THE CALCUTTA
MEDICAL SOCIETY.
The Second Mesting of 1882 was held at the Medical Colon the 8th of February ; DR- Coates presiding. Dr. Wallace exhibited the bladder and rectum of a child born with imperforate anus. The child was brought to hospital 40 hours after its birth. It was in other respects healthy and well developed. Three hours before admission an incision was made over the coccyx l-8th inch in depth without relieving the cliild>_ which was suffering from tympanitis and incipient peritonitis. There was no bulging in the region of the perinasum. After admission an incision was made in the perinaeum about half an inch in depth without reaching the rectum. Dr. HARVEY saw the child after 4 or 5 hours, and decided to wait a little in the hope that some bulging of the blind end of the gut might take place. In six hours fluctuation was felt on passing the finger into the wound. A trochar was inserted into the summit of it to a depth of ? an inch. Nothing came through the canula but some meconium was found in it on its withdrawal. Poultices were applied, but the little patient died in 2 or 3 hours. On dissection it was found that the incision, which was about ^th inch deep, had reached to within ?th inch of the ccecal rectum. The puncture which had been made by the trochar was distinctly visible. No communication existed with the bladder. The cul de sac lay pressed against the left iliac fossa.
lego
March
THE CALCUTTA MEDICAL SOCIETY.
1, 1882.J
Dr. McLeod remarked that the anus was developed from the skin and the rectum from the intestinal tube. Sometimes in these cases the anus was undeveloped, sometimes the rectum and sometimes a mere membrane separated the two, situated at the anal orifice or at the bottom of an anal cul de sac. The case which had been related, appeared to be Such cases were more difficult one of undeveloped rectum. to deal with. Occasionally an opening existed into the vagina the male. He had seen cases in in the female, or the urethra In a male child, in which an of both these conditions. imperforate anus co-existed with a recto-urethral fistula he had opened into the rectum from the perinscum, pulled down the gut and stitched it to the margin of the wound. Union took place and the anus was kept pervious by bougies. The fistula did not close while the patient was in hospital, but very little fseculent material entered the urethra. Cases of membranous occlusion of the anus were very common, and simply required a crucial slit and subsequent methodical dilatation. Dr. Coates had seen a case similar to that related two months ago. On the second day the child having passed no motion was seen by a doctor, who found the anus quite There was great and painful straining. A director closed. the anus for Jtli of an inch, but was passed in the direction of was found. Dr. Coates screwed his finger into the nothing orifice to a distance of li to 2 inches, pulled down a blue The membrane and divided it with a pair of scissors. and free evacuation of faeces finger was passed into the gut followed. A piece of sponge was inserted^n the wound and frequent dilatation by finger recommended. A fortnight afterwards the child was brought to him with the fistula contracted so that a director could not be passed. The process of dilatation by finger was again resorted to with .
.
success.
Dr. Cayley stated that he had seen the child several times since the second operation, and that the canal remained patent and the faeces were freely voided. Baboo Soorjee Coomar Surbadicary related the case of An operation a female who had been born without an anus. resulted in a recto-vesical fistula. was performed which The fseces were passed through the bladder. The child lived for 10 years, was married and died shortly after. Baboo Rakhal Das Ghose knew the case of a male child born with undeveloped anus. An incision was made followed by dilatation by means of bougies frequently inserted. The child was still alive, and bougies were not now
required.
Dr. Raye exhibited a woman who appeared to be without The rectum and vagina ended in a common a perinasum. cloaca. There was no history of rupture of perirueum or destructive ulceration about the rectum. There was absolutely no trace of perinasum. Dr. McLeod showed a cartilaginous tumour about the size of an orange, which he had removed from the neck of an adult male by enucleation. The following notes of the case have been compiled by Assistant-Surgeon Devendra Nath Dey, M. B.:? Baney Madhub, a Hindoo male aged 38, admitted into the 1st Surgeon's ward on the 23rd January 1882 with a firm circumscribed swelling on the right side of the pharynx. History.?12 years ago he had syphilis; a few months afterwards he had gonorrhoea, which lasted for one year. In February last he had severe aching pain in the right molar teeth ; a soft band appeared in the lower gum, at the same time he had a peculiar noise constantly heard in the right ear resembling that by closing both the meatus auditorii. The ridge in the gum gradually subsided, and simultaneously with the decrease of the band the tumour appeared ; at first of the size of a nut without any pain. The tumour increased in size till it became like a duck's egg, situated between the submaxillary and the parotid glands on the right side, of the neck, pressing on the right side of the soft palate, displacing the uvula to the left and becoming prominent on the right side of the velum palati. Excision of the tumour was performed on the 23rd January 1882 under chloroform and strict antiseptic precautions ; a semi-lunar incision 3 inches long was made in the digastric triangle below tl e lower jaw on the right side of the neck. The platysma was divided, the external jugular vein was cut across and tied. The finger was passed between the parotid and the submaxillary glands, both of which were free and healthy, and the tumour detached from the soft structures; it was situated
produced
very
deep,
73
and the styloid process of the
temporal
and the
pterygoid of the sphenoid could be felt. Separating it from its attachments with the finger, the tumour was shelled out
easily and completely and pulled out by means of two vulsellum forceps; no bleeding followed the removal of the tumour and no vessels were tied. A tube 4 inches long was passed into the wound which was stitched with 7 horse-hair sutures and dressed antiseptically. It remained aseptic throughout : tube shortened by half on the 25th and reinserted. The tonsil of the right side, at first concealed from view, was fully exposed ; the uvula regained its median position. On the 28th all the horse-hair stitches were removed except two, and the tube taken out; the wound healed by first intention. On the 31st all the stitches were removed, the wound completely healed, and a curvilinear cicatrix left. The patient was discharged on the 3rd February 1882. The wound healed in a week's time. Dr. Cayley showed a case of operation for scrotal tumour in which he had dissected two narrow flaps from the pubis and laid them on the under surface of the penis. They united in the middle line and adhered to the surface of the testes, effectually preventing that dragging down of the penis from adhesion of its under surface to the surface of the testes which was often so inconvenient after operations for removal of scrotal tumours. Baboo Behatii Lall Ciiuckerbutty submitted the following notes of this case :? Hari Panda, a Hindu male aged 35 years, was admitted on the 23rd December 18S1 with a small scrotal tumour. He was operated on on the 27th December 1881, and here he is nearly well in about 6 weeks. Patients generally complain of painful erection after the operation for scrotal tumour. There forms at the root of penis a hard, dense, and inelastic cicatricial mass when the wound entirely heals up. In order to avoid that we have in the last five cases adopted the plan of substituting skin flaps just at the root of the penis and thereby supplying skin instead of a cicatricial tissue. We gain two advantages by this method. It serves the purpose first alluded to, and it also quickens the healing process by forming a bridge of skin in the centre of the wound. We take the flaps from different directions according to the healthiness and abundance of the surrounding tissues. This one is our first case, and in it we took the flaps from the pubis, but in other cases we took the flaps from the inner sides of the thighs, leaving the junction either above or below as the nature of the case requires. We carefully stitch^ the two ends of the flaps by fine catgut ligature, and also stitch the flaps with the cellular tissue of the cord and testes, so that they may be kept in situ. We also take the measure of keeping the thighs close in order to avoid tension on the flaps. Almost all the cases are getting on favorably except one, in which the central portion of the flaps sloughed away. On the whole this method is a very good and successful ^
one.
Dr. Rate remarked that he had cut and transplanted flaps in several cases last year, but he had found them troublesome on account of abscesses forming under them, and he had' In one or two cases now reverted to the old operation. of involved penis he had cut flaps from the pubis with them to the under surface of advantage and transplanted the penis. he had that stated Dr. McLeod given flaps a very full trial both in 1880 and in 1881. He was in the habit of stitching the testes together with catgut and attaching them, thus united to the surface of the perinseum below the penis. He had cut quadrilateral flaps from the remains of the scrotum and skin of the thigh and stitched them together with a continuous catgut suture, bringing the edges almost or altogether into contact according to the bulk of the testes. In cases which remained aseptic the result was admirable ; but when the wound putrefied^ the flaps were a source of trouble. They cither sloughed partially or in whole, or became underHe had abandoned flaps and now conmined by abscesses. structed pockets for the accommodation of the testes by separating the deep layer of the superficial perinseal fascia from the mass of connective tissue vessels and fat in the centre of the perinseal space. The testes were secured by catgut sutures in these pockets and the edges of the wound The were dragged over them by continuous catgut sutures. result had been invariably good, better than had been obtained by cutting flaps. He was in the habit of prevent-
THE INDIAN MEDICAL GAZETTE.
74 ing embedding of
the penis by (1st) carefully dissecting out the root of the organ while operating, (2nd) disrupturing any adhesions which took place around the root with the finger on each occasion of dressing, and (3rd) encircling the root of the penis with a ring of boracic gauze. If the scrotal wound were got-to heal before the penile cicatrization was allowed to progress far, the penis retained its proper position. Baboo Behari La.ll Chuckerbu"tty read notes of a case of head injury in which a remarkable depression of temperature had been noted : Shaik Ramjan, a young healthy cooly of 24 years, was admitted into the Mayo Native Hospital on the 16th December 1881. Three days previous to his admission he fell headlong into the bottom of a ship from the deck. The height was about 12 feet. He injured the cervical spine, which was very tender and swollen when he came in. There was paralysis of both motion and sensation of the lower limbs. Bladder was highly distended, and a small calculus plugged the urinary meatus. Respiration hurried and chiefly diaphragmatic. to be heard all over the chest. He was Large crepitation fully in his senses. There was also priapism. Temperature was natural on his admission. His bladder was relieved and an ice bag was applied over the cervical spine. Then incontinence of feces took place ; his temperature became subnormal from the next day. On the 23rd December 1881, i. e., on the 28th day of his admission, we took his temperature in different places very carefully, and found that in the rectum and also in other places it was not above 87? F. He died on the 24th December 1881 at 2 P. M. Remarkx.?The great point of interest in this case is that the nervous power has a great influence on the temperature of the body. Here the damage to the cervical spine and the consequent disconnection of nervous force lowered the temperature to such an extent as to be inconsistent with life. Dr. McLeod enquired whether members of the Society had met with cases of catarrhal sore-throat accompanied with fever and associated with a roseolar or papular rash appearing on the third or fourth day. He had seen several cases of this kind. The tongue presented a creamy surface with bright spots on the sides and tip (strawberry tongue). In some cases aphthous patches had appeared on the tongue, fauces and gums ; and when the throat affection was acute tender and the lymphatic glands of the neck became swollen. Baboo Soorjee Coomar Surbadicary had seen several cases of sore-throat and eruption resembling what was described in books as modified scarlatina. These cases lasted 8 or 9 days. The sore-throat appeared first and then the eruption, which lasted 5 or 6 days. It was of a measly character, and best marked on the chest. In one case there The eruption was decided diminution of urinary secretion. was followed by a sort of desquamation ; the cuticle pealing a about dozen cases. In He had seen off in small patches. some the temperature had reached 104.? Dr. Harvey had seen a large number of cases of eruptive disease without sore-throat. He was inclined to call them The eruption appeared on the 3rd cases of febrile roseola. he had observed was 102-5?. The maximum ^
day.
One case had diarrhoea.
temperature
an
ulcerated
sore-throat.
There
was
no
Dr. Rayb had seen numerous cases of this febrile roseola ; he had met with no fewer than four cases on this very day. The eruption was well marked and roseolar in character. He had observed a diffused sore-throat in these The highest tempera tui-e he had recorded was 103?. cases. In the case of an infant 2\ months old the disease commenced with fretfulness and difficulty in swallowing. Two aphthous patches appeared in the throat, one on each tonsil. He removed these with the finger and they gave no further trouble. An eruption appeared on the skin next day. The illness lasted 7 days. The eruption spread from the face downwards in these cases. Baboo Lall Madhub Mookerjee had seen more than dozen of these cases. In each of two families he had met with two cases. He related the case of a boy of 9 or 10 The fever was interyears who had fever and sore-throat. mittent in type. There was superficial ulceration on the tonsils and strnwberry tongue : an eruption appeared on the 6th day. The boy ultimately made a good recovery. a
[March 1,
1882.
Dr. CAYLEY had seen a case of measles 3 weeks ago, the which had suffered from febrile roseola last year. Baboo Rajendra Chunder IVIitter had seen several cases. The fever was not excessive, temperature reached to about 102". The eruption in each case spread all over the body. There was a catarrhal condition of the nose and fauces ; some bronchial irritation. In two other cases with previous bad health patches of shallow ulceration appeared on the fauces.
subject of
The Secretary exhibited a patient sent by Dr. Birch who had undergone an operation for irreducible epiplocele. There was a depressed cicatrix over the right cord. The inguinal canal was blocked by cicatricial material and no hernial impulse was The following Dr. Birch :?
perceptible.
particulars
of the case were furnished
by
Adherent Epiplocele.?Richard Rossell, set. 25, seaman, admitted into hospital on the 24th Oct 1881, with a large scrotal tumour. About 7 years ago was ruptured on the right side by an accident ; remained as a reducible hernia till he In Calcutta he went came to Calcutta in October last. " on the spree"; does not know what happened, but his rapture got badly braised ; it rapidly swelled up and became very painful. In this condition he remained on board a week, unable to walk and suffering a good deal. When admitted the bowels had not been open for 3 days. The tumour was dense and painful, aboat the size of a foetal head at full term ; neck indurated to almost the thickness of wrist. He vomited a good deal. Temperature normal ; flatulency. Ice was applied ; enemata administered and sedative medicines given ; but for a week there was very little sleep on account of the pain, which extended into the abdomen. Tympanitis set in. So far as the scrotal part of the tumour was concerned a diminution took place in its size. On manipulation it was evident that a small knuckle of the down behind main intestine sometimes slipped tumour. State fluctuated?sometimes tumour became excessively tender and then the vomiting increased. Things remained so all November, and in this state I found him when I took charge. Patient demanded operation on the ground that unless something were done he could not earn his bread. On December 15th he was placed under chloroform, the dense tissues i.t the neck of the sac cut through, and the incision extended about 8^ inches in length into the scrotum ; all tissues carefully divided in the usual way, sac opened ; It (the omentum) was omentum then unfolded itself a little. found to be firmly adherent to the sac throughout except at with facility could enter neck, which was free ; the finger the abdomen through rings ; adhesions separated by finger. A good deal of capillary hemorrhage obstructed proceedings somewhat. The sac contained no intestine. The omental mass was pierced with double ligature and tied as two 1 inch from the ring. A stumps which were cut off about tied ; stout catgut was nsed third remaining portion was also and ends cut off short. Stump left in situ and wound brought together by deeply placed silver wire sutures; there opium given. A few hours afterwards the was depression; bandages?oozing temp. $1-2?. Blood exuded through from the vessels torn when separating adhesions. Retention of urine.
Temperature chart attached. Operation performed non-antiseptically,
as
apparatus went
out of order.
Some flatulency and tympanitis on 18th : griping pains. These symptoms left on 20th, enema was then administered followed by natural motion. The wound
suppurated freely and healed by granulation. vomiting, pain and diarrhoea with
On 27th December some
slight feverishness. Progress since satisfactory,
save
attacks of ague
on
3rd
and 5th January. No a
pain
radical
of the
trouble of any kind remaining : apparently of his hernia ; no refinements as to stitching &c., attempted in the operation.
or
cure
pillars,
March
MEDICAL NEWS.
1, 1882.] Temperature Chart. 15
16
17
Morning
97-2
99-4
99-7
Evening
97*2
102-6
Date.
18
99-8 ,101-2
19
20
21
101-4
102-2
99.8
101
After tliis date the temperature fluctuated between 98? and 100? till January 3rd, when he had an attack of ague followed by another. These were subdued by quinine. Dr. McLeod referred to an almost identical case which would be found detailed at length at page 99 of Vol. I. of the Transactions of the Society.
75
MEDICAL SOCIETY.
The Second Mesting of 1882 was held at the Medical Colon the 8th of February ; DR- Coates presiding. Dr. Wallace exhibited the bladder and rectum of a child born with imperforate anus. The child was brought to hospital 40 hours after its birth. It was in other respects healthy and well developed. Three hours before admission an incision was made over the coccyx l-8th inch in depth without relieving the cliild>_ which was suffering from tympanitis and incipient peritonitis. There was no bulging in the region of the perinasum. After admission an incision was made in the perinaeum about half an inch in depth without reaching the rectum. Dr. HARVEY saw the child after 4 or 5 hours, and decided to wait a little in the hope that some bulging of the blind end of the gut might take place. In six hours fluctuation was felt on passing the finger into the wound. A trochar was inserted into the summit of it to a depth of ? an inch. Nothing came through the canula but some meconium was found in it on its withdrawal. Poultices were applied, but the little patient died in 2 or 3 hours. On dissection it was found that the incision, which was about ^th inch deep, had reached to within ?th inch of the ccecal rectum. The puncture which had been made by the trochar was distinctly visible. No communication existed with the bladder. The cul de sac lay pressed against the left iliac fossa.
lego
March
THE CALCUTTA MEDICAL SOCIETY.
1, 1882.J
Dr. McLeod remarked that the anus was developed from the skin and the rectum from the intestinal tube. Sometimes in these cases the anus was undeveloped, sometimes the rectum and sometimes a mere membrane separated the two, situated at the anal orifice or at the bottom of an anal cul de sac. The case which had been related, appeared to be Such cases were more difficult one of undeveloped rectum. to deal with. Occasionally an opening existed into the vagina the male. He had seen cases in in the female, or the urethra In a male child, in which an of both these conditions. imperforate anus co-existed with a recto-urethral fistula he had opened into the rectum from the perinscum, pulled down the gut and stitched it to the margin of the wound. Union took place and the anus was kept pervious by bougies. The fistula did not close while the patient was in hospital, but very little fseculent material entered the urethra. Cases of membranous occlusion of the anus were very common, and simply required a crucial slit and subsequent methodical dilatation. Dr. Coates had seen a case similar to that related two months ago. On the second day the child having passed no motion was seen by a doctor, who found the anus quite There was great and painful straining. A director closed. the anus for Jtli of an inch, but was passed in the direction of was found. Dr. Coates screwed his finger into the nothing orifice to a distance of li to 2 inches, pulled down a blue The membrane and divided it with a pair of scissors. and free evacuation of faeces finger was passed into the gut followed. A piece of sponge was inserted^n the wound and frequent dilatation by finger recommended. A fortnight afterwards the child was brought to him with the fistula contracted so that a director could not be passed. The process of dilatation by finger was again resorted to with .
.
success.
Dr. Cayley stated that he had seen the child several times since the second operation, and that the canal remained patent and the faeces were freely voided. Baboo Soorjee Coomar Surbadicary related the case of An operation a female who had been born without an anus. resulted in a recto-vesical fistula. was performed which The fseces were passed through the bladder. The child lived for 10 years, was married and died shortly after. Baboo Rakhal Das Ghose knew the case of a male child born with undeveloped anus. An incision was made followed by dilatation by means of bougies frequently inserted. The child was still alive, and bougies were not now
required.
Dr. Raye exhibited a woman who appeared to be without The rectum and vagina ended in a common a perinasum. cloaca. There was no history of rupture of perirueum or destructive ulceration about the rectum. There was absolutely no trace of perinasum. Dr. McLeod showed a cartilaginous tumour about the size of an orange, which he had removed from the neck of an adult male by enucleation. The following notes of the case have been compiled by Assistant-Surgeon Devendra Nath Dey, M. B.:? Baney Madhub, a Hindoo male aged 38, admitted into the 1st Surgeon's ward on the 23rd January 1882 with a firm circumscribed swelling on the right side of the pharynx. History.?12 years ago he had syphilis; a few months afterwards he had gonorrhoea, which lasted for one year. In February last he had severe aching pain in the right molar teeth ; a soft band appeared in the lower gum, at the same time he had a peculiar noise constantly heard in the right ear resembling that by closing both the meatus auditorii. The ridge in the gum gradually subsided, and simultaneously with the decrease of the band the tumour appeared ; at first of the size of a nut without any pain. The tumour increased in size till it became like a duck's egg, situated between the submaxillary and the parotid glands on the right side, of the neck, pressing on the right side of the soft palate, displacing the uvula to the left and becoming prominent on the right side of the velum palati. Excision of the tumour was performed on the 23rd January 1882 under chloroform and strict antiseptic precautions ; a semi-lunar incision 3 inches long was made in the digastric triangle below tl e lower jaw on the right side of the neck. The platysma was divided, the external jugular vein was cut across and tied. The finger was passed between the parotid and the submaxillary glands, both of which were free and healthy, and the tumour detached from the soft structures; it was situated
produced
very
deep,
73
and the styloid process of the
temporal
and the
pterygoid of the sphenoid could be felt. Separating it from its attachments with the finger, the tumour was shelled out
easily and completely and pulled out by means of two vulsellum forceps; no bleeding followed the removal of the tumour and no vessels were tied. A tube 4 inches long was passed into the wound which was stitched with 7 horse-hair sutures and dressed antiseptically. It remained aseptic throughout : tube shortened by half on the 25th and reinserted. The tonsil of the right side, at first concealed from view, was fully exposed ; the uvula regained its median position. On the 28th all the horse-hair stitches were removed except two, and the tube taken out; the wound healed by first intention. On the 31st all the stitches were removed, the wound completely healed, and a curvilinear cicatrix left. The patient was discharged on the 3rd February 1882. The wound healed in a week's time. Dr. Cayley showed a case of operation for scrotal tumour in which he had dissected two narrow flaps from the pubis and laid them on the under surface of the penis. They united in the middle line and adhered to the surface of the testes, effectually preventing that dragging down of the penis from adhesion of its under surface to the surface of the testes which was often so inconvenient after operations for removal of scrotal tumours. Baboo Behatii Lall Ciiuckerbutty submitted the following notes of this case :? Hari Panda, a Hindu male aged 35 years, was admitted on the 23rd December 18S1 with a small scrotal tumour. He was operated on on the 27th December 1881, and here he is nearly well in about 6 weeks. Patients generally complain of painful erection after the operation for scrotal tumour. There forms at the root of penis a hard, dense, and inelastic cicatricial mass when the wound entirely heals up. In order to avoid that we have in the last five cases adopted the plan of substituting skin flaps just at the root of the penis and thereby supplying skin instead of a cicatricial tissue. We gain two advantages by this method. It serves the purpose first alluded to, and it also quickens the healing process by forming a bridge of skin in the centre of the wound. We take the flaps from different directions according to the healthiness and abundance of the surrounding tissues. This one is our first case, and in it we took the flaps from the pubis, but in other cases we took the flaps from the inner sides of the thighs, leaving the junction either above or below as the nature of the case requires. We carefully stitch^ the two ends of the flaps by fine catgut ligature, and also stitch the flaps with the cellular tissue of the cord and testes, so that they may be kept in situ. We also take the measure of keeping the thighs close in order to avoid tension on the flaps. Almost all the cases are getting on favorably except one, in which the central portion of the flaps sloughed away. On the whole this method is a very good and successful ^
one.
Dr. Rate remarked that he had cut and transplanted flaps in several cases last year, but he had found them troublesome on account of abscesses forming under them, and he had' In one or two cases now reverted to the old operation. of involved penis he had cut flaps from the pubis with them to the under surface of advantage and transplanted the penis. he had that stated Dr. McLeod given flaps a very full trial both in 1880 and in 1881. He was in the habit of stitching the testes together with catgut and attaching them, thus united to the surface of the perinseum below the penis. He had cut quadrilateral flaps from the remains of the scrotum and skin of the thigh and stitched them together with a continuous catgut suture, bringing the edges almost or altogether into contact according to the bulk of the testes. In cases which remained aseptic the result was admirable ; but when the wound putrefied^ the flaps were a source of trouble. They cither sloughed partially or in whole, or became underHe had abandoned flaps and now conmined by abscesses. structed pockets for the accommodation of the testes by separating the deep layer of the superficial perinseal fascia from the mass of connective tissue vessels and fat in the centre of the perinseal space. The testes were secured by catgut sutures in these pockets and the edges of the wound The were dragged over them by continuous catgut sutures. result had been invariably good, better than had been obtained by cutting flaps. He was in the habit of prevent-
THE INDIAN MEDICAL GAZETTE.
74 ing embedding of
the penis by (1st) carefully dissecting out the root of the organ while operating, (2nd) disrupturing any adhesions which took place around the root with the finger on each occasion of dressing, and (3rd) encircling the root of the penis with a ring of boracic gauze. If the scrotal wound were got-to heal before the penile cicatrization was allowed to progress far, the penis retained its proper position. Baboo Behari La.ll Chuckerbu"tty read notes of a case of head injury in which a remarkable depression of temperature had been noted : Shaik Ramjan, a young healthy cooly of 24 years, was admitted into the Mayo Native Hospital on the 16th December 1881. Three days previous to his admission he fell headlong into the bottom of a ship from the deck. The height was about 12 feet. He injured the cervical spine, which was very tender and swollen when he came in. There was paralysis of both motion and sensation of the lower limbs. Bladder was highly distended, and a small calculus plugged the urinary meatus. Respiration hurried and chiefly diaphragmatic. to be heard all over the chest. He was Large crepitation fully in his senses. There was also priapism. Temperature was natural on his admission. His bladder was relieved and an ice bag was applied over the cervical spine. Then incontinence of feces took place ; his temperature became subnormal from the next day. On the 23rd December 1881, i. e., on the 28th day of his admission, we took his temperature in different places very carefully, and found that in the rectum and also in other places it was not above 87? F. He died on the 24th December 1881 at 2 P. M. Remarkx.?The great point of interest in this case is that the nervous power has a great influence on the temperature of the body. Here the damage to the cervical spine and the consequent disconnection of nervous force lowered the temperature to such an extent as to be inconsistent with life. Dr. McLeod enquired whether members of the Society had met with cases of catarrhal sore-throat accompanied with fever and associated with a roseolar or papular rash appearing on the third or fourth day. He had seen several cases of this kind. The tongue presented a creamy surface with bright spots on the sides and tip (strawberry tongue). In some cases aphthous patches had appeared on the tongue, fauces and gums ; and when the throat affection was acute tender and the lymphatic glands of the neck became swollen. Baboo Soorjee Coomar Surbadicary had seen several cases of sore-throat and eruption resembling what was described in books as modified scarlatina. These cases lasted 8 or 9 days. The sore-throat appeared first and then the eruption, which lasted 5 or 6 days. It was of a measly character, and best marked on the chest. In one case there The eruption was decided diminution of urinary secretion. was followed by a sort of desquamation ; the cuticle pealing a about dozen cases. In He had seen off in small patches. some the temperature had reached 104.? Dr. Harvey had seen a large number of cases of eruptive disease without sore-throat. He was inclined to call them The eruption appeared on the 3rd cases of febrile roseola. he had observed was 102-5?. The maximum ^
day.
One case had diarrhoea.
temperature
an
ulcerated
sore-throat.
There
was
no
Dr. Rayb had seen numerous cases of this febrile roseola ; he had met with no fewer than four cases on this very day. The eruption was well marked and roseolar in character. He had observed a diffused sore-throat in these The highest tempera tui-e he had recorded was 103?. cases. In the case of an infant 2\ months old the disease commenced with fretfulness and difficulty in swallowing. Two aphthous patches appeared in the throat, one on each tonsil. He removed these with the finger and they gave no further trouble. An eruption appeared on the skin next day. The illness lasted 7 days. The eruption spread from the face downwards in these cases. Baboo Lall Madhub Mookerjee had seen more than dozen of these cases. In each of two families he had met with two cases. He related the case of a boy of 9 or 10 The fever was interyears who had fever and sore-throat. mittent in type. There was superficial ulceration on the tonsils and strnwberry tongue : an eruption appeared on the 6th day. The boy ultimately made a good recovery. a
[March 1,
1882.
Dr. CAYLEY had seen a case of measles 3 weeks ago, the which had suffered from febrile roseola last year. Baboo Rajendra Chunder IVIitter had seen several cases. The fever was not excessive, temperature reached to about 102". The eruption in each case spread all over the body. There was a catarrhal condition of the nose and fauces ; some bronchial irritation. In two other cases with previous bad health patches of shallow ulceration appeared on the fauces.
subject of
The Secretary exhibited a patient sent by Dr. Birch who had undergone an operation for irreducible epiplocele. There was a depressed cicatrix over the right cord. The inguinal canal was blocked by cicatricial material and no hernial impulse was The following Dr. Birch :?
perceptible.
particulars
of the case were furnished
by
Adherent Epiplocele.?Richard Rossell, set. 25, seaman, admitted into hospital on the 24th Oct 1881, with a large scrotal tumour. About 7 years ago was ruptured on the right side by an accident ; remained as a reducible hernia till he In Calcutta he went came to Calcutta in October last. " on the spree"; does not know what happened, but his rapture got badly braised ; it rapidly swelled up and became very painful. In this condition he remained on board a week, unable to walk and suffering a good deal. When admitted the bowels had not been open for 3 days. The tumour was dense and painful, aboat the size of a foetal head at full term ; neck indurated to almost the thickness of wrist. He vomited a good deal. Temperature normal ; flatulency. Ice was applied ; enemata administered and sedative medicines given ; but for a week there was very little sleep on account of the pain, which extended into the abdomen. Tympanitis set in. So far as the scrotal part of the tumour was concerned a diminution took place in its size. On manipulation it was evident that a small knuckle of the down behind main intestine sometimes slipped tumour. State fluctuated?sometimes tumour became excessively tender and then the vomiting increased. Things remained so all November, and in this state I found him when I took charge. Patient demanded operation on the ground that unless something were done he could not earn his bread. On December 15th he was placed under chloroform, the dense tissues i.t the neck of the sac cut through, and the incision extended about 8^ inches in length into the scrotum ; all tissues carefully divided in the usual way, sac opened ; It (the omentum) was omentum then unfolded itself a little. found to be firmly adherent to the sac throughout except at with facility could enter neck, which was free ; the finger the abdomen through rings ; adhesions separated by finger. A good deal of capillary hemorrhage obstructed proceedings somewhat. The sac contained no intestine. The omental mass was pierced with double ligature and tied as two 1 inch from the ring. A stumps which were cut off about tied ; stout catgut was nsed third remaining portion was also and ends cut off short. Stump left in situ and wound brought together by deeply placed silver wire sutures; there opium given. A few hours afterwards the was depression; bandages?oozing temp. $1-2?. Blood exuded through from the vessels torn when separating adhesions. Retention of urine.
Temperature chart attached. Operation performed non-antiseptically,
as
apparatus went
out of order.
Some flatulency and tympanitis on 18th : griping pains. These symptoms left on 20th, enema was then administered followed by natural motion. The wound
suppurated freely and healed by granulation. vomiting, pain and diarrhoea with
On 27th December some
slight feverishness. Progress since satisfactory,
save
attacks of ague
on
3rd
and 5th January. No a
pain
radical
of the
trouble of any kind remaining : apparently of his hernia ; no refinements as to stitching &c., attempted in the operation.
or
cure
pillars,
March
MEDICAL NEWS.
1, 1882.] Temperature Chart. 15
16
17
Morning
97-2
99-4
99-7
Evening
97*2
102-6
Date.
18
99-8 ,101-2
19
20
21
101-4
102-2
99.8
101
After tliis date the temperature fluctuated between 98? and 100? till January 3rd, when he had an attack of ague followed by another. These were subdued by quinine. Dr. McLeod referred to an almost identical case which would be found detailed at length at page 99 of Vol. I. of the Transactions of the Society.
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