drunk water in the city the day before, where the disease was very prevalent.
Sanitary precautions, — The usual sanitary precautions were strictly carried out, and, in addition, all drinking water was ordered to be boiled; the last case in the lines occurred five days after this order, so that the incubation must have been as long as that, or more proba- bly unboiled water had been drunk.
The day on which the last case occurred, the regiment was ordered into camp, but it probably had little or nothing to do with the outbreak ceasing, as the families of men had to remain in the lines, and no case occurred.
General remarks. — There was no prevalence of diarrhoea at the time, and very little fruit had been eaten iti the lines, as it was an exceptionally bad year.
The cases were all remarkable for the severity of the collapse and the in frequency of purging and vomiting. In fact, nearly all the fatal cases would come under the type described by Manson as cholera sicca.
No case occurred amongst the sick attendants or families of the men attacked, but one occurred in a man who had helped another to hospital when the latter was attacked.
A Mirror of Hospital Practive.
BRIEF NOTES ON SURGICAL CASES IN THE MEDICAL COLLEGE HOSPITAL, CALCUTTA.
By Captain E. O. THURSTON, I.M.S.,
Resident Surgeon, Medical College Hospital, Calcutta.
Tubercolous Disease of Breast. — K., female, OBt. 36, Hindu. Four months before admission patient noticed a swelling in the right breast and also in the axilla; the swelling in the breast increased, and finally an abscess burst. On admis- sion, the upper outer quadrant of the right breast was enlarged and indurated; in the centre of the indurated area was a small sinus dis- charging thin sero-pus; skin adherent. The axillary glands were enlarged, hard and not painful ; there was also another enlarged gland in the left axilla and several scars in the neck, the remains of previous abscesses.
The breast was treated with hot lead lotion and the induration largely disappeared, but the sinus persisted. The area surrounding the sinus and the axillary glands were removed; the latter were typically tuberculous to the naked eye and the microscope confirmed the diagnosis. (Wards of Lieut.-Col. R. H. Charles, M.D., IJIS.)
Sarcoma of Thyroid. — R., male, cet. 25, Mus- salman. Three months before admission he noticed a tumour in the leftside of his neck which rapid- ly increased, alteration of voice, diflSculty of
respiration and deglutition, with expectoration of blood, increasing in last two months.
On admission tumour about size ofcocoanut on left side of neck in position of thyroid ; hard and fixed to the deeper parts; skin not adherent. The trachea was pushed over to the right in a curve, the centre of the convexity being about one and-a-half inches from the middle line. Face suffused, voice a whisper, and he had attacks of increasing difiSculty of breathing. Operation — Owing to the danger of giving chloroform the operation was started without any anaesthetic whatsoever ; and the patient behaving as if he was insensible to pain, no anaesthetic was used ; in fact, he made more complaint of some lotion entering his ear at the termination of the operation than he did during its progress. Incision along the anterior border of the sterno-mastoid, continued outwards along the clavicle, flap reflected and muscles over the tumour divided ; the greater part of the tumour shelled out without very much difficulty, and with only a moderate amount of hsemorr- hage, the respiration was much relieved. The tumour had pushed the great vessels of the neck over to the right, had caused a small perforation if) to the oesophagus and extended down into the mediastinum, so that after removal the apex of the pericardium could be felt. A sterilised sponge was placed in the large cavity left and a drainage tube. There was very little shock. Rectal feeding for three days and then nasal feeding added, on the fourth day milk escaped from the rent of the oesophagus ; on the tenth day the feeding was carried out through a tube introduced into the rent of the oesophagus and retained there by the dressings ; he did well, wound granulating and the cavity closing until the 26th day, when, after coughing, some hce- morrhage occurred at 12 P. M., this stopped with pressure but recommenced about 6-30 P. M. On opening the dressings there was a spurt of blood from the common carotid, about an inch above the clavicle ; digital pressure easily stopped the haemorrhage, but the softened arterial wall gave way until the rent extended about a quarter of the way round the artery. The artery, vein and nerve were absolutely matted together and attempts to separate the artery failed, it being impossible to get a small curved aneurism needle round the vessels a Macewen's hernia needle was passed round the whole mass and the vessel ligatured in the ordinary way with catgut; this stopped the haemorrhage from the proximal end, but blood still came from the distal, so a fuither ligature was applied. HaemoiThage again occurred, so a thick double silk ligature was tied with Ballance and Edmund's " stay knot," and this stopped the bleeding for the time ; at 3-50 AM., a further re- currence took place, and an additional catgut ligature was applied. He had fever in the next few days, developed pneumonia on the right side, > and died on the 36th day. Post-mortem. — ^The ^
