365

DENGUB FEVER.

Dr. W. Burke Ryan, of Bayswater, has been kind enough to forward us acopy of the interesting brochure by Mr. José Gerson Da Cunha, of Bombay,giving a graphic description of the epidemic of dengue which prevailed inBombay during the years 1871-72. From this we learn that albuminuriaand dropsy, so often consequent upon scarlet fever, were absent in thecases described by Mr. Da Cunha. A previous attack of scarlatina, more-over, affords no protection against dengue.

THE communication of Dr. Balbirnie arrived too late for insertion in our

-present number. It shall appear in our next.

DISLOCATION OF THE TRUMB.—POISONING BY CABBOLIO ACID.To the Editor of THE LANCET.

SIR,—Having seen in your journal of last week a case of this very trouble-some dislocation reported by Dr. Taaffe, I beg to state that in one case Isucceeded in effecting reduction by bending the dislocated bone forciblybackwards towards the dorsum of the hand, and at the same time pushingthe edge of the dislocated surface forwards with my thumb until it slipped ;into its natural position. By this means reduction was effected with com-parative ease, after extension with the clove hitch had failed.In one instance of poisoning by carbolic acid, which came under my

treatment, a child of two years of age, who was completely comatose when Isaw him, consciousness was completely restored by the injection of a stronginfusion of green tea into the stomach, after it had been well washed out bythe stomach-pump. Dyspncea afterwards supervened, and the child died.

I am, Sir, yours truly,Rotherham, March 4th, 1873. WM. OXLBY, M.R.C.S.

Mr. A. R. Verity.—l. Parkes’s Practical Hygiene (Churchill).-2. Wilson’sHandbook of Hygiene (Churchill).-3. Report of the Medical Departmentof the Local Government Board on Certain Means of Preventing Excre-ment Nuisances in Towns and Villages (on application to the MedicalDepartment) ; Suggestions as to Main Sewage, Drainage, and Water-supply, published by the Local Government Board (on application to theBoard).

Muca delay having repeatedly arisen from letters of a purely business cha-racter being superscribed " To the Editor of THE LANCET," we have torequest that communications intended for the Publishing or Advertise-ment departments may in future be addressed to the Publisher.

COMMUNICATIONS, LETTERS, &c., have been received from-Sir H. Thompson,London; Dr. Forbes Winslow, London; Dr. Buzzard, London; Mr. Fry,York Town, Surrey; Mr. Brooks,Henley-on-Thames; Mr. Henry Hayman,Stokenchurch ; Dr. Woodhouse, Reading; Mr. Whitehead, Manchester :Mr. Baylis, Birkenhead; Mr. Holderness, Huntingdon; Mr. W. Morton,Southampton; Dr. Adams, Barnes; Mr. Benson, Oldham; Mr. Fenwick,Worksop; Mr. Watts, London; Mr. Ginders, Normanton ; Mr. Webber,London; Mr. Wilders, Birmingham; Mr. Morley, Burton; Mr. Furley,Edinburgh; Mr. Clements, London; Mr. Boyce, London; Mr. Sharman,Foxton; Mr. Elliott, London; Mr. Jackson, Caterham; Rev. H. Croskery,,Jamaica; Mr. Horsell, London; Mr. Boyd, Stockport ; Mr. Quicke, Truro ;- Mr. A. R. Verity, Pontypool; Dr. Davies, Jamaica; Dr. M’Creery, Fermoy;Dr. Walker, Hanley; Dr. M’Ewan, Dundee; Mr. Adamson, Rathkeale;Mr. Wickham, London; Mr. Allard, Tewkesbury; Dr. L. Roberts, Man-chester ; Messrs. Thorne, Whitby; Mr. Logan, Stamford; Mr. R. Minors,Weston; Mr. Stone, Ware; Mr. Wilkin, Wickhambrook; Mr. W. Harley,Bexhill; Mr. Hanfield, Portsea ; Dr. Mackintosh, Southsea; Mr. Lampton;Mr. Lupton, Liverpool; Mr. Nutt, Bolton-le-Moors; Mr. W. Maclehose,Edinburgh; Mrs. Brown, Gosmore; Dr. Savill, East Retford; Dr. Parsey,Hatton; Mr. Lawson Tait, Birmingham; Mr. Greenwell, Leek; Dr. Fox,Scarborough; Mr. Ringham, Nottingham; Dr. Thompson, Leamington;Mr. Weston, Burnley; Mr. Wainwright, Liverpool; Dr. Little, London;Dr. Kinloch, Charleston, U.S.; Mr. Craven, Hungerford ; Mr. J. Grayling,London; Mr. Gale, Cambridge; Mr. Warren, London; Mr. Jenks, Oundle;Mr. Biggs, Salisbury; Mr. Lloyd, Burton-on-Trent; Mr. Acton, March;Dr. Bottle, Birmingham; Mr. Bell, London; Dr. Wyllie, Scarborough;Mrs. Brown, Hitchin; Mr. Clay, London; Mr. Curtis, Tenby; Mr. Short,Chatteris; Mr. Munyard, Lancing; Mr. Thorpe, Aylesbury; Mr. Graham,Wallingford; Mr. Oxley, Rotherham ; Mr. Griffith, Belfast; Mr. Walford,Bedford; Mr. Crofts, Snitterneld; Mr. Tucker, London ; Mr. Cutbush,Leeds; Mr. J. Whitford, Douglas; Mr. Stevens, Richmond; Mr. James,Snitterfield; Dr. Briggs, Jersey; Mr. Bennett, London; Dr. Dale, Ply-mouth; Messrs. Weiss and Son, London; Mr. Burroughs, Shrewsbury;Mr. Chater, Rugby; Dr. Balbirnie, Sheffield; Mr. H. J. Brown, London;Dr. Blaxall, London; Mr. W. Irland, Oakham; Mr. Minter, Dartford;Mr. Poole, London; Dr. Gosset Brown, Hampstead; Mr. Churton, Coventry;Mr. Garrett, London; Mr. Pooley, Cambridge; Mr. Blackburn, Warriag-ton ; Mr. Coates, Ely; Mr. Langford, Southwell ; Dr. Maxwell, Boston;Mr. Roberts, Carnarvon; Mr. Forder, Darlington; Mr. Keene, Malmes-bnry; Mr. Coltmann, London; Mr. J. Raymond; Dr. Watson, Wortley;Dr. Farley, Loughborough; Dr. Stutter, Sydenham; Mr. Hill, London;Msssrs. Potter and Brown, Rotherham; Dr. Maclagan, Dundee; W. B.;The President of the Quekett Microscopical Club; Un Militaire; T. J. D. ;A Victim ; W. B. H. ; Anti-Humbug ; The Military Secretary, India Office ;Reporter; A. T.; A Pensioned Non-commissioned Officer; Subscriber;A Militia Surgeon; P. M.; T. H. H., York ; A Constant Reader ; Calpho ;Candidatus ; B. D. G.; A Provincial Surgeon; Medicus; &e. &c.

Manifield Reporter, Cork Daily Herald, Southport Visitor, Whitby Gazette,Colonial Standard (Jamaica), El Anfiteatro Anatómico Espanol, Man-chester Evening News, Whitby Times, RoyaL Leamington Spa Courier,Evening Express, Bulletin de l’Académie de Medecine, and South London.Press have been received.

Medical Diary of the Week.Monday, March 10.

ROYAL LONDON OPHTHALMIC HOSPITAL, MOORFIELDSS—Operations, 10½ A.M.ROYAL WESTMINSTBR OPHTHALMIC HOSPITAL.—Operations, 1½ P.M. _

ST. MARK’S HOSPITAL.—Operations, 2 p.M.METROPOLITAN FREE HOSPITAL.—Operations, 2 P.M.ROYAL COLLEGB OF SURGEONS OF ENGLAND.—4 P.M. Prof. Flower, "On the

Osteology and Dentition of Extinct Mammalia."MBDICAL SOCIETY OF LONDON.—8 P.M. Address by the President, Dr. S. 0.

Habershon.-Dr. Tilbury Fox, "On Acne."

Tuesday, March 11.ROYAL LONDON OPHTHALMIO H08PITAL, MOORFIELDS.—Operationsn 10½ A.M.ROYAL WESTMINSTER OPHTHALMIC HOSPITAL.—Operations, 1½ P.M.GUY’S HOSPITAL.—Operations, 11, P.M.WESTMINSTER HOSPITAL.—Operations, 2 P.M.NATIONAL ORTHOPÆDIC HOSPITAL.—Operations, 2 P.M.WEST LONDON HOSPITAL.—Operations, 3 P.M.ROYAL MEDICAL AND CHIRURGICAL SOCIBTY. - 8½ P.M. Dr. John Murray,

" On three Cases of an unusual form of Connective Tissue Hypertrophyin Children." - Mr. George Pollock : " Report of a Case of MolluscumFibrosum, or Fibroma," with Observations.

Wednesday, March 12.ROYAL LONDON OPHTHALMIC HOSPITAL, MOORFIELDS.—Operations, 10½ A.M.MIDDLESEX HOSPITAL.—Operations, 1 P.M.ST. GEORGE’S HOSPITAL.—Ophthalmic Operations, 1¼ P.M.ST. MARY’13 HOSPITAL.—Operations, 1¼ P.M.ROYAL WESTMINSTER OPHTHALMIC HOSPITAL.—Operations, 1½ P.M.ST. BARTHOLOMEW’S HOSPITAL.—Operations, It P.M.ST. THOMAS’S HOSPITAL.—Operations, 1½ p.M.KnrG’S COLLEGB HOSPITAL.—Operations, 2 P.M.GBBAT Noaxasax HOSPITAL.—Operations, 2 P.M.UNIVERSITY COLLBGB HOSPITAL.—Operations, 2 P.M.LONDON HOSPITAL.—Operations, 2 P.M.SAMARITAN FREB HOSPITAL FOR WOMEN AND CHILDBBN.—Operations, 2½ P.M.CANOBB HOSPITAL.—Operations, 3 P.M.ROYAL COLLEGE OF SURGEONS OF ENGLAND.—4 P.M. Prof. Flower, "On the

Osteology and Dentition of Extinct Mammalia."ROYAL COLLEGE OF PHYSICIANS OF LONDON. - 5 P.M. Dr. Robert Liveing,

"On Elephantiasis Græcorum."EPIDEMIOLOGICAL SOCIETY.-8 P.M. Dr. Smart, "On Cholera in Insular

Positions."Thursday, March 13.

ROYAL LolrnoxOPHxasLaIIC HOSPITAL, MOORFIELDS.—Operationsn 10½ A.3t.ST. GEORGE’S HOSPITAL.—Operations, 1 P.M.ROYAL WBSTMINSTBB OPHTHALMIC HOSPI[TAL—Operations, 1½ P.M.UNIVERSITY COLLEGE HOSPITAL.—Operations, 2 P.M.ROYAL ORTHOPÆDIC HOSPITAL.-Operations, 2 P.M.CBNTRAL LONDON OPHTHALMIO HOSPITA.L.-Operations, 2 P.M.ROYAL INSTITUTION. - 3 P.M. Mr. Vernon Harcourt, " On the Chemistry of

Coal and its Products."

Friday, March 14.ROYAL LONDON OPHTHALMIOHOSPITAL,MoosPISLas.-Operations,l0, A.M.ROYAL WESTMINSTER OPHTHALMIC HOSPITAL.—Operations, 1½ P.M.Guy’s HOSPITAL.—Operations, 1½ P.M.ROYAL SOUTH LONDON OPHTHALMIC HOSPITAL.—Operations, 2 P.M.CBNTBAL LONDON OPHTHALMIC HOSPITAL.-Operations, 2 P.M.ROYAL CLLHOH OF SURGEONS OF ENGLAND.—4 P.M. Prof. Flower, "On the

Osteology and Dentition of Extinct Mammalia."ROYAL COLLEGE OF PHYSICIANS OF LONDON. - 5 P.M. Dr. Robert Liveing,

"On Elephantiasis Gri3ecorum."QUEKETT MICROSCOPICAL CLUB.-8 P.M.CLINICAL SOCIETY OF LONDON.—8½ P.M. Mr. Barwell, "On a Case of Foreign

Body impacted in the Bronchus."—Mr. Christopher Heath, " On a Caseof Recto-Vesical Fistula in the Female successfully treated by Opera-tion." - Dr. John Ogle, "On a Case of Acute Rheumatic Fever, Peri-carditis, and Pleurisy; expected necessity for Tapping the Pericardium."

Saturday, March 15.HOSPITAL voit WOMEN, Soho-square.-Operations, 9t A.M.ROYAL LONDON OPHTHALMIC HOSPITAL, MOORFIELDS.—Operations, lOt A.M.ROYAL WBSTMINSTBB OPHTHALMIC HOSPITAL.—Operations, 1½ P.M.ST. BARTHOLOMBW’S HOSPITAL.—Operations, 1½ P.M.KiNa’a COLLEGB HOSPITAL.—Operations, 1½ P.M.ROYAL FRBB HOSPITAL.—Operations, 9 A.M. and 2 P.M.CHABiNG-OBoaa HOSPITAL.—Operations, 3 P.M.

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369

think; in the main correct, and it furnishes an additionalmotive for undertaking active treatment in such cases.

I have now, Sir, brought this course to a close, and haveto resign my Professorship into the hands of the Council.The pleasing duty remains of thanking the members of theCouncil, and the other distinguished surgeons who havehonoured me with their presence, for the courteous atten-tion which they have bestowed on what I feel has beenhardly worthy of the expenditure of time so valuable.Feebly, however, as the topics of these lectures have beenpresented to you, they are not in themselves unimportant.If it be true, as I have contended, that internal aneurism,one of the most common and most fatal diseases which wehave to treat, may sometimes be cured, and often checked,by methods of treatment which are as yet hardly under-stood, no duty can be laid upon us more pressing than thatof putting these methods to the test of scientific inquiryand practical experience. If the pleasant labour of pre-paring these lectures has done anything to promote thisend, it will have been amply rewarded. I shall seek fromthe Council the honour of re-selection to this Professorship,and if you should have the patience to listen to me again Ishall hope, in speaking of the surgical treatment of themain forms of external aneurism, to tread upon firmerground than in the present course, and to review the pro-gress of surgery in a province where its success has beenbrilliant and indubitable.

ON THE

VARIOUS MODES OF CONTRACTION OFCAVITIES IN PHTHISIS PULMONALIS.

BY C. T. WILLIAMS, M.A., M.D., F.R.C.P.,PHYSICIAN TO THE HOSPITAL FOR CONSUMPTION

AND DISEASES OF THE CHEST, BROMPTON.

(Concluded from page 300.)

CASE 4.-George G--, aged thirty-two, a baker, wasadmitted under my care July 5th, 1872. His father diedof phthisis. Has always enjoyed good health till 1861, whenhe had haemoptysis amounting to three pints, and in 1865another pint. Lost flesh after the first blood-spitting, andhas never completely regained it. Cough ca,me on four orfive years ago, and has continued up to the present time.Last Christmas he coughed up an ounce and a half of blood,and has steadily lost flesh ever since. At present the coughis constant, expectoration muco-purulent, tongue clean, ap-petite good, pulse and temperature normal. Physical signs :Dulness on left side from first to third rib; cavernous soundsaudible in first interspace; dulness and cavernous soundsabove the scapula; heart drawn up, apex beating betweenthe fourth and fifth ribs. Ordered oil in nitro-muriatic acidand calumba, and a morphia and squill linctus. A weeklater his weight was found to be 9 st. 9 lb.

Sept. 23rd.-Has had haemoptysis to the amount of 2 oz.,stopped by sulphuric acid and alum. Temperature 98’pulse 96.

Oct. 10th.—Much improved; has gained 7 lb. Had hse-moptysis (2 oz.) two days ago. Cough less and expectorationgrey. Marked flattening of the whole left front. Dulness overupper two-thirds, except one inch to the left of sternum,where marked resonance extending as far as the third ribindicates the right lung to be drawn over. Some crepita-tion is audible in the first and second intercostal spaces,and harsh tubular sounds in the upper front. Posteriorlythere is dulness over upper third, and distant cavernoussounds in the interscaputar region. The circumference ofthe left chest on a level with the second rib, and also withthe nipple, is found to be smaller than the right by an inchand a half.He remained in the hospital till Dec. 20th, when he left,

after a stay of four and a half months, improved in strength,with trifling cough and expectoration, but breath short onexertion. During the last fortnight his appetite had fallenoff, and he had lost 6 out of the 71b, he had previouslygained. Oil and tonics had been taken regularly.

The physical signs were the same as above except thatthe dulness in the left front had decreased, and the stomach-note could be detected as high as the sixth rib. Somecrackle was audible over the posterior region, but no ca-vernous sounds could be detected anywhere. Heart’s apexwas felt between the fourth and fifth ribs, one inch to theright of nipple.In this case the void formed by the contracting cavity was

filled, first by the displacement of the heart; secondly, bythe right lung being drawn across; thirdly, by the collapseof the chest-wall; and, fourthly, by the stomach beingdrawn up.

CASE 5.-M. A. J--, aged six, was first seen by me onAug. 31st, 1869. She had lost her mother, one sister, andtwo brothers from consumption, one brother dying at five andthe sister at seven years of age. Her aunt told me that shehad been ailing for four years, and had had cough and ex-pectoration with occasional tinge of blood and considerablewasting for the last five months. She had also been fever-ish at nights, and after great excitement epistaxis had,several times, come on. The physical signs were, dulnessover the upper two-thirds of the left chest, and loud cavern-ous sounds from the first to the third rib and above thescapula. Ordered oil in teaspoonful doses three times aday and the alkaline gentian mixture; and she was after-wards made an out-patient at the Brompton Hospital.

In November she became more feverish and complainedof pain in the left side. Syrup of iodide of iron was sub-stituted for the gentian mixture, and a mustard poulticewas ordered.

Dec. 30th.-Has improved considerably, having gainedflesh, and cough has diminished. Some collapse is visiblein the lower left side. Heart’s motions visible in the upperleft front, but apex not displaced.

In the beginning of 1870 she had measles with catarrhalsymptoms, but recovered from them, having persevered withthe oil throughout; and on Feb. 24th I found a diminutionof cavernous sounds in the left front, but about the sameamount audible behind. In May she had slight haemoptysis,and shortly afterwards was attacked with whooping-cough,from which she recovered fairly.May 23rd.-The physical signs are the same in the left

lung, but in the right lung, which has hitherto been free,tubular sounds are audible above the scapula. Oil hasbeen persevered with, and is now combined with quassiaand iron.

Oct. 27th.-Has grown considerably and gained weight.Respiration 20; pulse 80; temperature 976°. Indistinctcavernous sounds audible in the first intercostal space abovethe scapula and in the interscapular region of the left chest.The heart is drawn up, and the apex beats between thefourth and fifth ribs. There is no difference in circum-ference between the two sides.

Jan. 24th, 1871.-Has been gaining flesh and strength,and, at my request, Dr. C. J. B. Williams kindly examinedher with me. No cavernous sounds could be detected in theleft front, but they were still audible in the interscapularregion. Marked dulness over the upper portion of the leftchest, and but little breathing under the clavicle. Heart’sapex was felt beating against the fourth rib. We concludedthat the cavity had contracted in front, but not entirelybehind.

Oct. 9th.-Has been growing fast, not losing flesh, andgaining strength; has little cough and no expectoration;temperature normal. There is slight collapse under theleft clavicle, and dulness from the first to the third ribexcept one inch to left of sternum, where the stroke-soundis clear, showing the right lung to be drawn across to theleft side, The stomach-note reaches as high as the fifthrib, indicating that that organ is drawn up. Cardiac dul-ness is perceptible almost entirely to the left of the nipple;dulness and tubular sounds are heard in the left inter-

’

scapular region, and no cavernous sounds can be detectedanywhere.

Oct. 7th, 1872.-Oil has been taken steadily, and she hasgrown considerably, but has gained no flesh; has lately

. had enlarged inguinal glands, which have subsided under

. treatment. The physical signs remain the same, and careful

. measurement detects no difference in the circumference ofthe two sides. A month later the little patient was attacked

’ with hip disease, for which I sent her into St. George’s Hos-pital, where she still remains. I saw her last week, and