suprarenal apoplexy

1
666 along the lines laid down by G-ibson. The confirma- tion of his work so long after its performance, and by observers apparently unaware of his findings, must be regarded as highly significant. SUPRARENAL APOPLEXY. Dr. Felix Pearl and Dr. Harold Brunn,l of San Francisco, who describe a case in a man, aged 45, which has come under their observation, remark that haemorrhage into the suprarenal gland, though not infrequently found in infancy, is a rare condition in the adult, only 20 instances of bilateral suprarenal apoplexy in adults having been reported since 1906. The setiological factors suggested have been throm- bosis, capillary emboli, congestive diseases, infections and toxins, diseases of the solar plexus, surface burns, and the haemorrhagic diathesis. The cases have been classified by Arnaud into three types-peritoneal, asthenic, and nervous. Any combination of symptoms may form the clinical picture, but asthenia is the most constant and characteristic of all symptoms. Physical signs are usually of no assistance in locating the seat of the disease. There may be merely vague tenderness in the lumbar regions or epigastrium or abdominal distension as in the present writers’ case. There is no pigmentation of the skin as in Addison’s disease. The diagnosis has only once been definitely made before death, in a case reported by N. B. Foster in 1920, but the presence of severe abdominal symptoms, with few or no physical signs, in a patient who presents definite nervous mani- festations, profound asthenia, and gradual decline of blood pressure, should suggest acute adrenal disease. The prognosis is hopeless in well-marked bilateral cases, but small hsemorrhages may be absorbed without sequelae. Treatment of bilateral suprarenal apoplexy is usually unsuccessful. The best results are likely to be obtained by injection of normal saline, Ringer’s solution, and extracts of adrenal cortex or whole suprarenal gland. Epinephrin is ineffectual. Although operation is of no benefit in well-marked bilateral cases, it may be the only hope where there is massive unilateral haemorrhage and where death is likely to be due to severe haemorrhage and shock rather than to suprarenal failure. THE Royal College of Physicians of London will commemorate its benefactors on Thursday, Oct. 18th, when the Harveian Oration will be delivered by Sir Humphry Rolleston, at 4 P.M., in the large library. The annual sermon at the Church of St. Mary-le-Bow will be preached at 11 A.M. on the same day, and in the evening the commemoration dinner will be held in the College at 7.30 P.M. OUR advertisement columns contain an official notice of the forthcoming election of two members to the General Medical Council, to represent the registered medical practitioners resident in England. A group of not less than 12 practitioners is entitled to nominate a candidate, and nominations must be delivered in proper form to the Registrar of the Council on or before Oct. 13th. 1 Surgery, Gynecology, and Obstetrics, September, 1928, p. 393. DONATIONS AND BEQUESTS.-A cheque for 21000 from an anonymous donor has been handed to the Glasgow Dental Hospital by a chartered accountant of the citv.&mdash; Miss Martha Mills, of Nottingham, left &pound; 1000 to the Nottingham General Hospital for the endowment of a bed in memory of her brother-in-law, Morris Weisblum, and &pound; 100 each to Dr. Barnardo’s Homes and the Nottingham General Hospital; B50 each to several other charities.- Mr. Miles Daniel Whitehead, of Kingstown, Co. Dublin, left B500 to the Drogheda Memorial Hospital at the Curragh, Co. Kildare, and &pound; 400 to Laura Hitchins, and the income for life from 800 shares in the Imperial Tobacco Co., with remainder to the Manchester Royal Infirmary if Laura Hitchins predeceased him. OPENING OF THE LONDON MEDICAL SCHOOLS. ADDRESSES AND ANNUAL DINNERS. Charing Cross ospa!.&mdash;Prizea will be distributed at the hospital on Thursday, Oct. 4th, at 3.30 P.M., by Dr. Thomas Watts Eden. The annual dinner will be held at Gatti’s Restaurant on the same day at 7 for 7.30 p.vL, with Sir Herbert Waterhouse in the chair. Ouy’s ospt<6f!.&mdash;The session will begin on Tuesday, Oct. 2nd, but there will not be an opening ceremony. Killg’s College Hospifcal.-An introductory address will be given at the Medical School at 2.30 P.M. on Wednesday, Oct. 3rd, by Mr. Ernest Barker, professor of political science, in the University of Cambridge. Sir William Watson- Cheyne, F.R.S., will preside. The annual dinner of past and present students will be held at 7.30 P.M. on Wednesday, Oct. 3rd, at the Trocadero Restaurant, Piccadilly-circus, W., with Dr. B. R. Turner in the chair. London Hos])ital.-The old students’ dinner is to be held at the Trocadero Restaurant on Thursday, Oct. 18th, at 7.30 P.lII. London (R.P.H.) School of llTedicine for V’onzerz.-An introductory address will be given at the school at 3 P.M. on Monday. Oct. 1st, 1>y Dr. Andrew Balfour, whose subject will be the Tropical Field, its Possibilities for Medical Women. Middlesex; Ho.spital.-VTr. A. E. Webb-Johnson will deliver an introductory address, entitled the Enemies of Man, at the Queen’s Hall at 3 P.M. on Tuesday, Oct. 2nd, after which Prince Arthur of Connaught will distribute prizes and Princess Arthur will present the Pardon Memorial medals. The annual dinner will be held at the Savoy Hotel on the same day at 7.30 P.M., with Prince Arthur in the chair. Phai,i)taceiiticctl Society of Great Britairz.-On Wednesday, Oct. 3rd. at 3 P.-,Nf , an inaugural sessional address will be given bv Mr. Reginald R. Bennett, chairman of the British Pharmaceutical Conference. A presentation of the Pereira medal will be made. On the same day, at 6.45 for 7 P.M., the anniversary dinner will take place at the Hotel Victoria, Xorthumberland-avenue, W.C. 2. Royal Dental Hospital.-The dinner of past and present students will be held at Ei.30 for 7 P.M. on Saturday, Oct. 20th, at the Trocadero Restaurant. Mr. G. G. Campion will preside. St. Bartholorrrezc’s Hospital.-The old students’ annual dinner will be held in the Great Hall of the hospital at 7 for 7.30 P.M., on Monday, Oct. 1st, with Sir D’Arcy Power in the chair. St. George’s Hospital.-The prize distribution will be held in the Board Room of the hospital at 3 P.M. on Monday, Oct. 1st, when an inaugural address, entitled Hydrocephalus : A Study in Phylogeny and Pathology, will be delivered by Sir John Bland-Sutton The annual dinner will be held on the same day at the Hyde Park Hotel at 7.15 for 7.45 P.M. The chair will be taken by Dr. W. S. Fox. St. Marr/’s Hospital.-The annual dinner of past and present students is to be held at the Trocadero Restaurant on Friday, Oct. 5th, at 7 P.M. St. T/K)M:6ts’s Hospital.-The old students’ dinner will be held at St. Thomas’s House on Friday, Oct. 26th, with Mr. Edwin Francis White in the chair. U ni!’ersit,/ C’olleqe Aredical S’chool.-The session will open on Monday, Oct. 1st, when Sir Thomas Barlow, F.R.S., will give an introductory address in the Library at 4.30 P.M. The annual dinner of past and present students will take place at the Hotel Cecil on Friday, Oct. 12th, Surgeon Vice- Admiral Gaskell in the chair. r:V cstminster H omital.-An inaugural address will be given in the Board Room of] the hospital on Monday, Oct. 1st, at 3 P.M., by Mr. A. C. Powell, headmaster of Epsom College. Sir William Goschen will take the chair. The hospital dinner is to be held on the same day, at 7 P.M. for 7.30, at Gatti’s Restaurant, Strand, W.C., Sir James Purves-Stewart presiding. PRESENTATION OF WILLIAM MACKENZIE MEDAL.- This medal, given for valuable contributions to ophthalmo- logy, will be presented to Dr. A. Maitland Ramsay at the Glasgow Eye Infirmary, on Tuesday, Oct. 9th, at 8 P.M., when Dr. Ramsay will deliver an address on the Importance of General Methods in the Treatment of Eye Disease.

Upload: danghuong

Post on 02-Jan-2017

218 views

Category:

Documents


0 download

TRANSCRIPT

666

along the lines laid down by G-ibson. The confirma-tion of his work so long after its performance, andby observers apparently unaware of his findings,must be regarded as highly significant.

SUPRARENAL APOPLEXY.

Dr. Felix Pearl and Dr. Harold Brunn,l of SanFrancisco, who describe a case in a man, aged 45,which has come under their observation, remark thathaemorrhage into the suprarenal gland, though notinfrequently found in infancy, is a rare condition inthe adult, only 20 instances of bilateral suprarenalapoplexy in adults having been reported since 1906.The setiological factors suggested have been throm-bosis, capillary emboli, congestive diseases, infectionsand toxins, diseases of the solar plexus, surface burns,and the haemorrhagic diathesis. The cases have beenclassified by Arnaud into three types-peritoneal,asthenic, and nervous. Any combination ofsymptoms may form the clinical picture, but astheniais the most constant and characteristic of allsymptoms. Physical signs are usually of no assistancein locating the seat of the disease. There may bemerely vague tenderness in the lumbar regions or

epigastrium or abdominal distension as in the presentwriters’ case. There is no pigmentation of the skinas in Addison’s disease. The diagnosis has only oncebeen definitely made before death, in a case reportedby N. B. Foster in 1920, but the presence of severeabdominal symptoms, with few or no physical signs,in a patient who presents definite nervous mani-festations, profound asthenia, and gradual decline ofblood pressure, should suggest acute adrenal disease.The prognosis is hopeless in well-marked bilateralcases, but small hsemorrhages may be absorbedwithout sequelae. Treatment of bilateral suprarenalapoplexy is usually unsuccessful. The best resultsare likely to be obtained by injection of normalsaline, Ringer’s solution, and extracts of adrenalcortex or whole suprarenal gland. Epinephrin isineffectual. Although operation is of no benefit inwell-marked bilateral cases, it may be the only hopewhere there is massive unilateral haemorrhage andwhere death is likely to be due to severe haemorrhageand shock rather than to suprarenal failure.

THE Royal College of Physicians of London willcommemorate its benefactors on Thursday, Oct. 18th,when the Harveian Oration will be delivered by SirHumphry Rolleston, at 4 P.M., in the large library.The annual sermon at the Church of St. Mary-le-Bowwill be preached at 11 A.M. on the same day, and inthe evening the commemoration dinner will be heldin the College at 7.30 P.M.

OUR advertisement columns contain an officialnotice of the forthcoming election of two membersto the General Medical Council, to represent theregistered medical practitioners resident in England.A group of not less than 12 practitioners is entitledto nominate a candidate, and nominations must bedelivered in proper form to the Registrar of theCouncil on or before Oct. 13th.

1 Surgery, Gynecology, and Obstetrics, September, 1928,p. 393.

DONATIONS AND BEQUESTS.-A cheque for 21000from an anonymous donor has been handed to the GlasgowDental Hospital by a chartered accountant of the citv.&mdash;Miss Martha Mills, of Nottingham, left &pound; 1000 to theNottingham General Hospital for the endowment of a bedin memory of her brother-in-law, Morris Weisblum, and&pound; 100 each to Dr. Barnardo’s Homes and the NottinghamGeneral Hospital; B50 each to several other charities.-Mr. Miles Daniel Whitehead, of Kingstown, Co. Dublin,left B500 to the Drogheda Memorial Hospital at the Curragh,Co. Kildare, and &pound; 400 to Laura Hitchins, and the income forlife from 800 shares in the Imperial Tobacco Co., withremainder to the Manchester Royal Infirmary if LauraHitchins predeceased him.

OPENING OF THE LONDON MEDICALSCHOOLS.

ADDRESSES AND ANNUAL DINNERS.

Charing Cross ospa!.&mdash;Prizea will be distributed atthe hospital on Thursday, Oct. 4th, at 3.30 P.M., by Dr.Thomas Watts Eden. The annual dinner will be held atGatti’s Restaurant on the same day at 7 for 7.30 p.vL,with Sir Herbert Waterhouse in the chair.

Ouy’s ospt<6f!.&mdash;The session will begin on Tuesday,Oct. 2nd, but there will not be an opening ceremony.

Killg’s College Hospifcal.-An introductory address will begiven at the Medical School at 2.30 P.M. on Wednesday,Oct. 3rd, by Mr. Ernest Barker, professor of political science,in the University of Cambridge. Sir William Watson-Cheyne, F.R.S., will preside. The annual dinner of past andpresent students will be held at 7.30 P.M. on Wednesday,Oct. 3rd, at the Trocadero Restaurant, Piccadilly-circus, W.,with Dr. B. R. Turner in the chair.

London Hos])ital.-The old students’ dinner is to be heldat the Trocadero Restaurant on Thursday, Oct. 18th, at7.30 P.lII.

London (R.P.H.) School of llTedicine for V’onzerz.-Anintroductory address will be given at the school at 3 P.M.on Monday. Oct. 1st, 1>y Dr. Andrew Balfour, whose subjectwill be the Tropical Field, its Possibilities for Medical Women.

Middlesex; Ho.spital.-VTr. A. E. Webb-Johnson willdeliver an introductory address, entitled the Enemies ofMan, at the Queen’s Hall at 3 P.M. on Tuesday, Oct. 2nd,after which Prince Arthur of Connaught will distributeprizes and Princess Arthur will present the Pardon Memorialmedals. The annual dinner will be held at the Savoy Hotelon the same day at 7.30 P.M., with Prince Arthur in the chair.

Phai,i)taceiiticctl Society of Great Britairz.-On Wednesday,Oct. 3rd. at 3 P.-,Nf , an inaugural sessional address will begiven bv Mr. Reginald R. Bennett, chairman of theBritish Pharmaceutical Conference. A presentation of thePereira medal will be made. On the same day, at 6.45for 7 P.M., the anniversary dinner will take place at theHotel Victoria, Xorthumberland-avenue, W.C. 2.

Royal Dental Hospital.-The dinner of past and presentstudents will be held at Ei.30 for 7 P.M. on Saturday, Oct. 20th,at the Trocadero Restaurant. Mr. G. G. Campion willpreside.

St. Bartholorrrezc’s Hospital.-The old students’ annualdinner will be held in the Great Hall of the hospital at7 for 7.30 P.M., on Monday, Oct. 1st, with Sir D’Arcy Powerin the chair.

St. George’s Hospital.-The prize distribution will be heldin the Board Room of the hospital at 3 P.M. on Monday,Oct. 1st, when an inaugural address, entitled Hydrocephalus :A Study in Phylogeny and Pathology, will be delivered bySir John Bland-Sutton The annual dinner will be heldon the same day at the Hyde Park Hotel at 7.15 for 7.45 P.M.The chair will be taken by Dr. W. S. Fox.

St. Marr/’s Hospital.-The annual dinner of past andpresent students is to be held at the Trocadero Restauranton Friday, Oct. 5th, at 7 P.M.

St. T/K)M:6ts’s Hospital.-The old students’ dinner will beheld at St. Thomas’s House on Friday, Oct. 26th, with Mr.Edwin Francis White in the chair.

U ni!’ersit,/ C’olleqe Aredical S’chool.-The session will openon Monday, Oct. 1st, when Sir Thomas Barlow, F.R.S., willgive an introductory address in the Library at 4.30 P.M. Theannual dinner of past and present students will take placeat the Hotel Cecil on Friday, Oct. 12th, Surgeon Vice-Admiral Gaskell in the chair.

r:V cstminster H omital.-An inaugural address will begiven in the Board Room of] the hospital on Monday,Oct. 1st, at 3 P.M., by Mr. A. C. Powell, headmaster of EpsomCollege. Sir William Goschen will take the chair. Thehospital dinner is to be held on the same day, at 7 P.M.for 7.30, at Gatti’s Restaurant, Strand, W.C., Sir JamesPurves-Stewart presiding.

PRESENTATION OF WILLIAM MACKENZIE MEDAL.-This medal, given for valuable contributions to ophthalmo-logy, will be presented to Dr. A. Maitland Ramsay at theGlasgow Eye Infirmary, on Tuesday, Oct. 9th, at 8 P.M.,when Dr. Ramsay will deliver an address on the Importanceof General Methods in the Treatment of Eye Disease.