Functional or organic kidney failure thus becomes a factor in the production of lithiasis. At first, I would go further, and attribute to this cause no small part in producing the insanity which is so prevalent throughout Australia. The outpatient department of this hospital presents a continuous series of cases, where this line in the etiology of the disease is clearly present, and in which most of the symptoms already enumerated, up to hallucinations of all the special senses, can be found.
Since one of the main causes of lithiasis lies in dietary errors, it is clear that adjusting the diet is an essential part of the treatment. In tropical and even temperate climates such as ours, the functions of the skin require almost as much attention as those of the kidneys, and this is especially true in subjects of lithiasis. The pulse was single, diffuse and systolic, being approximately synchronous with that of the heart.
The auscultatory phenomena consisted of a reproduction of heart sounds, marked accentuation of the second, and a systolic murmur.
THE DIAGNOSTIC CONSIDERATIONS
I think we cannot and should not turn a blind eye to the fact that this patient was taking an enormous risk by following the advice given, and luckily favoring them with exceptionally good weather during the trip, could have had disastrous results. As it is, they are quite sad, considering the critical situation and circumstances of the patient. As for the particular aneurysm, the situation in the left scapular and interscapular region, with pallor at the level indicated, gives very strong presumptive evidence that the third part of the arch is affected.
THE PROGNOSIS
THE TREATMENT
The pain in the leg at this time was somewhat aggravated, but there was no pain in the joint. The place where it came from was gently gouged, but the rest of the bone looked perfectly healthy to the touch. From this time and for the next six weeks matters continued, chiefly, as usual in such cases, the temperature remaining low and the wound aseptic.
Examination of a longitudinal section, through the tibia, revealed the presence of an undoubted abscess cavity, the appearance of which is shown in the accompanying photograph (executed by the Imperial Photo Co.) The lower opening communicated with the surface in the center of the scar, overlying the skin and seat of the original injury. So completely was it concealed, and so small was the sinus through the bone leading to the central abscess, that it is very doubtful whether any pus could have escaped, or taken in any air, since the healing of the external wound which took place immediately after its occurrence. But the history of the case, and the connection of the central bony lesion with the original skin wound, must lead to the conclusion that a bony abscess may exist, and give little or no indication of its presence, for some years, until some new confusion of revive it and start it on its way to the nearest node.
The specimen, the photo of which was taken, was displayed at the February meeting of the Medical Society.
A CASE OF APOPLEXY--PARALYSISOF LEFT ARM AND LEG, WITH A SINGULAR EFFECT ON THE
255 nor sensation on the affected side; pinching and tickling of the foot gives no motor response. He finally got enough leg strength to walk with the help of a crutch, and then with a cane. During the entire time he was under treatment, there was never any return of the wrist to the right side, although his muscle strength and movements were quite good.
THE SECRETARY laid on the table a circular forwarded by the Secretary of the Royal Commission for Victoria, containing a copy of the address delivered by H.R.H. 34; SIR,—The impression that appears to have prevailed, that the Lunacy Commission intend to proceed with the inquiry entrusted to them, without consulting the members of the medical profession. The SECRETARY stated that he had already, following instructions from the committee, expressed the company's satisfaction and willingness to assist the Commission in its investigations.
NILD then proposed the following motion: - "This Society expresses its regret over the passing of Mr. Wilkie, in Paris, on April 2, and extends its sincere condolences to the family of the late gentleman.". Wilkie was a founding member of the Society, one of its first presidents, and an active member for many years.
Wilkie was a most amiable gentleman, well respected, and a useful and honorable member of the profession. NEILD then moved the following resolution:—"The Medical Society of Victoria expresses its sense of the loss experienced by the medical profession of these colonies in the death, held on the 1st instant, at Sydney, of Dr. Fortescue, and of the loss suffered by the profession and the public by his death.
But, with the permission of the meeting, he brought before the society a patient with an aneurysm of the aorta, which had bulged forward straight through the sternum. ALLEN then showed the following pathological specimens: (a) Double transverse fracture of the patella in the old state, firmly united by fibrous tissue.
VICTORIAN BRANCH
A ligature of kangaroo pee was placed around the thin and narrow stem, which was palpable at the bottom of the wound as a ventral one. When removing the tumor with scissors, the pedicle slipped back into the abdomen, revealing an opening in the peritoneum the size of a three-penny piece. The patient complained of mild abdominal fullness and occasional pain around the wound for a day or two.
Case of Compound Comminuted Fracture of the Lower Ends of the Tibia and Fibula—Symes' Amputation—Dissemination of Traumatic Gangrene—Death. The inner malleolus protruded about an inch from a wound on the inner part of the ankle joint. There is a dark, bright discoloration that spreads on the inside of the leg and the lower part of the thigh; the vicinity of the wound is almost free from the leaden color, although the whole limb is slightly swollen.
Remarks.-In this case the local injury, though very serious, rather than the exciting, must be regarded as the main cause of the gangrene, which was doubtless due to the conditions of the vascular system. Case of traumatic stricture of the urethra, with recto-urethral fistula—Teevan's operation—General emphysema—collapse. On examination, emphysematic crack was discovered in sacral region, along the outer and anterior aspects of the thighs extending to the ankles, over the chest regions, both arms, and extending to the angles of the jaw.
His intellectual faculties remained perfect until within five minutes of his death, which occurred at half past two on the morning of the 16th instant. The membranous part of the urethra, with bladder and rectum and part of the pubis, was carefully removed. The urethra was carefully opened with scissors; on the upper surface of the wall of the membranous portion was a wound about a foot of an inch long (the seat of the stricture), caused by Teevan's instrument.
265 found at the bottom of the urethra in the membranous part leading into the rectum. Cooke's case was probably similar, namely, the diffusion of rectal flatus through the areolar tissue of the pelvis and down the thighs and nats, gradually extending over the surface of the body and causing death by collapse.
THE LUNACY COMMISSION
Gilson, in the April issue of the Revue de Chirurgie, has. collected the recorded cases in which splenotomy has been performed. The wound was found in the sterno-mastoideus, approximately 2.5 cm below the bifurcation of the carotid artery. The wound in the artery could not have been large, as the temporal artery was easily palpable from the same side.
The absence of personal or hereditary rheumatic tendencies makes no difference in the appearance of arthritic phenomena. This ulcerative process is probably due to the elimination of the drug from the colon. At the meeting of the Council on the 18th, when the subject of clinical teaching was again brought up, the following letter was read.
At the meeting of the Committee, on the 19th ult., the Chief Medical Inspector reported that no new cases of erysipelas or pykemia had appeared in the hospital. Bage, who had previously taken charge of the outpatients, had agreed to act as assistant surgeon, in place of Dr. Webb to call a meeting of the medical staff to consider the scheme suggested by Dr.
The proposal of the University Council regarding the delivery of the clinical lectures was fully discussed, but. Robertson proposed a motion in favor of the scheme proposed by the medical faculty, which was duly seconded. Webb's letter be sent to the Registrar of the University," as the Committee could do nothing further in the matter.
There was no external wound and the source of the infection could not be determined. A letter had been placed on the table showing the presence of the medical officers from September 1883 to the end of 1883. The course is free and is attended by a number of ladies, in addition to members of the nursing staff.
15 JUNE 1885 Great opposition from the inhabitants of the neighborhood has been excited by the proposal to establish a temperance hospital in East Melbourne.
