Document da82q5dBJK87QZdjEvByyDGv5

3 A i i 'I f i a f l t f T M W n 'i I ilklM iiiT H 1 4 6 J i T L T 16, iga.*} A N t J N U S U A t * C A S E O P B I L A T E R A L R E N A L C A L C U L U S . [a tw > u Jcu j J O L T 25, 1924} UipioAc /ocaaas 147 m outh Ami iinkavoiircid to push it o uisatiun til rhuking passed off and bo { (It ta iu A t once O n admission to hospital At Cosham soon afte r he complained o f pain in O k u g h * side. o f O k r b i-d , and a c tr U in am ount of dv%pn<xa w ith txp uls n c rough A radiogram ta ken at oner shoved Die shadow o f a tooth plate on the ng)i> tide of lb " i ln -t at rIk iu L tlx lew I o f the sixth n li H e was trunsfeircd to Mill) auk m l a im e d H m foliov i ug d ay. A fu ith e i ladiogram w a ta ken and lo ca te d the tooth-plate still in tin position desrubed at Cosham (F ig . 1, spori.il p la t.) Op< ration a > di dded upon at onev, and tin pa l x lit n plan J umh I geueinl K'-tlniiia and a biomliosiope mtiodm ed with gnat o tlie tia i h i a , the diflhullv U mg ilm to the ocd.i a 'o f 't h e arvleno (p iglotlid can fold * and m ii lounding liss iii*. this tog . Ilu 1 v 11h (lie hug * airiOHljl of sit ri 1ion m IIn 11ai hi a, de( ]<h d nn to do a low trai lit c.tomv and lh<r<h\ olitali! n ilia Th is * * done a t oner, and, on iiiliodtn ing a in d iu m * ize tula , 11k tooth-plate wan locati.! in lh< right Iu o ii- I iuk alx. nt tlin e (pim t( Is nt an nn h ) \ nini 1In Infili u i` ***n of 11 fo litjis w ile in lro d u iid and oui k iv i In a , alhgvK l `i,t on pulling il vas inumi lU.it tin In lu the l.eihcigi.iin) limi pi >fui ali d tin hln iuh ia l w ell, nuil tin In uni 1ms m ull up with tin fu n ign beale v u u i l till lin I u lti ill pis were made lo lutale the |iluW, hut f .11i.i I. unit A ' tin p .U ic n ls rmnlltinn was not too gond tu ve pul l i n k to b id w ith a 1i .u h< otoirie I n t lift in tlie tiaihea H i U a g g c ll, eotiMlllmg lai .upom .'isl to tin hospital, was m lh d I to set tin i a -i win u furtlie l ladmgi n o ' w< < t.ike ti and shorn <1 ill'll tin fo n ign bo.lv liad In i u in m id abolii an unii ami now ].1 \ lu a position m ure r the mid-line- u n i m oie ei lie ills Ilian m tin radingiam N ota iv M W ccktt O n tp iil 28tb the patient w hs m good condition tin te in ja in tu n liad fatle`11 to in u m ai afte r a posi nj m l ion m i iii h id nn d> -pms a winli M ill nn ijun tiy in In d and In i at lung I \ tin meut 11 A n ant i ro posti l mr stemprini tain n a f' w hours pi i \ ton-Is slinwi d (lie tooth-plate Icing in an ninnisi veitirnl position a little in ilio nghl of tile middle Ime u( the lisci ut the spinal ai I n nlfct ion* ol tin liflh and sixlji lib s --a p n liu i vers sugg. stive ol im pattim i in M a jo r k k ffi diagnosis In le c orre *!, and tin ski .grimi <f show<d the fin tig li bnd\ lu n g n d l in fio n t ot the ophngus amt obiioiisH in i b light tu olii bus \\ ilb tin a s 'i'l him . if >1 ijm I iff. mid Ml >. 1) H u lls I npiin lcd m the silting jwi-lmi gi in ral nini (lirai O n n m o i.il of 1ht long mills i l ubi mIn. Ii b id passed in to the ligh t brow liti nbnig'idi tin al mut nit (mui i of foul pus m us i ungili il up A l t . i i Un la m ia and alhiwing dll In une buse np> , | o i- .i 11 .ic lu n io im Mounct, to tim u tt for a ninniti w ith with its ampli false laudi lu n g piM bile ' ' 1 f the lap nf tin ligh t hioiielnw, sud tho guld-wm lin th in lie ujipi r-liibi hinnikiis T ! u Ill II but nut g re id ) awalb u T h o . m . nn s,gu of Inm mo \\ h h " In in " I.rom basi ojm lo ie ijis lh i fe iiig n b o d i w a s re iA lii ' ' * * s long 1 a i', di-< ugagi d and u 11lull aw n, lin <lin I lilil, ol i I Un t liilllM s' fr<e firn i nr 'liio n s pillinom i i s* in|,| oui' t Jl H t ST 1 f M il TVvCC TT T ,m m ili .nid a liu lf (4 cm ) n <if un m ilt (2 m i ) in I n c .n l 'h u n ii .lim o si Oie- su in e ni he i ;lit F i g 3 ) T h e p i i i e n t , i tn .ir o f slight Ln ib l uni ,lim ili 5 ft 10 ni n h e ig h t, shuw i.l me w he n c sH .in n c il a m e.1 1.1t . 1 lit .ill Il il k .lh lr fi, ' p ig ln tt ,,, Kli cum e.iling the ghittls tin i tu g n o rm a l i <spit i- TlB 3 --Ai tu *l s tin ii T in - p a ti, n t i< j x i i t e J 1h .it hi f> It the limili] p late puss in to tho th io a t, sin k tlim*, and romici b icallim g niijMissihlc. F in d in g t i n t it hud 1. sn u d ici too fin for i s tu n turn, he ilei ided to m-h it Jm iii with Ins finger. 1 lim o little1 d o u b t th a t Ins fingci >ai lied mi faitlm i th a n th e epiglottis, gnessine njioii which piishi'd th e 1mgo Imok- und tooth-beaiing mrtinii tlueiiigli tlie g lo ttis As I le a rn t finn th e sctf-cm itinl and tnleiunco who h lie displaced txt th e time' of tlie e x tin ctio n , th e juitn n t whs u m an (juito capable o f pel form ing th is t i l i n g fe a t, w h n h pri`Kiinnibl\ Mtved hi* life, for ns soon as tlie folcigli bm h h ad pavsed th e g lo ttis all difficult) o f h ie a tln n g te .tM il. 1 he p r a itliu l valilo o f n n u m i siiih ns tins is to draw a tte n tio n m e m oie to tin danger m hm m it in tho m in in g of lim itai plates of small sire S udi platen lint mnvmuiiinh u u . on allow cel, und, bccsnnmg niipm lcd in tlie' uisoplmgu*, h a v e t o ho re m o ve d th r o u g h th e o e sophago6c o p e . I t is t i n * th a t lino n u th o d is a good deal safer th a n ocsophagotoiii) , h u t it is by no m eans fic e fio n i d a n g e r, in v o lv in g , as it fx s jin iit li d in s , th e disengagem ent o f shatp w irfrhooks fio m th e ' d a m a g e d w a ll n f th e g u l l e t. O c c a s io n a lly aucli p la te s h a v e to lie seven-el w *ifw w it h a c u t t i n g m t.li u n ic n t b e fo re < \ t in < tm n is p os s ible , a n d t h a t in iiiite u v rc c a n hn e x tr e n n h diflii till i f grave Ham ngo is to be avoided In the <js r ln ic recorded nothing lu ll nn nnusnal degree of jiie s .iK e o f m ind on the p u it o f the p a tie n t p revuitisl im mediate; death by suffocation. I. A X L X U S l 'A L C A S K O F I1I L A T K I A L l i E X A L L_ . i n t T h Iduod urea was 46 111 per 100 c cm T h e re were 110 (h n icn l sjin jito m s o f renal inailcfjuacy. no tln rs t or head ai be, and the tongue viva fa irly (Iran Il m j .i l i . il l , though th in , was 111 fa ir c o n d itio n , and lu d W e n at w ork 1)11 shoitly In fore adm ission. O n N u iu n W -r Bib, tlie l i f t k n ln .v lm n g jin lg .d the W t ttr of Ilm tw o , n e ph rolithotom y was d.1110 on th a t side th rough an oblique lumbar illusion, and insans n f brum bed pliuaplultc ' h u h s u e Kinoved lluougli a < ilu a l im ision in tho knlucy lln n ug h |H>ilibod und thinned out tissue, i.jiening into the la ly ie * winch (o n ta im d tin c alcu li, Si ih .ub m a were thus 1. m oved, and the r . 11 d a n a .h u m id T h e u p ju r th ird o f the k id n ey was (h a t chi. fly in v o lve d , ..n d ttie le n u in d e r showed sound secreting tissue 'I lie jm tu n t made an uneventful recovery from tin s ope ration , and le ft hospital feeling well on I). ccmiier 11th H e 1tu m id to ins home in Dim m forilem , and u lic a t M , n n d 4 0 h i c e n t, o f S iO .. a ih c a T h e tu m o r a l filu e n fll,,tn T ra n slu c e n t -Neejit n t th e f i a d t i r o d e n d * , w h ero V.H110 ( h a n g o ta k e p l.u e , th e fth io b o c o in in g b la c k e n e d un.l fiK g in e n te d A aW 'stos d u s t, n o n ia tU 'i fro m w h a t p a r t o f tlie noo-sa it is collected, x in tn itis these blackened p a ilid e a >n la ig o .iiiio u n U (*eo p lw to -im c T o g ra p h ). A woman, aged 33 years, had w orked in asbestos facton* since (lie uge o f 13, h u t fo r five y e ars previous to he r finally r>asm g w o ik in J u ly , 1922, h e r a ttendance* a t th e fatto rv had been Intel n iittc iit She died o,, M a ich 15th, 1924 M r E N M o h sw .iiili, e oioner f o r llcH lidale, a t tlie suggestion o f D r. -M.U k n Iihii, w ho p e rfo rm ed tin ju tr o p s y , *eni th e lu n g s fo r fm tliir evaininalion * A 11 * r-*' p la te show ed ij.lru.sive fihrosis, m ore m arked m th e ighl lung, tw o eaharcsius glands a t th e root of th e left lung, m l tw o , ' 'h jw iia r i u u s p a rlK le s tn lltu base o f th e le ft lower a BO RRO W ING LIB R A R I Fill 1 KFT T n HAIF OF FORM m l INCLUDING ,, BOTH UBRAFtY > ADDRESSES not in full DATE OF REQUEST 8/ 3/73____________ C A LL NO BORROW ING LIB R A R I laddiess in tuli) DHEW , PHS, Food and Drug Administration M edical Library, Room H B - 4 0 (BD-45) 5 6 0 0 Fishers Lana sexo sheets A a ANO CTO Rockville, M a ryla n d 20852 f" ' IENDING " LIBRARY ANO vtr ENCLOSE ruit ust ui- Kirsch stein to SHIPPING AUTHOR (or periodical title, vol and year) d is LABEL B r it . Ked. J ., v o l. 2, 192^ EO LD - A REQUEST D r\ t,0 - fr o m , Cilit ' NO ES 250 T 1T LE fwith author & pages for periodical aitidesl (Inc dition, place & date) Th ,s dition only Cooke> V v.E :Fib ro sis o f the lu n gs due to the in h a la tio n of a sb e sto s d u s t . l '+y t o end . VERIFIED IN (or source of reference) b /-of interlibrary loan request ACCORDING !0 THE A t A INKRMSRARY I0AN CODI B E P O R T S : CHECKED BY SENT By Q _ CHARGES S_ DATE SENT _ DUE LIBRARY HATE INSURED FOR S R ES T R IC T IO N S COPYING NOT PERMITTED ______ FOR LIBRARY USE ONLY NOT SENT BECAUSE- NON CIRCULATING NOT OWNED IN USE n ____________________________ ESTIMATED COST OF M lCROFItM____________ _ picul Appetir/wect is ihukcried over the entire surface ic m in im s o f d< ns, a dhesions to tlie i T h , lu n g is firm a nd sin ill T he lu n g m i' Im gei th a n nm nial, mid on --Im kened capsule, and some cahareoni fling is seen to be fibrosed and 1. a ung tissue being re p in e d l.\ fibrous a is a h u g e e a v itv , tlie sire c.f a T lie inidille and lower lobes slmwryilig in sere fiom a l u /.l m i! to a some o f w hich have lilocse-dcd to re dilated l< th ic k en e d and show s the Kin.ein -- vc.ill The thickening and idhesmns tho right lung Th.. lung is funirr of th - lung i.i. tw ., hirgi . ,d< ir.'tiu* lal go ll ItFMe' nui'I, ll'is' i.lln'r libelli h' a"lf 11I'll IS g;h1*,ilnds 'J he u th n gl nids am I. O n s iftn u i tin lung tissiio lui In lb . ' 1. It ijh' x .lim it the si/e c.f 1 M \p. 1I1IV S. atte n d tbiouglioilt t i nnsisti c 1 1, h i l b , 1. st n f di knit e .id.ai.e.ei - (i.liM.lu.elite I m LENDING <f>.v. LIBRARY ________ l " Filili 111 PERTINENT v ITEMS UNDER tli REPORTS pi RETURN nn SHEETS ee 8 ANO TO 80HROAING ' LIBRARY If NON CIRCULATING. PLEASE SUPPLY MICROFILM LENDING U B P A H Y laddiess m full) NOTE The receiving library assumes responsibility loi notilicabnn of non receipt AUTHORIZED BY |full name]l T IT LE_________ P,usions Brand, Pretm ia, j | t h r u was on .................. ` ` ' " ` " " j ! ' m U o A ski I, s taken o f ilm ,.gin n. w h oti showed tin w nv still ) i Hisiti.in fixing tin third nnd fnnitli i. iv n u l v.rtehrae 'Ilm nn nt nt th . li n k in .ill ilu* i t ions w illm ul |sim o r .list aiintni I, a n d tin i.a lu n t w as .n liv .K n n jik .y .d lip to tin s tunc in the engine c lin g d . putlm c n t o l th e Sm ith U i i i .im H allw ay s in HI... nifnnl. in J ills sk i.igi cm I 1. J)i udile ed (K m 1) III, n .itirn t Vlas a d m itte d to th e Jo liain iC 'l.u tg H o 'j.il.il u n d e r rn> .a re uu O iln h e r 19 th , 1923 A sk ia g ram o f ho lu m b a r regnm b y D r W illia m S t e n a il, w ho hIho took the u i \ i . . i l ski.igi.ii, showcsl hu g e masses o f calculi both is ai in cu s (l-ig 2) 'J Ik u n iir c sinU ined p u s, b u t n o t ipiKiitilv, was faintly alkaline, 0 77 per ceut. . a"nd alami 65 or- were w d m C'ystiseo|iy sbow ed ......m....i.a..lifr"a`t,ve degree of cystitis Indigo* a iiuiinnku; w aass du d.a. .y, c, d . . . i t ' a p p ararn e , ta k in g three hours for . . . . first indiciitm n fio m tb c l i f t side, and on a Mlhs.-qin " t e s tin ti rira tK .n o f tin- lig h t u ie te r was s till more l U l l.y u t , hut th - a . I owl lim e was not o m .i t e l v dolci m ined O pe ratio n vv n e idvisid, and the p atie n t 1. f t Irnsjutal fo r a w ln fe , to I * re adm itted on N o v . m l r 2n d, 1923 O n this occasion the arm s ln .w .d a seu-uli. g i a u t v n f 1004. v u s alka lin e , w ith a trace nt a lb u m in , glue*., ab sen t, pus a i d *i> Ih r o c y tc s , urea 0 8 t r HARO COPY IF COST DOES NOT EXCEED ! HARD COPY____________ _ BO RRO W ING LIB RARY R EC O R D : DATE RECEIVED_____________________ DATE R E T U R N S ____________________ BY LIBRARY RATE ________ ii In . POSTAGE ENCLOSED 5 ______ IflSUFlfO FOB S _ R E N E W A L S [REQUEST AND REPORT ON SHEET C) REQUESTED 0N _ 6 In 3 ii li 1 In photo- _ s]|,l| I. S T h e h u ijili.iU o and filirnsis <d, the lining cjiilluliiim t.n siv o ji. n b isn n lm il tiln us|s RENEWED T O - ) 1111 e.! (p itto s m u s s i l i ] , a n d is vu ]] s. s ..( sun il.i I t v ] ' '1 In- ell im i h u ll nt o ism sidm a lile , h u t t i m e is io n PERIOD OF RENEWAL) _ m torn itb a: n b ijill.n i V IE D IC A T j , s d u g i c a t ,, o b s t e t r i c a l ,. Tills 111,1V ho n e v e lit.'d 111 h o o p in g tlie {I <h ngs a n d lu t I A M P I IO s U K 'O M A O F T IIF . T(>\?TT/ n n if O V I ' l ) H Y M l m . U 's ( . U M . O I I N K K\ l C l. l'TL T 10V I a j i i lln s M ieiiv u .if tins to n sil g m w , s,v i.ipic]]y, a n d w h en l i m i o s i s O F T l l K l . l ' N t L S J> 1 'l-T J O T I K I N J f A L A * d an (sunm n ils l o i m n s , , g iv e s iis ..' t.> n in lu p ltf lo o k n me te in io n is , tli.el I w isli tn u j i o i t <uie e.ese w lie ia T IO N O F A S IK S T O S JH 'S T . W . K C 'O U K H , M D , V 1{ C P K i > , D I M I rATUOLOCIST, VllUiM l.SIRiUV ' ( H ' i f A Spermi J'hilc.) T u r f.dlowntg e lse js o f nn p .jitm u e I.ernnses d js tho first m Fnglish m edicai lito in tn rc tu ! .h tn u telv piove-el M edim i me n in u r.u a u h e ic ushoati.s m '.nanufae lui ed nive long suspm tod tlio du st to he th (anse nf chiom e brm iihilH etnei Jdirosis, and Pi >fossi,i J 3f H .u ttio )ius k ",M" *l'" t Ilio dust i nises m.iusis in gm ii.u-pig s Aslmst,,* evintaiii, utnoiigat i.tl.oi eamp.iuii.ls, cale inni and inngnesmiii iiiiin v .i] lia s so f,u h e en follow ed n e ith e r hy l o u d m u r l e n to n o i hy ic m n te i n ie l.is t.itie d is a s te r , th o u g h tw e n ty n io n liis lim e p a ssed Mins* th e o p e in tio n Tn O cttootbier, 1922, I was asked to < a ladv, aged 72 wl,,, ,, M ab|. to siacnnillow fluiidd' only, and rnniplannd of pain in th e lliroat. shoot mg to- t-hlie loft car, se rrn enough to p revent sleep T he Jeft tonsil was e ilar.g. rd in d alm ost to o...l..u...d.....t.h...e o_pposite aide of th a fauces H was very haiU and sm ooth, and was covnn.J m ik L of to itn o u s veins, which ronlile.d vividly w ith th e almost iiiin eiks y pallor of nur in .ie t the size o fsIauhe.linineedlj.u.k.g.l.ei.gv.m.e.iy.nd..g.,p..i.o.gn..ci.vo..1.we.riThshhoaA.p.t.eut..d.m.t,..lo.ieuiXruq--wpi.lpiseirt%f-pcory1lo of rns l th ln a a und no glands could lie felt. Mu. told me th a t m 1877, when 27 \oi-s of age, a sharp f la g m en t of m illion Imuo Ik e n n e filed in her h ft to il'll causing nuiel pain, sw .lhng, and uiflaimr.Khon \*,u>iis jin ,titu m e r s n ii.m p icd Iflout T H , `b I S A S IN T , | F P H p l O C O P Y M A D E B Y T H E N A T I O N A L , L I B R A R Y O K M L U I C I N - - ^ U H P n ^ f ^ n r c m I D Y O R R F S F 6 R C H IN i I R 1 O F L E N D I N G T H E c*a*BM*se* mt&SfpjpM 1 4 6 JO L T *6, *914] l NTJ8U A L C A S E O P B I L A T E R A L R E N A L C A L C U L U S . m outh anil endeavoured to push it on, aa Ihj fe lt i t h ad gone too far to bring it up into b n mouth again, he suriecdcd m getting th e InoUi-piato on down bis w indpipe a n d , having done so, his animation of choking pa(d off an d he fe lt earner a t once On adm ission to hospital a t Ooulmm soon a fte r he complain- d of ]min in the jig h * sid e of the chest, and a certain emouiit of dyspnoea w ith expulsive couch A radiogram ta k en a t once allowed the lmdow <>f a to o th -p late on th e right ttd c of the c h u t a t about the leu.] of (he 'i i l l i 11I1. He was l ia n s f ir u d to MillWuV mid a im e d Hie following dav A fu rth e r ta d io g ram >< ta k - 11 and icvc )< d th e tooth plate 't ill 111 tin position d e su ih c d a t In d iu m (l'ig 1, special pint ) Op< 1at ion ug> decided upon a t once, and lln pvlic tiL was placed undi 1 g e n u a! an.icMlnsiA and a h io m h o sio p ' in tio d u n d w ith g n a t diffhulty in to th e I iu iIkn till ihfluuhv h u n g dm to the oedema of the a i \ u no 1jngloll uk an fold' and 'u n o u n d in g tisam s, tins t..g i thr r 1 till th< l u g hmount of1s.ilari 1 the Inicio a, d u o li d . ubi. 1 eh hi T in ' an done a t onci, and, mi nilii.dm : lulu. tin to o th -p late was lu tati d m th u p h l b iom hits tumi t l u u - o iu i ii is ol an un h to Mind Ho Infili e 11 imi of tin t i.n ln .1 . a lligator f illu p s vton in lro d u iid und mu erige of tu r Inulti pinti g im pcd, b u l 011 pulling it m found lim i tin hook on tl.i loolli piati (-now 11 in lln lid i u g r n n i li..d p u 'u iH lid tin liuuulim l well, mil tin In on< bus 1 m u up w ith tin fon igu hoili , m m 1id fin tin 1 a ttu n p l* vvcri mude to lu ta li the jd a ti, hul ( u h i) , aitil a s tin p a ln tits oiidilioii was noi too good In < p u l hack to h id w ith a tr a i h<n inini tube li f t III Ihe lia r lu a li \ \ a g g eli, euiiMilt mg la 1vufulo.'isl lo tin hospital, na< < 1II1d 111 In u e tin. la s, , wIn 11 f ni I!n 1 1adiogi m i' w11 u 1h1ii.ii and sbovi 1ii th a t tin foieign b a d i liad In 111 uiovid jh o u t an n u li, ml now lav in a poMimn m a m tin. mid line and m oie H i u n l l ' th a n in tin fn .(, 1jidiogi am Not* a AI W n c u n r On Api il 28lh the p atien t wa in good conditio" H'< ti mpi rat tire had Inlleu to nornm l a fte r a poM npi 1tion m< Hi had no dyspnoea w in k sillin g q u u lly 111 b u i and b iu d h m g I i tin moirili A 11 ante ro post, n o r sk iig rm n ta k in fiw bo n is p u u o u s h sliowi.l tin to o th p late lu n g in an almost vertical position a I n l lo to Ihc n g h i of tin miilrtb lini at th e h u l of the pial ailK u U tio n * of tin tifili an d sixth lib s--a p n lu i. 1111 suggestivi of im p allin o 111 t 111 <>supla"!] \ | I <11mg n tin (1 fi u r li 1o laici il posi u n 111u n d M ajor r i t l - 's iliignoK to he m ire c t, and tin ' k iig m m ( r i g 2 i h a v e t o Iro re m o v e d th r o u g h th e M so p h a g o a c o p e . I t is t i n * th a t th is m ethod is a good d eal safer th a n o cso p h ag o to m t, b u t it is bv no m eans fie e fiom d a n g er, involving, as it f t c m io n tK ilim , th e iliM -ngiigeraoiit o f s h a r p w u o -h o o k s fio m the' dam aged wail o f th e g u llet. O ccasionally such p la te s h a v e to lie si v e n d m mfi w ith a c u t t i n g in s t r u m e n t befo re i s t i a i l u m is p o s s ib le . a n d t h a t m a n o eu v re c a n lm o x tr e i n e h iliiT m ilt i f g r a t e d a tn n g o is t o Ire a v o id e d I n th e case h u e iiiw ick-d n o th in g h u t un u n u su a l d e g re e of p i esc III. o f m in d on th e p a r t o f th e p a t i e n t p r o t o i t n l im n u 'ili.itc d e a th by suffo cation . ------------------- ' j \f A S I M 'b lA L CASH O F B H .V ir.K A L T lF .S A L C A L C U L I'S . I I T J . M I 'l . i : J l f l l M - . I . L , O 11 U , 1 1 , F II C S K , JKjSOHAl \ i U l K . 1, JOJUSVE'BIRC. JIO'MTAL (11 1II1 N p ir m f i ' l u f . .) featuics of um isiul , m id may l i m i t i n e he u n iti li of wild 27, d to ame No f u s t t nil r 1 G u 1.1 ispilal, \\ V u lg South A fncj v e ilin g is a i'l l ' from G< W est A fn . ....... N a ta l f i l l i hospital k , .unii tu bis .Imissimi to \ V u d .u g M ilitaiy Hohj.u ,1 ho d is ili mtn ilio sea a l Lutisi lU bniht loto slullovv strili k Ins In 1.) mi Oh s.inds bottoni, and 'listam eli HO injinv ' ssluili Mil.M.|Uent tm sslig-iti.m prosed to he a !.. 1ss1 ri bis thild .md fmirth c o n c a i v e itib ra c nlnussimi lo \\ \ nl.t 1g lie liad 1 complete jia ia ls-s ili tb. neru .111.1 'uh m Un b u i of liijuiy Drenti.- I.l.ls d lapin agni it 11, t In re n s patalysis o f hlad.hr and \li V. 1) l i n n 1 o p '-iatu ! 111 th e fulling jiomui, g im r.il uii,ii sthc'iH On n m m il of th e long m bla liad j. Iasi d into th e lig h t b ionrhus idung'id* tin nbnui nil ounce of foul pu t a lo u g b rd uji A ftci m Hu l a iin j uud allowing tin lironr)msui|i<, p u k ed H uongli tin 11.iihi'otoni) w ound, to Minnm fm a minute w ill, to lu a iic , wa# e-la ld i'h u l, it was e ast, uflcr swabbing, to see llu toulh-jibit. w ith its single fah-e to o th lu n g ju st below the level-oi the to p of tlm light hi oik bus, an d tho gold-wire hook h n lik n foi h alf its liiig lh 111 the upper-lobe hrom liu Tin n m u n a wa t . d and u l u U lint nut greatly swollen T here wa no sign of trau m a \ \ n h *' hi an " brnihosco|ii< fm , rjis th e fo ri ign hods w as 1ntat< d K n id i oil lU long axis, dise.Mggid, nml w ilhdinw n, th e th ie f dilh in lty niisin g M llu 11aclii otomy wound l i n o u i j was free fiom fever m serious pnlmonaiy symptoms ........ 1 , \t<usisi Iailsui 1 ossr lln sa.rum 'J beri w..s di ibbling and svi U nirli tosi n a ini mi .i-.li> 1s ..(T u .d tin . ds m il lb . fu ll..wing .i(iil 1 is s il i) ' 'ilio londilton scom d , Di LindsaV Sanili s of l.ip '- 1o ll.u lonilusion t h it i>|Kiat" <11.1 u of An ) icceiveiy, and they in ir u d n a d e 1 tlm ,, i.b |I)1(l u( ............ ..................................... to m s, a n d th e r e n d itio n p ii- Mcmslv show n tn th e ki.igr.im was f o u n d --n am ely, a tli*l<.a- tn.ii t.u w .m l o f 1lie n e ik lii ls s u n th e tln r d am i f u u rth r e iv n d S iri, b in An attem jit " a s made to ltd u tu this, b u t w ithout as hi), an d n u m d m g h th e s u ,.,u n . in ti tu la r pio cesses o f the ,n m .h u n t o l i s u l h u " i n 11 m o \s d a n d th c .e a f t e r thy r i dui lim i i\ is . 1s, !v . f f u l i d \ .to u t silv e r w ire w as p a 's .. th to u g li tin spm m is |ii 01essi s o f tin U n n i and font til c i n n a i t , inai and tightlv tw istid up T he wound was closed amt CotIM fcST BV M u AVICOETT. 1 i,e p l a t e tin a s m e d m e r 1111 m e lt a m i w W f (4 c m ) l e n g th , o \ e r th n * c q u . i i t e n o f a il n u l l (2 cm ) m b ie .u K h , tin In ad am i n u k m m iobil./id Compii te recovery slowly tu-k ,, I n , a n d tInev im nilbs b i c i th e p a tie n t was w alk in g alm i.l i,, d ru m ili d his um t fm ihstharge m N atal Ho subsequently 'c i v t d ag ain in (S im ian L i s t A frita , a n d nini w ith a u n it in m id a lm o s t th e s a m e 111 h e ig h t ( F ig 3 ). T h e p a t i e n t E n ro jie of slight build am i a b o u t 5 f t 10 : h e ig h t show isl m.-, The 1use u p to th is p o in t w as well w ottbv .if lo w n d , b u t th e su b se q u en t ilt w lo p in e u ts m th e ut m a rs ti.t e t a re th o -u w ith w liu h th is i.e o u l is tnoi. im m ofliately c n m ertie d . w h e n M in im eli ii wc o k I n te r , ti la ty n v licit n t all ic m .iik a lile fill M70. T h e t (itglnt 1 1* wus tiunglv cm 4d. Tn Oi to b m , 1023. th e p a tie n t se n t to me hvr th e M ilita ry P ulsions Ih i.o d , P t e l n r l i . oil H i-ount uf p u s and blood m the u in n and a ( iliu m .1. g l u of luinba lllst.ll of ;oil. A 'k lag iu v ic .il u g u m vvlmli show ed i l a w ire s till m p o sitio n f is i'i^ Fie 3 --tetiial st#e (he ih iita l ]d a te pttss nitri th r e m i. 1 b u i i t h i n g jinjuiH .sible concealing th e glo ttis d m m g 1u 1n u .il 11 k|i turn The p atien t to d tli.it In th io .it, stn k tlieie, F m d iu g tlm t it ha.! Un- th ir d and to u itli ic i v n a l u r t i h r a i lli e iu w as frus. mov. t (l) ji,, , , , , k in all d ilu t io n s w ith o u t pa in or d is io m fi.ih a n d th e i...tiuiL whs a itiv e lv u n jilo y td u ji to th is lin n in <h ...............!... .1. p a rtim n t o f ' th e P outh \ f n i a n H ad w a y s m i b i s s k iig ia m is 1, ( n o d u li,1 (lu g 1) D ii ji.it n ut was a d u n iti d to tin J o h a n n e sb u rg IIo sp ii d u iu lir im i.irr on (M olici 19th, 1923 A aknigram of th# i h s i n i d e d tu o f .u fu i e x t i u i t i i i u , lic th s itled t o p iis b il lu m b a r rV gun by D r W illia m f itc u a r t, who albo took tho d o w n w ith b is ( in g e i. 1 h u v o l i t t l e d o u h t t h a t h i fm g .'i 1u v 11.1l sk iacian. show n! large nmsM-i o f calculi in 1<th i . a 'h e d tu* f u i th o r tlia n t h c p ig lo tli s , jii e s s u t e u p o n n i n i li jiiished th luige hook* and to o th -b o a n n g |n n tin ti tb io u g li th g l.ittis As I le tiin t iiu n i th self-<sm tnil und tu te la rn e w h i. h h e ilnf{>luyed u t tlio tin te o f tlie e x tin c t io n , t h p a l i e n t w-iik n m a n q m t c co p u lile o f p e r f o n u in g th is t r y i u g f e n t. M in i lie ns (l ig 2) T ill u rin e lo n U u ir d p us, b u t n o t tn g n a t m n iu lJiv , was f -m tlv a lk a lm e . 0 77 p e r c e n t, u re a , a n d a bout 6 3 .1 / w eie passisi III tw e n ty four hour. P v sto sco n v slniwe.1 a nm ilciule d ig r e e o f cy stilt* Imliffm cainnno w as dolavcd m its appiarw m e, ta k in g th ree ho u rs (or lln fu st .m in a tim i from th e le ft tid e , and on a subsequ. nt w b n h p ie s liin h l> s in e d Iiih Ilio , fo t n s soon n s t h tn r e i g n tin U n a . Hon of th e lig h t U i.ter was still more delayed, k t Vi.ulv Jm d p a sstsl th g lo lt is id i d if f u u lty o f b i o a th in g u n s e tl t b - a d u a l tim e w as not ... cut a irly d ile im in e d O peratio n w ,* l i t e p r u i t u u ! v u lu e o f a ic is ii d b ikK n s th is ib t o d i a A ttentim i <m o m oie to th dan g er in h o icu t in tlie w e.ttnig o f di n t.il jd n tc s o f Minili s ir e S itili ]lutos H ot u uconinw inlv a ie sw ailuw eil, an d , b iu n m n g iin p a d e il in th o isu p h a g m , a d u s i l i , am ) Hie fwilicnt b i t IiosjoIhI fo r a w h ile , to l>e M" m lm ittisl on N n v m ib .r 2m l, 1923 O n th .a occasion th e u rurf show , d .1 s p in ile g .a v .tv o f 1004. v.as n lk a lm e . w ith a t r a " f album in, glucose ab sen t, pus and n y ih ro c y tis , u rea 0 8 l r J L T S , 199^] MEMORANDA. 147 n u t T h e blood u rea hs 46 mg p e r 100 c cm T h e re were no ilinicid symjiloms of renal ina.U quaiy, no th irst or brad.idle, and the tongue was fairly d e an ib o |ia tK u l, though I hut, was in f a ir (o m litio n , and b a d lurvii a t w m k til l sb o tlly bi fure admission On Novililber 8lli, the left kidm y b u n g judgul the b etter of the tw o, nephro lith o to m y was done 011 th a t side th ro u g h an uhhque ium oar incision, and masses of b ian d ied phopli itic .a h u ll W ire rem oved th ro u g h a m u tu a l n n isii.il in th o kidney ilnough pou d ied and thinned out tissue, ..(.eintig into the talyves w h lih contHiued th e ( a h u ll , 5 i d ia d u n s v u te thus uniovcd, aud the ren d area diallied The upper th ird of the kidney w as th a t elm fiy involved, a n d th e lem .iindvT show ed k.iund secretin g tissu e T h# p a tie n t m ade an u n e v en tfu l n c o v .rj from this opeiation, aud lif t hospital feeling w ill on Dicember 11th He id u n ii d to Ins home m B ln.m fontem , and was rciilmiMul to liosjnt d on J a n u a r y 11th, 1924, fur o im a tio u on ihe rig h t sidi 'ill# le ft lum bar wound bad h i.d e l w d i. On tins ociasnui the urine fiom the bladder show id 1 2 jier cent urea--<1 in a rk i.i im provem ent u p o n th o p revious o c ia s u m ; th e l. ft kidney urea was 1 1 per c e n t, tho blood u rea was. as In fore, 46 m g p i r 100 < cm C u ltiv a tio n * from (lie l i f t kidney show td no organism s there was a si.nitv growth of a -tr.p tu <iuius fiom llie b la d d ir urine In d ig o <uuiiim- a p p i i i i d fiom Ihe le ft In tlm tv im iiut, will] a f l u u im a iv s iu i tio n 1 rum the rig lit sid e tim e was a ta p id a n by t Inn ic 'i i n t i o n u f a pm nit nt urine, indigo rai mine appearing in bitv m inutes On Jan u ary 28th a rig h t lum bar oblique incision was made, md a im tih sacculated kidnev w as exposed (lie n t ultim o lu n g n.iim ly in th e 11pp. r (.ole M a s s u o f phnsj.hat ic c d m li. '.n u llin g 11 d ra th m s 50 g ra m s , w ere l u u o u d th ro u g h a io rtic a l illusion 111 th e th in n e d o u t u p p u jm le pom h '11ns k f l h big I ibby upper sac le id m g to the aly r.s w lioli had coni lined t c cah till A s th e w aits o f tin s iu show id no lU ib iic e of - t u t m g tis su e, and 15 tl s,< in. d only too pi rib d-lc tin s ju turn I tho k id n ty w ould m n r In d , itnl oidv h i v e a p e isiste n t h 'l u l i , th e s i r w is ro m p h tilv i i s e r t . d h in g ilu d m ill v some ,t.e p innUre>is s n tu ie s o f i.it g u t b. m g U 'e .l for Im uiiosI hsis, .ml Hi" edges th i n apptoM ni.it, d as a iu n .iliK as p o 's d d r, I ut n>om fo r d la m a g i b u n g a llo w id fm i lie kidiivV at a is d i.ii u c l. th e I uIk p assin g dow n to , b u t not in to tb , u n d 'i d .sta n ce T in tu b e was riin o v u l in fuitv o g h l Im u n and 1 (.la u d bv a Mti.dl g .n u e d i.im H a id K a m b .ik a g e m u . u . d K xiejil for .111 a lta i k o f n id a rm ind d v s e n tir y , lim n w lnib th p a in nt b a d pi 1 Vloiish suff. le d m F a st \ f r n .1, no nutovvaid ('.n t m .nreil Ins irm voiy On M ar. b 1st (lie lu lic n t w ilkcd 1 distance of a mile to n jio rt b m is ilf, lie b id tfiu i no u ru u rv - uiploms, ami th e iirin. ,..nt lined o n h a v u v smiH amount of pus, and under htv.inm ie anil a m i sudium |>bosplnte was a n d Tho la s o i,in bo talvi'n to be ih (im t.lv in n s iu id in g I.n il.Ill m fe itio n fio m th e m ig m .il i . u i c a l iiip iiv , w ith i .s i i l t a n t foi 111.1t 1011 o f c a lu tl i cm lu ith s llio n i is no p o sitiv e ovule m xj to slmw c x u t l v w h e n c t l . t d i w e ie f u s t bn inml, h u t a s i m d i i.il K i n d , h e ld in 1917 i n K tig! in d , s ta te d t b . i t th e p . i t n u t h a d l u ll ia r /i u , 0110 i 111 .issiim o be th o u Im d h a , m a tin i.t, th o u g h t h e io w as 110 e v id e n c e a d d in 1 d to jiixivo t h a t b e I n d h i l h m / m -- ( b a t is, th e r e w as to sta te m en t th a t ova bail been fo u n d . I t seems la llie r to lu x e heel) .isu tm o d b ecau se th o p a tie n t i.n iu j fro m S o u th AFi 1, a. T h e lo s e c tm n o f t h e u p p e r p o le o f the- t i g h t k id n e y |<loved q u ite su c c e ssfu l, u n d Is w ell w m tliv o f a d o p tio n 111 t s ol s im ila r tv p o The. (lia m e o f ic in iie n c o of b u ll a m (o iisid o lab le, b u t th e io is ita so u to hope th a t This m i \ b e p iiv e n te c l bv k e e p in g th e m i n e a u d bv m in u s i-t d in g s u n d d i e t * J l B i m S I S O F T H K U rN ( J S ] ) F K T O T I I 15 I N H A L A T IO N O F ASH K STOS m \S T. IT \V . K C O O K K , M D , F R C P F n , D .P I I., rxTIIOLOCIBT, WlCiX IXtlKVIAKV (Il'ifA Sprriai V la it ) T uv follow m g e a se is o f itiqioi ta n e e b e m u s e i t is th o f irst in E n g lish in. d i r a i i t e r a t i n e t o Im d e fin itely p io v e il M e dica l m e n III A rens w h e io .tsbi s to s is m u it lif u til l ed nave lo n g sn '|)c ctiH l th o d u s t to ho th e c a u s e o f lit on it' b ru lu lls u n d hlirosis, a n d P iu f.s s o i J M JJe attio lias show 11 t h a t t h e d u s t cattko fihioM s in g u in e a - p ig s A shostos um taiii, um oiiget olii. 1 uuiqxm ndv, cah m m a n d m agnesium silicate, an d 40 p er cen t of S iO ,, silica. T he m in eral (ibis is q m tu I n u i s l i u e n t e x c e p t a t t h e f r a e t u r e d e n d , wlier sonic (h an g o take place, tho fibre b ecom ing b lack en ed an d fiag in ciiteil Asbestos d u st, no m a tte r from w h at p a rt of th e p ro ciss it is eoH oited, contain th ese b lack en ed p a rtu le s nt largo a m ounts (sco photo-m icrograph). A woman, aged 33 years, bad worked in asbestos factonc since th e age o f 13, b u t fu r five y e ars p revious to he r finally ceasing w o ik in Ju )v , 1922, he r atten d a n ce s a t th e factoiy bad been H ile rm ilU n t. S he died 011 M a rc h 15th, 1924 M r. E N . M olesw oith, coroner for Rochdale, a t the suggestion of Dr. M.u kn ban, w ho p e rfo rm ed th e necropsy, se n t live lung for fm thi-r evam uiation A n a* rav p la te show ed e xtensive fibrosis, m ore m a ik ed 111 th a right lung, tw o calcareous gland* a t th e root of tho lif t lung, amI tw o u n ill calcareous p a r tu l e s 111 th e boss o f tile le ft lower Marroico/nrnl 4ji/xaranert 'hi 7 urn) --T lie jd e u ra is tlm k itie d o v ,r (be u iti r e su rface of the lung, and shows tho jem ains of dense adhesions (o th i l n s t w all .111J pciica rd itim T he lung is firm a n d sm all H ie g tim ls .1 tlie nol of th e lung a te la rg e r th a n norm !, a n d on s, 1(ion ,iu` b laik , show a tinekiive,l capsule, and some la lia re d iu j i u l i t l e s On s iitio n th e lung is seen to be fib res,,! am i to a b u g , c v lu il a n h 'S , th e lu n g tissue b u n g n p l a r u t bv lihrm,. tissue In th e apex U u io is a large cavitv, tlie si/e ,,f a p e l , ,1 T an g e rin e m a n g e T h e m iddle a n d low er lobes show niiim 1mis sm all a re as--vary m g in sire from a l u r , 1-nut to a p i n s In id --o f 1asrvt 1011, some of w hich h ave p ro ii'i dod to I ivitatiun D ie bronchi are dilated I It 1 u n -/--T h e p le u ra vs thic k en e d and shows th e rem ain* of i-thesion, to the best wall T he linekem ng and ulliesions a n not s., m ark ed as 111 th e rig h t lu n g T h o lung is firm er II an nui in il A t th e root o f th e lu n g a re 1 wu la rg i < ib jr .s ju i n u i's is . one th e sire o f a la ig e i n / i l n u t , th e o th e r iboiit !,,!{ l i n t si/, - , .ill ifi. d lilb.M uhnis g hinds 'l lu o lliu g lin d s .no b l.t.k , and show a tin , k. neil ( ijisule On si c tion, the lu ii g ti's tn i m is w ith g n a lir 1esistaiiee than iinitiial In the left apex t lli'i i* is in are a of old s ia r tissue a bout tlie st/e o f sivpennV (.tor, a m i a < ivitv tl.e st/.e o f a w alnut S , a t i , n , l tb io n g lu m t tlie lung ire sm.dl n e is of d e n s.r cinisistem e tli.m th. lis t of th e lu n g , some of w b x li show definite ial< ireous p i i t u b s , ..llieis sm ill a ie a s o f c is i.ition T im e is a (oils),leu,I.], i iH ii j'g III till- fill!,Ills llsslle, l/,eroi Ofnftt! f ppeor./nee,1 'l lie lig h t lu n g slu m s iX tu is u e fibiii- eiv m es wiih tlin k fibrous walls (Sun a ro u n d Die tmous m a s . an d lu lu ri It b 'I ho le ft lu n g slmxvs llie sviue m m lilu , b u t th e tibio' not so ev len siie In s, c1ions of bo th lungs, in th e u isim is a r ia s , and in th# h b io tic p u t s , u c s e n p a ilic h s of m n n r a t l i u t t i r T h ese .11 nf v a rio u s s ln ju s , but Hie la ig e m a jo rity h a v e sh a rp angle*. `J lie s i/,> v in e * from 393 6 lo 3 m icrons in le n g th T lie p h o to mi. logr qdi illusti ites th e sires am i shapes T he Ivmplnitia gblllds show (H I l.ldl m f l' Hlld fllirilMR. ` T lie 1>i iu | h ro d d iilu l, tins lin in g e p itln liu m h a s d it- a p |H a rv d , a n d th e re is exten siv e pcrih ro n c b i.d Jlbrusix. ^te m o rn ttita: M E D IC A L , S U R G IC A L , O B S T E T R IC A L . \.\ M FH O s\H C '()\rV OF T H E TONSIL REM OVED HY s l.l DKR'S (ililL L O T IN K KNFCLKATIOV. L i mi n o -u ico v r x o f tho tonsil glow so t ip u lly , and w hen rem oved so u.m m onlv t il u in s , or gives iiso to m ultip lo 1,'iik.ienin' tiim o iu s, t h a t I w i-.1i to ii'|m it one case w lic i* i.iu o v a l has -o fa r been followed 11. itb e r h y local u u i r 111110 nor liy ic m o le r m cList.itie d isaste r, thoiigh t w e n ty mouths have passed M ine the opeiation In Oi lolier, 1922. I wa# ask. >1 lo co a lady, aged 72. who waa aide to swallow fluid' only, and rompUimd of pain m the tin oat, shooting to (Iia left car, severe enough to prevent sleep The left tonsil wa* enlaiged Mill almost touched ill opposite aide of the fauces It wa# virv haid and smooth, and wa# covered with a m l of loitiioiu rein, wlmh contrasted vividly will tlie a!mot IVOIV I'.illni of the under),nig growth At the uppi r nolo of Ih tumour th 'ie vwi* a laggid, ci al. r shJVd, .iq u i- il.ly ensilivs ulcer the siae of a Hm >j* nny piece Tho tumour wa# very movahl and no gland- could be felt. him told me that 111 1877, when 27 tear* of age, a sharp frag ment of mutton hone heealne fixed m hri left toiirll, causing mmci pain, MM'llmg, mid mfiaimnation 3 a ,1011 |u 1, tit loners ntiem uiei its runovat, but ut tho end of teveial w o k s it cmc away wiluout 7m ; . T ` l IS A S IN C .I F P H 0 7 O C.CIPY M A D E B Y T H E N A T IO N A L L IB R A R Y O K W t,U IU iu .L L!Hfcl< O F IT 1 1n Y O R R I S I A R C H IN I I F I ) O F L E N D I N G T H F O F "