NOTE ON DR. NEWTON'S CASE.
In the absence of Dr. Newton, Dr. A. V. M. Anderson, whom we desire to thank for the trouble he has taken, corrected the solutions sent in. He awards the prize to Mr. J. D. Begg, of the Melbourne Hospital, with Mr. H. H. Stewart, of the Alfred Hospital, a close second.
Dr. Anderson says that he believes that he saw the case in question, and that the condition was one of abscess of the lung, which finally pointed in the mammary region, and was drained.
NOTE ON DR. QUICK'S CASE.
In the history of the case given for commentary, the complaint was of attacks of pain similar to those preceding the earlier passage of a stone, except that the pain extended across the back from the affected side. The history given, though brief, contained all that was necessary for a tentative diagnosis, and the case appeared an admirable one for commentary, not only affording scope for logical deduction from ascertained facts, but opportunity for showing familiarity with urological methods.
It is unnecessary to discuss at great length other renal causes of pain which may possibly simulate renal colic (certainly not hysteria and herpes !). Is it wise to cast doubts on the original diagnosis of renal colic, when, following the natural passage of a stone, complete relief for 18 months was obtained?
It should not be assumed that facts of material value in the history or find- ings were purposely omitted in order to make diagnosis more difficult. Surely it may be assumed that as the urine was found to contain "some pus cells," that urinoscopic examination had equally been made for red cells, crystals, organisms, etc. Surely, too, it is obvious that a simple cystoscopic examination, at any rate, was carried out, since it is stated that "excretion from the left kidney was slightly delayed," a fact which can be ascertained in no other manner.
The points which were particularly looked for were :-
1. Explanation of both the earlier and the recent negative X-rays, and of the previous negative result of exploration.
2 Explanation of the present attacks of pain, with but slight urinary changes.
3. Acquaintance with the fact that urologic diagnosis cannot be made without cystoscopic help.
4. The facts that can be obtained by special cystoscopic methods.
5. Some idea of treatment of ureteric obstruction.
The condition present was a ureteric stricture, clue to the contraction of scar tissue at a site of lodgment of the former stone in its passage down the ureter, causing a small hydronephrosis.
The commentary judged to be the best was sent in by Mr. David Zacharin, of St. Vincent's Hospital, to whom the prize is awarded. That sent in by Mr.
Buttsworth was of nearly equal excellence.
CASE FOR COMMENTARY (MEDICAL).
The Editor regrets that, owing to a misunderstanding, there is no medical case for commentary in this issue. He hopes to have one printed and circulated to the hospitals shortly.
Sri,
CASE FOR COMMENTARY (SURGICAL).
Mr. Hugh Trumble has offered a prize of £1/1/- for the best solution.
A male patient, aged 28 years, came to the O.P. department complaining that, since the war, he had had several attacks of pain in the upper abdomen, to- gether with jaundice. The attacks lasted from one hour up to three days.
The last attacks commenced eight days prior to the date of admission. The pain was situated in the upper abdomen, was intermittent in nature, and of moderate severity. The patient felt sick, but did not vomit. After two days he noted that he was jaundiced. The pain gradually passed away. The urine was darker than normal.
On examination, the patient was seen to he definitely jaundiced. There was
a tender area just below the rib margin on the right side, and Murphy's sign was present. Below the left rib margin a solid tumour could be palpated, which ap- peared to be an enlarged spleen. Nothing else of importance was discovered.
The Bio-chemical Department reported as follows :-
(a) Fragility of R.B.C.'s abnormal, hxmolysis occurring in concentrations of saline up to 0.6 per cent.
(b) Fouchet's Test : Strongly positive.
(c) Van den Berg's Reaction : The direct test was negative. The indirect test showed eight units of bilirubin to be present.
(d) Blood film—normal.
•
H.b., 60 per cent.R.B.C.'s, 4,000,000.
A skiagram of the abdomen was taken, and a shadow in the gall-bladder area seen. The radiologist diagnosed multiple stones in the gall-bladder.
As regards the family history, the patient stated that his mother, aged 64, had had recurrent attacks of jaundice for years, and that she was known to have a large spleen.
Discuss the case as presented :—
(1) From the point of view of diagnosis ;
(2) From the point of view of treatment ; and of (3) Prognosis.
lbospital anb Mar 1Rotes.
Melbourne lbospttal 'dotes.
Once again the all-important cry has gone forth, "What are they doing at the Melbourne ?"—and once again the scribe sits far into the night recording such happenings and culling from an o'er-fevered brain such mellow reminiscence
THE SPECULUM. 55 as may move the honourable reader to a sigh or cheat thee of a tear—probably • the latter.
First let us speak with fittingly bated breath of those in authority. Bill Hailes has now taken over from Victor Hurley that most thankless of tasks—
Dean of the Hospital Clinical School. "Gentlemen, did I say • thankless—I beg your pardon" (Berry)—for is there one of us who is not heartily grateful for the work done by men like these, whose interests are the school and the student, and whose policy is ever the ready ear and the kindly word. We learn with sincere regret of the resignation of Mr. Kent Hughes from the staff. Athlete, author, soldier, surgeon—henceforward the M.H. and kids know him no more.
He has that keen and active interest in things, which endows its fortunate pos- sessor with apparent perpetual youth, and the reason for his retirement came as a surprise to many. Students will miss him.
W. G. D. Upjohn is now indoors at the kids, while Frank Andrew coaches the M.H. student is the allied schools of rhinology and profanity. Charlie Littlejohn now runs his own clinic in S.O.P. Many swear by him—many are sworn at by him. It was in response to Charlie's inquiry for history of any neis- serian infection that one of his patients, drawing his semi-nude figure to its fine height, exclaimed to a room full of students : "No! No ! Not that ! Thank God I'm pure !" N.B.—True yarn.
After the March debacle we have many in our midst who were called, but, very unfortunately, not chosen. They bear tip cheerfully, and are the backbone
of the bridge and poker school. Fourth year roam the wards with spotless coats and shining faces—many of these colts are already playing a good fist round the tables. Fifth year in O.P. incline to shagginess as to visage and raiment. One of them has quelled a riot in a train, another has had a spindle celled sarcoma removed from one arm—apparently some people will do anything for notoriety.
One the whole, however, our fifth year are a worthy lot. They work thoroughly
—they do not f requent the vicious atmosphere of dance or dinner ; they sub- scribe to nothing but the policy that if a man does not waste his money on cigarettes, theatres, drink and women, he can have a rattling good time on what he saves. There are certain exceptions.
Now is the time when the special clinician stalks abroad, and the voice of the lecturer shatters the chilly dawn. Bid still rushes his auburn whiskers into half-past-eighters at about 8.57. Every now and then little groups of stalwarts go forth silently from us for a time—to return later—full of strange oaths and bearded like the pard—whispering together of normal and breech, and P.O.P., in the deep serious tones of men who have gone far and seen much. Gibby still wants to know how one can be at a skin clinic, at the Eye and Ear, at Fairfield, and at a forensic lecture at one and the same time. The answer is a sour fruit in five letters.
Besides ordinary lectures, Dr. Kellaway has commenced a series of lectures in clinical pathology on Saturday mornings, and has helpfully allowed us to choose our own subjects. Fourth year have finished mat. med., and still struggle with path. With regard to P.M. attendances, we believe that the authorities have in hand a scheme whereby students can back their favourites for the path.
ex. with the dean. It is hoped that this stimulus to interest in form will draw many more Walter-and-Eliza-ward at eleven-thirty. One appreciates the com- parative comfort of P.Ms. nowadays, after the old days of backache and cricked necks.
The roll call at lectures is still unsatisfactory. That a lecturer should grudge
the five minutes to call over the names of his class establishes a bad precedent for the normally not over-punctilious student. Anyhow, why have rolls ? Ask Siddy Sewell !
The M.S.S. dinner ! How delicious ! How nutritious ! Of it much is written elsewhere. We desire to place on record that we enjoyed it. So did Dr. Hurley—especially Newport's joke about the dog. Mr. Newton's speech was inclined to be a little didactic. He tried to tell us that once he was floored in an exam.—some question apparently of the relation between pots and beer.
With all due respect to Mr. Newton, we consider that he carried self-deprecia- tion to the point of heresy. His modesty—like the last mouthful of that delect- able M.S.S. pudding—will simply not go down. The idol of omniscience still stands.
On the tenth of June the resident staff and nurses bade us to a dance in the Out-patients' Hall. This we gladly obeyed, and passed an exceedingly pleasant evening. Harold Dew rolled up with that Jacksonian look and his wife—for full account see social columns. Thanks to Nurse Fisher and Dr. O'Donnell, who ran the show, everything ticked over to perfection. One of Ormond's most promising students wishes to thank certain unknown persons for their con- siderate manipulation of the electric light. He considers it saved him untold blushes.
Still missina
b from the library are the new volumes of Choyce, Minor Maladies, and other standard text-books. Would that lineal descendant of the Gadarene swine who removed them kindly replace them. He causes endless in- convenience, and lays himself and the hospital school generally open to all sorts of nasty remarks.
In conclusion, we beg to congratulate heartily our predecessors who have crossed the Rubicon. With those who were shot we sympathise. Our turn next !
ELfreb lboopttal 'Rotes.
Events have followed one another so closely this term that we feel some- what in the position of the shy boy with the brand-new flapper. We don't know quite where to begin or what to leave out. But, like the shy boy, we will do our best.
Hearty congratulations to the final honours' men, Drs. Buchanan, Deane, Almond, Downie, Nye and Brown ; and to the additional residents, Drs. Fre- mantle, Henderson, Peacock, Grimshaw and Mackay. Also to the registrars, Drs. Mills, Thomas and King. Fourth year in particular are glad that "Kingy"
is staying on. He has been, and promises still to be, an unselfish and efficient friend to them in path.
We were pleased to see Downes and Kaye take high places in the honour lists last November. In path. they equalled top place of the second-class lists, being second to the exhibitioner.
The students' library this year has taken gratifying steps ahead. Amongst many generous donators we would like to thank particularly Messrs. W. Ramsay and Alan Grant for their valuable contributions.
A good muster of Alfred men turned up to the med. dinner. The pity is that this excellent function is so poorly patronised by the earlier years.
The speeches were many, and for the most part witty. The supragranular was not allowed to step out of its turn. Newport and Ray more than held their ends up (metaphorically speaking) in telling of anecdotes.