198 to its mucous surface. In this way, I have frequently given a patient a good night by a morphia pessary, where rectum suppositories and other means have failed. Liverpool. HELOUAN, EGYPT, ITS BATHS AND MINERAL WATERS. BY T. J. PYLE, M.D., MEMBER OF THE GENERAL MEDICAL COUNCIL. I HAVE just returned from a fortnight’s visit to the Baths of Hélouan, which were first prominently brought into notice by Dr. W. Reil in 1874. It is to this gentleman, who was formerly director and physician to the baths, that I am indebted for much of the following information. It was two years ago when I first visited these springs, when I found the travelling and other difficulties too great for invalids to surmount, and I did not consider myself jus- tified in recommending them to the notice of the profession. Happily since then his Highness the Khedive, fully appre- ciative of their medicinal virtues, has constructed a railway which conveys the traveller in one hour of comfortable travel from the citadel of Cairo. Helouan stands on the desert, eighteen miles to the south of Cairo, on the slopes of the Mokkattam range of hills, two miles and a half from the Nile, and one mile and a half from the cultivated land. The hotel, which is within a stone’s throw of the baths, contains forty good bed-rooms, saloon, dining and billiard-rooms, and library. The cuisine (French) I found excellent, the wines certainly good, and supplied at a more moderate price than at some other Egyptian hotels. The tariff for board, apart- ments, and attendance is 12s. per diem, with an extra charge for private rooms. On the whole it is admirably presided over at present by Mr. Lombard, by whom certain suggestions of my own have been favourably received. The other buildings of the village are mostly newly-built villas and gardens, occupied by the families of the Khedive, the pachas of his court, and Europeans. As others are in course of construction, it is probable that shortly houses and private apartments may be obtainable by those who desire greater privacy. An abundance of pure Nile water is supplied by a steam- pumping engine, which may be said to have created in Helouan a new " oasis of the desert." The pleasure grounds of the hotel are tastefully laid out, .and planted with sub-tropical shrubs and trees, now (mid- winter) in all their glory of leaf and flower. The view from the hotel is imposing, extending over the sloping plateau of the desert, across the cultivated valley of the Nile and its wonderful river, across what remains of ancient Memphis, and. terminating in the table-land of the Libyan desert, whereon, and seemingly close to the spectator, stand the eternal Pyramids. From the flat roof of the hotel, where visitors often congregate to view the sunset and superb after-glow, eighteen pyramids can be counted. There are many places of interest within reach of Helouan, among others, Memphis, three miles ; Sakkara, with its pyramids, tombs, and serapeum, seven miles ; and in the eastern range the wonderful quarries of Massara and Tourali, which sup- plied stones for them all. For lovers of sport good bags of wild fowl can be obtained in the Nile neighbourhood: quails in their season; ducks, . geese, and snipe at all times; pelicans, flamingoes, herons, and birds of that class, are in abundance. In the desert are antelopes, hyenas, jackals, wolves, and wild cats. For excursions into the mountains donkevs and camels can be easily procured. Now, as regards the mineral springs, the bathing establish- ment is divided into two portions. The part reserved for the harem of the Khedive is fitted up with the usual oriental magnificence, and appears to be much frequented. The other half, for the general public, is divided into fourteen bath-rooms, with arrangements similar to those of German spas, and floored with Minton’s tiles. The charge per bath is two francs and a half. One of the four sulphur springs is diverted to an open pool, fifty feet across, by a depth of three feet six inches, with dressing-rooms attached for the accom. modation of swimmers. The temperature of the sulphu] springs i-< 88° F. at the source, and 77° F. at the baths; which may be further heated at the pleasure of the bather by hot-water pipes. I have found the water not so unpleasant to the taste as other sulphur waters, nor is the smell so pungent. Accord- ing to an analysis made by Professor Gastenel Bey, one litre of suluhur-water contains The saline springs are situated about one mile distant; they are yet only in the form of open wells with brick in cement surroundings, and are said to resemble Pullna and Carlsbad in their properties. I have not as yet seen any analysis, but from their taste I should say they are not so strongly impregnated with saline matter, but contain evident traces of iron. On my return to England I shall submit samples for cor. rect analysis. The ordinary temperature of Helouan is one and a half degrees lower than that of Cairo, and being two and a half miles from, and over 100 feet above the level of the river, enjoys an immunity from the fogs which are of frequent occurrence in that city. It therefore appears to me that Helouan will in the future hold an important posi- tion as a sanatorium, or as a winter residence for invalids. It is preferable to Dahabeeah travelling on the Nile-and here I can speak from the experience of two seasons in Dahabeeahs-in these respects. Communication, postal and telegraphic, is daily kept up with the outer world. Medical advice can be readily obtained from Cairo, while a resident European physician is expected shortly to be appointed by the Khedive ; and it is entirely free from the many inconveniences and irritations so constantly met with on the river, which, in my opinion, go far to neutralise the fine Egyptian climate. In conclusion, Helouan is well worthy the attention of the medical pro- fession for the class of patients that require a course of such baths and waters, and are debarred from the use of corre- sponding spas nearer home by the inclement winter weather of Europe. Cairo. A Mirror OF HOSPITAL PRACTICE, BRITISH AND FOREIGN. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, turn aliorum, turn proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Caus. Nlorb., lib. iv. Prommium. SEAMEN’S HOSPITAL, GREENWICH. GANGRENE OF THE LUNG IN A CASE OF LEAD- POISONING. (Under the care of Dr. RALFE.) FOR the notes of this case we are indebted to Dr. H. Mnrphy, the house-physician. P. J-, aged twenty-eight, was admitted on Oct. 16th, 1877, suffering from lead colic, which had first attacked him whilst painting six weeks previously. The blue line was well marked on his gums. He was pallid, and looked ex- tremely haggard and ill; stated that he had had syphilis and a severe attack of ague five years ago. Slight systolic murmur; aorta, chest-sounds otherwise normal; urine L clear, acid, with one-eighth albumen. The morning after s his admission, he complained of indistinctness of vision, and about 4 P.M. he became insensible, without convulsion or . rigidity, and in this state remained some hours. The next day he had fully recovered consciousness, and could see , distinctly. No paralysis.
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to its mucous surface. In this way, I have frequently givena patient a good night by a morphia pessary, where rectumsuppositories and other means have failed.
Liverpool.
HELOUAN, EGYPT, ITS BATHS AND MINERALWATERS.
BY T. J. PYLE, M.D.,MEMBER OF THE GENERAL MEDICAL COUNCIL.
I HAVE just returned from a fortnight’s visit to the Bathsof Hélouan, which were first prominently brought intonotice by Dr. W. Reil in 1874. It is to this gentleman, whowas formerly director and physician to the baths, that I amindebted for much of the following information.
It was two years ago when I first visited these springs,when I found the travelling and other difficulties too greatfor invalids to surmount, and I did not consider myself jus-tified in recommending them to the notice of the profession.Happily since then his Highness the Khedive, fully appre-ciative of their medicinal virtues, has constructed a railwaywhich conveys the traveller in one hour of comfortable travelfrom the citadel of Cairo. Helouan stands on the desert,eighteen miles to the south of Cairo, on the slopes of theMokkattam range of hills, two miles and a half from theNile, and one mile and a half from the cultivated land. Thehotel, which is within a stone’s throw of the baths, containsforty good bed-rooms, saloon, dining and billiard-rooms, andlibrary. The cuisine (French) I found excellent, the wines
certainly good, and supplied at a more moderate price thanat some other Egyptian hotels. The tariff for board, apart-ments, and attendance is 12s. per diem, with an extracharge for private rooms. On the whole it is admirablypresided over at present by Mr. Lombard, by whom certainsuggestions of my own have been favourably received. Theother buildings of the village are mostly newly-built villasand gardens, occupied by the families of the Khedive, thepachas of his court, and Europeans. As others are in courseof construction, it is probable that shortly houses and privateapartments may be obtainable by those who desire greaterprivacy.An abundance of pure Nile water is supplied by a steam-
pumping engine, which may be said to have created inHelouan a new " oasis of the desert."The pleasure grounds of the hotel are tastefully laid out,
.and planted with sub-tropical shrubs and trees, now (mid-winter) in all their glory of leaf and flower. The view fromthe hotel is imposing, extending over the sloping plateau ofthe desert, across the cultivated valley of the Nile and itswonderful river, across what remains of ancient Memphis,and. terminating in the table-land of the Libyan desert,whereon, and seemingly close to the spectator, stand theeternal Pyramids. From the flat roof of the hotel, wherevisitors often congregate to view the sunset and superbafter-glow, eighteen pyramids can be counted. There are
many places of interest within reach of Helouan, amongothers, Memphis, three miles ; Sakkara, with its pyramids,tombs, and serapeum, seven miles ; and in the eastern rangethe wonderful quarries of Massara and Tourali, which sup-plied stones for them all.For lovers of sport good bags of wild fowl can be obtained
in the Nile neighbourhood: quails in their season; ducks,. geese, and snipe at all times; pelicans, flamingoes, herons,and birds of that class, are in abundance. In the desert areantelopes, hyenas, jackals, wolves, and wild cats. Forexcursions into the mountains donkevs and camels can beeasily procured.Now, as regards the mineral springs, the bathing establish-
ment is divided into two portions. The part reserved for theharem of the Khedive is fitted up with the usual orientalmagnificence, and appears to be much frequented. Theother half, for the general public, is divided into fourteenbath-rooms, with arrangements similar to those of Germanspas, and floored with Minton’s tiles. The charge per bathis two francs and a half. One of the four sulphur springs isdiverted to an open pool, fifty feet across, by a depth of threefeet six inches, with dressing-rooms attached for the accom.modation of swimmers. The temperature of the sulphu]springs i-< 88° F. at the source, and 77° F. at the baths;
which may be further heated at the pleasure of the bather byhot-water pipes.
I have found the water not so unpleasant to the taste asother sulphur waters, nor is the smell so pungent. Accord-ing to an analysis made by Professor Gastenel Bey, one litreof suluhur-water contains
The saline springs are situated about one mile distant;they are yet only in the form of open wells with brick incement surroundings, and are said to resemble Pullna andCarlsbad in their properties. I have not as yet seen anyanalysis, but from their taste I should say they are not sostrongly impregnated with saline matter, but contain evidenttraces of iron.On my return to England I shall submit samples for cor.
rect analysis. The ordinary temperature of Helouan is oneand a half degrees lower than that of Cairo, and being twoand a half miles from, and over 100 feet above the level ofthe river, enjoys an immunity from the fogs which are offrequent occurrence in that city. It therefore appears tome that Helouan will in the future hold an important posi-tion as a sanatorium, or as a winter residence for invalids.It is preferable to Dahabeeah travelling on the Nile-andhere I can speak from the experience of two seasons inDahabeeahs-in these respects.Communication, postal and telegraphic, is daily kept
up with the outer world. Medical advice can be readilyobtained from Cairo, while a resident European physicianis expected shortly to be appointed by the Khedive ; and it isentirely free from the many inconveniences and irritations soconstantly met with on the river, which, in my opinion, gofar to neutralise the fine Egyptian climate. In conclusion,Helouan is well worthy the attention of the medical pro-fession for the class of patients that require a course of suchbaths and waters, and are debarred from the use of corre-sponding spas nearer home by the inclement winter weatherof Europe.
Cairo.
A MirrorOF
HOSPITAL PRACTICE,BRITISH AND FOREIGN.
Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborumet dissectionum historias, turn aliorum, turn proprias collectas habere, etinter se comparare.—MORGAGNI De Sed. et Caus. Nlorb., lib. iv. Prommium.
SEAMEN’S HOSPITAL, GREENWICH.GANGRENE OF THE LUNG IN A CASE OF LEAD-
POISONING.
(Under the care of Dr. RALFE.)FOR the notes of this case we are indebted to Dr. H.
Mnrphy, the house-physician.P. J-, aged twenty-eight, was admitted on Oct. 16th,
1877, suffering from lead colic, which had first attacked himwhilst painting six weeks previously. The blue line waswell marked on his gums. He was pallid, and looked ex-tremely haggard and ill; stated that he had had syphilisand a severe attack of ague five years ago. Slight systolicmurmur; aorta, chest-sounds otherwise normal; urine
L clear, acid, with one-eighth albumen. The morning afters his admission, he complained of indistinctness of vision, and
about 4 P.M. he became insensible, without convulsion or. rigidity, and in this state remained some hours. The next
day he had fully recovered consciousness, and could see, distinctly. No paralysis.
199
Under appropriate treatment, the colicky pains dis-appeared, and the patient began to improve in appearance;but thirteen days after the seizure which had attacked himthe day after admission he began to be troubled with cough.This continued to increase, and the following note was madeon Nov. 17th :—Lower lobes of both lungs rather dull; theright, bubbling crepitation; the left, tubular breathing; andat extreme base some crepitation; expectoration dark-coloured, with fetid stench; pulse 100. Temperature:Morning, 101’4°Fahr.; evening, 104.1°. On Nov. 20th, hehad some decided hsemoptysis, and exhaustion rapidly setin. He died at 1.15 A.M. the next day.Post-mortem examination.-Pericardium contained three
ounces of clear serum. Heart weighed ten and a halfounces; no valvular disease, but a few small spots ofatheroma at commencement of aorta. Pleurae flrmly ad-herent, especially the left. Right lung weighed twenty-fiveounces; very pale ; posterior part of lower lobe quite solid.Left lung weighed twenty-one ounces; greater part quitesolid, except apex. At the posterior and outer part, a cavityabout four inches long; the outer wall formed of thickenedpleura, the other wall shreddy, brownish-green, softened,and gangrenous. The dead tissue formed an isolated, ab-ruptly limited, gangrenous patch, about the size of a walnut,separated from the surrounding pneumonia by a yellowishmembranous deposit of lymph. Brain not examined.Remarks.-Dr. Ralfe observed that the gangrene of the lung
in this case was, without doubt, proximately due to embolism,and that the mischief might be dated from the day after theadmission of the patient to the hospital, when he becameinsensible; that attack being due, no doubt, to the simulta-neous plugging of one of the arteries of the brain with an em-bolus. The inflammation excited in the lungs by the emboluswas, at first, apparently of a very mild character, for it was nottill eleven days after the first appearance of lung trouble thatany suspicion of gangrene existing was entertained. Fromthis slowness of onset, and also from the fact that the manhad suffered from the effects of syphilitic, malarial, and me-tallic poisoning, it would appear as if the gangrene in thiscase resulted rather from a depraved textural condition ofthe lung itself, which rendered it unable to resist an attackof inflammation of moderate intensity, than from the actualcutting off of the blood-supply by the embolus.
ABERDEEN ROYAL INFIRMARY.CASE OF PSOAS ABSCESS ; ANTISEPTIC TREATMENT ;
RECOVERY.
(Under the care of Dr. OGILVIE WILL.)
J. N-, aged fourteen, suffering from angular curvatureof the spine, involving the seven lower dorsal and first lum-bar vertebrae, of long duration, was admitted to the infirmaryon account of a psoas abscess pointing in the left groin, ofwhich the following is a condensed history. He stated thatabout six months before admission, when taking violentexercise, he "felt something give way." About a monthafterwards he observed a small swelling in his groin, whichgradually increased, but was unattended by pain. He ap-plied to Dr. Garden, who aspired the swelling on threeoccasions, drawing off a small quantity of fluid at eachtapping, but failing to perceptibly reduce its size. Asaspiration was evidently insufficient, he was sent into Jacob’sward for the purpose of having the abscess opened antisep-tically. At that time a large, tense, fluctuating swellingwas observed on the inner side of his left thigh directlyunder Poupart’s ligament, presenting the usual features of apsoas abscess.On August 17th, 1877, the skin having been thoroughly
purified by washing with carbolic lotion, the abscess wasopened under spray, and a large quantity of pus, containingnumerous flakes of curdy material, was allowed exit. Di-gital pressure was employed to squeeze out the remainingfluid, and several pieces of bone, evidently derived from thebodies of the affected Vertebrae, were removed by passing aforefinger into the cavity. A long drainage-tube, of largecalibre, was introduced, and the usual antiseptic dressingswere applied, an elastic-web spica bandage holding all inposition. It may be here mentioned that, had it not beenfor this elastic bandage, it would have been perfectly im-possible to prevent the access of putrefactive elements tothe wound, for the boy felt so well from beginning to end,
and he was, as Mr. (ilass (one of the dressers of the case)truly remarked, so " full of life," that he could not be keptstill; he was so active in his movements that fifty timeseach day he ran the risk of displacing the dressings, but bythe aid of the bandage, and a Liston splint, which it wassubsequently found necessary to apply to restrain him, thedanger was averted.August 18th.—Dressings removed under spray, a small
quantity of red, serous discharge staining the deep dressing.Temperature 99-4°; pulse 92. Dressing as before.
19th.—No sign of inflammation about wound. Tube filledwith curdy material. A very little serous fluid obtained bypressure. Temperature 99’2°; pulse 96.
21st.—Very slight serous’discharge. Curdy substance intube. No inflammation. Temperature 98’8° ; pulse 84.23rd.-Discharge similar in character, but less in quantity.
Temperature 98’6° ; pulse 72.Sept. 5th.-A smaller tube was substituted for that first
inserted. From this date progress towards recovery wassteady, the cavity gradually contracting, necessitating thelessening of the length and calibre of the drainage-tube fromtime to time ; but as the notations, which were carefullytaken on each occasion when the dressings were changed byMr. Aitken, are similar to those given, repetition is un-called for.On Sept. 30th there was a sudden increase of discharge,
the fluid being light-yellow in colour, mixed with curdymatter, but there were no signs of inflammation about theopening, no tenderness on pressure, and no putrefactiveodour. At this date the temperature, which had beenslightly higher than usual for some days previous, ran up to102-4°; pulse 100. On the following day it fell to 100-9°,and the dressings were not removed. On Oct. 4th it wasagain normal. During the next four weeks the dischargevaried in quantity, but the abscess cavity gradually becameobliterated. On Nov. 5th, on the wound being exposed,after the dressings had remained unchanged for three days,only a slight stain on the gauze directly in contact with theopening was found. A very narrow drainage-tube, one
inch long, was inserted with difficulty. On Nov. 12th itwas shortened to half an inch; and on Nov. 17th it wasremoved altogether, after which the opening speedily healed,and the patient was dismissed from the hospital. He pre-sented himself a short time afterwards in perfect health, andsince his dismissal he has been disporting himself in a mostactive manner without showing the slightest inconvenience.
CARDIFF UNION HOSPITAL.INTESTINAL OBSTRUCTION.
(Under the care of Dr. SHEEN.)A. B-, aged eighteen, a pawnbroker’s assistant, was
admitted at noon on January 21st. He was a Jew, hada strumous look, a red-and-white complexion, and dark hair.He stated that he had not passed wind or had a motion sincethe 18th, that his bowels had been regular up to that time,that he had a similar attack twelve months ago which lastedtwo weeks, cause unknown, and that he had been subject tosuch seizures since childhood. Up to the 18th he was quitewell, and had had his bowels moved daily and naturally. Inthe morning he was roused from sleep by a pain round theumbilicus, which went away in half an hour, but soon re-turned, and got worse towards evening, when he went tobed and took two pills, sent him by the doctor, after whichhe slept, and the pain was easier. A medical man saw himon the morning of the 19th, and from that time to his ad-mission he was treated chiefly by enemata and poultices.On admission there was uniform enlargement of the
abdomen, with tympanites and pain, occasional hiccough,and an anxious expression. A turpentine stupe was appliedto abdomen, and an enema of turpentine and castor oil wasadministered. Fifteen drops of tincture of belladonna in
half an ounce of water were given every two hours.On the 22nd the abdomen was immensely distended and
tympanitic throughout. There was no relief, and the anxiouslook continued. He had been sick once or twice during thenight, but not afterwards. The pulse was fairly good;pupils not dilated, and the throat not dry. Treatment con-tinued. A warm-water injection to one pint was given.After 4 P.M. the bowels acted four or five times, and several
