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both lungs. One of the thrusts had pierced the cricothyroid membrane and after dissecting down, this opening was enlarged downwards and a tube inserted. He died of pneumonia four days after- wards. The other death after tracheotomy was in the case of a Malay suffering from Bright's Disease where the operation was performed for relief in a case of a gangrenous cervical cellulitis the man dying of septicemia three days afterwards. The other cases of tracheotomy were performed for suicidal cut-throat; these recovered.
LOOSE CARTILAGE IN KNEE-JOINT.
The loose cartilage in knee mentioned in the list of operations was cut down upon and removed by Dr. ATKINSON. It was oval in shape the long diameter being about two inches and the short diameter one inch. The wound healed by first intention, result perfect.
EMPY EMA.
The case of empyema mentioned in the operation list did exceedingly well after operation, his weight at time of operation being 113 bs. and three months later when he left for Australia his weight was 124 lbs. While in Australia he developed Phthisis and again came back to Hospital here and died in the early part of this year (1893).
BUBOES.
In several of the operations on buboes severe hemorrhage was met with from enlarged branches of superficial circumflex iliac and superficial epigastric arteries. It is of little use trying to stop this until one has thoroughly removed out the diseased gland then the artery can be seized and securely tied.
JAS. A. Lowson,
TETANY.
An Indian boy, aged 16 years, was admitted on the 16th November from the P. & O. S.S. Formosa. He stated that ten days before admission he was suddenly attacked with stiffness in the arms, this soon extended to the muscles of the chest and neck so much so that his chin was drawn down towards his chest; after lasting for a few hours this would pass off only however to return again, at the onset before the spasms set in there was distinct pain in the muscles affected.
On admission there was well-marked rigidity of the muscles of both upper and lower extremities, in the upper extremity there was extension of the phalanges on the metacarpal bones, flexion of the wrist and elbow, and adduction of the arm, in the lower extremity the rigidity was most marked in the extensor muscles of the thigh, so that he walked as if his knees were stiff, the sternocleido- mastoids were both firmly contracted, approximating the chin to the chest, the masseters were so firmly contracted that it was with great difficulty that his mouth could be opened and the muscles of the back stood out like firm boards.
His temperature on admission was 100° F., after this it never rose above 99° F.
This spasm did not come on in paroxysms but was continuous, a tonic rigidity of the affected muscles lasting for some hours and only passing off during sound sleep. I could find out no cause for this condition.
He was given first of all chloral and bromide, five grains of the former and ten of the latter thrice daily; this was increased to ten grains of the chloral with ten grains of the bromide every four hours, but with very little benefit. On the 29th November as his condition had not materially improved Extract Physostigmatis gr. was given in the form of a pill every two hours.
The Sister reported "that after the first, but more especially after the second pill, there was complete relaxation of all the affected muscles but in the course of half an hour the rigidity returned.”
On the 2nd December the pills were increased to gr. 24 of the Extract and given every two hours. Soon after this there was decided improvement, the muscles relaxed and the spasms returned much less frequently. On the 11th the Extract Physostigmatis was discontinued as there had been no rigidity for 24 hours. There was no return and he was discharged cured on the 19th December.
At no time was there any anaesthesia. On the 19th November there is a note that the muscles of the back were so strongly contracted that the back was quite bowed (emprosthotonus) with the concavity backwards.
Diagnosis. At first I was considerably puzzled over this case and thought the boy was suffering from tetanus-the favourable issue and the condition of the muscles affected distinguish it from this disease; the bilateral condition and the absence of other symptoms usually met with distinguish it from hysteria.
SEVERE INJURIES TO A CHILD AT WONG-MA-KOK.
A Chinese girl, aged 9 years, was admitted from Wong-ma-kok on the 29th October, 1892, in a state of collapse suffering from the following wounds said to have been inflicted by some wild animal:-
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i. A severe lacerated wound of the right forearm extending from the inner part of the arm just above the elbow downwards and outwards. The hand, with the exception of part of the thumb which