Imagens das páginas
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A more practical hint is derived from an inquiry into the probabilities of a concurrent failure or absence of symptoms. Thus the odds are 2 to 1 against the simultaneous absence of hæmorrhage and cachexia; 2 to 1 against the failure of hæmorrhage and anorexia; 40 to 1 against the absence of tumour and vomiting; 60 to 1 against the absence of vomiting and pain; 65 to 1 against the absence of tumour and pain; 225 to 1 against the absence of the more obvious and important symptoms of pain, vomiting, hæmorrhage, and tumour; and lastly, about 2560 to 1 against the absence of all the six symptoms tabulated above.

In alluding to such calculations, however, we must remember how large a variation of probabilities would often be brought about by a slight alteration in the original estimates. Supposing, for example, that we adopted the lower of the two estimates mentioned for most of the above symptoms, on the assumption that they were absent in every case in which they were not mentioned, the difference, we have seen, would not amount to much for each symptom separately. But its results would of course diverge far more widely; so that, for example, the odds would be about 55 to 1 (instead of 11 to 21) against all six symptoms concurring in any single case. The uncertainty which attaches to all calculations founded on limited numbers of cases may seem still more obvious. But in even as few as 200, this element of contingent error becomes comparatively small. Indeed the actual collation of these 200 cases singularly confirms the above calculations.

A similar, though less exact, check appears to be afforded by observation with respect to the general results of the preceding inquiry-which suggests, I think, rather a more secure diagnosis than many excellent authorities have hitherto thought practicable in this disease. This suggestion has certainly been confirmed by my own observations. In other words, I have rarely been unable to diagnose a cancer of the stomach, and have generally found that where its presence seemed long doubtful, there it was, in reality, absent.

But in whatever degree the facts above collected may aid diagnosis, by establishing conclusions such as no scantier series of observations could have justified, still it is right to add, that grounds for a definite opinion in any single case will sometimes be wanting. As already pointed out, in the phenomena of gastric cancer, time is everything. Hence the physician who examines a chronic case, or (what is practically the same thing) sees the malady only in its early stage, must often remain in complete uncertainty respecting its nature, until the progress of the disease, increasing (in something like a geometrical progression) the number and distinctness of its symptoms, enables him to come to a decision. Indeed, it is hardly too much to say, that this peculiar mode of accretion of the symptoms may sometimes form a specific aid to our recognition of the disease.

My limits forbid any allusion to the diagnosis of the various complications of gastric cancer. As pathological incidents or events of the malady, they have already been mentioned elsewhere. Their

symptoms are, on the whole, less distinct than those of the ordinary diseases which affect the organs they respectively occupy. Indeed, the late period of the gastric malady during which they usually occur, brings them into a coincidence with a degree of prostration such as obscures these symptoms, alike in respect to their own prominence, and to their reaction on the organism generally.

ART. III.

Annual Report of Cases admitted into the Medical Wards of St. George's Hospital during the Year ending December 31st, 1856. By G. GODDARD ROGERS, M.D., Medical Registrar.

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REMARKS.

The present Report is drawn up in exactly the same manner with regard to the classification and nomenclature of diseases, as that of last year. At present I have not seen my way clear to suggest any marked alterations, although, doubtless, room exists for improvement. Amongst the divisions in which some modifications are desirable, may be mentioned 16, cachemia, a vague term, to which considerable objections have been raised, but which has been found useful for including cases which otherwise could only come under the last heading of "anomalous ;" and Section 36, in which a complete and more scientific arrangement of kidney diseases is sadly wanted. It would be no small gain if means could be devised whereby this Report should convey a more accurate idea of the mortality caused in the hospital by each individual disease. Hitherto it has been usual for a fatal complicated case to be entered as fatal under each head; as, for example, in acute rheumatism complicated with pericarditis, should death result, the fatal termination is recorded in Division 4 and 26, thus manifestly giving an erroneous idea of the results of the treatment of rheumatic fever, which in itself rarely, if ever, kills the patient. The only mode, as the system of registration now stands, is to indicate in the remarks on each division of diseases the particular cases in which the accidental complication caused death. I now proceed to give a brief sketch of the more important facts observed in the above forty-three divisions, taking them in their numerical order.

1. Fevers.-Amongst the fatal complicated cases of continued fever, 2 had disease of the brain. In 1 of these the brain substance was studded with small abscesses

2 cases were complicated with pneumonia.

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pleurisy and gangrene of the lung.
hæmaturia and Bright's disease.
fistula in ano and acute rheumatism.
diarrhoea.

enormous enlargement of the spleen.
delirium tremens.
miscarriage.

In 18 fatal cases, extensive ulceration of the intestines was found in 9; in 1 the glands were greatly enlarged; 3 were free from ulceration; and 5 were not examined.

In the 39 complicated cases which terminated favourably, the complications are thus distributed :

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