382 CLINICAL NOTES.

arrangement which was worked by the patient himself.The diet was restricted to peptonised preparations withwhite of egg, stale bread, and green vegetables, and as littleliquid nourishment as possible. When any signs of putre-factive changes showed themselves I immediately washed outthe stomach, and to procure complete antisepticity I orderedthe following mixture : four grains of hydronaphthol, fifteengrains of salicylate of bismuth, and ten grains of bicarbonateof soda; to be taken in cachet form three times daily one hourafter meals, and a tumblerful of hot water (temperature from110° to 120° F.) to be sipped before mealtimes. After twelvedays of this treatment a slight improvement showed itself,and at the end of the thirteenth week my patient nolonger required the stomach to be washed out ; he tooknourishment well. The pyrosis was completely checked, andhe talked of returning to work after an enforced period ofidleness extending over nearly two years. My principalobject in mentioning this case is to show the remarkable

properties of hydronaphthol as an alkaline antisepticwhen used in combination with salicylate of bismuth andbicarbonate of soda.Broadgate, Lincoln.

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CASE OF COMPLETE LATERAL DISLOCATION OFTHE ELBOW-JOINT.

BY C. S. SIMPSON, L.R.C.P. LOND., M.R.C.S. ENG.,SENIOR HOUSE SURGEON, BRIGHTON AND HOVE DISPENSARY.

A PORTER at the Brighton railway station was brought tothe Brighton and Hove Dispensary on May 19th, havingfallen a distance of 6 ft. from a ladder upon the platform,falling directly upon the left elbow. On examination bothbones of the forearm were found to be completely dislocatedoutwards, the olecranon lying external to the outer condyleof the humerus. The head of the radius lay in front of theolecranon, occupying the position of the coronoid process,for which, in fact, I at first mistook it. A bony prominencebelow the internal condyle was probably the fracturedcoronoid process. The bones of the forearm were pronated.The dislocation was reduced under chloroform without diffi-culty ; but the case deserves to be recorded on account ofits extreme rarity.Brighton.

GALL-STONE PRODUCING ACUTE INTESTINAL

OBSTRUCTION ; OPERATION; RECOVERY.BY W. ARBUTHNOT LANE, M.S.,

ASSISTANT SURGEON TO GUY’S HOSPITAL AND TO THE HOSPITAL FORSICK CHILDREN, GREAT ORMOND-STREET.

A PATIENT fifty-four years of age was admitted into Guy’sHospital on Tuesday night, April 24th, suffering from sym-ptoms of acute intestinal obstruction, which had commencedat 3 A.M. on Friday, the 20th, more than four and a half dayspreviously. From the commencement of the attack up tothe time I saw her she had suffered from very severe gripingpain at frequent intervals, from vomiting, and from con-stipation. She had been treated with opium, belladonna,and nutrient enemata. The material vomited was never

faecal. On her admission the abdomen was distended,very tender on pressure, and a distinct thrill could befelt on percussion. There was no evidence of any dis-tension of the large intestine, and the character of thevomited material suggested that the distension was pro-bably limited to the upper part of the small intestine.She had never been troubled by constipation. Duringthe last three years she bad suffered off and on fromattacks of indigestion, during which she experienced muchdistension of the abdomen, with some tenderness on pressure.Two or three months after the appearance of the indigestionshe was jaundiced for several days. There had never been

any particular pain or tenderness in the region of the gall-bladder. Immediately on her admission I opened the abdo-men by means of a long median incision, when a quantity offluid more or less turbid in character and tinged with bloodescaped. The upper part of the jejunum was very muchdistended, the walls being deeply injected and covered withlymph where the ceils approximated. A gall-stone wasfound at the lower limit of the distended intestine, whichinvolved about the upper eight feet of the small bowel

that beyond the obstruction being quite empty. Thestone was removed through an incision which was closedwith a horsehair suture. The amount of distension was soconsiderable that very great difficulty was experienced inbringing the aponeurotic edges into apposition. Under theconstant care of the resident medical officer, Mr. Freeland,she gradually regained her strength. I am putting this case onrecord as it is the first instance of intestinal obstruction dueto gall- stone in which I have had an opportunity of operating.Such cases must be relatively very rare as compared to othercauses of obstruction. The conditions presented at the opera-tion were such as to render it probable that she could hardlysurvive the inflammatory changes consequent on the greatdistension of her obstructed intestine. It seemed that

recovery was largely due to the absence of decomposablematerial in the bowel, the distension being almost entirelygaseons. I would point out that the symptoms presentedby this case differed in no manner from those usually seen inobstruction of this part of the bowel by band or by thestrangulation of a knuckle in a hernial sac.

St. Thomas’s-street, S.E.

THE INGESTION AND PASSAGE OF A POCKET-KNIFE.

BY G. B. GOODALL, M.B., C.M.EDIN.

THE following case is interesting as showing the tolerationof the intestinal tract, even in the very young. At half-pasteight on the evening of June 21st A. B-, a child two years

and eleven months of age, swallowed a pocket-knife just unde]three inches long, of the familiar shape-two blades, motherof-pearl sides, and brass tips. On the evening of MondayJune 25th, the knife was passed by the rectum, and at n<

time did the child experience pain or even inconvenience.Greenwich.

_________________

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

WESTMINSTER HOSPITAL.NOTES ON TWO CASES OF ENTERIC FEVER WITH EXCEP-

TIONAL NERVOUS SYMPTOMS.

(Under the care of Dr. STURGES.)

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et mor-borum et dissectionum historias, turn aliorum tum proprias collectashabere, et inter se comparare.&mdash;MoReAGNl De Sed. et Caus. Morb.,lib. iv. Prooemium. &mdash;&mdash;&mdash;&mdash;&mdash;

NERVOUS symptoms of the pronounced character describedin the two following cases are by no means commonly presentin enteric fever. True meningitis occurs sometimes, thoughrarely, at an early period of the fever, and is then attendedwith the symptoms displayed by the patient in the firstcase. Recovery from such a condition is very unusual.For the reports of these cases we are indebted to Mr. W. B.Winckworth, house physician.The following notes refer to two patients, lads of seven-

teen and twenty years of age, both friends and from West-minster, but not living in the same house or having theirmeals together. The fathers of the lads are also friends,and it is possible that the two boys may have been infectedfrom the same source and at the same time, as, for example,from a common food-supply. The cases have many points ofresemblance, the striking feature in both being the markednervous phenomena of a kind very rarely met with in con-nexion with enteric fever and hardly mentioned in text-books. In the younger patient, who had had a dischargefrom his right ear intermittently for years, these consisted