1095

of the Sussex County Hospital devoted to children’s u

diseases into a section for diseases of women and to ptransfer the children to the existing Children’s Hos- a

pital. It is pointed out that the effects of redistribu- cltion in this case are the development of the Women’s i:

Hospital as a maternity institution, increased bed accom- r,

modation being available for this purpose, the parallel de- t

velopment of the Children’s Hospital, the formation of an inde- r

pendent gynsecological department, and a saving of 20,000.Centralisation after this model has much to recommend it.

It has thus far been shown to be inexpensive. It allows of

autonomy, the comparative lack of which has proved fatal toless elastic systems. It owes its adoption to the support of ]all the medical charities which it is intended to serve, a frecognition of its disinterested character., We shall watch rits further progress with attention and we may express the 1hope that success in the place of its origin will justify. its (

extension to other populous areas. f

A CASE OF EMPYEMA COMPLICATED BY ANŒSOPHAGEAL FISTULA INTO THE PLEURA.

J.

A CASE of some interest and considerable rarity is recorded cby Dr. Alexander Jehle in the Wiener Medicin4cAe Wochen- s

schrift, No. 22, 1904. The patient was a child, aged two aand a half years, who six weeks previously had suffered from Ia right-sided pneumonia. About ten days before admission rinto the Wilhelmina Hospital at Vienna the child, developed cfever, followed by emaciation and oedema of the lower ex- ctremities, but at no time was colic, hasmatemesis, or vomit- 1ing observed. On admission the pulse and temperature were tnormal and there were oedema of the feet and ankles and r

some degree of emaciation. Physical examination of the Ichest showed dulness with weak bronchial breathing on the tright side, while the heart was displaced towards the left, ,

the sounds being normal. Exploratory puncture proved thepresence of pus from which a pure culture of the pneumo-coccus was obtained on bacteriological examination. The

pleura was incised in the fifth intercostal space in the

posterior axillary line and a considerable quantity of thickgreenish-yellow odourless pus was evacuated. The course ofthe case was at first quite satisfactory, the oedema disappearedby the third day, the patient rapidly improved, and theempyema cavity became smaller, but about three weeks laterthe pus which escaped acquired a sour, pungent odour andcontained small cheesy masses like curdled milk. This first

suggested the presence of an oesophageal fistula, which wasconfirmed by the discovery of seeds in the pus escaping fromthe drainage-tube after their administration by the mouth,although fluid given by the mouth did not apparently escapeinto the pleura. The empyema continued to clear up and the

oesophageal fistula closed for a time but later small particlesof food were again found in the pus and this condition

recurred at intervals for about four months, after which theoesophageal fistula closed permanently and the empyemaoperation wound healed shortly after, since which time thechild had remained quite healthy. The explanation putforward by Dr. Jehle is that the communication betweenthe oesophagus and the pleura was due to a mediastinal

gland infected by the pneumococcus at the time of the

pneumonia breaking down simultaneously into the pleura andthe oesophagus and not to direct invasion of the oesophagusby the empyema, which he regards as negatived by theinterval which elapsed between the opening of the empyemaand the development of the fistula and by the narrownessof the track which only at times allowed food material topass and even then in such small quantities as frequently tobe recognisable only by chemical or microscopical examina-tion. For treatment he recommends washing out the pleurawith non-toxic solutions to clear away the escaped foodmaterials, while the thoracic wound is to be kept open

UUbii L11C Le:"V’plläei;t1 11,,-L111i.L iS taVi:!eu..111 Vi:tMVll Ut l1e

pleura by disease of the oesophagus is well known to occurand empyema and pneumothorax resulting from malignantdisease of the oesophagus may be quoted as examples, butinvolvement of the cesophagus from the pleura is certainly .amuch more rare event notwithstanding Dr. Jehle’s suggestionthat such cases may occur more frequently than they arerecognised.

-

CENTENARY OF THE ROYAL MEDICAL ANDCHIRURGICAL SOCIETY.

THE opening meeting of the centenary session of the-

Royal Medical and Chirurgical Society will be held at theSociety’s rooms, 20, Hanover-square, London, W., on

Tuesday, Oct. 25th, at 8.30 P.M. The two followingpapers will be read-viz., the Pathology and Prevention

of Secondary Parotitis, by Mr. -Rupert T. H. Bucknall, andSymptomatic Parotitis, by Mr. B. N. Tebbs, and it is

anticipated that there will be an exceptionally interestingdiscussion. The society always welcomes the presence of

visitors who are invited to take part in the discussions.

Persons intending to be present will recieve abstracts

of the papers on application to the secretary, 20, Hanover-square, W. In many ways the society is showing that it isactuated by a progressive spirit. Formerly, even though apaper was received and approved for reading and read at ameeting of the society, it might not be considered worthyof a place in the Transactions and publication in any journalof any paper before the issue of the Transactions was pro-hibited. Wiser counsels have prevailed and at the presenttime all papers accepted for reading are published in theTransactions and authors are at liberty to publish their

papers in medical or scientific periodicals immediately afterthey are read. On May 22nd, 1905, the centenary of the-society will be celebrated and at the present time a com-mittee is considering the arrangements for this celebration.

SIR ISAMBARD OWEN.

Sir Isambard Owen has been unanimously appointedprincipal of Armstrong College in the University of Durhamin place of the late Dr. Gurney. Sir Isambard Owen,who entered upon the performance of his new duties onOct. 8th, is well known in London, for he has till quite re--cently been physician and lecturer on the principles andpractice of physic at St. George’s Hospital. He is, more-over, a Vice-Dean of the Faculty of Medicine of the Univer-sity of London and an examiner in medicine for the RoyalArmy Medical Corps. He rendered yeoman service in the

formation of the University of Wales and is at the presentmoment the senior deputy chancellor of that body. The

great experience which he possesses in educational questions-renders it peculiarly fitting that he should have been selectedto be the principal of an institution such as ArmstrongCollege and the city of Newcastle, together with the Uni-versity of Durham, is to be congratulated upon havingobtained the services of so able a principal for one of theirforemost educational institutes. B

THE BRITISH MEDICAL BENEVOLENT FUND.

IN a letter published in the Times of Sept. 30th Sir-

: William Broadbent states that the British Medical.: Benevolent Fund is suffering considerably by reason of the, prevailing financial depression and that the sum available, for the relief of aged or invalided medical men and

. of widows and children left unprovided for is quite

. inadequate. He truly says that for a large proportion

. of medical men it is impossible to save much outL of their earnings and if they die early, which is veryL common, their widows and children may be left on

i the border of destitution. The fund gives 120 annuities