ST. MARY'S HOSPITAL
On inquiry his mother said that a fortnight before I was first sent for he was eating some nuts when a piece " went the wrong way"; he choked and coughed for a time, but soon recovered himself, and she thought that he had got the offending morsel up, but from that time he had complained of pain in his chest and he had been a little unwell until I was sent for. I suppose that the nut found its way into one of the bronchial tubes which it closed up, causing the lung mischief and setting up some
... d setting up some inflammation resulting in a small abscess, and so becoming loose was coughed up, as I have described, a month after the accident. The case is an unusual one, and as such I have thus briefly described it, thinking it may be of interest to other readers of THE LANCET. ON Nov. 24th, 1896, at 9.30 P.M., I was hastily called to a man whom I found in bed writhing in the most intensely agonising pain in the epigastric region. I immediately gave him a hypodermic injection of half a grain of morphinm sulphas and one-seventy-fifth of a grain of atropinm t sulphas, and applied flannels wrung out of hot water and i sprinkled with laudanum over the region of the pain. Before f my arrival he had fortunately vomited freely several times. When in the course of an hour or so the pain slightly moderated, upon inquiry as to the supposed cause of the trouble, I learned from him that he had arranged to dine with a few friends in the city (Liverpool) and to commence with he had three oysters. He was perfectly well when he sat down to dinner, but had not swallowed the oysters more than two minutes before a feeling of discomfort, rapidly merging into more and more acute painfulness, was felt in the stomach. Not wishing to disappoint his friends, he endeavoured to mask his condition, and partook of a little soup. The pain continued to get worse, however, but he still tried to bear it, and waited until the next course was served. The agony he then suffered overpowered him, and he was compelled to leave the hotel, and by means of cabs and railway reached his home, some five miles out of the city, and went to bed, where, as I have mentioned, I found him in great pain with symptoms of collapse rapidly setting in. I remained a considerable time with him and used morphine freely. The pain became somewhat modified by the opium, but lasted all the first night and following day. On the second day the pain had left him, but he was exceedingly weak. I prescribed four-hourly doses of a mixture of three grains of subnitrate of bismuth, ten minims of solution of perchloride of mercury, B.P., and two minims of diluted hydrocyanic acid until the stomach could retain milk and soda water, and subsequently a little dry champagne. On the fifth day he was able to resume his duties, and his recovery was uninterrupted. The interesting point in this case arises from the exceedingly short period that elapsed between the time of swallowing the oysters and the onset of toxic symptoms. swallowing the oysters Waterloo, Liverpool. WOLVERHAMPTON AND STAFFORDSHIRE GENERAL HOSPITAL. -The forty-eighth annual meeting of the Wolverhampton and Staffordshire General Hospital was held in the Bell Medical and Surgical Library on March 9th. The report showed that 1859 in-patients were treated during the past year ; there were also 12,195 out-patients, who made 42,879 attendances. The average cost of the inpatients was f:3 9s. 8d. per patient and k50 4s. 4d. per bed occupied ; the average stay in the hospital was twenty-three and three-quarter days. The total income for the past yeaI was f:8714 and the expenditure was f:8461. At the meeting held a year previously attention was called to the necessity for renovating the operating theatre in order to adapt it tc modern requirements, and it was now stated that the neces sary alterations and re-furnishing were carried out under thE superintendence of Mr. T. Vincent Jackson, the senio] honorary surgeon, at a cost of E287 11s., and that th theatre was re-opened on July 24th last by Mr. Christophe: Heath. In the afternoon a reception was held in the hos pital and grounds by Mrs. Thorneycroft and Mrs. Twentyman (Under the care of Mr. A. QUARRY SILCOCK.) Nulla antem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, turn aliorum tum proprÎ8S collectas habere, et inter se oomparare.—MOB&A&NI De Sed. et Caus. h f o r b . , lib. iv. Procemium. -OF the many morbid conditions at one time considered purely medical which have of late years been handed over to the surgeon, few give more satisfactory results from surgical treatment than perforation of a simple gastric ulcer; but it is essential that only a few hours should intervene between the perforation and the laparotomy, and the satisfactory ending of Mr. Silcock's case, though perforation had occurred twenty-four hours before operation, must be attributed to the careful cleansing of the peritoneum in the neighbourhood of the perforation. The method employed in this case to cover the perforation has been used for the treatment of dilated stomach, as in a case under the care of Dr. Ewart and Mr. Bennett.1 A woman, aged* twenty-five years, was brought to St. Mary's Hospital by Mr. E. Archer Wood, of Dulwich, on July llth, 1896, suffering from perforating gastric ulcer and peritonitis. Her history was as follows. She had been in delicate health since the age of sixteen years. On Sept. 5th, 1895, she suffered from haemorrhage from the stomach and much vomiting. Since that date she had been under treatment for gastric ulcer from time to time, having once been an in-patient at Charing Cross Hospital. on the evening of the llth, nearly twenty-four hours after the accident, she was evidently extremely ill and very pallid. The pulse was 100 per minute, regular, and fairly strong. Her temperature was 100° F. The tongue was somewhat dry. The respiration was entirely thoracic, 20 per minute ; the diaphragm did not descend in inspiration ; the abdomen was considerably distended, the distension being evenly distributed. She complained of pain and tenderness. all over the abdomen, but especially in the left hypochondriac region. On percussion the abdomen was found to be generally tympanitic. The liver dulness was lost. The urine was normal. She was at once taken to the operating theatre. An incision about four inches long was made, commencing one inch to the outside of the ensiform caitilage and carried outwards on the left side parallel to, and about half an inch below, the lower border of the ribs. On the peritoneum being opened a large amount of gas escaped. The wound was found to be immediately over the perforation of a large gastric ulcer, through which' white curds of milk mixed with gastric juice were escaping. The perforation was in the anterior wall of the stomach about two inches to the left of the middle line. A stomach tube was passed down the oesophagus, about ten ounces of fluid containing a good deal of white curd were syphoned off, and the stomach was thoroughly washed out. Around the perforation the stomach wall was indurated and covered with lymph. The zone of induration extended through all the coats and for an area roughly three-quarters of an inch in width beyond the margin of the perforation, which was about the size of a No. 9 catheter. The silk sutures, inserted 1 THE LANCET, July 4th, 1896, p. 8.