1917 BMJ (Clinical Research Edition)  
Under the care of Mr. HARMAN BROWN; reported by J. H. DOVE, M.B., Ch.B., Senior House-Surgeon.) A GIRL, aged 19, presented herself at the out patient department of the Coventry and Warwickshire Hospital collmplaining of diffuse abdominal pain wlhich came on with increasing severity at each period. A large tense swelling could be defined lying in the pelvis, rather to the. left of tlje middle line, and hardly to be dissociated from.the uterus; no os could be discovered. Mr. F. L. Harman Brown
more » ... rated; tle niedian abdominal incision exposed dark brown mass in the pelvis, almost as large as. a child's head. On the right of thle mass, and fused to it, was a smaller swelling, re sembling a large Fallopian tube, which proved, lhowever, to be a small independent uterus. Tlfe larger mass was opened; it contained a great quantity of dark-brown viscid material, retained menses, and was found to terminate as a blind sac deep in the pelvis, being, in fact, a separate uterus with a. cougenital stenosed tagina, and, as the uterus functioned at the periods, a lhaematometra had.developed. Tlhe smaller uterus was functioning, but from its -abnorimal appearance and situation it was decided to be iscIcss. Its cavity, when exposed; was seen to be continuous with a long, narrow cervical canlal whicl passed behind the larger swelling, opening into / a normial vagina. From the accoinpanying dliagram it secns clear tllat tllere was a double uterus -~aild double vagina--tlhe condition known as uterus bicolrnis. CBoth hiorns of the uterus were remnoved at the level in(dicated by the line ..B, anid tlle two vaginae were closed and covered over witlh peritoneum. Tlhe iuperforate vagina was thus converted into a comnpletely closed sac. The question was raised wlhetlher an opening should be made at the point c, so as to draini the closed tlhrouali tlle open* vagina; but, as tlhe corresl)onding uterine lhorn had been removed, it seemled iml)robable that tlhe closed vagina would fill again. It was tlherefore left intact, but an opening Wvill be madle slhould alny trouble develop. At the end of thlirty-eight days the patient, after an uneventful recovecy, left the lhospital in g,ood lhealtlh. Mr. Harniiani Brown lhas kindly consented to tlhc publication of this case. PNEUMONIA WITII IIYPERPYREXIA AND HEART-BLOCK. AT a miieetinig of tllc Section for tllh Study of Diseases in Children of tlhe Royal Societv of Medicinie oIn January 26tlh, wlen Dr. ROBERT HUTCHISON was in the clhair, Dr. J. PORTER PARKINSON related tlhe caso of a boy aged 14 sears, admitted to the lhospital oln tlhe fiftlh day of hiis illness witlh pneunonic consolidation of the lower lobe of thie righlt lung. Thje temperature was 104" F., bbut rose a few hodrs later to 110' F.; it was taklen in the rectumi with tvo other tlhermometers, in botlh of wlhiclh tlhe imercury rose to the highest lpoint for wlhichl they were calibrated, 110' F. Tlhe patienlt's 'genieral conldition rem:ained good, and he was neithler coinatose nor delirious. He was treated at once withl towels wruung out in iced water and applied to tlle clhest and abdomen. Some houts later the temrrperature rose to 109.6', an)d wns, -lowered in tlie samne way. After remaiininga at about 105' F. for foqr m-ore days it fell by crisi. F)DIIinig thle fovcv the 'pulse. rate varied between 100 and 120. and after the crisis fell to 70. Two days later it fell to 44, atid it was de0monstrated that a condition of 2 to 1 heart-block was p)resent. After two days it rose to between 50 and 60, and became irregular, showing tlhat thle conductivity of the lheart muscle lhad improved, and a week later it had become regular and of normal rate. The boy made a comijp!ete recovery. The case was interestiiig owing to the presenco of two rare cow'plications of lobar pneumonia-hyper. pyrexia and heart block. "THE PANEL DOCTOR." THE little book on /7w Panel Doctor' by Dr. TIBBETTS iS readable and instructive. Those medical practitioners engaged in panel work will learn something to their idvantage, and those who have nothiing to do with this kind of work will also gain by its perusal; thjey will learn how one large section of our community works, and besides they will find much to their own profit in the chiapter4 tllab deal with certification, a matter of great and growing importance. Dr. Tibbetts writes with no air of apology. He states that: The National Insurance Act of 1911 embodied the most serious and comprehensive eftort on the part of the British and probably of any other Government to minimize and remedy the damage from ill health and injuries among the working, classes. The Act, he considers, combined an attempt to alleviato evils that exist, and to prevent-greater by redressing tllo lesser. Tlhroughlout hie makes it clear that he at least views tlho work in whidh -he is engaged as one of real national importance. The book begins withd a statement of tlho mothods of workinig of tlle Act, tlle relation of the doctor to meiinber-8 of societies anid to deposit contributors, tlle difficulties that arise witlh eachi class of insurei person, anld the nmanner in whiclh clhan'ges of relation between doctor and patient miay be effected. Then come sections on certificates and incapacity for work. Dealinig with" law and etlhics, thlo me,dical curriculum and literature of student life is, 11e thinklis, "perhaps too dogmuatie, and tlhe fitst year's experience of thie newly qualified of too liimited a range for the
doi:10.1136/bmj.1.2928.192 fatcat:oh4agsy5hndafeq6ngnr4seuky