June 28, 1890.j THE BRITISR MEDICAL JOURNAL. that of the previously inserted forefinger), and the ring tightly 3. The two serous surfaces of the stump are applied and unite closed, leaving, of course, sufficient play for the cord (Fig. 2). The in, say, thirty-six hours. J 12:~~~~,.x'herrj,D ;' cr- ~7rr.C'g Incistion in Skin. Serous :i it! Surfaces. i7;frf -b ri .t1 4_ :. ~.;a4. Fig. 4.-Profile View. I have had several successful cases following this operation, and notably one: a patient who was operated on about two years ago, and into whose abdominal aperture one could, previous to the operation, almost put one's fist, who assures me that he has since put himself to the severes test of ascending the Matterhorn; and another, a lady, operated on about three years ago, who has experienced no return of her trouble. In no case has a truss been itgt. e. 4a2i hi worn subsequently to the operation. | e rt ,F~, 2.' MEMORANDAI MEDICAL, SURGICAL, OBSTETRICAL, THERA PEUTICAL, PATHOLOGICAL, ETC. NOTE ON VACCINIA OF THE EYELIDS. I HAVE not been able to find any reference, in the different text- t t_ x i i.; books on diseases of the eye, to the accidental occurrence of vaccine pocks on the eyelids. I am inclined to think, however, that such an accident is by no means so rare as this would appear to indi- cate. Possibly a good many cases do not come under the notice of the ophthalmic surgeon at all, but are recognised and treated by the family doctor. I have seen in all five well marked cases. i ~~~~~~~~',- j ...s.6X&t;,i..,.r. Four of these occurred in women, one was in a man aged 30.1 MI all there was a distinct history of inoculation, or rather of the possibility of inoculation. A child had been vaccinated ten or fourteen days before the patient was seen. In all the pock oc- Fig. 3. curred on the lower lid, but there were also to be found. one or inintheusuioaltheusu alway,way,ureatgreat careouighcare beingthroughouttakentakensthmreougowtotoestopstopleverye very more ulcerated patches on the margin of the upper lid where it The c ofu ring ardte oeainiopee came into contact with the macerated surface of the primary vac- tighvatagy operation cine ulcer. The swelling was always great, and involved not only 1\,J8 S. .tas the lids, but also the cheek. The base of the ulcer was decidedly septic....TepeliiayicsionF%sources.; -i isf)removed far "1p'osibl],;; fomi setcso r e. 2 i; :-si3. t s ? .;,,te ;, J harder than the surrounding swelling, but not so distinctly indu- 2.An4iLadirbl> smot inera pad is otaie(.F\.'ig. 4 rate I as in the case of chancre of the lid, and the glands were not *.;.>'L~.r';ztK~b'ii' swollen. There was, comparatively speaking, very little pain; practically no spontaneous pain, and but little tenderness to touch. In no case was the eye affected. The affection never led to any alteration in the position of the lid, and even the cicatrix left was slight, barely perceptible, owing no doubt to the laxity of the skin in this situation. The main interest in these cases consists in the possibility of the , .. b- ·n. ... .4 .it .q, d i 4 .. ... inoculation taking place at all, and in the differential diagnosis 9ta.z,JZ o L 's',o' '-;nu9n ,Iul>ti..'lo between vaccinia and a primary syphilitic sore. As to the man- ner of inoculation: in three of my five cases this could not be satisfactorily ascertained; in one there was little doubt that a direct transference of lymph took place, owing to the child's arm vestige of h*emorrhage. I In my book on Diseases of the Eye there is a sentence in the paragraph de- The advantagesof the operation areted voted to chancres and vaccine pocks of the lids which somehow has got.trans- 1. The preliminary incision is removed as far as possible from posed, and which I take this opportunity of correcting. The sentence is as follows: aI have seen it in both adults and children." this should have come after Instead of hbefore the next sentence, as it refers to chancres and not to 2 An .admirable smooth internali pad s obtained (Fig.4). vaccinia. 1484 TAI.E BRATIAT1 M.JBDICAZ JO?1R_NAL. [June 28, 1890. being often in contact with its mother's face; in another the twenty-four hours, and almost invariably I find the hammorrhage handkerchief used for wiping the vaccinated arm was admittedly lessened. The treatment is simple and devoid of danger and pain, used by the mother also. and may be repeated if required. Chancres of the lids, to judge from one's own experience, are of Clifton. A. E. AUST LAWRENCE, M.D. decidedly more frequent occurrence than vaccine ulcers. For the reason above stated this may, however, be only apparent. It is not unlikely that vaccine pocksi in this situation have sometimes been mistaken for syphilitic sores. The latter is always a more REPORTS distinctly clean-cut, eaten-out ulcer, which has taken a consider- ON able time to develop from its first appearance as a pimple at the MEDICAL & SURGICAL PRACTICE IN THE HOSPITALS lid margin. The opposite lid margmi is not ulcerated as a rule. AND ASYLUMS OF GREAT BRITAIN, IRELAND, The base of the ulcer is greatly indurated, and the preauricular, as well as the submaxillary, glands are often swollen. There is no AND THE COLONIES. history which can in any way connect the case with vaccination, and usually one which renders a syphilitic contagion possible. ULSTER HOSPITAL FOR WOMEN AND CHILDREN. Lastly, secondary symptoms appear in due course. A CASE OF RAYNAUD'S DISEASE. GIEORGE A. BERRY, M.B., F.R C.S.Ed., [Under the care of WILLIAM CALWELL, M.A., M.D., Surgeon to tte Ophthalmic Surgeon, Royal Infirmary, Edinburgh. Hospital, and Assistant-Surgeon to the Ophthalmic Hospital, Belfast.] ANACHRONISM OF INVOLUNTARY MUSCLES. THIS case, a girl, M.A.G., aged 12, was admitted from the out- THE JOURNAL of May 17th refers to a description of acute car- patient department of the Ulster Hospital for Women and Chil- diac strain by Dr. Schott, of Nauheim, and others. I have met dren, Fisherwick Place, Belfast, on May 7th last, by Dr. M'Kisack, cases presenting symptoms corresponding to those described. who showed her the same evening before the Ulster Medical There is one symptom, however, not alluded to in the annotation Society. which I saw well marked, in one case at least, namely, anachro- Her family history is exceptionally good on both sides. When nis n of the ventricular contraction. Very many years ago, I myself 3 years old she was severely burnt on the back, and during a c3mpeted in a running match with a very healthy but stout man. lengthy recovery contracted bronchitis, from which since she has Immediately the competition was over he was seized with a sense never been completely free. When 8 years old her mother noticed of faintness and cardiac distress, which lapsed into an almost for the first time that at times her cheeks got mottled and her chronic condition of some months' duration, but at last ended in fingers became "dead." When about 10 years old, one winter perfect recovery. All during this time a distinct reduplication of morning, she accompanied her mother to a neighbouring small cardiac impulse and first sound was constantly present. The im- town on foot, but her fingers. feet, and face "got so black and pulse felt as if it were broken. I accounted for the anachronism swollen" that she had to be taken home quickly on a car. Some by the strain thrown on the right side of the heart by the im- little time after this she had the measles; the rash, however, was pediment offered to the pulmonic circulation, which impediment not so bright or marked as on the seven other children. Since temporarily strained and dilated it, for the subsequent physical her first severe attack on the winter's morning she has been con- signs pointed to this. tinually subject to similar ones, varying, however, in frequency We meet, however, with other interesting phenomena of ana- from one in a month to two a week, and she is always unfavour- chronism in other parts of the system, and it is with the idea of ably affected by cold. During this time the nails on the hands pointing more especially to certain such conditions in the genito- have suffered, and the tips of the fingers might be said never to be urinary apparatus that I offer this memorandum. In the normal completely free from small patches of feeble suppuration. Daring act of ejaculation the vesicule seminales and vasa deferentia of an asphyxial exacerbation she always suffers great pain, and is both sides usually contract together, but sometimes those of one peevish and irritable. No dark-coloured urine has ever been ob- side contract before the other side, or not at all. Next the pros- served. tate and bulbo-cavernosus muscle contract and eject the fluid; but here arises an interesting and practical phenomenon, namely, the two latter often contract without a preceding contraction of the vesicles and vasa deferentia. Hence many persons the subjects of irritable prostate are said to suffer from "spermatorrheea," often whea such a disease does not exist, but a prostatorrhcea ac- companied by the phase of contractile emission, generally noc- turnal, sometimes diurnal. When to this fact we add the further fact that such emitted fluid generally is devoid of spermatozoa, or only a few motionless ones killed perhaps by the chemical altera- tion in the prostatic juice, we have in part an explanation of the condition looked upon as grave by some, namely, where the disease is supposed to have run riot, and gone on to the stage of alteration in the constitution of the seminal fluid itself.