A QUE 11Y. By LEONARD II.
Civil Surgeon of Akyab. I should like, through the medium of your columns, to obtain the opinion of my professional brethren regarding the following obscure case which occurred in my practice here some short time ago : " Nuckun Singh, policeman, 37 years of age, was admitted into hospital on the 2nd March last. Five or six days before admission he was seized with griping and diarrhoea, and two or three days afterwards a painful swelling appeared above the pubis. No difficulty was experienced in passing water. On admission he presented the following symptoms :?Anxiety of countenance, eyes sunk and hollow, sordes on the lips; dry, brown, furred tongue, constipated bowels, excessive thirst, no appetite, skin below the natural temperature, pulse 96, feeble, urine high-coloured; locally an elastic, circumscribed tumour The typhoid symptoms was observed in the supra-pubic region. continued many days, and the swelling, limited at first to the supra-pubic region, gradually extended upwards to within 1? inches of the navel; naturally, but especially on the right side, its boundaries were well marked, extending downwards and outwards to the crista of the ilia, so that the swelling was conical in shape. The right boundary was on a higher level than the left. There was more or less tympanitis all over, except in the right iliac region, where there was much dulness on percussion, corresponding with a solid feel on palpation. A catheter introduced into the bladder, drew off only a small quantity of high-coloured urine." The nature of this case puzzled me, and others who saw it with me. Flatulent distension of the lower bowels, and foecal accumulation in the coecum, no doubt were the main causes of the symptoms latterly, as evidenced by the copious lumpy evacuations and discharges of wind, on the exhibition of enemata ; but the history of the case, the site, progress, and conformation of the tumour seem to point to some other agency at work. Carminative aperients and enemata restored in time the_ tone of the bowels, and subsequently, under a course of tonics, the patient gradually regained his strength, and was discharged. What conditions could have given rise to this circumscribed, painful, semi-tympanitic, conical swelling ? ?