Saint Thomas's Hospital reports
Saint Thomas's Hospital reports.
SS RAN SN NN CY aK ~ Ae _ UX \ \ \ iO) et ZL e at RAS A AN NY \ \ AX : LS SS SAS ‘ \ AN \\ ‘ eR \\ : SS Rak ie SAN if MMA NS A SN QQ \ \ << \ WN oA LO ee eee OE ee eA ce eee \. ba SS fi : : ESS BANS bi st AS RRS BASS ci S \ OSS Bas aN ¢ , a 1 ¥ zl ahs eo AN — — » » a° f ~~. : ist -. - ;. ee tthe ame pr Praise 9 er i iN le flee wii [=1\N VIEW OF ST. THOMAS’S HOSPITAL FROM THE SOUTH-EAST, SAINT. THOMAS’S HOSPITAL REPORTS. Alew Series. EDITED BY Dr. HADDEN anv Mr. ANDERSON. VOL. XIX. LONDON: J. & A. CHURCHILL, NEW BURLINGTON STREET. MDCOCXCT, WELLCOME INSTITUTE LIBRARY weiMOmec CONTENTS. PAGE In Memoriam: George Gulliver ee XVI I. The Influenza Epidemic of 1890. By H. P. Hawkins, M.A., M.B., M.R.C.P. : : 1 II. On a Case of Total Transverse Lesion in the Upper Dorsal Region of the Cord. By J. Micnent Crarke, M.A., M.B., M.R.C.P. f tee III. Sixty-four Cases of Non-Strangulated Hernia treated by Radical Cure. By Henry Betuam Rosrysoy, M.D., M.S., F.R.C.S. : . 83 IV. Hydatid Cyst between Bladder and Rectum. Reten- tion of Urine; Surgical Kidneys; Death. Reported by Jonn R. Luny, F.R.C.S.Ed. ; ros V. Report ona Sample of Condensed Milk. By ALBERT J. Bernays, Ph.D.. ; : POL VI. Intubation of the Larynx. A Thesis for the Degree of M.D. in the University of Oxford. By W. W. Orv, M.A.,M.D., M.R.C.P.. ; . 65 VII. Dangers of Intubation in Diphtheria. By Hee. Turney, M.A., M.B., M.Ch., M.R.C.P. eh. VIII. The Treatment of Erysipelas by Hypodermic Injection. By L. Zouarp A. Brewster, F.R.C.S. IX. Remarks on the Radical Cure of Hernia. By Sir William MacCormac, M.A., M.Ch., F.R.C.S. XI. Clinical Instruction at Fever Hospitals. By Epwarp Sraton, M.D., F.R.C.P.: ores. XII. Recent Cases of Myxedema. By W. M. Opp, M.D. XIII. Report of the In-patient Department for Diseases of Women for the year 1889. By Cuarun J. CuirunewortH, M.D., F.R.C.P.: ety XIII. Forty-one Fatal Cases of Acute Infective Osteomyelitis, terminating with Pysemic Symptoms, contrasted with Two Hundred Cases of Ordinary Pyemia. By G. H. Maxins, F.R.CS., and F.C. Apport, B.S. 2 ins XIV. Seven Consecutive Cases of Operation for Injury to the Cranial Vault. By Wittam Henry Barrie, M.D., M.R.C.P. XV. Cranio-Tabes in Young Children. A Clinical Inquiry into its Origin. Illustrated by 100 Cases. By George Carpenter, M.D., M.R.C.P. XVI. An Anatomical Note upon the Relation of the Internal Carotid Artery to the Inner Wall of the Tympanum. By Wrirtam Anperson, F.R.C.S. 248 XVII. An Analysis of 708 Cases of Acute Pneumonia, admitted to St. Thomas’s Hospital during the Eleven Years from 1880 to 1890 inclusive. By W. B. Happen, M.D., F.R.C.P., Heor W. G. Macxenziz, M.D., M.R.C.P., and W. W. Orp, M.D. XVIII. Experimental Observations on the Brain of the Monkey. By W. B. Happen, M.D., F.R.C.P., and C. A. Batanzas, M.S., F.R.C.S., 278 XIX. Umbilical Polypi. By W. Heprinsrann Mizar, M.R.C.S., T.S.C.P. 279 XX. Three Cases of Septic Poisoning of Obscure Origin. By FREDERICK Pottarn, M.D., 285 XXI. Report of the Aural Department for the year 1889. By Ricuarp Laxg, F.R.C.S., Clinical Assistant. 291 Contents. XXII. Report of the Department for Diseases of the Skin, 1889. By H.C. Low, M.A., M.B., B.C., and A.J. Apxins, L.R.C.P., M.R.C.S., Clinical Assistants XXIII. Report of the Midwifery Department for 1889. By Rozert Cory, M.A., M.D., F.R.C.P. XXIV. Medical Report, 1889. By Huctor W. G. MacKenzie, M.A., M.D., M.R.C.P. XXV. Surgical Report, 1889. By E. Sonny, M.B., F.R.CS. XXVI. Statistical Report of the Ophthalmic Department for the Year 1889. By W.G. Laws, M.B., C.M., XXVII. Calendar of St. Thomas’s Hospital, Session 1890-91 LIST OF ILLUSTRATIONS. PLATES. TO FACE PLATE I. Illustrating Dr. Michell Clarke’s paper on Total Transverse Lesion in the Upper Dorsal Region of the Cord II. Illustrating Dr. Ord’s paper on Recent Cases of Myxedema: III and IV. Illustrating paper on Acute Pneumonia by Drs. Hadden, Mackenzie, and W.W. Ord Chart I shows the relation between the number of cases and the mortality per cent. at each period of life. Chart II shows the onset at the various period II. of the year and the mortality per cent. Chart III shows the number of cases in each year, with the mortality per cent. for the year. V and VI. Illustrating paper on Experimental Observations on the Brain of the Monkey by Dr. Hadden and Mr. Ballance; Figs. 1, 2, 3, 4, and 6.—Right hemisphere of the brain of the monkey (Macacus Sinicus) Fig. 5.—Internal aspect of right hemisphere. VII. Illustrating Mr. Richard Lake’s Report of the Aural Departiment; List of Illustrations. WOODCUTS. Illustrating Dr. Hawkins’s paper on Influenza. Chart 1.—Showing temperature Charts 2 and 3.—Ditto. Chart 4. Ditto. Chart 5. Ditto. Chart 6. Ditto. Illustrating Dr. W. W. Ord’s paper on Intubation of the Laryng. Diagram showing method of introducing the tube. Modified introducer (half size) Illustrating Dr. Turney’s paper on Dangers of Intubation in Diphtheria. Ulceration of larynx and trachea. Ditto. ditto. Illustrating paper by Mr. Makins and Mr. Abbott on Acute Infective Osteo-Myelitis. Curve showing proportional monthly frequency of occurrence of pyeemia and acute infectious myelitis during the year. Illustrating Mr. Anderson’s paper on Relation of Internal Carotid Artery to Inner Wall of Tympanum. Diagram of inner wall of tympanum. Section of temporal bone showing relation of tympanum to carotid canal. LIST OF SUBSCRIBERS. Ackerley, R., M.A., M.B., B.Ch.Oxon., Alexandra House, Ashburton, Devon. Acton, T. D., M.A., M.D. Oxon., F.R.C.P., 74, Brook Street, W. Apam, A. Mercer, M.D., The Church Close, Boston, Lincolnshire. ALLINGHAM, William, F.R.C.S., 25, Grosvenor Street, W. Auttiorr, A. J., M.D., Cantab., Rosendal, St. John’s, Sevenoaks. Amyot, Thomas E., F.R.C.S., Diss, Norfolk Anperson, Henry B., 18, Clarendon Villas, West Brighton. ANDERSON, William, F.R.C.S., 2, Harley-street, W. Anson, G. E., M.A., M.B.Cantab., St. Thomas’s Hospital, S.E. Armstrong, H. G., Wellington College, Wokingham BaLuance, Cuarzes A., M.S. Lond., F.R.C.S. Eng., 56, Harley Street, Cavendish Square, W. Bamber, H. K., 5, Westminster Chambers, S.W. Barber, T. A., M.D., F.R.C.P., 109, Gloucester Place, Portman Square, W. Barnes, Roser, M.D., F.R.C.P., 15, Harley Street, W. Barton, J. Krneasron, 2, Courtfield Road, Gloucester Road, S.W. Barrie, W. H., F.R.C.S., 6, Harley Street, W. Barton, A., Bay Villa, Grange-over-Sands, Lancashire Beepford, R. J., Kegworth, Leicestershire Bett, J. Vincent, M.D., F.R.C.S.8., Star Hill, Rochester Bennett, Str J. Rispon, M.D., F.R.C.P., F.R.S., LL.D., 22, Caven- dish Square, W. Bernays, Albert J., M.A., Ph.D., St. Thomas’s Hospital, S.E. Birchwett, L. A., F.R.C.S., 34, Lee Terrace, Lee, S.E. Brackett, W. Curnpert, 6, Old Elvet, Durham Braker, N. P., 29, Old Steyne, Brighton Bonn, W. A., M.A., M.D. Cantab., St. Thomas’s Hospital, S.E. Bristow, John Syer, M.D., F.R.C.P., F.R.S., LL.D., 13, Old Burlington Street, W. Britton, Thomas, M.D., Victoria Avenue, Harrogate Brockart, A. A., St. Cuthbert’s, Gt. Malvern, Worcestershire Brown, Frep. Gorpon, 7, Finsbury Circus, E.C. Brown, L. D., Henley Villa, Ealing, W. Browne, Evear A., F.R.C.S. Edin., 39, Rodney Street, Liverpou! List of Subscribers. Bryan, Frepericx, M.B., County Asylum, Colney Hatch, N. Bucxey, T. W., The Poplars, Thrapston Buustrope, H. T., B.A., M.B. Cantab., South Western Hospital, Stockwell, S.W. Carpenter, A., M.D., Heath Lodge, Morland Park, Croydon Carpenter, Epwarp, Trevathan, Albemarle Road, Beckenham, Kent Carter, William, M.D., LL.B., F.R.C.P., 78, Rodney Street, Liverpool Caupiz, A.W.W., Henfield, Sussex Coarrers, Epwarp, F.R.C.S., North Street, Keighley, Yorkshire Cuatpecorr, Cuartus W., Dorking, Surrey Cuaries, T.C., M.D., Albert Mansions, 108, Victoria Street, S.W. Cluapton, Epwarp, M.D., F.R.C.P., F.R.C.S., 22, St. Thomas’s Street, S.E. Crapron, Witir1aM, F.R.C.S., 27, Queen Street, Cheapside, E.C. Cuark, Frep. Le Gros, F.R.C.S., F.R.S., Sevenoaks, Kent Cuark, James Hunry, Jamaica, per J. W. Goodinge, Esq., 16, Aldersgate Street, E.C. CruaRKe, J. Micuett, M.B.Cantab., 2, York Buildings, Clifton, Bristol Cuirron, G., 48, London Road, Leicester “Cuirron Merpican Reapine Society,” per J. Fawn and Son, Queen’s Road, Bristol Cuurron, H.H., F.R.C.P., 2, Portland Place, W. Cockett, F.E., jun., Holly Lodge, Forest Road, Queenstown. Corsy, W. Taylor, M.D., The Mount, Malton, Yorkshire Cooper, G.F., M.B., B.S.Lond., St. Leonard’s, Uxbridge Road, Ealing, W. : CopeMay, S.M., M.A., M.B. Cantab., 134, York Road, Lambeth, S.E. Corsy, M.A. Baziuue, F.R.C.S., St. Peter Port, Guernsey Cory, R., M.A., M.D., 73, Lambeth Palace Road, S.E. Cowszury, A.D., 134, York Road, Lambeth, S.E. Cowen, Purp, M.D., 47, Ingleby Road, Upper Holloway, N. Crort, John, P.R.C.S., 48, Brook Street, Grosvenor Square, W. Crosby, T.B., M.D., F.R.C.S., 19, Gordon Square, W.C. Crowpy, F.D., M.A., M.D. Oxon., 1, Higher Terrace, Torquay “Croydon Mepican Reapine Society,” per Mr. Grattan, 16, The Borough, S.E. Cullinewortn, C.J., M.D., F.R.C.P., 46, Brook Street, Grosvenor Square, W. Davis, G.W., M.B., B.S. Durham, Sunrydene, Main Road, Sidcup. Denne, T.V. px, Cradley Heath, Brierly Hill, Staffordshire Dosson, Newson C., F.R.C.S., 27, Victoria Square, Clifton, Bristol Duxes, Crement, M.D., B.S. Lond., Sunnyside, Rugby Duncan, W., M.D., 6, Harley Street, W. List of Subscribers. Dunn, J. E., 24, Stephenson Terrace, Preston, Lancashire Durnam, Arthur E., F.R.C.S., 82, Brook Street, Grosvenor Square, W. | Epwarps, Vertu, Shottisham, Woodbridge, Suffolk Exort, J. W., 5, Manor Road, Forest Hill, S.E. Enwin, Cuaries J., 6, City Road, E.C. Emson, ALFRED, Dorchester Evz, R. W., M.B., Tyrwhitt House, 101, Lewisham High Road, 8.K. Farrant, Samuel, North Street House, Taunton Freut, W., M.B., Wellington, New Zealand Fouracr, Robert P., 20, Tollington Park, N. FRANKLIN, Geo. C., F.R.GS., 39, London Road, Leicester Gervis, Freeprick H., 1, Fellows Road, Haverstock Hill, N.W. Gervis, Henry, M.D., F.R.C.P., 40, Harley Street, W. Gipson, John R., F.R.C.S., 10, Russell Square, W.C. Goppard, Everns, M.D., North Lynn, Highbury New Park, N. Greaves, Cuariss A., M.B., LL.B., 84, Friargate, Derby Green, C.D., M.D.Lond., Addison House, Upper Edmonton GREENFIELD, Wm. Smiru, M.D., F.R.C.P., 7, Heriot Row, Edinburgh Grooms, W.W., M.B., Stowmarket, Suffolk Gross, S., M.D., F.R.C.S., Westbourne, Melksham, Wilts Gurst, Eis S., 263, Oxford Street, Manchester Gurst, Dr. P., Berlin, per Julius Lesser & Co., 2, South Parade, St. Mary’s, Manchester Happen, W. B., M.D., F.R.C.P., 21, Welbeck Street, W. Hagus, J. T., 320, Brixton Road, S.W. Harpy May, CHARLES E., M.D. Durham, F.R.C.P., 110, Queen Street, Cardiff Hartley, John, M.D., F.R.C.P., F.L.S., 9, Stratford Place, W. Harroney, Horace, Stone, Staffordshire Harvey, S. F., 42, Perham Road, West Kensington, W. Hastam, W. F., F.R.C.S., 33, Paradise Street, Birmingham Hawkins, H. P., M.A., M.B.Oxon., 59, Lambeth Palace Road, S.E. Hawkins, Wirtam, Abbotsbury, Dorsetshire HEarnpen, Wittam Atex., M.D., Down House, Sutton, Surrey Hretis, R., M.B., 318, enter Boulevard, Nottingham Hobbs, R., M.B., B.S.Oxon., St. Thomas’s Hospital, 8.E. Hobbs, H.N., Bast Molesey, Kingston-on-Thames Hoven, C.H., Full Street, Derby Howe, Thomas S., The Old Vicarage, Wandsworth, S.W. Howse, H.G., M.S., 59, Brook Street, W. Howse, Wo., 8, London Street, New Swindon, Wilts Huupert, H.H., B.A. Oxon., Vineyard’s Cottage, Ely, Cambs. List of Subscribers. Hunterian Society, London Institution, Finsbury Circus, E.C. Hurton, H.R., M.A., M.B., 8a, St. John Street, Manchester Jacop, E.K., M.A., M.D. Oxon., 12, Park Street, Leeds Jackson, James, 15, Huntingdon Street, Barnsbury, N.J. Jounston, G.D., Georgia Street, Vancouver, British Columbia Jones, Evan, Ty-mawr, Aberdare, Glamorganshire Jones, Sypney, M.B., F.R.C.S., 16, George Street, Hanover Square, W. Jones, Thomas, M.D., 2, St. Stephen’s Terrace, Albert Square, Clapham Road, S.W. Kitner, W.J., M.B., 57, Queen Anne Street, Cavendish Square, W. Lake, R., F.R.C.S., Thornleigh, Castelnan, Barnes, S.W. LanKesteR, H. H., M.D., 1, Elm Park Gardens, South Kensington, S.W. Larper, H., Whitechapel Infirmary, Baker’s Row, N.E. Laver, A. H., 26, Cemetery Road, Sheffield Lawrorp, J. B., M.D., C.M., F.R.C.S., 55, Queen Anne Street, W. Laxton, T. L., Taunton Road, Bridgwater Leeps Mepicat Society, Dee A. F. McGill, F.R.C.S., 23, Park Square, Leeds Lrzs, Joseph, M.D., 21, Heeton Road, S.W. Lieut, EH. M., M.A., M.B.Cantab., The General Infirmary, Leeds. LITTELJOHN, S.C. M.B., C.M., Central London District School, Hanwell, W. Lopae, SAMUEL, jun., M.B., B.S. Durh., Windrush House, Bradford Lurwetyy, D. W. H., Southborough, Tunbridge Wells Lynceu, G. W.A., B.A., M.B.Cantab., Post Office, Suva, Fiji Mac Cormac, Sir William, F.R.C.S., M.A., M.Ch., D.Se., 13, Harley Street, W. Macevoy, H. J., M.D.Lond., London Fever Hospital, Liverpool Road, N. MACKELLAR, A.O., F.R.C.S., M. Ch., 79, Wimpole Street, W. Macxenzig, H. W.G., M.D., Cantab., St. Thomas’s Hospital, S.E. Macra@an, T. J., M.D., 9, Cadogan Place, Belgrave Square, S.W. MacLzay, "ALLAN, Harpenden Hall, St. Albans MacLzay, "ALLAN, Harpenden Hall, St. Albans MacLzay, "MARCH, G. H., F.R.C.S., Infirmary House, Down-patrick, co. Down Maconcay, Joun K., M.B., B.A., F.R.C.S.1., Infirmary House, Down-patrick, co. Down Mason, G. H., F.R.C.S., 2, Queen Street, Mayfair, W. Mancuster Royat INFIRMARY, per W. L. Saunders, Secretary Manners, W. F., Claygate, Esher Marcu, H. Conrey, M.D., 2, West Street, Rochdale Marriner, W. H. LISTER, M.B., Westbourne Tower, Bournemouth. Mavricg, O. C., 75, London Street, Reading Maysoury, A. V., M.D., Mile End, Bortsin MENNELL, Z., 31, Shepherd’s Bush Road, W. List of Subscribers. Gate House, Guildford Mourpuy, G. WynpHam, M.B., M.Ch., The Lawn, Dunstable, Beds. Naren, R., Cheswardine, Market Drayton, Salop Neale, C. P. W., M.R.C.P., F.R.C.S.E., 3, Wellesley Villas, Forest Hill, S.E. Nerries, E., F.R.C.S., 5, Wimpole Street, W. Newsnorme, A., M.D., 15, College Road, Brighton Norent, F. E., M.A., M.B.Cantab., 11, Ethelbert Terrace, Margate Norzis, EH. S., M.A., M.B., 117, High Street, Eton Oranee, W., C.B., M.D., F.R.C.P., 12, Lexham Gardens, Kensington, W. Orv, George R., Streatham Hill, S.W. Orv, William M., M.D., F.R.C.P., 37, Upper Brook Street, W. Oszory, S., F.R.C.S., 10, Maddox Street, W. Paterson, A. M., Old Whittington, Chesterfield Parsons, F.G., F.R.C.S., 79, Lambeth Palace Road, S.E. Payne, J. F., M.D., F.R.C.P., 78,  Prowmay, S., F.R.C.S., Pharmaceutical Society, Melbourne, Australia Pong, EH.D.Y., Slade, Ivybridge, Devon Potlar, FrepERICK, M.D. Lond., 137, Trinity Road, Upper Tooting, S.W. Porrer, H. Preroy, F.R.C.S., Kensington Infirmary, Marlboro Road, W. Powett, J. J., Norwood Lodge, Weybridge Purvis, John P., 38, Royal Hill, Greenwich, S.E. Rayner, H., M.D., 2, Harley Street, W. Rerp, R. W., C.M., Anatomical Department, University of Aberdeen. RENDLE, G., St. Thomas’s Hospital, S.E. RopatuHan, G. B., Risca, Newport, Mon. Roztnson, H. B., M.D., B.S.Lond., St. Thomas’s Hospital, S.E. RocKuiFFre, W. C., M.A., M.D., 9, Charlotte Street, Hull Rossirer, W. C., M.A., Cairo, Egypt Sansom, H. A., M.D. Lond., 1, Eresby Sans, John Surron, Eltham Road, Lee, S.E. Sanpwitu, F. M., Cairo, Egypt Sansom, H. A., M.D. Lond., 1, Eresby Sans, John Surron, Eltham Road, Lee, S.E. Sanpwitu, F. M., Cairo, Egypt Sans, John Surron, Eltham Road, Lee, S.E. Sanpwitu, F. M., Cairo, Egypt Sans, John Surron, Eltham Road, Lee, S.E. Sanpwitu, F. M., Cairo, Egypt Sans, John Surron, Eltham Road, Lee, S.E. Sanpwitu, F. M., Cairo, Egypt Sans, John Surron, Eltham Road, Lee, S.E. Sanpwitu, F. M., Cairo, Egypt Sans, John Surron, Eltham Road, Lee, S.E. Sanpwitu, F. M., Cairo, Egypt Sans, John Surron, Eltham Road, Lee, S.E. San Road, Kilburn, N.W. SaunpDzERs, Sir Epwin, F.R.C.S., 13a, George Street, Hanover Square, W. Vix List of Subscribers. Saunpers, H.W., M.B., F.R.C.S., Cape Town, Cape of Good Hope Savitz, T.D., M.D., Paddington Infirmary, Harrow Road, W. Scurr, T. Homer, 21, Micklegate, York. Seaton, Epwarp, M.D., 35, George Street, Hanover Square, W. Sepewick, James, M.D., Boroughbridge, Yorkshire Sepewick, L. W., M.D., F.R.C.P., 39, Wimpole Street, W. Semon, Fretz, M.D., F.R.C.P., 39, Wimpole Street, W. Suarkey, Seymour J., M.D., F.R.C.P., 2, Portland Place, W. Suarrock, S. G., F.R.C.S., St. Thomas’s Hospital, S.E. Saw, John, M.D. Lond., Willoughby Road, Hampstead, N.W. SHEPHEARD, Joun, J. P., North Walsham, Norfolk Surrinton, C. S., M.A., M.B.Cantab., St. Thomas’s Hospital, S.E. Srumonps, H. M., 66, Camberwell Road, S.E. Simon, Sir Jonny, K.C.B., F.R.C.P., 40, Kensington Square, W. Simon, FrepericK W., 40, Newington Causeway, S.E. “Sourn Lonpon Mezpican Reaprne” Society, per Dr. Taylor, 11, St. Thomas’s Street, S.E. SPRAKELING, Ropert J., 58, Merton Road, Bootle, Liverpool Srappon, John H., 6, Silent Street, Ipswich Sramp, Hueu W., 50, Woburn Place, W.C. Srewarr, Cartes, F.L.S., Royal College of Surgeons, W.C. Stor, W.H., M.A., M.B., F.R.C.P., 3, The Sanctuary, Westminster, S.W. Srance, W. Hearn, M.D., 2, Belsize Avenue, Hampstead, N.W. Srasspure, Imperat, Unverstry, Lumber (Alsace). Stuart, J.B., Standishgate House, Wigan Srurron, Husert W. S., 2, South Street, Greenwich, S.E. Surron, S.W., M.D., per Messrs. Dickeson & Stewart, 4, Queen Victoria Street, H.C. Suzux, S., Medical Department, Japanese Navy, Tokyo, Japan Takaki, Kan Eutro, F.R.C.S., Kyobashiku, Tokyo, Japan Taytor, S., M.D., 16, Seymour Street, Portman Square, W. Thompson, F.H., Cleobury Mortimer, Salop Torsk, K., Medical Department, Japanese Navy, Tokyo, Japan Treves, W. Kyieut, F.R.C.S., 31, Dalby Square, Margaret Truman, C.E., M.A. Cantab., 23, Old Burlington Street, W. Turner, Richard, 22, School Hill, Lewes, Sussex Turney, H.G., M.A., M.B. Oxon., F.R.C.S., St. Thomas’s Hospital, S.E. TYRRELL, W., 95, Cromwell Road, South Kensington, S.W. Very, T. A., M.B., A.B., M.Ch., Knapton, Rosstrevor, co. Down Wamp, Freverick J., M.B., ©.M., Prospect House, Richmond, Surrey Waastarre, W. W., B.A., F.R.C.S., Purleigh, St. John’s Hill, Sevenoaks List of Subscribers. XV Watters, F. R., M.D., 20, Finsbury Circus, E.C. Warp, Frep. Henry, County Asylum, Tooting, S.W. WesBER, W. W., Crewkerne, Somerset Weuts, Sir T. Spenour, Bart., F.R.C.S., 3, Upper Grosvenor Street, W. West, Cuazues J., Beaminster, Streatham Common, S.W. Wurre, E. F., F.R.C.S., 7, Dealtry Road, Putney, S.W. Winthrop, T. M., F.R.C.S. Ed., 7, Lindum Road, Lincoln Wittams, F. N., F.L.S., 181, High Street, Brentford Wittams, F. N., Tylorstown, Pontypridd. 7 Witziams, W. Ruys, M.D., Linden House, Bertie Road, Leamington Wirriams, W. Wittam, Tylorstown, Pontypridd. 7 Witson, W., M.D., Florence, care of C N. R. Hutton, Esq., 6, Philip Lane, London Wall, E.C. Warencie, Epwarp M., F.R.C.S., Park Lodge, Baslow, Derbyshire Waieut, E. H., Swiss House, St. Saviour’s, Jersey Wray, W. S., M.D., F.R.C.S., Red Brae, Putney Hill, 8.W. York Mepicau Society, 1, Low Ousegate, York In order to facilitate the safe transmission of the ‘St. Thomas’ Hospital Reports, it is particularly requested that the attention of the Editors be directed to any inaccuracies in the above list of Subscribers. In EXCHANGE. St. Bartholomew’s Hospital Reports St. George’s Hospital Reports Guy’s Hospital Reports London Hospital Reports Westminster Hospital Reports The Obstetrical Society’s Transactions Proceedings of The Medical Society of London Transactions of The Clinical Society of London The Medical Chronicle (John Heywood, Deansgate, Manchester) Royal College of Physicians Royal College of Surgeons The Journal of The Pharmaceutical Society of Great Britain Bristol Medico-Chirurgical Journal (Dr. L. M. Griffiths, 9, Gordon Road, Clifton, Bristol) Le Progrés Médical (Dr. Bourneville, 6, Rue des Ecoles, Paris) Journal of The American Medical Association (65, Randolph Street, Chicago, Illinois) American Journal of the Medical Sciences (H. C. Tee 706, Sansons Street, Philadelphia) Transactions of New York Academy, 12, West Thirty-first Street New York The Johns Hopkins Hospital Reports, Baltimore, U.S.A. Walsh’s Retrospect (Publisher of), Washington, D.C., United States Royal College of Surgeons, Dublin (The Librarian) Parkes Museum (Hon. Sec.), 74.4, Margaret Street, W. Tokyo Medical Library, Kyobashiku, Japan (per Messrs. Harris & Co., 5, Bishopsgate Street, Without, H.C.) Senatus Academicus, University of Edinburgh. College of Physicians, Philadelphia Archives de Physiologie normale et pathologique (G. Masson, Editeur, 120, Boulevard St. Germain, Paris) Harvard University, Medical School, Boston, Mass. University of Toronto (The Library) McGill University, Montreal (The Library, Faculty of Medicine) University of Brussels (The Library) University of Berlin (The Library) Su sMemortam. GHEORGHE GULLIVER. Tue year 1891 commenced very sadly for St. Thomas’s. George Gulliver, after a few days’ illness, was taken from us on January llth. He began the year in full health and vigour, and it was very difficult for his friends to realise that he had fallen so suddenly a victim to acute pneumonia. The Hospital Reports would indeed be incomplete without a record of one who was so promising a member of the hospital staff, and who was so loved and esteemed by all who knew him, and who was also one of the editors of these Reports for the three years 1885, 1886, and 1887. The obituary notices by Dr. Sharkey in the ‘Lancet’ of January 24th, and Dr. Hadden in the ‘British Medical Journal’ of the same date are so complete, and give such a faithful outline of Gulliver’s life and work, that the writer of this notice feels he cannot do better than to try and combine them, giving such brief additions as may seem in place when the record is specially for St. Thomas’s men. George Gulliver was born at Windsor in 1851. He was the only son of the late George Gulliver, F.R.S., the celebrated naturalist, who was Professor of Anatomy and Physiology at the Royal College of Surgeons, at one time Surgeon to the Royal Horse Guards, and who was specially distinguished for his classical researches on the blood-lymph and chyle, and contributed largely to various branches of natural history. George Gulliver, jun., was educated at the King’s School, Canterbury, whence he proceeded to Pembroke College, Oxford. Inheriting his father’s love of science and specially of biology, he selected the latter subject for his degree examination, and became a pupil and admirer of the late Professor Rolleston. In 1873 he graduated in the 1st class in the Natural Science School, and was soon after appointed Demonstrator to Professor Rolleston, who had previously shown the high opinion he had of Gulliver’s character and ability by obtaining for him the post of Assistant Naturalist to the Transit of Venus Expedition. In this capacity Gulliver spent some months at Rodriguez, and on his return contributed to the 'Philosophical Transactions' a Report on the Zoology of the Island of Rodriguez, for which he received the thanks of the Royal Society. He entered St. Thomas’s Hospital as a student in 1875, and in 1879 he took the degrees of M.A. and M.B. in the University of Oxford, and the Membership of the Royal College of Surgeons. Directly after obtaining these medical qualifications, he served as Clinical Assistant to the Hospital for Consumption at Brompton, and to the City of London Hospital for Diseases of the Chest. During his student’s career he had made his mark as a man of considerable ability and promise, and in 1880 was elected to the office of Resident Assistant Physician at St. Thomas’s; he held this post, together with that of Medical Registrar, for two years. He then took the M.R.C.P., and a vacancy in 1882 occurred on the Medical Staff of the Hospital, he was appointed Assistant Physician. In 1883, when the cholera was rife in Egypt, he was sent out by the Foreign Office, and attached to the Ibrahim Pacha Hospital at Cairo; but later, at his own request, he was transferred to Assouan to carry out whatever sanitary measures he might think necessary. While there, his dragoman was attacked with cholera, and Gulliver, who was the only European on the spot, nursed him successfully through his illness, sleeping in the same room with him. When the epidemic subsided he returned to London, and read a valuable paper on the ‘Etiology and Pathology of Cholera’ before the Epidemiological Society. In 1884, when Mr. C. Stewart was appointed Curator to the Royal College of Surgeons, Gulliver was made Lecturer on Comparative Anatomy at St. Thomas’s, and subsequently a Demonstrator of Morbid Anatomy, appointments which he still held at the time of his death. In 1886 he became a Fellow of the College of Physicians. In addition to the posts he held at his own Hospital, Gulliver was in 1883 appointed Assistant Physician to the London Fever Hospital, and in 1889 became Physician. A few weeks before his death he had agreed, at the request of a firm of publishers, to write a treatise on Fevers, a task for which his experience at the London Fever Hospital, and his lucid style of writing, specially fitted him. Gulliver was a member of various Medical and Scientific Societies, at which he read from time to time papers of considerable value. Amongst his writing may be mentioned “Syphilitic Ulceration of Trachea,” ‘Cysticerci of Brain,’ “Malenant Growth of Thyroid in Mycenae,” which appeared in ‘Transactions of the Pathological Society.’ To the ‘St. Thomas’s Hospital Reports’ he contributed the ‘Statistical Medical Reports’ for 1880 and 1881, and papers on ‘Ulcerative Endocarditis after Acute Pneumonia,’ and “Gangrene of the Lung.” In 1888 he contributed a paper on “The Structure of Pelomyxapelustris’’ to the ‘Journal of the Royal’ Microscopical Society. Gulliver, who was a thoroughly practical and well-read physician, was considerate and kind to his patients, and to all who were associated with him in his professional work. Gifted with great natural ability and sound judgment, he was singularly rapid and correct in forming an opinion about a difficult case. To those who did not know him well, it might often appear in a consultation that he was paying but slight attention to the statements of the patient, or to the observations of those who had watched the case, and it was only on reviewing the whole matter subsequently that they would find out how keenly he had noted all points of real importance for the diagnosis, and how carefully he had been weighing the evidence before him. As a teacher, his quiet and reserved manner made it difficult for any large number of students in the out-patient room to follow his practice. He took, however, considerable delight in his systematic lectures and in individual teaching; and his clear and cultivated manner of expression, and the keen sense of humour which he so often displayed made his remarks exceedingly interesting and instructive. In addition to his professional and scientific accomplishments, Gulliver had a large acquaintance with English and French literature, and was well informed on most questions of general interest. The opinions he formed were generally very decided, and he would defend them with vigor and considerable tenacity. To those who knew him well, he was an invaluable companion and a staunch friend. Of a hospitable disposition, he never seemed so happy as when entertaining his friends, and many who had no direct claim upon him have found him a warm and helpful friend when in difficulty. His mother, who is over eighty years of age, lived with him in Welbeck Street, and by his death she has lost her constant and devoted companion. Gulliver was a very regular attendant at the Savile Club, and well known to many of the members. Within the last year he had been elected a member of the Atheneum Club. Of medium height and spare build, he led rather a sedentary life in London, but when in the country for a holiday, he delighted in long walks, and in the summer at every opportunity indulged in his favourite pastime of swimming. His shortness of sight prevented him from taking part in most forms of sport. As a youth he was made by his father a Fellow of the Zoological Society. On many Sundays in the year, both winter and summer, he would spend several hours in the Gardens studying the habits of the various animals; and was a most instructive and entertaining guide to those of his friends who accompanied him. He was taken suddenly ill on January 28th, and there is little doubt that the malady was due to the extreme severity of the weather. It was soon apparent that the disease was acute pneumonia, and to this he succumbed on January 11th, the eighth day from the onset. He was buried by the side of his father in the ancient churchyard of Nackington, a hamlet near Canterbury.—B. P. THE INFLUENZA EPIDEMIC OF 1890. By H. P. HAWKINS, M.A., M.B. RESIDENT ASSISTANT PHYSICIAN. Any contribution to the vast literature of influenza must be conceived in an apologetic frame of mind. The epidemic of 1890 has been followed by a shower of papers, pamphlets, and books, mingled with records of isolated cases in every available publication, so that a student might be pardoned for supposing that in influenza. At any rate, he had met with a disease of which our knowledge is complete. I believe, however, that we have gleaned nothing from this epidemic, save a more accurate knowledge of the rise of temperature, which we owe to the use of the clinical thermometer, and that we know less of the cause and origin than in the case of any other specific fever. Influenza has always exercised a strange fascination upon those who come in contact with it, and the secret of this fascination confessedly lies in our own ignorance of the subject. Nothing is wanting to invest it with surpassing interest. The mystery of its origin, the suddenness of its appearance, and the rapidity with which it overruns a continent or the entire world, place it somewhat apart from the other specific fevers. Its total disappearance for so long a space of time that its very name becomes degraded and misapplied, and its sudden reappearance, possessing all its old characters and running a course in no way modified or disturbed either by the improvements in sanitation or by the new theories of disease which have accrued in its absence, make it a very fitting subject for reflection. At any rate, it does not seem right that an epidemic which so largely affected our hospital should be allowed to pass beyond our memory without comment; and in this view an endeavour is made to set forth the main features of the disease as it was seen at this hospital, in a bare report, which shall make but scanty reference to the work of others, and shall include only such generalizations as lie upon the surface of the mass of facts. I beg to thank the physicians, under whose care the patients were placed, for their permission to make this report. Number of Cases seen. The first cases at this hospital were recognized in the week ending on December 29th, 1889. The epidemic rapidly acquired impetus, and reached its highest point in the second week of January, 1890: from this time it showed a gradual abatement, and may be said to have ceased at the end of February, though 8 cases were seen here in March, 24 in April, and a few in July and August. The average weekly number of patients applying for our 140 weekly out-patient letters is 8306. In the week ending on January 11th the number of applicants was 913, in the next week 807, and the normal was not reached till the end of February. In all, 1890 patients suffering from influenza applied for treatment—1043 males, 347 females and children. Of this number, 82 were admitted (for the most part into special wards)—66 males and 16 females; of these 82 in-patients, 8 males died. Of these 1890 patients, 846 applied in the first two weeks of January. Those who presented themselves suffering merely from consecutive anemia or debility are not included in these figures. All classes of the hospital population suffered to some extent, viz.— The Influenza Epidemic of 1890. Sisters and nurses... 22 out of 105 Probationers of May 35 Medical residents... 9 Non-medical residents... 9 Wardmaids, &c. FOSDL pie 27 Porters... 6012 Total 68 Of the patients in the general wards (daily average about 360), 34 acquired it. Thus about 1500 cases were seen, and in 172 of these the course of the disease could be watched at the bedside. In the following account all these 1500 cases are utilized, and when the frequency of any symptom is given numerically this whole number is referred to, unless it is otherwise stated. Description of a Common Case. Owing to the wide range of symptoms (wider, perhaps, than in any other specific fever), and the inconstancy of those symptoms which more particularly attract attention, description is difficult, and apt to degenerate into a mere tabulation of phenomena which is not well fitted to present a clear picture of the disease. The following account is one which will cover a large majority of the cases seen, but that it falls far short of a complete description of influenza will be subsequently shown. The patient is suddenly seized with shivering or alternate feelings of heat and cold, his back and legs begin to ache, his head grows heavy and his forehead may throb, while he not uncommonly vomits; in a few hours he looks and feels extremely ill. If taken ill in the morning he may endeavour to perform his daily work, and may in a manner succeed, but more commonly he quickly realizes defeat and betakes himself. himself to bed. The pain in his head becomes severe, it may be more severe than any pain he has ever felt before; for the dull aching in his back and legs he is constantly seeking ease by change of position, and in spite of the fever which is now upon him he cannot get warm. After twenty-four hours or less his eyes may begin to water and smart, or may merely become blood-shot, while the eyeballs themselves become tender, and are the seat of just such an aching as he has previously felt in his back. His nose, at first, stopped up, begins to discharge freely, and his throat may become dry and sore. From the very first he may suffer from pain and tightness in the chest, with a troublesome objectless cough; but more commonly cough sets in about the third or fourth day, and is attended with watery sputum, which are on occasions be blood-streaked. The temperature, which in the first twenty-four hours will reach 102° or 104°, falls to the normal in two to four days. The tongue is pale, flabby, and furred, but moist; the appetite is lost, and the bowels are usually confined, though occasionally there is a sharp attack of diarrhea. The pulse is seldom much accelerated in spite of the fever, and is commonly diminished in strength and volume. Prostration and muscular weakness are marked features throughout the illness. The limb pains pass away, the headache leaves him gradually, he shakes off the nasal catarrh, and the first stage of the illness is over. About the fourth or fifth day he emerges from seclusion, pale, feeble, and irritable, as unfitted for mental as for bodily work, and as giddy as a convalescent from a month of typhoid. For a few days more he retains his cough, and perhaps can still feel pain on breathing deeply; recovery of the appetite for food and tobacco is delayed, and for two or three weeks more he is liable to severe neuralgia. Such an illness as this is the commonest form of influenza; many cases are slighter, a few are more severe. It only remains to add that at every point of his illness from the first day to the last the patient has been liable to an extension of inflammation from the upper part of the respiratory tract to the smaller air-tubes and air-cells, from which if a man escape with his life, let him call himself fortunate. Varieties of Influenza. Now in this account there is no one symptom (save probably the rise of temperature) which may not be absent from first to last. At the same time any one symptom may assume such predominance as to give a different character to the illness, and even obscure the diagnosis; and these cases in which one symptom throws all others into shade fall naturally into four classes, according as (1) fever or (2) pulmonary affection or (3) pain or (4) disturbance of the digestive system becomes the leading feature. Other specific fevers are ‘open to similar subdivision into varieties, each marked by some one prominent point, such varieties being linked together by some constant pathological lesion, as in typhoid fever, or by some constant objective feature, as in scarlet fever and measles. But in influenza we have neither coarse lesion nor rash, and nothing constant save rise of temperature; so that, if we would find a connecting link between its several varieties, we must fall back upon mere “succulent occurrence.” In fact, so much do these varieties of influenza differ, and so far apart do extreme instances lie, that they would never be grouped together nor be recognized as parts of the same disease were not their identity indicated by their simultaneous occurrence in the course of an epidemic, and by the frequent occurrence of intermediate cases, the symptoms of which are drawn from each variety. Of these four varieties the following cases are instances: (1) Febrile form.—Case 1. R. B. W—, eet. 23. December 22nd, 1889.—He was playing whist and feeling quite well, when his head suddenly became hot, and he felt giddy and feverish; he fanned himself, and then felt cold. Later in the day headache came on, his back and legs began to ache, and he lost his appetite. 235rd.—He was restless last night and obtained no sleep; was sick once. In the morning the headache continued, but the limb pains had nearly left him; his throat felt rather dry, but there was no catarrh of eyes or nose; his tongue was covered with thin, white, plastered fur, flabby and moist, and he could take no food. Bowels confined. Temp. 105°. 24th.—He had a much better night, during which his temperature fell to 99°. Headache only slight, no sweating, no return of appetite. 25th.—No pain anywhere; began to take solid food. 6 The Influenza Epidemic of 1890. High fever, frontal headache, aching of back and legs, loss of appetite, and constipation are the chief features here; there was at no time any affection of eyes, nose, or lungs, and notwithstanding the high temperature his condition was far from alarming. Compare this with Case 2, where in an equally healthy individual the brunt of the attack falls on the lungs, the illness is of three weeks’ duration, and life is for some time endangered. (2) Pulmonary form.—Case 2. C. H—, ext. 28. January 2nd.—He was suddenly seized in the morning with violent shivering, followed by sweating and pain in the forehead, back, and limbs. In a few hours he was obliged to give up work and go to bed; in the evening he lost his voice. The Influenza Epidemic of 1890. 3rd.—Sick several times; pains and sweating continued; cough began; bowels confined. 4th.—He was admitted in a collapsed condition. His voice was hoarse, his hands tremulous, and his pulse (92) very feeble; his lungs were full of rhonchitis, his breathing was laboured, his tongue thickly furred, and his temperature over 104°. There was no catarrh of eye or nose. His temperature fell in the usual manner and the pains disappeared, but for three weeks his bronchitis was severe and the event was doubtful. On several occasions the profuse bronchitis sputum contained streaks and small clots of red blood. (3) Painful form.—Case 3. A. A—, et. 29. January 4th.—He was suddenly seized with frontal headache, pain in the back, and general malaise, but went through his day’s work as a grocer. Headache continued; he felt chilly at times, but attended to his work all day. Headache is increasing and becoming more general. The intense pain, mostly in the forehead but felt also about the occiput and down the back of the neck, made him at last take refuge in bed. The next three days he spent in bed, suffering pain the like of which he had not before realized, and completely sleepless. On admission there could be no doubt as to the severity of the headache. The tongue was thickly furred, the pulse was 110, and a few rhonchi were audible in the chest; the temperature was 101° and then became normal. The bowels had been confined throughout. There had been no affection of eyes or nose, no vomiting, and no shivering. (4) Gastro-intestinal form.—Vomiting or diarrhea or both may be the chief feature of the illness; this is by no means common, but it occurred in a sufficient number of cases to deserve separate mention. Case 4. G. A—, et. 21. December 31st.—He was suddenly attacked with severe frontal headache, pain in the back and epigastrium, repeated sneezing, running from the eyes, and vomiting. For the next six days this patient suffered from frequent vomiting and uncontrollable diarrhea, the occurrence of vomiting and uncontrollable diarrhea. which with continued fever aroused a suspicion of typhoid in the mind of his doctor. Compare these cases. They certainly do not bear much resemblance to each other. But if we think that for one case of each of these varieties we meet with a dozen mixed cases, in which all or some of these leading features are blended in varying proportion, and if we think that such cases are pouring in shoals into the waiting-room of every London hospital every day for some three or four weeks, we gain some idea of the character and magnitude of an epidemic of influenza. Symptoms in Detail. Mode of invasion.—The onset may be said to be always sudden. In some cases it is startling in its rapidity and severity. A strong man on finishing a day of hard work in the Vauxhall gasworks was seized with vomiting, giddiness, weakness of the legs, and distressing breathlessness. When brought to the hospital a few hours later he was too feeble to stand and sweating profusely; his hands were cold and tremulous, his speech broken for want of breath, and his pulse scarcely perceptible at the wrist. One man was overtaken in the street, sought refuge in a shop, and had to be carried to his home; another was attacked while driving an omnibus, and could not sit upright to finish the journey; another was seized with a sudden sensation of falling, so that he lay down upon the ground and “panted like a dog.” But in most cases, though the patient can state the exact time at which he was taken ill, the extremity of illness is not so quickly reached. Many with the courage of ignorance struggle on for a few days with their work, succumbing later to sheer weakness or bronchitis; and many no doubt pass through slight attacks without desisting from their occupation. In a large majority of our cases (e.g. in 55 out of 70 out-patients taken at random) the illness was ushered in by chilliness and shivering or alternate feelings of heat and cold with headache, and aching of the back and legs, and sometimes of the eyeballs. A severe rigor was very uncommon. The Influenza Epidemic of 1890. Nausea or vomiting at the commencement was tolerably frequent (e.g. 30 out of 70), lachrymation and coryza (e.g. 10 out of 70) did not commonly occur in the first few hours, but cough (e.g. 23 out of 70) was met with more frequently. In a few cases where shivering, headache, and limb pains did not mark the actual onset, they were preceded for a few hours by such general symptoms as depression, languor, stupidity, giddiness, and muscular weakness. Sometimes what seemed at first to be an ordinary “cold in the head” was seen to pass into genuine influenza. CHART 2.—Case 5. M. M—, eet. 21. CHART 3.—Case 6. G. B—, et. 21. Temperature.—Influenza is a fever, not a catarrh. The fever may be slight and transitory, but if cases occur in which there is at no time any rise of temperature they must be exceedingly rare, and no such cases were met with in this hospital in a large number of observations made on the first day of illness. One cannot, however, speak with absolute certainty on this point, because the majority of our patients did not present themselves till the second, third, or fourth day of illness, but even in these a normal temperature was not commonly found. Taking uncomplicated cases, and so eliminating any sympathetic fever consequent on pulmonary inflammation, there is seen a rapid rise to 101°—105° in the first twenty-four or thirty-six hours, followed by a defervescence. Occupying from one to four days; and I believe that the accompanying charts represent as nearly as may be the typical course of the fever of influenza (Cases 5 and 6). If the fever is of longer continuance, some pulmonary complications may be found to account for it. The curve of the essential fever may fuse with that characteristic of lobar pneumonia, or it may be drawn out and rendered irregular by the concurrence of bronchitis. In some few cases, however, apart from any complication, the form of the chart is modified, in so far as a secondary rise of temperature (not necessarily accompanied by fresh symptoms) occurs after an afebrile interval of one or two days, as in Case 7. There appears to be no relation between the height of the temperature and the severity of the other symptoms; with a temperature of 105° one patient had nothing more than slight headache and backache; another, with temperature scarcely above normal, was moaning with pain and could not be comforted. Nor is there any fixed relation in point of time between the course of the fever and the progress of the other symptoms; the temperature may be already falling rapidly before the more distinctive signs of influenza have appeared. TENDER CHART 5.—Case 8. P. I—, ext. 21. as in Case 8: the temperature may be still well above normal when The headache and pains have disappeared, or it may already be subnormal before the general symptoms have begun to abate. The Influenza epidemic of 1890. 