousness,  stertor,  and  dilatation  of  pupils,  right  the 
larger,  rather  fixed.  P.M. — Fracture  of  vault  of  skull;  basal  meningitis;  rup- 
ture of  liver  (extensive),  and  also  of  right  kidney. 

Female,  set.  2,  fell  from  second  story  window.  Convulsive  seizure  with  dilata^ 
tion  of  pupils;  unconsciousness;  considerable  discoloration  of  scalp,  chiefly  poste- 
rior part  of  head ;  sodden  feeling,  apparently  from  extravasation  of  blood  under 
and  into  its  substance;  no  further  symptom.  P.M. — Fracture  of  vertex 
extending  from  left  temporal  region  to  greater  wing  of  sphenoid  on  right  side. 
Compound  depressed  fractures  of  vault. — Males  2.     C.  2. 

Male,  set.  56.  Fall  on  spike  whilst  in  epileptic  seizure.  Walked  to  hospital ; 
starred  wound  of  scalp  over  posterior  superior  angle  of  left  parietal,  under  which 
depressed  portion  ;  trephined.  3  pieces  of  bone  removed ;  antiseptic ;  no  sym- 
ptom from  first  to  last ;  50  days. 

Male,  a-t.  25.  Fell  backwards  with  head  on  a  revolving  wheel.  Wound 
extending  from  occipital  protuberance  forward  for  two  inches,  under  which 
depression  and  sharp  spiculum  of  bone.  Frequently  vomited  before  admission. 
Severe  headache ;  mind  clear.  Trephined,  a  piece  of  bone,  removed ;  antiseptic ; 
headache  for  4  days  after ;  on  5th  day  pulse  48,  temp.  98'4;  highest  temperature' 
evening  2nd  day  100'6°. 


380  1881— Surgical. 

Compound  fractures  of  skull. — Males  2.     C.  1,  D.  1. 

C,  set.  28.  Insensible  3  minutes  after  blow  from  crowbar  on  forehead,  wbicb 
produced  a  linear  fracture  of  skull  and  wound  over  it  to  left  of  median  line. 
Some  suppuration  followed  and  slight  headache. 

J).,  set.  14.  Bullet  from  pistol  fired  at  six  yards'  distance  entered  side  of  head 
through  pinna  of  left  ear.  Probe  passed  for  2  inches;  no  bullet  found ;  vomit- 
ing. 5th  day  :  discharge  from  wound  and  swelling  round  it;  temp.  104'2°,  and 
incision  made;  vomited  very  frequently;  insensible  last  2  days.  P.M. — Small 
portion  of  bone  driven  into  tempero-sphenoidal  lobe,  surrounded  by  acute  cere- 
britis,  confined  to  grey  matter ;  bullet  found  loose ;  acute  meningitis  of  left 
hemisphere. 

Fractures  of  base. — Males  13,  females  1.     D.  9,  C.  5. 

Cases  discharged  cured. — Male,  set.  26.  3  years  ago  haemorrhage  from  right 
ear  after  severe  inj  ury  to  head.  Fell  down  area  12  feet,  admitted  soon  after  ; 
insensible  ;  widely  dilated  pupils ;  haemorrhage  from  ears ;  gradual  recovery  of 
consciousness ;  vomited  constantly  for  2  days ;  slight  discharge  from  right  ear> 
ceasing  on  7th  day. 

Male,  set.  21.  Found  on  line,  unconscious ;  constant  vomiting;  irregularity 
of  pupils ;  haemorrhage  from  right  ear ;  small  scalp  wound  back  of  head  on  right 
side ;  bone  exposed ;  discharge  from  ear  went  on  until  7th  day ;  refused  to 
remain  longer  than  11  days. 

Male,  set.  8.  Knocked  down  by  tramcar,  pole  striking  head ;  slight  scalp 
wound ;  haemorrhage  from  left  ear,  and  rupture  of  tympanic  membrane,  lower 
and  posterior  part.     Was  in  hospital  23  clays. 

Male,  set.  6.  Fall  from  third  story  window  ;  iusensible,  and  continued  so  for  2 
hours;  collapsed;  hajmorrhage  from  nose;  vomiting;  proptosis  of  left  eye  and 
contusion  of  lids  ;  right  pupil  dilated  ;  paralysis  of  6th  nerve ;  probable  damage 
to  optic  nerve  in  optic  canal,  or  haemorrhage  into  orbit.  6  weeks  after  admission 
there  was  still  paralysis  of  6th  nerve,  and  in  addition  marked  white  atrophy  of 
the  disc,  only  on  injured  side. 

Male,  aet.  6.  Fall  from  third  story  window,  30  feet ;  insensible ;  scalp  wound ; 
haemorrhage  from  left  ear,  nose,  and  mouth ;  fracture  of  upper  part  of  right 
femur,  and  Colles'  fracture  of  left  radius.     Discharged  in  43  days. 

Fatal  cases. — Males  8,  females  1. 

Female,  set.  37.  Fell  downstairs  whilst  drunk.  Had  vomited ;  insensible ; 
pupils  unequal,  fixed  ;  hsemorrhage  from  left  car ;  became  suddenly  in  condition 
of  asphyxia  on  3rd  day,  and  venesection,  external  jugular,  was  performed  to  10 
ounces,  and  repeated  on  other  side  to  8  ounces ;  some  but  only  temporary 
relief.  Lived  2  days.  P.M. — Fracture  of  base  from  frontal  on  left  side  to  fora- 
men magnum ;  hsemorrhage  under  dura  mater  on  left  side ;  contusions  of  ante- 
rior part  of  brain ;  temp.  105"2  in  rectum,  15  minutes  before  death. 

Male,  set.  23.  When  first  found  "  could  answer  questions,"  but  3  hours  after 
unable  to  do  so,  though  able  to  walk  with  assistance  ;  scalp  wound  over  a  commi- 
nuted fracture  above  left  ear,  which  required  removal  of  pieces  of  bone.  Regained 
consciousness;  restlessness;  headache;  temp.  105"4°.  Venesection  right  elbow 
to  12  ounces;  marked  improvement;  restlessness;  twitching  of  right  side; 
profuse  perspiration;  slight  convulsion.    Venesection  left   elbow  to  7   ounces. 


1881—  Surgical.  381 

P.M. — In  5  minutes  temperature  in  rectum  108-8°  ;  fracture  extended  across  to 
middle  of  sphenoid  ;  much  laceration  of  brain  ;  some  laceration  at  apex  of  each 
frontal  lobe.     Lived  3  days. 

Male,  set.  23.  ?  Idiot.  Fell  from  hay-loft.  Unconscious  since;  stertor; 
pupils  equal  and  acting;  traces  of  haemorrhage  from  right  ear,  mouth,  and  nose; 
moaning  and  restless  ;  temp.  105*4°  before  death.  Lived  4  days.  P.M. — Large 
clot  in  position  of  right  middle  meningeal  artery ;  fractures  of  middle  fossa  and 
right  side  of  anterior  fossa;  extravasation  into  and  contusion  of  brain. 

Male,  03t.  54.  Pitched  out  of  a  cart,  fell  on  head.  Oblique  scalp  wound  over 
right  temporal  fossa ;  subconjunctival  haemorrhage  and  haemorrhage  from  nose ; 
coma;  stertor;  pupils  insensitive;  unilateral  convulsion  confined  to  leftside; 
hiccough.     P.M. — Fracture  of  base.     Lived  2  days. 

Male,  set.  40.  Fall,  30  feet.  Insensible  since  ;  stertor;  profuse  perspiration  ; 
haemorrhage  from  nose  and  under  eyelids ;  marked  rigidity  of  left  side ;  temp. 
105°  soon  after  admission.  Lived  1  day.  P.M. — Fracture  extending  from  a 
wound  over  right  frontal  bone  down  to  base. 

Male,  set.  55.  Fall,  35  feet,  scaffold.  Insensible  and  in  state  of  collapse; 
fracture  of  base  and  vault,  of  ribs  and  right  clavicle. 

Male,  aet.  51.  Found  insensible  by  side  of  his  cab.  No  haemorrhages ; 
small  scalp  wound ;  fracture  of  posterior  fossa ;  cerebral  haemorrhage ;  fracture 
of  ribs. 

Male,  aet.  32.  Fall,  20  feet.  Severe  scalp  wound  ;  insensible ;  restless ;  occa- 
sional twitchings  of  right  hand  and  arm  ;  fracture  of  posterior  fossa,  and  haemor- 
rhage from  lateral  sinus. 

Male,  aet.  24.  Knocked  down  by  engine.  Compound  comminuted  fracture  of 
skull  extending  from  vertex  to  base ;  protrusion  of  brain ;  rupture  of  right  eye- 
ball; removal  of  bone ;  venesection. 

The  last  4  cases  lived  under  12  hours  after  injury. 


INJUEIES  OF  THE  ABDOMEN,  CHEST,  SPINE,  AND 

PELVIS. 

Injuries  of  the  abdomen.— Contusions  27.  C.  20,  R.  4,  D.  3.  Majority  of 
these  severe ;  in  7  vomiting  chief  symptom ;  4  haematemesis ;  4  haematuria ;  7 
retention  of  urine ;  shock  marked  in  9  ;  contusion  of  intestine  1 ;  peritonitis  2. 

Fatal  cases. — Male,  aet.  54.  Died  shortly  after  admission,  about  10  hours  after 
receipt  of  injury,  kick  from  horse.  Collapse  ;  great  abdominal  pain ;  tenesmus  ; 
rigidity  of  abdominal  walls.  P.M. — Clean-edged  rupture  of  small  intestine,  6 
inches  from  pyloric  orifice  ;  commencing  peritonitis. 

Male,  aet.  13.  Kick  from  horse.  Collapse  and  great  abdominal  pain ;  lived  2 
days.  P.M. — Rupture  of  intestine  in  upper  part  of  jejunum,  and  extravasation  of 
contents ;  acute  peritonitis. 

Female,  set.  4.  Run  over  by  Hansom  cab.  Great  collapse;  rules  all  over 
chest;  contusions,  face.  P.M. — Rupture  of  liver;  haemorrhage  into  and  behind 
peritoneum  ;  contusion  of  lungs. 


382  1881—  Surgical. 

Fractures  of  sternum. — Males  2.     C.  2.     Male,  set.  31.     Pall  of  plank,  causing 
depression  of  second  part;  2  days  after  admission  regained  normal  position. 
Male,  £et.  40.     Fall  of  15  feet;  same  situation.     Pneumonia  on  6th  day. 

Fracture  of  ribs.— Males  33,  Females  8.  C.  18,  R.  21,  D.  2.  In  7  only  1  rib 
broken  ;  23  indirect  violence,  17  direct ;  1  muscular  action.  Complications. — 
Hsemoptysis  8  ;  emphysema  3  ;  cough  6 ;  bronchitis  3 ;  pleurisy  2 ;  pleurisy  and 
bronchitis  1 ;  contusions  3 ;  injury  to  abdomen  4. 

Fatal  cases. — Male,  set.  61.  Thrown  from  Hansom  cab.  Fracture  of  9th, 
10th,  and  11th  ribs  on  left  side ;  broncho-pneumonia ;  pleurisy ;  contracted 
granular  kidneys. 

Male,  set.  20.  Struck  by  pole  of  tram  car.  Fracture  of  6  ribs,  2  to  7 ;  hsema- 
tothorax  ;  pneumothorax ;  laceration  of  lung  ;  pleurisy.     Lived  2  days. 

Fracture  of  spinal  column. — C.  1,  D.  3. 

Cured. — Male,  set.  21.  Fell  15  feet  on  to  his  head.  Fracture  of  2nd  dorsal 
spine,  which  was  very  movable ;  scalp  wound  and  general  contusions. 

Fatal  cases. — Male,  set.  26.  Four  days  before  admission  fell  out  of  a  cart  and 
was  bent  between  wheel  and  body  of  cart.  Paraplegia  followed,  but  not  loss  of 
sensation  ;  no  control  over  sphincters  ;  bed-sores  began  to  form ;  complete  absence 
of  abdominal  reflex,  also  of  tendon-reflex  in  legs.  Respiration  became  almost 
purely  diaphragmatic,  and  patient  died  3  days  after  admission,  with  a  tempera- 
ture of  108"6°.  P.M. — Transverse  fracture  of  1st  dorsal  vertebra  and  rupture  of 
ligaments;  effusion  of  blood  into  muscles  over  seat  of  injury  and  into  spinal 
canal,  also  into  central  part  of  lower  cervical  enlargement ;  arachnitis;  softening 
of  cord ;  cystitis,  and  recent  peritoneal  inflammation  round  bladder. 

Male,  set.  52.  Fell  14  feet  on  to  his  head.  Loss  of  sensation  and  power  as 
high  as  'nipple,  partial  in  arms ;  respiration  laboured ;  vomited ;  retention  of 
urine.  Lived  1  day.  P.M. — Fracture  of  6th  cervical  vertebra  and  displacement 
forwards,  crushing  spinal  cord. 

Male,  set.  75.  Picked  up  unconscious  in  street.  Scalp  wound,  with  bared 
bone  ;  stertor ;  complete  insensibility.  Lived  3  hours.  P.M. — Transverse  frac- 
ture of  5th  and  6th  cervical  vertebra  and  much  extravasation  of  blood  into 
pi-evertebral  muscles ;  laceration  of  spinal  cord. 

Fractures  of  pelvis. — Males  8.     C.  2,  R.  1,  D.  5. 

Cured. — Mb.  6.  Wheel  of  cart  passed  over  pelvis.  Insensible  j  Involuntary 
evacuations ;  much  pain  ;  crepitus  elicited  on  left  side  of  pelvis.     Left  in  63  days. 

Mt.  26.  Crushed  between  cart  and  gate-post.  Fracture  of  left  iliac  crest 
2  inches  from  anterior  superior  spine. 

iEt.  43.  Fell  downstairs.  Fracture  of  right  anterior  superior  spine ;  htema- 
turia.     Plaster-of-Paris  splints  in  each  case. 

Died. — iEt.  3.  Run  over  by  omnibus.  Deep  laceration  of  right  thigh  and 
scrotum;  fracture  of  left  internal  malleolus;  fracture  of  right  side  of  pelvis 
2  inches  from  symphysis.     Temperature  96-2c>.     Died  from  sh6ck  in  2  days. 

Mt.  10.  Run  over  and  kicked  by  the  horse.  Extensive  fracture  of  right  side 
of  pelvis ;  much  bruising  and  extravasation  of  blood  around ;  wounds  of  face ; 
vomited  almost  continually  for  2  days,  then  much  abdominal  pain.     Lived  3 


1881— Surgical  383 

days.  P.M. — Double  fracture  of  right  pubes  and  dislocation  of  right  sacro  iliac 
synchondrosis.     Recent  peritonitis. 

iEt.  25.  Fell  30  feet.  Much  pain  in  liead ;  fracture  of  inferior  maxilla ; 
delirium ;  restlessness ;  swelling  and  pain  in  left  elbow.  P.M. — Comminuted 
fracture  of  pubic  bones;  large  abscess  surrounding  seat  of  fracture  and  suppura- 
tion in  left  elbow-joint ;  compound  fracture  of  inferior  maxilla  ;  congestion  and 
codema  of  lungs. 

Mb.  34.  Crushed  between  two  railway  carriages.  Fracture  of  pelvis  on  right 
side  ;  rupture  of  urethra  ;  dislocation  of  sternal  end  of  left  clavicle  forwards  and 
inwards ;  ecchymosis  of  face ;  restlessness ;  delirium  ;  tremulous  hands  ;  dry, 
brown  tongue ;  diarrhoea ;  abdominal  distension.  Some  spots  resembling  those 
of  typhoid  fever  10  days  after  admission.  Lived  12  days.  Highest  temperature 
104°.  P.M. — Abscess  cavity  beneath  and  about  dislocated  end  of  clavicle ;  frac- 
ture of  ribs  1 — 6  on  left  side,  1st  rib  on  right,  and  suppuration  at  point  of 
fracture  in  more  than  one ;  extensive  fracture  of  pelvis  on  each  side ;  rupture  of 
urethra  and  abscess  cavity  containing  urine  between  symphysis  and  bladder. 

iEt.  3£.  Run  over  by  tram  car.  Fracture  of  pelvis  on  left  side,  of  left  femur, 
and  severe  laceration  of  soft  parts  on  right  side  of  perinseum  and  anus.  Died 
from  shock. 


INJTJEIES   OF  THE  UPPEE  EXTEEMITIES. 

Wounds, — C.  9,  R.  8.  Tendons  divided  in  2 ;  lacerated,  followed  by  erysipelas, 
1 ;  cellulitis  I ;  sloughing  1 ;  requiring  amputation  of  digit  3 ;  gunshot  wound 
1 ;  needle  removed  1. 

Wounds  of  artery. — C.  5,  R.  2.  Superficial  palmar  arch,  incised  1 ;  lacerated 
1  j  in  3  cases  incised  of  ulnar  artery,  nerve,  and  tendons  ;  in  2  division  of  radial 
artery,  in  1  of  which  flexor  carpi  radialis  also  divided ;  in  4  of  these  tendons 
successfully  sutured. 

Fracture  of  acromion. — R.  Male,  set.  50.  Fall  from  fire  engine  on  shoulder. 
Separated  at  junction  with  spine  of  scapula. 

Fractures  of  humerus  (simple). — 6,  Direct  violence  8  ;  indirect  2  ;  spontaneous 
(?)  tumour  lj  1  separation  of  lower  epiphysis;  2  lower  end  into  elbow-joint;  1 
impacted  of  neck ,  2  of  shaft ;  fracture  of  radius  in  1 ;  synovitis  of  elbow  1 ;  of 
knee  1 ;  severe  contusion  of  arm  1. 

Fracture  of  humerus  (compound). — 5.  1  admitted  with  concussion  and 
haemorrhage  from  nose ;  2  separation  of  lower  epiphysis  ;  injury  to  brachial 
artery  1 ;  extending  into  elbow-joint  2 ;  partial  resection  1 ;  delirium  tremens  1 ; 
3  direct  violence.  Compound  comminuted. — 4.  C.  3,  D.  1.  All  due  to  direct 
violence.  Bullet  wound,  with  bullet  wound  of  hand,  1 ;  with  fracture  of  ulna  1 ; 
into  elbow-joint  3 ;  fracture  of  skull  and  ribs  1 ;  primary  amputation  2. 

INJUEIES  OF  THE  LOWEE  EXTEEMITIES. 

Dislocation  of  femur.— Males,  5.  JEt.  8.  Fall  on  hip;  dorsal  dislocation 
easily  reduced  under  anfesthetic  by  manipulation. 


381-  18S1— Surgical. 

Mb.  6.  Dorsal  dislocation ;  history  of  injury  to  hip  2  or  3  months  ago,  but 
probably  congenital ;  easily  reduced  on  extension,  but  returning  to  same  position. 

Mb.  5.  Pubic  dislocation ;  lameness  for  some  time,  worse  lately,  probably 
congenital.     No  attempt  made  at  reduction. 

Mb.  7.  Fell  whilst  running.  Dorsal  dislocation,  2%  'inches  shortening.  Re- 
duced by  manipulation  under  ana3sthetic.  Readmitted  3  months  later  with 
similar  dislocation  of  same  hip,  but  reduction  took  place  whilst  being  carried  to 
ward. 

Dislocation  of  head  of  fibula. — Male,  tet.  36.  Forwards;  result  of  fall  from 
platform  of  railwaylstatiou  on  line  below.  As  a  complication  in  a  case  of  fracture 
of  tibia  and  fibula. 

Dislocation  of  foot. — Male,  set.  14.  Partial,  backwards ;  no  fracture  detected  ; 
deformity  and  widening  of  ankle.     Easily  reduced. 

Dislocation  of  astragalus. — Male,  sat.  39.  Fall  from  ladder  on  outer  side  of 
foot,  which  was  bent  under  him,  displaced  forwards  and  outwards;  skin  tightly 
stretched  over  head  of  bone.     Easily  reduced  under  anaesthetic. 

Fractures  of  femur.— SO.  C.  66,  R.  5,  U.  2,  D.  7.  Simple.— hi,  of  which  40 
were  of  the  right  and  17  of  the  left  femur,  and  only  17  apparently  due  to  direct 
violence ;  2  fracture  into  knee-joint ;  3  double  fracture  of  shaft ;  3  refraction ;  1, 
sat.  42,  compound  fracture  of  tibia  and  fibula,  other  limb,  and  general  contusions ; 
2  for  reapplication  of  splint. 

Fatal  cases. — Male,  ret.  40.     Contusion  of  brain  and  fracture  of  right  femur. 

Male,  set.  56.  Fracture  of  right  femur ;  synovitis  of  left  knee.  Died  on  22nd 
day.     Pulmonary  embolism. 

Male,  set.  74.  Fracture  of  right  femur ;  cirrhosis  of  liver  and  kidneys ;  hypos- 
tatic congestion  of  lungs. 

There  were  also  15  fractures  of  neck  of  femur,  10  intracapsular,  5  impacted,  5 
unimpacted;  5  extracapsular,  2  impacted,  3  unimpacted.  Complications. — Deli- 
rium tremens  1 ;  sprain  of  wrist  1 ;  Colics'  fracture  1 ;  thrombosis  internal 
saphena  vein  1. 

Compound  fractures. — C.  1,  D.  1. 

Cured. — Male,  set.  42.  Fall,  20  feet.  Compound  fracture  of  shaft ;  transverse 
small  wound  ;  dressed  antiseptically  ;  no  shortening.     47  days. 

Died. — Male,  ret.  65.  Run  over.  Fracture  of  right  thigh,  compound ;  upper 
fragment  protruding ;  considerable  laceration  ;  fracture  of  right  tibia  and  fibula, 
also  compound;  much  collapse.  Antiseptic  dressing.  In  5  days  gangrene  of 
left  leg  appeared  and  delirium  came  on.     Lived  9  days. 

Compound  comminuted. — C.  1,  D.  3. 

Cured. — Male,  set.  29.  Crush  of  right  femur  2  days,  united  without  a  bad 
symptom.     Carbolic  oil  applied.     Residence  63  days. 

Died. — Mt.  5.  Smash  of  left  femur,  with  crush  of  soft  parts ;  considerable 
hamiorrhage  ;  shock  ;  amputation  upper  third  thigh.     Died  4  hours  afterwards. 

Mt.  42.  Run  over  by  loaded  van.  Smash  of  lower  end  left  femur;  much 
injury  to  leg;  amputation;  lisematuria.  P.M.— Congestion  of  kidneys,  and 
blood  mixed  with  urine  in  bladder. 


1881— Surgical.  385 

Mt.  20.  Tram  car  wheel.  Collapse  ;  compound  comminuted  fracture  of  right 
femur  into  knee-joint,  and  much  damage  to  soft  parts  ;  also  simple  fracture  of 
tibia  aud  fibula  of  left  leg  ;  rallied  somewhat;  amputation  middle  of  thigh. 
Lived  24  hours. 

Fractures  of  patella. — C.  19.  Right  patella  13.  2  cases  of  refraction ;  in  2 
old  fracture  of  other  bone,  in  3  aspiration  of  knee-joint. 

Fractures  of  tibia  (simple). — 40.  20  right  tibia,  15  left  tibia.  20  due  to 
direct  violence,  15  to  indirect  violence,  5  doubtful.  Transverse  fractures  25 ; 
oblique  8,  comminuted  1,  ununited  3;  of  internal  malleolus  3;  1  operation  for 
ununited  fracture.  All  the  other  cases  were  treated  by  lateral  plaster-of-Paris 
splints,  and  in  majority  of  cases  gum  bandage  applied  over  splints  before  dis- 
charge. 

Compound. — C.  3.  1  due  to  indirect,  2  to  direct  violence ;  1  had  delirium 
tremens;  1  erysipelas.     All  treated  antiseptically. 

Compound  comminuted. — C.  3.     In  1  secondary  amputation. 

Fractures  of  fibula  (simple). — 47.  C.  18,  R.  29.  Of  these  the  internal  lateral 
ligament  of  ankle-joint  was  ruptured  in  16,  and  the  internal  lateral  ligament 
of  knee,  followed  by  synovitis,  1 ;  displacement  of  foot  3 ;  injury  .to  ribs  2 ; 
general  contusions  1. 

Fractures  of  tibia  and  fibula.— 92.  Simple  70.  C.  27,  R.  42,  D.  1.  Majority 
due  to  indirect  violence ;  comminuted  3 ;  ununited  3 ;  more  than  one  point  of 
fracture  3 ;  synovitis  of  knee  1 ;  dislocation  of  head  of  fibula  and  rupture  of 
quadriceps  tendon  1 ;  fracture  of  forearm  1 ;  fracture  of  ribs  followed  by  hron- 
chitis  1 ;  pneumonia  (fatal)  1 ;  epileptic  1 ;  general  paralysis  of  insane  1. 

Compound. — C.  13.  Fracture  of  other  leg  1 ;  delirium  tremens  2;  syphilis  1  j 
requiring  incisions  and  secondary  amputation  1 ;  in  2  wound  only  small,  treated 
with  carbolic  oil,  remainder  dressed  antiseptically. 

Compound  comminuted. — 9.     D.  3. 

Cured. — Male,  set.  42.     Severe,  followed  by  necrosis. 

Male,  set.  27.     Run  over  by  express.     Primary  amputation  of  thigh. 

Male,  eet.  28.  Run  over  by  engine.  Primary  amputation  of  leg ;  also  sus- 
tained compound  fracture  of  vault  of  skull. 

Male,  eet.  56.  Fall  in  street.  Fracture  into  ankle-joint,  with  dislocation  ; 
division  of  tendo-Achillis ;  secondary  amputation  of  leg ;  sloughing  of  flaps ; 
suppuration  in  knee-joint;  amputation  of  thigh.     In  hospital  141  days. 

Male,  aet.  39.  Considerable  comminution  of  tibia;  small  wound.  2nd  day 
delirium  tremens,  8th  day  haemorrhage,  requiring  amputation  below  knee;  9th 
day  after  amputation  haemorrhage  from  popliteal,  which  was  ligatured ;  delirious 
for  some  time.     In  hospital  94  days. 

Male,  sat.  36.  Engine  ran  over  left  leg.  Primary  amputation  of  leg ;  slight 
secondary  haemorrhage  8th  day ;  developed  pleurisy  when  nearly  well. 

Fatal  cases. — Male,  aet.  29.  Secondary  amputation ;  pysemia.  See  special  table- 
Male,  set.  40.     Smash  of  both  legs.     Died  from  shock. 

Male,  aet.  75.  Smash  of  tibia  and  fibula  into  knee-joint ;  laceration  of  lower 
part  of  thigh  ;  primary  amputation  of  thigh.     Lived  4  days.     Enlarged  prostate. 


386  1881 — Surgical. 


APPENDIX. 

The  following  more  important  injuries  occurred  as  complications,  and  are  not 
enumerated  under  above  headings,  which  only  include  those  admitted  for  injury 
under  which  they  are  grouped  : 

Concussion  6 ;  fractures  (compound)  of  skull  2 ;  inferior  maxilla  2 ;  clavicle  1 ; 
ribs  11 ;  radius  and  ulna  3 ;  radius  6,  1  compound ;  ulna  2  ',  femur  2 ;  tibia  and 
fibula  4  j  tibia  1 ;  metacarpal  (compound)  1 ;  fingers  1 ;  dislocations,  clavicle 
from  sternum,  1 ;  head  of  fibula,  with  rupture  of  quadriceps  tendon,  1  j  injury  to 
chest  5 ;  abdomen  7,  in  1  hematuria  ;  1  rupture  of  liver  and  kidney  j  rupture  of 
urethra  1  (pelvic  fracture);  wound  of  wrist-joint  1;  synovitis  of  knee  7;  of 
ankle  5 ;  of  wrist  3. 


1881 — Surgical. 


387 


« 
n 
E-t 

►h 
O 

w 
02 


•us 


en 

8 
0) 

0) 

a 

en 
S 

3 

cj 

1 

d 
0 

a 
'8 

a 

9 
00 

b 
S 

a 

ks 
-9 

O 

3 
O 
DO 
er. 
3 
." 

13 

a 

OH 

O 

*a 

.3- 

0 

15 

oved. 
wed   bjr 

OJ 

b 

-d 

3 
es 

13 
OJ 
b 

O 

"o 

CJ 

;ion,  re- 
sac  dis- 
s  before 

i 

a 

s 

■^> 

2 

"3 

b 

a 
a 

5 
u 

d 

.2 

OJ 

s 
« 

u 

p 

b 
a 

OJ 

d 

a 

CJ 

a 

01 

en 

en 
*B0 

O 

3 
13 
A 

€ 

,2 

0J 

°b 

3 

O 

d 

b     «*     03 

..."■    — 

0  a  « 

013,3 

■^       br 

a  l^ 

.2  "3  'd 

«  a  a 

OJ    0    o3 

-a  t3  _. 
r3-2  3 

03   eS    3 

d  bS 

OJ    r°    "OJ 

oj  13   w 

3 

3 
O 
EH 

00 

Tt 

0 

d 

a 

ft 

3 
O 

"3 

3 

"d 
3 

be 

>d 

3 

a 

'3 
sj 

ft 

^ 

OJ 

a 

M 

0 
9 
J3 

3       0 
-B3.2^ 

3  _6B-g  ^ 

a  -g  0  3 

hog  "> 

r3  be  g'd 

0   3   £   a 

_!   "   0         cS 

TJ    OJ    u 
CD    _           >>  00 

b    CD    oj  i-r<  -^ 

K  2  at-- 

CJ 

OJ 

d 

e3 

■d 

OJ 

d 

3 
_bp 

St 

3 

■d 

OJ 

CJ 

OJ 

en 

0 

3  t3 
oj 

b     "> 

OJ  1-3 

r3      OJ 

•T3  ■*£ 

s  2 

en    bD 

a  0 

»     CJ 

3  -3 
O    O 
0    3 

..a 

cj     » 
3  M 

»J 

oj  ^3 

.1  § 

rH' 

0 
sj 

8 

-fi 

b 

^d 

CJ 

sd 

en 

.3 

a  .«  0 
■S  g| 
.2.93 

•d  -g  > 

_,  oj  a 

3-P   0 

2  a  0 

3  -rt 

atg-3T 

.»  u    OJ 
"d   4>   £     • 

OJ     b    2     ° 

bes  a. 2 
§  2  2  1 

rJ    H  ^    b 

0  ft  d  ft 

*>        08  O 

S     ^ftrH 

»  X3    Sf  OJ 
OJ         .elf 

ad-g'S 

1 

,a 

'■fa 

M 

b 

OJ 

a 

0J 

b 

CD 

a 

OJ  ,3 
O    > 

be 

»d 

5 

QQ 

S.-3  "^3   g 

f-4   CU     GJ 

rd 

a 

3 

0 

> 

0 

a 

bD  2 

"8 

oj.2  S  a 

-+3   <— <      CQ      rf 

ft 

ft 

0 

3    3    e8 

<3  a 

o 

O 

<£ 

so 

1—4  1— 1  OQ 

cX! 

rH   rH 

M 

3 
pj* 

d 

'J 

d 

d 

ddd 

d 

d« 

Q 

OJ 

OJ 

.— «             OJ 

"ai 

CO 

OJ 

OJ 

SrS 

5 

C/3 

CD 
U 

o 

0) 

J 

IS 

CJ 

0 

.s* 

"ft 

"oj 

CJ 

p 

CD 

9.®   0) 

■£21* 

OJ     oj  •" 

b    C    (3D 
oj  W    b 

1  * 

CU 

rH     OJ 

:— 1  u 

•a  2 

oj  3 
a 

R 

•n 

~ 

rd 

>d 

OJ 

OJ 

"3 

a 

d 

ea 

0 

3 

oi 

0 

d 

I 

S, 

b 

O 

OJ 

a, 

„  „  „ 

b 

3 
0 

ft   . 

^ 

« 

o 

■s. 

0 

■y. 

^ 

0    " 

cj 

H 

r 

0 

W 

C 

0 

H 

o3 
02 

<U    03 
ShCB 

^  a 

C  "3 

en 

en 

b 

CO 

b 

en 

3  "3 

3 

>> 

3 

;     ;h 

CO  so 

O 

e3 

O 

*     "   03 

>-  a 

3    C3 

r3 

t3 

rd 

13 

n-s 

"* 

3 

01 

U3 

CM 

CM  i-l  CM 

■<* 

CM  -^ 

01 

, 

,_, 

1 

C3 

Ja 

e3 

eo 

a 

42 

•+3 

o 

-4-> 

00 

eo 

•a 

a 

a 

d 

b 

1 

V 

0 

a 

-      .   OJ 

S3 

«    OJ 

be 

d 

a 

OJ 

"    "  bp 

OJ 

bD 

a 

© 

CM 

10 

J>io  0 

O 

eo  0 

o 

rH 

r-l  O 

rH 

rH  O 

60 

< 

o 

H 

eo 

00 

HCOtJI 

0 

Oi 

as  co 

0  g 

CM 

CO 

CO 

T?   CM    rH 

w> 

rjt  -^ 

a 

03 

N 

3 

M 

3 

s^" 

N 

s's 

H 

A. 

| 

OJ 

-  ! 

b 
OJ 

03 

al 

1 

3 

3 

3 

a 

b    c3     ' 

a 

3    g 

o 

a 

0 

^2  a 

-i-3 

0  0 

o 

r<=> 

03 

u 

03 

03 

en    0 

O 
O 

-33 

03    O 

J 

O 

rH" 

OPM 

M 

J  ^ 

d 

rH 

CM 

CO 

"* 

occu> 

00 

os  0 

rH 

S 

rH 

rH 

388 


1881 — Surgical. 


a 

&3 


w 

n 
< 

EH 

1—1 

o 

w 


s 

3 

§ 

Large   intestine ;    taxis  successful  three  days 
after  strangulation  commenced ;  symptoms 
continued ;  incision  over  hernia  carried  into 
abdominal    cavity ;    intestine    gangrenous. 
P.M. — Hepatic  flexure  of  colon  attached  to 
wound  and  forming  artificial  anus ;  localised 
peritonitis ;  pneumonia. 

Very  large ;   hernia  could   not   be   reduced. 
No  P.M. 

Intestine  dark  coloured,  with  greyish  mottling; 
dull  ;   lymph  in  sac ;    retention   of  urine. 
P.M. — Gangrene  of  intestine;  perforation; 
peritonitis. 

Kind  of  hour-glass  contraction  of  sac;  intes- 
tine  congested  ;    secondary   haemorrhage  ; 
incision    carried    into    abdomen.     P.M. — 
Regular  examination  refused ;  haemorrhage 
probably  from  veins  of  cord. 

Intestine  black,  but  polish  good ;  sac  removed;: 
peritonitis ;  incision  carried  into  abdomen  ; 
gut  improved  in  appearance  ;   left  close  to 
wound ;  large  drainage  tube ;    seven  days 
after  first  operation  faecal  matter  passed  by 
wound ;  rigors ;  tumid  swelling  below  um- 

3 

F>5 

fi                                   Q       O           «'                     Q*                          ft 

1 

s 

33 

a> 

o                            • 

o                                                                   .ir                     " 
o                            „                 „                p,                   g 

&                                                             "                                                                         <U                                           a) 

■H                                                                           o                        a 

a 
w 

"a 
J 

H 

H 

m                                                        <D                      TO              CD 

""a                           a       as  2       a 

£  o                            o       «-£       o                    1                         1 
H  «                            2      H  S       2 

>-                                                                                             W                                    35                      TO 

ra                                         03                 P<       CO 

o.2 

S3 
ffl  bo 

5§ 

03                                                                                 CO    •                                                            CO 

tn                                                          CO            S*                    CO                                   t-i 

a                             >*     ss          >>                 a 

O                                                     (3           O                  CO                                 O 

o                               eo      -*          eo                   ■■#                       i> 

CM                                                             CM                                                CM 

a 

M 

3 

Q 

co                                        ^5           co                   rS 

b                                    a          £                 a 

«                                                          CXI              ®                            60 

<■"->                                      c           ^                  a 

O                                                    O           <=                 t?                                 O 
CM                                                    CM          O                                                    O 

Ui                                                    •*?          l-H                 35                               CO                                      M> 
■^                                                    t>                              CO                               02                                 ,     CO 

M 

CO 

s                  s    a      a           s             a 

o 

p. 

3 
O 

O 

s-t                                           a; 

1                     1 

1j                                                      TO                                                                  -2                                       * 

jo                                 a                   W 

6 

CM                                             CO        •>*               »0                           CO                                i> 
rH                                                    rH          r-H                 i-H                               rH                                      rH 

1881— Surgical. 


a  <s  >>  g  .13 
2  *  -  ■£,  S 

T3  '3 

-3  -fi  j§  _  5 
«.-e  *  g  9 


0)  -rj    O 

CD    O     <V 


a  * 


91 


CO 


s  a 

>>  3 


5s    cu 

*■  a 


■ 


br  o>  ^ 
JP  be  s  •£  o 
.2  j  —   fl 

.2  I  ^     ^ 

"g  a    •  S  » 

£a     «| 

CJ    CD  -*N   w 

■*      a  <m 
§■3-8 


•3  Oh 

£  I 
2    • 


« °  s 

o3  T3    a) 


a  c 


S  o  SMS  5- 


,fi  «C  .3    eS    cS 


V  ri     •  — 


a    5 


o 

CO 

r3 

T-J 

-<-> 

o 

ja 

«4-i 

Ml 

a 

a 

o 

0 

09 

CS 

a 

d 

u 

b 

Ah     WW 


a) 

£>  .£> 

u 

S 

3 

■5  ^3 

O) 

cu 

P3.P3P3      p4tfP3P3      P3.P3P3      OOG««« 


I    I 


°  .2 


o,  a 
WW 


I    I 


^<       JZ        o 

o         o       .5* 
o        O        S. 

tn  CV.    Vi  ex.    ST 


H      H 


H        t3 


1  8^ 

is       fa 
o  —  o 

a. a  a 

••>    oj     ... 

Oti     -J 

o  ^   o 


o    co    cj     5    :  J 

1-1  "S1"1  H 


-  ol    O 


>>  »  >j  a 

03        «   5j     o 

•3        T3  J3 


•>#  CO  CM         ^NHOO        00  CM  rH 


,1 


be  9 


■* 

rH           l-H 

■*  O  (M    O 
CM        O 

CM    On 
r-l  O  ^H 

O  CM               ON 
O                     i-H 

1*1 

■*ji  ^f  CO 

05  O  i-l  -^ 
CO  O  CO 

OlJlOO 
fl   CO  ^  ^ 

NHtC  tDiO(M 

3 

Sgg 

SSSS 

££S 

3  £  3  S  ri  N 

Messenger 

Labourer 

Dock 

labourer 
Labourer 
General  de 
Painter 
Child 

Labourer 
Shoemakei 
House  dec 

rator 
Painter 
Printer 
General  de 
Labourer 
Married 
Ostler 

OOH 
rl  CM  CM 

N  (O^liS 
CM  CM  CM  <M 

cot- 00 

CN  CM  CM 

OlOHNcO-J 
CM  CO  CO  CO  CO  CO 

VOL.    XI. 


27 


390 


1881 — Surgical. 


*« 


8 


~  5 


GO 


+3 

>, 

a  .a 

03 

h 

.a 

»o 

03 

S3 

P 

S 

o 

10 

-^ 

-a 

•  to     ■ 

a       »•=  £ 

o  a  -S  a-a 

"S  56  -  £  .. 


-O  Ph'  •= 

03         .- 

~\  a  *  o 
<R  o>3  a 


'  'S  «  x  ©  ° 

;.a  |^3--S  g  3.3 

;  -13  r  a  *  §  a  > 

i  p  a  a.  "a  -a  eo  a 


t>  Cm 


g  -w    p 


2  o< 

a  s 

?  o 


03    5 


.5  a ' 


>J     03     w     P 

%  <*ri  a 

5  «t-    ?  ,±4 
T3    °    o  — 

*  5  §  a 
—  02  x 


o;  ^3 

«  a 


,  -  T3       c3  g 

-a  'a  S'n-i  5  'S  ""  ° 

0)  .a  cb  t3  s  a 

£  a  a  a,  03  ^  0..2 

O    ~      «    ^      2"".'"      PH 

-w  ^,a  a  S   " 
a  £  >  a  •'  w 

c  .g   £^   |  -43  "£  8 

aas-^o«i~o 
aj;aaqa33T 


O  "- 


S3 

.     13 
33     CO 

■  !-§ 

•R  -t3 

.2  3  » 

■*->    Cu  W) 

S  -  2 

S  >  o 
°  a  * 
£>5  S 

•S    !-    03 


a  3  03 


■S  B-«  53 


03 

a 

a 

S3 

2 


-  «  a 

=g    to    o 

M     O  ^3 


-  -a 

03    2 


w 


a  a  >>-  a 


a  a  o 

_     03     03 
ij     O     to 

a  u« 

^13'^ 


s 

d 

o 

ooo 

o 

o 

o 

Q 

fi 

Q 

M 

03 

03 

03 

03 

03 
"03 

o 
o 

03 

03 

03 

o 

43 

Ph 

Pi 

Ph 

0H 

CL     1        1 

1 

1 

1 

1 

a 

1 

3 

03 

03 

03      |       | 

1 

1 

1 

1 

0) 

1 

O 

a 

o 

o 

03 

W 

03 

03 

a 

a 

a 

W 

w 

W 

O  ■*  so 


a  ^ 


en 

< 

00 

WQON 
C>0  rj>  CO 

o 

OS 

to 

N 

-* 

M 

03 
0(3 

fe 

&h 

N  &J  fc 

a 

Eh 

ri 

fe 

ri 

fe 

a 


ws 


CO        CO 


a 


1881—  Surgical.  391 


e  o  t,       s*       **  o  2       fl  p* 
o  p,         ■«       s  "3    .  J  7, 


«  S 
—  CO 


05  *c3 

*<  . 

3-=« 


<£*-h 


§    <bOi   O 

-^3,3        «■•        >Q.a>cD(a  -t? 

9  5  o  ••<"^2      ^  p-*a  £< 

O    ^   "**;           ««     ...    B  m 


fl  ° 

.2-ri 

a 

j    1)7 

p, 

cag 

3  *C 
*0 

0 

>   ^  Oh 

t4      * 

S  9 

fc  g^^  a^       g  a 
E  ^>«  3,  u"2  s-5  «*'«'H  J!       3 '-3 

«jS^    OflT"    C    OOfi    g    P.3  *fl<fl 

o     a  £  d 

OP  d        pis     «  d     d     dp  « 


fl 

-H  "9 

o 

o 

•2 

*fl    03    ?■» 

o 

■^  Pa 

CD 

^= 

CO 

fl 

«  a  i 

O    s    91 

S 

fl.S  a 

►» 

o 

fl 

aceic 
inte 
oot  0 

S 

'fl 

03 

tflcM     «H 

3  a 

>> 

fl 
CD 

> 

a  . 

*°.2  9 

-gfl 

OJ     Co     cu 

-ta 

3    P    3 

Z* 

H 

duci 
rang 
om 

Ph 

o 

-"■     at 

*t!  y 

to 

03  *0 

.2     1     CD 
1     fl 

fl 
a  as 

.2  | 

— •  a 
S5* 

ernia 
P.M 
pass 

-+3     CD 

g    Dh 

P> 

Ph 

o 

ph£ 


Ph 


I       I 


r^  ^  3  .&  fl 

w •«*  pa g      pa 


"Q 


eg  a  fl 

9       »  3:2 

Pi         O      *:  3  Tn 


M 


H 


a 

g     OJ 

P  CO. 


I      I  I 


&  a 


to 

!-H 

i-H 

Hjl 

f-H 

<N  05 

i-h 

05 
CO 

o 

CO 

CD  <* 

■^  co 

CO 

CD 

Ph 

g 

S 

P-h6m 

Pk* 

CD 

CO 

ift  o 
CM  CM 

10 

CD 

U5 

■*JI  -* 

a 

fe 

p<Jb3 

^ 


03  eg  «         f"    B  " 


SPECIAL  TABLE  II.— PYEMIA. 


1.  Male,  set.  29.  Jockey,  struck  leg  against  a  post  whilst  racing.  Trans- 
verse lacerated  wound  below  tubercle  of  right  tibia,  comminution  of  that 
bone  and  a  double  fracture  of  fibula  at  same  level,  skin  stripped  up  from  wound 
down  to  fracture;  washed  out  with  carbolized  solution  and  dressed  antisepti- 
cally  ;  some  sloughing  followed,  and  on  10th  day  haemorrhage,  temperature 
falling  to  97'2° ;  amputation  of  thigh  in  lower  one  third  done  under  spray  ;  8  days 
after  amputation  slight  rigor ;  temperature  103*8°,  and  an  hour  afterwards  105-4°, 
next  day  vomiting;  3  days  later,  discharge  from  wound,  slight  and  granulating 
surface  pale;  tongue  brown  and  dry;  on  evening  of  3rd  day  after  rigor  salicylate 
of  soda  commenced,  and  gr.  xx  every  four  hours  given  ;  8  doses  taken,  but  no 
appreciable  effect  on  temperature ;  another  rigor  followed  after  fifth  dose,  and 
temperature  ranged  from  102-6°  to  106°,  until  19  days  after  amputation,  when 
patient  died,  typhoid  condition,  hepatic  pain,  and  pericardial  friction  having  been 
present  during  last  4  days  of  life.  P.M. — Suppurative  phlebitis  of  femoral  vein, 
pericarditis,  infarcts  in  lungs  and  abdominal  viscera.     No  union  of  flaps. 

2.  Male,  set.  12.  3  days  after  a  fall  on  the  ice  complained  of  pain  below  the  left 
hip  ;  was  admitted  2  days  after  symptoms  commenced,  delirious,  but  sensible  to 
pain,  thirsty,  face  flushed,  dry  brown  tongue,  temperature  of  103°,  pulse  and 
respiration  very  hurried,  slight  occipital  headache,  a  tender  red  spot  over  upper 
part  of  left  rectus,  slight  fulness  below  left  hip,  and  great  tenderness  below 
trochanter  major  on  that  side;  superficial  redness  over  right  shin,  and  tenderness 
over  upper  part  of  tibia  and  fibula,  with  possibly  a  little  effusion  in  knee-joint; 
thrill  over  precordial  region  but  no  friction  sound  ;  linear  osteotomy  of  left  femur 
in  position  of  greatest  tenderness  gave  outlet  to  about  1  drachm  of  pus ;  similar 
operation  on  right  leg,  no  result ;  temperature  fell  to  97-2°  and  pulse  to  100  in 
3  hours;  slept  quietly  and  awoke  free  from  delirium.  Next  day  temperature 
again  103°,  falling  to  99°  after  change  of  dressing ;  delirious  at  night,  and 
abscess  2nd  phalanx  middle  finger;  later  frequent  vomiting,  drowsiness,  sweating, 
pulse  130;  antiseptics  left  off,  stimulants  and  quinine  given;  abscess  in  left 
rectus  incised  on  3rd  day,  temperature  from  103°  to  105°.  5th  day,  almost 
unconscious,  left  hemiplegia,  marked  pericardial  friction,  general  riles  in  chest, 
swelling  and  redness  over  right  radius  and  left  ulna,  effusion  into  right  ankle, 
with  swelling  over  tibia.  No  rigors  during  illness ;  no  albuminuria ;  died  6th 
day.  P.M. — Acute  osteomyelitis  of  left  femur,  pus  in  tissues  round  knee,  also 
in    lower   end    of   riglit    tibia,  pericarditis,  pleurisy,  points  of  suppuration  in 


1881— Surgical.  393 

lungs  and  kidneys,  recent  intussusception  of  small  intestine,  slight  excess  of 
fluid  in  ventricles  of  brain. 

3.  Male,  aet.  7.  No  injury,  quite  well  with  exception  of  broken  chilblain  on 
left  heel,  which  caused  him  to  limp  4  days  before  admission ;  same  night  was 
hot  and  feverish ;  for  one  day  swelling  over  inner  side  of  left  knee,  which 
rapidly  increased,  spreading  to  thigh  day  of  admission,  when  the  temperature 
was  105-8°.  Swelling,  oedema,  and  slight  redness  of  surface  from  above  knee  to 
foot,  great  pain  and  tenderness,  with  apparently  phlebitis  of  right  saphena  vein, 
double  pleurisy,  and  one-sixth  albumen  in  urine  ;  no  inflammatory  signs  about  heel, 
where  there  is  a  small  sore  ;  delirium  during  night,  noisy.  Next  day  fluctuation 
above  and  to  inner  side  of  head  of  tibia ;  incision  made  and  pus  found  behind  the 
bone,  counter-openings ;  continued  delirious  but  could  answer  rationally  if  roused, 
vomited  3  a.m.  next  day  and  died  soon  afterwards.  Temperature  varied  from 
101 -2°  after  incisions  to  104-6°;  no  rigors.  P.M. — Periosteum  elevated  for  an 
inch  or  so  over  posterior  surface  of  tibia  near  upper  epiphysis,  and  there  was  pus 
beneath;  recent  ante-mortem  clot  in  the  femoral  vein,  pleurisy,  flaky  lymph  in 
effusion,  pyaemic  infarcts  in  heart,  lungs,  kidneys  ;  other  parts  fairly  healthy. 

4.  Male,  aet.  66.  Admitted  with  hard,  brawny  cedematous  swelling,  without 
fluctuation,  involving  nearly  whole  of  right  side  of  neck,  chiefly  posterior  part, 
which  had  been  coming  on  3  weeks,  with  much  tensive  pain;  had  had  much 
family  trouble  before  that;  knew  of  no  cause.  Incision  made  9  days  after,  letting 
out  a  little  pus.  14  days  after  incision  temperature  rose  to  105*4°,  and  right  ear 
became  red  and  swollen;  there  was  also  some  phlebitis  of  right  leg.  Next  day 
had  two  rigors,  and  temperature  varied  from  99-4°  to  1042° ;  pain  in  calf  of 
each  leg,  and  also  in  wrists,  followed  by  swelling  and  redness  in  each  situation. 
17th  day  after  incision,  delirious  ;  another  rigor ;  slight  diarrhoea.  18th  day. — 
Temperature  varied  4-5°.  20th  day. — Distension  of  abdomen  and  retention  of 
urine;  no  discharge  from  wound  for  7  days,  but  looking  well,  and  is  not  offensive. 
21st. — Conscious  at  intervals ;  increased  distension  of  abdomen;  slight  diarrhoea 
continues ;  motions  passed  involuntarily ;  mouth  and  tongue  dry,  and  covered  with 
black  sordes ;  much  rattling  in  chest.  Temperature  before  death  1022°.  P.M. 
— Pus  in  right  shoulder  and  wrist-joints ;  softened  adherent  clot  in  right  femoral 
vein  ;  hypostatic  congestion  of  lungs ;  no  internal  deposits. 

5.  Female,  aet.  55.  A  month  before  admission  a  swelling  appeared  over  back 
of  neck,  and  a  week  before  admission  had  been  discharging ;  large  carbuncle 
over  left  side  of  neck  and  back  ;  much  of  slough  already  separated  ;  temperature 
104,°  passing  much  urine,  sp.  gr.  1021,  containing  sugar  and  albumen ;  no 
rigor;  breathing  hard ;  temperature  varied  from  102-2°  to  104,4°.  Lived  4  days. 
P.M. — Peripheral  pyaemic  infarcts  in  lungs  and  localised  pleurisy  corresponding; 
viscera  softened,  but  no  recent  disease;  rheumatoid  arthritis  of  knees. 


SPECIAL  TABLE  III.— ERYSIPELAS. 

(Developed  in  Hospital.) 


1.  Male,  set.  36.  2  months  after  removal  of  part  of  lower  jaw  and  application 
of  actual  cautery  for  recurrent  epithelioma;  recovered  from  erysipelas,  but 
died  day  after  2nd  operation  for  growth  6  months  afterwards.  Highest  tempe- 
rature during  attack  102'6°. 

2.  Female,  set.  65.  2  operations  for  sarcoma  of  leg.  19  days  after  2nd  opera- 
tion. 1st  attack.  53  days  after  2nd  attack,  and  91  days  after  the  3rd.  All 
slight.     Cured. 

3.  Male,  set.  27.  43  days  after  incisions  into  abscess,  developed  in  connec- 
tion with  sarcoma  of  neck.  Lasted  4  days.  Ultimately  died  from  extension  of 
growth  and  sloughing. 

4.  Male,  set.  45.  9  days  after  removal  of  lipoma  of  neck.  Duration  18  days. 
Cured. 

5.  Male.  set.  11.  26  days  after  removal  of  congenital  cyst  of  chest  wall. 
Lasted  4  days.     Cured. 

6.  Female,  set.  26.  Erysipelas  of  face  came  on  18  days  after  operation  for 
ruptured  perinseuin.  No  affection  of  wound.  This  was  her  second  attack,  and 
there  was  strong  hereditary  tendency  to  it.     Lasted  4  days.     Cured. 

7.  Female,  set.  25.  Developed  5£  months  after  incision  into  abscess  of  hip. 
Patient  suffering  from  hectic.     Removed  by  friends.     Relieved. 

8.  Female,  set.  4J.  51  days  after  excision  of  hip-joint.  Duration  20  days. 
Highest  temperature  104-2°.     Cured. 

9.  Female,  set.  19.  5  days  after  excision  of  hip-joint.  Lasted  10  days. 
Highest  temperature  101*6°.  A  month  later  had  abscess  opened  in  groin,  and 
2nd  attack  of  erysipelas  3  months  later,  lasting  7 — 10  days,  after  which  she 
died.     Amyloid  degeneration  of  viscera. 

10.  Male,  set.  8.  9  days  after  amputation  of  thigh  for  disease  of  knee. 
Duration  3 — 5  days.     Cured. 

11.  Female,  set.  27.  1st  attack,  lasting  3  days.  Came  on  3  days  after  scraping 
bone  in  old  excision  of  knee.  2nd  attack  17  days  after  amputation  of  thigh, 
lasting  10  days.     3rd  attack  a  month  later,  lasting  6  days.     Cured. 

12.  Male,  set.  35.  Attack  lasting  9  days.  Commenced  2  days  after  operation 
for  strangulated  femoral  hernia  carried  out  under  antiseptic  precautions. 

13.  Male,  set.  5.  After  sequestrotomy  for  disease  of  tibia.  Notes  imperfect. 
Cured. 


1881—  Surgical.  395 

14.  Male,  set.  13.  Attack  came  on  7  months  after  operation  for  necrosis  of 
tibia,  sinuses  from  which  still  remained.     Slight.     Relieved. 

15.  Male,  set.  47.  Developed  16  days  after  admission,  in  connection  with 
necrosis  of  tibia;  and  again  day  after  a  plastic  operation  on  leg.     Cured. 

16.  Female,  set.  27.  Admitted  with  necrosis  of  os  calcis  and  localised  redness, 
but  no  history  of  invasion.  Day  after  admission  sinuses  probed.  Next  day 
marked  erysipelas,  lasting  until  death.     13  days  after. 

17.  Female,  set.  27.  Incision  made  into  suppurating  axillary  gland  before 
admission,  and  one  into  suppurating  cervical  gland  after  admission.  21  days 
afterwards  erysipelas  of  right  side  of  neck,  spreading  across  face  to  other  side, 
lasting  7  days.     It  then  recurred  and  lasted  5  days.     Cured. 

18.  Female,  set.  36.  Glandular  abscess  in  arm.  Incised  day  after  admission. 
Erysipelas  5  days  after.     Slight.     Cured. 

19.  Male,  set.  36.  Large  scalp  wound.  Day  after  admission,  temperature 
in  evening  103'2°.     Erysipelas  lasting  5  days.     Cured. 

20.  Male,  set.  4.  Contused  wound  over  right  temple.  14  days  after,  slight 
attack.     Cured. 

21.  Male,  set.  6.     Scalp  wound.     3  days  after,  slight  attack.     Cured. 

22.  Female,  set.  46.  Lacerated  wound  of  hand.  5  days  after,  erysipelas  of 
arm  extending  to  shoulder.     Lasted  12  days.     Cured. 

23.  Male,  set.  19.  Bullet  wound  of  hand.  4  days  after  admission.  Lasted  5 
days.     Cured. 

24.  Male,  set.  23.     General  contusions  and  contused  wound  over  right  elbow. 

2  days  after  admission.     Lasted  5  days.     Cured. 

25.  Male,  set.  33.  Severe  contusion  of  foot,  followed  by  sloughing.  25  days 
after  admission.     Lasted  5  days.     Cured. 

26.  Male,  set.  65.  Subcoracoid  dislocation  of  humerus,  and  slight  laceration 
of  skin  in  axilla;  unsuccessful  attempt  at  reduction.  6  days  after  admission, 
preceded  by  general  oedema  of  arm.  In  hospital  49  days.  P.M. — Contracted 
granular  kidneys. 

27.  Male,  set.  21.  Compound  fracture  of  tibia.  Sequestrum  extracted.  2  days 
afterwards,  and  lasted  7  days.     Cured. 

28.  Female,  set.  24.  Extensive  burns.  Came  on  5  days  after  admission,  and 
lasted  till  death,  9  days  after  onset  of  erysipelas. 

29.  Female,  set.  13.  Came  on  2  days  after  admission  for  scald  of  legs.  Lasted 
6  days.     Cm-ed. 

30.  Female,  set.  2£.  8  days  after  incision  for  glandular  abscess  of  arm. 
Lasted  8  days ;  slight.     Cured. 

31.  Male,  set.  42.  18  days  after  counter-opening  for  large  abscess  of  thigh. 
Lasted  13  days.     Cured. 

32.  Male,  set.  45.    5  days  after  incision  opening  up  sinuses  in  buttock.    Lasted 

3  days.     Cured. 

33.  Male,  set.  42.  43  days  after  admission  for  ulcers  of  legs.  Lasted  5  days. 
Cured. 

34.  Nurse,  set.  26.     Face ;  2nd  attack ;  no  wound.     Lasted  6  days.     Cured. 

35.  Nurse,  set.  24.     Face  and  ears.     Lasted  8  davs.     No  wound.     Cured. 


OPHTHALMIC  REPORTS. 


STATISTICAL   REPORT 


THE    OPHTHALMIC    DEPARTMENT 


FOR  THE  YEAR  1880. 


By  A.  D.  DAVIDSON,  M.D., 

LATE   OPHTHALMIC   CLINICAL   ASSISTANT. 


During  the  year  there  were  2647  new  patients  (exclusive 
of  renewed  letters).  246  in-patients  were  admitted,  and  233 
major  operations  performed. 


Analysis  of  In-patients  admitted  during  1880. 


Phlyctenular  conjunctivitis 

1 

Gumma  of  iris 

1 

Gonorrhceal  ophthalmia 

1 

Cataract,  senile     . 

25 

Granular  lids 

2 

„         soft 

8 

Symblepharon 

2 

„        lamellar 

2 

Anchyloblepharon 

1 

„        congenital 

1 

Ulcer  of  cornea     . 

29 

„         secondary 

7 

Pannus 

3 

„         traumatic 

6 

Staphyloma  cornese 

2 

„         anterior  polar 

1 

Adherent  leucoma 

4 

Dislocation  of  lens 

1 

Nebula 

4 

Glaucoma,  acute   . 

3 

Anterior  synechia 

2 

„          subacute 

1 

Keratitis,  heredito-syphilitic 

20 

„          chronic 

3 

„          non-syphilitic 

1 

„          absolute 

1 

Pterygium    .... 

1 

„          secondary     . 

2 

Iritis,  syphilitic     . 

6 

Atrophy  of  optic  nerve 

8 

„      rheumatic  . 

10 

Choroido-retinitis,  syphilitic 

3 

„      not  classed 

4 

Detachment  of  retina    . 

2 

400 


Ophthalmic  Report  for  the  year  1880. 


Tobacco  amblyopia 

1 

Sycosis  tarsi 

1 

Hypermetropia 

7 

Entropion     .... 

.       2 

Myopia         .... 

5 

Coloboma  of  eyelid 

1 

Strabismus,  convergent 

1 

Congenital  ptosis 

2 

„           divergent    . 

.       3 

Mucocele      . 

2 

Paralysis  of  third  nerve 

3 

Lacrimal  abscess  . 

2 

Myosis          .... 

1 

Sebaceous  cyst 

2 

Wound  of  eyeball  (complicated) 

5 

Dermoid  cjst        .         .         . 

1 

„          sclerotic 

1 

Sympathetic  inflammation    . 

1 

Burn  of  eye 

4 

Readmissions        . 

25 

Panophthalmitis  . 

3 



Lost  eyes      .... 

4 

246 

Buphthalmos 

1 

Operations  performed  during  1880. 


{The figures  refer  to  the  number  of  eyes.) 

Removal  of  cataract — 46. 

„         by  extraction        .... 

.     32 

„           „  suction  operation 

.      9 

„           „  discission  for  lamellar  cataract     . 

.       1 

„           „          n           »    congenital   „ 

.       2 

„          „          ,,           »»    traumatic     „ 

.      2 

Discission  for  ripening  cataract  (eyes) 

.       2 

„        after  extraction             „ 

.     12 

Iridotomy             ..... 

.       5 

Iridectomy — 39  : 

„            for  acute  glaucoma 

.       3 

„              „  subacute     „ 

.       2 

„              „  chronic       „ 

.      3 

„              „  absolute      „                .                .                . 

2 

„               „  secondary    „                 .                 .                 . 

6 

„              „  iritis            .... 

6 

„            preliminary  to  extraction  of  cataract 

.       1 

„            for  artificial  pupil  after  extraction  of  cataract 

.      4 

„             other  cases  of  artificial  pupil 

9 

„            by  Carter's  method 

3 

Sclerotomy           ..... 

4 

Division  of  anterior  synechia 

6 

Tenotomy  of  internal  rectus                . 

29 

„        „  external      „                                                    . 

13 

Advancement  of  internal  rectus                         .                .                , 

6 

„              external      „             . 

1 

Congenital  ptosis                .                                                  .                ■ 

2 

Coloboma  of  lid                    .                .                .                .                , 

1 

Pterygium            .                 •                                                                     • 

1 

Rodent  ulcer       .                 .                                                                  • 

1 

Ophthalmic  Report  for  the  year  1880.  401 


Paracentesis  of  sclerotic  in  detached  retina 

Peri  torn  y 

Enucleation 

Operations  on  the  eyelids    . 

Various 


3 

1 
34 

7 
11 


Many  minor  operations,  chiefly  done  in  the  out-patient  room 
(lacrimal  strictures,  meibomian  cysts,  &c),  not  recorded. 

Analysis  of  Cataract  Operations. 

In  the  following  cases  of  cataract  extraction  the  section  was 
made  upwards  in  all  except  Case  19,  where  it  was  made  out- 
wards, and  in  Case  25,  where  it  was  made  downwards. 

In  Case  25  no  iridectomy  was  made  ;  in  Case  27  an  iridectomy 
was  made  for  subacute  glaucoma  seven  weeks  previous  to  ex- 
traction ;  in  all  the  other  cases  an  iridectomy  was  made  at  the 
time  of  the  operation. 

In  all  the  cases  the  pupil  was  contracted  with  eserine  before 
the  operation,  and  in  Cases  16,  23,  26,  28,  29,  30,  31,  and  32, 
this  myotic  was  also  used  twice  or  three  times  during  the  forty- 
eight  hours  following  the  operation.  The  dressing  used  was  a 
piece  of  dry  linen  and  a  pad  of  absorbent  cotton  wool  kept  in 
position  with  a  knitted  Liebreich's  bandage,  unless  in  Column  7 
a  flannel  one  is  stated  to  have  been  used.  Atropine  was  always 
commenced  on  the  third  day,  being  used  once  daily  until  about 
the  tenth  day,  and,  of  course,  more  often  if  there  were  iritis. 

In  the  cases  of  removal  of  cataract  by  suction,  Bowman's 
syringe  was  always  used,  and  the  cases  treated  by  the  constant 
application  of  cold,  by  means  of  lint  wetted  with  ice-cold  water 
and  frequently  changed,  the  pupil  being  kept  widely  dilated 
with  atropine. 

In  addition  to  the  cases  tabulated  below,  5  cataracts  were 
needled,  viz.  2  traumatic,  2  congenital,  and  1  zonular. 

In  one  of  the  traumatic  cataracts  there  was  threatened  suppu- 
ration with  hypopyon  and  increased  tension,  so  an  iridectomy 
was  performed  on  the  day  after  the  injury,  which  completely 
relieved  the  symptoms,  and  it  was  needled  one  year  after  the 
injury  on  account  of  some  membrane  remaining  in  the  pupil. 
All  the  cases  did  well,  but  it  is  impossible  to  give  the  resulting 
sight,  as  the  patients  were  either  too  young  to  take  the  vision, 
or  else  they  did  not  return  to  have  it  tried. 


402 


Ophthalmic  Report  for  the  year  1880. 


»«w 


W 


.2-- 


V 


'•a 

"a  oio 

O   Ml*      • 

a  ii  « 

HCOrl 


»■  -2-c 

<u  c  -3 

"  Hj 

-U     QJ     o 

06  _j 

D 

ks  a 
pat 
anc 

K  _ 

<D 

£  -2  os 

ti  S 

o 

a 

o 

s  H  a 

"5«fl 


a  c 
2  a 


t2  «  *?  -°.  V 


S-2  S 

Rh-13    a> 


oi  »-s 


*8 


ic 


oj    a 

• m  i  ii  I  °£ 


8    O    go 


£?*    BOi 


si 

T3  J3 


3.3  2 


s 

o 

(9 

o 

be 
^3 

CD 

bo 

03 

(H 

a 

OS 

a  _. 

O     (13 

^  a 

o 

a 

a 

08 

fa 

a 

a 

"3 

X! 

a 
o 

2  a 
5.2 

as 


s 


O) 


bo.g 
53   Oi 


o    c5 

.2-2 

03     03 

2  2 

2*  * 


,a  ^ 

C3 

(4 

Fh 

o 

> 

08 

03 

o 

rfl 

TJ 

£ 

a 

B 

^ 

no 


^    fc  T5 

'O  -S 

(-  2 

c3  -a   > 

c«    «S 

&  a  2 

&    £ 

P-  03    3 

&-£ 

a       5 

43     .»  * 

43 

-a    >> 

r«      ... 

t>o  a  m 

T    5    0) 

.S>* 

«H     g     o 


£>  bo 
"3a 
«*.  ©  o 

U  .a 

"3       t'H 


"  & 


•aa* 

•£    Q    e8 


a  ^3 
X3   9.   08    ••> 


0)     01  CO 

•■s  3  .9  g  bn 

o  —  a 

«  ,3  .— i  T3 

t-  +i  «  -i-.  a 

■g  -r  »  a  c3 


>tj 


Ph  O 


3ff 

o 

OH   *> 
O     U  _ 

2^'3 

■+^  ■—    s 


_   to  x  oa 

08  «  S  a 

^^  0J  g 

Dh  03  ^  ,2 


a  s 


ew 


08  _a   at  ^,  ' 


o  a  rs 
60^  ««.2 


43     ,     CD 

S  go 
>       o  o 


*=     CS 


08 


bo  60-M 


X 


•5-2 


IS 


a 


on 


43 

ft  rH 

H  9 


s 


Ophthalmic  Report  for  the  year  1880.  403 

i^ai        01   01  o         01     •   o         01   ©         *->  01   C,  .;S   ^  ©  .  •  s-i  13   !T,   n  M  E 

a Q  co co co O co co 

JB  ID'S  _  ^  <"  o 
I  I  I  II  I  I  *3 .1  S  ^  S  u  •■§ 


— 

01 

A 

^3 

g 

o 

ja 

>» 

* 

.■s 

•1h 

o 

& 

S 

e*H 

fe 

01 

"O     00 

?    m 

13 

01    U 

01     u 

5i 

O 

JJ     01 

o3  -g 

01     03 

^;| 

OS 

01 

.» 

^3 

*ii 

-<j 

2^ 

09 

.«^3 

13 

..-3 

oi  a 

.^ 

01 

g    01 

a  .2 
a  i* 
g  S 

>  o 

lis* 

a! 

-*3     u 

'-5  * 

'£  oi 

-+3  a. 

01 

-w    Ai 

>  « 

§  2 

oi  ■ 33 
K   1 

'C    01 

.2 

-d    2 

J3       O 

a 

j:   o 

oi  2 
H  ° 

,fi  o 

^3 

6Ej- 
K3    03 

P 

bi3i 

a3  os 

bx;  j- 

_b0 

as 

3 

cb 

05 

05 

05 

05 

3  a 

b    O 

3  « 

T3  .£ 

3  o 

13 
C3 

0 

a 

£     01 

01  ~j 

01 

o 

CD 

09 

01 

3  3 

13  'd 

o5 

01 
U    01 

5     U 

^33 

>o 

^ 

a 

&  id 

01 

sd 

DO 
3 
® 

CM 

O 

oi    ^a 

[S     03 

01    * 

bo 

®  a 
o  -a 

a,  oi 
3   <° 
3    •  * 

75 

— 

"I 
.43    eD 

a 

^2 

tfl 

a* 

«h  a 
°  >> 

a  S 

I 

+2 

03 

D-,  a 

p     01 

,a  ■* 

On  13 

05  oi 

6  > 

8i 

be  >i 

bo  t* 

a 

®    ^ 

be  >> 

6C  >» 

01  _i 

s  a 

o 

3    « 

01 

3-0 
|'g 
0 

a  a 

1 

4) 

a 

5 

8 

**  a 

C4-I    O 

§:§ 

d  J3 

0 

s 

> 

=*H 

0 
01 

a 

-3 

'3 

h 

0) 

a 

o  .3 
o 

"-B  a 

a]  ,£) 

3 

o 

a 
.2 
a 

5 

o 
o 

rt  a 

01 

a  'O 

bfi-S  .3 

"2  *a 

01 

bx 

S! 

~g  sh  2:  t- 

T3    P-         3 
-2    -    >>« 

o,  rt  «  o 

s  o 
a<  w 

o    "^ 

oi  S; 

T3~     P-: 

oi         o 
m  «4-i  i3 

—  o    oi 
05           01 

u  -a  .a 
■fi  S  - 

01 

bo 

05 

-a 

■a  a 

O    o 
0) 

a  "3 
,2'S 

01 

cs  ^3 

43     oi 

S  3 

01     •« 

-I 

01 

a  ., 

13 

O  .3 

O    33 

s  a 

3* 

■ 

> 

p. 

05 
U 

r. 

73 

a 

"S 

-a 

at 

^3 

5^ 

41 

12 

o  a 

a  a 

a 

S3 

*a 

a  > 

&       g>  =3"H      -« 

Ph       .3 


--    O 


^.9 


^  E  « ^  °S  -2  g  I  ^-bc^gs 


a  g 


H 

03 

CD 
6                      CD 

CD 

CO 

CO 

CO 

o 

CO 

i         fe 

&h' 

ft 

ft 

ft 

ft 

N 

J 


rg  -S  r3  j  iS  -g  ^a 

Ml    "I    *%  *$    4S        ril      °l 

00  Oi  O  ^  (M  CO  ^ 


404 


Ophthalmic  Report  for  the  year  1880. 


.2  §  g  °  £ 

"S  £P  £  fe  Is 


S  s.S-o 


us  .p  .s  -e  >> 

-13  o  -£  c  „ 

b  a  3  .2  ^ 

S  P    Su    8 

9  c3    ft  «    >, 


1  a 


g  qj 


6,0  „,  US 

'■s'g  is 


_   cs  oj 


S*   rO   US 

a  a 

OJ     V 

a  a 


U  ft-^ 
53  O  • 
U  '-'  to 
-P  O 

*      .    B 


>-B  KJ    o 

!  Sp  ft^ 
>  ;s  a  a 


%j    o    ft^ 

o  oo  s  a 

oj  ft  «J 


0) 


H 


s-  CO 


eo 


.9  "3 


os  a  g 

ED     *     S 

US  -Jo  u 


«3  a 


OJ    03 

I  se-9  "I I 

o  fell    S  |o 

>.2ai     aiSS'SoajaS'g 


1  a  2 '-3 

a»  F  o 


f»>.ii   oj     • 

a.s-g^ 


k  -     0|°. 


os  a 

*  a 


S    S    6C 


"    fe 


^1 
*SJ   *a    5 

'o  us  -g. 

•  B    oo  -w 
£  03 

2  ^  fe 

OJ  (M'g    2 
B         J_S    0J 

3  2  £;2 


-t=   ft 
us  o 

6Dis 


U3    . 

■B  a 


-<    oj 
5^3 


•J--    fcJD        £ 
03  jS  'V 

^  feul 


>B 
.B°>> 

«-  a 

o-g 

=S .5 

u 
«  us 

*  fe 


t_3    6c 


2  sp  a 

bc.S  o 
a  > 
CO 


"3  oioQ 

fe    ll| 

i-H  CO  iH 


>>  03 

S  a, 
5  fe 


2   °  US   S   •*> 
>  u  +3 .2  oj 


.g-S'i  a  o 


ft  o 

■S  a 

O 

4i   ^ 

*  c 

0J    o 

us  * 

'/j  us 

"      °   I    X    >° 


M  ft  m  -c  *§ 

•o  B  ••-  fe 
u2  S      ^  a 

oj         US    >    ** 

<*£?    'fe  § 

c    oo    ••»  03    B 

es  s  a  fe  u2 

03-2   §  •§ 

■8  g  '€  §  - 

°  ^g-a  a^ 


» 5"g  a 


■n  -u  "O    ? 


^  c2 

O    h 

eo  -j  •'" 

u2  a^ 

"T3  -«  "S 

oj    *   S 
oj    oj 


UV  fe 


S4  ^iS 


to 


•0M 


us 

■43 

•-s  a 

9 


•2  fe 


to 


<J 

■aSy 

oo 

CO 

CO 

CO 
CO 

co 

C?3 

1— 1 

CO 

3 

fe 

fe 

fe 

a 

a 

us 
1-1  >° 

US 
«2  0? 

UJ 

p$8 

3 

fe  a 
a 

1-9 

^"I3 

^9 

Ha 

i-s 

i-s 

OO     0J   jj 

go  | 
o 

CM 


Ophthalmic  Report  for  the  year  1880. 


405 


a  -£  a 

cu  1-3  o 

«   »     •  rt 

*?     .«    P."*3 

rt  «  fl  rt 

m   «   £  co 

3>  wit.  g  a> 

CD  L- 

to 


t-»-9 


'oa  a 


co 


as         ej  t3 

o|o  s3               2 

||  S  g  s  •*» 
"  a  §  *  II 

CO    So    &        02 

CO 

"S  J 

, 

cu  S3   t. 

U 

Need! 

5  mon 

afte 

si 

d 

-(J 

o 

<L> 

fl  g 
.2  -2 


■hj  tH 

a  U 

a    S3 

j  a-- 

ge.|»S 

I   "I    £ 

a  CO    to 

Ml 


•a  J 

_co  J 
o  .2 

JLS  "3d 

C 
W 

0)  'ti^ 

«  2  £ 


•a  s  3^ 

J>   S3  -^    w 


Ph  « 
p    Ph 


3~ 


oj  ■— i       a. 

03 

s 

■*>  o       a 

K    U     "".3 

;er 
.Li 

gers 
tter 

•-5 

J3n 

>2  aa  s 

rt^^  a 

rt  d 

CO    o           cu 

.d    « 

1« 

> 
OS 

bc£ 

> 

S3 

UH 

55 

En 

-a 

rs  2 

-a 

H 

«-  d 

fH 

3 

f    01    o 

S3 

Ph 

Ph  23  '-5 

Ph 

d 

F  right  u 
tomy  ;    ( 
of  opera 

d 

-jj 

HJ 

CJ 

>! 

,2      >> 

=4-1 

| 

^ 

4-3 

on  o 

ridec 

end 

u 

d 
o 

-3 

d,2 

H-> 

C 

-^             S3 

h3   fc> 
CJ  ■■"■ 

es 

A 

gd-c 

«  -d 

M 

\t 

£  £  s 

*  fe 

W 

H 

fa 

J?  ° 
a '-3 


-fi  d 

2*2- 

o  P 

*    S3 


>>£ 

o  .3 
T3   P 

d  =s  d 
«   h  o 

CU  >^H 

•>-§  2 
.2d 
'-3  cu  .2 

:££  , 

rd    •--    S 

55s* 


p,d 
«.2 


a>    cb 

•°  2 

o  P 


fa 


i  2 


S3   ag        6c 

£    £  *  T3 

P  -3  p<  d 

o    °  «    S 


-  S-e  2 


r;  d  «h 
°  o  -"^ 


^  CO 

■  ^     r-l  h  ■    CD 

h     g    O     &« 

q-i  hS  .w  .2 
cu  d  d 

jh  T3    cu   a 

2"£  -w'° 

-"  "<    to    S3 


cu    to 

CO     *^* 
CO 

M 

tH       <» 

>3  s3 

i a 

"5  2 
<°  3 

'd  ^ 
*S  6C 


.2  °> 

tH 

13  -d 

HJ 
d     in 

O   eS 

H0     & 

2    Ph 


CD     CU     ^ 

""*  a 


S3-S    S 

&S3  a 

Ph  w  -2 

■e  ••>  d 

■a  t^  o 
.SPo"-S 

S    d    S3 

Oh 
tu-«     «> 

o    °    Ph 

d  3  ^ 

O    h    $    41 

£  —  «S  w 

o        as   cs 


bo 


bo 


-w  o  -d  S  ^ 

"S  o  ^  a  ^  a 

d  be  15  o  £  o 

O  _    £.  M    «  -ra 


>  ~ 


<HO    »    d 


^^2  IfJ 

w  .2  'd  "^ 


'd  d  cd  H  B 
cu  s3  c  eC  o 

•"S  60 1  *  -g 

a  d  ■  »  g 

©  "c  *■"  a  « 


CM 

«o 
co 

o 

<M 

O 

CO 

o 

CX) 

fa 

fa 

3 

fa 

3 

fa 

fa* 

f 

rH 

HJ 
P. 
« 

CO 

43 

-;  ^ 

h^  IN 

J!  *" 

<!    Ph 
cu 
CO 

i-s  O 
O 

o 

M.  D. 
Oct.  19th 
operation 

by  Mr. 
Davidson 

D.  M. 
Oct.  22nd 

S.  L. 

Oct.  29th 

operation 

by  Mr. 

Davidson 

J.  D. 

Nov.  5th 
(same  as 
Case  9) 

CO 
(M 

CM 

\a                    co 

CM                             CM 

00 
(M 

VOL.   XI. 

28 

406 


Ophthalmic  Report  for  the  year  1880. 


•oji 


CO  l-S 


03  ^n 


^ 


hS 


«H  TJ    ... 

ai  a>  _. 

^h    OS    o 


o  g 


0Q 


W 


co  =   g  <D 
>  5  »   9 

CO     ft=H     O 


13    03 

.2  g  ^      ,2 


3  £  co 
8  £  " 

••.CO  , 


O     *■<     W 


S   &c  ^"-§ 


.3  a 


CM 


c3 


e!    "     >-> 
5  T1    CO 

2  .£  df 


.a  3 -a 

:^  a.s 
!  fe-2  a 


co  -^3  .H  <S 
flu         03 


&   =« 


bo -^3  •"  «n  so 

OS    o  03    CS 

C   *3  -e  co  S3 

^5|   &  3^2 


O.K. 
K*£ 


a 


•3 

•gSV 

CO 

CD 

CD 

CO 
CO 

CD 

GO 

Ph 

P* 

ti 

Pm 

.  u 

03  O 

MM 

CO     M  </J  CM 

<o  CO 

w  s 

g    CO      • 

03     03  3     9. 

M 

^  « 

o 

CO 
CO 


S* 

SQ 


5ss 


"« 


o  ~ 


fl    o  '*    o   >l 


a 


S  J3^  s 


55  k 


K    0 


T3.2      2  S 

g-^'O-'S    03 

p  .-.     CO  Ti     S-, 

r— ;     q     cu     ™     l— ' 
O  '^     go  , — . 

=4-1    CJ  +3     CO  ^ 

"^     ^  a. 

g  ta    ••>  o   o3 

3    «    rt    0)    ffi" 

^3  "a,  o  ■— ■  a 

03  _V  t^  CO    O 
g  03    S.-S.5 


cu         g    « 


2-S  M 

p^*3 .2 

<»  a  2 

£>»    <" 

*    d    ft 
'O    Sj    O 


CO 


01    o     * 
S5    M    60 

°j  '".2 


o> 


-^   a 


w 


s«s  &> 


T3  23 


a 

rS      CO 


CO     CO 

a  co 


&j   a 


Ophthalmic  Report  for  the  year  1880. 


407 


Sn      «SrH 

43  OIO      .   43  OlO 

S3  «lu>  bB  S3  ci|* 


03  S  a 


■^  =i=  -.  "5 


«2    e3 


'  3D 


a-s 

o  o 


■   o  ,r  v> 

s  &-s  a 

'&•§  |  -a  JJ 

S3    S3    tc    O 


P  .£  cJ  5  ' 
S3    S3    „, 


3  o 

■—4     05 


H3   N   co  t; 


£3    S3    5 
g  o  «  q 


3.2 
P-i 


••>     CO 

o  o 

»    h  o 

•_s  *>  S 


43*    & 


O    o    S3 
.2    S3 
<u   »   * 

a  S  » 
Sgg>    ■ 

»  s3  >>-« 

^  g  «  ^>. 

t«o-P    o 
£3    «o    eS   a 


as    ii 
13  43 


•2  a  »  a 

O    •»vrO  ■ — ' 
-S3  "S    2  ^ 


■s-g 

_*  a 


n    0)    S<  ■-< 


c3  a 

a  a 


6C.2 

S  > 


a  ce  to  g  C 
a  ,H  tJ  ns  43  -a 

-  q_,     O  O     CO 

Ji  o  a-*  a : 


C8    S  "> 


a       fc  g  co  a  <» 

OflO    £3  13    o   fe    ^    d 
-tJo>ai£,-«'S3e8ea 

g£  o3  a  Sr 


g2-§ 

o 


S3  a 

CD    g 

-a  o 

*«  P 

d>     1h 

-a  ,2 


43 


a  a 


•a  ,2 


w§ 

wa 

3? 

00 

i-H 

1ft 

o 

CO 

oo 

r-l 

i 

a 

Ph 

£ 

a 

Ph 

J     >lfl     Id        -43 

5-3  a^^^? 


P^  r-l 

o 


Ph'I 

w-s" 


O 


^3  »  _ 

•  a  S 

"'lis 


fin 


STATISTICAL  REPORT 


OF 


THE    OPHTHALMIC    DEPARTMENT 


FOR  THE  YEAR  1881. 


By  J.  B.  LAWEORD, 

OPHTHALMIC    CLINICAL    ASSISTANT. 


During  the  year  there  were  2620  new  patients  (exclusive 
of  renewed  letters).  255  in-patients  were  admitted,  and  252 
major  operations  performed. 


Analysis  of 

In-patients. 

Phlyctenular  conjunctivitis  . 

2 

Cataract,  lamellar 

3 

Mucopurulent  ophthalmia     . 

3 

„         congenital     . 

3 

Purulent  ophthalmia    . 

1 

„         posterior  polar 

1 

Syniblepharon 

1 

„         secondary 

2 

Ulcer  of  cornea     . 

22 

„         traumatic 

2 

Abrasion  of  cornea 

1 

Membrane     after    extraction    ol 

f 

Pannus  from  granular  lids   . 

10 

cataract         .         .         .         . 

7 

Nebula         .... 

3 

Dislocated  lens 

1 

Adherent  leucoma 

4 

Glaucoma,  acute  . 

3 

Anterior  synechia 

2 

„          subacute 

1 

Anterior  staphyloma     . 

1 

„          chronic 

7 

Conical  cornea 

1 

„         absolute 

1 

Keratitis,  heredito-syphilitic 

12 

„          secondary    . 

3 

„         punctata 

3 

Optic  neuritis 

2 

Kerato-iritis 

3 

Atrophy  of  optic  nerve  (primary) 

.       3 

Iritis,  syphilitic    . 

1 

„                 „     (post-papillitic 

I       1 

„      rheumatic  (recurrent) 

9 

Retinitis,  syphilitic 

3 

„     not  classed 

3 

Detached  retina   . 

.       1 

Irido-cyclitis 

2 

Amblyopia  (unclassed)  . 

.       3 

Episcleritis  .... 

1 

Hypermetropia     . 

1 

Cataract,  senile     . 

30 

Strabismus,  convergent 

.       2 

„         soft 

4 

„           divergent  . 

.       6 

410 


Ophthalmic  Report  for  the  year  1881. 


Ruptured  inferior  rectus  tendon 

1 

Entropion     .... 

.       2 

Wound  of  eyeball  (complicated) 

18 

Congenital  ptosis 

.       1 

„       of  sclerotic 

2 

Mucocele      .... 

.       1 

Burn  of  eye . 

.       3 

Sympathetic  irritation  . 

1 

Orbital  cellulitis  . 

2 

„            inflammation    . 

.       2 

Intraorbital  tumour 

.       2 

Herpes  frontalis   . 

.      3 

Lost  eyes 

8 

Miner's  nystagmus 

.       1 

For  partial  union  of  lids 

2 

Readmissions 

.     24 

Trichiasis 

6 



Ectropion     . 

1 

255 

Operations  performed  during  1881. 
{The  figures  refer  to  the  number  of  eyes.) 


Removal  of  cataract — 51 : 

„        by  extraction       ....                                 .48 

„        by  suction  operation 

.       3 

Discission  after  extraction 

8 

Iridotomy 

.     14 

Iridectomy — 41 : 

„          for  acute  glaucoma 

.       4 

„          for  subacute     „ 

.       1 

„           for  cbronic        „ 

.       8 

„          for  absolute      „ 

.       1 

„           for  secondary    „ 

.       1 

„           for  iritis 

.      5 

„          preliminary  to  extraction  of  cataract 

.      1 

„           for  artificial  pupil  after  extraction  of  catarac 

t 

.      2 

„          for  other  cases  of  artificial  pupil     . 

.     18 

Sclerotomy 

.      6 

Division  of  anterior  synechia 

.      1 

Trephining  for  conical  cornea 

.      1 

Removal  of  apex  of  cone  in  do. 

.      1 

Tenotomy  of  internal  rectus — 42  : 

Liebreich's  method     . 

.     31 

Critchett's       „ 

.     11 

Tenotomy  of  external  rectus 

.      2 

„        of  inferior        „ 

.       1 

„         of  superior       „                  . 

.      2 

Advancement  of  internal  rectus 

.      6 

„             of  inferior       „ 

.      1 

Peritomy 

.     15 

Enucleation 

.     36 

Operation  for  congenital  ptosis 

.      2 

„        for  shortening  palpebral  fissure 

.      4 

„        for  ectropion 

.       1 

„        for  entropion     . 

.       1 

Ophthalmic  Report  for  the  year  1881.  411 


Operation  for  trichiasis      .  *. 

„        for  syinblepharon 
Removal  of  necrosed  malar  bone 
Nerve  stretching  for  after-pain  of  herpes  frontalis 
Excision  of  portions  of  nerves  for  do. 


10 
1 
1 
2 
1 


Many  minor  operations  performed  in  the  out-patient  room 
(for  lacrimal  abscess  and  stricture,  Meibomian  cysts,  &c.)  are 
not  recorded. 

Analysis  of  Operations  for  Cataract. 

I.  Extractions  of  hard  cataract — 36. 

Of  the  cases  in  this  table  the  section  was  made  upwards  in 
nearly  all.  In  Nos.  2  and  32  it  was  made  outwards,  and  in  7, 
13,  23,  and  35  downwards.  In  all,  save  three,  an  iridectomy 
was  performed  at  the  time  of  extraction.  In  Case  7  no  iridec- 
tomy was  made,  and  in  Cases  13  and  32  an  iridectomy  had 
been  previously  made  elsewhere.  In  the  greater  number  of 
the  cases  (see  Tables)  the  pupil  was  contracted,  previous  to 
operation,  by  eserine.  This  myotic  was  also  used  four  times 
in  the  forty-eight  hours  following'  the  operation.  In  Nos.  2, 
7,  13,  23,  30,  32,  34,  35,  36,  no  eserine  was  used  after  the 
operation.  In  Nos.  7,  13,  and  35  atropine,  and  in  No.  30 
duboisin,  was  used  before  the  operation. 

With  the  exception  of  Case  30  (in  which  duboisin  was  used), 
and  Cases  33  and  36  (in  which  no  mydriatic  was  used),  atro- 
pine was  always  commenced  on  the  third  day  after  the  opera- 
tion, and  used  twice  daily  for  a  week  or  ten  days,  or  more  often 
if  iritis  set  in. 

The  dressing  in  all  cases  was  a  piece  of  dry  linen  and  a  pad 
of  absorbent  cotton-wool,  kept  in  position  by  a  flannel  bandage. 

II.  Cases  of  removal  through  a  small  corneal  incision  ("linear 
extraction")  and  suction — 15. 

In  these  cases  the  pupil  was  always  dilated  by  atropine  pre- 
vious to  the  operation.  Most  of  the  cases  were  treated  by  the 
constant  application  of  cold  by  means  of  lint  wetted  with  ice- 
cold  water  and  frequently  changed. 

In  Nos.  38,  39,  40,  41,  43,  and  45,  however,  a  dry  compress 
was  applied,  but  atropine  was  always  used  frequently. 

In  the  cases  in  which  suction  was  performed  Bowman's 
syringe  was  used. 


412 


Ophthalmic  Report  for  the  year  1881. 


§  ^ 

.2 

'-±3 

a 

o     . 
'-3  Hs 

'3  « 

action 

irs    of 
knows 
read. 

a  •" 
1^ 

tion 
old 
lens 

%S 

o 

O  ^ 

S^ 

O  rH 

03    .. 

03 

03  r-4 

03 

°3      .    •"  J 

Fh 

^ 

H 

H     >"     .      w 

•+3  ^ 

■P~     C3       . 

«  CO    03    c3 

03   _J      r-l 

"  a  o 

i3  a  03  — 
a  *  °  "O 

fe   II    a  a 

"3 
! 

^3       "* 

^3   ci|* 

S*  r-l 

qH  a 

OS     53 

-a  o= 
a   h 

«    03 

S^ 
CM     U 

d   o3 
A 

IB 

^4  op 

03  C|1. 

03  t-j 

w  l-H 

0J  _ 

<y-(  a 

03  03  a  £ 
o  a 

U              ,03 

*=  ^3  a    . 
««  a  03  to 

to          ct3  43 

03    03 
do     ,    rH 

r«    °l°      . 
03   «l«    bC 

^2 

K 

S(« 

£    II    US 

r«       II      I--!      03 

S  II  -3 

"  t>  <N 

Or»H5 

r>^^3 

■* 

00 

eo 

\a 

1-1 

CO 

co 

CS    O 

a  a 

| 

DO 

6  t-vg 

s  a  § 

A 

a 
o 
•-3    1 

03 

I 

•  ^m  A 

rg      S1   »     * 

t3     a      O     rl 

a 

o 

1 1 

1 

455  a 

CJ 

03 

a 

<a  O, 

H 

r-l  -^  ._  5i 

S 

co  o 

CO 

3 

-M 

CO    03 

-*j 

i  ^  £ 

r»3   t*J 

^•5  s 

—      >-l 

."S  °  o 

^     03 

"tH               'tl 

> 

CO 
CO 

1 

a 

T3rB    G 
oj       n3 

T3 

03  jj 

-«  a 

O    03 

r2^ 

"fc* 

2    ,  a 

-D    03 

U 

o 

3-Sa 

ft 

53 

g 

O     O    M 

, 

«3 

M 

ft  rt  -3 

03 

'ft  -"S 

p  s  § 

ft  a  o 

«H     03 
13    03    O 

3  S-J3 

CO 

4 

o 

fa 

0 

O 

> 

03             03 

.S  ••k'B 

ft  a  a 

O    «    0J 

h  v  h 

p. 

0J 

a 

(4 

0) 
03 

s 

o 

> 

'it 

60 

03 

03 

a 

o 
> 

'u 

rB 

be 

(8 

-^  '-£   bo  o 

03 

^ 

03 

-3 

Eh 

<l 

fe 

OJ 

rH 

CO 

0)           ■      •     ,■ 

M      Wr^ 

en  13    03 

to      i      Q) 

00  rj-J     03 

»o  O  o 

a         ~U    O    ti 

'v    3    D 

a 

T3    £.    ^ 

t3  a  a 

T3    C    U 

a  a  ° 

■& 

£  a  ft 

.a      a  03  o 

CO                           rH       "^ 

b    03  --3 

g  ^  o 

03 

ft 

o 

t-     03    O 

>  ^H     03 
Is     CO  _Q 

■-   a  •- 

03          «i 

>  rC     03 

P-    g    to 

ft  5     03 

gra'S 

P    CO  ,Q 

^    03  js 

o  ..  a 

00 

ft   0)     CS 

03           +2  ,rt    » 

3 

a.     tA 

fta* 

ft  a  a, 

r?    -    S 

SS 

3  —    W 

.*      a-d  s 

g 

s      -3 

-a    a  "^ 

.Sfo  s 

CM     S 

•— 

a  03  2 

4-1     O     •« 

a  03  ft 
o  [2  .£* 

0j3  ., 

s-.a 

-^  9  a  -2 

■Ka 

4 

a 
o 

O 

-t3    >n 

•~  3  5 

-h    o 
4-   -w 
O    03    ~ 

a  ^a 
.2"S 

s  fi"  °  « 
°  o      _a  a 

2  -J  ^  f  D  « 

•^     03     ^     Sh     3 

ew  ft  a„s  J 
o  o  .2  *= 

Fh 
O 

a 

o 
> 

o 

o 

EH 

a 

^2 
03 

.9 

o 
a 

03 

— 1     a     rH     o 

4-i  §  8-e 

_    -.     03  4H     03 

a  a  ^  o  a, 
o  ,2  -a  to  o 

j*3  •w'E 

<*—     t       03 

0)    >,  S 

— .     g     03 
4-1     O     - 

«rg     O 

°     ft  ^ 

cm  13    ""    ft  | 

°  :s  >>  ° 

■P      03 

rH      O               K 

a  a  s       o 

i'-S      »      ^rS 

ft-s  g  s.a 

O^      tt      rH      ft 

i 

w 

►h 

4J    «H    n-> 

s  -  » 

p  -a   r- 

-3--  2 
*  fe  3 

03     03   "t?    co     '" 

1S|II 

o 

|^  2 

O 

bo 
a 

O  **J  --<    (J 

3^  c:  ol 

■go"''    '"  ? 

2«aS§ 
oj  «h  *3  a  tH 

'■§.5  gj 

25  2 

o 

n 

fcc5 

•< 

bo 

S  ^ 

E-< 

a 

1 

o 

> 

13  B  ,2 

•hOj 

S  <d  ca 

i 

1 

1 

1 

03 

a 
o 

l 

o 

•a  o 

o 

03 

03 

43 

a  a 
•a  o 

03 

J3 

-♦J  c. 

a 

a 

a 

a 

-»J  CS 

a 

j-  o 

o 

o 

o 

o 

5S   2 

o 

8 

a 

•a 

fc 

^ 

fc 

K 

03     b 

-a  ^ 
H-g 

ft 

•33y 

lO 

ft 

o 

CO 

co 

CO 

CO 

o 

\n 

■* 

IC 

CO 

CD 

CO 

CO 

s 

a 

N 

fe 

M 

Ph 

a 

c     -J 

H 

.a 

rB 

■HP 

.rB 
"1    "** 

.  rH 

-a 

.  CO 

>-S  rH 

£° 

'"s   a) 

►■»  a 

»-s  p" 

CO  3 

^-    *       rH 

«  oi 

r«S 

03 

o3 

03 

Eh 

1 

°s 

a 

"M     | 

tH 

CM 

CO 

■* 

IO 

CO 

t. 

Ophthalmic  Report  for  the  year  1881.  413 


a 
.2 

'■4J 

o 

action 
;  thin 
1. 

super- 
wards, 
moved 
result 

n 
.2 
o 

-d 
ft 
o 
d 

at 
Da 

>> 

.O 

action 
t  had 
syphi- 
result 

a 
o 

a 

•2 
'■3 
a 
si 

"Hi 

H^    p 

nl    U    O    ... 

§£  2  ^ 

»  cj  5  « 

+3 
S>4 

S   gcd 

»  3 

5  cq 

_2t3"- 

s  ■  *  a 

o  J2  d  «d 

cu  r-4 

-u , 

T3 

>> 

n   ft<2 

0J   r*-. 

-2  ■"• 

to    * 

^0  op 
a>  «|o 

e«    es   o 
>    II    cu 

>  a 

-5^  S.S 

a  * 

&    CO    * 

CO 
43 

a 

o  CN    <o 

a 
is 

o 
d 

03      S3 

ft 
to 

gj    CI,* 

CO     33 

5  op 

gll 

c3   d  t3  *i 
»    >    03   -P 

§ 

P 

S(y 

M 

-3 

s 

^ 

l> 

i> 

l> 

s 

■* 

J> 

-* 

■ti   >i  i   fl 
,2}  IS  £  S 

oj        -S   o3 


2                               ^  d 

_  °s 

-p                                                                      13  S-C 

d                                        q  .a 

«  J                             S  .2  ® 

^                    a-s  a 

as  a 

R  ft 


.2    03 

.O                 3                                      _Z  Frt  -S  03    03 

03                  03                                      'Sfli  g  h    CO 

>              >                             o   p<  o  ft  ° 

Pn           En                        >  ^  go 


03  .2 


COCU  CQi*«  COJ3I  COrrtCD  CO     _l     ••»  i    1     5     id     •  COCD  CO     QJ 

s  -e     3  a  -g  H  3  g  s  3  b ' -a     3  a  «  q  |  -§  a  ®  a  »    a  "3     a  -a 

I  hm  I  I  111  Ir|  §s  §1 1  sjifi  I  gs  bS  ri 

fl^fta^g^  «2|g  cs°a«-§^  fil-S^JB*^  ftSS  ftgS  ft 

o  S  o  o2      -°  o.S  d«H  o-sMoo.s^-"  o^3.a<u'^cSoo,aoOi:o 

£  .-s  «g  j3  .-s  §  I  -s  --s  ^  «  -^•-S's^-cJs  -^3§&sles-E--^^' 


'"O          -v    bi    o  *^ 

S      ^  -2  -§  ,%d 

*    60^  «H  *>  3   »    g 

&C.2      dr2      °13  2                                           >^^-§ 


p  ■-« 


SpiJ  SsS      !  £ 


g       -sacuSgi^  >^gr  g  §  -a 

o      ^^  g ^ u_ 

a  a 
s  a 

°  n  •  ir;  "^  o 

°Ss  s  so  ^  ^e 

3£  »  S  ^o 


s-s 

o 

CO 

CD 

1> 

CO 

CO 

in 

i-H 

co 

Pm 

fe 

a 

Ph 

Pm 

Ph 

Ph 

H 

lJ    t.         W    (.  fe-^i  «<'-'  .*  Hr,03  .    OS         O 


ft 


Q0Oi~  O  i-Hd  CO  ^ 


414 


Ophthalmic  Report  for  the  year  1881. 


"'OP 
T3    O  -"i 


'O  O'" 

g  bc«w  o 

I,       *  » 

P  *  u  © 

-g   •I>+;|  a> 

O    W  fl 

o  u£  ^ 

§.-2  S  S 

U3  .p  «w  ... 

a  o      o  _ 


•9  5  S^ 


&  p  .3 

Pap  *^ 
F-5     <u 


bB  t»  ■« 


a>  us  P  o  P  J? 
fn  a>  m  o  o  te 
•H    p,  Ph  a)  ■«    K 


Ph 


•pa      ■?  ''S  ra 


T3    O 


SV«0  c3    p    !> 

c  a-s^-c  a,1 


o  "S  -S  -^3  o  o 


a>    £  rO 

-P  2  a> 

p  a  a 


P-    to 
P<  a) 

P 


S-P  s? 


o  . 


S  g 

o>  o 
P<'-£3 
o  o 

■S  « 


T3  'P 


a  a. 


a  »*S  Sf9 


1:2  S  ?  « 


O     03  ,p 


S  -C5  ^ 


S  w  9<p 
fe«S  p«-s 

Pn  —  *> 

p    P    P    o3 

a  ,fh  & 

rP      >->   ^   -P      ",CH      P" 

toafl   be  ^   O 
"E  o-2'S  B  »  » 

«*-  •+=  "2  I-    O    P    P 

.s;s  0.2:2  -^ 

p  "o  '      £  -g  .3  g  a 

,.2  £  rS  £  g^S'S 

'-b  .3  :P  "S  •«  •"£   «3   a) 

,2*  ^°^as 


p 

E 

o 

+^ 

X= 

!S-° 

2 

3 

T3 

CD 

o 

hr 

S3 

0) 

H 

.P 

=4-1 

o 

6Dfl 

P    a> 

o  — ' 

p 

H 

.^ 

o 

>1 

a 

IT 

T3 

o 

;-. 

H 

n 

^ 

N 

6f 

,4 

0 

be 

a» 


C  to 

■       .P  >H 

P  iS    P  OS 

".§  P 


,P  be  •» 
be  P  p 
p  -g  o 

Ibop; 


■S  <u  §j 

a  a^ 


Szj 


p  p 

a>   S 

•a  o 

-"  =p 
o 


p  a 


0,    55 


a  a 

■«  -O 


-b  !3 


-b  tp 
-    o 


CO 


-P^ 

-B  5 


•aSy 


lO 


Pm 


Ph 


H  i-i 


^3 

«i  c? 


aiS 

r3 

^1 

.  a> 

Hi 

.,p 

.  i-l 

^bb 
^_ 


Ophthalmic  Report  for  the  year  1881. 


415 


•*  a  T3 
.2  ~ 

cS    £  op 
Oj  43  ei|a 


03    a    ca    a 

5 .2  A  -5 

H  «  a 


a>  H 


a  *->  *-i 
-  <u  03 
5  f±2  -K 


a   2  «   ... 

1:6    S  8     i-H 

PL,     P"  ^ 


03    Tjt 

"Si 

CO     03 

a  <*^ 
1  " 


to 


5.2 


co    ci 

q-  c.|o     , 

§  n  o 


o  a 


13     - 

>  a 


t»>  a 


3   o  I  „ 

>.  03  _a     ^ 


a.^  3 


!  ^  is  3  ^  -g-0 

'  S    ?    4)    Ort 

:  5h  cu  >>  >      ^ 

'  °  £<  S  '3  2  -e 


^•12 


,2  a  ■ 


P"1  £  'to    03  -M 

o  £  2  J|  ed 


ai1.^' 


a  03  o  03 
03  r;  ~  do  a 
3  a- 2-2  § 

„  •?  a  a)  <u  *; 

=4-1    &,  CL|  w  -^    03 

o  a       «-h  § 

Q"-     •«  «i    S    u 
03  wj 


■P   H!1!)    is. 

^H        £1        03 


t< 


o 


&2 


5  s  5 


a  a 
a  3 


i  5?-S  "  -2  £  -3  s  .2 

J2°9-So3o^-So3 

t— I  *J     J^|     (,»»   m*     h! 
.      .-,    3   -M  ?5  W    oj   +J 


»^3    oo 
03  ^A 


a 

s  1.1  § 


-3   f{       :£ 


-*.5 


a  a 


'2'0 


a,  03  a 

S-3 


8.9 


°5  .S  ^5 


by  s 

was 

atien 

a 

a 

ated 
ters ; 
>rue  p 

A 

-t-> 

03  ^ 


o  Ph  a 


DQ 


53 


-g  'O  .o  "o 

>     03  ~    03 


3  c 

2  ,q 


a     03 


00     03 

'H.S 

c3    a 


J3     03  00.-*^      " 

u  a     rP^-^ 


-  «  a  ^ 

a o3       a       o  to  --* 

a  o>  .2  s  ■" 


,IS     H      Q.O 

1  se  'a  .2  p 

.SP  a?     g  S  -SP  2  § 

k  a  -  S  as 


i  is 

p      ^      CO 

Ph        03 

0  •-.  ., 

.2  3 


_,    O    C3 

gMSg 
?  w  a  o 
a-  a  Q3  -j3 

a     03    J3     js 


O     03 


^  ^  °  2  « 


.2  •£  ?<  =H 


si 


o^ 


e3    O 

o  '-e 


2  a 


2  'Eh     O 


3    Oh 


03^3 


4-1   .-h      0)      X    ■*-"    4- 


•-  03  a  a 


g  03  -  .a 

o  -°     03 

a  2  25 


2  .a    c  ° 


P4  3 


-a  a  ^= 
'2  2  0 


«  j'g  s  «j^ 


'H 


'  M 


•r  03 


W 


fc  jj  «a  -g  -s  'a 


f»3    "> 


a     03  03 
03    >       . 

^     DO  03 

ph  a  «■ 

rj     03 


T3     03     a 

S    6C.S 

«     S.    h 

-J  aB  03 
«  P  a  .. 


.9  53  « 

•&     "•  P.45  V^    03 

bc>->6Do  o>  ^  •  a 

■as.|9rtg?.§ 

■w  2-a  g=g  o 


«S 


-S    03 

S^-a^.o-S  tag/ 
«a-?-s  g^l?  o 

^    ^^3    03^    £^^ 


X 


a  s 


>    6X) 


a  a 

03  8 

u  p 

2  § 


o   a 

'a  o 


a 
o 


(M 


a 
<1 


«2  ti 


1  Swail 


^0«£ 


-a 

•     4J 

W  P. 

03 


C_3 

W-g 

a 

O 

CO 

oo 

oo 

CO 

Gi 

oo 

o 
1> 

ftH 

Ph 

N 

Pm 

8 

Ph* 

M 

416 


Ophthalmic  Report  for  the  year  1881. 


^     . 

fl   7 

.2i-5 

.2  a 

a 
o 

a 
o 

a 

o 

HP 

a 

HB 

"3 

3 

"8  CD 
P  T3 

«  s 

**£? 

eo  t3 

00 

^   CO 

co  <xV> 

o  o 

CO   T;J 

es 
CO 

a 

o 

o 

EH 

43 

CO 

d 
-(J 
M 

h3  i-s 

3CD 

43  'O 

«  a 

CO    & 

CO 
43 

a 
.2 

43 

S3 

ft 

a 
cr" 

"£< 
a 
ft 

43 

o 

rt 

43 

M 

CJ 

i-> 

ca 

CH 

s 

CO 

CO 

CO 
r3 

a 

pi 

CO 

ft 

Ah 
fir 

to    oi 

5  <=»= 

^■3 

»c|o 

43      .„ 

"a  ■« 
S  cl 

H    Eh 

Eh 

H-l 

Eh 
09 

ft 

=  1= 

a 

co    . 

'-    a 

K 

43 

ed 

2  II 

1> 

o 

£  II 

n3 
o 
o 

4-J 

o 
a 

09 

b 

II 
> 

43 
CO 

\a 

«* 

CD 

t* 

CO 

a  o 

■     T? 

EO 

kl 

Sfl  » 

H 

a 

.  eo 
°  ^ 

^  o 

CO     n 

c^  ^ 

M 

a 

TS    co 

X 

a 

-J 

O      »rM 

09 

o 

O     CJ  45 

o 

O  eg 

«  p. 
co  o 

CO     >-j 

s  s 

G  o 

hH  43 

o 
a 

Eh 

=+h 

■rt  53  co 

S  «o  te 

C«     J)     F 

•Sto  eo 

o 

EH 
Si 

a 

B 

•*> 

9  ^ 

O     CO 

g<s 

,rH  53    C3 

43   ~      o 

CO     CO    g 

&  ^  3 

09 
43 

=4-1 
r: 

43 

o 

C8 
Eh 

43 

53   o> 

~     CO 

CO    t» 

toco 

Eh 

4H 

I1 

43 

1 

52  >> 

09 

cd 

A  'a 

CO 

0 

ftp. 

a 

&-. 

2  « 
ft3' 

a 

a 

03 

-O 

^ 

^= 

33 

3 

5 

S3 

S 
a 

s 

CO 

CO    2 

g§ 

CO  "-< 

g 

CO 

g 

g 

o 

g 

o 

"E  53 

H 

•«  pS 

•«  4J 

a 

a 

s 

it 

2    ►, 

43 

co  •- 

g  ^ 

CO  •-+ 

CO     CO 

rO      >> 

CO 

53   m 

*("•>.  3 

Oh    ° 

43     CO 

5 

■a 

43 

£ 

ft 

I8 

3 

_>5 

CO  ^ 

S  s 

5  ft 

6  a 

CO  1-1 

43      O 

03 

Eh     CO 
O     io 

T3 

a 
a 
o 

=: 

iH 

o 

CO  ^ 
o    ft 

5  a 

&H  'rt 

CO 

CS 

Eh 

O 

> 
c3 
fa 

CO 

09 
Eh 

o 
> 

'ft 

a 

CO    +3 

f-<     9. 

^3      Ld 

Sh    c3 

CH 

o 

ft 

s  g 

»     Co 

n3    co 
3  ^ 

a 

a 

CO 
ft 

r^    "P 

'd 

bn 

09 

-p 

a 

o 

o 

CS  ,£3 

cS 

od 

a 

03 
CO 

'co 

43 

o 

CO 

g 

08 
CO 

a 
_o 

c 
O 

43     ^ 
CH     •» 

«    !>> 

3 

O  43 

c 

C     0) 
O  "^ 

08 
— 
CO 

S3 

cs 
o 

p 

.2 

09 

H 

co 
ft 
O 

CO 

=2 

09 

ft  i#i 

^  g 

o  ,2 
e  "B 

o  ,,H 

^3 
□ 

CO 

d 

CO 

<D 

11 

'^  >— ■ 
c  o 

S  a 

ft 
o 
o 
o 

co 
> 
o 

g 

43 

"B  g 

1-.    o 

o  -^ 
co 

S=r2 

.2  ^2 

"3 
a 

CO 

H 

Cj 

tr 

CO 
Eh 
O 

e+H 
CO 

^3 

CO 

.2 

"«H 

CO 
CO 

&      2 

a  co 

S  •• 
be  >i 

■a  g 

1-.    O 
°  "o 

a  co 

O  t3 

CD 

| 

o 
T3 
43 

CO 

o 
o 

u 
0 

g 
5 
o 

CD 

"C 

O 
Eh 

43 

n 
^j 

CJ 

09 

Eh 

03 
5 

a 
.2 

43 
09 

CO 
O 

& 

a 

1H 

O 

CH 
O 

a 
o 

a 

c 

43 

a 

09 

'£ 

eo  •— 
M  *£ 

co  .3! 

1-1 

o 

"3 

5 

so 

-2  5 
o  3 

2    ^ 

CO 

u 

a 

CO 

co  "-1  •«  •-  a 
S  5  *  'S  -2 
•S  -s  -  8  -s 

43      t-. 

o  — 

43    "S 

-3 
a 

08 

43 

o 
03 
Eh 
43 

M 

CO 

Eh 

a  o 

08  I-i 

.a  co 
a  -a 

4-3 

a 

09 

X 

43 

CO 

x> 

g 

es 

9 

eo 

CO 

B 

1 

1 

i 

| 

a 

1 

a 

o 

> 

to 

1 

1 

1 

1 

o 

to 

1 

■a 

a 

a 

co 

la 

o 

e 

CO 

CO 

a 

09 

^3 

c2 

CO 

a 

8 

to 

o 

to 

8 

09 

-a 

o 
o 

o 

to 

■51 

W 

o 

•aSy 

-* 

<35 

i-H 

»o 

CO 

CO 

CO 

-* 

»A 

W5 

VO 

CO 

ID 

CO 

Ph 

P-" 

a 

fe 

^ 

s" 

F>h' 

.  -» 

M    ft 

oq 

^2 

WcS 

to 

5 

O 
H 

CO 

p 

£ 

a 

-a 
o 

H 
eg 

p 

03  CO 

2  <» 

1  3 

•on 

1     ° 

1     eo 

i-i 

CO 

CO 

CO 
CO 

if 

CO 

eo 

CO 
CO 

Ophthalmic  Report  for  the  year  1881.  417 


3 

a    . 

U 

S'O 

■A 

a>  ei 

OS  rQ 


3     ||  P.  -W  _  *    3rt  _  to 


0)     II      Si  n     II    >« 


s> 


^3  g  il 


resul 
t  sigh 
to  wax 

ri    1>    Pi 

jnt     go 

oung  to 

drawn 

■d 

n  ^r3 

rt    ,-    (i. 

S^  S    -< 

o 

^  °    ft 

* 

<l 

t>    o  =  >    ft 


lO  .  ■*  2  K  a 

rH                  O  ^,5   "  -2 
©  <3 


9  is  <u^ 

a  a  a  a  © 

??  9  a>  r„  «H 


~-  ...  ...^  (J 

m  ^H  ' —  »-50  -— .  i — i  ~_j    ■  - 

?S  oft  o.-S  oft  -|  a 


fa  ""  fa  '"*  'H  fa  fa 


'b 


i  **'*  lis.  ifli  is*1  "ii g  i§ii 

»  -Sao  ~      •*  §«           ^s:u  s~  >>£»  o^'p      «js  s  S  . 

g  g»  5.~  g  £^  ^  S  2     .3  §  -8  ■§  .2  8     11  .s  a     °     •  I « ~  s 

i  ItH  40=1  |i|i  fill'1  ill!  Jlfll 


^2  4. 

=2  §  -a  Si 

■ill     if!     ip    is 


bo1 


W  a  g 

<J-a  5  e  ;  j-,o,a 

c-t  fa  j^  pq 


fa-3 

CO 
1-H 

to 

to 

1—1 

to 

1— 1 

N 

a 

H 

a 

S 

s 

is  -a  -a  ^a  ^a  j 

^W  ^'S  "S  «S  aSS  &SZ* 

^•|  «|  ^|  o|  h,- a  fe-|l| 

tj  00  Cl  O  ^H  CO 


418 


Ophthalmic  Report  for  the  year  1881. 


"a  ^3  43  cs  ■> 


o   a   <" 

"3     d     0) 


ft 


S3 


S-i  ^ 

ol    a 
to    cS 

|  SB 

I  " 


rC  _ej 


o 
G3 

epa 

09 

.rH 

^ 

.« 

a 

o 

fc 

o 

■* 

ej  T3 

•2  «  p,^ 

43  _^,  K"     l«  ea 


M^1  a 
i         a>    _ 

«0  „ 

■        a>  d 

)      •  43  a> 

i  ;d    „   fe<  ft 


o    ft 


?      I      «     M     «    +)  I 


fl| 


.    «    „    g    g 


?,  -a  *  a  9 


^ 


43   o>   o    o 


cq^^H 


o  »-p  e  o 

43    T3      9  .       43 

u   »   2  i!   u 

«  «  a  s  « 


^^  a 

o?  ^ 

«  »3 

e«    '"  ft 
bC  fl    O 

0)    o    fl 

el  J3 
2  53  >> 

S     ftrQ 

cS    o  _ 

a  *-  £, 

S^  2 


2  a 

60  2 


.2  a 


CO 


ii 


o 

a 

O 

a 

43 .3 

43 

r^i 

P    n 

S 

u 

'oS 

-p 

M 

93 
U 

•ji 

o 

£« 
.£    «* 


o>    60  .„ 


o  M  a>  ,a 

9  P  ^  d 
s  f  «  fl 


03    a 


»  o,2 


ft  43.2     » 

ft^  o^ 


a  d  u  !5 

•  -H     .~     ^       03    I— < 

«•-    o  d 

tj  d  "^  •  ».;; 

■a  "  &"g  s 

»  ^  o  Z      ^ 

r5  aj    t,  43         03 

.a  g  43  o  o  a 


U>  a  ft   tc-s  ,§ 


in  -d  "^ 

O    6D  >» 
o   «* 


cs  a 
.2rt  "* 

43      03 


«  S  d 
.2^-S 

43    43     y 


g  C4_i 


o  2  p  - 
.S  d  o  o  o 
>  •-  T3  ^  .« 

M 


O  ,^ 


^-r  .  *  °  oj 

w  b  d  ea  >j  >— < 

§  I  &  a  a  £ 

•2  d  o  o  §  's 


CO     03 

d  d^ 

d  d 
o.2 


?S»p< 


-o  d'S 


W 


3 


•a3y 


5  a 


a 


a 


fe 


&( 


•ON 


a  o  oj  a 


.'d 


"  in 


li_ 


4-3 

r  *  CO 

p-     03 

P 


QQ 


a 


Ophthalmic  Report  for  the  year  1881, 


419 


o 

s 

at 

„a 

P< 

49 

Tj 

a 
> 
d 
3 

M 

u 
o 
o 

3 

a 

a 

"55 

43 

s 

43 

a> 

3 

O 

14 

^-> 

a>  «h 

43 

> 

ri 

be 

cu 

p 

en 

a 

d 

a 

43 

'§ 

2  >» 

cu 

b 

03    O 

O 
1 

43 

^3 

i 

1 

i 

o 

ca  n3 

«  P< 

T3    S 

•a  ft 

o  a 

o  ■-< 

5C  U 

<D 

88  S 

>1(  05 

CD 

to  g 

2 

„£!    <U 

el 

03    a> 

s* 

^   cr1 

o 

O    03 

t- 

>  n. 

a 

o3    o 

Pm 

En 

o 

_>-> 

u    i 

p 

09 

s  ft 

w 

4-> 

2 

Z     Pi 

>> 

*9 

Q 

•°    o? 

'C 

g 

T3  T3 

> 

o 

a 

a 

o 

a  ^ 

a> 

Oi 

§  ^ 

53 

tl   rQ 

QQ 

o 

m    <D 

a 

0) 

fl  2 

u> 

a 

•s    i? 

p 

^, 

•* 

o 

C4_, 

43     ••>"» 

rfl 

a 

•^  fl  s 

60 

0 

o> 

mo  o 

« 

4= 

JO 

g'43  e 

0) 

1 

a 

I 

o 

ft 

0) 

a 

u 
<u 

43 

OS 

H« 

CM 

00 

a 

P=i 

,d 

*c 

.  43 

>•' 

o 

01 

« 

S3 

s 

O 

o 

i-i 

VO 

i© 

PRINTED  BY 
J.   E.   ADLARD,   BARTHOLOMEW   CLOSE. 


JSt.  Stows  gjnspital 

MEDICAL    SCHOOL 


CALENDAR 


PROSPECTUS 


YEAR     COMMENCING     OCTOBER    1st,    1882. 


1882    &   1883 


LONDON: 
PRINTED  BY  WILLIAM  CLOWES  AND  SONS,  Limited, 

STAMFORD    STREET    AND    CHARING    CROSS. 


TABLE  OF  CONTENTS. 


PAGE 

Winter  and  Summer  Sessions           ...         ...         ...  5 

Introductory  Address...          ...         ...          ...          ...  5 

Annual  Dinner           ...          ...          ...          ...          ...  5 

Historical  Notice  of  the  Hospital  and  School          ...  5 

General  Description  of  the  Hospital  and  School    ...  14 

Number  of  Patients               14 

Nightingale  Training  School             ...         ...          ...  15 

Medical  and  Surgical  Officers  and  Lecturers           ...  16,  17 

Lectures  and  Demonstrations            ...          ...         ...  18 

Tables  of  Days  and  Hours  of  At  tinliince    ...          ...  19,20 

Special  Departments  ...         ...         ...         ...         ...  21 

Suggestions  to  Students         ...  22,  23 

Fees 24,25 

Classes  for  London  University  Examinations  ...  26 
Entrance    and     other     Scholarships,    Prizes     and 

Appointments      ...         ...         ...          ...         ...  27 

Regulations  for  Examination  and  Classification   of 

Students ...         30 

Prize  Lists      ...          ...          ...          ...         ...          ...  31 

Museum           ...         ...         ...         ...         ...         ...  34 

Medical  and  Physical  Society           ...          ...          ...  37 

St.  Thomas's  Hospital  Reports          ...          ...          ...  38 

Calendar         39-50 

List  of  Students  who  have  obtained  Honours          ...  51-65 


Full  information  on  all  matters  connected  with  the  Medical  School, 
Prizes,  &c,  will  be  obtained  on  application  to  the  Secretary,  Dr.  Gillespie, 
at  the  Hospital,  Albert  Embankment,  S.E. 


A  Register  of  Lodgings  suitable  for  Students  has  been  recently  revised, 
and  is  kept  in  the  Secretary's  Office.  Information  as  to  terms,  accommo- 
dation, &c,  can  be  obtained  on  application.  This  Register  has  been  especially 
prepared,  with  a  view  to  the  convenience  of  gentlemen  newly  arriving  in 
town,  without  definite  arrangements  having  been  made  for  their  accommo- 
dation in  lodgings  or  otherwise. 

Several  Medical  Practitioners  and  Private  Families  residing  in  the 
neighbour] lood  receive  Students  for  residence  and  supervision. 

There  is  a  Restaurant  in  the  Medical  School  where  Students  can  take 
their  meals  at  moderate  charges. 

A   2 


\ttvxnf%  giTSjjital 


MEDICAL  SCHOOL. 

The  Winter  Session  1882  -  83  will  commence  on 
Monday,  October  2nd,  and  terminate  on  March  31st. 

The  Summer  Session  will  begin  on  Tuesday,  May  1st, 
and  terminate  on  July  31st. 

An  Introductory  Address  will  be  given  by  Dr.  Sharkey 
in  one  of  the  Theatres  of  the  Hospital  on  Monday,  October 
2nd,  at  3  p.m.,  after  which  the  various  Departments  of  the 
Hospital  and  School  will  be  thrown  open  in  working  order 
for  the  inspection  of  Visitors. 

Eefreshments  will  be  provided  in  the  Library. 

The  Annual  dinner,  in  which  all  former  and  present 
Students  are  invited  to  join,  will  take  place  the  same  evening 
in  the  Governors'  Hall,  at  b*  for  6.30. 

The  Annual  Distribution  of  Prizes  will  be  made  during  the 
Summer  Session. 


ALL  accounts  agree  in  attributing  the  origin  of  St.  Thomas's 
Hospital  to  circumstances  more  or  less  accidental.  In 
Stow's  "  Survey  of  London,"  we  find  "  that  a  fire  happened 
in  the  Borough  of  Southwark  in  the  year  1207,  which  de- 
stroying the  Priory  of  St.  Mary  Overie,  the  Canons  erected 
an  Hospital  hard  by  for  the  celebration  of  divine  service,  till 
their  Monastery  could  be  rebuilt  ;  which  they  soon  after 
accomplishing,  Peter  de  Bupibus,  or  de  la  Eoche,  Bishop  of 
Winchester,  for  the  greater  convenience  of  air  and  water, 
removed  the  said  Hospital  in  the  year  1215,  and  erected  it 
in  a  place  where  Richard,  Prior  of  Bermondsey,  but  two 
years  before  had  built  an  Almonry  or  Almshouse  for  the 
reception  of  indigent  children  and  necessitous  Proselytes,  and 


6 


having  dedicated  the  same  to  St.  Thomas  the  Apostle, 
endowed  it  with  land  to  the  amount  of  three  hundred  and 
forty-three  pounds  per  annum." 

It  is  difficult  to  say  whether  it  is  owing  to  deficiency  of 
historical  accuracy  in  Maitland  (from  whom  the  above  is 
quoted),  or  to  excess  of  orthodoxy,  that  he  names  St.  Thomas 
the  Apostle.  Certain  it  is,  however,  that  Peter  de  la  Roche 
denominated  its  foundation  "  The  Spital  of  St.  Thomas  the 
Martyr  of  Canterbury,"  in  honour  of  Thomas  a  Becket 
whose  shrine  in  Canterbury  Cathedral  was  already  drawing 
what  Chaucer  aptly  terms  "shoals"  of  pilgrims  down  the 
"  Old  Kent  Road,"  and  past  the  very  door  of  the  Hospital  to 
the  Tabard  Inn. 

The  next  fact  of  importance  seems  to  be  the  cession  of  the 
Hospital  by  the  Prior  of  Bermondsey  to  a  President,  Master 
and  Brethren,  in  1482 ;  unless  we  note  an  altercation  in  1252 
between  the  then  Archbishop  of  Canterbury  and  the  Bishop 
of  Winchester  for  the  patronage  of  it.  This  ended  iu  favour 
of  the  latter,  whose  palace  hard  by  survives  in  name,  and 
partly  in  structure  to  the  present  day,  as  Winchester  House. 
From  an  estimate  formed  about  the  later  of  these  dates,  it 
appears  there  were  a  master  and  brethren,  and  three  lay- 
sisters,  residing  in  the  Hospital ;  forty  beds  were  made  up 
for  poor,  infirm  and  impotent  people,  all  of  whom  had  victuals 
and  firing  allowed  to  them. 

From  this  time,  Golding  truly  says,  nothing  of  importance 
occurred  either  in  the  government  or  revenues  of  St.  Thomas's 
Hospital  until  the  2Gth  year  of  Henry  VIII.,  when  an  estimate 
was  formed  of  the  latter,  which  were  found  to  amount  to  the 
annual  sum  of  £347.  3s.  6d.  It  is  not  to  be  wondered  at 
that  we  have  so  little  to  record  during  these  early  times ;  for 
the  "Hospitium"  dependent  on  the  rich  Abbey  of  Bermondsey 
was,  as  the  name  strictly  implies,  more  an  Almshouse  than  a 
Hospital.  No  doubt  the  sick  found  their  way  into  it  with 
other  distressed  persons ;  and  no  doubt  some  learned  monk, 
using1  the  shelter  and  leisure  of  the  cloister  for  researches  in 
alchemy  and  medicine,  was  told  off  to   minister  to  their 


physical  necessities.  The  brotherhood  of  the  Rosy  Cross,  to 
which  Gower,  now  lying  in  the  neighbouring  church,  belonged, 
was  intimately  connected  with  the  early  quest  after  Arcana 
and  Elixirs  of  Life  which  represented  the  science  of  the  time. 

In  the  year  1535,  Henry  VIII.  was  excommunicated  by 
Pope  Paul  III.,  and,  declaring  himself  head  of  the  church, 
proceeded  to  dissolve  the  Catholic  houses,  whose  large 
revenues  went  to  the  Crown.  There  seem  to  have  been  645 
monasteries  and  abbeys  thus  treated,  twenty-eight  of  which 
had  abbots  with  seats  in  Parliament,  ninety  colleges  and  free 
chapels,  and  110  hospitals  of  various  descriptions.  It  is 
certainly  in  favour  of  the  sweeping  change  that  so  able  and 
honest  a  man  as  Sir  Richard  Gresham,  the  Lord  Mayor  of 
London,  should  have  put  his  hand  to  the  following  petition 
to  the  King : 

"  Most  redowted,  puysant,  and  noble  Prince  *  *  *  * — nere 
and  within  the  cytie  of  London  be  iij  hospitalls  or  spytells 
commonly  called  Seynt  Georges  Spytell,  Seynt  Barthilmews 
Spy  tell,  and  Seynt  Thomas  Spytell,  and  the  new  Abbey  of 
Tower  Hill,  founded  of  good  devotion  by  auncient  fathers, 
and  endowed  with  great  possessions  and  rents  only  for  the 
reliefe,  comforte,  and  helping  of  the  poore  and  impotent 
people  lying  in  every  street,  offending  every  clene  persone 
passing  by  the  way  with  theyre  fylthy  and  nasty  savors. 
Wherefore  may  it  please  your  merciful  goodness,  enclyned  to 
pytie  and  compassion,  for  the  reliffe  of  Xts  very  images,  created 
to  his  own  similitude,  to  order  by  your  high  authoritie,  as 
supreme  head  of  this  Church  of  England,  or  otherwise  by 
your  sage  discretion,  that  your  mayer  of  your  cytie  of  London, 
and  his  brethren  the  aldermen  for  the  time  being,  shall  and  may 
from  henceforth  have  the  order,  disposition,  rule  and  govern- 
aunce  both  of  all  the  lands,  tenements,  and  revenues  apper- 
teynyng  and  belongyn  to  the  said  Hospitals,  governors  of 
them,  and  of  the  ministers  which  be  or  shall  be  withyn  any 
of  them,  and  then  your  grace  shall  facilie  perceyve  that  where 
now  a  small  number  of  Chanons,  Priests,  and  Monkes  be 
founde   for  theyr  own  profitt  only,  and  not  for  the  common 


8 

utilitie  of  the  realm e,  a  great  number  of  poore,  needy,  syke 
and  indugent  persones  shall  be  refreshed,  maynteyned,  and 
comforted ;  and  also  healed  and  cured  of  their  infermities 
frankly  and  freely  by  physicions,  surgeons  and  potycaries, 
which  shall  have  stipende  and  salarie  only  for  that  purpose ;  so 
that  all  impotent  persones  not  able  to  labour  shall  be  releved, 
and  all  sturdy  beggars  not  willing  to  labour  shall  be  punished." 

St.  Thomas's  Hospital  being  claimed  by  the  King  as  Church 
property,  was  surrendered  to  him  by  Nicholas  Buckland,  the 
then  master,  on  the  15th  July,  1538.  It  was  called  St. 
Thomas  a  Becket's  Spittil.  Its  yearly  revenue  was  estimated 
at  £266.  17s.  6d.,  and  an  annual  pension  of  5s.  8d.  was 
payable  by  the  master,  and  another  of  2s.  Id.  by  the  curate, 
to  the  Archdeacon  of  Surrey.  Soon  after  the  seizure,  we  find 
that  the  Citizens  of  London  purchased  of  the  Crown  some  of 
its  landed  estates,  producing  about  £160  yearly.  The  want 
of  the  hospital  thus  destroyed  was  felt  immediately.  Wounded 
soldiers  from  the  army  in  France,  and  the  sick  poor  in  general 
were  without  provision  or  help,  and  Henry  proposed  granting 
to  the  City  the  Mansion  house  of  St  Bartholomew's,  the  dis- 
solved house  of  Grey  Friars  adjoining,  and  the  unoccupied 
fabric  of  St.  Thomas's  Hospital.  The  latter  was  intended  by 
Henry  to  receive  the  name  of  the  Hospital  of  the  Holy 
Trinity,  and  to  be  allotted  exclusively  to  lame,  wounded,  and 
diseased  soldiers.  The  monastery  of  Grey  Friars  was  to  be 
for  the  education  and  maintenance  of  fatherless  children  and 
those  of  poor  parents.  The  intentions  of  Henry  were  over- 
taken by  death,  but  not  before  he  had  conferred  upon  the 
Citizens  of  London  the  Hospital  of  St  Bartholomew's  and 
also  that  of  Bethlem  for  lunatics. 

It  is  from  the  death  of  Henry  that  the  connection  of  St. 
Thomas's  Hospital  with  the  city  of  London  appears  to  begin. 
To  meet  the  needs  of  the  sick  and  destitute  who  had  before 
depended  on  the  charity  of  the  religious  houses,  a  Committee 
or  Board  of  Inquiry  was  instituted  by  the  Citizens,  with  the 
sanction  of  King  Edward.  About  2,100  souls  were  reported 
as  fit  recipients  of  relief,  as  fatherless  children  and  invalids 


or  as  "  Idle  rogues  of  both  sexes  who  were  levying  contribu- 
tions on  public  sympathy  by  feigned  tales  of  sorrow."  It 
was  proposed  to  establish  receptacles  for  each  class  in  the 
unoccupied  monastic  buildings,  and  a  pecuniary  contribution 
was  set  on  foot  to  complete  the  work.  They  bought  the  dis- 
solved house  of  the  Franciscans  or  Grey  Friars  near  St. 
Bartholomew's  Hospital,  and  also  by  charter  from  the  King 
received  a  grant  as  follows  :  "  That  the  said  mayor,  common- 
alty, and  citizens,  and  their  successors,  may  have  and  enjoy 
all  the  franchises,  immunities,  and  privileges  whatever,  which 
any  Archbishop  of  Canterbury,  and  which  the  said  Charles 
late  Duke  of  Suffolk,  or  any  master,  brethren,  or  sisters  of 
the  late  Hospital  of  St.  Thomas  in  Southwark  aforesaid ;  or 
any  Abbot  of  the  said  monastery  of  St.  Saviour,  Saint  Mary 
Bermondsey,  next  Southwark  aforesaid,  or  any  prior  and  con- 
vent of  the  priory  of  St.  Mary  Overie,  ever  had  or  enjoyed,  or 
which  we  hold  or  enjoy,  or  our  most  dear  father  Henry  the 
Vlllth,  late  King  of  England,  or  had  enjoyed,  or  ought  to 
have,  hold,  and  enjoy  the  same  :  and  that  none  of  our  heirs 
or  successors  may  intermeddle  with  this  our  grant." 

The  Greyfriars  became  Christ's  Hospital,  and  the  Southwark 
site  the  Hospital  of  the  Holy  Trinity  or  St.  Thomas's.  The 
Lord  Mayor  and  certain  citizens  then  met  on  the  6th  of 
October,  1552,  and  constituted  themselves  by  royal  per- 
mission governors  of  the  hospitals,  and  almoners  of  the  money 
collected.  The  Hospital  of  the  Holy  Trinity  they  named,  in 
compliment  to  Edward,  the  "  King's  Hospital,"  and  ordained 
it  to  receive  260  "  wounded  soldiers,  blind,  maimed,  sick,  and 
helpless  objects." 

They  also  directed  that  380  children  should  be  received 
into  Christ's  Hospital. 

To  complete  the  scheme,  the  old  palace  of  Bridewell,  in 
Blackfriars,  where  the  Emperor  Charles  V.  had  lodged  in 
1522,  when  on  a  visit  to  Henry  VIII.,  and  where  subsequently 
Wolsey  had  lived,  was  granted  to  the  City  by  Edward  as  a 
house  of  correction  for  dissolute  persons  and  idle  apprentices, 
and  for  the  temporary  maintenance  of  distressed  vagrants. 


10 


Lastly,  the  lauds  lately  belonging  to  the  Palace  of  the 
Savoy  were  conferred  jointly  on  the  three  foundations ;  and 
a  month  only  before  the  end  of  Edward's  short  reign,  he 
incorporated  by  a  second  charter  bearing  date  the  6th  of 
June,  1553,  the  Lord  Mayor  and  commonalty  of  the  City 
of  London  in  succession  as  perpetual  governors  of  Saint 
Bartholomew's,  Christ's,  Bridewell,  and  the  king's  Hospital 
(which  last  received  the  name  of  St.  Thomas  the  Apostle), 
and  secured  to  them  the  possession  of  all  the  estates  and 
revenues  appertaining  to  them  by  previous  deeds  of  gift.  So 
were  the  royal  hospitals  founded. 

In  1557  the  laws  were  framed  and  printed  under  the  name 
of  "  The  Order  of  the  Hospitals  of  K.  Henry  the  VIII.  and 
K.  Edward  the  VI.,  viz.  St.  Bartholomew's,  Christ's,  Bridewell, 
St.  Thomas's.  By  the  Maior,  Cominaltie,  and  Citizens  of 
London,"  &c. 

Successive  bequests  and  donations  continued  to  augment 
the  property  of  the  charities,  but  during  the  reigns  of 
Elizabeth,  James  I.,  Charles  I.,  and  the  Protectorate,  there 
appear  few  facts  to  note.  In  the  abstract  of  the  charter  of 
confirmation  granted  to  the  City  in  1663  by  Charles  II.  on 
his  restoration,  we  find  the  charter  of  Edward  acknowledged 
and  confirmed.  The  Great  Fire  of  London  in  1666  injured 
St.  Thomas's  in  its  revenues  only ;  and  a  fire  in  Southwark 
anno  1676,  ceased,  "as  if  by  divine  interposition,"  at  the 
Hospital,  probably  a  strong  and  isolated  block  of  building. 
Shortly  after  this,  however,  it  was  found  necessary  to  rebuild 
the  fabric,  and  in  1693  subscriptions  were  opened  for  this 
purpose.  A  long  list  of  benefactions  in  this  and  the  succeed- 
ing year,  amounting  in  all  to  £37,769.  3s.,  is  given  by 
Golding,  who  especially  singles  out  Sir  Eobert  Clayton  for 
eulogium.  The  statue  then  erected  to  him,  and  still  extant, 
was  originally  dated  1701,  but  this  was  altered  on  his  death 
to  1714.  He  was  the  founder  of  the  old  square  in  which 
it  stood,  replacing  what  Golding  terms  "a  low  swampy 
structure  of  the  monastic  order."  In  1707,  Mr.  Guy,  founder 
of  the  neighbouring  hospital,  erected  three  wards  at  his  own 


11 


charge.  In  1717,  the  back  block  of  buildings  adjoining  Guy's 
Hospital  was  added.  With  the  exception  of  the  two  large 
blocks  forming  the  Borough  frontage,  the  north  wing  erected 
in  1833,  and  the  south  wing  in  1839,  the  fabric  seems  to 
have  remained  unchanged  until  its  purchase  by  the  railway. 
In  the  centre  of  the  front  quadrangle  stood  the  brass  statue 
of  King  Edward,  by  Scheemakers,  erected  first  in  1737,  in 
pursuance  of  the  will  of  Charles  Joye,  some  time  treasurer 
of  the  Hospital.  It  now  stands  in  the  grounds  of  the  New 
Hospital. 

It  is  a  matter  of  more  difficulty  to  trace  the  early  history 
of  the  medical  school  in  connection  with  the  hospital.  For 
the  facts  which  follow  we  are  indebted  to  the  late  R.  G. 
Whitfield,  Esq.,  who,  from  the  long  period  during  which  his 
family  had  been  associated  with  this  foundation,  was  perhaps 
more  qualified  to  speak  than  any  other  person. 

The  earliest  mention  in  the  hospital  books  of  an  apprentice 
is  on  December  31st,  1561.  It  is  not  until  1702  that  a  law 
is  met  with  precluding  pupils  or  surgeons  from  dissecting  the 
dead  body  without  permission  from  the  treasurer. 

In  1703  the  grand  committee  resolved  that  no  surgeon 
should  have  more  than  three  et  Cubbs,"  a  term  altered  in 
1758  to  that  of  "  Dressers."  Besides  these  there  were  also 
apprentices  to  the  surgeons  of  the  hospital,  and  ordinary 
pupils.  The  first  mention  of  lectures  occurs  soon  after  the 
appointment  of  Wm.  Cheselden,  in  1718.  These  he  at  first 
gave  at  his  own  house,  but  afterwards  by  permission  in  the 
hospital.  They  were  on  anatomy  and  surgery.  In  1723  a 
regular  registry  was  ordered  to  be  kept  by  the  apothecary, 
of  pupils  entering  to  surgical  practice.  In  1725,  Guy's 
Hospital  was  opened  for  the  reception  of  patients.  In  1751 
the  assistant-physician  was  allowed  to  take  two  pupils  for 
his  own  benefit.  In  1768,  an  additional  surgeon,  Mr.  Joseph 
Else,  was  elected  to  read  lectures  to  the  pupils. 

The  students  of  Guy's  Hospital  had  by  courtesy  been 
allowed  to  attend  the  operations,  and  a  similar  favour 
admitted  the  St.  Thomas's  men  to  those  at  Guy's.     But  on 


12 

the  8th  November,  1768,  it  was  formally  resolved  that  the 
pupils  of  each  hospital  have  the  liberty  of  attending  not  only 
the  operations,  but  surgical  practice,  and  the  money  to  be 
divided  between  the  six  surgeons  and  two  apothecaries. 
Hence  the  appellation  of  the  "  United  Hospital ; "  an  amal- 
gamation never  extended  beyond  the  surgical  practice. 

To  Mr.  Else  is  due  the  foundation  of  a  regular  anatomical 
school.  Mr.  Cline,  who  in  1781  was  appointed  to  read 
lectures  conjointly  with  Mr.  Else,  was  mainly  instrumental 
in  bringing  it  to  its  greatest  celebrity.  At  Mr.  Else's  death, 
Mr.  Cline  purchased  the  collection  of  preparations  made  by 
him  and  Mr.  Girle,  a  former  surgeon,  which  are  now  in  the 
hospital  museum,  and  became  sole  lecturer  on  anatomy.  In 
1788  he  also  became  surgeon  to  the  hospital.  Mr.,  afterwards 
Sir  Astley,  Cooper  was  apprenticed  to  Mr.  Cline  in  1784,  and 
before  his  election,  as  one  of  the  surgeons  to  Guy's  Hospital 
in  1800,  was  joint  lecturer  with  his  teacher  on  anatomy  and 
surgery.  They  both  added  materially  to  the  pathological 
museum. 

In  1812  Mr.  Henry  Cline  was  elected  surgeon  to  St. 
Thomas's  Hospital  on  his  father's  resignation,  and  carried  on 
the  anatomical  lectures  conjointly  with  Astley  Cooper.  In 
1813  a  new  anatomical  theatre  and  museum  were  built,  the 
hospital  giving  £3000  for  the  purpose,  and  the  two  lecturers 
£1000  each.  In  1815  Mr.  Benj.  Travers,  an  apprentice  of 
Astley  Cooper's  at  Guy's,  was  elected  surgeon,  according  to 
the  established  rule  which  gave  the  vacancy  to  the  senior 
apprentice  of  either  institution.  Mr.  Travers  joined  in  the 
lectures,  devoting  his  attention  specially  to  ophthalmic 
surgery.  In  1820  Mr.  Joseph  Henry  Green  was  elected 
surgeon  on  the  death  of  his  cousin  Mr.  Hy.  Cline,  having 
been  apprenticed  to  his  uncle  Mr.  Cline  in  the  year  1809. 
From  1820  to  1825  he  lectured  with  Astley  Cooper.  At  this 
period  all  the  branches  of  medical  study, — viz.,  medicine, 
chemistry,  materia  medica,  midwifery,  botany,  and  physiology 
— were  lectured  on  at  Guy's  Hospital,  and  no  physician  of 
St.  Thomas's  was  allowed  to  share  them. 


13 

In  1824  Sir  A.  Cooper  resigned  the  surgical  chair,  and  Mr. 
C.  Aston  Key,  his  apprentice  and  nephew  by  marriage,  joined 
Mr.  Green  in  the  office.  Mr.  Fred  Tyrrell,  standing  in 
exactly  the  same  relation  to  Cooper,  received  permission  to 
lecture  on  diseases  of  the  eye.  In  the  following  year  Cooper 
showed  signs  of  cerebral  disturbance,  and  the  family  desired 
that  his  nephew,  Mr.  Bransby  Cooper,  should  be  his  suc- 
cessor. But  the  claims  of  Mr.  John  Flint  South  were  con- 
sidered superior,  and  he  was  appointed.  From  this  cause 
the  "  United  Hospitals"  were  severed,  and  a  complete  school 
set  up  in  both.  The  majority  of  the  students  clung  to  Guy's, 
where  the  prestige  of  the  great  Sir  Astley  was  still  strong  ; 
and  St.  Thomas's  school  began  to  sink.  The  establishment 
of  the  Aldersgate  Street  private  school  under  Tyrrell  and 
Lawrence  materially  aided  in  this  declension,  as  did  also  the 
secession  of  Dr.  Elliotson  to  the  newly-established  Univer- 
sity College,  and  the  foundation  of  a  fresh  school  at  King's 
College,  where  for  a  time  the  surgical  lectures  were  given 
by  Mr.  Joseph  Henry  Green,  although  a  surgeon  of  St. 
Thomas's. 

Owing  to  the  unprosperous  state  of  affairs  in  1842,  the 
Governors  came  forward  to  reorganize  the  school,  and  the 
aid  of  Mr.  R.  D.  Grainger,  whose  popularity  had  been  esta- 
blished in  the  Webb  Street  private  school,  was  obtained. 
Mr.  Joseph  H.  Green  also  rejoined  the  school ;  and  Dr.  Mar- 
shall Hall,  Dr.  Hodgkin,  Dr.  Martin  Barry,  Dr.  Gregory, 
and  Mr.  Benjamin  Travers  contributed  to  its  efficiency. 
This  state  of  affairs  continued  until  1858,  when  the 
Governors  gave  back  the  management,  and  its  attendant 
risks,  into  the  hands  of  the  lecturers. 

For  some  years  it  was  maintained  with  difficulty,  and  at 
much  self-sacrifice  on  the  part  of  the  staff,  during  what  may 
be  termed  a  transitional  period,  in  the  hope,  now  realized,  of 
its  once  more  developing  into  an  institution  worthy  of  its 
old  traditionary  glories. 

From  its  foundation  down  to  the  year  1862,  the  Hospital 
occupied  the  original  site  near  London  Bridge,  but  in  that 
year  the  property  was  sold  for  the  extension  of  the  railway 


14 

accommodation,  and  the  establishment  temporarily  removed 
to  the  Surrey  Gardens,  where  it  was  carried  on  till  the 
Summer  of  1871.  In  1868  the  first  stone  of  the  new 
Hospital  at  Westminster  Bridge  was  laid  by  the  Queen,  and 
the  completed  building  was  opened  by  Her  Majesty  in  1871. 
In  September  the  patients  were  first  admitted  into  the  new 
Hospital,  and  the  Medical  School  was  opened  on  October 
the  2nd. 

The  original  Hospital  latterly  contained  500  beds.  The 
present  building  contains  in  all  572  beds.  It  consists  of  six 
blocks  appropriated  to  the  reception  of  patients;  with  one 
for  the  administrative  and  other  offices,  and  one  for  the 
Medical  School.  The  Ward  blocks,  though  connected  by 
corridors,  stand  apart,  so  as  to  afford  free  exposure  in  all 
directions.  The  Wards,  with  the  exception  of  four  which 
are  placed  on  the  ground  floor,  occupy  the  first,  second,  and 
third  floors.  Generally,  each  Ward  affords  accommodation 
for  28  beds,  which  are  placed  against  the  piers  between  the 
windows,  so  as  to  secure  thorough  ventilation.  In  a  small 
Ward  annexed  to  each  larger  Ward,  there  are  two  beds  for 
cases  requiring  special  care  or  treatment. 

Of  the  whole  accommodation  of  the  Hospital,  about  180 
beds  are  appropriated  to  ordinary  Medical  cases,  and  230  to 
ordinary  Surgical  cases.  There  are  also  special  Wards  for 
the  reception  of  diseases  peculiar  to  women ;  for  diseases  of 
the  eye ;  for  venereal  affections ;  and  for  children  under  six 
years  of  age.  In  one  of  the  blocks,  separated  from  the  rest 
of  the  establishment,  there  are  Wards  for  infectious  diseases. 

The  space  provided  for  each  bed  in  the  ordinary  Wards  is 
upwards  of  1,800  cubic  feet,  and  in  the  block  appropriated 
to  infectious  diseases,  about  2,500  cubic  feet. 

The  Out-patients'  Department  is  extensive  and  well 
arranged,  and  every  facility  is  afforded  for  the  treatment  of 
different  forms  of  Medical  and  Surgical  casualties  and 
diseases. 

During  the  twelve  months  ending  December  31st,  1881, 
the  number  of  patients  admitted  into  the  Hospital  amounted 


15 


to  4,060.  la  the  same  period,  20,037  Out-patients  have  been 
treated,  and  in  the  Maternity  department  2,104  women  have 
been  attended  at  their  own  homes.  Casualties,  to  the 
number  of  54,817  attendances,  were  treated  during  the  same 
period.  836  Children  were  successfully  vaccinated  at  the 
Hospital  as  a  Government  Station. 

The  School  buildings  stand  at  the  southern  extremity  of 
the  Hospital,  from  which  they  are  quite  isolated.  They 
contain  ample  accommodation  for  large  classes  of  students. 

The  Museum  is  one  of  the  most  important  in  the  metro- 
polis. There  is  a  large  Reading  Room  and  Library  for  the 
use  of  the  pupils. 

In  addition  to  these  are  the  various  Lecture  Rooms,  the 
Dissecting  Rooms,  the  Laboratories  for  Practical  Physiology 
and  for  Practical  Chemistry,  and  the  Post-mortem  Rooms. 


The  Committee  of  the  "Nightingale  Fund  "  have  arrange- 
ments with  the  authorities  of  St.  Thomas's  for  educating: 
Women  as  Hospital  Nurses.  On  the  satisfactory  completion 
of  one  year's  training,  they  will  be  required  to  enter  into 
service  as  Nurses  in  the  Metropolitan  or  Provincial  Hospitals 
or  Infirmaries.  A  limited  number  of  gentlewomen  can  be 
admitted  under  special  agreements  to  this  course  of  training, 
with  a  view  to  qualify  themselves  for  superior  appointments. 

The  Regulations  as  to  the  admission  of  Candidates  may  be 
obtained  by  writing  to  Henry  Bonham  Carter,  Esq.,  the 
Secretary  of  the  Nightingale  Fund,  91,  Gloucester  Terrace, 
Hyde  Park,  London,  W. 

Institutions  requiring  trained  Superintendents  or  Nurses 
are  requested  to  apply  to  the  Secretary  of  the  Nightingale 
Fund,  or  to  Mrs.  W.  W.  Wardroper,  the  Matron  of  the 
Hospital,  giving  as  long  previous  notice  as  possible  of  their 
requirements. 

Women  wishing  to  be  trained  should,  whenever  it  is 
possible,  make  personal  application  to  Mrs.  Wardroper,  to 
be  entered  on  the  list  of  Candidates,  for  admission  as 
vacancies  occur. 


16 
MEDICAL  OFFICERS,  LECTURERS,  &c, 


OF 


ST.    THOMAS'S    HOSPITAL 


AND 


MEDICAL  SCHOOL. 


CONSULTING     PHYSICIANS. 

T.  A.  Barker,  M.D.  Cantab,  et  Edin.    ..27,  Wimpole  Street,  W. 
Sir  J.  Kisdon  Bennett,  M.D.  Edin.,  F.K.S.  22,  Cavendish  Square,  W. 

CONSULTING     SURGEONS. 

P.  Le  Gros  Clark,  Esq.,  F.R.S.         ..    Sevenoaks,  Kent. 

John  Simon,  Esq.,  C.B.,  F.R.S.,  D.C.L.  40,  Kensington  Square,  W. 

CONSULTING    OPHTHALMIC    SURGEON. 

R.  Liebreich,  Esq 29b,  Albemarle  St.,  W. 

PHYSICIANS. 

J.  S.  Bristowe,  M.D.  Lond.,  F.R.S.  ..  11,  Old  Burlington  Street,  W. 

W.  H.  Stone,  M.A.,  M.B.  Oxon.       ..  14,  Dean'sYard,Westminster,  S.W. 

W.  M.  Ord,  M.D.  Lond 7,  Brook  Street,  W. 

John  Harley,  M.D.  Lond 39,  Brook  St.,  W. 

OBSTETRIC     PHYSICIAN. 

H.  Gervis,  M.D.  Lond 40,  Harley  Street,  W. 

SURGEONS. 

Sydney  Jones,  Esq.,  M.B.,  Lond.       ..  16,  George  St.,  Hanover  Sq.,  W. 

John  Croft,  Esq 48,  Brook  St.,  Grosvenor  Sq.,  W. 

Sir  William  Mag  Cormac,  M.A.,  D.Sc.  13,  Harley  Street,  W. 

Francis  Mason,  Esq 5,  Brook  St.,  Grosvenor  Sq.,  W. 

OPHTHALMIC    SURGEON. 

E.  Nettleship,  Esq 5,  Wimpole  Street,  W. 

ASSISTANT     PHYSICIANS. 

J.  F.  Payne,  M.D.  Oxon 78,  Wimpole  Street,  W. 

Seymour  J.  Sharkey,  M.A.,  M.B.  Oxon.  77,  Lambeth  Palace  Road,  S.E. 
George  Gulliver,  M.A.,  M.B.  Oxon.      75,  Lambeth  Palace  Road,  S.E. 

ASSISTANT    OBSTETRIC     PHYSICIAN. 

R.  Cory,  M.A.,  M.D.  Cantab 73,  Lambeth  Palace  Road,  S.E. 

ASSISTANT    PHYSICIAN    FOR    DISEASES    OF  THROAT. 

F.  Semon,  M.D.,  Berlin       59,  Wclbeck  Street,  W. 

ASSISTANT    SURGEONS. 

A.  0.  Mac  Kellar,  Esq.,  M.  Ch.      ..     22,  George  St.,  Hanover  Sq.,  W. 
H.  H.  Clutton,  Esq.,  M.A.,  Cantab..     77,  Lambeth  Palace  Road,  S.E. 
W.  Anderson,  Esq 13,  Welbeck  Street,  W. 


17 


MEDICAL  OFFICERS,  &c- Continued. 

DENTAL     SURGEON 

J.  W.  Elliott,  Esq 4,  Finsbury  Square,  E.G. 

ASSISTANT     DENTAL    SURGEON. 

W.  G.  Ranoer,  Esq 4,  Finsbury  Square,  E.G. 

RESIDENT     ASSISTANT     PHYSICIAN. 

C.  E.  Sheppard,  M.U.,  Lond St.  Thomas's  Hospital,  S.I1]. 

RESIDENT     ASSISTANT     SURGEON. 

B.  Pitts,  Esq.,  M.A.,  M.C.,  Cantab.  ..    St.  Thomas's  Hospital,  S.E. 

AN/ESTHETIST. 

S.  Osborn,  Esq 10,  Maddox  Street,  W. 

ELECTRICIAN. 

W.  J.  Kilner,  B.A.,  M.B.,  Cantab.    ..    104,  Ladbroke  Grove  Road,  W. 

APOTHECARY. 

S.  Plowman,  Esq.         St.  Thomas's  Hospital,  S.E. 

DEMONSTRATORS  OF  MORBID  ANATOMY. 

S.  J.  Sharkey,  M.A.,  M.B.  Oxon.      ..    77,  Lambeth  Palace  Road,  S.E. 
W.  B.  Hadden,  M.D.,  Lond 21,  Welbeck  Street,  W. 

ANALYTICAL     CHEMIST. 

Albert  J.  Bernays,  Ph.D.,  F.C.S.,  F.I.C.  Acre  House,  Brixton  Rise,  S.W. 

LECTURERS. 

A.W.  BENNETT,Esq.,M.A.,  B.Sc,  Lond.,  6,   Park   Village    East,   Regent's 

F.L.S.  Park,  N.W. 

Alfred  Carpenter,  M.D.,  Lond.       ..   Croydon. 

T.  Cranstoun  Charles,  M.D St.  Thomas's  Hospital,  S.E. 

George  Rainey,  Esq 1,  Western  Road,  Gresham  Park, 

Brixton,  S.W. 

R.  W.  Reid,  Esq.,  CM 75,  Lambeth  Palace  Road,  S.E. 

Charles  Stewart,  Esq.,  F.L.S.         ..    42,  Sinclair  Road,  Addison  Road, 

W. 
H.  Rayner,  M.D Hanwell,  W. 

REGISTRARS. 

Medical— G.  E.  Sheppard,  M.D.,  Lond.      Surgical — W.  H.  Battle,  Esq. 

CURATOR     OF     THE     MUSEUM.  LIBRARIAN. 

C.  Stewart,  Esq.,  F.L.S.  E.  H.  Denison,  Esq. 

SECRETARY    TO    SCHOOL.  DEAN     OF    THE     SCHOOL- 

J.  W.  Gillespie,  M.D.  W.  M.  Ord,  M.D. 

25,  Porchester  Terrace,  W.  7,  Brook  Street,  W. 

B 


18 


LECTURES  AND  DEMONSTRATIONS. 


_,  ,.  .  j  Dr.  Bristowe. 

Medicine j  Dr.  0rd< 

IDr.  Bristowe. 
Dr'  Ord 
Dr.  Harley 
Do.  Obstetric         Dr.  Gervis. 

j  Mr.  Sydney  Jones. 
Surgery j  Sir  William  Mac  Cormac. 

IMr.  S.  Jones 
IVTr  CJroft 
Sir' William  Mac  Cormac. 
Mr.  Mason. 
Do.  Special  Course   ..         Mr.  Croft. 

Descriptive  Anatomy      {  Mr*!  Anderson. 

„         7    .     .  7  r>i.     •  7  \  Dr.  John  Harley. 

General  Anatomy  and  Physiology      j  Mr>  gTEWART> 

Practical  Physiology Dr.  T.  C.  Charles. 

Ophthalmic  Surgery      Mr.  Nettleship. 

Chemistry  arid  Practical  Chemistry    ..  Dr.  Bernays. 

Midwifery,     and    the    Diseases    of    )  pr  qervis# 

Women  and  Children    ....        ) 

Physics  and  Natural  Philosophy         . .  Dr.  Stone. 

Materia  Medica,  and  TJierapeutics      ..  Dr.  Stone. 

Forensic  Medicine Mr.  Clutton  and  Dr.  Cory. 

Pathological  Anatomy         Dr.  Payne  and  Dr.  Sharkey. 

Botany Mr.  A.  W.  Bennett. 

Comparative  Anatomy        Mr.  C.  Stewart. 

Mental  Diseases Dr.  H.  Bayner. 

State  Medicine      Dr.  A.  Carpenter. 

TEACHERS  OF  PRACTICAL  SUBJECTS  &  DEMONSTRATORS. 

Practical  Chemistry     Dr.  Bernays. 

Practical  and  Manipulative  Surgery    \  Mr.  Mac  Kellar. 

{Mr.  Beid,  Mr.  Anderson, 
Dr.  Taylor,  Mr.  Ballance, 
and  Assistants. 
Demonstrations  in  Morbid  Anatomy  ..   Dr.  Sharkey  and  Dr.  Hadden. 
Demonstrations  in  Physiology     ..        X  j)r  T.  D.  Acland. 
Demonstrations  inPractical  Physiology) 

Diseases  of  the  Eye       '..   Mr.  Nettleship. 

Diseases  of  the  Shin      Dr.  Payne. 

Diseases  of  the  Throat Dr.  P.  Semon. 

Diseases  of  the  Ear       Mr.  Clutton. 

_.             ,,,     „   .,  \  Mr.  J.  W.  Elliott. 

Diseases  of  the  Teeth      1   Mr.  W.  G.  Banger. 


19 


TIMES   OF   ATTENDANCE  OP  THE  PHYSICIANS   AND   SURGEONS 
IN  THE  WARDS. 


Dr.  BRISTOWE     

Dr.  STONE 

Dr.  ORD 

Dr.  HARLEY 

Dr.  GERVIS   

Mr.  SYDNEY  JONES 

Mr.  CROFT     

Sir  WILLIAM  MAC  CORMAC 

Mr.  MASON    

Mr.  NETTLESHIP   


Mon. 

Tues. 

Wed. 

Thurs. 

Fri. 

Sat. 

2 

2 

2 

2 

— 

2 

2 

2 

2 

— 

2 

— 

2 

— 

2 

2 

2 
2 

2 
2 

2 
2 

— 

9 

— 

9 

— 

TIMES  OF  ATTENDANCE   OF   THE   ASSISTANT-PHYSICIANS   AND 
ASSISTANT-SURGEONS  ON  THE  OUT-PATIENTS. 


Dr.  PAYNE     

Dr.  SHARKEY 

Dr.  GULLIVER    

Dr.  CORY  (Women  and  Children). 

Mr.  MAC  KELLAR 

Mr.  CLUTTON 

Mr.  ANDERSON 


Mon. 

Tues. 

Wed. 

Thurs. 

Fri. 

Sat. 

— 

12.30 

— 

— , 

12.30 



12.30 

— 

— 

12.30 

— 

— 

— 

— 

12.30 

— 

— 

12.30 

— 

— 

1.30 

— 

— 

12.30 

12.30 

— 

— 

12.30 

— 

— 

— 

12.30 

— 

12.30 

— 

— 

12.30 

— 

— 

12.30 

TIMES   OF    ATTENDANCE    ON   THE    OUT-PATIENT   SPECIAL 
DEPARTMENTS.     (See  p.  21.) 


Mr.  NETTLESHIP  (Diseases  of  Eye) 

Mon. 

Tues. 

Wed. 

Thurs. 

Fri. 

Sat. 

1.30 

4 

1.30 

1.30 

1.30 

— 

Dr.  PAYNE  (Diseases  of  Skin)   .... 

— 

— 

— 

12.30 

— 

— 

Dr.  SEMON  (Diseases  of  Throat)    . . 

— 

12.30 

— 

— 

12.30 

— 

Mr.  CLUTTON  (Diseases  of  Ear)  .. 

12.30 

— 

— 

— 

— 

— 

Mr.  ELLIOTT  \  /TV              -  „,    ,,  . 
Mr.  RANGER  /  (Dlseases  of  Teeth) 

— 

10 

— 

— 

10 

— 

Dr.  CORY  (Vaccination) 

— 

— 

11.30 

— 

— 

— 

B    2 


20 


DAYS  AND  HOURS  OF  ATTENDANCE  ON  LECTURES  AND 
DEMONSTRATIONS. 


WINTER  SESSION. 

Physics     

Chemistry     

Descriptive  and  Surgical  Anatomy   . . 

Anatomical  Demonstrations*    

Physiology    

Physiological  Demonstrations 

Practical  and  Manipulative  Surgery 

(  Oct.  1st  to  Dec.  31st 
\  Jan.  1st  to  Mar.  31st 

/  Oct.  1st  to  Dec.  31st 
1  Jan.  1st  to  Mar.  31st 


Mc 


10—4 


Medicine 


Surgery.. 

Pathological  Anatomy  (Practical) 
Clinical  Surgery  (Special  Course) 
Obstetric  Demonstrations 


Tues. 


10| 

H 

10—4 
4 


Wed. 


9* 
10—4 

4 
11.30 


Thurs. 


Fri. 


10J 
10—4 


10J 

9| 
10—4 

4 
11.30 


Sat. 


12 


10—2 


Years  of 

Attendance. 


1st  Year. 

do. 
1st  &  2nd. 

do. 

do. 

do. 

2nd. 


= 


3rd. 


do. 


11 i-l ; 


3rd  or  4th. 
do. 

do. 


Demonstrations  of  Morbid  Anatomy  2  p.m.  daily. 


SUMMER    SESSION. 

Materia  Medics    

Botany 


Mon. 


Practical  Chemistry    10—12 

Practical  Physiology — 

Midwifery     |       4 

Comparative  Anatomy  12 

Forensio  Medicine — 

Pathological  Anatomy I     — 

Do.          Demonstration |       4 

Ophthalmic  Surgery   I     — 

Practical  and  Manipulative  Surgery  i     — 

Mental  Diseases j     — 

State  Medicine     — 

Clinical  Surgery  (Special  Course)    . .  — 


Tues.     Wed. 


10 

12.30 

4 


Thurs.     Fri 


9 
10 

—  10—12 
12.30  — 

-  4 

-  !     12 

—  :     9 

9  - 


—  9 


10 


10—12     — 


Sat. 


12.30 
4 


4 
12 


Years. 


1st  Year. 

do. 

do. 

do. 

2nd. 

do. 

3rd. 

do. 

do. 
3rd  or  4th. 

do. 

do. 

do. 

do. 


Demonstrations  of  Morbid  Anatomy  2  p.m.  daily. 


The  times  of  delivery  of  the  Clinical  Lectures  are  arranged,  in  accordance  with  other  work, 

in  the  course  of  the  Session. 


*  The  Dissecting  Room  is  open  to  the  Students  from  9  a.m.  till  5  p.m. 


21 


SURGICAL  OPERATIONS  aro  performed  on  Wednesdays  and 
Saturdays  at  1.30  p.m.,  except  in  cases  of  emergency. 

In-Patients  arc  admitted  daily  at  Half-past  11  o'clock. 

Out-Patients  with  Diseases  of  the  Skin  are  seen  by  Dr.  Payne,  on 
Thursdays  at  Half-past  12  o'clock. 

Diseases  of  Women  and  Children  occurring  amongst  Out-Patients 
are  treated,  on  Wednesdays  at  1.30,  and  Saturdays  at  12.30,  by  Dr.  Cory. 

Ophthalmic  cases  are  seen  as  Out-patients  by  Mr.  NettleshIp,  at  1.30 
daily,  except  Saturdays ;  and  the  Operations  are  performed  on  Tuesdays 
at  4  and  Fridays  at  2  o'clock. 

Out-Patients  with  Diseases  of  the  Ear  are  seen  by  Mr.  Clutton, 
on  Mondays  at  Half-past  12  o'clock  ;  and  those  with  Diseases  of  the  Throat 
by  Dr.  Semon  on  Tuesdays  and  Fridays  at  the  same  hour. 

Instruction  in  Dental  Surgery  is  given  by  Mr.  Elliott  and  Mr.  Ranger, 
on  Tuesdays  and  Fridays,  at  10  o'clock. 

Practical  Instruction  in  the  administration  of  anesthetics  will  be  given 
by  Mr.  Osborn. 

Post-Mortem  Examinations  by  Dr.  Sharkey  and  Dr.  Hadden,  and 
Pathological  Demonstrations,  daily,  at  2  o'clock  p.m. 

The  Medical  and  Surgical  Casual  Patients  are  seen  by  the  Resident 
Assistant-Physician,  the  Resident  Assistant-Surgeon,  the  House-Surgeons, 
Assistant  House-Surgeons  and  Dressers,  at  12  o'clock  daily. 

In  addition  to  the  Clinical  instruction  given  in  the  Wards  and  the 
Out-Patients'  Rooms  by  the  Medical  and  Surgical  Officers,  and  the  Special 
Course  of  Clinical  Surgery,  Lectures  on  Clinical  Medicine  and  Surgery 
are  delivered  weekly  during  both  the  Winter  and  Summer  Sessions  by 
the  Physicians  and  Surgeons  to  the  Hospital ;  a  Clinical  lecture  and 
Ophthalmoscopic  demonstration  are  given,  and  a  class  for  instruction  in 
Diseases  of  the  Eye  is  held  by  the  Ophthalmic  Surgeon,  each  once 
a  week. 

Practical  instruction  in  Vaccination  is  given  by  Dr.  Cory  once  a  week. 

St.  Thomas's  Hospital  is  now  recognised  as  a  Local  Vaccination  Station, 
and  Dr.  Cory  is  authorised  to  give  certificates  of  instruction  in  Vaccination 
according  to  the  requirements  of  the  Local  Government  Board.  Fee  One 
Guinea. 


22 


SUGGESTIONS  TO  STUDENTS. 


All  gentlemen  who  propose  to  obtain  the  Licence  of  the  Royal  College  of 
Physicians  of  London,  the  Diploma  of  the  Royal  College  of  Surgeons  of 
England,  or  the  Licence  of  the  Society  of  Apothecaries,  must,  in  order  to 
be  able  to  register  their  attendance  upon  Hospital  practice  or  lectures, 
possess  the  certificate  in  Arts  granted  by  one  of  the  bodies  whose 
certificates  are  recognised  by  the  General  Medical  Council.  The  Regula- 
tions of  the  Medical  Council  as  to  the  registration  of  Medical  Students 
contain  particulars  of  the  Preliminary  Examinations,  and  can  be  had  from 
Spottiswoode  &  Co.,  30,  Parliament  Street. 

Students  wishing  to  obtain  a  Medical  Degree  of  the  University  of 
London  must  pass  the  Matriculation  Examination  ;  no  other  Preliminary 
will  suffice.  For  the  Matriculation,  the  Preliminary  Scientific,  and  the 
Intermediate  M.B.  Examinations,  Special  Classes  are  held  here  (see  p.  26). 

Students  not  proposing  to  seek  a  degree  in  the  University  of  London, 
will  always  reap  much  advantage  by  acquiring,  in  the  Preliminary  Scien- 
tific Class,  the  amount  of  scientific  knowledge  and  training  demanded  by 
the  University  ;  generally,  with  respect  to  the  formation  of  a  sound  foun- 
dation of  Medical  Study  ;  specially,  in  that  such  knowledge  is  necessary 
in  the  competition  for  the  Entrance  Science  Scholarship. 

Students  proposing  to  enter  should  put  themselves,  at  an  early  period, 
in  communication  with  the  Secretary,  who  will  be  always  ready  to  advise 
them.  It  is  necessary,  when  writing  to  him,  to  state  if  any,  and,  if  any, 
which  Preliminary  Examination  has  been  passed,  and  if  the  name  of  the 
Student  has  been  registered  at  the  Medical  Council  Office. 

Students  when  joining  must  produce  a  Certificate  of  Preliminary 
Examination  or  of  Registration.  It  is  best  to  join  at  the  beginning 
of  a  Session,  Winter  or  Summer,  but  it  is  in  the  power  of  a  Student 
to  enter  at  any  time  which  he  may  find  suitable. 

Students  are  not  obliged  to  remain  at  the  Hospital  more  than  three 
years,  provided  they  have  obtained  the  certificates  of  attendance  upon 
lectures  required  by  the  respective  licensing  bodies.  They  must,  however, 
in  the  event  of  leaving  the  Hospital,  be  engaged  during  the  fourth  year 
in  the  acquisition  of  professional  knowledge  elsewhere,  unless  they  have 
completed  a  recognised  period  of  study  before  coming  to  the  Hospital. 

It  is  right,  however,  that  Students  should  be  aware  that  the  loss  of  the 
fourth  year  of  Hospital  Study  is  strongly  to  be  deprecated,  inasmuch  as 
at  that  period  the  necessity  of  attending  Lectures  having  ceased,  the 


23 

whole  time  can  be  spent  in  the  study  of  disease  in  the  wards  of  the 
Hospital. 

Students,  when  qualified,  are  strongly  advised  to  use  every  effort  to 
obtain  the  Senior  appointments  open  to  them,  and  especially  those  of 
Assistant  and  full  House  Physician,  House  Surgeon,  &c.  These  appoint- 
ments are  accessible  to  Students  of  the  Hospital  without  payment,  and 
offer  opportunities  for  obtaining  practical  professional  knowledge,  the 
value  of  which  it  is  impossible  to  estimate  too  highly. 


Students  are  recommended  to  attend  the  Lectures,  &c,  in  the  following 
order;  and,  in  accordance  with  the  Regulations  of  the  Qualifying  Bodies, 
are  required  to  show  by  their  answers  in  the  Sessional  Examinations, 
that  they  have  paid  proper  attention  to  the  Lectures  in  each  Course. 

FIRST  YEAR. 

Winter  Session. — Anatomy,  Dissections,  Physiology,  Chemistry. 
Summer  Session. — Materia  Medica,  Botany,  Practical  Physiology,  Practical 

Chemistry. 

SECOND  YEAR. 

Winter  Session. — Anatomy,  Physiology,  Dissections,  Practical  Surgery, 

Clinical  Medicine  and  Surgery. 
Summer  Session. — Midwifery,  Comparative  Anatomy,  Clinical  Medicine 

and  Surgery. 

N.B. — Students  should  defer  further  attendance  on  Lectures  until  they  shall  have 
passed  the  first  Examination  of  the  College  of  Surgeons. 

THIRD  YEAR. 

Winter  Session. — Medicine,  Surgery,  Clinical  Medicine  and  Surgery. 
Summer  Session. — Forensic  Medicine,  Pathological  Anatomy,  Clinical 
Medicine  and  Surgery. 
In  addition  to  the  above,  Students  are  advised,  during  their  first  Winter 
Session,  to  attend  the  Lectures  on  Physics  and  Natural  Philosophy ;  in 
their  third  or  fourth  Summer  Session,  to  attend  the  extra  course  of 
Practical  and  Manipulative  Surgery ;  the  course  of  Ophthalmic  Surgery, 
and  instruction  in  the  examination  of  the  Eye ;  and  the  Lectures  on 
Mental  Disease,  and  on  State  Medicine  ;  and  in  the  third  or  fourth  Winter 
the  Practical  Course  of  Pathological  Anatomy,  and  the  Obstetric  Demon- 
strations.    All  these  courses  are  freely  open  to  Students  of  the  Hospital. 

They  are  also  strongly  recommended  to  devote,  during  the  whole  period 
of  their  attendance  at  the  Hospital,  as  much  time  as  they  can  spare  from 
other  engagements,  to  the  study  of  Practical  Medicine  and  Surgery  in  the 
wards  and  in  the  out-patients'  rooms. 


24 


FEES  FOR  ATTENDANCE  ON  THE  LECTURES 

AND   ON   THE 

PRACTICE  OF  THE  HOSPITAL. 

PERPETUAL    TICKETS. 

Admitting  to  Hospital  Practice  and  Lectures  for  an  unlimited 

period. 

The  Perpetual  Fee  to  Hospital  Practice  and  Lectures  may 

be  paid  in  several  ways : 
1st.  One  Hundred  and  Twenty-five  Pounds  paid  on  entrance ; 
2nd.  One  Hundred  and  Thirty-five  pounds  in  two  payments, 
£75  on  entrance,  and  £60  at  the  beginning  of  the  next 
year  ; 
3rd.  Payment  by  three  instalments,  viz.,  of  £65  at  the  be- 
ginning of  the  first  year,  £50  at  the  beginning  of  the 
second  year,  and  £30  at  the  beginning  of  the  third  year. 
Gentlemen  entering  at  St.  Thomas's  in  the  second*  year  of 
their  Studentship  pay  £65  for  that  year ;  £25  for  the  third 
year ;  or  upon  paying  £85  on  entrance,  they  will  become 
Perpetual  Students.     Students  entering  in  their  third  year 
pay  £40 ;  for  the  next  year  £20,  or  one  payment  of  £55  on 
entrance  will  entitle  them  to  be  Perpetual  Students. 

The  Fee  for  attendance  on  the  general  subjects  required  of 
Students  in  Dental  Surgery,  is  for  the  two  years,  £55,  or  by  in- 
stalments, £50  for  the  first  year,  and  £10  for  the  second  year. 
If  certificates  for  Dental  practice  are  also  required,  the  special 
fee  for  that  subject  (page  25)  has  to  be  paid. 

Eegularly  qualified  Medical  Practitioners  are  admitted  to 
the  Hospital  practice,  and  to  the  Lectures  and  Library,  on 
payment  of  a  fee  of  £12.  10s.  for  unlimited  attendance;  but  are 
not  entitled  to  receive  certificates  for  such  attendance  without 
payment  for  the  special  certificates  required  (see  p.  25). 

All  privileges  in  respect  of  Hospital  attendance  are  granted 
subject  to  the  approval  of  the  Governors,  and  Students  must 
conform  to  the  regulations  of  the  Hospital  and  Medical  School, 
on  which  understanding  alone  cards  of  attendance  are  granted. 

EXTRA    CHARGES. 

Students  are  now  supplied  with  chemicals  and  materials 
to  work  with  in  the  courses  of  Chemistry  and  Physiology 

*  Students  who  have  commenced  the  study  of  the  Profession  otherwise  than  by  attendance  at 
a  Medical  School,  will  be  considered  to  be  first  year's  Students  on  joiuing  (he  Medical  School,  as 
the  time  previously  spent  does  not  count  until  three  years'  l/ectures  have  been  attended,  but  a 
deduction  from  the  Perpetual  Fee  will  be  allowed  in  such  cases. 


25 

without  extra  charge,  but  there  are  certain  instruments  and 
materials  required  during  the  course  of  study,  as  follows,  viz.: 

Those  attending  the  Class  of  Practical  Physiology  in  the 
summer  should  provide  themselves  with  Microscopes. 

Students  Dissecting  pay  for  the  parts  they  dissect  at  fixed 
rates,  which  are  notified  in  the  Library. 

The  Clinical  Clerks  must  provide  themselves  with  a  Stetho- 
scope and  Kegistering  Clinical  Thermometer.  The  Dressers 
are  required  to  have  a  Eegistering  Clinical  Thermometer,  a 
Pocket  Case  of  Instruments,  and  a  Case  of  Silver  Catheters. 

The  fee  for  Practical  Pharmacy  is  not  included  in  the 
Perpetual  fee,  as  many  Students  have  learned  it  before  join- 
ing a  Medical  School;  but  instruction  in  Pharmacy  and 
Pharmaceutical  Manipulation,  to  meet  the  requirements  of 
the  Eoyal  Colleges  of  Physicians  and  Surgeons,  and  of  the 
Society  of  Apothecaries,  is  given  in  the  Dispensary  of  the 
Hospital  by  the  Apothecary,  Mr.  S.  Plowman.  The  fee  for 
this  course  of  instruction  is  5  Guineas  for  three  months. 
Application  to  be  made  to  the  Secretary,  Dr.  Gillespie. 

The  different  Courses  of  Lectures,  or  the  Hospital  Practice, 
rnay  also  be  attended  separately  on  the  following  terms, 
which  entitle  to  Certificates  for  such  Attendances. 

For  the  Medical  and  Surgical  Practice,  including  Clinical  Lectures  and  the 
Special  Departments. 


Twelve  months £40 

Perpetual  £55 


Three  months     £15 

Six         ditto        £26 

Nine     ditto      ...      ..      „      ..   £35 

Deutal  Practice,  1  year  2  Gs.,  Perpetual  3  Gs. 

Midwifery  Practice,  5  Gs.  Ophthalmic  Practice,  2  Gs. 

For  Lectures  and  Demonstrations.  1  Course.     Perpetual. 

Medicine,  Surgery,  Physiology,  Anatomy,  Chemistry  each  7  Gs.   ..10  Gs. 

Midwifery 5   „      ..   6    „ 

Materia  Medica,  Botany,  Physics,  Forensic  Medicine, )     ,  c 

General  Pathology,  and  Comparative  Anaty.      each/         " 

Mental  Diseases,  Ophthalmic  Surgery,  State  Medicine  each  2    „      ..  3    ,, 

*  Practical    Chemistry,  Practical   Surgery,  Practical  1 

Physiology,  Pathological  Anatomy,  including  the  >  6   „  — 

Practical  Course  each  J 

Dissections,  three  months  4  Gs.,  six  months  6  Gs.,  Perpetual  10  Gs. 

Operative  Surgery — A  voluntary  class  will  be  formed  by  Messrs.  MacEellar 
and  Clutton  during  the  Summer,  and  at  other  convenient  times,  for  Gentle- 
men who  wish  to  prepare  for  the  Fellowship  or  other  Examinations.  This 
course  will  not  include  Operations  on  the  Eye-ball.     Fee,  £5  5s. 

Operative  Surgery  of  the  Eye. — A  voluntary  class  will  be  formed  by  Mr. 
Nettleship  during  the  Summer,  in  connection  with  the  preceding  course. 
Fee,  £1  Is.  This  course  may  also  be  taken  separately,  either  in  Summer  or 
Winter.     Fee,  £2  2s. 

Special  Courses  of  Obstetric  Demonstrations  are  given  by  Dr.  Cory  throughout 
the  year.     Fee,  £3  3s. 

*  Those  amounts  do  not  include  the  extra  charges  in  the  Practical  Courses  for  Materials, 
Instruments,  &c. 


26 
UNIVEESITY   OF   LONDON 

MATRICULATION,    PRELIMINARY,   SCIENTIFIC,   AND 
INTERMEDIATE   M.B.   CLASSES. 

MATRICULATION    EXAMINATION. 

Classes  in  the  following  subjects  will  commence  in  October 
for  the  January  Examination,  and  in  March  for  the  June, 
and  be  continued  as  follows : 

Chemistry Dr.  Bernays       ..  ..     Mon.  and  Fri.  at  12. 

English  Language, History\  -     M.vnTTRV  /Mondays,  Wednesdays, 

and  Geography      ..      . ./  ut-  mAYBURY     ••  "\    Thursdays,  2  to  3. 
French  and  German . .      . .     A.  Von  Watzdorf 


Mon.  and  Thurs.,  3. 
(Mondays,  Wednesdays, 
\     Thursdays,  1  to  2. 

Tuesdays  and  Fridays, 


Greek  and  Latin       ..      ..     Dr.  Maybury 

f 

\     2  o  clock. 

Fee  for  the  whole  Course,  Ten  Guineas ;     arrangements  can  be  made  to 
attend  one  or  more  Subjects  only.     Subsequent  Courses,  half  Fee. 


PRELIMINARY    SCIENTIFIC    EXAMINATION. 

Special  Classes  in  the  subjects  required  for  the  Preliminary 
Scientific  Examination  at  the  University  of  London,  will  be 
held  from  October  to  July,  and  will  include  all  the  subjects 
required  as  follows  : 

Botany {^nd?™'  ^^-^jwediiesdays,  11  to  12. 

Chemistry  (Inorganic)     A.  J.  Bernays,  Ph.D., F.C.S.    Tuesdays,  11  30. 
Do.        (Practical)  Do.  Fridays,  11.30. 

M™i™N:tura!} w- H-  Soti-  MB-  «HS8i$2a$S$. 

z°°^  ^^""-•'teissf 

The  Fee  charged  to  Students  of  the  Hospital  for 

instruction  in  the  above  is*    .       Six  Guineas. 

To  others,  inclusive  of  Practical  Chemistry  and 

Chemicals         Twelve  Guineas. 

Fee  for  any  single  subject Tliree  Guineas. 

Subsequent  Courses,  half  Fee. 
*  Instruction  in  Practical  Chemistry  is  necessary  for  this  Examination. 
This,  so  far  as  Students  of  the  Hospital  are  concerned,  is  held  to  be  given 
in  the  course  of  Practical  Chemistry  attended  by  all  Students  in  their  first 
Summer,  the  requirements  of  the  University  being  specially  regarded  in 
this  Course,  but  Students  requiring  a  Second  Course  of  Practical  Chemistry, 
are  charged       A  Guinea  and  a-half  for  Chemicals. 

INTERMEDIATE  EXAMINATION  IN  MEDICINE. 

Special  Classes  in  the  subjects  required  for  this  Examina- 
tion are  held  by  the  different  Lecturers  on  those  Subjects, 
from  January  to  July. 

Anatomy       ..      ..     R.  W.  Keid,  Esq.,  CM.      ..   Thursdays,  11. 
Materia  Medica  andfW.  H.  Stone,  M.B.  Oxon  ..  Wednesdays,  2.30. 

Therapeutics      ..  |S.  Plowman,  Esq Tuesdays,  2 .  30. 


27 

Organic  Chemistry  A.  J.  Bernays,  Ph.D Wednesdays,  11.30. 

Do.      Analysis  Do.  ..      ..    Saturdays,  10. 

Physiology    ..      ..   Mr.  Stewart Fridays,  11. 

Fee  to  Students  of  the  Hospital  inclusive  of 

Organic  Analysis  and  Chemicals* Nine  Guineas. 

Toothers  ditto  Twelve  Guineas. 

Fee  for  any  Single  Subject      Three  Guineas. 

Subsequent  Courses,  half  Fee  (except  Chemicals,  for  which  full  fee  is  charged). 
*  Instruction  and  Practice  in  Organic  Analysis  is  essential  for  this  Examination. 
N.B. — Private    Classes    are    held   for    the    Final    M.B.    Examination. 

SCHOLARSHIPS,     PRIZES,     APPOINTMENTS, 
AND    HONORARY    DISTINCTIONS. 

OPEN    SCHOLARSHIPS    IN    NATURAL    SCIENCE. 

As  an  inducement  to  the  study  of  Natural  Science  before  the  commence- 
ment of  the  strictly  Medical  Course,  two  Scholarships,  of  the  value  of  £100 
and  £60  respectively,  are  awarded  annually,  after  an  examination  in  Physics, 
Chemistry,  and  either  Botany  or  Zoology,  at  the  option  ot  Candidates.  The 
Examinations  for  these  Scholarships  will  be  held  on  October  4th,  5th,  and 
6th,  1882,  the  subjects  being  the  same  as  those  for  honours  in  the  Pre- 
liminary Scientific  Examination  of  the  London  University,  viz. :  Botany, 
Zoology,  Inorganic  Chemistry  (including  Practical  Chemistry),  and  Physics 
or  Natural  Philosophy.  These  Scholarships  are  open  to  all  Students  who 
have  passed  a  recognised  Preliminary  Examination  in  Arts,  and  have  not 
yet  attended  Lectures  on  Anatomy  and  Physiology  of  the  first  year,  without 
any  condition  as  to  their  becoming  Students  of  the  Hospital,  except  in  the 
case  of  successful  Candidates,  who  must  enter  at  once  as  Perpetual  Pupils. 
Chemistry  and  Physics  shall  be  compulsory  subjects  for  this  Examina- 
tion, and  Candidates  must  take  up  one  of  the  other  subjects  at  their 
option.  The  Examination  will  be  conducted  by  means  of  written  papers  and 
practical  work.  The  names  of  Competitors  with  Certificate  of  Preliminary 
Examination  must  be  sent  to  the  Secretary  not  later  than  September  30th. 
THE  WILLIAM  TITE  SCHOLARSHIP. 

This  Scholarship,  founded  by  the  late  Sir  W.  Tite,  C.B.,  M.P.,  F.R.S., 
and  endowed  with  £1,000  Consols,  producing  £30  per  Annum,  is  awarded 
each  year  to  the  Student  placed  highest  in  the  1st  Class  List  in  the 
examinations  at  the  end  of  the  first  Winter  Session.  Preference,  in  case 
of  equality  between  Students,  is  to  be  given  to  the  son  of  a  medical  man, 
and  more  particularly  of  one  who  has  been  educated  at  St.  Thomas's 
Hospital  or  is  in  Practice  in  Bath. 

THE  MUSGROVE  SCHOLARSHIP. 

This  Scholarship,  founded  by  Sir  John  Mtjsgrove,  Bart.,  the  late 
President  of  the  Hospital,  and  endowed  with  £1,400  Consols,  producing 
40  Guineas  per  Annum,  is  awarded  biennially  to  the  Student  who  shall 
take  the  highest  place  in  the  1st  Class  List  in  the  examinations  at  the 
end  of  the  Second  Winter  Session.  It  is  tenable  for  two  years,  provided 
the  holder  obtains  a  place  in  the  1st  Class  in  the  Examinations  at  the  end 
of  the  third  winter. 

A  COLLEGE  SCHOLARSHIP. 

A  Scholarship,  of  the  value  of  40  Guineas,  also  tenable  for  two  years, 
will  be  given  every  second  year,  alternately  with  the  Musgrove  Scholar- 
ship, and  on  similar  conditions,  as  to  second  tenure. 

Gentlemen  obtaining  these  Scholarships  are  not  precluded  from  receiving 
any  of  the  Prizes  awarded  at  the  subsequent  periodical  examinations. 


28 
PRIZES. 

The  following  Scholarships,  Prizes,  and  Medals,  will  he  offered  for  Com- 
petition during  the  year  1882-1883  : — 
TWO   OPEN   SCHOLARSHIPS   IN   NATURAL   SCIENCE  of  the 
value  of  £100  and  £60  respectively,  at  Entrance. 

At  the  End  of  First  Year. 

1st.     ..     The  William  Tite  Scholarship £30. 

2nd.    ..     College  Prize        £20. 

3rd.     ..  Ditto  £10. 

Summer. 

1st.       ..     College  Prize       £15. 

2nd.     ..  Ditto  £10. 

Second  Year. 
Winter. 

1st.      ..     The  Musgrove  Scholarship        £42. 

2nd.     ..     College  Prize       £20. 

3rd.     ..  Ditto  £10. 

Summer. 

1st.      ..     College  Prize        £15. 

2nd.     ..  Ditto  £10. 

Third  Year. 
Winter. 
Second  Tenure  of  College  Scholarship  (if  holder 

obtains  1st  Class)  in  this  examination   ..      ..     £42. 

1st.     ..     College  Prize       £20. 

2nd.    ..  Ditto       £15. 

3rd.     ..  Ditto       £10. 

Summer. 

1st.      ..     College  Prize       £15. 

2nd.     ..  Ditto        £10. 

Students  of  each  year  are  classed  according  to  their  respective  merits 
in  the  examinations,  and  those  in  the  first  class  in  each  year  receive 
Certificates  of  Honour,  and  a  preference  in   the   selection   for  Hospital 

Appointments. 

In  addition  there  are  awarded — 

The  CHESELDEN  MEDAL,  Annually. 

The  MEAD  MEDAL,  do. 

The  SOLLY  MEDAL  and  PRIZE,      Biennially. 

The  GRAINGER  TESTIMONIAL  PRIZE,  do. 

The  TREASURER'S  GOLD  MEDAL,  Annually. 

The  Ciieselden  Medal,  founded  by  the  late  George  Vaughan,  Esq., 
is  annually  awarded  to  the  Fourth  Year's  Student  who  most  distinguishes 
himself  in  respect  of  a  Special  Practical  Examination  in  Surgery  and 
Surgical  Anatomy. 

The  Mead  Medal,  founded  by  Mr.  and  Mrs.  Newman  Smith,  is 
awarded  annually,  to  a  Fourth  Year's  Student,  in  respect  of  a  Special 
Practical  Examination  in  Medicine,  Pathology  and  Hygiene. 

Competitors  for  either  of  these  Medals  must  have  been  Students  of 
St.  Thomas's  for  at  least  two  out  of  the  four  Winter  Sessions. 


29 


The  Solly  Medal,  together  with  a  Prize  in  Money,  will  be  awarded 
biennially.  Those  Students  are  eligible  to  compete  who  shall  be  of  from 
three  to  six  years'  standing.  The  award  is  made  for  the  best  scries  of 
Reports  of  Surgical  cases  coming  under  the  Students'  personal  observation 
in  the  Wards,  not,  however,  to  exceed  ten  in  number.  Preference  is  given, 
merit  in  other  respects  being  equal,  to  Reports  illustrated  by  the  author's 
drawings,  and  short  Clinical  Remarks  must  accompany  each  Report.  The 
next  award  will  be  made  at  the  end  of  1883-84,  papers  to  be  sent  in  before 
April  1st,  1884. 

The  Graingek  Testimonial  Prize,  of  the  value  of  Twenty  Pounds,  is 
awarded  biennially  to  Students  who  shall  be  of  from  three  to  six  years' 
standing,  for  the  best  Physiological  Essay,  to  be  illustrated  by  preparations 
and  dissections.  Competitors  for  this  Prize  must  be  Medical  Students  of 
St.  Thomas's  Hospital,  and  on  the  day  of  sending  in  their  Essays,  Dissec- 
tions, and  Preparations,  shall  have  completed  the  Second,  and  not  more 
than  the  sixth  year  of  their  medical  studies.  The  next  award  will  be  made 
in  1882,  papers  to  be  sent  in  before  October  1st,  1882. 

The  Treasurer's  Gold  Medal  for  General  Proficiency  and  Good 
Conduct,  is  awarded  at  the  end  of  the  4th  Winter  Session  to  the  Student 
who  has  passed  through  his  pupilage  in  St.  Thomas's  Hospital  in  the  most 
meritorious  manner. 

Two  Resident  and  one  Non-Resident  House  Physicians,  and  an 
Assistant  House  Physician,  Two  House  Surgeons,  an  Assistant 
House  Surgeon,  and  a  Resident  Accoucheur,  are  selected  every  three 
months  from  Gentlemen  who  have  obtained  their  professional  diplomas ; 
they  hold  office  for  three  or  six  months.  The  Assistant  House  Physician 
and  House  Surgeon  are  non-resident,  but  the  other  Officers,  together  with 
the  Dressers  and.  Obstetric  Clerks,  are  provided  with  Rooms  and  Commons 
during  their  period  of  attendance  in  the  Hospital,  free  of  expense. 

An  Ophthalmic  Clinical  Assistant,  chosen  from  Qualified  Students 
who  have  worked  satisfactorily  in  the  Ophthalmic  Department,  is  appointed 
for  six  months  with  a  Salary  at  the  rate  of  £50  per  annum,  with  board 
but  not  residence ;  the  appointment  is  renewable  for  a  limited  period. 

Clinical  Clerks,  and  Dressers,  to  In-Patients  are  selected  to  the 
number  of  at  least  100  each  year.  They  are  chosen  from  amongst  the 
most  eligible  pupils.  Clinical  Clerks,  and  Dressers,  for  the  Out- 
patients are  also  appointed  to  the  number  of  at  least  80  to  100  each  year. 

All  Students  have  the  opportunity  afforded  them  of  being  engaged  in 
the  performance  of  practical  duties  in  connection  with  the  Medical,  Surgical 
Obstetrical,  Ophthalmic,  and  Pathological  Departments  of  the  Hospital. 

Two  Hospital  Registrars,  at  an  annual  Salary  of  £100  each,  are 
appointed  in  each  year.  Preference  will  be  given  to  Gentlemen  who  have 
been  distinguished  for  meiit,  and  have  completed  their  studies  in  the 
School.  The  payment  of  the  Registrars  is  subject  to  the  presentation  of 
a  Report  upon  the  Practice  of  the  Hospital,  and  to  such  Report  bein" 
regarded  as  satisfactory  by  the  Medical  Officers  to  whom  it  shall  have  been 
referred. 

Two  or  more  Students  are  selected  from  those  who  have  completed 
their  Second  Winter  Session,  to  act  as  Assistants  in  the  Physiological 
Laboratory. 

Two  or  more  Students  are  selected  from  those  who  have  completed 
their  Second  Winter  Session,  to  act  as  Assistants  in  the  Dissecting  Room, 
They  receive  Certificates  of  Honour  according  to  merit. 

Prosectors  are  appointed  in  the  early  part  of  the  Winter  Session,  and 
Prizes  are  awarded  to  the  best  Dissectors  at  the  termination  of  the  Session. 


30 


Students  are  likewise  appointed  to  act  as  Assistants  to  the  Demon- 
strators of  Pathological  Anatomy  in  the  Post-mortem  Eoom. 

Obstetric  Clerks,  who  reside  and  have  Commons  in  the  Hospital, 
are  appointed  in  rotation.  Each  holds  office  for  a  fortnight,  and  Certificates 
of  Honour  are  awarded  to  those  Gentlemen  who  have  satisfactorily  attended 
Sixty  Maternity  cases. 

Students  have  access,  with  the  permission  of  the  Officers  under  whose 
superintendence  they  are  placed,  to  the  Museums  of  Human  and  Com- 
parative Anatomy  and  Pathology — of  Materia  Medica — of  Botany —  and  of 
Chemistry  and  Mineralogy — and  to  the  Laboratories  of  Practical  Physiology 
and  Practical  Chemistry  ;  also  to  the  Library,  which  contains  a  large 
collection  of  works  of  reference  and  modern  text-books. 


REGULATIONS  for  the  EXAMINATION  AND  CLASSIFICATION 
OF  THE  STUDENTS. 

1.  In  accordance  with  the  Regulations  of  the  Qualifying  Bodies,  Students 
will  be  required  to  attend  the  Class  Examinations  in  the  subjects  for  which 
they  have  to  be  certified,  and  show  by  their  answers  to  the  questions  that 
they  have  paid  proper  attention  to  the  Lectures,  otherwise  their  Schedules 
cannot  be  signed. 

2.  There  shall  be  held  at  least  two  Examinations  in  each  Winter  and  one 
in  each  Summer  Session  in  each  subject  on  which  attendance  is  required 
during  that  Session,  and  the  marks  obtained  in  these  Examinations  shall 
be  the  basis  for  the  Classification  of  Students  and  the  Award  of  Prizes  for 
each  Session  respectively.  Provided  that  any  extra  Examination  in  the 
course  of  the  Session,  in  any  subject,  be  not  allowed  to  interfere  with  the 
ordinary  Lectures  in  other  subjects. 

3.  The  number  of  marks  allotted  to  each  subject  in  the  following  Schedule 
is  not  to  be  exceeded  in  case  the  number  of  Examinations  held  during  the 
Session  be  more  than  two,  but  must  be  distributed  amongst  the  several 
Examinations. 


1st  YEAR'S  SUBJECTS. 

Winter  .  Anatomy 600 

Practical  Anatomy  .     .  200 

Physiology     ....  600 

Chemistry      ....  600 


Total 


2000 


SUMMER 


♦Practical  Chemistry      .  300 

Materia  Medica  .     .     .  300 

Botany 150 

Practical  Physiology     .  300 

Total       .     .     .1050 

2nd  YEAR'S  SUBJECTS. 

Winter    .  Anatomy       ....  600 

Practical  Anatomy  .     .  200 

Physiology     ....  600 

Practical  Surgery     .     .  200 


2nd  Year's  Subjects — continued. 
Sdmmer    .  Midwifery      ....     BOO 
Comparative  Anatomy  .    100 

Total      ...     600 


3rd  YEAR'S  SUBJECTS. 

Winter   .  Medicine 650 

Surgery 650 


3rd  SUMMER. 
Forensic  Medicine  .  , 
Pathological  Anatomy 

Total     . 


250 
360 


*  Students  who  have  been  already  examined 

in  this  subject  in  the  Preliminary  Scientific 

Course  need  not   go  in  again,  and  will  be 

Total       .     .     .   1600  allowed  to  count  the  marks  then  obtained  as 

part  of  the  1st  Summer  Examination. 

4.  All  Students  who  have  obtained  at  least  one-third  of  the  total  number 
of  marks  in  each  subject,  and  not  less  than  two-lhirds  of  the  total  number 
allotted  to  all  the  subjects  collectively,  shall  be  placed  in  the  1st  Class. 

Those  who  have  obtained  one-third  of  the  total  number  of  marks  allotted 

to  all  the  subjects  collectively  shall  be  placed  in  the  2nd  Class. 
The  names  of  those  who  do  not  obtain  either  a  1st  or  2nd  Class  position 
will  not  be  published,  but  a  General  List  showing  the  exact  position 
of  each  Student  at  every  Examination  shall  be  kept  by  the  Secretary, 


31 

from  whom  any  Student  can  learn  his  own  position,  but  no  Lecturer 
shall  make  known  to  Students  the  number  of  marks  obtained  by  any 
Student  in  any  subject. 

5.  The  Prizes  shall  be  awarded  to  the  Students  holding  the  1st,  2nd,  and 
3rd  positions  in  the  1st  Class  of  each  Winter  Session,  and  to  those  holding 
the  1st  and  2nd  positions  of  the  1st  Class  in  each  Summer  Session. 

6.  The  number  of  marks  allotted  to  the  Examinations  for  the  Mead  and 
Cheselden  Medals  shall  be  6"0  each. 

7.  In  awarding  the  Treasurer's  Medal  the  number  of  marks  obtained  at 
the  Sessional  Examinations  and  in  the  Mead  and  Cheselden  Examinations 
shall  be  counted,  provided  that,  ns  regards  the  Examination  for  the  Medals, 
two-thirds  of  the  maximum  marks  be  obtained,  but  those  obtained  in  the 
Entrance  Scholarship  Competition  shall  not  be  included. 

8.  The  Authorities  reserve  the  right  of  withholding  any  Prize,  if  no 
competitor  of  sufficient  merit  presents  himself. 


$istriJmtiau  rf |)rx$e&  far  %  |)a$t  j&essimrc. 

SUMMER     SESSION,    1881. 

FIRST  YEAR'S  STUDENTS. 

G.  A.  Carpenter,  Streatham      /  Colle^erfr^e'  £1f > 

[  ana  Certificate  of  Honour. 

B.LxwBO*,Winthank,N.BrU (  CoUeg1enPr?-fle'+£19'xT 

I  and  Certificate  of  Honour. 

G  S  Sims  Derby  /  c<>llege  Prize,  £5, 

'  J "  \  and  Certificate  of  Honour. 

SECOND  YEAR'S  STUDENTS. 

H.  B.  Eobinson,  Lower  Norwood       (  College  Prize,  £15, 

(  and  Certificate  of  Honour. 


WINTER    SESSION,   1881-82. 

ENTRANCE    SCIENCE    SCHOLARSHIPS. 

H.  Sydney  Jones,  George  Street,  Hanover  Square    {  Scholarship,  £80, 

J  I  a"d  Certificate  of  Honour. 

J.  S.  Hutton,  Sevenoaks     (  Scholarship   £80, 

I,  and  Certificate  of  Honour. 

FIRST  YEAR'S   STUDENTS. 

(  The  Wm.  Tite  Scholarship, 
H.  Sydney  Jones,  George  Street,  Hanover  Square     <         £30, 

(         and  Certificate  of  Honour. 

J.  S.  Hutton,  Sevenoaks     /  College  Prize,  £20, 

(  and  Certificate  of  Honour. 

H.  C.  Kidd,  Upper  Norwood       {  CollegePrize,  £10, 

I  and  Certificate  of  Honour. 

E.  S.  Gooddy,  Hampstead Certificate  of  Honour. 

K.  Totsuka,  Japan      Certificate  of  Honour. 

S.  Warren,  Dover        Certificate  of  Honour. 

A.  E.  Olding,  Brighton       Certificate  of  Honour. 

F.  D.  Crowdy,  The  Temple Certificate  of  Honour. 

G.  Cranstoun,  Ludlow        Certificate  of  Honour. 


32 


SECOND  YEAR'S  STUDENTS. 


H.  H.  Lankester,  Leicester 

R.  Lawson,  Winthanh,  N.  Brit. 

G.  A.  Carpenter,  Streatham 

R.  T.  Cann,  Plymouth 

H.  Bidwell,  Ely 

J.  R.  Staddon,  Ipswich 
W.  J.  Maurice,  Kennington 


[The    College    Scholarship, 
40  Gs., 

and  Certificate  of  Honour, 
f  College  Prize,  £20, 
\  and  Certificate  of  Honour. 

(  College  Prize,  £10, 
I  and  Certificate  of  Honour. 

Certificate  of  Honour. 

Certificate  of  Honour. 

Certificate  of  Honour. 

Certificate  of  Honour. 


THIRD  YEAR'S  STUDENTS. 


Y.  Saneyoshi,  Tolcio,  Japan   

W.  B.  Tomson,  Luton,  Beds 

J.  P.  Glover,  Lansdowne  Road 

H.  B.  Bobinson,  Lower  Norwood    . . . 
F.  F.  Caigek,  Gloucester  Street,  S.  W. 


(  College  Prize,  £20, 
"'\  and  Certificate  of  Honour. 

I  College  Prize,  £15, 2nd  Tenure 
of  Musgrove  Scholarship, 
£42 ,  and  Certificate  of  Honour. 
/  College  Prize,  £10, 
'"  \  and  Certificate  of  Honour. 

Certificate  of  Honour. 
Certificate  of  Honour. 


ANATOMICAL  ASSISTANTS. 


R.  Relton,  Ealing        

H.  B.  Robinson,  Lower  Norwood 
Y.  Saneyoshi,  Tolcio,  Japan 


Certificate  of  Honour. 
Certificate  of  Honour. 
Certificate  of  Honour. 


PROSECTOP.S. 

G.  A.  Carpenter,  Streatham     | 

R.  Lake,  Dover     \ 


Prize, 

and  Certificate  of  Honour. 
Prize, 

and  Certificate  of  Honour. 


SOLLY  MEDAL  AND  PRIZE. 
W.  A.  Duncan,  M.D Medal  and  Prize,  £25. 


PRACTICAL  MEDICINE. 


W.  Hull,  Acton    j 


The  Mead  Medal,  founded  by 
Mr.  &  Mrs.  Newman  Smith. 


W.  F.  Haslam 
H.  P.  Butler  ... 
W.  A.  Duncan 

T.  D.  ACLAND 


RESIDENT  ACCOUCHEURS. 


Certificate  of  Honour. 
Certificate  of  Honour. 
Certificate  of  Honour. 
Certificate  of  Honour. 


33 


T.  D.  Savill 
G.  F.  Coxwell     ... 
A.  B.  Carpenter... 
8.  W.  Sutton 


HOUSE  PHYSICIANS. 


Certificate  of  Honour. 
Certificate  of  Honour. 
Certificate  of  Honour. 
Certificate  of  Honour. 


ASSISTANT  HOUSE  PHYSICIANS. 


C.  A.  Ballance  . 
M.  P.  M.  Collier 
A.  B.  Carpenter  . , 
H.  N.  Holberton 
S.  W.  Sutton 
A.  E.  Wells  ...  . 
F.  W.  Marlow  ., 
R.  Heelis       ...     . 


Certificate 
Certificate 
Certificate 
Certificate 
Certificate 
Certificate 
Certificate 
Certificate 


of  Honour, 
of  Honour, 
of  Honour, 
of  Honour, 
of  Honour, 
of  Honour, 
of  Honour, 
of  Honour. 


T.  D.  Acland 
F.  W.  Marlow     .. 
M.  P.  M.  Collier 
E.  F.  White 


HOUSE  SURGEONS. 


Certificate  of  Honour. 
Certificate  of  Honour. 
Certificate  of  Honour. 
Certificate  of  Honour. 


ASSISTANT  HOUSE  SURGEONS. 

S.  W.  Sutton       Certificate  of  Honour. 

A .  E.  Wells         Certificate  of  Honour. 

E.  F.  White         Certificate  of  Honour. 

C.  W.  Haig  Brown     Certificate  of  Honour. 


FOR  GENERAL  PROFICIENCY  AND  GOOD  CONDUCT. 

/  The  Treasurer's  Gold 
1  Medal. 


W.    J.    SlIEPPARD 


The  following  Distinctions  have  been  obtained  by  Students  of  St.  Thomas's 
Hospital  during  the  past  year : — 

The  Gold  Medal  in  Medicine  at  the  M.D.  Examination  of  the  London  Univer- 
sity, by  Dr.  C.  E.  Sheppard,  Resident  Assistant  Physician. 

The  Gold  Medal  in  Surgery  at  the  B.S.  Examination  of  the  London  University, 
by  Mr.  C.  A.  Ballance,  M.B. 

Dr.  A.  Newsholnie  qualified  for  the  Gold  Medal  in  Medicine  at  the  M.D.  Examina- 
tion of  the  London  University. 

Mr.  C.  F.  Coxwell  obtained  the  "  Murchison  Memorial  Scholarship."  awarded  at 
the  Royal  College  of  Physicians,  London,  for  the  first  time  thii  year. 


34 


THE  MUSEUM  OF  HUMAN  AND  COMPARA- 
TIVE ANATOMY  AND  PATHOLOGY. 


Curator.- Mr.  C.  STEWART. 


Among   the   earliest    contributors  to  this  Museum  were  Mr.  Clink,  Sir 
A.  Cooper,  Mr.  Travers,  and  Mr.  Tyrrell. 

The  Printed  Catalogue  of  the  Museum  consists  of  three  octavo  volumes  : 
in  the  first  volume,  edited  by  Mr.  John  F.  South,  are  described  the  pre- 
parations of  Health y  Human,  Microscopical,  and  Comparative  Anatomy  ; 
and  the  2nd  and  3rd  volumes,  edited  by  Mr.  Sydney  Jones,  contain 
descriptions  of  the  specimens  illustrative  of  Pathological  Anatomy. 

The  COLLECTION  of  HUMAN  ANATOMY  consists  of  a  Physio- 
logical and  a  Pathological  Department :  the  former  contains,  besides 
wax  models  and  casts,  a  large  number  of  dissected  Preparations,  illus- 
trating the  Organs  of  Locomotion  and  Sense  ;  the  Nervous  System  ;  the 
Digestive,  Respiratory,  and  Urinary  Apparatus ;  the  Vascular  System, 
the  Organs  of  Reproduction,  and  the  Tissues. 

The  Pathological  Division  is  very  rich,  containing  above  3000 
Specimens,  arranged  in  thirty-seven  Sections,  as  follows : 


SECT. 

A.  Injuries  of  Bone :  Fractures. 

B.  Injuries  of  Joints :  Dislocations. 

C.  Diseases  of  Bone. 

D.  Diseases  of  joints. 

E.  Diseases  of  the  Spinal  Column. 

F.  Injuries  and  Diseases  of  the  Muscular 

System. 

G.  Injuries  and  Diseases  of  the  Eye. 
'     Injuries  and  Diseases  of  the  Ear. 

Injuries   and    Diseases  of  the   No?e, 

Antrum,  &c. 
Injuries  and  Diseases  of  the  Skin  and 

Subcutaneous  Cellular  Tissue. 
Injuries  of  the  Skull. 
Injuries  of  the  Spine. 
Injuries  and  Diseases  of  the  Nervous 

System. 
Injuries  and  Diseases  of  Mouth,  Fauces, 

Pharynx,  and  the  GSsophagu**. 
Injuries  and  Diseases  of  the  Stomach. 
Injuries  and  Diseases  of  the  Intestines 

and  Peritoneum. 


II. 
I. 

K. 

L. 
M. 

N. 

0. 


R. 


Intussusception,  Internal  Strangulation , 
and  Hernia. 


SECT. 

W.      Injuries  and  Diseases  of  the  Respi- 
ratory Apparatus. 
X.       Injuries  and  Diseases   of  the  Heart 

and  Pericardium. 
Y.       Injuries  and  Diseases  of  Arteries  and 

Veins. 
Z.        Diseases  of  Lymphatic  and  Lacteal 

Vessels  and  Glands. 
AA.    Injuries  and  Diseases  of  the  Kidneys, 

and  Ureters. 
BB.     Injuries  and  Diseases  of  the  Bladder. 
CC.     Diseases  of  the   Prostate  Gland  and 

Vesiculae  Seminales,  Urinary  and 

Prostatic  Calculi. 
DD.    Injuries  and   Diseases  of   the  Penis 

and  Urethra. 
EE.    Injuries  and  Diseases  of  the  Testicles 

and  Scrotum. 
FF.    Diseases  of  the  Ovaries  and  Fallopian 

Tubes. 
GG.     Injuries  and  Diseases  of  the  Uterus, 

Vagina,  and  external  organs. 
HH.     Diseases    and  displacements  of  the 

Ovum. 
II.       Diseases  of  the  Breast. 
KK.    Tumours    and    other    allied    Morbid 

Growths. 
LL.      Malformations. 
MM.    Wax  Models  and  Casts. 


S.     Injuries  and  Diseases  of  the  Liver. 

T.    Diseases  of  the  Tancreas  and  Salivary 

Glands. 
U.     Injuries  and  Diseases  of  the  Spleen. 
V.    Diseases    of    Thyroid,    Thymus,   and 

Suprarenal  Capsules. 

Bones,  Joints,  &c — Amongst  the  specimens  illustrating  Injuries  of 
Bones  and  Joints,  are  nearly  all  those  described  and  figured  in  Sir  A. 
Cooper's  Treatise  on  •  Dislocations  and  Fractures  of  the  Joints,'  and  in 
Cooper's  and  Travers's  '  Surgical  Essays.' 


35 

This  section  has  been  recently  much  enriched  by  numerous  specimens 
of  gunshot  injuries,  presented  by  Sir  William  Mac  Cormac,  chiefly  fractures 
from  bullet  and  shell  wounds  obtained  from  cases  under  his  treatment 
during  the  Franco-German  War. 

Sir  A.  Cooper's  preparations,  illustrating  repair  after  fracture,  are 
contained  in  this  Section. 

Eye. —This  Section  has  been  arranged  by  Mr.  D'ixon,  and  contains 
specimens  described  and  figured  by  Sir  A.  Cooper,  Mr.  Travers,  and 
Mr.  Saunders. 

Skin. — Several  Tumours  are  contained  in  this  Section,  as  well  as, 
amongst  others,  that  horny  growth,  ten  inches  in  length,  removed  from 
a  man's  forehead  by  Sir  A.  Cooper. 

Head,  Spine,  Nervous  System. — Showing  all  kinds  of  Injuries  to  the 
Skull ;  Spinal  Injuries,  which  have  been  subjected  to  operation  by  Cline, 
Tyrrell,  and  South,  as  well  as  every  variety,  frequent  and  rare,  of  disease 
of  the  Nervous  System. 

Intestines  and  Peritoneum. — Travers's  Preparations,  illustrating 
'  The  Process  of  Nature  in  repairing  Injuries  of  the  Intestines,'  are 
contained  in  this  Section.  There  are  also  Specimens  illustrating  the 
Morbid  Anatomy  of  Fever,  &c. 

Hernia. — This  Section  contains  nearly  all  the  Preparations  figured 
and  described  in  •  Cooper's  Hernia.'  Besides  the  more  common  varieties 
of  Hernia,  there  are  Specimens  of  Mesenteric,  Mesocolic,  Vesical, 
Thyroideal,  Ischiatic,  Perineal,  and  Phrenic  Hernia. 

Liver. — Besides  every  variety  of  Liver  Disease,  this  Section  contains 
a  large  number  of  Biliary  Calculi. 

Kespiratory  and  Vascular  Systems. — Amongst  these  Preparations 
are  two  Specimens,  showing  ligature  of  the  Abdominal  Aorta ;  one  of 
them  the  case  of  Sir  A.  Cooper;  the  other  that  of  Mr.  John  F.  South. 
There  are  also  Specimens  of  spontaneous  obliteration  of  the  Aorta. 

The  Preparations  illustrative  of  Travers's  experiments  on  Arteries 
and  Veins  are  in  the  collection. 

There  are  also  very  interesting  Specimens  of  Diseased  Heart,  described 
by  Dr.  Wells  and  Dr.  Elliotson. 

Kidneys. — Described  and  arranged  by  Mr.  Simon. 

Urinary  Calculi. — 250  in  number — analysed  by  Mr.  Heisch  and 
Dr.  Bernays. 

Testes. — Most  of  the  preparations  figured  in  Sir  A.  Cooper's  work 
'  On  the  Testis,'  are  contained  in  this  Section. 

c  2 


36 

Malformations. — This  Section  contains  Specimens  of  Spina  Bifida, 
Acephalous  and  double  monsters,  Ectopia  Cordis,  Malformations  of  the 
Heart,  Urinary,  and  Generative  Organs.  Most  of  them  have  been 
elaborately  described  by  Mr.  E.  D.  Grainger,  and  the  malformations  of  the 
heart  are  referred  to  by  Dr.  Farre  and  Dr.  Peacock  in  their  works.  There 
are  also  very  interesting  specimens  of  malformation  described  by  Dr. 
Bristowe,  Mr.  Le  Gros  Clark,  and  Mr.  Sydney  Jones. 

The  Museum  contains  a  considerable  number  of  valuable  Ethnological 
Specimens. 


The  Museum  of  Comparative  Anatomy  contains  about  1,000  Prepara- 
tions, some  of  them  very  rare  and  valuable. 

A  large  number  of  these  Specimens  were  made  by  Sir  A..  Cooper,  to 
illustrate  his  Lectures,  when  Professor  of  Comparative  Anatomy  to  the 
Royal  College  of  Surgeons. 


The  Cabinet  of  Microscopical  Anatomy  contains  upwards  of  600 
injected  and  other  Specimens. 

The  principal  part  of  these  Preparations  was  made  by  Mr.  Rainey,  to 
illustrate  the  Histological  Course  of  Lectures ;  and  there  are  other 
Preparations  described  by  him  in  Papers  published  in  the  Philosophical 
Medico-Chirurgical,  and  Microscopical  Transactions,  and  in  other  scientific 
works. 


The  Materia  Medica  Museum  contains  at  least  600  specimens, 
arranged  and  labelled  according  to  the  British  Pharmacopoeia  of  1867,  and 
is  now  under  the  superintendence  of  Dr.  Stone. 


The  Museum  of  Chemistry  and  Mineralogy  is  under  the  Superin- 
tendence of  Dr.  Bernays,  who  founded  the  Museum  and  presented  the 
larger  part  of  the  Specimens  contained  in  it. 


37 


Si   Cjjxrmas'a   INpitaL 

MEDICAL  AND  PHYSICAL  SOCIETY. 


Hon.  President,  1882-83. 
H.  H.  Clutton,  Esq. 


Vice-Pres  iden  ts. 
The  Physicians.  The  Surgeons. 

The  Assist.-Phtsicians.  The  Assist.-Surgeons. 

C.  Stewart,  Esq.  Dr.  A.  Carpenter. 

Dr.  Bernays.  E.  W.  Reid,  Esq. 

Dr.  Gillespie.  B.  Pitts,  Esq. 

G.  Gulliver,  Esq.  Dr.  Rayner. 

Dr.  Cranstoun  Charles.  W.  J.  Kilner,  Esq. 

Dr.  C.  E.  Sheppard. 


Hon.  Secretaries. 
Mr.  Sydney  Plowman,      Mr.  W.  J.  Maurice. 


Committees. 
4th  Year,  Mr.  F.  A.  Ployer,  Mr.  J.  P.  Glover. 

3rd  Year,  Mr.  H.  Bidwell,  Mr.  R.  Lawson. 

2nd  Year,  Mr.  F.  D.  Crowdy,  Mr.  J.  S.  Hutton. 

Mr.  W.  F.  Manners. 


This  Society  was  originated  in  the  early  part  of  the  present  century  by 
students  of  the  Hospital,  and  has  for  its  object  the  reading  and  discussion 
of  papers  on  Medicine,  Surgery,  and  subjects  of  General  Interest,  the 
narration  of  cases,  and  the  exhibition  of  specimens  of  Physiological  and 
Pathological  interest.  The  Meetings  are  held  in  the  Library  on  alternate 
Thursdays  at  7.30  p.m.,  and  terminate  not  later  than  9.30. 

Three  Prizes  with  Certificates  of  Honour  are  annually  awarded  by  the 
Medical  School  to  the  authors  of  the  best  papers  written  by  the  fourth, 
third,  and  second  year's  students  respectively,  and  read  before  the  Society. 
The  annual  soiree  is  held  in  December. 

Further  information  can  be  obtained  of  the  Hon.  Secretaries. 


38 


ST.  THOMAS'S  HOSPITAL  REPORTS. 


VOL.   XI.,   NEW   SERIES, 

EDITED    BY 

F.  MASON,  F.E.C.S.,  and  E.  COKY,  M.A.,  M.D.  Cantab., 

Will  be  Published  immediately. 

It  will  contain  contributions  from  Members  of  the  Staff  and 
others,  together  with  the  Statistical  Eeports  of  the  Hospital, 
by  Kthe  Medical  and  Surgical  Registrars,  for  two  years,  to 
December  31st,  1881. 

The  New  Series  commenced  in  1870,  and  complete  Sets 
may  still  be  had. 

Intending  Subscribers   are  requested    to   communicate  with 

the  Secretary,  Dr.  Gillespie,  at   the   Hospital,   to  whom  P.O. 

Orders   on   the  Westminster  Bridge    Office    are    to   be    made 
payable. 

PRICE  OF  THE   VOLUME  {including  Postage  or  delivery):— 

To  Subscribers  in  Great  Britain  and  Countries  within 

the  Postal  Union        ..  ..  ..  ..  6s.  Qd. 

To  Non- Subscribers  do.  do.  ..  ..      Is.  6d. 


OCTOBER,  1882. 


1 

5 

2 

M 

3 

Tu 

4 

W 

5 

Th 

6 

F 

7 

S 

8 

£ 

9 

M 

10 

Tu 

11 

W 

12 

Th 

13 

F 

14 

S 

15 

s 

16 

M 

17 

Tu 

18 

W 

19 

Th 

20 

F 

21 

S 

22 

& 

23 

M 

24 

Tu 

25 

W 

26 

Th 

27 

F 

28 

S 

29 

& 

30 

M 

31 

Tu 

Seventeenth  Sunday  after  Trinity. 
Introductory  Address,  3  p.m.     Annual  Dinner. 
Clinical  Clerks  and  Dressers  commence  duty. 
Entrance  Scholarships  Exam.,  4th,  5th,  &  6th. 
Exam.  Soc.  Apoth.,  every  Thursday. 


Eighteenth  Sunday  after  Trinity. 


Nineteenth  Sunday  after  Trinity, 
St.  Luke. 

Twentieth  Sunday  after  Trinity. 


Twenty-first  Sunday  after  Trinity. 


The  Hospital  Entrance  Science  Scholarships  Examination  takes  place  during 
this  month. 

The  Registration  and  Museum  Committees  meet  during  this  mouth. 


NOVEMBEK,  1882. 


30 


1 

W 

2 

Th 

3 

F 

4 

S 

5 

£ 

6 

M 

7 

Tu 

8 

W 

9 

Th 

10 

F 

11 

S 

12 

& 

13 

M 

14 

Tu 

15 

W 

16 

Th 

17 

F 

18 

S 

19 

& 

20 

M 

21 

Tu 

22 

W 

23 

Th 

24 

F 

25 

S 

26 

& 

27 

M 

28 

Tu 

29 

W 

Th 


All  Saints'  Day. 

Exam.  Soc.  Apoth.,  and  every  Thursday. 


Twenty-second  Sunday  after  Trinity. 
Univ.  Lond.  2nd  M.B.  Exam. 

[Surgs.,  &  A^st.  do. ;  of  Res.  Acconch.,  &  Ophth.  Asst.* 
Last  day  for  applications  for  offices  of  House  Phys.  and 
Prince  of  Wales  bom,  1841. 


Twenty-third  Sunday  after  Trinity. 

[and  Surgical  Registrarships. 
Notice—  30th,  last  day  tor  applications  for  Medical 
Meeting  to  appoint  House  Officers,  &c. 


Twenty-fourth  Sunday  after  Trinity. 

Univ.  Lond.  M.B,  list  published. 
Univ.  Lond.  2nd  M.B.  Honours  Exam. 
Exam.  Soc.  Apoth. 


Twenty-fifth  Sunday  after  Trinity. 


I  Saint  Andrew.  [Registrarships. 

(Last  day  for   applications  for  Medical    and  Surgical 


Royal  College  of  Surgeons'  Primary  and  Fans  Examinations  during  this  Month. 
*  Applications  for  these  appointments  to  be  made  to  the  Secretary,  by  letter, 
staling  the  Student's  qualifications,  the  offices  which  he  has  previously  held  in  the 
Hospital  and  the  number  of  Maternity  Cases  attended. 


DECEMBER,  1882. 

1 

F 

Princess  of  Wales  born,  1844. 

2 

S 

3 

$ 

Advent  Sunday. 

4 

M 

Univ.  Lund.  M.D.  and  M.S.      [Assist,  commence  duty. 

5 

Tu 

House  Phys.  and  Surgns.,  Asst.  do.,  R.  A.  and  Ophth. 

6 

W 

Last  day  for  applications  for  Clinical  Clerkships  and 

7 

Th 

[Dresserships. 

8 

F 

9 

S 

10 

d 

Second  Sunday  in  Advent. 

11 

M 

12 

Tu 

13 

W 

Meeting  to  appoint  Clinical  Clerks  and  Dressers. 

14 

Th 

15 

E 

16 

S 

17 

£ 

Third  Sunday  in  Advent. 

18 

M 

1st  Sessional  Examination  commences. 

19 

Tu 

20 

W 

21 

Th 

Saint  Thomas. 

22 

F 

23 

S 

Last  day  for  Certs.,  for  Matric.  Exam.,  Univ.,  Lond. 

24 

3 

Fourth  Sunday  in  Advent. 

25 

M 

Christmas  Day. 

26 

Tu 

27 

W 

28 

Th 

29 

F 

30 

S 

31 

& 

First  Sunday  after  Christmas. 

JANUAEY,  1883. 


1 

M 

2 

Tu 

3 

W 

4 

Th 

5 

F 

6 

S 

7 

£ 

8 

M 

9 

Tu 

10 

W 

11 

Th 

12 

F 

13 

S 

14 

& 

15 

M 

16 

Tu 

17 

W 

18 

Th 

19 

F 

20 

S 

21 

£ 

22 

M 

23 

Tu 

24 

W 

25 

Th 

26 

F 

27 

S 

23 

& 

29 

M 

30 

Tu 

31 

W 

Vacation  terminates,  and  Lectures  re-commence. 
Clinical  Clerks  and  Dressers  commence  duty. 


First  Sunday  after  Epiphany. 
Loud.  Univ.  Matric. 


Second  Sunday  after  Epiphany. 


Septuagesima  Sunday. 


Sexagesima  Sunday. 

Matric.  Pass  List  Univ.  Lond.  published. 


Royal  College  of  Surgeons'  Primary  and  Pass  Examinations  during  this  month. 
The  Registration  and  Museum  Committees  meet  during  this  month. 


FEBRUARY,  1883. 

1 

Th 

2 

F 

3 

S 

4 

£ 

Quinquagesima  Sunday. 

5 

M 

6 

Tu 

[Surgns.,  of  Asst.  Surgns.,  and  of  R.A.* 

7 

W 

Last  day  for  applications  for  offices  of  House  Phys.  and 

8 

Th 

9 

F 

10 

S 

11 

& 

First  Sunday  in  Lent. 

12 

M 

13 

Tu 

14 

W 

Meeting  to  appoint  House  Officers,  &c. 

15 

Th 

16 

F 

17 

S 

18 

& 

Second  Sunday  in  Lent. 

19 

M 

20 

Tu 

21 

W 

22 

Th 

23 

F 

24 

S 

25 

£ 

Third  Sunday  in  Lent. 

26 

M 

27 

Tu 

28 

W 

*  Applications  for  these  appointments  to  be  made  to  the  Secretary,  by  letter, 
stating  the  Student's  qualifications,  the  offices  which  he  has  previously  held  in  (he 
Hospital,  and  the  number  of  Maternity  Cases  attended. 


MARCH,  1883. 

1 

Th 

St.  David. 

2 

F 

3 

S 

4 

& 

Fourth  Sunday  in  Lent. 

5 

M 

[commence  duty. 

6 

Tu 

House  Physns.  and  Surgns.,  and  Asst.  do.,  also  R.  A. 

7 

W 

Last  day  for  applications  for  appointments  of  Clinical 

8 

Th 

[Clerks  and  Dressers. 

9 

F 

10 

S 

11 

d 

Fifth  Sunday  in  Lent. 

12 

M 

13 

Tu 

14 

W 

Meeting  to  select  Clinical  Clerks  and  Dressers. 

15 

Th 

16      F 

17 

S 

18 

£ 

Palm  Sunday. 

19 

M 

Sessional  examination  commences. 

20 

Tu 

21 

W 

22 

Th 

23 

F 

Good  Friday. 

24 

S 

25 

£ 

Easter  Day. 

26 

M 

27 

Tu 

28 

W 

29 

Th 

30 

F 

31 

S 

i  Registrar's  Report  for  last  year  due. 

(Last  Day  for  Reports  for  Solly  Medal,  1884. 

APRIL,  1883. 

1 

£ 

Low  Sunday. 

2 

M 

3 

Tu 

Clinical  Clerks  and  Dressers 

commence  duty. 

4 

W 

5 

Th 

6 

F 

7 

S 

8 

& 

Second  Sunday  after  Easter. 

9 

M 

10 

Tu 

11 

W 

12 

Th 

13 

F 

14 

S 

15 

& 

Third  Sunday  after  Easter. 

16 

M 

17 

Tu 

18 

W 

19 

Th 

20 

F 

21 

S 

22 

& 

Fourth  Sunday  after  Easter. 

23 

M 

24 

Tu 

25 

W 

26 

Th 

27 

F 

28 

S 

29 

£ 

Fifrh  Sunday  after  Easter. 

30 

M 

Royal  College  of  Surgeons'  Primary  and  Pass  Examinations  during  this  month. 
The  Examinations  for  the  Mead  and  Gheselden  Medals  take  place  this  month. 
The   Annual  Inspection  of  the  Museum  and  meeting  of  Museum  Committee 
take  place  during  this  month. 

The  Registration  Committee  meets  during  this  month. 

Preliminary  Examination  in  Ails  of  Apothecaries  Society  held  this  month. 


MAY,  1883. 

1 

Tu 

Summer  Session  commences. 

2 

W 

3 

Th 

Ascension  Day. 

4 

F 

5 

S 

6 

£ 

Sunday  after  Ascension. 

7 

M 

8 

Tu 

[and  Surgns.,  and  Asst.  do.,  of  K.  A.,  &  Ophth.  Asst.* 

9 

W 

Last  day  for  applications  for  offices  of  House  Phys. 

10 

Th 

11 

F 

[H.M.  the  Queen,  1868. 

12 

S 

First  Stone  of  St.  Thomas's  New  Hospital   laid  by 

13 

$ 

Whit  Sunday. 

14 

M 

15 

Tu 

[Asst. 

16 

W 

Meeting  to  appoint  House  Officers,  R.  A.  and  Ophth. 

17 

Th 

18 

F 

19 

S 

20 

£ 

Trinity  Sunday. 

21 

M 

22 

Tu 

23 

W 

24 

Th 

Queen  Victoria  born,  1819. 

25 

F 

26 

S 

27 

$ 

First  Sunday  after  Trinity. 

28 

M 

29 

Tu 

30 

W 

31 

Th 

Royal  College  of  Surgeons'  Primary  and  Pass  Examinations  during  this  Month. 
*  A i 'plications  for  (hex?  appointments  to  be  made  to  the  Secretary,  by  letter, 
elating  the  Student's  qualifications,  the  offices  which  he  has  previously  held,  in  the 
Hospital,  and  the  number  of  Maternity  Cases  attended. 


JUNE,  1883. 


1 

F 

2 

S 

3 

£ 

4 

M 

5 

Tu 

6 

W 

7 

Th 

8 

F 

9 

S 

10 

5 

11 

M 

12 

Tu 

13 

W 

14 

Th 

15 

F 

16 

S 

17 

& 

18 

M 

19 

Tu 

20 

W 

21 

Th 

22 

F 

23 

S 

24 

& 

25 

M 

26 

Tu 

27 

W 

28 

Th 

29 

F 

30 

S 

Second  Sunday  after  Trinity. 

[Ophth.  Asst.  commence  duty. 
House  Phys.  and  Surgns.,  and  Asst.  do.,  R.  A.  and 
Last  day  for  applications  for  appointments  of  Clinical 

[Clerks  and  Dressers. 


Third  Sunday  after  Trinity, 


Meeting  to  select  Clinical  Clerks  and  Dressers. 


Fourth  Sunday  after  Trinity. 
Matriculation  Lond.  Univ. 

[1871. 
New  St.  Thomas's  Hospital  opened  by  H.  M.  the  Queen, 


Fifth  Sunday  after  Trinity. 


Queen  Victoria  crowned,  1838. 


The  Harveian  Oration  is  delivered  at  the  Royal  College  of  Physicians  annually 
in  the  month  of  June. 

Doctor  of  Science  Examination  at  London  University  takes  place  within  the 
first  21  days  of  June. 

Distribution  of  Prizes  for  past  Sessions  during  this  month. 


1 

£ 

2 

M 

3 

To 

4 

W 

5 

Th 

6 

F 

7 

S 

8 

& 

9 

M 

10 

Tu 

11 

W 

12 

Th 

13 

F 

14 

S 

15 

& 

16 

M 

17 

Tu 

18 

W 

19 

Th 

20 

F 

21 

S 

22 

& 

23 

M 

24 

Tu 

25 

W 

26 

Th 

27 

F 

28 

S 

29 

& 

30 

M 

31 

Tu 

JULY,  1883. 

Sixth  Sunday  after  Trinity. 

Clinical  Clerks  and  Dressers  commence  duty 


Seventh  Sunday  after  Trinity. 

[Officers  for  September. 
Last  day  for  applications  for  appointment  of  House 


Eighth  Sunday  after  Trinity. 

Preliminary  Science  London  University  Examination. 

Meeting  to  appoint  House  Officers  for  September. 


Ninth  Sunday  after  Trinity. 
Sessional  Examination  commences. 


Tenth  Sunday  after  Trinity. 


Royal  College  of  Surgeons'  Primary  and  Paxs  Examinations  during  this  Month. 
The  Registration  and,  Museum  Committees  meet  during  this  month. 


AUGUST,  1883. 


W 

Th 
F 

S 


M 

Tu 

W 

Th 

F 

S 


Eleventh  Sunday  after  Trinity. 


Twelfth  Sunday  after  Trinity. 


M 

Tu 
W 
Th 
F 

S 


M 
Tu 
W 
Th 

F 

S 


M 

Tu 
W 
Th 
F 


Thirteenth  Sunday  after  Trinity. 


Fourteenth  Sunday  after  Trinity. 


SEPTEMBER,  1883. 

1 

S 

2 

£ 

Fifteenth  Sunday  after  Trinity. 

3 

M 

[commence  duty. 

4 

Tu 

House  Phys.  and   Surgns.,  and  Asst.    do.,  also  R.  A. 

5 

W 

Last  day  for   applications  for  appointments  of  Ward 

6 

Th 

[Clerks,  Clinical  Clerks,  and  Dressers. 

7 

F 

8 

S 

9 

$ 

Sixteenth  Sunday  after  Trinity. 

10 

M 

11 

Tu 

12 

W 

Meeting  to  appoint  Clerks  and  Dressers. 

13 

Th 

14 

F 

• 

15 

S 

16 

& 

Seventeenth  Simday  after  Trinity. 

17 

M 

18 

Tu 

19 

W 

20 

Th 

21 

F 

22 

S 

23 

$ 

Eighteenth  Sunday  after  Trinity. 

24 

M 

25 

Tu 

26 

W 

27 

Th 

28 

F 

[1883,  to  be  awarded  in  1884. 

29 

S 

Announcement  of  subject  and  date  for  Grainger  Prize, 

30 

£ 

Nineteenth  Sunday  after  Trinity. 

Royal  College  of  Surgeons'  and  Apothecaries    Hall   Preliminary   Examina- 
tions in  General  Knowledge  this  month. 


51 


LIST    OF    STUDENTS 

WHO   HAVE  OBTAIKED 


w  refei  s  to  Winter  and  s  to  Summer  Session. 
The  Addresses  are  those  given  at  the  time  of  Entry. 


Acland  iT.  D.),  Oxford. 

w  1877-8.  3rd  Year  Physical  Society's  Prize. 
Paper    published    in     Hospital 
Reports,  Vol.  VIII. 
w  1878-9.  4th   Year  Student.     The   Mead 
Medal. 

Addy  (B.),  West  Deepiug,  Lincoln- 
shire. 

1869.  1st    Year    Student,    1st    College 

Prize ; 
Physical  Society's  1st  Year's  Prize. 

1870.  2nd  Year  Student,  1st  Coll.  Prize; 
Physical     Society's     2nd     Year's 

Prize. 

1871.  3rd  Y'ear  Student,  1st  Coil.  Prize; 
Prosector's  Prize ; 

Treasurer's  Gold  Medal. 

Allingham  (W.),*  Bermondsey. 

1852.  Descriptive  Anatomy,  Hon.  Cert.  ; 
Chemistry,  Hon.  Cert. 

1853.  Midwifery,  Hon.  Cert. 

1854.  Medicine,  Hon.  Cert. ; 
Descriptive  Anatomy,  Prize ; 
Midwifery,  Hon.  Cert. ; 
Physical  Society's  Essay,  Prize ; 
Surgery,  Prize ; 
Physiology,  Hon,  Cert. 

1855.  Medicine,  Prize ; 

Descriptive  Anatomy,  Hon.  Cert.  ; 
Physiology,  Hon.  Cert. ; 
Clinical  Medicine,  President's  Prize  ; 
Clinical  Medicine,  Treasurer's  Prize. 

Anderson  (W.),t  Clapham,  Surrey. 

1865.  1st  Year  Student,  3rd  Coll.  Prize. 

1866.  2nd  Year  Student,  3rd  Coll.  Prize. 

1867.  3rd  Y>ar  Student,  1st  Coll.  Prize; 
Physical  Society's  3rd  Year's  Prize ; 
Cheselden  Medal. 

Armstrong  (H.  G  ),  Beading. 

s  1872.  1st  Year  Student,  Hon.  Cert. 
W1874.  3id  Year  Student,  3rd  Coll.  Prize. 


*  Late  Surgical  Tutor,  Surgeon  to  Great 
Northern  Hospital,  Surgeon  to  St.  Mark's 
Hospital. 

f  Assistant  Surgeon  to,  and  Joint  Lec- 
turer on  Anatomy,  Examiner  in  Anatomy 
and  Physiology,  Royal  College  of  Physicians, 
formerly  Demonstrator  of  Anatomy,  and 
Surgical  Registrar  at  St.  Thomas's  Hospital, 
late  Medical  Officer  to  H.B.M.  Legation  in 
Japan,  and  Professor  of  Medical  Sciences  at 
the  Japanese  Naval  Medical  College,  Jeddo. 


Atkinson  (F.  P.),  Kew. 

1861.  1st  Year  Matriculation  Examina- 
tion— Classics  and  Mathematics, 
Hon.  Cert. 

Atkinson  (J.),  Kiikby-Lonsdale. 

1853.  Chemistry,  Hon.  Cert. 
Aveling  (C.  T.),  Shacklewell. 

1863.  Matriculation  Examination — 

Physics  and    Natural    History, 
1st  College  Prize ; 
1st  Year  Student,  1st  College  Prize. 

1864.  2nd    Year    Student,    2nd    College 

Prize. 

1865.  3rd     Year     Student,    3rd    College 

Prize. 

Bailey  (J.  H.  T.),  Greenwich. 
1843.  Materia  Medica,  Hon.  Cert. 

Bain  (J.) 

1855    Midwifery,  Hon.  Cert. 
Ball/ynce  (C.  A.),  Lower  Clapton. 

w  1875-6.  1st  Year  Student,  Hon.  Cert. 

w  1876-7.  3rd  Year    Student,    3rd   College 

Prize,  and  Physical  Society's  3rd 

Year's  Prize ; 
18H0.  The  Solly  Medal  and  Prize. 

Barker  (P.  B.),  Aldershot. 

w  1875.  Prosector's  Prize. 

Barron  (H.  J.),  Guilford   Street, 

Bussell  Square, 
w  1877-8.   2nd    Year    Student,    Prosector's 
Prize. 

Barwell  (B.).J  Norwich. 

1Sj7.  Medicine,  Hon.  Cert.  ; 
Midwifery,  Hon  Cert. 
1848.  Physical    Society's    Essay,    Trea- 
surer's Prize; 
Physiology    und    Anatomy,    Hun. 

Cert. ; 
Midwifery,  Hon.  Cert. ; 
Dresser's  Surg.  Repts.,  Hon.  Cert. 
1850.  Clinical  Medicine,  Prize. 

Bateson  (J.  M.),  Kirkby-Lonsdale. 
1855.  Chemistry,  Hon.  Cert. 

Battle  (W.  H.),  Hanwortli,  Lin- 
colnshire. 

s   1874.  Hon.  Cert. 

w  1875.  2nd  Year  Student,  3rd  College 
Prize. 

w  1876-7.  3rd  Year  Student,  The  First 
Solly  Medal  and  Prize. 


J    Surgeon  to  Charing  Cross  Hospital. 
D   2 


52 


Beal  (P.),  Plymouth. 
1S44.  Chemistry,  2nd  Prize. 

Beardsley  (A.),  Shipley,  Derby. 
1843.  Midwifery,  2nd  Prize. 

Bedford  (R.  J.),*  Sleaford. 

1858.  Midwifery,  Hon.  Cert. 

Benwell  (H.  D.),  Greenwich. 

1843.  Chemistry,  2nd  Prize. 
1845.  Physiology  and  Anatomy,  Medal. 
1847.  Clinical  Medical  Reports,  Prize; 
Gen.  Proficiency,  Trea.  Medal. 

Bell  (C.  N.),  Rochester. 

1867.  3rd  Year  Student,  3rd  Coll.  Prize. 

Bell  (J-  V.),  Rochester. 

1859.  1st   Year  Student,  Treasurer's  2nd 

Prize;  Matriculation  Examina- 
tion— Classics  and  Mathematics, 
Hon.  Cert. 

1860.  2nd  Year  Student,  Hon.  Cert. 

1861.  3rd  Year  Student,  3rd  Coll.  Prize. 

Bernays  (H.  L.),  Chatham. 
\v  1873.  Prosector's  Prize. 

Bernays  (A.  V.),  Great  Stanmore. 

s  1876.  1st  Year  .Student,  Hon.  Cert. 

tv  1880-81.  3rd  Year  Student,  1st  Coll.  Prize. 

Bickle  (L.  W.),  St.  Leonard's-on- 
Sea. 

s  1*78.  1st  Year  Student,  3rd  Coll.  Prize  ; 
s  1*79.  2nd  Year  Student,  1st  Coll.  Prize. 

Biddle  (D.),  Wotton-under-Edge. 

1860.  1st  Year  Student,  Trea.  Prize ; 
Matriculation  Exam. — I'rize. 

1861.  2nd  Year  Student,  Hon.  Cert. 

1862.  3rd  Year  Student,  Hon.  Cert. 

Birtwell  (H.  H.),  Enfield,  Lanca- 
shire. 
1865.  3rd  Year  Student,  Hon.  Cert. 

Black  (J.),  Kentish  Town. 

w  1872.  2nd  Year  Student,  Prosector's  Prize. 

Black  (W.  S.),  Chesterfield,  Derby. 

1855.  Midwifery,  Hon.  Cert.; 
Medicine,  Hon.  Cert. 

Blackett  (W.  C),  Durham. 
1851.  Descriptive  Anatomy,  Hon.  Cert. 

Blades  (C.  C.) 

1855.  Midwifery,  Hon.  Cert. 

Bone  (W.),  Camberwell. 

1857.  1st  Year  Student,  Trea.  1st  Prize. 

1858.  2nd  Year  Student,  Trea.  1st  Prize. 

Bonser  (J.  H.),  Sutton-in-Ashfield. 
1871.  3rd  Year  Student,  2nd  Coll.  Prize; 
Cheselden  Medal. 

Boulger  (J),  Gravesend. 

1870.  1st  Year  Student,  Sir  Wm.   Tite's 

Scholarship. 

1871.  2nd  Year,  Sir  \V.  Tite's  Scholarship. 

w  1872.  3rd  Ve.tr,  Sir  W.  Tite's  Scholarship. 

*  Lite  Assistant-Surgeon  at  the  "  Dread- 
nought "  Hospital  Ship. 


Bowen   (E.\  Llyn,   Gwair,   Pem- 
broke. 

1847.  Descriptive  and  Surgical  Anatomy, 

Hon.  Cert. ; 
Materia  Medica,  Hon.  Cert. 

1848.  Descriptive  and  Surgical  An.-.tomy, 

Hon.  Cert. ; 
Physiology    and    Anatomy,    Hon. 

Cert. ; 
Botany,  Hon.  Cert. ; 
Comparative  Anatomy,  Hon.  Cert. 

Bown  (J.  Y),  America. 

1848.  Descriptive  and  Surgical  Anatomy, 
Hon.  Cert. 

Brake  (J.),  Holt,  Wilts. 

1851.  Matriculation     Scholarship,    Hon. 

Cert. ; 
Descriptive  Anatomy,  Hon.  Cert.; 
1st  Year  Student,  Scholarship ; 
Chemistry,  Hon.  Cert. 

1852.  2nd  Year  Student,  Scholarship; 
Physiology,  Prize ; 

Materia  Medica,  Hon.  Cert. 
Botany,  Hon.  Cert. ; 
Medicine,  Hon.  Cert. 

1853.  3rd  Year  Student,  Scholarship ; 
Clinical  Medicine,  Trea.  Prize ; 
Midwifery,  Prize; 

Forensic  Medicine,  Prize. 

Bristowe  (J.  S.),t  Camberwell. 

1847.  Medicine,  Hon.  Cert. ; 
Physiology    and    Anatomy,    Hon. 

Cert. ; 
Descriptive  and  Surgical  Anatomy 
Prize. 

1848.  Descriptive  and  Surgical  Anatomy, 

Hon.  Cert. ; 
Physiology  and  Anatomy,  Prize; 
Practical  Chemistry,  Prize; 
Botany,  Prize ; 
Midwifery,  Hon.  Cert.; 
Comparative  Anatomy,  Prize ; 
Surgery,  Prize ; 
General    Proficiency,    Treasurer's 

Medal. 

Britton  (T.),  Doncaster. 
1861.  1st  Year  Student  Hon.  Cert. 

Brock  (J.),  Northwich. 

w  1872.  1st  Year  Student,  2nd  Coll.  Prize. 

s  1872.  Hon.  Cert. 

Brown  (F.  G.),  London. 

1860.  1st  Year  Student,  Hon.  Cert. 

1861.  2nd  Year  Student,  3rd  Coll.  Prize. 

1862.  3rd  Year  Student,  3rd  Coll.  Prize. 

Brown  (G.  D.),  Croydon. 

1851.  Physiologv,  Hon.  Cert. ; 
Botany,  Prize; 
Surgery,  Hon.  Cert.; 

1852.  Physiology,  Hon.  Cert. ; 
Physical    Society's    Essay,    Trea- 
surer's Prize ; 

Medicine,  Hon.  Cert.; 
Pathology,  Prize. 

Brown  (T.  J.  E.),  Dorchester. 

1848.  Practical  Midwifery,  Hon.  Cert. 
Bucknill  (E.  R.),  Bedford. 

1855.  1st  Year  Student,  Scholarship; 
Midwifery,  Hon.  Cert.; 

f  Physician  to  and  Joint  Lecturer  on 
Medicine  at  St.  Thomas's  Hospital.  Late 
Lecturer  on  General  Pathology. 


53 


Chemistry,  Hon.  Cert. : 
i  Descriptive  Anatomy,  Hon.  Cert. ; 
Materia  Medica,  Hon.  Cert. 
Bull  (J.),  Norwood,  Surrey. 

1848.  Midwifery,  Hon.  Cert. 
Butler  (W.),  Stoke  Newington. 

.'845.  Materia  Medica,  Hon.  Cert. 
Caiger  (P.  F.),  Gloucester-st.,  S.W. 
w  1879-80.  1st  Year  Student,  3rd  Coll.  Prize, 
w 1880-81.  2nd  Year  Student,  3rd  Coll.  Prize. 
Carpenter  (A.),*  Rothwell. 

1848.  Descriptive    and    Surgical    Ana- 

tomy, Hon.  Cert. ; 
Chemistry  Prize ; 
Materia  Medica,  Hon.  Cert. ; 
Matriculation  Scholarship,  Prize. 

1849.  Physiology  Hon.  Cert. ; 
Midwifery,  Hon.  Cert. ; 
Descriptive  Anatomy,  1st  Prize; 
Medicine,  2nd  Prize. 

1850.  Physiology,  Hon.  Cert. ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Botany,  Prize; 

Medicine,  Prize; 

Surgery,  Prize ;  [Medal. 

General     Proficiency     Treasurer's 

1851.  (Accoucheur)  Midwifery,  Prize; 
Essay  on  Chorea,   Mr.  N.  Smith's 

Prize. 

1852.  Surgical  Reports.  President's  Prize ; 
Medical  Reports,  Dr.  Roots'  Prize  ; 
Ophthalmic     Reports,     a    Gover- 
nor's Prize ; 

Clinical  Medicine,  Senior  Prize. 

Carpenter  (A.  B.),  Croydon. 

w  1876-7.  1st  Year  Student,  Hon.  Cert. ; 

Carpenter  (G.  A.),  Streatham. 

w.  1880-81.  1st  Year  Student,  3rd  Coll.  Prize. 

8  1881.  1st  Coll.  Prize. 

w  1881-2.  2nd  Year,  3rd  Col'.  Prize. 

Prosector's  Prize. 
Carr  (J.  T.),  Bombay. 

1844.  Surgery,  Prize. 
Castle  (H),  Newport,  I.  of  "Wight, 
w  1874-5  1st  Year  Student,  2nd  Coll.  Prize. 
s  1875.  3rd  College  Prize. 
W1S76-7.  Physical  Society's  3rdYear's  Prize. 

Caulde  (A.  W.W.),  Henfield,Sussex. 

1858.  Clinical  Medicine,  Prize. 
Chaldecott  (C.  W.),  Dorking. 

1849.  Descriptive  Anatomy,  Hon.  Cert.; 
Chemistry,  Hon.  Cert. ; 
Materia  Medica,  2nd  Prize ; 
1st  Year  Student,  Scholarship. 

1859.  Physiology,  Hon.  Cert. 
Surgery,  Prize. 

1851.  Physiology,  Prize; 

Descriptive  Anatomy,  Hon.  Cert.; 

Medicine,  Hon.  Cert.  ; 

Physical  Society's  Essay,  Trea- 
surer's Prize  ; 

Surgery,  Hon.  Cert. ; 

General  Proficiency,  Treasurer's 
Silver  Medal. 

Chaldecott  (T.  A.),  Newington. 

1848.  Descriptive  Surgical  Anatomy,  Hon. 
Cert.; 
Chemistry,  Hon.  Cert.; 
Botany,  Hon.  Cert. ; 
Materia  Medica.  Hon.  Cert. 


*  Lecturer    on     State 
Thomas's  Hospital. 


Medicine    at    St . 


Comparative  Anat.,  Hon.  Cert.; 
Matriculation  Scholarship,  Prize  ; 
Practical  Chemistry  Hon.  Cert. 

1849.  Physiology,  Hon.  Cert. ; 
Midwifery,  Hon.  Cert.  ; 
Surgery,  2nd  Prize ; 
Medicine,  Hon.  Cert. 

1850.  Physiology,  Hon.  Cert. ; 
Forensic  Medicine,  Prize; 
Pathology,  Prize; 
Medicine,  Hon.  Cert.; 
Surgery,  Hon.  Cert. 

Chapman  (C.  E.),  Preston. 

1855.   Midwifery,  Hon.  Cert. ; 

Materia  Medica,  Hon.  Cert. 
1857.   Clinical  Assistant,  Prize; 

Physical  Society's  Essay,  Prize. 

Cherry  (A.  H.),  Clapham. 

1845.  Clinical  Medicine,  Hon.  Cert. 
Chipperfield  (W.  N.),  Reading. 

1852.  1st  Year  Student,  Scholarship  ; 
Descriptive  Anatomy,  Prize. 

1853.  2nd  Year  Student,  Scholarship; 
Physiology,  Prize ; 
Descriptive  Anatomy,  Prize ;  * 
Midwifery,  Prize; 

Physical  Society's  Essay,  Prize ; 
Medicine,  Prize ; 
Surgery,  Prize. 

1854.  3rd  Year  Student,  Scholarship. 
Medicine,  Prize ; 
Descriptive  Anatomy,  Hon.  Cerf. 
Midwifery,  Prize  ; 

Physical  Society's  Essay,  Trea- 
surer's Prize ; 

Forensic  Medicine,  Prize  ; 

Chemistry,  Hon.  Cert.; 

Comparative  Anatomy,  Prize ; 

Pathology,  Prize ; 

Surgery  and  Surgical;  Anatomy, 
Cheselden  Medal  ; 

Clinical  Medicine,  Treasurer's 
Prize  ; 

Physiology,  Prize ; 

General  Proficiency,  Treasurer's 
Medal. 

Clapton  (E.),t  Stamford. 

1851.  Matriculation     Scholarship,     Hon. 

Cert. 
1st  Year  Student,  1st  Scholarship  ; 
Descriptive  Anatomy,  Prize; 
Chemistry,  Prize. 

1852.  2nd  Year  Student,  Scholarship  ; 
Physiology,  Prize  : 

Materia  Medica,  Prize ; 
Botany,  Prize ; 
Medicine,  Hon.  Cert. 

1853.  3rd  Year  Student,  Scholarship ; 
Physiology,  Hon.  Cert. ; 
Clinical       Medicine,      Treasurer's 

Prize  ; 

Midwifery,  Hon.  Cert. ; 

Physical  Society's  Essay,  Trea- 
surers' Prize  ; 

Medicine.  Hon.  Cert.  ; 

Forensic  Medicine,  Hon.  Cert. ; 

Chemistry,  Hon.  Cert. ; 

Surgery,  Hon.  Cert. 

1854.  Ophthalmic     Reports,    Governor's 

Prize ; 
Clinical  Medicine,  Mr.  N.  Smith's 
Prize. 

f  Late  Physician  to  and  Lecturer  on 
Materia  Medica  at  St.  Thomas's  Hospital. 
Physician  to  the  Magdalen  Hospital. 


54 


Clapton  (W.),  Stamford. 

1855.  Midwifery,  Hon.  Cert. ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Materia  Medica,  Prize. 

1856.  Clinical  Medicine,  Prize. 
1858.  Midwifery,  Hon.  Cert. 

Clarke  (A.),  Dorking. 
1856.  1st  Year  Student,  Treasurer's  2nd 
Prize. 

Clark  (J.  H.),  Jamaica. 

1867.  2nd  Year  Student,  Physical  Society's 
2nd  Year's  Prize. 

Clarkson  (J.  W.),  Surbiton. 
w  1872.   2nd  Year  Student,  3rd  Coll.  Prize, 
w  1873.   3rd  Year  Student,  2nd  Coll.  Prize ; 
Surgery    and    Surgical    Anatomy, 
Hon.  Cert. 

Cleghorn  (G.),  Bedford. 

1872.  3rd  Year  Student,  Hon.  Cert. 

Coggins  (T.),  Hayford,  "Woodstock. 

1847.  Chemistry.  Hon.  Cert. 

1848.  Descriptive  and  Surgical  Anatomy. 

Hon.  Cert. ; 
Midwifery,  Hon.  Cert. 

1849.  Midwifery,  Hon.  Cert. ; 
Medicine,  Hon.  Cert. 

1850.  Surgical  Reports,  Prize  ; 
(Accoucheur)     Midwifery,     Hon. 

Cert. 

Colby  (W.  T.),  Malton,  York. 
1849.   Descriptive  Anatomy,  Hon.  Cert. ; 
Midwifery,  Hon.  Cert. 

Collier  (T.  P.),  Worship  Square. 
1847.   Practical  Midwifery,  Prize. 

Complin     (E.  J.),      Charterhouse 
Square. 

1851.  Clinical  Medicine,  Prize  ; 
Medical  Cases,  President's  Prize  ; 
Surgery,  Hon.  Cert. 

1852.  Midwifery,  Hon.  Cert. ; 
Pathology,  Hon.  G  rt. 

Cook  (W.),  Gainsboro'. 
1844.  Chemistry,  Hon.  Cert.; 

Materia  Medica,  Hon.  Cert. 

Cooke  (J.),  Stamford. 

1855.  Comparative  Anatomy,  Prize ; 
Midwifery,  Hon.  Cert. ; 
Physiology,  Hon.  Cert. 

Cory(R.),*  Carlisle. 

1870.   Physical  Society's  3rd  Year's  Prize. 

Cousins  (J.  W.),  Portsea. 

1864.   Descriptive  Anatomy,  Hon.  Cert.; 
Chemistry,  Hon.  Cert. 

1855.  Surgery,  Prize; 
Midwifery,  Prize  ; 
Midwifery,  Hon.  Cert. 

1856.  Clinical  Medicine,  Prize; 
Surgery    and    Surgical    Anatomy, 

Cueselden  Medal. 

flnwF.N  fP.\  Kennineton. 

1862.  1st  Year  Student,  2nd  Coll.  Prize. 

1863.  2nd  Year  Student,  2nd  Coll.  Prize. 

1864.  3rd  Year  Student,  2nd  Coll.  Prize. 

*  Assistant    Obstetric  Physician  to    and 

Joint    Lecturer    on    Forensic   Medicine   at 
St.  Thomas's  Hospital 


Cox  (E.),  Maiden  Newton,  Dorset 
shire. 

1866.   1st  Year  Student,  3rd  Coll.  Prize. 

1868.  3rd  Year  Student,  2nd  Coll.  Prize. 
Coxwell  (C.  F.),  Brighton. 

1880.  4th  Year  Student,  the  Mead  Medal. 

Crick  (S.A.),  Cosby-hill,  Leicester- 
shire. 
s  1875.   1st  Year  Student,  Hon.  Cert, 
w  1875-6.  Prosector's  Prize, 
w  1876-7.  3rd  Year  Student,  3rd  Coll.  Prize. 

Croft  (J.),t  Clapton. 

1851.   Descriptive  Anatomy,  Hon.  Cert. 
1853.   Midwifery,  Hon.  Cert. 

Crofts  (W.  C),  Rowston,  Lincoln. 

1855.   Surgery,  Hon.  Cert. ; 
Midwifery,  Hon.  Cert. 
Crosby  (T.  B.),  Gosberton,  Lincoln. 

1851.  Physiology,  Prize ; 
Descriptive  Anatomy,  Prize ; 
Medicine,  Prize ; 

Surgery,  Prize. 

1852.  Physiology,  Prize ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Medicine,  Hon.  Cert. ; 

Forensic  Medicine,  Prize ; 
Practical  Chemistry,  Prize ; 
Surgery,  Hon.  Cert. ; 
Surgery    and    Surgical    Anatomy, 

Bronze  Cheseldea  Medal; 
Comparative  Anatomy,  Prize. 

Crossman  (J.),  Bedruth. 

1871.  Physical  Society's  1st  Year's  Prize. 
1»72.  Physical  Society's  2nd  Year's  Prize. 
1873.   Physical  Society's  3rd  Year's  Prize 

Davies  (D.),  Carmarthenshire. 

1843.  Chemistry,  1st  Prize; 
Midwifery,  Hon.  Cert. ; 
Materia  Medica,  Prize. 

1844.  Medicine,  Hon.  Cert. ; 
Physiology    and    Anatomy,    Hon. 

Cert. 

1845.  Clinical  Surgical  Reports,  Medal. 
Davies  (D.  S.),  Bristol. 

1875-6.   Physical    Society's    1st    Year's 
Prize. 
Day  (W.  H.),  Norwich. 
1844.   Surgery,  Prize ; 

Physical    Society's    Essay,     Hon. 

Cert. ; 
Dresser's  Clinical  Surgery,  Prize. 

Deck  (J.  F.),  Nelson,  New  Zealand. 

1860.  1st  Year  Student,  1st  Coll.  Prize. 

1861.  2nd  Year  Student,  1st  Coll.  Prize ; 
Physical  Society's  Prize. 

1862.  3rd  Year  Student,  1st  Coll.  Prize; 
Physical  Society's  Prize ; 
Cheselden  Medal ; 
Treasurer's  Gold  Medal. 

Dickerson  (S.  H.),  Hartest, 
Suffolk. 

1853.  Physiology,  Hon.  Cert. ; 
Materia  Medica,  Hon.  Cert.; 
Midwifery,  Hon.  Cert. ; 
Medicine,  Hon.  Cert. 

+  Surgeon  to  and  Lecturer  on  Clinical 
Surgery  at  St.  Thomas's  Hospital ;  late 
Assistant  Demonstrator  of  Anatomy. 
Si'rgeon  to  the  Magdalen  Hospital. 


55 


Dixon  (E.  L.),  Preston,  Lancashire. 

1852.  1st  Year  Student,  Scholarship; 
Chemistry,  Hon.  Cert. 

1853.  2nd  Year  Student,  Scholarship; 
Physiology,  Hon.  Cert. ; 
Materia  Medica,  Prize ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Midwifery,  Hon.  Cert. ; 

Botany,  Prize ; 
Medicine,  Hon.  Cert. 

1854.  3rd  Year  Student,  Scholarship  ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Practical  Chemistry,  Prize ; 
Physiology,  Hon.  Cert. 

Dobson  (N.  0.),*  Holbeach,  Lincoln- 
shire. 

1865.  1st  Year  Student,  1st  Coll.  Prize. 

1866.  2nd  Year  Student,  1st  Coll.  Prize. 

1867.  3rd  Year  Student,  2nd  Coll.  Prize  ; 
A  Prize  and  Hon.  Cert,  for  Pro- 
ficiency in  Surgery  and  Surgical 
Anatomy     at     the     Cheselden 
Medal  Examination ; 

Treasurer's  Gold  Medal. 

Drake  (A.  J.),  Kingsclere,  Hants. 
1870.  3rd  Year  Student,  1st  Coll.  Prize. 

Drake  (C.  H.),  Kingsclere,  Hants. 

1857.  1st  Year  Student,  Hon.  Cert. ; 

1858.  2nd    Year     Student,     Treasurer's 

1  st  Prize ; 
Clinical  Medicine,  2nd  Prize. 

1859.  3rd  Year  Student,  Hon.  Cert. ; 
Surgery    and    Surgical    Anatomy, 

Cheselden  Medal ; 
General    Proficiency,    Treasurer's 
Medal. 

Drake  (T.),  Kingsclere,  Hants. 

1858.  2nd    Year    Student,     Treasurer's 

1st  Prize; 

1859.  2nd  Year  Student,  President's  Prize. 

1860.  3rd  Year,  1st  College  Prize  ; 
Surgery   and    Surgical    Anatomy, 

Cheselden  Medal; 
General    Proficiency,    Treasurer's 
Medal. 

Drew  (G.  F.  A.),  Plymouth. 

1848.  Descriptive  and  Surgical  Anatomy, 

Prize ; 
Chemistry,  Hon.  Cert. ; 
Botany,  Prize; 

Comparative  Anatomy,  Hon. Cert.; 
Practical  Chemistry,  Prize ; 
Gen.  Proficiency,  Hon.  Cert. 

1849.  Physiology,  2nd  Prize; 
Midwifery,  Hon.  Cert. ; 
Descriptive  Anatomy,  Hon.  Cert.; 
Medicine,  Hon.  Cert. 

1850.  Physiology,  Prize ; 

Descriptive  Anatomy,  Hon.  Cert. ; 
Medicine,  Hon.  Cert. ; 
Surgery,  Hon.  Cert. 

Dukes  (0.),  Dalston. 

1865.  1st  Year  Student,  Hon.  Cert. 
1867.  3rd  Year  Student,  Hon.  Cert. ; 
Prosector's  Prize  and  Hon.  Cert. 

*  Surgeon  to  the  Bristol  General  Hospital 
and  Lecturer  on  Anatomy  at  the  Bristol 
Medical  School. 


Dunoan  (W.  A.),  Manchester. 

w  1876-7.  1st  Year  Student,  The  William 

Tito  Scholarship, 
s  1877.  1st  College  Prize. 
w  1877-8  2nd  Year  Student,  The  Musgrovc 

Scholarship, 
w  1877-8.  2nd  Year  Physical  Society's  Prize, 
s  1878.  1st  College  Prize, 
w  1878-9.  2ndTenure  Musgrovc  Scholarship. 

1st  College  Prize ; 

3rd  Year  Physical  Society's  Prize ; 

Grainger  Testimonial  Prize. 
1880.  4th  Year  Student,  The  Cheselden 
Medal. 

The  Treasurer's  Medal, 
w  1881-2.  The  Solly  Medal  and  Prize. 

Dunman  (G.),  Camberwell. 
1852.  Chemistry,  Hon.  Cert. 
1854.  Midwifery,  Hon.  Cert. 

Dyer  (F.  J.),  Blackheath. 

1847.  Chemistry,  Prize ; 

Materia  Medica,  Hon.  Cert.; 
1849.  Physiology,  Hon.  Cert.; 

Midwifery,  2nd  Prize; 

Medicine,  Hon.  Cert. 

Eddowes  (J.  H.),  Loughboro'. 

1843.  Physiology    and    Anatomy,    Hon. 

Cert. ; 
Chemistry,  Hon.  Cert. ; 
Comparative  Anatomy,  Prize. 

1844.  Physiology    and    Anatomy,    Hon. 

Cert. ; 
Clinical    Medical   Reports,    Silver 
Medal. 

1845.  Clinical  Medicine,  Prize. 

Eddowes  (W.  D.),  Loughboro'. 

1845.  Descriptive  and  Surgical  Anatomy, 
Prize. 

Edmonds  (S.),  St.  Helen's,  Lanca- 
shire. 

1852.  Chemistry,  Hon.  Cert. 

1853.  Midwifery,  Hon.  Cert. ; 
Medicine,  Hon.  Cert. ; 
Surgery,  Hon.  Cert. 

1854.  Surgery  and    Surgical    Anatomy, 

Hon.  Cert.; 
Clinical  Medicine,  Treas.  Prize ; 
Clinical  Medicine,  Pres.  Prize. 

1855.  Surgical  Reports,  Pres.  Prize ; 
Clinical  Medicine,  Dr.  Roots'  Prize. 

Edwards  (S.),  Littlehampton. 
1855.  Midwifery,  Hon.  Cert. 

Edwards  (V.),  Woodbridge,  Suffolk. 
1843.  Surgery,  Prize. 

Elbokough  CP.  J.),  Heme  Bay. 

1845.  Chemistry,  Hon.  Cert. 

1847.  Medicine,  Hon.  Cert. ; 
Midwifery,  Prize. 

1848.  Medicine,  Hon.  Cert.; 
Surgery,  Hon.  Cert. ; 
Surgical  Report,  Pres.  Prize. 

Ellis  (J.),  Portsea,  Hants. 

1857.  Clinical  Assistant  (Medicine),  Hon. 
Cert. 

Elwin  (C.  J.),  London. 
1855.  Practical  Midwifery,  Prize. 

Evans  (C.  W.  de  Lacey),  Bangor. 

w  1876-7.  3rd  Year  Student,  The  Solly  rrize 
and  Hon.  Cert. 


56 


Fairbank  (J.),  Islington. 

1865.  1st  Year  Student,  Hon.  Cert. 

1866.  2nd  Year  Student,  Prosec.  Prize. 

Farrant  (S.),  Collumpton,  Devon. 

1859.  2nd  Year  Student,  Hon.  Cert. 

1860.  3rd  Year  Student,  Hon.  Cert. 

Faulkner  (R.),  Oamberwell. 
1844.  Botany,  Prize ; 

Clinical  Medical  Reports,  Hon.  Cert. 

Fell  (W.),  Kensington. 

w  1878-9.  2nd  Year  Student  Prosector  Prize. 

Fenton  (H.  A.  H.),  Westminster, 
w  1875-6.  1st  Entrance  Science  Scholarship. 
6  1876.  1st  Year  Student,  1st  College  Prize. 

Fernie  (A.),  Yeldon,  Beds. 

1853.  Physiology,  Hon.  Cert. ; 
Surgery,  Hon.  Cert. 

Fernie  (W.  T.),  Yeldon,  Beds. 

1852.  Practical  Midwifery,  Prize ; 

Midwifery,  Hon.  Cert. 

Fisher  (T.),  St.  Michael's. 

8  1872.  1st  Year  Student,  Hon.  Cert, 
s  1873.  2nd  Year  Student,  2nd  College  Prize. 
w  1874.  2nd  Year  Student.  3rd  College  Prize. 
W1875.  3rd    Year    Student,    Surgery    and 

Surgical    Anatomy,    Prize,    and 

Cert,  of  Hon. 

Ford  (G.  W.),  Cape  of  Good  Hope, 
w.  1880-81.     3rd  Year  Student,  Prosector's 
Prize. 

Fowler  (J.  T.),  Winterton,  Lincoln. 

1854.  Chemistry,  Hon.  Cert. 

1855.  Botany,  Hon.  Cert. 

Fowler  (J.),  Winterton,  Lincoln. 

1859.  1st  Year  Student,  Hon.  Cert. 

1860.  2nd  Year  Student,  2nd  College  Prize. 

1861.  3rd  Year  Student,  2nd  College  Prize. 

Freeman  (D.),  Kennington. 

1859.  Clinical  Medicine,  Prize. 

Freeman  (A.  J.).  Southsea,  Hants. 
1865.  3rd  Year  Student,  Hon.  Cert. 

Fclton  (J.  A.),  Stockwell. 

1852.  Botany,  Hon.  Cert. 

1853.  Practical  Chemistry,  Prize. 

Furnival  (F.  H.),  Nottingham, 
w  1878-9.  1st  Year  Student ; 

The  Sir  Woi.  Tite  Scholarship. 

Gardner  (E.  B.),  London. 

1858.  Matriculation    Examination — Clas- 
sics and  Mathematics,  Prize. 

Garton  (W.),  St.  Helier's. 

1870.  2nd  Year  Student,  2nd  College  Prize. 
Physical  Society's  2nd  Year's  Prize. 

1871.  Physical  Society's  3rd  Year's  Prize. 

Gimblett  (J.),  Taunton. 

1860.  1st  Year  Student,  Hon.  Cert. 

George  (C.  F.),  Kirton-on-Lindsay. 
1855.  Midwifery,  Hon.  Cert. 
iKf,r>.  2nd  Year  Student,  Dr.  Root's  Prize. 
1857.  3rd  Ifear  Student,  Hon.  Cert.; 

Surgery    and    Surgical    Anatomy. 
Cheselden  Medal. 


Gervis  (F.  H.),  Tiverton. 

1861.  1st  Y'ear  Matriculation  Scholarship. 

—  College     Prize,    2nd    College 
Trize. 

1862.  2nd  Y'ear  Studeut,  1st  College  Prize. 

1863.  3rd  Year  Studeni,  Hon.  Cert,  and 

Physical  Society's  Prize. 

Gervis  (H.),*  Tiverton. 

1856.  1st  Year  Student,  Trea.  1st  Prize; 
Matriculation  Examination,   Thy- 

sics,  &c,  Prize. 

1857.  2nd  Year  Student,  Pies.  Prize  ; 
Physical  Society's  hi  say,  Prize. 

1858.  Clinical  Assistant  (Medicine),  2nd 

Prize ; 
Physical  Society's  Essay,  Prize  ; 
General    Proficiency,    Treasurer's 

Medal. 

Giles  (F.  W.),  Henley-on-Thames, 
w  1875-6.  3rd  Year  Student,  Hon.  Cert. 

Gimlette  (G.  H.  D.),  Southsea. 

8  1874.  1st  Year  Student,  Hon.  Cert, 
w  1875-6.  3rd  Year  Student,  Hon.  Cert, 
w  1876-7.  Physical    Society's    3rd    Year's 
Prize. 

Glover  (J.  P.),  Lansdowne  Boad. 

w  1881-2.  3rd  Year  Student,  3rd  Coll.  Prize. 

Goddard  (E.),  London. 

1860.  Matriculation    Examination,    Clas- 
sics, &c,  Prize. 

Goddard  (L.),  London. 

1856  Matriculation    Examination,   Clas- 
sics and  Mathematics,  Prize. 

Gowland  (W.),  London. 
1845.  Botany,  Hon.  Cert. 

Grabham  (0.),  Islington. 

1857.  Matriculation  Examination,  Modern 
Languages,  Prize. 

Gkabham  (G.  W.),t  Islington. 
1855.  Matriculation   Examination,  Scho- 
larship ; 
Midwifery,  Hon.  Cert. ; 
Materia  Medica,  Hon.  Cert. 

Grabham  (J.),  Rochford,  Essex. 

1848.  Descriptive  and  Surgical  Anatomy, 
Hon.  Cert. ; 
Chemistry,  Hon.  Cert.; 
Botany,  Hon.  Cert. ; 
Comparative  Anatomy,  Prize. 

1850.  Physiology,  Hon.  Cert. 

1851.  Physiology,  Hon.  Cert. ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Forensic  Medicine,  Prize ; 
Surgery,  Prize ; 

Midwifery,  Hon.  Cert. 

Grabham  (M.  C),  Islington. 

1860.  2nd  Year  Student,  Hon.  Cert. 

1861.  3rd  Year  Student,  Hon.  Cert. 

*  Obstetric  Physician  to,  and  Lecturer  on 
Midwifery  and  Diseases  of  Women  and 
Cliildrcn.  Examiner  in  Obstetric  Medicine, 
University  of  London. 

f  Resident  Medical  Superintendent  at 
Eailswood  Asylum. 


57 


Greaves  (C.  A.;,  Derby. 

1861.  1st  Year  Student,  Treasurer's  Prize; 
Matriculation   Examination,    Hon. 

Cert. 

1862.  2nd  Year  Student,  2nd  College  Prize; 
Physical  Society's  Prize. 

1863.  3rd  Year  Student,  1st  College  Prize ; 

Physical  Society's  Prize ; 
Cheselden  Medal. 

Green  (C.  D.),  New  Cross. 

w  1879-80.  1st  Year  Student,  The  Wm.  Tite 

Scholarship, 
s  1880.    3rd  College  Prize. 
w  1880-81.     1st  College  Prize. 
Green  (J.  T.),  Peckham,  Surrey. 
1865.  1st  Year  Student,  Physical  Society's 
Prize. 
Green  (M.  H),  Peckham. 
b  1873.  1st  Year  Student,  2nd  College  rrize. 

Grose  (S.),  Boston,  Lincoln. 

1858.  2nd  Year  Student,  Hon.  Cert. 

1859.  Physical  Society's  Essay  Prize. 

Griffiths  (A.  L.),  London. 

1859.  Midwifery,  Hon.  Cert. 
Gulliver  (G.),  Canterbury. 
w  1876-7.  Physical  Society's  2nd  Year's  Prize. 

Gtjrney  (K.  A.  F.),  Eampton,  Cam- 
bridge. 

1851.  Practical  Midwifery,  Prize. 
Hague  (S.),*  Camberwell. 

1863.  1st  Year  Student,  2nd  Coll.  Prize. 
Haig-Brown  (C.  W.),  Godalming. 
s  1878.  1st  Year  Student,  2nd  College  Prize; 
w  1878-9.  2nd    Year  Student,  2nd   College 

Prize. 
w  1880-81.    The  Cheselden  Medal. 

Hahmerton  (E.),  Elland,  York. 

1857.  1st  Year  Student,  Hon.  Cert. 
Hammond  (J. H), Bridlington,  York. 

1850.  Medical  Cases,  President's  Prize. 

Harding  (J.  A.),  Bath. 

1859.  Clinical  Medicine,  2nd  Prize. 

1860.  Clinical   Assistant  (Medicine),  1st 

Prize. 
Harper  (R.),  Brighton. 

1844.  Clinical  Surgical  Reports,  Hon.  Cert. 

1845.  Physical  Society's  Essay,  Prize. 
Dresser's  Clinical  Surgery,  Prize. 

Hatchett  (F.  W.),  S.  "Wales. 

s  1880.  1st  Year  Student,  1st  College  Prize. 

Hatton  (G.  S.),  Neweut,  Glo'ster- 

sliire.  [Prize. 

w  1876-7.    2nd    Year    Student,    Prosector's 

Haslam  (W.  F.),  Beading. 

8  1876.  2nd  Year  Student,  1st  College  Prize. 

w  1877-8.  The  Cheselden  Medal. 

Heelis  (R.),  Carshalton. 

s   1877.  1st  Year  Student,  2nd  College  Prize. 

s  1878.  2nd  Year  Student,  2nd  Coll.  Prize. 

Hewlett  (T.  J.),  Harrow. 

1850.  Matriculation  Scholarship,  Prize. 

Heygate  (W.  N.),  Harslope,  Bucks. 

1863.  2nd  Year  Student,  Hon.  Cert. 

1864.  3rd  Year  Student,  Hon.  Cert. 


*  Late  Medical  Regirtrar  at  St.  Thomas's 
Hospital. 


Hicks    (J.    W.).f  Higligatc    New 
Town,  N. 

1852.  1st   Year  Student,  Treasurer's    1  -t 

rrize. 

1860.  2nd  Year  Student,  1st  College  Prize  ; 

Physical  Society's  Prize. 

1861.  3rd  Year  Student,  1st  College  Prize; 
Physical  Society's  Prize; 
Cheselden  Medal; 

Treasurer's  Cold  Medal. 

Higgins  ( A.  II.),  Bermondsey. 
1857.   Midwifery,  Hon.  Cert. 

Heighton  (T.),  Leicester. 

w  1873.  3rd  Y'ear  Student,  Hon.  Cert. 

Hilditcii  (J.),  Sandbach,  Cheshire. 

1857.  1st  Year  Student,  Hon.  Cert. 

1858.  Physical  Society's  Essay,  Prize. 

1859.  Essay  on  Neuralgia,  Mr.  X.  Smith's 
Prize. 

Hodges  (H.  B.) 

1855.  Midwifery,  Hon.  Cert. 
Hodges  (R.),  London. 

1843.   Physiology    and    Anatomy,    Hon. 
Cert. ; 
Medicine,  Hon.  Cert. ; 
Clinical  Medicine,  Hon.  Cert. ; 
Surgical  Essay,  Silver  Medal. 

Ho  Kai,  Hong  Kong,  China, 
w  1875-6.  1st  Year  Student,  Hon.  Cert. 
6  1876.  Hon.  Cert. 
w  1876-7.  2nd  Year  Student,  Hon.  Cert. 

Holberton  (H.  N.),  Hampton. 

w  1876-7.  2nd  Entrance  Science  Scholarship, 

and  2nd  College  Prize, 
w  1877-8.  2nd  YTear  Student,  1st  Coll.  Prize. 

Hopton  (A.  W.),  Stockwell. 

1851.  Descriptive  Anatomy,  Hon.  Celt. 

Hooper  (J.  H),  Upton  Warren. 

1858.  1st  Year  Student,  Hon.  Cert. 

1859.  2nd  Year  Student,  College  Prize. 

1860.  3rd  Year  Student,  Hon.  Cert. 
Howell  (T.),  Loudon. 

1850.  Practical  Midwifery,  Prize. 
Hubbard  (J.  W.),  Leicester. 
1847.  Clinical  Medical  Reports,  Prize; 
Medicine,  Prize ; 
Physiology    and    Anatomy,    Hon. 

Cert.; 
Physical    Society's    Essay,    Trea- 
surer's Prize. 

Hull  ( W.  W.),  Acton. 

w  1878-9.  2nd  Entrance  Science  Scholarship 

w  1881-2.  The  Mead  Medal. 

Hunt  (J.  A.),  Derby. 

w  1873.  1st  Year  Student,  Hon.  Cert, 
w  1874.  Prosector's  Prize. 

Hunter  ("VV.  F.),  Margate. 

1859.  1st  Year  Student,  Hon.  Cert. ; 
Matriculation      Examination      in 

Classics  and  Mathematics,  Prize  ; 
Matriculation      Examination      in 
Modern  Languages,  Prize. 

1860.  2nd  Year  Student,  3rd  Coll.  Prize. 

1861.  3rd  Y'ear  Student,  Hon.  Cert. 

Hurman  (H.  B.),  Bridgewater. 

1853.  Midwifery,  Hon.  Cert. 

+  Late  Lecturer  on  Botany  at  St.  Thomas's 
Hospital ;  late  Curator  of  the  Museum. 


58 


Hutton  (J.  S.),  Sevenoaks. 
w  1881-2.  Entrance  Science  Scholarship. 
2nd  Coll.  Prize. 

Iles  (D.),  Fairford. 

1863.  2nd  Year  Student,  Hon.  Cert. 

1864.  3rd  Year  Student,  Hon.  Cert. 

Inglis  (W.  W.),*  Brixton  Hill. 

1864.  1st  Year  Student,  2nd  Coll.  Prize. 

1865.  2nd  Year  Student,  2nd  Coll.  Prize 

1866.  3rd  Year  Student,  3rd  Coll.  Prize; 
Cheselden  Medal. 

Ives  (K.) 

1855.  Midwifery,  Hon.  Cert. 

Jackson  (T.  C),  Eotherhithe. 

1844.  Materia  Medica,  Hon.  Cert. 

Jacob  (E.  H.),  Winchester, 
w  1875-6.    Physical    Society's    3rd    Year's 
Prize. 

Jacobson  (T.  E.),  Sleaford,  Lincoln. 

1852.  Practical  Midwifery,  Prize. 

Jardine  (J.  L.),  Brixton. 
1848.  Physiology    and    Anatomy,    Hon. 
Cert. 

1850.  Medical  Reports,  Dr.  Roots'  Prize. 

Jay  (M.),  Wallaroo,  South  Australia, 
w  1877-8.  1st  Year  Student,  3rd  Coll.  Prize. 
w  1878-9.  2nd  Year   Student,  2nd  College 
Prize ; 
Prosector's  Prize. 

Jefferson  (T.  J.),  Hull. 

1861.  2nd  Year  Student,  Hon.  Cert. 

1862.  3rd  Year  Student,  Hon.  Cert. 

Johnson  (W.  G.),  Wandsworth. 

1853.  Chemistry,  Hon.  Cert. 

1854.  Midwifery,  Hon.  Cert. 

1855.  Comparative  Anatomy  Prize ;  Mid- 

wifery, Hon.  Cert. 

Jones  (S.),tCricklewood,  Middlesex. 

1851.  Matriculation  Scholarship,  Prize  ; 
Descriptive  Anatomy,  Hon.  Cert.; 
Chemistry,  Hon.  Cert. ; 

1st  Year  Student,  Scholarship. 

1852.  2nd  Year  Student,  Scholarship  ; 
Physiology,  Hon.  Cert. ; 
Descriptive  Anatomy,  Prize ; 
Botany,  Hon.  Cert. 

1853.  Physiology,  Hon.  Cert. ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
3rd  Year  Student,  Scholarship ; 
Materia  Medica,  Hon.  Cert. 

Jones  (H.  Sydney),  George  Street, 

Hanover  Square, 
w  1881-2.  Entrance  Silence  Scholarship. 
The  Wm.  Tite  Scholarship. 

Jones  (T.) 

1855.  Midwifery,  Hon.  Cert. 

Jones  (T.  M.),  Swansea. 

Surgery,  Hon.  Cert.  ; 
Midwifery,  Hon.  Cert. 

*  Late  Medical  Registrar  at  St.  Thomas  's 
Hospital. 

f  Surgeon  to,  and  Joint  Lecturer  on 
Surgery  at,  St.  Thomas's  Hospital ;  late 
Lecturer  on  Anatomy  and  Ophthalmic 
Surgery. 


Jones  (A.  O.),  Islington. 

1862.  1st  Year  Student,  Hon.  Cert. 

Jones  (J.),  Ilfracombe. 

1863.  Matriculation  Examination  — 
Modern    Languages    and    Modern 

History,  College  Prize. 
Jones  (W.  Wansbrough),$  Leek, 
w  1877-8.  1st  Year  Student ; 

1st  Entrance  Science  Scholarship ; 

£60. 
The  William  Tite  Scholarship. 
w  1877-8.  1st  Year  Physical  Society's  Prize ; 
s  1878.  1st  Year  Student,  l5,t  Coll.  Prize  ; 
w  1878-9.  2nd  Year  Student,  The  College 

Scholarship ; 
s  1879.  2nd  Year  Student,  2nd  Coll.  Prize  ; 
w  1879-80.  3rd  Year  Student,  2nd  tenure  of 
Coll.  Scholarship,  and  1st  Coll.  Prize, 
w  1880-81.     The  Mead  Medal; 

Treasurer's  Gold  Medal. 
Joseph  (S.  W.  J.),  St.  Leonards. 

1873.  Physical  Society's  2nd  Year  Prize 
Keele  (J.  T.),  South  Lambeth. 

1853.  Materia  Medica,  Hon.  Cert. ; 

Midwifery,  Hon.  Cert. 

Kerakoose  (J.),  East  Indies. 

1854.  Midwifery,  Hon.  Cert. 

Keyworth  (J.  W.).§  Aston,  Berks. 

1848.  Chemistry,  Hon.  Cert. ; 
Materia  Medica,  Prize ; 
General  Proficiency,  Hon.  Cert. 

1849.  Physiology,  Hon.  Cert. ; 
Midwifery,  3rd  Prize; 
Medicine,  Hon.  Cert. ; 
Physical  Society's  Essay,  Prize. 

1850.  Physiology,  Hon.  Cert. ; 

( Accoucheur)Midwifery,Hon.  Cert. ; 
Ophthalmic  Reports,  a  Governor's 

Prize ; 
Essay  on  Neuralgia,  Mr.  Newman 

Smith's  Prize. 

1851.  Comparative  Anatomy,  Prize; 
Clinical  Medicine,  Prize ; 
Surgical  Reports,  Prize  ; 
Midwifery,  Prize; 

Medical  Reports,  Prize; 

Pathology,  Prize; 

Physical  Society's  Essay,  Prize. 

Kidd  (H.  G.),  U.  Norwood. 

w  1881-2.  1st  Year  Student,  3rd  Coll.  Prize. 

Knaggs  (E.  H.  E.),  Trinidad,  W. 

Indies, 
w  1875-6.  Prosector's  Prize. 
Lake  (W.  W.),  Ilford,  Essex. 

1873.  Physical  Society's  1st  Year's  Prize. 
Lake  (K.),  Dover, 
w  1881-2.  Prosector's  Prize. 
Lankester  (H.),  Poole,  Dorset. 

1850.  1st  Year  Student,  Scholarship  ; 
Descriptive  Anatomy,  1st  Prize; 
Chemistry,  Prize. 

1851.  Physiology,  Prize; 
Materia  Medica,  Prize ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Botany,  Hon.  Cert. ; 
Medicine,  Prize ; 

Physical  Society's  Essay,  Prize; 
Surgery,  Hon.  Cert. 

J  UatcliffeTravelling  Fellowship,  Oxford, 
1880. 

y  Lecturer  on  Physiology  at  Sydenham 
College,  Birmingham. 


59 


1852.  3rd  Year  Student,  Scholarship; 
Physiology,  Hon.  Cert. ; 
Descriptive  Anatomy,  Hon.  Cert.; 
Medical  Cases,  President's  Prize ; 
Medicine,  Prize ; 

Surgery,  Prize ; 

Surgery    and    Surgical    Anatomy 

Cheselden  Medal ; 
General    Proficiency,    Treasurer's 

Medal. 

1853.  Surgical  Essay,  President's  Prize. 

Lankester  (H.  H.),  Leicester. 

w.  1880-81,    Entrance  Science  Scholarship. 

1st   Year  Student  2nd    Coll. 
Prize, 
w  18°l-2.  2nd  Year  Student,  The  College 

Scholarship. 

Laveb  (H.) 

1855.  Midwifery,  Hon.  Cert. 

Layer  (A.  H.),  Rayleigh. 

1870.  1st  Year  Student,  3rd  Coll.  Prize. 

1871.  2nd  Year  Student,  2nd  Coll.  Prize. 
w  1872.  3rd  Year  Student,  2nd  Coll.   Prize, 

Cheselden  Medal. 

Lawson  (R.),  Winthank,  N.B. 

w  1880-81. 1st  Entrance  Science  Scholarship. 
1st  Year  Student,  The  VVm.  Tite 
Scholarship. 
8  1881.  2nd  Coll.  Prize. 
w  1881-2.  2nd  Year,  2nd  Coll.  Prize. 

Laxton  (T.  L.),  Stamford, 
w  1876-7.  2nd    Year    Student,    Prosector's 
Prize. 

Ledger  (M.),  London. 

1845.  Dresser's  Clinical  Surgery,  Prize. 

Lees  (J.),*  Wolverhampton. 
1859.  1st  Year  Student.  Hon.  Cert.  ; 
3rd  Year  Student,  Hon.  Cert. ; 
Physical  Society's  Prize. 

Leeson  (T.),  Snaith,  York. 

1847.  Medicine,  Hon.  Cert.; 
Surgery,  Prize ; 

Physiology    and    Anatomy,    Hon. 

Ceit.; 
Descriptive  and  Surgical  Anatomy, 

Hon.  Cert.  ; 
Midwifery,  Hon.  Cert. 

1848.  Descriptive  and  Surgical  Anatomy, 

Hon.  Cert. ; 
Physiology    and    Anatomy,    Hon. 

Cert.; 
Medicine,  Hon.  Cert. ; 
Midwifery,  Prize. 

Le  Gros  (J.),  Jersey. 

1844.  Medicine,  Hon.  Cert.  ; 
Midwifery,  1st  Prize. 

1845.  Clinical  Medical  Reports,  Medal ; 
Medicine,  Hon.  Cert.  ; 
Dresser's  Clinical  Surgery,  Prize. 

Lerew  (F.  W.),  Miiitla  Vale. 

s  1*76.  1st  Year  Student,  Hon.  Cert. 

Litteljohn     (S.     G.),    Falmouth, 
Jamaica. 
1365.  1st  Year  Siudent,  Hon.  Cert. 

*  Late  Demonstrator  of  Morbid  Anatomy 
at  St.  Thomas's  Hospital. 


Locock  (II.  S.),  Blackhcath. 

1848.  Descriptive  and  Surgical  Anatomy, 

Hon.  Cert. ; 
Physiology    and    Anatomy,   Hun. 

Cert.; 
Midwifery,  Hon.  Cert. 

1849.  Physiology,  Hon.  Cert. 

Longstaff(G.  B.),  Wandsworth. 

w  1873-4.  1st  Year  Student,  2nd  Coll.  Prize. 
s  1874.     1st  Coll.  Prize; 

Physical  Society's  1st  Year's  Prize ; 
s  1875.  2nd  Year  Student,  2nd  Coll.  1'rize. 
w  1875-6.  3rd  Year  Student,  1st  Coll.  Prize, 
w  1876-7.  4th  Year  Student,  Mead  Medal. 

Lush  (W.  H.),  Devizes, 
w  1872.     2nd     Year    Student,    Prosector's 
Prize. 

Lush  (J.  S.),  West  Lavington. 
8  1873.     1st  Year  Student,  3rd  Coll.  Prize. 

Macmurdo    (H.   H.),  New    Broad 

Street. 
1847.  Chemistry,  Hon.  Cert. 
1849.  Midwifery,  Hon.  Cert. 

Manby  (W.  G.),  Barking,  Essex. 
1851.     Descriptive  Anatomy,  Hon.  Cert. 

March  (H.  C),  Newbury. 

1868.  1st  Year  Student,  Treasurer's  2nd 

Prize. 
1856.  2nd  Year  Student,  Hon.  Cert. 
1860.  3rd  Year  Student,  Hon.  Cert. 

Mason  (M.  T.),  Newington. 

1845.  Practical  Midwifery,  Hon.  Cert. 

May  bury  (A.  C),  Frimley,  Surrey. 
1865.  3rd  Year  Student,  Hon.  Cert. 

Mayburt  (W.  A.),  Frimley,  Surrey. 
1867.  1st  Year  Student,  3rd  College  Prize. 

Maybury  (H.  M.),  Frimley,  Surrey. 

1869.  1st  Year  Student,  2nd  Coll.  Prize; 
1871.  3rd  Y'ear  Student,  3rd  Coll.  Prize. 

Maybury  (A.  V.),  Frimley. 

187u.  1st  Year  Student,  2nd  Coll.  Prize. 

1871.  2nd  Y'ear  Student,  1st  Coll.  Prize. 

W1872.  3rd  Y'ear  Student,  1st  Coll.  Prize; 

Treasurer's  Gold  Medal. 

Maynard  (J.  C.  M.) 

1855.  Midwifery,  Hon.  Cert. 

Meadows  (H.),  Leicester. 

1867.  1st    Year    Student,   The    William 

Tite  Scholarship ; 
Phys.  Soc.  1st  Year's  Prize. 

1868.  2nd  Year,  Tite  Scholarship; 
Phys.  Soc.  2nd  Year's  Prize. 

Miller  (B.),  London. 
1845.  Midwifery,  Hon.  Cert. ; 

Practical  Midwifery,  Prize; 
Clinical  Medicine,  Prize. 

Milne  (C.  W.),  Aberdeen. 

1865.  1st  Year  Student,  Hon.  Cert. 

Mitchell  (J.),  Leicester. 

1866.  1st  Year  Student,  2nd  Coll.  Prize; 
Phys.  Society's  1st  Year's  Prize. 

1867.  2nd  Y'ear  Student,  2nd  Coll.  Prize. 

1868.  3rd  Year  Student,  2nd  Coll.  Prize. 


60 


Money  (F.  J.),  Offham,  Kent. 

1849.  Descriptive  Anatomy,  2nd  Prize ; 
Chemistry,  Prize ; 

Materia  Medica,  1st  Prize ; 
Matriculation  Scholarship,  Prize ; 
1st  Year  Student  Scholarship. 

1850.  Physiology,  Prize ; 
Comparative  Anatomy,  Prize ; 
Descriptive  Anatomy,  Prize ; 
Medicine,  Prize ; 

Surgery,  Hon.  Cert. 

1851.  Descriptive  Anatomy,  Hon.  Cert. ; 
Midwifery,  Prize ; 

Medicine,  Prize  ; 

Physical  Society's  Essay,  Prize  ; 

Surgery,  Prize ; 

Surgery  and    Surgical    Anatomy, 

Cheselden  Medal ; 
General    Proficiency,    Treasurer's 

Gold  Medal. 

Moreton  (J.  E.),  Marton,  Cheshire. 

1850.  1st  Year  Student,  Scholarship; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Chemistry,  Hon.  Cert. 

1851.  Materia  Medica,  Hon.  Cert. ; 
Botany,  Hon.  Cert. ; 

1852.  Physiology,  Prize ; 
Descriptive  Anatomy,  Prize : 
Physical  Society's  Essay,  Prize ; 
Medicine,  Prize ; 

Surgery,  Prize ; 

2nd  Year  Student,  Scholarship. 

1853.  3rd  Year  Student,  Scholarship ; 
Physiology,  Prize ; 

Clinical  Medicine,  Pres.  Prize ; 
Clinical  Medicine,  Treas.  Prize. 
Clinical  Medicine,  Mr.  N.  Smith's 

Prize ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Midwifery,  Hon.  Cert. ; 
Ophthalmic  Surgery,  Prize ; 
Medicine,  Prize; 
Forensic  Medicine,  Hon.  Cert. ; 
Surgery,  Hon.  Cert. ; 
Surgery   and    Surgical   Anatomy 

Cheselden  Medal ; 
Gen.  Proficiency,  Treas.  Medal. 

1854.  Clinical  Med  ,  Dr.  Roots'  Prize  ; 
Pathology,  Hon.  Cert. 

Moreton  (T.),  Marton,  Cheshire. 
1867.  1st  Year  Student,  Treasurer's  2nd 
Prize ; 
Matriculation    Examination,  Clas- 
sics and  Mathematics,  Prize. 

1858.  Clinical  Medicine,  Prize. 

1859.  3rd  Year  Student,  Hon.  Cert. ; 
Clinical  Medicine,  Hon.  Cert. 

Morgan  (S.),  London. 

1852.  Descriptive  Anatomy,  Hon.  Cert. 

1853.  Midwifery,  Hon.  Cert. 

1854.  Midwifery,  Hon.  Cert. ; 
Forensic  Medicine,  2nd  Prize. 

Morris  (0.  K.),  Spalding,  Lincoln- 
shire. 
w  1875.  Prosector's  Prize. 

Morton  (J.),  Holbeach,  Lincoln. 
1881.  lbt  5fear  Student,  Hon.  Cert. 

1862.  2nd  Year  Student,  Hun.  Cert. 

1863.  3rd  Year  Student,  Hon.  Cert. 

Moxon  (H.  M.„  Brigsham. 

1871.     Prosector's  Prize. 


Musson  (W.  E.),  Birkholme,  Lin- 
coln. 

1850.  Matriculation  Scholarship,  Prize  ; 
Descriptive  Anatomy,  Hon.  Cert. 

1851.  Physiology,  Hon.  Cert. ; 
Comparative  Anatomy,  Hon.  Cert. ; 
Medicine,  Hon.  Cert. 

Newby  (C.  H.),  London. 

1870.    Prosector's  Prize. 
Newsholme  (A.),  Bradford, 
w  1875-6.  1st  Year  Student,  1st  Coll.  Prize, 
w  1876-7.  2nd  Year    Student,  1st    College 

Scholarship, 
s  1877.  Ditto  1st  Coll.  Prize, 

w  1877-8.  3rd  Year  Student,  The  "College 

Scholarship,"  1st  Coll.  Prize. 

Newth     (A.      H.),     Kennington, 

Surrey. 
1865.  1st  Year  Student,  Hon.  Cert. 
Nichol  (R.),  Camberwell. 

1844.  Chemistry,  1st  Prize; 
Materia  Medica,  Prize. 

1845.  Physiology    and    Anatomy,    Hon. 

Cert. ; 
Botany,  Prize ; 
Comparative  Anatomy,  Prize. 

Nicholson  (F.  W.),  Putney. 

s  1877.  1st  Year  Student,  3rd  Coll.  Prize, 
w  1877-8.   2nd    Year    Student,    Prosector's 

Prize. 
Nicholson  (J.  F.),  Brigg,  Lincoln, 
■w  1873.  1st  Year  Student,  1st  Coll.  Prize. 
s   1873.       Ditto  1st  Coll.  Prize, 

w  ls74.   2nd  Year  Student,  1st  Coll.  Prize. 
8 1874.        Ditto  1st  Coll.  Prize. 

w  1875.  3rd  Year  Student,  1st  Coll.  Prize ; 

Cheselden  Medal ; 

Mead  Medal ; 

Treasurer's  Gold  Medal. 

O'Callaghan  (C),  Killarney. 

1847.  Chemistry,  Hon.  Cert. ; 
Materia  Medica,  Prize. 

1848.  Medical  Reports,  Presidents  Prize; 
Physiology    and    Anatomy,'  Hon. 

Cert. ; 

Midwifery,  Hon.  Cert. ; 

Practical  Midwifery,  Prize; 

Forensic  Medicine,  Prize ; 

Physical  Society's  Essay,  Prize, 
'     1849.  Physical     Society's    Essay,    Trea- 
surer's Prize ; 

Resident     Accoucheur's     Report, 
Prize. 

Orange  (W.),*  Torquay. 

1854.  Midwifery,  Hon.  Cert. 
1856.  Midwifery,  Hon.  Cert. 

Ord  (G.  R.),  Brixton. 

1858.   Midwifery,  Hon.  Cert. 

Ord  (W.  M.),f  Brixton. 

1853.  Matriculation  Examination, 

Scholarship ; 
1st  Year  Student,  Scholarship; 
Descriptive  Anatomy,  Prize ; 
Chemistry,  Prize. 

*  Resident  Medical  Superintendent  at 
Broadmoor  Asylum. 

t  Physician  to,  and  Joint  Lecturer  on 
Medicine,  late  a  Lecturer  on  Physiology 
and  Practical  Physiology  at  St.  Thomas's 
Hospital.  Late  Lecturer  on  Comparative 
Anatomy. 


61 


1854.  2nd  Year  Student,  Scholarship ; 
Medicine,  Prize; 

Materia  Medica,  Prize ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Midwifery,  lion.  Cert. ; 
Surgery,  Hon.  Cert. ; 
Physiology,  Prize. 

1855.  3rd  Year  Student,  Scholarship  ; 
Surgery    and    Surgical    Anatomy, 

Cheselden  Medal : 
Forensic  Medicine,  Prize ; 
Pathology,  Prize; 
Practical  Chemistry,  Prize ; 
Medicine,  Hon.  Cert. ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Physiology,  Prize ; 
General    Proficiency,    Treasurer's 

Medal. 

1856.  Registrar,  Prize. 

Osborn  (S.),  Brixton. 
1870.  Physical  Society's  2nd  Year's  Prize. 

Oughton  (T.),  London. 

1858.  Clinical  Medical  Assistant,  1st  Prize. 

Ozanne  (C.  H.),  Guernsey. 

1844.  Descriptive  and  Surgical  Anatomy, 
Prize. 

Ozanne  (J.),  Guernsey. 

1843.  Physiology  and  Anatomy,  Chesel- 

den Medal ; 
Comparative  Anatomy,  Hon.  Cert. 

1844.  Medicine,  Prize ; 

Midwifery,  2nd  Prize; 
Surgery,  Hon.  Cert. ; 
Physical  Society's  Essay,  Prize ; 
Clinical    Surgical    Reports,  Silver 
Medal. 

Page  (W.  H.),  Cheltenham. 

a  1872.  1st  Year  Student,  Hon.  Cert, 
w  1873.  3rd  Coll.  Prize. 

Palmer    (M.    H.     C),   Newbury, 
Berks. 

1870.  Physical  Society's  2nd  Year's  Prize. 
1872.  Physical  Society's  3rd  Year's  Prize. 

Pearce  (G.),  Salisbury. 

1860.  1st  Year  Student,  2nd  Coll.  Prize. 

1861.  2nd  Year  Student,  2nd  Coll.  Prize. 

Peek  (F.  H.),  Diss,  Norfolk. 
s  1872.  1st  Year  Student,  1st  Coll.  Prize, 
w  1873.  The  William  Tite  Scholarship. 
w  1874.  2nd  Year  Wm.  Tite  Scholarship. 

Penberthy  (J.),  Eedruth. 

1854.  1st  Year  Student,  Scholarship ; 
Descriptive  Anatomy,  Prize; 
Chemistry,  Hon.  Cert. 

1855.  2nd  Year  Student,  Scholarship  ; 
Midwifery,  Hon.  Cert.; 
Botany,  Prize ; 

Descriptive  Anatomy,  Hon.  Cert. 

Pern  (A.),  Winchester,  Hampshire. 
1865.  1st  Year  Student,  Hon.  Cert. 

Phillips  (G.  G.),  Newcastle  Emlyn. 

1859.  2nd  Year  Student,  Hon.  Cert. 

1860.  3rd  Year  Student,  3rd  Coll.  Prize. 

Pickford  (J.  K.),  Brixton. 

w  1872.  1st  Year  Student,  3rd  Coll.  Prize, 
s  1872.  Hon.  Cert. 

Pike  (W.  R.),  Leicester. 

186«.  Physical  Society's  1st  Year's  Prize. 


Pike  (J.  B  ),  Loice-ter. 

w  1872.  2nd  Year  Student,  Hon.  Cert. 

w  1873.  3rd  Year  Student,  Hon.  Cert. 

Plowman  (R.),  Bridgewater,  Somst. 

1862.  1st  Year  Student.  Hon.  Cert. 

1863.  2nd  Year  Student,  Hon.  Cert. 
1865.  3rd  Year  Student,  Hon.  Cert. 

Pollard  (F.),  Taunton,  Somerset. 

1865.  1st  Year  Student,  2nd  Coll.  Prize 

1866.  2nd  Year  Student,  2nd  Coll.  Prize; 

Physical  Society's  2nd  Year's  Prize. 
1868.  3rd  Year  Student,  1st  Coll.  Prize  ; 
Physical  Society's  3rd  Year's  Prize  ; 
Cheselden  Medal. 

Potter  (H.  P.),  Denmark  Hill. 

w  1872.  1st  Year  Student,  Hon.  Cert. 

8  1872.  3rd  College  Prize. 

w  1*73.  2nd  Year  Student,  2nd  Coll.  Prize  ; 

Prosector's  Prize, 
w  1874.  3rd  Year  Student,  1st  Coll.  Prize ; 

Cheselden  Medal ; 

Hon.  Cert,  for  Gen.  Proficiency. 
1875.  Grainger  Testimonial  Prize. 

Poynder  (G.  F.),  Clapham. 

1872.  Phys.  Society's  1st  Year's  Prize. 
1874.  Phys.  Society's  3rd  Year's  Prize. 

Purkiss  (A.),  Kennington. 

w  1875-6.  1st  Year  Student,  Hon.  Cert. 

s  1876.  Hon.  Cert. 

Purvis  (J.  P.),  Blackheath. 

1861.  1st  Year's  Student,  Hon.  Cert.; 
Matriculation  Examination,   Hon. 

Cert. 

1862.  2nd  Year  Student,  Hon.  Cert. 

1863.  3rd  Year  Student,  Hon.  Cert. 

Rainbow  (F.),  Lower  Norwood. 

1864.  1st  Year  Student,  Hon.  Cert. 

1865.  2nd  Year  Student,  3rd  Coll.  Prize. 

1866.  3rd  Y'ear  Student,  2nd  Coll.  Prize. 

Relton  (B.),  Ealing. 

18s0.  2nd  Entrance  Science  Scholarship. 
Rayner  (H.),*  Hythe,  Kent. 

1862.  MatriculationExamination — Physics 

and  Natural  History,  Hon.  Cert. ; 
1st  Year  Student,  1st  Coll.  Trize. 

1863.  2nd  Year  Student,  1st  Coll.  Prize. 

1864.  3rd  Y'ear  Student,  Hon.  Cert.; 
Hon.  Cert,  for  the  Cheselden  Medal. 

Richardson  (C.  S.),  Greenwich. 

1851.  Surgery,  Hon.  Cert. 

1852.  Midwifery,  Prize. 

Richardson  (L.),  Greenwich. 

1848.  General  Pathology,  Prize. 

Ridge  (J  J.),  Horsleydown. 

1864.  1st    Yrear    Student,    The    'Willia'ii 

Tite  Scholarship. 

1865.  2nd  Year  of  Tite's  Scholarship  ; 
Physical  Society's  2nd  Year's  Prize ; 
Prosector's  Prize. 

1866.  The  Grainger  Testimonial  Prize. 
1868.  3rd  Year  Tite  Scholarship; 

Hon.    Cert,    for     Proficiency     in 

Surgery  and  Surgical  Anatomy ; 
Treasurer's  Gold  lledal. 

*  Medical  Superintendent  Hanwell  Asy- 
lum, and  Lecturer  on  Psychology  at  St. 
Thomas's  Hospital.  Late  Lecturer  on 
Psychology  at  Middlesex  Hospital. 


62 


Robinson  (H.  B.),  L.  Norwood. 
s  1881.  2nd  Year  Student,  1st  Coll.  Prize. 

Eoe  (A.  D.),  Eccles. 
w.  1880-81.    3rd  Year  Student,   2nd    Coll. 
Prize. 

Rogers  (R.  S.),  Greenwich. 

1843.     Midwifery,  First  Prize ; 

Clinical  Medicine,  Hon.  Cert. 

Rossitee  (G.  F.),  Taunton. 

1871.  1st  Year  Student,  1st  Coll.  Prize. 
w  1872.  2nd  Y'ear  Student,  2nd  Coll.  Prize, 
s  1872.  1st  Coll.  Prize. 
w  1873.  3rd  Year  Student,  3rd  Coll.  Prize ; 

Cheselden  Medal; 

Treasurer's  Gold  Medal. 

Rouse  (R.  E.),  Woodbridge). 

s  1880.    2nd  Year  Student,  3rd  College  Prize. 

Rtjdall  (J.  T.),  Crediton,  Devon. 
1853.  Physiology,  Hon.  Cert. ; 
Midwifery,  Hon.  Cert. ; 
Medicine,  Hon.  Cert. ; 
Surgery,  Hon.  Cert. 

Sandford  (H.  C),  Brixton. 

w  1872.  1st  Year  Student,  1st  Coll.  Prize. 

sl872.  2nd  College  Prize, 
w  1873.  2nd  Year  Student,  1st  Coll.  Prize. 

s  1873.  3rd  College  Prize. 
w  1874.  3rd  Year  Student,  2nd  Coll.  Prize ; 
Treasurer's  Gold  Medal. 

Saneyoshi  (Y.),  Tokio,  Japan. 

w  1881-2.  3rd  Year  Student,  1st.  Coll.  Prize. 

Sankey  (G.  G.),  Ashford,  Kent. 

1864.  3rd  Year  Student,  3rd  Coll.  Prize. 

Saunders  (G.  M.  C),  London. 

1843.  Midwifery,  Hon.  Cert. 

Saunders  (H.  W.),  London. 

1867.  1st  Year  Student,  2nd  Coll.  Prize. 

1868.  Prosector's  Prize. 

1869.  3rd  Y ear  Student,  1st.  Coll.  Prize; 

Treasurer's  Gold  Medal ; 

Physical  Society's  3rd  Year's  Prize. 

Saunders  (W.  S.),  Camden  Town. 

1844.  Midwifery,  Hon.  Cert. 

1845.  Medicine,  Prize ; 
Midwifery,  Prize; 
Clinical  Medicine,  Prize. 

Savill  (T.  D.),  Brixton, 
w  1875-6.  2nd  Entrance  Science  Scholarship; 
1st   Year    Student,   The   William 
Tite  Scholarship, 
s  1876.  3rd  College  Prize, 
w  1876-7.  2nd  Y'ear  Student,  Hon.  Cert, 
s  1877.  2nd  Year  Student,  2nd  Coll.  Prize. 

Scott  (R.  J.),  Omagh,  Tyrone. 
1861.  1st  Y'ear  Student,  Hon.  Cert. 

Sewell  (E.),  Little  Oakley. 

1848.  Physiology    and    Anatomy,    Hon. 
Cert. 

Sedgwick  (J.),  Boroughbridge. 

1*54.  Descriptive  Anatomy,  Hon.  Cert. 

1865.  Surgery,  Hon.  Cert. ; 

Midwifery,  Hon.  Cert. 

Sedgwick  (L.  W.),  Boroughbridge. 
1848.  Descriptive  and  Surgical  Anatomy, 
Prize; 


Physiology  and  Anatomy,  Prize ; 
Medicine,  Hon.  Cert. ; 
Midwifery  Prize; 
Surgery,  Prize ; 
1849.  Physiology,  1st  Prize  ; 
Midwilery,  1st  Prize; 
Suigery,  Prize; 
Medicine,  1st  Prize ; 
General    Proficiency,    Treasurer's 
Medal. 
Sergeant  (E.),  Preston. 

1870.  3rd  Y'ear  Student,  3rd  Coll.  Prize ; 
Cheselden  Medal. 
Sharkey  (S.  J.),*  Galway. 

1874.  I'hysical  Society's  2nd  Year's  Prize. 
Shaw  (J.),  Clapham  Road. 
w  1874-5.  1st  Year  Student,  1st  Coll.  Prize. 

s  1875.  1st  Coll.  Prize. 
w  1875-6.  2nd  Year  Student,  1st  Coll.  Prize. 

Shea  (H.  G.),  London. 

1860.  1st  Year  Student,  Hon.  Cert. 

1861.  2nd  Year  Student,  Hon.  Cert. 

1862.  3rd  Year  Student,  2nd  Coll.  Prize. 

Shea  (J.),  London. 

1855.  Midwifery,  Hon.  Cert. 
1859.  Midwifery,  Hon.  Cert. 
Sheppard  (C.  E.),f  Kensington. 
w  1873-4.  1st  Year  Student,  1st  Coll.  Prize. 
S1874.  1st  Year  Student,  2nd  Coll.  Prize, 
w  1874-5.  2nd  Year  Student,  1st  Coll.  Prize, 
s  1875.  1st  Coll.  Prize, 
w  1875-6.  3rd  Year  Student,  2nd  Coll.  Prize ; 
Physical  Society's  2nd  Year's  Prize, 
w  1876-7.  4th  Year  Student,  the  Treasurer's 

Gold  Medal, 
w  1877-8.  Solly    Medal    and     Prize,    £20. 
Paper     published     in     Hosp. 
Reports,  Vol.  VIII. 
Sheppard  (W.  J.),  Kensington, 
w.  1880-81.    3rd   Year  Student,   3rd  Coll. 

Prize, 
w  1881-2.  The  Treasurer's  Gold  Medal. 

Siddai.l  (J.  B.),J  Morton,  Derby. 

1862.  1st  Year  Student,  Hon.  Cert. 

1863.  2nd  Year  Student,  Hon.  Cert. 

1864.  3rd  Year  Student,  Hon.  Cert. ; 
Hon.  Cert,  for  the  Cheselden  Medal. 

Simon  (M.  P.),  Blackheath. 

1866.  1st  Year  Student,  1st  Coll.  Prize. 
1869.  3rd  Year  Student,  3rd  Coll.  Prize  ; 
Prosector's  Prize ; 
Prize  and  Hon.  Cert,  for  Surgery 
and  Surgical  Anatomy. 
Simmons  (H.  B.  M.),  West  Indies. 

1849.  Descriptive  Anatomy,  Hon.  Cert. 
Sims  (G.  S.),  Derby. 
s  1881.  1st  Y'ear  Student,  3rd  Coll.  Prize. 

SlSSONS  (W.  H.),  Hull. 

1858.  Matriculation  Examination — 

Physics,  &c,  Prize. 

1859.  2nd  Year  Student,  Hon.  Cert. ; 
Clinical  Medicine,  Prize; 
Physical  Society's  Essay,  Prize. 

1860.  3rd" Year  Student,  2nd  Coll  Prize; 
Physical  Society's  Prize. 

*  Assist.- Physician  to  and  Joint  Lecturer 
on  Pathological  Anatomy  at  St.  Thomas's 
Hospital. 

f  Resident  Assistant -Physician  to  St. 
Thomas's  Hospital. 

I  Late  Physician  to  II.B.M.  Legation, 
Japan. 


63 


Slater  (J.  S.),  Bath. 

1868.  1st  Year  Student,  1st  Coll.  Prizo. 

1869.  Physical  Society's  2nd  Year's  Prize. 

1870.  3rd  Year  Student,  2nd  Coll.  Prize  ; 
Treasurer's  Gold  Medal. 

Slaughter  (C.  H.),  Farningham. 
1855.  Midwifery,  Hon.  Cert. 

Slaughter  (G.  M.),  Farningham. 

1854.  Midwifery,  Hon.  Cert. 

Skinner  (W.),  Stockton-on-Tees. 

1848.  Botany,  Hon.  Cert.  ; 

Materia  Medica,  Hon.  Cert. 

Skipper  (J.),  Dalston,  London. 
1852.  Midwifery,  Hon.  Cert. 

Skipton  (S.  S.),  East  Indies. 
1851.  Midwifery,  Hon.  Cert. 

Smith  (H.  U.),  Beading, 
w  1876-7.  4th     Year     Student,     Cheselden 
Medal. 

Smith  (B.  P.),  Belvedere. 

s  1876.  2nd    Year    Student,    2nd    College 
Prize. 

Snaith  (F.),  Boston,  Lincolnshire. 
1864.  3rd  Year  Student,  Hon.  Cert. 

Sprakeling  (B.  J.),  Canterbury. 

1855.  Midwifery,  Hon.  Cert. 

1856.  2nd  Year  Student,  Hon.  Cert. ; 
Clinical  Medicine,  Prize. 

Staddon  (J.  H.),  London. 

1858.  Clinical  Medicine,  Prize. 

1859.  Clinical  Medicine,  Prize. 

Stefhens     (J.    N.),    "Walton  -  on  - 

Thames, 
w  1876-7.  Physical  Society's  1st  Year's  Prize. 

Stephens  (S.  Sanders),  Taunton. 
1863.  Physical  Society's  2nd  Year's  Prize. 

Stoddart  (F.  W.),  Bristol. 

w  1877-8.  1st  Year  Student,  1st  Coll.  Prize. 

Stone  (W.  H.),*  London. 

1854.  Matriculation  Examination — 

Scholarship ; 
1st  Year  Student,  Scholarship  ; 
Descriptive  Anatomy,  Hon.  Cert. ; 
Botany,  Prize ; 
Chemistry,  Prize. 

1855.  2nd  Year  Student,  Scholarship  ; 
Forensic  Medicine,  Prize; 
Physical  Society's  Essay,  Prize; 
Practical  Chemistry,  Prize ; 
Medicine,  Prize; 

Descriptive  Anatomy,  Hon.  Cert. ; 
Materia  Medica,  Prize ; 
Physiology,  Prize ; 
Clinical  Medicine,  Mr.   N.  Smith's 
Prize. 

1856.  Clinical  Medical  Prize; 

General    Proficiency,     Treasurer's 
Medal. 

*  Physician  to,  and  Lecturer  on  Physics 
and  Natural  Philosophy,  and  on  Materia 
Medica  at  St.  Thomas's  Hospital;  late 
Assistant-Physician  to  the  Hospital  for 
Consumption  and  Diseases  of  the  Chest, 
Brompton. 


Summerhayes   (H.),  Crewkernc, 
Somcrsi'tsliire. 

1861.  Matriculation  Examination  — 

Classics        and        Mathemuti<  s, 

President's  Prizo ; 
Modern    Languages,    &c,    College 

Prize ; 
Physics     and     Natural     History, 

College  Prize ; 
The  William  Tite  Scholarship. 

1862.  2nd  Year  Tite's  Scholarship. 

1863.  3rd  Year  Tite's  Scholarship ; 

Treasurer's  Gold  Medal. 

Simmerhayes     (W.),     Crewkernc, 
Somersetshire. 

1856.   Matriculation    Examination — Clas- 
sics    and     Mathematics,     Hon. 
Cert, ; 
Matriculation  Examination — 

Modern  Languages,  Prize. 

Sutcliff  (E.),  Camberwell. 
1861.   1st  Year,  3rd  College  Prize  ; 

Matriculation   Examination — Hon . 
Cert. 
1863.   3rd  Year  Student,  3rd  Coll.  Prize. 

Sutcliffe  (J.),  A  shton-under-Lyne. 

1869.   Prosector's  Prize. 

Swallow  (J.  D.),  Beading. 
1861.   2nd  Year  Student,  Hon.  Cert. 

Sweeting  (B.  B.),  Beading. 

1853.  1st  Year  Student,  Scholarship; 
Descriptive  Anatomy,  Hon.  Cert. : 
Chemistry,  Hon.  Cert. 

1854.  2nd  Year  Student,  Scholarship  ; 
Midwifery,  Prize. 

1855.  3rd  Year  Student,  Scholarship ; 
Midwifery,  Hon.  Cert.  ; 

Clinical      Medicine,      Treasurer's 
Prize. 

Sweeting  (T.),  Beading. 
1855.  Midwifery,  Hon.  Cert. 

Takaki  (Kanehiro),  Kasumigaseki, 
Tokei,  Japan. 

w  1875-6.    1st  Year  Student,  3rd  Coll.  Prize. 

s  1876.    2nd  College  Prize. 

w  1876-7.   2nd  Yr.  Student,  1st  Coll.  Prize. 

8  1877.  2nd  Year  Student,  3rd  Coll.  Prize. 

w  1877-8.  3rd  Year  Student,  2nd  Coll.  Prize. 

W  1S7S-9.  4th  Year  Stud  nt; 

"  'I  he  Cbe.-elden  Medal ;" 
The  Treasure) 's  Gold  Medal. 

Talbot  (G.  T.),  Kidderminster. 
1848.  Medical  Reports,  Dr.  Roots'  Prize. 

Taylor  (C.  M.),  Wrawby,  Brigg. 

1871.   1st  Year  Student,  2nd  Coll.  Prize, 
w  1872.   2nd  Year  Student,  1st  Coll.  Prize, 
w  1873.  3rd  Year  Student,  1st  Coll.  Prize ; 
Surgery    and    Surgii-al   Anatomy, 
Hon.  Cert. 

Taylor  (S.),  Burton-on-Trent. 
w  1872.  3rd  Year  Student,  Hon.  Cert. 

Taylor  (S.  J.),  Grantham. 

s  1875.    1st  Year  Student,  Hon.  Cert. 

w  1875-6.   2nd  Year  Student,  The  Musgrove 

Scholarship. 
w  1876-7.   3rd     Year    Student.    2nd     Year 

Musgrove  Scholarship,  and   Jst 

College  Prize. 
W  1877-8.  The  Mead  Medal ; 

The  Treasurer's  Gold  Medal. 


64 


Teanby  (F.  W.),  Tumham  Green. 
1851.   Practical  Midwifery,  Prize. 
1S52.  Clinical  Medicine,  Junior  Prize; 
Midwifery,  Hon.  Cert. 

Thomas  (L.  M.),  Camberwell. 

1866.  1st  Year  Student,  3rd  Coll.  Prize. 

1867.  2nd  Year  Student,  3rd  Coll.  Prize. 

1869.  3rd  Year  Student,  2nd  Coll.  Prize; 

Cheselden  Medal. 

Thomas  (W.L.),  Neath,  Glamorgan. 
1845.   Chemistry,  Prize ; 

Materia  Medica,  Prize. 
1847.   Medicine,  Hon.  Cert. ; 

Physiology  and  Anatomy,  Prize  ; 

Physical  Society's  Essay,  Prize. 

Thompson  (F.  H.),  Tenbury. 

1870.  Prosecior's  Prize. 

Thui  ichtjm  (G.  D.),  Kensington, 
w  1878-9.    Physical    Society's    2nd  Y  cat's 
Prize. 

Timothy  (P.  V.),  London. 
1851.  Practical  Midwifery,  Prize; 
Midwifery,  Hon.  Cert. 

Todd  (A.  J.  M.),  Gravesend. 

w  1863.  1st  Year  Student,  2nd  Coll.  Prize. 

W1864.  Prosector's  Prize. 

Tomson  (K.),  Luton,  Beds. 

1842.  Materia  R1edi<a  Prize. 

1843.  Medicine,  Prize ; 

Clinical  Medicine,  Hon.  Cert. 

Tomson  (W.  B.),  Luton,  Beds. 

w  1879-80.  1st  Year  Student,  2nd  Coll.  Prize. 
s  1880.  1st  Year  Student,  2nd  Coll.  Prize, 
w  1880-81.  2nd  Year    Student,  The    Mus- 
grove  Scholarship,  Prosector's 
Prize, 
w  1881-2,  3rd  Year  Student,  2nd  Coll.  Prize; 
2nd     Tenure     of     Musgrove 
Scholarship. 

Trend  (H.  G.),  Bridge  water. 

1853.  Practical  Midwifery,  Prize  ; 
Midwifery,  Hon.  Cert. 

1854.  Midwifery,  Hon.  Cert. ; 

Clinical      Medicine,      Treasurer's 
Prize. 

Treves  (W.  K.),  Dorchester. 

1863.   Matriculation  Examination — 

Physics    and    Natural    History, 
Hon.  Cert.  ;  and 
Modern    Languages    and    Modern 
History,  College  Prize  and  Hon. 
Cert.  ; 
1st  Year  Student,  Hon.  Cert. 
1865.   3rd  Year  Student,  2nd  Coll.  Prize; 
Prosector's  Prize. 

Tyrrel  (W.),  Richmond. 

1851.  Descriptive  Anatomy,  Hon.  Cert. 

1 852.  Medicine,  Hon.  Cert. ; 
Surgery,  Hon.  Cert. 

1853.  Forensic  Medicine,  Hon.  Cert. ; 
Ophthalmic    Essay,    Mr.    Dixon's 

Prize. 

1854.  Surgical  Reports,  President's  Prize. 

Vardy  (J.  L),  London. 

1854.  Midwifery,  Hon.  Cert. 

1855.  Practical  Midwifery,  Prize. 

Vbedok  (H.  W.),  Eocles. 

3rd  Ye  'i  Student,  lion.  Cert. 


Wagstaffe  (W.  W.),*  Kennington. 

1862.  Matriculation  Examination— Clas- 

sics and  Mathematics,  President's 

Prize. 
Physics     and     Natural     History, 

College  Prize; 
Modern    Languages'    &c,  College 

Prize  ; 
1st    Year     Student,     Treasurer's 

Prize ; 

1863.  2nd  Year  Student,  1st.  Coll.  Prize. 

1864.  3rd  Year  Student,  1st  Coll.  Prize; 
Physical  Society's  3rd  Year's  Prize  ; 
Cheselden  Medal ; 

Treasurer's  Gold  Medal. 

Waller  (A.),  Islington. 

1864.  1st  Year  Student,  1st  Coll.  Prize. 

1865.  2nd  Year  Student,  1st  Coll.  Prize. 

1866.  3rd  Y'ear  Student,  1st  Coll.  Prize ; 
Physical    Society's      3rd     Year's 

Prize  ; 
Treasurer's  Gold  Medal. 

Waller  (C.  B.),  London. 

1860.  2nd  Year  Student,  Hon.  Cert. 
Walker  (R.),  Kendal. 

1854.  Descriptive  Anatomy,  Hon.  Cert. ; 
Midwifery,  Hon.  Cert. 

1855.  Midwifery,  Hon.  Cert. 

Ward  (F.  H.),f  Scarboro'. 

1863.  1st  Year  Student,  Treas.  Prize. 

1864.  2nd  Year  Student,  1st  Coll.  Prize ; 
Physical  Soc.  2nd  Year's  Prize. 

1865.  3rd  Year  Student,  1st  Coll.  Prize  ; 
Physical  Soc.  3rd  Year's  Prize ; 
Cheselden  Medal ; 
Treasurer's  Gold  Medal. 

Watson  (F.),  Nottingham. 
1859.   1st  Year  Student,  Hon.  Cert.; 

Matriculation  Examination — 

Physics,  &c,  Prize. 

Way  (F.  W.),  Fratton,  Portsmouth. 
]  853.   Descriptive  Anatomy,  Hon.  Cert. ; 

Chemistry,  Hon.  Cert.  ; 
1854.   Midwifery,  Hon.  Cert. ; 

Surgery,  Hon.  Cert. 

Way  (J.  P.),  Portsmouth. 

1861.  1st  Year,  Hon.  Cert. 
Webber  (W.  W.),  Crewkerne. 

w  1876-7.  1st  Year  Student,  3rd  Coll.  Prize. 

Webster  (H.),  Dulwich. 

1851.  Matriculation  Sch.,  Hon.  Cert. ; 
Descriptive  Anatomy,  Hon.  Cert. 

1852.  Botany,  Hon.  Cert. 

1853.  Midwifery,  Hon.  Cert. 

Weekes  (F.  H.),  Southampton. 

w  1873-4.  1st  Year  Student,  3rd  Coll.  Prize. 

s  1874.   3rd  Coll.  Prize. 

w  1874-5.  2nd  Year  Student,  2nd  Coll.  Prize. 

s  1875.    3rd  Coll.  Prize. 

w  1875-6.  3rd  Year  Student,  3rd  Coll.  Prize. 

Wells  (A.  E.),  Brixton. 

w  1877-8.  1st  Y'ear  Student,  2nd  Entrance 
Science  Scholarship. 

*  Assistant  Surgeon  to,  and  late  Joint  Lec- 
turer on  Anatomy  at,  St.  Thomas's  Hospital. 
Late  Assistant  Demonstrator  of  Anatomy 
and  Surgical  Registrar. 

f  Assistant  Medical  Officer,  Wandsworth 
Lunatic  Asylum. 


05 


West  (J.  P.)* 

1853.  Midwfii  i.v,  Hon.  0  it, 

1854.  Forensic  Medicine,  Hon.  Cert, ; 
Pathology,  Hon.  Cert. 

1855.  Ophthalmic  Keports,  Prize. 
Wheaton  (F.  D.  W.),  Honiton. 

1845.   Practical  Midwifery,  Hon.  Cert. 

Wiles  (J.),  Hitchin,  Herts. 

1S50.  Physiology,  Hon.  Cert. 

1851.   (Accoucheur)  Midwifery,  Prize. 

Whitehead  (J.),  Preston. 

1861.  1st  Year,  Hon.  Cert. 

1862.  2nd  Year  Student,  3rd  Coll.  Prize. 
Ib63.  3rd  Year  Student,  2nd  Coll.  Prize. 

Williams     (H.),    Longley,     near 
Gloucester. 
1869.   1st  Year  Student,  2nd  Coll.  Prize. 
1869.   2nd  Year  Student,  3rd  Coll.  Prize. 

Williams  (J.),  Westerleigh,  Bristol. 
1855.   1st  Year  Student,  Scholarship ; 

Midwifery  Prize; 

Botany,  Prize; 

Chemistry,  Hon.  Cert. ; 

Descriptive  Anatomy,  Prize  j 

Materia  Medica,  Hon.  Cert. 
1*56.   2nd  Year  Student,  Treas.  1st  Prize. 
1857.  3rd  Y'ear  Student,  Hon.  Cert. ; 

General    Proficiency,    Treasurer's 
Medal. 

Williams  (J.),  Doncaster. 

1868.    1st  Year  Student,  Hon.  Cert. 

1859.  2nd  Year  Student,  Hon.  Cert. ; 
Clinical  Medicine,  Prize. 

1860.  3rd  Year  Student,  Hon.  Cert. 

Williams  (P.  H.),  Monmouth. 
b  1872.   1st  Year  Student,  Hon.  Cert. 

Williams    (P.  M.  G.),    Newcastle 
Emlyn. 
1864.  Practical  Midwifery,  Prize. 

Williams  (R.  M.),  Beaumaris. 

1880    1st  Entrance  Science  Scholarship. 

*  Surgeon  to  Queen's  Hospital,  and  Pro- 
fessor of  Clinical  Surgery  at  Queen's  College, 
Birmingham. 

f  One  of  H.  M.  Commissioners  in  Lunacy, 
late  Resident  Physician  to  Bethlehem  Royal 
Hospital;  late  Lecturer  on  Mental  Diseases 
at  St.  Thomas's  Hospital. 


WlJXiAMfl  (W;  l!  ),1  Nottingham. 
1856.   Mati  i'  ni.it  inn         Examination  — 
ice,  Mathematics,  Hon.  Cert. 
Williamson  (R.  J.),  Ripon. 
w  1876-7.  1st  Entrance  8c.  Scholarship. 

Witherby  (W.  H.),  Croydon. 

185*.   Matriculation      Examination      in 
Modern  Languages,  Prize. 

Woakes  (E.),  Luton,  Beds. 

1856.  1st  Year  Student,  Hon.  Cert. 

1857.  2nd  Y'ear  Student,  2nd  Prize  ; 
Clinical  Medical  Prize. 

1858.  Essay  on  Neuralgia,  Mr.  N.  Smith's 

Prize ; 
Surgical   and    Medical    Anatomy, 
Chesclden  Medal. 

Wood  (G.  J.),  London. 
1863.  Descriptive  Anatomy,  Hon.  Cert 

Wood     (R.     H.),     Loughborough, 
Leicester. 

1854.  Descriptive  Anatomy,  lion.  Cert. 
1855    Surgery,  Hon.  Cert. ; 

Midwifery,  Prize; 
Medicine,  Hon.  Cert. ; 
Descriptive  Anatomy,  Prize ; 
Physiology,  Hon.  Cert. 
1856.   Physical  Society's  Essay,  Prize. 

Woodhotjse  (T.  J.),  London. 

1855.  Chemistry,  Hon.  Cert.; 
Materia  Medica,  Hon.  Cert. 

Woodman  (W.  E.),  Camberwell. 
s  1875.  1st  Y'ear  Student,  2nd  Coll.  Prize. 

WOTTON  (H.  G.) 

1855.  Midwifery,  Hon.  Cert. 

1856.  Midwifery,  Hon.  Cert. 

Wrench  (E.  M.),  Cornhill. 

1851.  Descriptive  Anatomy,  Hon.  Cert. ; 
Physical    Society's    Essay,    Trea- 
surer's 1st  Year'6  Prize ; 

1852.  Physiology,  Hon.  Cert. 

Wyman  (W.  S.),  Kettering,  North- 
hampton. 
1852.   Matriculation  Examination 

Scholarship. 


All  old  Students  of  St.  Thomas's  Hospital  are  requested  to  send  their  present 
addresses  to  Dr.  Gillespie,  St.  Thomas's  Hospital  Albert  Embankment, 
Westminster  Bridge,  S.E- 


LONDON : 

PRINTED    BY   WDLLIAM   CLOWES   AND   SONS,   LIMITED, 

STAMFORD   STREET   AND   CHARING    CROSS. 


Mr 


