Sessional_Paper_1901 — Page 264

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perature fell to normal and he was practically well though he looked very pale and pinched. Sputum had ceased entirely. Under tonics and full diet he rapidly convalesced and left the hospital on the

3uth.

Remarks.--This patient had roughly 280 grains of Carbolic Acid without any bad symptoms. From his friends we obtained the information that he had en down once to Ship Street but they were uncertain of the date-4 to 20 days before admission. One case proves nothing, but the high rate of mortality from this form of the dis ase, the serious condition of the patient and his rapid improvement makes one feel that the drug had a good deal to do with the successful result.

PUERPERAL FEVER-RECOVERY AFTER THE INFECTION OF ANTISTREPTOCEUS SERUM,

A Chinese female aged 20 was admitted to the Maternity hospital on the 15th March. with a his- tory of having been in labour for 4 days. The patient's temperature was 103° an she was already suffering from septicemia. The head of the child was outside the vagina. After some difficulty a blunt hook was passed into the left armpit and delivery effected. The temperature kept up betwe 'n 101° and 194° with most offensive vaginal discharge, bad pulse (120-137) and offensive diarrhea. The usual antiseptic douches were used, good diet, camphor and strychnia hypoderinically for the pulse which was constantly threatening to fail. On the 19th the patient was very ill and evidently sinking with tenpera ure 104° pulse 120 and very offensive discharge an I diarrho.

As a last resource

10 cc. of serum were injected at 7 p.m. Next day the temperature had fallen to 102° but the dis- charge was still very offensive so another 10 cc. were given at 11 am. From now on everything changed rapidly for the better. Pulse and temperature both improved, discharge quickly became nor mal and t e diarrhoea ceased. The convalescence was retarded a little owing to the formation of an abscess at the seat of the first injection. The patient was discharged quite well on the 19th April. The serious condition of the patient and the rapid general improveinent leave no doubt that the success was entirely due to the use of the serum.

ACUTE PANCREATITIS-Recovery.

An American aged 19 was admitted on the 21st August suffering from malarial fever. Temper- ature 104.6, vomiting furred tongue and conjunctiva very yellow. He had had previous attacks of malaria. Under morphia hypodemnery calomel and quinine the vomiting ceased and the fever rapidly subsided and on the 5th day he was up and out of bed. There was a slight relapse for which he was treated. On the 11th day he was suddenly taken alarmingly ill. Intense abdominal pain chiefly at the pit of the stomach, cold clammy perspiration, hurried respiration, vomiting and an almost uncount- able pulse were the chief symptoms. He was at once seen and the abdomen found to be very tympa- nitic and tender, the pain being most intense over an area above the umbilicus and to the left of the middle line. An enema brought away a large quantity of pale pasty fœces and this relieved the pain somewhat. The condition-which puzzled us very much-ontinued for 48 hours during which time he required constant hypodermics of camphor and strychnia to keep him alive. His

pu se now im- proved rapidly though the pain and tympanites still continued. A dull area corresp ndig to the janer as could now be made out easily and this was very ten ler on deep pressure. The patient slowly improved and was gradually brought on to solid diet. The dulness continued for some days and then disappeared. He was discharged well on the 14th September.

Remarks. This case was most puzzling after the collapse set in and it appeared as if an ulcer- duodenal or otherwise-had ruptured. Just at the time the Lancet of July 28th arrived containing Mayo Robson's article on pancreatitis and at once gave us the clue to the disease. I have no doubt that this was the cause of the patient's serious collapse and other symptoms.

OVARIAN TUmour—(peraTION-RECOVERY.

A Japanese female was admitted to the Maternity Hospital on 14th January and delivered with- out any trouble of a male child. On the 6th day the temperature rose suddenly to 102° with great pain and tenderness on pressure all over the abdomen chiefly on the right side at McBurney's point. The patient gave an account of a similar attack some time previously and it was thought she was suf fering from an attack of appendicitis. Under treatment she slowly recover and after a mouth she was removed to the general hospital. An examination now showed a tumour extending to both sides of the abdomen and probably growing from the right ovary. On March 28th abdominal section was performed. the incision extending from the umbilicus to an inch above the symphysis pubis. The tumour was a thin-walled multilocular cyst growing from the left ovary and with only one extensive adhesion to the right loin. One of the cavities contained a considerable amount of flaky pus and this. no doubt accounted for the attack after pregnancy. Some time was taken in clearing out the fluid which had escaped into the abdominal cavity and in arresting the hemorrhage from the dee, adhesion. Silk and silkworm gut were used for the sutures and a gauze drain was left in the lower end of the wound for 48 hours. There was no shock although the operation lasted hour and no after vomiting.