THE SYMPTOMS OF CONGENITAL DIAPHRAGMATIC HERNIA. and his renal excretion had been normal. On Jane 13th, 1897, Dr. Marchand operated at the Saint-Loui...

186KB Sizes 6 Downloads 238 Views


and his renal excretion had been normal. On Jane 13th, 1897, Dr. Marchand operated at the Saint-Louis Hospital,

reproducing his predecessor’s incision, but prolonging it slightly downwards. The tumour contained yellowishgreen, grumous pus, and was firmly adherent to the parietal peritoneum. Its walls were very thick and fairly smooth internally, but the contained cavity was somewhat irregular in shape. The pus, examined under the microscope and also by culture on gelose, was pronounced Hooklets and other relics of the echinococcus carefully searched for but with negative results. In conclusion Dr. Rebreyend gives it as his opinion that the case is the first on record in which recurrence of an hepatic abscess occurred after operative interference followed by such a long interval. The cause or causes which led to the recurrence are, however, still to seek, but the fact that the pus evacuated at the second operation was sterile is greatly in favour of the view that the second abscess was not of recent formation; the thickness of its walls also points in the same direction, so that we are justified in thinking that it had formed a long time, probably years, previously-perhaps it had commenced immediately after the first operation. The sudden appearance of the abscess may easily have been due to a little fresh exudation into it caused perhaps by some slight unnoticed trauma and the increase in size may have sufficed to break through some fascia which had held it down, so that it formed an obvious to be sterile.





inquest was held on Oct. 6th at Lincoln upon the of body a child, aged seven years and eleven months, who ,died after eating "chewing gum." The sweetmeat in question was labeled "for chewing only "and "this is not to be eaten." After hearing the medical evidence the jury returned a verdict " that death was due to peritonitis of which they were unable to say the cause. At the same time the foreman stated they would like to say that in their opinion the sale of chewing gum should be strictly prohibited and shopkeepers asked to refrain from selling it." This last request seems to us to ba superfluous in view of the preceding words, and besides to ask anyone to refrain from selling a harmful substance is silly. The right course is to pass a law to make anyone who sells stuff of this kind liable to a heavy penalty. We refer in our leading columns to this subject, but it is our firm opinion that quack medicines and the like will never be got rid of until such practices are made unprofitable. A fine of 10s. for adulterating foodstuffa is absurd, and in addition to increasing the fine by at least a hundred times the recommendation of the Select Committee ought to be enforced as to the convicted person publishing a notice of conviction in his place of business. What chewing gum is made of we do not know, but it is probably similar to that delectable mixture "chocolate chumps," which consist largely of paraffin wax and are


than normal. The vomiting ceased in a day or two, but the laboured breathing continued. On the sixth day there was an exacerbation, and a frightfal picture of Henoch’s asthma dyspepticum was presented. After a short spell of crying the child suddenly became blue in the face and hands; he made violent respiratory efforts with slight success; his pulse was not perceptible; the extremities became cold, and cold perspiration dripped from the face. Active movements of intestinal gas could be heard. Warm mustard cloths were applied, but the paroxysm was not relieved until it had lasted an hour. He improved during the next few days, losing the inspiratory recession of the chest. But another asthmatic paroxysm occurred on the ninth day in which the ensiform cartilage was retracted almost to the spine and twitchings of the muscles of the face and arms occurred. After this other attacks took place from time to time, but they gradually diminished in number and intensity. They generally passed off with an escape of gas from the stomach and intestine. Gas could be felt moving in the abdomen and sometimes over the whole body. At the end of six weeks, when the child was apparently quite well, a moderate paroxysm occurred, in which he died. At the necropsy a deficiency was found in the diaphragm on the left side. The left pleural cavity was filled by the whole of the small intestine except the first two inches of the duodenum, the caecum, the ascending, transverse, and part of the descending colon, together with the pancreas. The left lung was compressed into a small space. The heart was situated to the right of the median line deep in the mediastinum. During life the case was diagnosed by the writer, Dr. Booker, of Johns Hopkins University, and by Dr. Osler as asthma dyspepticum. A correct diagnosis of these cases is scarcely ever made.


YELLOW fever is still prevalent in the southern paxt of the United States, and if the sensational accounts published daily in the New York lay papers can be credited the condition of affairs in the Mississippi States is indeed lamentable. Happily, these are without a doubt highly coloured reports, and it would seem, judging from the American medical journals, that the epidemic is of a mild type and likely when cold weather sets in to disappear entirely. The circumstance that the outbreak has occurred in the autumn rather than in the .spring must be regarded as fortunate, for it is more than probable that if the germs had been conveyed to the Gulf shore in the early part of the year a far-spreading and severe epidemic would have been the consequence. The work of combating diseases of an epidemic nature falls on the Marine Hospital Service, and most effectively have they discharged this duty. The appearance of yellow fever so soon after the announced discovery of the germ of that disease by Sanarelli is a somewhat peculiar coincidence. Another feature of the outbreak is the extraordinary panic that has seized the inhabitants of quite indigestible. the districts, not only within the infected area, but of districts far outside. In fact, the inhabitants of the region in THE SYMPTOMS OF CONGENITAL DIAPHRAGMATIC which the disease is raging appear to have kept calm in HERNIA. comparison with these outsiders. Every town and village in CONGENITAL diaphragmatic hernia is rare; much more Alabama and Mississippi has established what a wellrarely is it the subject of clinical observation. The following informed correspondent in the district has termed case, published in the Arc7zives of Pediat’J’ics (New York), in a communication to us a 11 shot-gun quarantine." September, 1897, is therefore important. A healthy child, aged Although the disease has been officially declared to one month, was attacked by indigestion and colic, attended be yellow fever, and doubtless is, yet several medical men with frequent vomiting and quickened, laboured breathing. in New Orleans and the adjacent country stoutly deny the The pulse was from 130 to 160 and the respirations were from assertion, but say that it is a form of malaria or what is 60 to 80, with inspiratory recession. Percussion resonance known in India as sun fever. Many of the resident health of the chest was accentuated and the tympanitic sound of officers, who, of course, support the contention that it is the abdomen was transmitted high into the thorax. Vesicular yellow fever, say that the disease is as yet in an inchoate breathing was heard everywhere, but it was much more feeble form; and Dr. Alfred Duperier, a southern health official, -