Special Notice to Melbourne University
66 THE SPECULUM. . May, 1918.
dulness, diminution of breath sounds, and of resonance and fremitus. Nothing abnormal was detected elsewhere.
Comment upon the case with a view to diagnosis, fur- ther methods of examination, and progressive treatment.
[Dr. Noonan has offered a prize of £2/2/- for the best solution of this commentary. Solutions should be sent to the Editor or Dr. Noonan before July 1st. The best. solution will be published in the next issue, together with suggestions and comments by Dr. Noonan.j
Surgical Commentary.
Mr. B. T. Zwar.
An unmarried woman, aet. so, was admitted to hospital on 26th June, 1917.
Her family history did not disclose anything of importance.
She had enjoyed perfect health up to 1912, when she had been an in-patient of a metropolitan hospital for five weeks, suffering from colitis. After this she remained well until June, 1915, when she was ill with an attack of vomiting and diarrhcea, accompanied by generalised abdominal pain;
this attack lasted some days. She had a similar attack in June, 1916.
At the end of January of this year the patient was again taken ill with vomiting and pain between her shoulders. This attack lasted for a few days. Between these attacks the patient had enjoyed perfectly good health.
Three weeks later she had a similar attack with more marked abdominal pain, which commenced in the epigastrium and radiated to between her shoulders. She now noticed that her urine had become dark in colour ; she also had several shivers accompanied by rises of temperature. She did not improve, and was admitted to a metropolitan hospital on 15/4/17. Here, under medicinal treatment and dieting, she improved and was discharged on 17/6/17. On her return home, she was seized with severe abdominal pain and vomit- ing. The pain and vomiting came on suddenly, lasted for three days, and ceased suddenly.
Three days later, the pain and vomiting recurred, and she was admitted to hospital.
On examination the patient was distinctly jaundiced, the urine was dark in colour, and contained bile pigment, the
stools were clay coloured. There was well-marked rigidity in the right upper quadrant of the abdomen. The area of liver dullness extended downwards to three fingers breadth below the costal margin. A mass could be felt under and to the outer side of the right rectus ; this mass extended from the lower edge of the liver to the level of the umbilicus, and was tender on pressure.
In hospital the patient ran a mildly febrile temperature without any marked exacerbation, and she had no shiver.
Discuss the diagnosis and detail how you would deter- mine (both before and during operation), the exact patholo- gical condition present. Discuss the treatment of the same.
Answers to Correspondents.
Atheroma.—"Specific Sonnet" a bit too ulcerous. Try it on your cobbers; they'd probably laugh at anything.
Harold.—"Matron's Moan" was an eye-opener. But this is a respectable paper.
Satan.—You thought we might find a place for "Fizzy Floss." "Fizzy F." found a place for herself—walked straight into it.
Fresher.—You expected us to print your ideas of re- forming the curriculum, did you ? Alas, Fresher, the age of miracles is past.
Prostate.—In spite of your engaging pseudonym, you're a very dull person.
Skatole.—Smother your symptoms till after August.
After all, you've only got him for eighteen months. He's had himself for many years.
Lot's Wife.—Now then, Lot's Wife, don't you leap on us. We didn't say you tasted salty.
Scalpel.—You get into print. Scalpel, but it's only as a warning to others :-
"A CACHETIC CHANT."
" 'Twas gastric carcinoma
That brought the man to me, His chances of recovery
Were one in thirty-three.
I made a clean incision there;
I took the stomach out ;
68 THE SPECULUM. May, 1918.
And would have made away with it, When suddenly a shout
Of wild distress and fearful pain Went up with angry yells—
The patient slung his hook and took My three new Spencer-Wells."
Sandy.—Another lot of "poetry" like that and we'll go into tetany but not before we've put you out of yoUr misery.
Bill the Basket.—Perhaps you are right in saying that some of the women students' skirts are too short. But the Editor can't go round investigating such things. It's not his place—besides, it's rude.
Alpha.—Such general criticism of the Spec-it/um is use- less. You don't say what you object to, and seem to endeavour to explain things by saying you are a Particular Baptist. Well, that's not our fault, anyway.
Bols: They're off.
" Some talk of Egyptian senna, And some of Calomel pills.
Of swift and fierce cathartics, To cure their passing ills.
But the most wondrous purgative That constipation halts,
Is the one that's sold in packets—
The good old Epsom salts."
Is one enough? It is.
(We mean verses, not packets).
Ramus.—It sounds like New York Life; and it wasn't too good.
Zulu.—Not exciting enough.
V. H. W.--Your diatribe against ''The Petticoat Inva- sion was too dangerous. Do you want to see us get chopped off? If we printed it we certainly would get into hot water.
Us! Why, we'd hate to get into any sort of water.
E.W.—Thanks for your effort. If the others had backed up the first verse it would have romped in.