1005

became extremely restless, with a rapid running pulse of135 to 150, and soon passed into a condition of partialcollapse. Repeated gastric lavage with postural changesgave temporary relief, large amounts of fluid and gasescaping. Eight hours after the onset of the attack the lowerborder of the stomach seemed to be in the right iliac fossa.On the following morning the distension began to decreaseand all the acute symptoms disappeared within the following48 hours. He was discharged from hospital at the end

of four weeks and cautioned to remain under observation asthe herniotomy scar had been put to a severe test. The

hernia recurred in a short time and was repaired under ether.Uninterrupted recovery followed this operation. Dr. Lylesuggests that the removal of such a large portion ofomentum profoundly altered the circulation and possibly thenervous mechanism of the stomach, inducing temporaryparalysis. The importance of the case is increased by thefact that a cause of dilatation sometimes given, the toxicaction of ether or chloroform, is excluded. So also is roughhandling of the stomach or intestines. Great care was takento avoid all unnecessary handling, and the omentum was notdragged on.

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A SCOTTISH JOINT HOSPITAL BOARD AND ITS MEDICAL SUPERINTENDENT.

A PARAGRAPH will have been noticed by some of our

readers, occurring principally in Scottish newspapers, whichstated that "At the monthly meeting of the Renfrew andClydebank Joint Hospital Board the recommendation to

dismiss Dr. Butchart, medical superintendent of BlanarthillHospital, was considered. Dr. Batchart refused to carry out

the instructions of the board to treat scarlet fever patientsunder what is known as the Milne system, which, it was

declared, reduced the period of detention of patients in thehospital."

" The paragraph went on to amplify the reasonsalleged at the meeting in question for the adoption of the"Milne system," including a statement that the board inquestion, if it had been adopted in 1908, would thereby haveeffected an economy of ,gn,305. On the other side therewas the contention that the board had no right to dictate toits medical superintendent the course of treatment that hewas to employ upon patients coming under his care, and astatement that " the Milne system was not recognised to anyextent by the medical profession." " The paragraph con-

cludes : "As a result the board, by a majority of one,

adopted resolutions to terminate the engagement with Dr.Butchart and to advertise for a new medical superintendent.’’We need not enter into any discussion of the merits

claimed by Dr. Milne for his system of treatment for scarletfever or of the degree of its acceptance by the medicalprofession, but are concerned rather with the conduct of ahospital board which has first endeavoured to dictate the

course of medical treatment to be followed by its medicalofficer, and upon his declining to accept such dictation hasdismissed him from his post. In other words, the membersof the board, by a narrow majority, have ordered theirmedical officer to try an experiment upon the bodies of thepatients entrusted to their charge in their capacity of apublic body ; he has expressed his opinion against theadvisability of such an experiment in the most forcible andunequivocal manner open to him, and they have expressedtheir determination to employ no medical man who will not besubservient to them in such matters-i.e., in the medicaltreatment of his patients. It is for the members ofthe Renfrew and Clydebank Joint Hospital Board to con-sider their position, not only as a public body responsible tothose whom they represent, but personally if they haveexceeded the limits of their proper authority. The positionof the governors of a hospital, whether voluntary or rate-upported, has been pretty clearly defined in cases where a

patient has complained with regard to his medical treatment,but such a claim advanced against governors who have usurpedthe functions of their medical officer would be a very differentmatter. With regard to the action of Dr. Butchart, no medicalman, and, we should think, but few laymen, will express

anything but unqualified approval. A man in the positionwhich he now ceases to occupy is responsible in the eyes ofhis professional brethren for the welfare of his patients,having as his plain duty to treat them according to the bestof his ability and j judgment. Is he placed otherwise in theeye of the law ? If so we should like to know upon what

grounds, always bearing in mind that we are discussing thecase of one who might have to say: "I I treated a patientcommitted to my care in a public institution in a manner inwhich I should not have treated him if he had been myprivate patient, and I did so because the persons who engagedme and who pay me my salary ordered me to do so, andwould have deprived me of my post and salary if I had

refused." The circumstances of Dr. Butchart’s dismissal are

for the serious consideration of anyone who may contemplatethe possibility of filling his post, and presumably more willbe heard of the manner in which it has been declared vacant.Meanwhile we accord to Dr. Butchart himself our full sym-pathy and congratulate him upon having acted in accordancewith the dictates of personal and professional honour.

PRIMARY SARCOMA OF THE STOMACH

CLINICAL and pathological rarities are dear to the writersof medical monographs, as is shown by the list of contribu--tions to medical literature treating comprehensively of

primary gastric sarcoma. The latest article on the subject,by Professor A. Gosset, of Paris, in La Presse Medioaleof March 16th, is brief and practical. A new case is

recorded, that of a man, aged 61, who was sent to ProfessorGosset on account of an epigastric tumour, the appearanceof which had been preceded by a year and a half of vague,indigestion and loss of flesh. The swelling was first noticedby the patient himself six months before he came underGosset’s notice, and during this time it increased rapidlyin size. There was neither vomiting nor hasmorrhage.The tumour felt in the epigastrium was hard, craggy,and painless, moveable in both directions, and separablefrom the liver. Radioscopy demonstrated a normaltransverse colon, but the cavity of the stomach was.

narrowed to a mere channel by a dark mass projectinginto it from above downwards and to the left. At the

operation this mass proved to be a firm growth about the-, size of a large fist, lying in the concavity of the lesser

curvature. It was removed, together with about a quarter of, the stomach, between clamps, the cut surfaces being brought, together by suture. The after-symptoms confirmed the fears

expressed at the operation, that the artificial gastric channel; would be too narrow ; accordingly a gastro-enterostomy was; performed with satisfactory results, and six weeks later the-: patient was doing well and increasing in weight. The-I pathologist reported that the tumour was a spindle-celled. sarcoma, probably arising from the muscular layer of the gastric wall and possibly representing the malignantt development of a myoma. Gosset, in reviewing thel recorded cases, 171 in number, divides them into two

! groups: in the one the tumour is endogastric and

L in the other exogastric. It seems that extension to

f other organs is less common than in cases of carcinoma of- the stomach, and the possibility of gastrectomy is therefore) determined largely by the size of the tumour. Symptoms are often wanting ; the absence of vomiting is possibly explainedi by the fact that the pylorus is not often implicated, the- growths arising frequently from the middle zone of the

t stomach. Haemorrhage is unusual, which is singular in view