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healed well and good recovery ensued. Owing to theadhesions the cyst had been so fixed as to simulate a

pregnant uterus or an ovarian cyst. I I

A SIGN OF ACUTE PANCREATITIS.

ACUTE pancreatitis is difficult of diagnosis and often dis-covered only on operation. In the Australasian MedicalGazette of March 29th Dr. C. E. Todd, who has had a goodmany cases under his care at the Adelaide Hospital in thelast few years, has called attention to a sign which previouslyappears to have escaped observation-absolute dulness inboth flanks unaltered by any change of posture. In all his

cases the patients were sent in with the provisional diagnosisof intestinal obstruction, and this sign was present. It is

due to a collection of partially digested blood in both kidneypoaches. Dr. Todd describes the sign as " not ordinarydulness, but a dulness so absolute that it can be felt.’

"

THE PULSE-RATE AND ARTERIAL TENSION INTHE NEW-BORN INFANT.

A SATISFACTORY study of the blood pressure in the

newly born infant has hitherto been prevented by theimpossibility of using most of the usual apparatus withanything like scientific accuracy. Different observers, usingsphygmomanometers of the Riva-Rocci type, have attainedwidely divergent results, probably because it is difficultto tell by tactile sense alone at what point the radial

pulse actually disappears. The infant’s arm is so softand the artery so small that it is often quite difficult

enough to feel the pulse at all. For these reasons thereis a good deal to be said for the claim which M. Balard,of Bordeaux, puts forward in his communication to the

Gazette des Hopitaux of May 8th, to the effect that the

introduction of oscillometry into clinical medicine putsaccurate information as to the arterial pressure of infancywithin reach of the clinician for the first time. The

Pachon oscillometer, a modification of which has been

used by M. Balard in researches on 40 infants, has

this great advantage, that it registers automatically thedisappearance of the pulse beneath the pressure of the

inflated armlet, so that the personal equation is apparentlyexcluded altogether. In adults it has been found that

readings are in general higher with this instrument thanwith apparatus of the Riva-Rocci type, and that the higherthe pressure the wider is the divergence. It is, of course,impossible to find out whether this holds good of infantsalso, owing to the variability of the Riva-Rocci readings ininfancy; at any rate, M. Balard makes no statement onthis point. With regard to the pulse-rate he finds that itfalls during the first six hours of the first day of extra-uterine life from about 150 to about 100 per minute ;this is to be ascribed to a closely parallel drop in

the temperature which occurs during the same period. ’,From the second day onwards the pulse reaches and

maintains a rate of about 150 per minute, a littlemore or a little less. The blood pressure, on the other

hand, is not in the least affected by the initial fall of tem-perature. At birth it lies between 35 and 55 millimetres of

mercury, and does not apparently vary with the infant’s

weight. From this time onwards the maximum or systolicpressure and the minimum or diastolic pressure increase

steadily and in parallel, the difference between the two-the pulse pressure-remaining approximately constant.

M. Balard has found it impossible to estimate the effectof respiration and of digestion on the blood pressureowing to the rapidity and short duration of these pro-cesses in the infant. Certain facts have, however, beenaelicited as to the effects of sleep, rest, and suckling. The.diastolic pressure rises little, if at all, with waking or

at the breast; the systolic pressure, on the other hand,always rises appreciably in both cases, often by as much as15 millimetres. Waking increases the rate of the pulse betslightly, but it is quickelled by 15 or 20 beats per minute bythe process of suckling. M. Balard suggests that deviationsfrom these averages of variation with activity may be ofimportance through the light thrown by them on underlyingpathological states; but this of course requires exhaustiveinvestigation, and apart from research it is scarcely likely thatoscillometry will ever be applied in a general way to theexamination of the new born infant.

IN-PATIENT ACCOMMODATION AT GUY’SHOSPITAL.

A COMMITTEE of King Edward’s Hospital Fund forLondon has considered the allegations of the Southwarkboard of guardians against the authorities at Guy’s Hospitalthat patients in a dying condition had been refusedadmission at the hospital and had been sent to the infirmaryand workhouses under the control of the guardians. The

Distribution Committee, who held the inquiry, state

in their report that they had before them a summaryof the cases upon which the complaints were foundedwhich had been previously considered by the Fund.

Among these were three cases reported by the guardiansin 1903, one case in 1905, when the Fund expresseditself satisfied with the explanation of Guy’s Hospital; andtwo cases in November, 1911. The committee state that theold question was raised of the reference from Guy’s Hos-pital to the guardians of cases for which there is no room,or which they consider more suitable for the Poor-law

infirmary than for the hospital. The explanation of

Guy’s Hospital is that their beds are limited, so that theycannot take in all kinds of cases, or even all urgent cases;that it is the duty of the guardians to provide for the sickpoor for whom there is no ’accommodation in the hospitals;and that the difficulty in urgent cases arises because theSouthwark infirmary is four miles off, and the guardians willnot provide an emergency receiving house. The guardiansargue that their duties are confined to the necessitous

poor"; that Guy’s Hospital ought to take in all cases

above that class and particularly urgent cases ; that the

workhouses and infirmary already provide adequately forthe local necessitous poor ; and that to provide a receivinghouse would encourage the hospital to send cases belong-ing to other unions. The Distribution Committee reportedin 1911 that they considered it desirable that additional pro-vision should be made at Guy’s Hospital for emergencycases, especially at night ; and they adhere to that

view. They suggested at the time that two or more

surgery beds might be kept free every night for

emergencies. To this the hospital authorities repliedthat until they were in a position to build new accidentwards and a new casualty department they could notmake better arrangements. The hospital authorities nowstate that the scheme of extension upon which they are atpresent engaged will, when completed some years henoe,afford space for a female accident ward, if funds for its

upkeep are then available. The Distribution Committee

consider, however, that as the infirmary is so far away,the guardians ought to establish a reception station in theneighbourhood, where it is required, since they have thepower to do so. The committee think it would be absolutelywrong for the hospital to overcrowd its surgical wards withemergency cases, the same observation applying, though notso strongly, to the medical wards. In their opinion avoluntary hospital should not be expected to admit in-curable cases. The fact that Guy’s Hospital attracts

patients resident outside the union, who subsequentlybecome chargeable to the Southwark union, is no reflection