September, Iglu. THE SPEC:III:UAL 137
realise what there is yet to learn—on "general principles" or even "secundum artem."
Mr. Devine has done the other side, and both of these gentlemen are deserving of our best thanks for the pains they have taken and the unfailing courtesy they have shown us.
Dr. Grantley Shelton has been appointed surgeon to out- Patie nts.
done the Path. has been stirred up. Dr. Hickey has
°°ne excellent work among the neglected microscopic speci-
Tens: of which there is an unusually good collection. As ,`"ese are now all indexed and diagnosed, there is a fine oppor- ,T i nity for the men doing pathology. Among the recent addi- aons is a unique specimen named after its discoverer—Daly's Faecal Spleen.
_ The King of the Bookmakers has of late acquired the habit
°t dropping over to Sydney for afternoon tea, and has also Presented an extra letter rack to the Students' Rooms—for is own daily batch of letters. If this continues much longer
e shall begin to suspect une affaire avec une femme!
w The current rumor is that our curly-haired resident al- aYs shows Prudence when dealing with casualty cases.
lia Our three star FIennessy has been shining with extra bril- D.D.Sc. in March, Exhibitioner in Pathology, Thera- peutics and Public Health in August. Gee whiz! and yet our nonoraries stand unawed.
i: Dr. Alex. Lewers' therapeutic lectures were on practical Tles and much appreciated.
, We are pleased to record a goodly number who are now _? longer boys, but doctors, and about to assume the rank u Captain—good luck go with them. Since their departure, ce rtain among the nurses wend their way sadly and slowly, with downcast eyes and pensive face. Return, Andy—how long?—return e'er the blossoms wither under the stern gaze
Tak.The great gag. at present is impressing our honoraries.
is Ing as they do so kindly an interest in our welfare, it
foirly natural they should enquire about exam results. The a few conversation has been overheard several times, with
Hon.: "Good morning, my boy."
Hon.: Boy: "Good morning, sir."
'on.: "How did you get on in your exams, my boy?"
My Boy : "I passed, sir."
Hon.: "What did you pass in, my boy ?"
My Boy : "I passed in Bacteriology, Immunity. Pathology, General and Special, Public Health, Regional Anatomy, Thera- peutics, Hygiene Dietetics, and Applied Anatomy."
Hon.: "Thank God, I am only an honorary, and am not expected to know anything."
We have to congratulate our ex-President, Tod Lang, on having found his better half—and a very charming better half she is. Tod now wears quite the time-honoured careworn hen- pecked expression of the orthodox paterfamilias.
Among other notable occurrences we must record the in - teresting fact that Harold appeared for the first time on two consecutive days. It is vaguely reported that he is taking ad- vantage of Charlie Bennett's absence, and tending that little plot of ground where Pansies flourish.
We are glad to announce that the Children's Ward is open again. It is a great sight—pictures, models of ships, a rocking horse, and other things dear to the youngsters adorn the ward, and the place is generally a Babel of conversation. It is a most valuable addition from our point of view, and gives us a big pull over the other hospitals.
Finally, just a word to congratulate Jack McDonald, Monty Inglis, and Dave Uodycomb on their successful achieve - ment of acting as residents and stewing for early exams. We appreciate fully the difficulties, and applaud the success.
Case for Commentary.
Dr. W. J. Denehy.
J.R.—Male, aet. 53.
Quite well till ten weeks ago, when he gradually became ill ; noticed pain in right chest, and then developed a cough.
Patient has been in bed during the greater part of his illness.
One clay before admission, right chest was needled, and since then he has had pain in right upper abdomen ; appetite good; no vomiting; bowels regular. Breathinc , has been diffi- cult, and he has been coughing up much frothy phlegm since onset ; no change in sputum recently ; no haemoptysis.
Previous History.—Pleurisy 20 years ago; no other ill - ness.
Family History.—Good ; no history of chest complaints.
Clinical Examination.—T. 100.4°, B.P. 120, R. 36. Pa -
•ient looks ill; is somewhat cyanosed.
SeMember, 1917. THE SPECULUM. 139
Heart.—Displaced en masse towards left axilla. A.B. in 4th space, 3 inches outside nipple line; sounds clear.
Lungs.—Left, hyper-resonant; breathing harsh and pue- rile. Right, wooden dulness everywhere; complete absence of breath sounds and vocal resonance.
Liver.-3 inches below costal margin; enlarged and tender.
o„ Operation under local anaesthesia. Resection of piece of 8th rib; pleura opened; only a little serous or sero-purulent fluid obtained locally.
Temperature persisted, ranging up to 104° ; septic type for three or four days ; patient becoming gradually worse.
Comment on diagnosis, prognosis, and lines of treatment.
[The solution of this case will be found on another page.]
Mr. L. Doyle, M.S.
11)•M., ad. 31, Barman.
a Three months ago got an attack of influenza, which lasted a_ week in bed. When he got up he was weak and groggy, Vd had no appetite. After a week he went back to work.
Before going back he became a dirty duck yellowish colour, which did not affect his eyes, and which lasted for 6 weeks.
After working a week, he commenced to get sharp pain near 1
ht border of right ribs. The pain would shoot towards was shoulder for three or four inches. At times when pain _w,as on him he would get a sharp "rheumatic" pain in the ,s,uoulder. The pain in "abd." was present for a month at the start—then got better for a month—and now has been Present for the past 16 days. Pain not worse after meals, and has never had indigestion. He has had about 5 attacks of vomiting since pain began, and after each pain has been slightly eased. No peculiarity about stools, and for last week trouble. Has
been a dirty red colour, He has had no other urinary o
Has lost 3 stone weight since illness began. He was writing however, hoand told his liver was in a bad state; his doctor wever, says nothing was found. C2H60 slight.
(:) .E.—Pt. is a big man, who looks wasted ; has a pictiliar mudd colour, and his conjunctiva is faintly tinged.
100.6, P. my
o, R. 22, B.P. 104.; urine, 1020, acid, no alb., no sugar, bile present.
Abdomen.—There is a definite rigidity of upper right rectus, and upper part of it obliques, so that it is impossible to palpable kidney. Tenderness on deep pressure in this area. Liver dullness, 3 finger breadths below costal margin , splenic dullness, slightly invert. Much palpation of back, very painful on right side.
There is marked fullness on right kidney area behind, and some doubtful deep fluctuations can be felt there.
What further means would you take to arrive at a diag - nosis? Comment as to diagnosis, prognosis, and treatment.
[Mr. Doyle has offered a prize of /2/2/- for the best solution to this case.—Ed.]