Document JN6ppYXNL3xwY0aXdgkXkwNnr

r*- jvut sfl. *o*j] MEMORANDA. -* .V coeV>nctc.luinaTiichaAeli blood urea was 46 raj. per 100 ssymptoms* oofi rreannal iinaaiude^quiaci.y/,i c.cm., There were *no thirst --or,,.head. * 1 ac:Jhie, and' t"he *to--n--g--u-e- was fairly clean. ^The - tbiiioo,, 'ii in ,fair condition, and bad beta at work till shortly ' before admission. .. , ' On November 8th, the left kidney being judged the better of i the two. nephrolithotomy was done on that side through an I oblique lumbar, incision, and masses of branched pbospnaac 1 calculi were removed through a cortical incision m the kidney i through pouched and thinned-out tissue, opening mto the Vcalyces which contained the calculi; 5i drachma.were thos removed, and the renal ares drained. The upper third of the kidney was that chiefly involved, and the remainder showed sound secreting tissue. The patient made an uneventful recovery from this operation, and left hospital feeling well on December 11th. . / ' He returned' to his home, la Bloemfontein, tad was re* 1 admitted to hospital on January 11th, 1924, for operation on l.j the right side. The left 1amber wound had healed well. On i this occasion the urine from the bladder showed 1.2 per cent, area--* marked improvement upon the previous occasion; the left kidney urea was LI per cent., the blood urea was, as before, 46 rag. per 100 .csl Cultivations from the left kidsey showed no organisms; there waa a scanty growth of a strepto coccus from the bladder urine.' Indigo-carmine appeared from the left in thirty minates with a free urinary secretion. From the right side there was a rapid arrhythmic secretion oi a purulent urine, indigo-carmine appearing in fifty minutes.. .. . On January 28th a right lumbar oblique Incision was made, t3.5fV^vv.-fa| a mQCii sacculated kidney was exposed, the sacculation * ' ' being mainly in the upper pole, biasses of phojphatic calculi, weighing 11 drachms 60 grains, were removed through a cortical incision in the tbinned-out upper pole pouch. Thu left a bic flabby upper sac leading to the calyces which had contained the Alfnlt- As the walls of this sac showed no evidence, of .via secreting tissue, and as it seemed only too probable thb portion of the kidney would never heal, and only leave a persistent fistula, the sac was completely resected longitudinally, some deep mattress sutures of catgut being used for haemostasis, and the edges then approximated as accurately as possible, but room for drainago being allowed for. The kidney area was drained, the tube passing down to, hut not into, tho renal substance. Tho tube was removed in forty-eight hoars and replaced by a small gauze drain. Hardly any leakage occurred. Except for .in attock of malaria and dysentery, from which the patient bad previously suffered in Fast Africa, no untoward event marred his recovery. On March 1st the patient walked a distance of a mile to report himself; he had then no urinary -- - a.- -*e symptoms, and the urine contained only a very small amount of pus, and under heramino and acid sodium phosphate was acid in reaction. * * Tito case can bo taken to he definitely an ascending urinary infection from the original ccirical iujury, with resultant formation of calculi on both sides. There is no positive cridenco to show exactly when calculi were first formed, hut as a medical board, held in 1917 in England, stated that the patient had bilharzia, one can assume lie then had haemaiuria, though there was no evidence adduced to prove that be had bilharzia--that is, there was no statement that ora bad been found. It seems rather to hero been assumed because the patient came from South Africa. The resection of the upper pole of the right kidney proved quite successful, and is well worthy of adoption in cases of similar type. The chances of recurrence of calculi are considerable, but there is reason to hope that this may be prevented by keeping the urine acid by means of drugs and diet. * l FIBROSIS OF THE LUNGS DUE TO THE INHALA- ; TION OF ASBESTOS DUST. . ST ` ,TF. E. COOKE, AU>., FJR.C.P.En., D.P.H., j j MTHOIOOIST, wxoix istxxuaxy. (IFifA Special Plate.) . i ^ fs life *!5rst \ .^5^sh~ti\edTcariiterature to be dcfinitelv proved. " i. ' * , '1 -itt-arenar;whewN'aabestos js~raanufaciurcd i,r5s;rS|lS_isr>qcted_tha dust to. bo tho causefcof chronic tKktJ^rosisyand Professor- J\_ M. Beattia'Isas' \wmuin* JTM causvfibrosis- in gninea-pfgs. Asbestos V on3*t other compounds, calcium aud magnesium silicates, and 40 per cent. riltca. Tho mineral fibre is quite translucent except at tho fractured ends, whore some chango takes place, tho fibre becoming blackened and fragmented. Asbestos dust, no matter from what, part of the process it is collected, contains these blackened particles in large amounts (see photo-micrograph). ' ' A woman, aged 35.years, bad worked in asbestos factories "since tbe-acw of'13, but for five years previous to her finally ceasing work in July, 1922, her attendances^** the factory had been intermittent. She died on March&SU 1924. Mr. Eh N- hlolesworth, 'coroner for Rochdale, at the suggestion of Dr. Mackichaa, who performed the necropsy, sent the lungs foe further examination. . An s-ray plate showed extensive fibrosis, more marked in tho right long, two calcareous glands at the root of the left lung, and two small calcareous particles in the base of the left lower lobe. .; ' Macrotcopical Appearance*, '* Bight Lung.--The pleura is thickened over the entire surface of the lung, and shows the remains of dense adhesions to the chest wall and pericardium. The lung is firm and smalL The glands at tha root of the lung are larger than normal, and on section are black, show a thickened capsule, and some calcareous particles. Oa section, the lung is seen to be fibrosed: and to a large .extent airless, the long tissue being replaced by fibrous tissue. In the apex there is a large cavity, the size of a peeled Tangerine orange. The middle and lower lobes' show numerous small areas--varying in size from a hazel-nut to t pin's head--of caseation, some of which have proceeded tc cavitation. The bronchi are dilated. 1 * Left Lung.--The pleura is thickened and shows the remain: of adhesions to the chest wall. The thickening and adhesion: are not so marked as in tha right lung. The lung is firme: than normal. At the root of the long are two large calcareou. masses, one the size of a large hazel-nut, the other about bal that size--calcified tuberculous glands. The other glands ar black, and show a thickened capsule. Oa section, the lung tissu cuts with greater resistance than normal. In the left ape there is an area of old scar tissue about* the size of a sixpenn piece and a cavity the rise of a walnut. Scattered thxoughoa tiie lung are small areas of denser consistence than the rest c the long, some of which show definite calcareous particle others small areas of caseation. There is a considerable increai in the fibrous tissue. . '' ' Siicrotcopical Appearance*. "*. The right lung shows extensive fibrosis, caseous foci, ar cavities with thick fibrous walls. Giant cells are numeroi around the caseous areas, and tubercle bacilli are present The left long shows the same condition, bat the fibrosis uot so extensive. *. - In sections of both lungs, in the caseous areas, and in ti fibrotic parts, are seen particles of mineral matter. These a of various shapes, but the large majority have sharp angle The size varies from 333.6 to 3 microns in length. The phot micrograph SZostrates the sizes and shapes. The lymphal glaads show periadenitis and fibrosis. ' The bronchi are dilated, the lining epithelium has* d. appeared, and there is extensive peribronchial fibrosis. ' ;V ; MEDICAL, SURGICAL, OBSTETRICAL. LYMPHOSARCOMA OF THE TONSIL REMOVED I SLUDER'S GUILLOTINE ENUCLEATION.' LraTHOSARCOilA of tho tonsil grows so rapidly, and irh removed so commonly returns, or gives riso to multi; leukaemio tumours, that I wish to repqrt ono case wJk removal bus so far been followed neither by-local recr rence nor by remoter metastatic disaster, though twee months hare passed since the operation. - In October. 1922, I was asked to see a lady, aged 72, who t able to swallow fluids only, and complained ot pun in the thro shooting to tho left ear, severe enough to prevent sleep. The ] tonsil was enlarged and almost touched the opposite side of - fauces. It was very hard and smooth, and was covered with net of tortuous vtins. which contrasted vividly with tho aim ivory pallor of tho underlying growth. At the upper polo of tumour there was a ragged, crater-shaped, exquisitely enstl ulcer the si** of a threepenny piece. The tumour was very mova and no glands could be felt. She told me that in 1877, when 27 years of age, a sharp fr mettt of mutton bone became fixed hi her left tonsil, causing or naiu swelling, and inflammation. Various practitioners attemn Us removal, but at the end of several weeks it came away wai- 5S3SSW *UUg. .JTSsLk.-----l,i