fatal hÆmatemesis due to angioma of the portal vein

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is continual and has been seen to be practised evenby sucklings, chewing betel nut, and careless,unregulated depositing of fasces. His hope for thefuture is with the Government labourers and

recruits, who shall find so good sanitary arrange-ments in barracks that they will be unable to livewithout them in their homes on their return.

EARLY DAYS OF CHLOROFORM.

THE death, at the age of 83, of a niece of SirJames Simpson, which occurred last week at

Streatham, brings to mind the early days of anees-thetics. We have grown so accustomed to theiruse, and alterations and advances in the practice ofanaesthesia follow so rapidly one upon another,that we easily lose sight of the fact that it is reallyonly a short time since the first anaesthetics wereintroduced. Mrs. Agnes Thomson was, so far as weknow, the first woman to inhale chloroform, whichshe did experimentally at Simpson’s house in Queen-street, Edinburgh, where he and his assistants wereinvestigating the newly discovered drug. MissPetrie,as she then was, after witnessing the effects ofchloroform on Simpson and some of his assistants,volunteered to try it, and apparently she enjoyedthe inhalation, for she repeated it on more than oneoccasion. No doubt what we now regard as surgicalanaesthesia was never attained, and the pleasantsensations she experienced are often paralleledat the present time by those who are subjectedonly to short periods of administration and to nodeep degree of narcosis. Chloroform, we mayremind our readers, was no haphazard discovery,but was the direct result of Simpson’s desire tofind an anaesthetic less irritating than ether, whichhad been already introduced and was used bySimpson early in 1847. It was in November of thesame year that he read his " notice of a new anæs-thetic agent as a substitute for ether in surgeryand midwifery," in consequence of which chloro-form rapidly supplemented ether, until the greaterdanger of the former drug became apparent. Thereis an interesting picture of these early chloroformexperiments of Simpson, which partook almost ofa domestic nature, and of those taking part inthem, in Lady Priestley’s "Story of a Lifetime."Her husband, the late Sir William Priestley, wasone of the many young Edinburgh medical men whowere infected with the enthusiasm and joyous spiritof investigation which animated their great teacher.

FATAL HÆMATEMESIS DUE TO ANGIOMA OF

THE PORTAL VEIN.

IN the Berliner Klinische Wochenschrift forDec. lst, 1913, Dr. Hart has reported a case whichthrows light on the origin of one form of gastrichaemorrhage. His patient was a governess, aged 20,who had previously been well. In March, 1913, anattack of violent haematemesis was followed bycollapse. After five days, during which thehtematemesis continued, the patient died. The

necropsy showed dilatation of the veins of the

cesophagus and the stomach, and a rupturedvaricose vein in the latter. The spleen was muchenlarged and surrounded by adhesions. There wasno sign of a normal portal vein, the place of whichwas taken by a spongy structure consisting ofinnumerable minute blood-vessels. This was

evidently the point at which obstruction tothe circulation of the abdominal veins had

induced enlargement of the spleen and dilata-tion of the gastric veins. As there was noteven a fibrous cord in place of the portal vein, thiscannot at any time have existed, and the angiomamust be regarded as a congenital anomaly. It isastonishing how such a condition could have lastedfor 20 years before the congested veins gave way.The liver contained gummata, and at first sight theangioma would seem to be dependent on congenitalsyphilitic disease of the liver; but Dr. Hart thinks,in view of the patient’s history, that the syphiliswas acquired, and had nothing to do with theangioma. Of late years a few cases have beenrecorded in which the portal vein was replaced bycavernous tissue. Sometimes this has been limitedto the portal vein, and at other times it hasextended to the splenic vein and to the intra.

,

hepatic branches of the portal vein. It is ,

practically impossible during life to distinguish this condition from cirrhosis of the liver, Banti’s disease,and polycythaemia. The condition may be fatal asa result of late thrombosis of the branches of theportal vein with infarct of the correspondingportions of the intestine, or as a result of hagmo).’-rhage from an cesophageal or gastric vein. Thecondition does not necessarily affect the liver, andits origin is still in dispute. Some authoritiesregard the angioma as a sequel to thrombosis of theportal vein, followed by recanalisation and theformation of capillary, collateral blood-vessels.Others consider that an angiomatous tumour hasgrown from the wall of the portal vein, which hasultimately become obstructed. Others, again,regard the condition as a congenital malformation.It has probably been overlooked more than once atnecropsies, and thus the cause of a fatal gastro-intestinal haemorrhage has not been discovered.

THE POLICE PATIENTS IN METROPOLITANHOSPITALS.

THE metropolitan police force now numbers

22,000 men, and they form a picked body, for onlyabout 25 per cent. of the candidates are accepted.The last published report of the Chief Surgeon ofthe Metropolitan Police, that for the year 1912,shows the general health of the force to be good,but reveals also how their arduous duties entail a

corresponding sickness rate, whilst the number ofpolice injured in the course of their routinework is very large. For instance, in 1912 3075policemen were injured in the execution of theirduty, over 2500 having been assaulted when makingarrests, of whom 329 were placed on the sick listfor more than one week. 369 patients during thesame year were admitted into general’ hospitals,33 into cottage hospitals. and 172 into special hos,pitals, making a total of 574, 22 of whom died. The

figures show that the hospitals of the metropolisminister in an important manner to the healthand well-being of the police force over a huge area.We have just received with particular pleasure acommunication from the Office of the Commissionerof Police stating that it is proposed to alter thebasis on which subscriptions are paid to the metro-politan hospitals from the Police Funds in returnfor the ministrations rendered to police in-

patients. Hitherto certain subscriptions havebeen paid by Scotland Yard to different hospitals ina completely arbitrary way, so that it might easilyhappen that one charity, receiving a small sub-scription, would be affording treatment to 40 or 50police in-patients during the year, while another,