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(FROM OUR SPECIAL CORRESPONDENT.] Modern Bullet Wounds; Medical Aid in India ; Lecture on Inebriety; A
New Expedition ; Case of Typewriter's Cramp; Glycerine and Calf Lymph; Oysters and Typhoid; "He War Dead."
Surgeon Captain Dutch recently gave a very interesting lecture on bullets and bullet wounds produced in modern warfare, and the means by which they are located and removed by the surgeon. In the course of his remarks Surgeon Captain Dutch contrasted the controlling influence which determined their flight as regards the size, weight, shape, and atmospheric density with those of the old form of ammunition. Specimens of fired and unfired bullets were also shown, and the lecturer argued that the nature of the wounds produced behooves the army surgeon of the present day to make a study of their "flattening-up" properties in order to render the prognosis of any case being of value. The latest fashion of locating bullets in situ and injury to bones resulting therefrom by means of the X-rays was also demonstrated.
According to the report for the last year of the United Kingdom Branch of the Dufferin and Ava fund for supplying medical aid to women in India, the growth of the movement is phenomenal. In the twelve months under review no less than 1,327,000 women received attention, either in hospitals or their own homes, from lady doctors. There are now 103 hospitals and dispensaries under the charge of twenty-eight ladies, whose names are on the English Medical Register, seventy lady assistant surgeons, and seventy hospital assistants, most of whom are native women, educated at the Indian universities. At the present time there are two hundred and forty ladies studying in the medical colleges, among them being high class Hindus, Mohammedans, Parsees, Karens, and Burmese.
Guy's Hospital benefits to the extent of £20,000, the gift of Henry Lewis Raphael, who has given that sum to the Institution for the building and endowment of a Nurses' Home, to be known as the Henrietta Raphael Nurses' Home, in memory of his wife.
Dr. W. L. Brown contributed at a meeting of the London Society for the Study of Inebriety a paper on the subject of “Inebriety and Its Cures among the Ancients.” He said, among other things, that prohibition was first tried in Britain by the Saxon King Edgar (959-971), who reduced the number of ale-houses in the villages, and introduced the custom of pegging the huge drinking cups then in use. King Edgar made it a penal offense for any one to drink beyond the peg. St. Anselm, who died in 1079,
forbade priests to go to "drinking bouts" or to “drink to pegs." Early closing was first tried, it appears in the reign of Edward the First, to prevent “excessive drinking and its noxious effects.” Laws were passed to secure good ale for the public and the punishment of those who sold adulterated liquors. Ale couriers were appointed by many corporations to see that the ale was good and the brewer had to swear on the Blessed Evangelists to “brew good ale and wholesome so far as ability and human frailty permits."
The first exploring expedition ever sent out by a university has just sailed to Torres Straits. The University of Cambridge has the honor of having provided the funds for this venture. The chief of the expedition is Dr. Hadden, Lecturer on Anthropology at the University, and there are with him Dr. McDougall, of St. Thomas' Hospital, Mr. C. S. Myers, of St. Bartholomew's Hospital, and Dr. Rivers, the Lecturer on Experimental Psychology at Cambridge. Dr. Hadden is especially charged to study the subject of folk lore. After Torres Straits Borneo and New Guinea will be visited, the expedition expecting to be away fifteen months. The party are taking a phonograph and a kinemalograph so as to be able to bring back records of songs and dances.
Dr. F. H. Simpson has recorded an interesting case of a patient suffering from typewriter's cramp; he says he is unacquainted with any authentic record of a similar case. The patient is a muscular man, thirty-three years of age. He began working as a clerk when eighteen years of age; after seven years of this employment the first symptoms of writer's cramp showed themselves. He then learned to use the typewriting machine. After a year of this he went to sea, and did not again take up typing for some six years, when he entered an office as typewriter, but was only engaged working the machine for two or three hours daily. After about two months' work, one day, while at work typing his right index finger became bent by cramp. Daily after this a repetition of the cramp occurred each evening, a slight involuntary flexion of the wrist being superadded. After a few weeks he had to substitute the middle for the index finger; in six days the middle finger became involved. He then, acting upon advice, used a small hammer to strike the keys. For some time he experienced much relief, but eventually cramp affected the whole right forearm, necessitating his abandoning his present occupation. The patient when piano-playing has no symptoms of any digital spasm.
The Maidstone Water Company's offer of £3.000 as compensation to sufferers by the late typhoid epidemic has been rejected, and it has been decided in numerous instances to commence actions against the company forthwith. No legal liability is at present admitted by the company.
It is considered that the researches by Dr. Copeman on the influence of the addition of glycerine to the calf lymph used in vaccination is a noteworthy contribution to the history of vaccination against smallpox. Dr. Copeman has shown that a single calf will yield from ten to fifteen grams' weight of vaccine material; to this may be added equal parts of water and glycerine, to an extent equal to fourteen times the original bulk of the
matter obtained from the calf. Thus the result, if properly and judiciously used, will suffice to vaccinate fifteen thousand persons. Dr. Copeman claims that the glycerine serves to destroy forms of microbe life which may cause accidents of untoward character.
Dr. G. S. Buchanan, of the Local Government Board, has just presented his report on certain cases of enteric fever which occurred in Essex during 1897, and were considered as being due to eating oysters which had become contaminated with sewage containing the bacillus of typhoid. Dr. Buchanan as a result of his exhaustive investigation considers that the oysters were at fault. It is expected that the remaining volumes of the System of Medicine edited by Professor Clifford Allbutt will be issued before the end of the year.
A juror at Horsham in Hampshire, having been sworn, proceeded recently in company with the other “good men and true” to view the body. On returning to the coroner's court this juryman was missed. After the inquest the missing juryman was discovered, and when asked to account for his non-appearance he quite innocently replied, “Well, what more do 'ee want? I saw'd the poor fellow; he war dead. The cor'ner didn't tell I to come back.”
LONDON, March, 1898.
Abstracts and Selections.
A CASE OF PUERPERAL SEPTICEMIA.— The following notes of a severe case of puerperal septicemia may be of interest from the fact that grave complications seem to have been modified by the use of antistreptococcic serum. I have reason to believe that some practitioners in such cases take no steps to remove from the uterus any putrescent offending matter or to render its cavity surgically clean, and such a case as the following amply demonstrates the necessity for such interference, otherwise the probability is that the patient slips through one's fingers.
The patient was a very thin, pale, and delicate woman, aged twenty-five years. At her confinement on December 10, 1897, she could render herself very little help, the pains were feeble and useless, consequently she was delivered by forceps, in regard to which operation there was no particular difficulty. For two days she did very well, but on December 13th the temperature in the morning was 102° F. and the pulse was 104. There was no abdominal tenderness but there was very slight fetor of the lochia. On the 14th the temperature was still 102° and the fetor was more marked. The uterus was washed out with a 1 in 60 solution of carbolic acid and then with hot water. On the 15th the temperature was 101°, but no local treatment was allowed as the patient felt so ill. On the 16th the temperature was 101.5° in the morning and 103° at night. On the 17th the temperature reached 103°, and during the night a severe rigor had occurred; the onlookers
thought she had convulsions. The pulse was very fast and thready, nearly “running.” The face was pinched and anxious, with a death-like pallor. With difficulty the uterus was cure well washed, and flushed with carbolic acid solution, and then packed to the fundus with iodoform gauze. Its cavity was large and uncontracted and before the washing the odor was very strong. She was being well nursed and was fed with milk, raw meat juice, and brandy. On the 18th the temperature was 104.2° in the morning and the pulse was 120, soft, and very compressible. The gauze was removed from the uterus, but the septic odor was easily perceptible through the iodoform, and the skin was sweating profusely and was blotched over the chest and abdomen. At 3 P. M. 10 c.c. of antistreptococcic serum were injected into the cellular tissue of the abdominal wall. At 8 P. M. the temperature was 102.6°, the pulse was 106, the respirations were 24, and headache was nearly driving the patient frantic. She felt so ill and weak that neither she nor her friends would allow further washing. On the morning of the 19th the temperature was 100° and the pulse was 92. The patient had had a better night; the headache was much less severe, the discharge was not so fetid, and she had a sense of feeling better. 10 c.c. of the serum were injected. At 8:30 P.M the temperature was 101.2° and the pulse 104. The discharge did not smell fetid. The headache, however, was still severe, but a six-grain dose of butyl-chloral relieved it. On the 20th the temperature was 101° and the pulse was 104. The headache was easier, the pulse firmer, the tongue cleaner, the skin drier and less blotchy, and the anxious, pinched face had smoothed out a little. The uterus was washed out with carbolic solution and 10 c.c. of the serum was injected. On the 21st the temperature was 100° and the pulse was 108. The headache was easier, as also were the other symptoms. On the 22d the morning temperature was 99.6° and the pulse was 1oo. She was still improving, and the head especially was comfortable. The uterus was washed out with strong carbolic solution and a shred came away of what appeared like macerated membrane about two inches long. The fetor was not marked. At 8 P.M. the temperature was 101° and the pulse was 108. The headache was worse, and altogether the patient was not so well. On the 23d, to my great disappointment after such a struggle, the temperature was 104°, the pulse was 120, and all the symptoms were aggravated, the headache being terrible. A severe pain had attacked the left leg which was slightly swollen. The veins in the popliteal space were hard and corded and the calf was very tender to tonch. Large linseed poultices were applied. On the 24th the temperature was 103.4o and the pulse was 116. The head was very painful, but the pain in the leg was not so intense. There was no fetor at all from the discharge and the other symptoms were more favorable.
The course of events from this point is of great interest, for the temperature fell 1° every morning until it reached normal on the 29th, the pulse corresponding. The tenderness of the leg gradually disappeared, likewise the swelling, the corded veins softened very quickly, and by the end of the
month the patient could move the leg about quite freely and without pain. Her further progress has been uneventful if slow. It seems to me that it is just possible that the serum may have assisted such a very rapid resolution of symptoms which had all the appearance of a genuine phlegmasia. Charles L. Fraser, F. R. C. P., in the London Lancet.
TRAUMATIC PULMONARY TUBERCULOSIS.-Schrader (Berl. klin. Woch., November 15, 1897,) says that trauma has long been recognized as a possible cause of acute pneumonia, but that the connection between injury and chronic disease of the lung is less easily established. He relates the following case: A man, aged twenty-nine, previously healthy, and with no family history of phthisis, had a severe fall on the right side of the back, and was unconscious for fifteen minutes. On the same evening he felt ill, and was admitted into hospital two days after the accident. There was then considerable grazing over the right scapula, and pain was complained of in the chest corresponding to the injured part. The breathing was difficult and the temperature 38.8° C. The breath sounds were absent, vocal vibration increased, and the percussion note impaired in the region underlying the injury. The diagnosis of pneumonia of the right middle and lower lobes was eventually made. About thirteen days after the accident tubercle bacilli were found in the sputum. The patient's condition remained much the same for some days. There was loss of weight. Eventually improvement took place, so that four months after the accident there were no abnormal physical signs beyond a slightly impaired note over the lower part of the right lung. The author refers to some recorded cases of supposed phthisis following injury. He draws attention to the fact that before the traumatism the patient was absolutely well. Whether the pneumonia following upon the injury is to be looked upon as a contusion pneumonia which favored the invasion of the tubercle bacillus, or whether it was a tuberculous broncho-pneumonia from the beginning, is difficult to decide. The author is inclined to accept the latter interpretation. The temperature chart was characteristic of tuberculosis. Finally, the author summarizes the evidence in favor of this view: (1) The development and course of the tuberculous lesion were carefully observed after the accident; (2) the disease corresponded to the site of the injury; (3) there was no clinical evidence of tuberculous disease in the lung immediately after the injury, and no history of previous illness; and (4) certain proof of tuberculosis was forthcoming some little time after the accident, the development of which was quite in keeping with that of the ordinary disease.-British Medical Journal.
TABETIC ANESTHESIA.- Marinesco (Sem. Méd., December 3, 1897,) investigated fifty cases of tabes dorsalis with a view of determining the proportion and extent of the anesthesia which is usually present. Tabetic sensory disturbances are not fixed, but appear and disappear without