• No results found

Australian Medical Journal: (March, 1876) - Digitised Collections

N/A
N/A
Protected

Academic year: 2023

Share "Australian Medical Journal: (March, 1876) - Digitised Collections"

Copied!
33
0
0

Loading.... (view fulltext now)

Full text

(1)

THE AUSTRALIAN

MEDICAL JOURNAL.

MARCH, 1876.

MEDICAL SOCIETY OF VICTORIA.

ORDINARY MONTHLY MEETING.

WEDNESDAY, MARCH 1, 1876.

(117 Collins Street East.)

Present : Dr. Day, Dr. Blair, Dr. McMillan, Dr. Ryan, ?Dr.

Graham, Dr. Rowan, Dr. Bleasdale, Dr. P. Smith, Mr. Rudall, Dr. Neild, Dr. Jonasson, Dr. Bowen. The president, Dr. Day, in the chair.

CORRESPONDENCE.

letter was read from Dr. Hudson, of Ballarat, expressing his willingness to act as the Society's representative at the forthcoming International Medical Congress at Philadelphia.

CONTRIBITTIONS TO THE LIBRARY

The following contributions to the library were acknowledged : Pratt's Poisonous Plants, Smith's Aural. Diseases, Moquin-Tandon's Medical Zoology, 18 numbers of the Edinburgh Medical Journal, presented by the Rev. A. Morison ; Vol. 9 of Fragmenta Phyto- graphim Australiw, by the Baron Von Mueller ; 300 numbers of the Lancet, by Mr. Ford.

NEW MEMBERS.

Dr. Hudson of Ballarat. and Dr. Kennedy of the Melbourne Hospital, were elected members.

EXHIBITS.

Mr. RUDALL exhibited the eye-ball of an aged woman, in which there was a deposit of true bone in the choroid, the lacunie and canaliculi being plainly to be seen under the microscope. The sight of the eye had been lost for some years, and the globe had become atrophied.

Dr. BLAIR exhibited Hawkesley's Ether Inhaler, forwarded by Mr. Hill, pharmaceutical chemist. Mr. Rudall stated that he had

VOL. XXI.

(2)

[Mar.

used it and found that it effected a great saving of ether, for whereas ordinarily it required from four to seven ounces to procure complete anaasthesia, by means of the inhaler little more than one ounce sufficed. Its chief objection was its bulk, but it had certainly the advantage of excluding the risk of suffocation.

Dr. BOWEN mentioned that in the Eye and Ear Hospital Dr. Ryan had lately been in the habit of giving ether by means of a simple

• wire gauze funnel, and that it answered the purpose very well.

The average quantity used was four ounces, and the time occupied about six minutes.

Mr. GILLBEE had found about four ounces the quantity of ether required, and about four minutes of time. Under the same circum- stances a considerably less quantity of chloroform was needed, and about half the time required. He thought the simpler the apparatus the better.

Dr. RYAN testified to the advantage of ether in respect of its greater safety. It was slower in operation, but he did not think that a disadvantage. In reply to Mr. Rudall, he said that the minimum and maximum quantities used were respectively one ounce and nine ounces. To Mr. Gillbee, he had found the sickness to come on afterwards, and not during the inhalation.

The following paper was then read :

THE PHYSIOLOGY AND DISEASES OF THE CAPUT CIECUM COLI.

By T. L. McMILLAN, M.D. St. And., L.R.C.P. Ed.

Mr. President and gentlemen,—I have ventured to call your attention this evening, to one of the most obscure corners in the wide domain of the human economy ; not that I can hope to throw much new light on the matter from the scanty stores of my own experience, but from a simple wish that I may be able to excite some degree of interest in your minds, regarding a subject which has been, in a measure, neglected by the cultivators of medical science, viz., the cmcum, and the diseases to which it is liable.

When we take a general view of the digestive apparatus, we cannot fail to observe the beautiful adaptation of means to an end.

And though we are yet in ignorance, or doubt, as to the exact nature of the office which some of the abdominal organs perform, still while confessing our ignorance in regard to some of these, we cannot consider the peculiar conformation of the cmcum with any degree of attention, and not arrive at the conclusion that it has a special function to perform analagous to that of the stomach.

Some of our medical writers seem to attach very little importance to the cmcum, so little indeed that they take no notice of it at all ; while others dismiss the subject in a very few words. However, if we consider the anatomical relations and functions in man and many of the lower animals, we may be justified in regarding it as a distinct

(3)

1876.] DR. MCMILLAN on Diseases of the Ccecum. 67 organ, performing offices modified in their nature from the function of other parts of the alimentary canal. And it appears to me that this subject has not yet been properly investigated, nor has it attracted that degree of attention among medical men which it evidently deserves.

I will endeavour to state very briefly what is known regarding the physiology of the cmcum ; at the same time I may mention that physiologists are much at variance in their opinions upon this matter.

The resemblance of the cmcum to the stomach in most of the graminivorous, and particularly the ruminating animals, as well as its form and situation throughout all the higher classes of the animal kingdom, are circumstances showing that this is an important organ, and one in which the last act of digestion seems to be performed.

The situation of the cmcum, its capacity, its attachment to the walls of the abdomen, and the circumstance of its contents being propelled in opposition to their gravity, prove that they are longer retained here than in any other part of the intestinal canal, and this tends to confirm the view that has been taken as to its being a kind of reservoir or supplemental stomach, which receives the materials remaining in the ileum, in order that they may be subjected to the

last stage of digestion and the first of fmcation.

The canum is abundantly supplied with large follicular glands, which, according to the experiments of Tiedimann and Gmelin, secrete an acid, albuminous, and solvent fluid, which mixes with and pro- motes the digestion of those portions of the alimentary matters which have resisted the action of the stomach and small intestines, or have been 'insufficiently changed by them ; and, again, in order that this office may be more completely performed, we have seen that the anatomical relations of the ceecum admit of the retention for a longer or shorter time of the matters which pass into it, so that a last effort is here made, as it were, to obtain the remaining nourishment from the ingesta ; and thus it performs, if not the very last act of digestion, at least the last important part of it.

It also seems to fulfil an additional office, viz., that of secreting from its numerous follicles an unctuous or oily fluid, which serves to protect the surface of the large intestine from the irritating effects of the faecal matters passing along it, and some have supposed that the constituents both of this fluid, and of the other secretions poured out from its surface, consist of elements which require to be eliminated from the blood, so that in addition to its other functions, it is also a depurating organ. This last function assigned to the ceecum appears to me to be rather far-fetched and hypothetical, and one in support of which we cannot easily obtain proof. I only state it as an opinion which Dr. Copland and others seem to hold.

As an example of those who hold opposite opinions on this subject, I may state that Dr. Carpenter is one of those physiologists who seem to attach very little importance to the cmcum in man—

believing it to be merely the analogue of the second stomach in

F 2

(4)

animals, which he admits, in the case of animals, has a power of completing the process of digestion ; but, he adds, " There is no reason to believe that any such process takes place in man, whose real cmcum is rudimentary, that part of the intestine which has received the name, being merely the dilated commencement of the

colon."

Our great men being thus divided in opinion upon the subject, it follows that we must exercise our own judgment in the matter.

For my own part, notwithstanding the status of Dr. Carpenter, and the weight which his opinion ought to carry, my convictions are carried along with Tiedimann and others, who have made this mat- ter the subject of special investigation, and whose opinions are embodied in what I have stated above. flaying thus briefly referred to the physiology of this organ, I will now direct your attention to certain diseases to which it is liable. We may very properly divide the diseases of the cmcum into three classes, viz. :-

1. Disease caused by atony and disordered function.

2. Disease caused by the lodgment of foreign bodies, intestinal concretions, and indigestible substances.

3. Organic and strumous diseases.

Regarding the first of these classes, I will do no more than is simply sufficient to indicate their nature.

It has been frequently noticed that when the vital energies are weakened and the alimentary canal debilitated, the cmcum shows more frequently signs of disorder than any other part of the digest- ive system. In some cases the irritation produced by morbid or accumulated matters is slight, and readily productive of sufficient reaction of its muscular coats to propel them along the colon. In other instances the efforts made to accomplish this end are ineffectual, owing to the obstructions occasioned by the lodgment of flatus about the right flexure of the colon ; or by irregular spasmodic contraction of this bowel. This is a common cause of colicky pains, &c.

It has been observed that the contents of the bowels do not acquire their peculiar freculent odour until they reach the cmcum.

And this, according to Tiedimann and Gmelin, is caused by the vola- tile oily substance secreted by its follicles. During the changes that are effected by the cmcum on its contents, an acid and hydro- sulphuretted hydrogen gas are disengaged. This gas seems to be generated only in small quantities during the healthy functions of the organ ; but when, from any cause, its vital power is diminished, and when, consequently, its contents are retained an undue length of time, then air is disengaged in much greater quantity, and often to the extent of injuring its healthy tone.

Whilst the cmcum re-acts energetically upon this distending power, the flatus and a portion of its other contents are propelled along the colon ; but on many occasions, and under particular cir- cumstances, considerable opposition about the right flexure of the colon is offered to their transit, and hence pain and uneasiness in

(5)

1876.] DR. MCMILLAN on Diseases of the Coecum. 69 this part of the colon, as well as in the CO3CUM, are complained of, sometimes giving rise to the idea of the existence of either hepatic or nephritic disease. If the interruption is removed, disorder soon subsides ; but if it continue for any considerable time, the more violent forms of colic or ileus are apt to supervene.

When the internal surface of the cmcum is in an irritable state, disorders of this description are readily produced by the accumu- lation, even to a small extent, of the intestinal matter, poured into it from the ileum, especially when these secretions are of a stimu- lating or morbid character.

Accumulations of alimentary and fecal matters sometimes take place without causing much disorder, until the distension and irri- tation thereby occasioned, give rise to disease of the internal surface, of its follicles, or its parietes generally.

Persons advanced in life, of a phlegmatic temperament, or lax and torpid habit of body ; those who take little exercise, or whose occupations are sedentary, and especially aged females, are very liable to be thus affected. During this state, the retained matters are more or less changed, partially decomposed, become acrid, exco- riating, and a source of much irritation, both to the mucous surface itself and to its follicles. which are thereby obstructed and ulti- mately inflamed and ulcerated.

Ulceration and perforation are more frequently associated with disease of the appendix vermiformis, than in cases where the disease is confined to the cmcum itself. Dr. Habershon records several such cases in his excellent work on " Diseases of the Alimentary Canal." He devotes a whole chapter to the subject, which is well Worth a careful perusal.

Having said enough upon this part of the subject to indicate the nature of these diseases, and the conditions by which they are pro- duced, I will now proceed to the second division of the subject, and speak of the lodgment of foreign bodies, concretions, &c., and the diseases to which they give rise.

Substances incapable of digestion, either taken accidentally, or from a depraved appetite, frequently lodge in the cmcum, and remain in it for a very long period ; sometimes without producing much disorder, at other times occasioning the most violent effects.

Dr. Habershon, who has had very unusual opportunities of observing, says he has seen nails, pins, stones of fruit, shot, bristles of tooth-brushes, and entozoa, in the mourn. He has also found the appendix filled with f aeces in its whole length, or in one or more hard nodules. These frequently form the nucleus of calculi, and become encrusted with layers composed of carbonate and phosphate of lime, sometimes attaining the size of a cherry-stone, some the size of a date-stone, and there is one to be seen in the museum of Guy's Hospital the size of a hen's egg. It was removed from a sinus leading from the parietes of the abdomen to the cmcum.

Large balls of worms, both lumbrici and ascarides, collect in this viscus, occasioning much local irritation, and even inflammation.

& Mr. Blackadder has published some cases of this kind. In a

(6)

[Mar.

patient who had complained of various disorders, and among others of a gnawing soreness in the right iliac region, he found ragged ulcerations of the inner surface of the cmcum, which contained an immense number of worms. The rest of the alimentary canal was sound. Another case is recorded by the same author, where violent abdominal symptoms were occasioned by a large lumbricus, which had passed into the canal appendix of a person otherwise diseased.

Several instances have been recorded by the older writers, where the stones of fruit, biliary and intestinal concretions, hardened faecal matters, &c., have lodged in the cmcum, causing severe colic, and even fatal ileus. Some cases of this kind are referred to in Dr. Monro's book on " Morbid Anatomy." In one of these a concre- tion upwards of seven inches in circumference filled up the cmcum.

Fontanus found an earthy concretion in the mown as the only morbid appearance after death from ileus. Helm found nearly 300 cherry-stones in the same situation, and in the ileum before it opens into the ceecum, in a fatal case of this disease, Amyand detected a small nail in the appendix after fatal ileus. Mr. Waldron discovered a small concretion in it after a fatal case of peritonitis.

Dr. Hyerdahl, of Christiana, whom I knew at the Edinburgh University, told me that he had two cases of this kind under his care, which had deeply impressed his memory. The first was that of a boy who died from peritonitis, caused by a small shot which he had swallowed ; and the second case was of a lady, who died from the same cause. She had accidentally swallowed a piece of lead or tin, which had become detached from some culinary vessel. The singular feature in this last case was, that an interval of three years had elapsed from the time of swallowing the leaden pellet till the fatal attack came on. The leaden pellet in this case was of a some- what angular shape. One of our late eminent Edinburgh professors lost a daughter in this way ; she had swallowed a small shot while eating a portion of fowl. Dr. Struthers has seen several cases,.

one caused by hardened feces in the appendix ; another by an artificial tooth having been swallowed, lodging in the appendix, causing ulceration and fatal peritonitis. Dr. Gairdner records a case where a needle was found hanging from the point of the appendix, which caused secondary abscess in the liver.

Fatal inflammation is frequently caused by the lodgment in the cmcum of small pieces of crude unripe fruit, or vegetables. The- first case of this kind which I saw impressed my memory very much. While resident in America, many years ago, Dr. Bertody called my attention to a case of limited peritonitis which he had under his care. He told me that he believed the cause to be a piece- of cucumber lodged in the appendix ; he suspected this as soon as he examined the case. The patient, a strong healthy man, of thirty years, had enjoyed excellent health up to that time. He said he was fond of cucumbers, and had been eating specimens which were not over-ripe. I saw this patient several times with Dr. Bertody, and can remember that along with the peritonitis, which gradually became more diffused and general, there was a distinct tumour felt

(7)

1876.] DR. MCMILLAN on Diseases of the Ccecum. 71 in the right iliac region, and to this point the treatment was more immediately addressed, in the shape of leeches, fomentations, &c.

The man died in a week after he applied for medical relief, and about fifteen days from the time he had swallowed the fatal morsel.

A post-mortem was obtained, at which I was present, and, to my great admiration, the result was exactly as had been anticipated. A small piece of cucumber, solid and pretty hard, was impacted in the opening of the appendix, forming the nucleus of an abscess, with a great amount of inflammation and exudation into the neighbouring textures. On expressing my surprise at the accuracy of his diag- nosis, Dr. B. seemed to think little of it. He stated that he had seen a good many cases of the same kind, and that they were most common in warm climates, or during the hot season in temperate climates.

A characteristic case of this kind occurred in my own practice last July. A lady, who had partaken freely of some kind of salad, was taken ill soon after, the chief symptom being pain and tender- ness in the right iliac region, accompanied with small, quick pulse, feverishness, &c. Over the ccum a degree of fulness and hardness Could be felt, which is quite diagnostic of the disease of which we are treating. In this case the tenderness extended over the abdo- minal region, with tympanitic swelling. Happily the case yielded to treatment, and the patient recovered in about fourteen days.

On this subject Dr. Copland remarks : " I have treated, or been consulted respecting, four cases in which foreign bodies and concre- tions have been found in the appendix after death, and in all the symptoms were those of the most violent peritonitis, complicated with ileus, and terminating in sphacelation of this process itself."

Dr. Watson records two cases in his practice, one caused by cherry- stone, and the other by hardened fees, both fatal.

In some instances accumulation of fmcal matter occurs with great distension of the caecum, and when very much distended it is generally diseased in other respects ; its coats are more or less thickened, inflamed, and ulcerated, or its follicles enlarged.

Mr. Wilmot relates a case in which it was dilated to the extent Of containing a gallon, filled with fwcal matters, and perforated by a circular ulceration. Of course, when distension by fmcal matters is great, the tumour rises higher into the abdomen, presses upon the nerves, vessels, and ducts in its vicinity, sometimes occasioning numbness and oedema of the right lower extremity, retraction of the testicles, and derangement of the urinary secretion.

And thus it may be mistaken for disease of the kidney.

In general, the seat of the tumour arising from a collection of morbid matters in the ccum, and the disorders connected with it, readily lead to a recognition of its nature. When, however, there is little or no tumour formed, and the symptoms are of a chronic and less violent kind, the cause of the disorder may long exist and escape detection.

Dr. Copland mentions a case in point, which he attended with Mr. Annesly, where the ccum was considered to be the seat of the

(8)

Medical Society of Victoria. [Mar.

disorder, from its fulness and hardness upon examination, and a treatment in accordance with this view was strenuously insisted upon. The patient, a lady, had been attended by several eminent physicians during the preceding three or four years, and very different opinions had been entertained as to the nature of her ailment. After persistence in the treatment recommended, hardened balls containing indigestible substances which she had chewed and swallowed a long time previously, were evacuated : the fulness and hardness in the right iliac region disappeared, and the patient .perfectly recovered. Connected with this part of the subject there is yet another condition worthy of special mention, where the vermiform appendix plays an important part, viz., strangulation of the ileum.

Cases are recorded by various authors, where adhesion of the extremity of the appendix has taken place, after passing round a convolution of the ileum, thereby causing strangulation, with all its painful and fatal consequences.

Under the third class of diseases to which this organ is liable, I had intended to refer to cancer and other forms of disease associated with the strumous diathesis, but it would be unwise to comprehend so much within the limits of a single paper. I will pass on to the consideration of the leading symptoms or phenomena usually caused by fmcal or other matters collected in the cmcum, and by distension, enlargement, or irritation of this viscus.

As we might suppose, these vary with the nature of the offending substances, the extent to which they have accumulated, the age, temperament, and habit of body of the patient, &c. As has already been stated, the local signs are more or less fulness, hardness, or distension in the right iliac region.

Sometimes, on examining carefully with the tips of the fingers (the abdominal muscles being relaxed), a doughy hardness is felt over the ccum. Dr. Jackson, of Boston, states that the symptoms which may be regarded as essential to the disease, are pain in the right iliac quarter, but not confined to this, for it often passes beyond the limits of this locality, particularly upwards, and a tumour, varying in size, so deeply seated in the abdomen, as not to be felt without some direct pressure on the part, which is more or less tender, sometimes very tender. This tumour is to be felt near'the outer edge of the right rectus muscle, where this is crossed by a line drawn horizontally from the anterior superior spinous process of the right ilium. It must not be understood that the centre of the tumour is to be found exactly under the angle formed by the lines above mentioned ; only that some part of the tumour lies under it.

This may not be mathematically correct, but the indurated body will always be felt when the fingers are pressed down as near to this angle, as one would come in an examination of this sort.

In some cases little or no pain is complained of ; but if the dis- order be about to produce inflammation, both tenderness and pain are felt more or less constantly, or in paroxysms. The patient usually lies on his back, inclining to the right side, with the knees

(9)

1876.] DR. MCMILLAN on Diseases of the Ccecum. 73 drawn up so as to relax the abdominal muscles. When the bowels are constipated, with interruption to the passage of matters through the crecum, then the paroxysms of pain are very acute, sometimes accompanied by vomiting, and all the symptoms of severe colic, or even that of ileus.

In such cases signs of obstruction, either in the cmcum or in its vicinity, are detected, unless general peritonitis may have come on ; and even then the origin of the disease is generally referred to the meal region, for the tenderness and pain are usually most acute in that situation.

Inflammation of the caecum is caused chiefly by the continuance of the disorders already described. When irritation and over-disten- sion are maintained for any length of time, it goes on to inflammation.

It very often constitues the earliest pathological state in dysentery and diarrhoea. Although inflammations of this viscus have been generally overlooked or confounded with those affecting the colon, the small intestines, or the peritoneum, there are few diseases more defined in their character or •more distinctly limited than this in a large proportion of instances. When the mucous surface of the cmcum is the seat of inflammation, the symptoms are very similar to what we observe in dysentery ; the distinguishing characteristic being tenderness upon pressure over the ccecal region, the evacu- ations being generally preceded by tormina or griping pain, extend- ing upwards on the right side and down towards the pelvis. The tongue may be slightly furred, and more or less symptomatic fever present. In the more slight or chronic cases, the patient often com- plains of little beyond irregularity of the bowels and colicky pains in the abdomen, with slight emaciation and loss of healthy com- plexion, till at last an acute attack supervenes from the extension of the inflammatory action to the more external coats ; or the slow organic change has proceeded so far as to implicate adjoining parts.

In this manner the most dangerous forms of dysentery not unfre- quently take place. Acute inflammation of the coats of the C2CUM usually commence with violent pain in the right side, frequently accompanied with a burning sensation and the most exquisite ten- derness, particularly when the serous coat is affected ; but in a general way the symptoms differ only in degree from those of chronic inflammation—with this difference, however, that peritonitis is much more likely to ensue upon the acute form • also obstinate vomiting, with great frequency of pulse and general:fever.

Inflammation of the appendix appears to be attended from its commencement with more acute symptoms than that of the cmcum itself. When this takes place, general peritonitis is very quickly produced. Adhesions are formed between it and the adjoining peritoneal surface, and the appendix soon sphacelates, a fatal result taking place usually in a very short time.

In some cases the disease assumes a less violent character, and terminates in suppuration, owing to the areolar tissue connecting the coats of the intestine to one another, and to the abdominal parietes being chiefly affected. When this occurs, the issue is

(10)

Medical Society of Victoria. [Mar.

not so rapid as in the former instance, but is sometimes prolonged for a considerable period, and some cases end in recovery.

The cases above described are closely analogous to the pelvic cellulitis of puerperal women. The abscesses formed generally open internally ; sometimes the pus is discharged externally, but seldom without previously establishing a communication with the cavity of the cmcum.

The chronic state of the disease may give rise to very great thickening of the parietes of the cmcum. Dr. Beezley has detailed a case of this kind where, during life, the large tumour in the iliac region was mistaken for aneurism of the iliac artery. On inspection, post-mortem, the coats of the cmcum were found to be above an inch in thickness, scirrhous, inflamed, ulcerated, perforated, and its cavity enlarged. When the disease has thus gone on to thickening, particularly if it be attended with ulceration, amendment is procured with great difficulty. Still we should never despair, for cases are on record where medical treatment was persisted in for many months, and even years, and ultimately the health was re-established.

On the subject of treatment I shall be very brief ; for although certain general principles may apply to all, each case must be treated upon its own particular merits. If the case be seen early, a well-timed purgative may do much to check the progress of the mischief ; but if the disease has advanced, the treatment necessary in peritonitis will be found most applicable. In the last case which I treated, that of a lady (quoted in these pages), peritonitis supervened, with much pain, tenderness, and a highly tympanitic state of the abdomen. In this case I obtained the most excellent effects from.

occasional doses of oleum ricini and sp. terebinth. The effect of this medicine was always to give vast relief to the patient, and to modify all the urgent symptoms.

I am of opinion that when a purgative is necessary in such cases, this medicine is very superior in its effects to the calomel and jalap, so much recommended by some writers. Whatever treatment we may employ ought to be of a decided and positive character. And it is of great importance that such cases be seen and treated in their earlier stages.

In conclusion, I will make only a very few general observations.

I may state, that in seeking for information on this subject beyond what my own experience could supply, I have quoted freely from several authors. And there are comparatively few who have devoted special attention to the subject. I am also very conscious that my arrangement of the subject is faulty and imperfect, but this is partly due to the very short time granted me for the production of this paper.

I selected this subject because I am of opinion that the disease is one that is apt to be overlooked or underrated.

The late Dr. Jackson, of Boston, one of the most painstaking and sagacious physicians in America, in his " Letters to a Young Physician," says, that in his early years he noticed as others had, done, that in peritonitis the inflammation was often greatest on the-

(11)

1876.] DR. MCMILLAN on Diseases of the Ccecum. 75- right side of the abdomen and in the lowest half of it, but he had been in practice upwards of thirty years, before he learned to distinguish this inflammation of the cmcum with tumour.

To quote his own words, he says " After I had been led to distinguish it from the others, I could look back and find that I had seen it before. In a case which I quoted, the patient had been attended by several eminent physicians during the preceding three or four years, and very different opinions entertained as to the nature of her ailment. The consequence of ignorance on the part of these gentlemen was, that the patient had to suffer on, and the wonder was.she had not died. But when other physicians came who under- stood the matter, the patient was rapidly restored to perfect health.

Surely the simple statement of such cases should induce us to gain all the knowledge we possibly can upon such an important subject, lest perchance some one who looks to us with hope and confidence, should all unconsciously pay the penalty of our ignorance with his life."

Enough has surely been said to convince us that the cmcum has an important function to perform in the human economy, and that it is liable to be affected by a very dangerous class of diseases. I am therefore of opinion that in all cases of intestinal obstruction or abdominal inflammation, we should never fail to make careful examination of the right iliac region.

I have trespassed much longer upon your time than I intended.

however, if I have awakened an interest in your minds regarding this matter, or in some degree impressed you with a sense of its importance, then your time will not have been spent in vain.

The PRESIDENT believed that many cases of dysentery arose from accumulations in the cmcum.

Dr. BLAIR believed that judiciously timed purging would generally relieve these cmcal accumulations.

Dr. JONASSON thought the diagnosis of cmcal distensions not easy. We could not regard every tumour in the region of the osecum as an obstruction in that organ, and therefore it would be unwise always to give purgatives as a means of relief. Many cases

Of presumed cmcal obstruction might be instances of ordinary colic, which the enemata of ol. ricini, and ol. terebinth. would certainly relieve.

Dr. RYAN thought it would be the reverse of easy to diagnose inflammation of the cmcum from inflammation of other contiguous Parts. Moreover, when ulceration had pierced the coats, then. Purgatives were clearly out of the question.

Dr. P. SMITH had seen some extraordinary accumulations removed from the cmcum, and it was remarkable how a small thing would sometimes set up fatal inflammation, when very large objects went through without occasioning any injury.

Dr. NEILD had recently examined the body of a lunatic who had been in the habit of chewing his bed clothes, and in this case the was enormously distended with pieces of masticated, blanket.

(12)

Medical Society of Victoria. [Mar.

" NATIVE SENNA."

The PRESIDENT exhibited a specimen of a shrub found in the neighbourhood of Cape Otway. Its leaves somewhat resembled the senna, and the inhabitants of that district were in the habit of using it for purgative purposes.

AUSTRALIAN WINE.

Dr. BLEASDALE expressed his desire to submit some samples of Australian wine to the Society, for the purpose of' obtaining an opinion as to their suitability for dietic purposes. It was arranged to call a special meeting for this purpose on the 15th inst.

WEDNESDAY, MARCH 15, 1876.

SPECIAL MEETING TO EXAMINE SAMPLES OF AUSTRALIAN WINES.

(Technological Museum.) Dr. Neild in the chair.

The following samples were examined and pronounced upon : No. 1. Shiraz, 1870, from Adelaide ; a warm, generous, some- what fruity wine, containing 26 per cent. of alcohol.

No. 2. A blended wine, made by Holbrook, of Adelaide, full- bodied and generous, but giving the impression of still fermenting.

Three years old.

No. 3. A white wine, from Bishop's Garden, Adelaide, blended ; its composition pointing to the respective vintages of 1869 and 1873. Possesses a fine bouquet, and has a warm exhilarating quality.

No. 4. A clarety wine, 1869, made by Mr. J. S. Johnstone, of Sunbury. A good sound wholesome liquor, suitable for general purposes.

No. 5. Hermitage, made by Mr. Hubert de Castella, of Yering, Victoria, three years old. A pure, drinkable, and palatable wine.

No. 6. A dark wine (carbinet), also made by Mr. Hubert de Castella. A. sound drinkable wine.

No. 7. Hermitage, two years old, made by Mr. Albert Bruhn.

Full-bodied and of good flavour.

THURSDAY, MARCH 21.

(Technological Museum.)

Adjourned special meeting for the further examining Australian wines.

Dr. Blair in the chair

No. 8. Hermitage, from Goornong, Victoria, five years old, made by Mr. F. King. A good sound wine, fit for general medicinal purposes.

No. 9. A red wine, three years old, made by Mr. Maplestone, of Riddell's Creek. Thin and acid.

No. 10. Verdot (red wine), made by Mr. Alexander Munro, of Bebeah, N.S.W. A pleasant light drinkable wine.

(13)

1876.] DR. GARDNER on a Case of Hydatid of the Liver. 77 No. 11. Muscatel, 1871, made by Mr. Wright, of McGill, S.A.

A. palatable wine, suitable for convalescents and likely to be accept- able to them.

No. 12. Reisling, ten years old, made by Mr. Parrell, of West Maitland, N.S.W. Rough and " physicky " to the palate.

No. 13. A white wine made from a red grape (Grenache), five years old, made by Mr. Richmond, of Walker's Ville, S.A. A good strong wine, suitable for pharmaceutical purposes.

No. 14. °Red wine, made by Mr. Vettler, of Echuca, six years old.

Recommended as a good sound clarety wine for average use.

No. 15. Shiraz, six years old, made by Mr. Docker, of Wanga- ratta, Victoria. A good nourishing patients' wine.

No. 16. Carbinet, five years old, made by Mr. Vettler, of Echuca. Stale, flat, and generally unpalatable.

No. 17. Verdeilho, five years old, made by .Mr. J. S. Johnstone, of Sunbury. An exceedingly good useful wholesome wine.

It was agreed to recommended as suitable for medicinal uses Nos. 4, 5, 6, 8, 10, 11, 14, 15, 17.

Dr. Bleasdale undertook to arrange to have these wines kept in stock by Mr. Walker, grocer, of Russell-street, and to have them sold at a price within the means of patients of limited circumstances.

Re thought that eventually it would be convenient to narrow down the selection to about four kinds, and to make certain that these could always be obtained without difficulty or variation. He thought also it would be well if a permanent committee or jury were appointed, to whom could be entrusted the task of tasting and deciding upon the merits of such samples, as might from time to time be sent in.

NOTES OF A CASE OF HYDATID OF THE LIVER, TREATED BY A FREE OPENING WITH POTASSA FUSA. RECOVERY.

(Under the care of DR. CLINDENING.) By W. GARDNER, M.B. et Ch. M. Glas.

(Junior House Surgeon Adelaide Hospital.)

C. H., mt. 42 years, was admitted to the Adelaide Hospital on 14th January, 1876, and the following notes of her case were taken :-

Was confined eight weeks ago, and three weeks after that felt a

" lump" in the right side of her abdomen, and for this she was blistered by a medical man. A week before she discovered the Swelling jaundice came on, and has continued ever since. Never had jaundice before. The swelling has caused little or no pain. She is very much emaciated, conjunctivEe yellow, skin yellowish, and water very dark-coloured. Has had nine children, who are all alive and well. The water which she drinks is procured from casks sunk in the sand, to which both sheep and dogs have access. On exami-

(14)

[Mar.

nation, there is found to be a prominent fluctuant swelling in the right side of the abdomen, just below the ribs, and at the most prominent point of the swelling ; the circumference of the abdomen is 35f in. ; at the umbilicus it is 33 in. The dulness, on percus- sion, reaches from the upper edge of the fourth rib to the level of the umbilicus, being 92 in. vertically, and laterally it stretches 2 in.

beyond the median line.

On the day of admission the tumour was aspirated and 84 ozs.

of dark-coloured fluid drawn off, which was found to contain perfect echinococci, and loose hooklets. S.G. of the fluid 1 . 010, and it gave the reaction for bile.

15th January.—Yellow tinge of conjunctivm and skin much less.

Slight pain in the lower part of the abdomen ; bowels open.

Temp. morning, 103 . 6; evening, 105

16th 71 101 „ 104.4

17th 1) 100 . 6 )9 104 .2

18th If 101 7) 103.2

19th 1.1 7)

99.2 11 103.5

20th 7) f) 99.8 1) 103.5

22nd ••• 1) 11 98.5 ,) 101 . 2 Tumour is now gradually refilling; jaundice very much less; bowels open ; tongue clean.

25th January.-53 ozs. of a dark reddish-brown fluid removed, and then the needle became blocked. Temp. evening, 104.8.

26th January.—Temp. morning 98'4. Slight pain in the abdomen; vomited once after the tapping. Temp. evening, 100 .2.

29th January.—Temp. evening, 102.

31st January.—Complains of great pain in the chest and abdomen.

The swelling has enlarged considerably since the last tapping ; motions are clay-coloured ; jaundice increased ; bowels regular ; tongue clean. Liver dulness extends from the fourth rib to two fingers' breadth above the level of the umbilicus. Circumference of the abdomen at the most prominent point of the swelling, 36f in.

120 ozs. of a deep reddish-brown fluid (S.G. 1 .016) withdrawn and found to be loaded with pus. Temp. evening, 99.

1st February.—Temp. morning, 99.4. No pain in abdomen or chest ; no vomiting ; appetite very much improved ; jaundice almost gone. Temp. evening, 100.

12th February.-742 ozs. of a reddish fluid removed, containing pus and hooklets. Temp. evening, 99.8.

15th February.—Had a rigor this morning, which lasted for a quarter of an hour ; no vomiting.

17th February.—Temp. morning, 102 .7.

19th. February.—On examination the upper margin of liver-dul- ness is found to be in the third interspace, and the lower margin is two inches below the level of the umbilicus on the right side ; the edge of the left lobe of the liver can be felt at the umbilicus

(15)

1876.] DR. GARDNER on a Case of Hydatid of the Liver. 79 and stretches obliquely upwards into the left hypochondrium. From a point midway between the right nipple and the border of the sternum the vertical dulness is 11 in. At the ensiform cartilage the circumference of the body is 341- in., and at the umbilicus 31i in. ; at a point midway between these two it is 34i in. She has had no shivering since last report ; - bowels open daily ; com- plains of loss of appetite. A piece of potassa fusa was used to create adhesions between the cysts and the abdominal wall, to allow of cure by a free opening, and the use of drainage tubes. Consider-

able cedema of both legs.

20th February.—A slough about the size of a florin has formed ; linseed poultices applied.

22nd February.-66 ozs. removed by aspiration at a point away from the slough to relieve tension. No albumen in urine ; abundant deposit of urates. Slough beginning to separate.

25th February.—The slough has separated so far as to expose the cyst, and strong adhesions have formed between it and the abdominal wall. A large-sized trocar and canula were thrust into the cyst and 90 ozs. of a very offensive brick-colored fluid withdrawn, which was found to contain pus and hooklets. A probe could be passed for 10 in. into the cyst. The canula was tied in and covered with oakum.

26th February.—Cyst injected out with lot. carbol. (1 in 50), and a large drainage-tube inserted through the canula after being steeped in ol. carbol. Temperature normal ; considerable discharge from the canula.

29th February.—No smell at all from the discharge now, which is slightly more purulent ; bits of cyst coming away. There has been no rise of temperature since the operation ; patient takes food readily and declares herself quite comfortable.

6th March.—Almost no discharge and no smell ; cyst is evidently contracting, as there is now some difficulty in introducing a probe.

A curved rectal canula introduced instead of the straight one first used.

16th March.—Patient is able to get up and walk in the garden daily, the canula and drainage tube being tied in and covered with oakum.

28th March.—Discharge has almost ceased, and so canula left out.

30th March.—The opening has almost healed up ; complains of great pain in the abdomen this evening and the temperature is 102 .4, and as this rise was probably caused by suppuration going on inside the sac, the opening was dilated by laminaria and sponge-tents and the canula re-inserted, giving exit to a quantity of fetid pus and shreds of membrane. Injected out with lot. carbol.

15th April.—Injected out daily since last report, and shreds of

giL

Membrane with a glutinous fluid brought away by reversing the action of the syringe after injecting lot. carbol. Canula removed and wound allowed to heal up.

(16)

MR. PENFOLD on a Case of Hydatid of the Liver. [Mar.

26th April.—Opening quite closed, and there has been no rise of temperature. Liver-dulness now only 3i in. in the vertical line.

Discharged well.

This case is a very good example of an old hydatid cyst of the liver, in which the treatment by aspiration absolutely failed and in which, I believe, death would have resulted from exhaustion had not a free opening been made in time. From the date when the cyst was opened into, there was no pyrexia and the patient gained flesh rapidly ; there was no return of pyrexia until the cyst was allowed to heal up, and this was speedily got rid of by reopening the wound.

After the second closure of the wound, there was never any increase of temperature. The treatment adopted in this case was simply a revival of the treatment of aecamier ; but he treated all cases of hydatid of the liver in the same way and I would limit the applica- tion of his method to old-standing cases, in which the fluid was purulent and fetid from the first, and in which continued aspiration is useless.

A CASE OF HYDATID OF THE LIVER.

By OLIVER PENFOLD, M.R.C.S. Eng. &c.

The following notes and details of treatment I have thought worth recording, as an instance of great recuperative power possessed by an individual, who for some days, lay apparently dying from the exhaustion produced by the discharge from a large cavity in the right hypochondrium, probably as large as a man's head, but which gradually drained away, and the patient's health completely returned.

Mrs. W., aged about 35 years, a multipara, was confined by a midwife in September 1875, and had an attack of pelvic cellulitis subsequently. About a month after delivery, she complained of abdominal pains, debility, and anorexia. There was a tender spot near the centre of the epigastrium, and an increased percussion-dulness in the right hypochondriac region, a tense thrilling sensation being com- municated to the percussed finger. There was a distinct bulging of the parietes from the free margin of the right rib-cartilages, and the skin was oedematous in the neighbourhood. Inferiorly, the dulness extended below the umbilicus and across to the left for two or three inches ; above, it reached to the seventh interspace ; behind, the dul- ness was not notably increased. The patient thought the swelling was of at least five years' standing, and said that she had consulted different medical men, who did not agree as to the nature of the tumour.

On the 17th October I punctured it in the most prominent portion, which was near the eighth rib-cartilage, and drew off only about five ounces of clear hydatid fluid. She was somewhat relieved, and absorption and cure were hoped for. Soon, however, fever and sweatings followed and her strength failed fast.

(17)

1876.] MR. PENFOLD on a Case of Hydatid of the Liver. 81 As matters were getting critical, chloroform was administered on the 15th November, and a cut made with a scalpel at the Puncture-site boldly though the abdominal wall into the cyst, following nearly the contour of the rib-cartilage. A little branch of the internal mammary artery was severed in the upper angle of the incision, but bleeding was easily stopped by plugging with lint, wetted with perchloride of iron. A great quantity of filthy-looking pus, of sui generis odour, escaped, and the gap was filled up with glycerined lint. This was pulled out in three days. More pus flowed. The plugging was repeated daily, and cysts and discharge flowed away. Sponge tents were also inserted into the wound, but the opening into the cyst was not enlarged by them on account of the unyielding cartilage being adjacent, but the skin-cut was stretched considerably.

On December 12, the sac• was washed out with warm water with permanganate of potass, a grain to the pint, dissolved in it. The fluid was introduced by means of an india-rubber tube, fastened on an ordinary flute-key lever stomach.pump, which process proved very convenient and satisfactory. The first few ounces of warm disinfectant seemed to pain, but the rest was soon tolerated. Two days aftewards, however, on repeating the injection, such severe pain was complained of, that I did not think it right to continue washing out the sac. Gave 20 minims of liq. opii. sedat., and continued it nightly for nearly a month.

On 20th December very hot weather suddenly set in, and the patient's general condition became very low. Ice and effervescing malt liquors were ordered. Odour in bedroom very foul. All silver instruments were quickly blackened by mere exposure. Introduced a piece of solid india-rubber catheter into cyst, and left about an inch projecting. Four days later, severe pain in the right side and scapular region set in. Her ' facies ' was now very discouraging, her sallow wistful visage, with pinched skin stretched over the prominent cheek bones, giving one the impression of speedily- impending death. Opium was continued at night, and hydrochloric acid and cinchona mixture given frequently during the day.

Early in January a large piece of cyst-wall escaped, followed by a great discharge. A pair of dressing forceps passed into the cyst up to the handles did not touch the bottom at this time. Improve- ment now began, and the tube was removed for cleaning every few days. By the 15th January, she was able to do without the opiate, and merely took an occasional dose of bicarbonate of potass and infusion of gentian. The menses returned in March for the first tim e since her confinement. The opening was now about three inches deep and was narrow. It was dressed with oiled lint till the 27th, when an iron wire helix was put in. This was easily made by coiling the wire round a thick probe. After about a fortnight this was removed and the skin-wound completely cicatrised, and the Patient was in excellent health shortly afterwards.

Sandhurst, March 1876.

(18)

[Mar.

Australian rbiral irurnaI.

MARCH 1876.

SCARLET FEVER.

Up to this date, scarlet fever has been prevalent nearly all through the colony, ever since last August. There have been occasional lulls in the intensity of its manifestations, but it has never ceased, and it would seem as if no locality, however remote, or however isolated, could claim an immunity from its approach. It is hardly possible that any practitioner can have been without more or less experience of it ; and some have been almost constantly engaged in its treatment. So long a continuance of the disease has very naturally excited a feeling of alarm in the public mind, and the question is constantly asked, is medical science unequal to devising some effectual means of bringing its progress to an end, or is it to become endemic among us ? It has frequently appeared under the most unexpected circumstances, and where the channel of communication was not at all obvious.

Consequently, all sorts of theories have been started to explain its mode of propagation. Of this, however, there can be no doubt, that the poison, whatever be its nature, is more active in showing its effects than almost any of the other zymotic ferments, and that therefore the precaution of isolation carries with it a strong quality of recommendation.

As to what are called disinfectants, it would seem as if, with few exceptions, they were inert, so far as any effect they may have upon this poison ; for the disease has shown itself where every adverse condition of the kind has been instituted.

In respect of treatment, there appears to be no common plan, every practitioner consulting his own preferences, looking as a rule to symptoms only. And this can hardly be wondered at, inasmuch as we are so completely in the dark as to the essence of the poison to be dealt with. There may come a time when antidotes to all poisons, zymotic and otherwise, will be at our disposal. -Up to this present, we can only speculate upon the nature of the ferment, and therefore we know nothing of the true antagonism with which we ought to meet it. In the popular mind the disease is still generally deemed a product of the decomposition of animal and vegetable organisms, and hygienic regulations have more or less reference to this belief. And, indeed, failing other explanation, the theory that scarlet fever may

(19)

1876.] The University of Melbourne. 83 present itself de novo, as a vegetable growth upon a given substrate, is far from lacking in reasonableness. The disease has certainly arisen under circumstances where infection Was out of the ordinary limits of explanation. What we are just now most concerned to get at, however, is an explanation why the disease should have continued so long, and with an intensity so much more marked, than has been usual in the case of previous epidemics of scarlet fever.

No doubt there are meteorological conditions favourable for its continuance, but of these we seem to be not sufficiently conscious. The fact remains that since August last, a great part of the colony has been over-run with the disease.

State schools have been closed, and isolation has been, as far as circumstances permitted, adopted. An amended Health Act, having an almost exclusive reference to the arrest of scarlet fever has been devised, and the profession generally has been fully alive to all the precautions desirable of adoption. Yet still it rages, and if awhile it lulls-in one locality, it shows itself in others with all the greater virulence.

At a meeting of the Central Board of Health, on the 29th inst, it was very properly resolved to call the attention of the profession to certain circulars variously issued, desir- ing information on some of the more important diseases of the colony, and among these to one requesting such informa- tion on the subject of scarlet fever. We hope this appeal Will be responded to, for it is only by the collection of data such as the profession alone can supply, that correct con- clusions can be arrived at. And it is especially in this present epidemic, that we require the collective knowledge Which can be gathered by a generally applied endeavour of the whole profession.

gke nibeersitg of jAi tibounte.

FEBRUARY TERM.

RESULTS OF THE ORDINARY EXAMINATION IN MEDICINE, FIRST YEAR : Charles John Trood, Thomas Rupert, Henry SECOND YEAR : Robert Fitzgerald, Harry Sydenham Lyons, Henry Augustus Samson.

THIRD YEAR : Louis Stewart Agnew, John Henry Browning, Thomas llastie, Richard Sides.

FOURTH YEAR : None.

G 2

(20)

84 Legislative Assembly.

FIFTH YEAR : Harry Brookes Allen, Ed ward Hamilton Blair Barker, George Haley, William Edward Le Fanu Hearn, Thomas Rowan.

HONOUR EXAMINATION.

SECOND YEAR—FIRST CLASS : John Rae Menzies Thomson.

SECOND CLASS ' None. THIRD CLASS : Henry Blackett Forster.

Exhibition awarded to John Rae Menzies Thomson.

T Man YEAR—FIRST CLASS : None. SECOND CLASS : Charles Henry Scott, Robert Andrew Stirling, Richard Sides. Exhibition awarded to Charles Henry Scott.

FOURTH YEAR—FIRST CLASS : None. SECOND CLASS : Thomas Augustine Garlick, John Alexander Kennison--equal. Thomas Augustine Garlick and John Alexander Kennison to be Exhi- bitioners, and the emolument of the Exhibition to be divided.

FIFTH YEAR—FIRST CLASS : Harry Brookes Allen. Scholarship awarded to Harry Brookes Allen.

LEGISLATIVE ASSEMBLY.

MARCH 14.

MEDICAL PRACTITIONERS STATUTE 1865 AMENDMENT BILL.

Mr. Lock moved the second reading of the Medical Practitioners Statute 1865 Amendment Bill. In doing so, he explained that the bill was a very short one, its sole object being stated in the first clause as follows :—" The Minister in whose department this Act and the Act numbered 262 are administered may, by a license under his hands, authorise the Chief Medical Officer, the Inspector- General of Penal Establishments, the Inspector of Lunatic Asylums, or any resident or honorary medical officer connected with any public institution, supported wholly or in part by funds from the general revenue, to permit the body of any person who may die in such public institution to undergo anatomical examination, unless to the knowledge of such licensee such person shall have expressed his desire, either in writing at any time during his life, or virtually in the presence of two or more witnesses during the illness whereof he died, that his body after death might not undergo such examination, or unless the surviving husband or wife or any known relative of the deceased person, shall, require the body to be interred without such examination." The hon. member urged that such a measure would be most advantageous to the students of medical science.

The motion was agreed to and the bill was read a second time and committed.

In reply to the question, the Attorney-General said that due pro- vision would be made for decent burial after the dissection of the body in all cases.

Mr. Cope expressed a strong objection to the bill, and said that he would oppose it at every stage.

(21)

1876.] Legislative Assembly. 85 Mr. Bosisto thought that the examination should take place only in some recognised school of medicine or public institution, and moved an amendment to that effect.

Mr. Johnston saw no necessity for such a bill, and as it was well known that most persons had a great objection to having the bodies of their friends dissected, he trusted that the house would not sanction the measure, unless the hon. member who introduced it was prepared to give some better reasons for its adoption.

Mr. Lock said that the advantage to science would be indubitable.

According to the present law no body could be anatomically examined except in a school of anatomy or public institution. He considered that the bill ought to be passed, in order to give medical students an opportunity of becoming acquainted with their profes- sion, especially as there were no other means of obtaining subjects to examine.

Mr. Woods : Legislate body-snatching then.

Mr. Bosisto's amendment was put and agreed to.

Mr. Witt proposed to strike out the words "in the presence of two or more witnesses."

After some discussion the amendment was withdrawn.

Mr. Wrixon moved as an addition to clause 1, " That a printed copy of this act shall be posted up at the entrance-hall, or other prominent place of hospitals, lunatic asylums, or gaols."

Mr. Macpherson suggested that lunatic asylums should be ex- cepted, and the words were struck out.

Mr. Ramsay thought gaols might be very well excepted also.

The motion was agreed to, the bill was reported, with amend- Merits, and the report agreed to.

MARCH 22.

MEDICAL PRACTITIONERS STATUTE 1865 AMENDMENT BILL.

This bill was read a third time, and ordered to be transmitted to the Legislative Council.

CORONERS' JURIES LAW AMENDMENT BILL.

Mr. Lock moved the second reading of this bill, and explained that its object was to reduce the number of jurors on coronial inquiries from twelve to five, and to provide for their payment.

Mr. Service said reform in this direction was necessary, but it had been proposed by the Kerferd Government to do away with coroners' juries altogether, and make the coroners discharge the whole duty, as they could very well do. The subject should be taken up by the Government, and dealt with thoroughly. The present bill, pro- posing as it did to appropriate money out of the consolidated revenue, ought to have been initiated in committee, and it could not therefore proceed.

The Speaker held this objection to be fatal.

Mr. Kerferd said the Government would deal with the subject at an early date.

(22)

[Mar, UNIVERSITY DEGREES BILL.

The house then went into committee to consider a bill to enable the council of the University of Melbourne to confer degrees in surgery.

On clause 1, providing that " The council of the University of Melbourne is hereby empowered to confer after examination at any time after the passing of this act the several degrees of Bachelor in Surgery and Master in Surgery, according to statutes and regula- tions to be made by the said University : Provided always that it shall be lawful for the said University to make such statutes as they may deem fit for the admission without examination to any such degree, of persons who may have graduated at any other university,"

being submitted,

Mr. Bosisto observed that there were graduates of the Melbourne University quite as well qualified for the degree without examination as those of other universities, and he therefore moved the insertion of the words, " at the University of Melbourne," after the words

" graduated at," in the last line.

The motion was agreed to, and with this amendment the bill was passed through all its stages.

MELBOURNE HOSPITAL CHRONICLES.

February 8.—Committee Meeting : Letters were received from Dr. Williams, asking for specific information as to the admission of cases of delirium tremens ; from Mr. Lawton, desiring that the charges preferred against him by Mr. Beaney should be considered publicly.

The sub-committee appointed to investigate the charges made against Dr. Lawton by Mr. Beaney of disobedience of instructions, and of his neglecting to inform him of a serious accident which was admitted until twelve hours afterwards, brought up their report upon- the matter,•which was as follows :-

The sub-committee beg to report that the following charges, contained in a letter from Mr. Beaney, may be enumerated as follows :-1st. That Mr. Lawton disobeyed an instruction of his honorary surgeon, Mr. Beaney, by administering hypodermic injection of morphia, after he had been desired not to do so, in the case of Mrs. Belly, deceased. 2nd. That Mr. Lawton neglected to report to his honorary surgeon, Mr. Beaney, until more than twelve hours had elapsed, the admission of a case of severe injury, which terminated fatally, and in contravention of rule 11, section 5, which directs that immediate notice in writing should be forwarded. The sub-committee beg further to report that they have taken evidence, and have received a statement from Mr. Lawton, and find the first charge, of administering hypodermic injections to the late Mrs. Belly, to be fully sustained, and they are of opinion that Mr. Lawton is highly censurable for neglecting to follow out the directions of his honorary surgeon ; and, as regards the second charge, they find that Mr. Lawton was guilty of great neglect in omitting to inform Mr. Beaney of the admission to the ward of a case of severe injury, although that gentleman was in the hospital shortly after the case was received ; and that he is further blameable for neglecting to comply with rule 11 of section 5, which directs that on the admission of -

(23)

1876.] Melbourne Hospital Chronicles. 87 a case of injury requiring the presence of the honorary officer, notice in writing shall be forwarded forthwith. The committee have also considered a statement to the effect that Dr. Jonasson had informed Mr. Beaney of the admission of the case referred to in the second charge, and they are of opinion that Mr. Beaney has explained that he was prevented attending, he having been summoned to the bedside of a private patient—a serious case.

In carrying out the investigation, the attention of the sub-committee was called to the fact that although Mr. Lawton deemed it advisable to adopt treatment in opposition to specific instructions, he neglected to make any entry thereof, or his reason for doing so, in the case-book. The necessity for a connected and complete history of all important cases is so obvious to all, that it is desirable to call attention to the omission.

J. BAILLIERE, Chairman.

It was resolved that the report lie on the table for a week.

February 15.—Committee Meeting : A letter was read from Dr. Youl, informing the committee that the jury in an inquest held on the 1st inst., wished to bring under their notice the necessity for strictly enforcing the rules with reference to consultations and operations. He further stated that from the evidence in the case of M. A. Kelly, it appeared that the most important rules of the hospital had been set aside by Mr. Beaney. First, he had per- formed a capital operation without consultation with the other surgeons. Second, he had neglected to inform the patient of her leg having to be removed. The communication was referred to Mr. Beaney.

The discussion on the sub-committee's report was resumed, and Subsequently it was resolved to adopt only such portions as related to the charges preferred by Mr. Beaney against Mr. Lawton, the resident-surgeon. The passage relating to the allegation of neglect preferred against Mr. Beaney in the Joske case was referred back to the sub-committee, in order that they might enter into the case more fully. The attention of the meeting was drawn to the fact that Messrs. Fitzgerald and Howitt had frequently neglected to attend consultations of the honorary medical staff, and the secretary was directed to communicate with those gentlemen on the subject.

Mr. GILLBEE gave notice that he would move "That in future the resident medical staff be allowed to attend all consultations."

February 22.—Committee Meeting : Letters were read from Mr. Beaney, with reference to the case of Mr. Joske and Margaret Kelly ; with reference to the former he complained that he had had no opportunity of explaining at the inquest. He quoted the rule directing the resident to send forthwith for the honorary in case of accident, and complained that this had not been done, nor had a verbal communication been made to him on the subject when he Was at the hospital on the day of Mr. Joske's admission. The several messages received other than the official one sent to him at Midnight, he did not consider merited his notice. The letter was referred to the sub-committee appointed to consider the case ; with reference to the second case he remarked :—" The Coroner calls attention to the infringement of two of the rules of the hospital by me—Firstly, the performance of a capital operation without pre- viously holding a consultation ; and, secondly, neglecting to inform the patient of the probability of her leg having to be removed. To

(24)

Melbourne Hospital Chronicles. [Mar.

the first of these allegations I have already replied to the Committee in my communication of December last. To the second I have to say that I did not think before performing the operation that the necessity would arise to remove the woman's leg. I fully explained to the patient and her husband the danger of the operation, and the object I had in view in performing it, and I had their joint permis- sion to do the best I could for her. I can honestly affirm that in doing what I did I carried out that intention to the best of my ability. It was quite impossible to ascertain beforehand the extent to which the bones of the leg were diseased, and in my opinion it would have been not only injudicious but cruel, to have stopped in the course of the operation and allowed the patient to recover from the effects of the chloroform, to get her permission to do what was absolutely necessary to save her life. The shock of such a com- munication, and the knowledge that she had again to be put under chloroform to undergo another operation, would in my opinion, and in the opinion, I will venture to say, of every unprejudiced person, have been infinitely greater than that which she underwent."

February 29.—Committee yleeting The sum of £40 was received from Mr. D. M'Larter, of New South Wales, for medical assistance rendered to his son during his treatment as an in-patient of the hospital.

A letter was read from the city coroner, stating that for the information of the committee he referred them to a portion of Mr. Lawton's evidence on the occasion of an inquest at the hospital on the body of a man named Denis Lane, who was made the subject of a double amputation by Dr. Webb.

The following letter was received from Dr. Webb :—" To the chairman and committee of the Melbourne Hospital,—Gentlemen, My attention has been drawn to a newspaper report of an inquest held on the body of a man named Lane, who was admitted into the hospital, and died after operation. At the inquest the city coroner seriously and most unfairly censured my treatment of the poor fellow, and, behind my back, without affording me an opportunity of offering rebutting evidence, he listened to and promulgated a mis- statement of what actually occurred. I trust you will, therefore, afford me an inquiry, as the coroner's censure I consider to be most unjust, and likely to more or less damage my professional reputation with the outside public, wholly unacquainted with the true nature of the occurrence.—Yours obediently, J. H. WEBB."

Both letters were referred to a sub- committee. ,

It was resolved : That all the drugs required for the next twelve months should be procured from Melbourne wholesale houses.

The report of the sub-committee appointed to inquire into certain allegations made by the city coroner with regard to the treatment of Mr. Joske, stated that, on consideration of the last clauses of their previous report, they were of opinion that Mr. Beaney was wrong in not visiting Mr. Joske, on the receipt of the letter from the resident surgeon, particularly after having received a previous communication on the subject from Dr. Jonasson, and was censurable for not doing so.

References

Related documents

Following completion of all inspections and tests, and other physical pre-commissioning process aspects, the submission of; a satisfactory inspection and test results refer paragraph