Calendar: 1873-1874 Page 586

586 MEDICAL DEPARTMENT giving the reasons which would lead you to open the sac remove portion of omentum or to make rn artificial anus State also the ultimate results in case in which the latter step had been taken successfully Commentary on Cage in J&urgtrj -Any remarks you may think it advisable to make out of the direct questions below given will be marked for or against as they are correct and judicious or irrelevant and erroneous Δ muscular and full-bodied man of the age of 40 years is brought into the Hospital in the night having been picked up by the police in state of insensibility On examination you find that his breath smells strongly of spirits and that he has small wound on the left temple leading through the scalp down to the bone in front of and above the left ear which has bled freely and saturated the hair and upper clothing probe feels bare bone with slight irregularity ridge or chink in it There are slight bruises here and there on the body and limbs The face is flushed both the pupils contracted and insensible to light the pulse quick but compressible and the respiration full and heavy all the limbs are more or less contracted and resist ex- tension hard fulness is observed in the hypogastrium What would be the primary diagnosis and treatment The next day the patient is partially sensible and answers questions but not coherently when roused but he cannot keep up sustained attention and has dazed or bewildered look He has lifted his head to drink after which he complained of giddiness confusion of ideas noises in the ears and dull pain over the left side of the head He has vomited everything he has taken and the bowels are confined His face is pale and the pupils are more dilated and contract sluggishly on exposure to the ight The pulse is slower and the respiration less deep but somewhat irregular and occasionally he sighs deeply He can move his limbs and has passed his water consciously The tem- perature in the axilla is 965 What would be your diagnosis and treatment at this stage