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SECTION X.—DISEASES OF CHILDREN.
807 SECTION X.—DISEASES OF CHILDREN. President, M. J. DE BÓKAY. Managing Secretary, M. P. HEIM. Professor HUTINEL (Paris) read a paper on
throat, adenoids, dyspepsia, a tendency to vomit, entero-colitis, and appendicitis. It has been ascribed to the liver and fatty acid poisoning, acidosis, and acetonasmia. If sore
in fatal cases a fatty condition of the liver has been found it is very evident that it has not been primary but secondary to digestive troubles. It is necessary to look for lesions of the The Pathogeny of Rickets. appendix. The symptoms consist of uncontrollable vomiting He said that the pathogeny of rickets is still obscure. The with rapid wasting, which suggests meningitis, peritonitis, theories put forward to explain it are many, but most of internal strangulation, or appendicitis. Constipation, fever, them have the fault of being too exclusive. A study of the and acetonuria are frequent. The prognosis is generally cartilaginous and periosteal ossifications, and especially of favourable, but at least ten fatal cases have been published. the formation of bone in the medullary cavity, can serve as It is necessary to think of appendicitis which is often the the basis of a wider explanation. At the beginning of the cause of periodical attacks of vomiting. After having disease the cartilage at the line of junction of the epiphysis eliminated indigestion, the ingestion of some poisonous and the diaphysis is thickened (chondroid tissue, as it may substance, migraine, intestinal obstruction, and peritonitis, be called), and between it and the cancellous bone appears a the appendix should be examined by an operation. Medical new structure, sometimes in islets and partly in thin bands, treatment consists of the administration of alkalies, a which may be called " cancelloid tissue." When the disease vegetarian diet, hydrotherapy, and saline injection. Surgical is most marked the lesions become more accentuated and treatment is comprised in appendicectomy in an interval. In then nodes are formed at the site of the epiphyses. The 50 per cent. of his own cases he has found chronic thickening of the I I chondroid " tissue is great, and between appendicitis. it and the cancellous bone the " cancelloid " tissue forms a wavy band. Sometimes the diaphysis of the long bones has SECTION XI.—NEUROLOGY. an interleaved appearance. In the "I chondroid" tissue the President, M. E. JENDRÁSSIK. cartilaginous cells have multiplied in a tumultuous manner, and the intercellular substance forms a kind of network Managing Secretary, M. CH. SCHAFFER. between the groups of cells. The cancelloid tissue is Dr. B. SACHS (New York) read a paper on composed of islets of cartilaginous tissue of which The the intercellular substance has undergone an imperfect Pathology of Hereditary Diseases of the Nervous System. these vessels islets are enclosed calcification ; The term "family diseasesis, he said, preferable to "herediseparated by " in connective tissue. The chondroid" " zone, the cancelloid tary diseases," since very few diseases are conveyed directly zone, and even the cancellous tissue are intermingled, from parent to child, whereas the morbid tendency exists in especially in severe cases. The new subperiosteal bony one or both parents which leads to the development of a tissue is composed of alternations of layers of bone and of family disease. There is a very marked difference between connective tissue. The marrow is more abundant than in the cerebral and the spinal groups ; the family diseases of health; at first it exhibits a proliferation (sometimes cerebral origin are due to changes in the highest nerve enormous) of the myeloid tissue. It enlarges the lacunas of elements-viz., the ganglion cells; the spinal affections are the cancellous bone and transforms them into hollows com- due largely to disease of, or mal-development of, one municating with the medullary cavity, and it leads to or more systems of white fibres. The one exception to absorption of the layers of bone which surround the cavity. this group is the spinal form of progressive muscular Histological examination shows evidence of a great cellular atrophy, and that is only rarely inherited. Family diseases activity; the fatty areolæ disappear ; sometimes there is of cerebral origin include hereditary diplegia, hereditary some sclerosis, especially round the arterioles. Often there optic nerve atrophy, and amaurotic family idiocy, the are to be seen islets of lymphoid tissue. The quantitative infantile form the juvenile form (Spielmayer (Tay-Sachs) and changes are even more important than the qualitative ; it is and Vogt). In both types of the latter disease the ganglion not, however, the marrow which breaks through the line of cells of the entire nervous system exhibit a marked swelling ,ossification : this is caused by the processes composed of of the cell body and of the dendrites, while the axones connective tissue and blood-vessels. Are these lesions of in- remain intact. The active cytological factor is an abnormal flammatory natureIt seems more reasonable to say that they swelling of the hyaloplasm and not a degeneration of the In fact, in addition to the reactions which fibrillæ. are dystrophic. The occurrence of the disease among Hebrews are truly inflammatory there are others which are of a that in the members of a race whose nervous suggests regressive nature If in rickets the dystrophic action system is prone to deterioration children are born with the manifests itself especially in the bony tissue, it does not highest nerve cells so defective that they are entirely unequal limit itself to that tissue ; for often it attacks the to the ordinary vital functions, and at a very early perform tissues of other organs, especially when they are developperiod undergo a typical disintegration. It is not the function ing. This idea assimilates rickets to other dystrophies that unfits them, but they are ab ovo defective. which are seen in children during the most active Professor BIANCHI (Naples) read a paper on periods of development. When the patient is very young the troubles of assimilation affect all the tissues, causing The Function of the Frontal Lobes, a kind of general atrophy; when the patient is older certain organs show more resistance, and the organs affected of which the following is an abstract: 1. For experithe only satisfactory are those with least power of resistance. Later still are mental work on the frontal lobes animal is the ape, since in it these structures are seen forms of anasmia which resemble chlorosis in their well developed and their architectonic structure corresponds hæmatological characters. Other children show a lymphatic to that of the human cerebrum. The psychical activities of condition the characters of which vary according to the each must be carefully studied both before and after ape age of the child. These various morbid manifestations appear area (Rolandic) is an to be allied to rickets ; they occur in analogous conditions operation. 2. In front of the motor from the mesial excitable zone extending electrically and can coexist with rickets in variable proportions. These of the over the outer aspect to where margin hemisphere can at of but occur all periods childhood, dystrophies apart with the orbital from the early years they show themselves again at puberty. that surface becomes continuous the frontal lobe of It is an integral surface. part Chlorosis, bony deformities, and the status lymphaticus of and fissure. From this to the prefrontal corresponds adolescents have certainly points of contact with the area the muscles of the neck, eyes, and ears can be dystrophies of young children. stimulated. 3. The extirpation of the frontal lobes never Dr. J. COMBY (Paris), in a paper on produces permanent motor or sensory defects. Visual Cyclic V omiting in Children, defects, similarly, are fugitive. 4. The whole intellectual said that periodic or cyclic vomiting occurs in attacks lasting life of the ape is altered after removal of the frontal lobes. two or more days with variable intervals ; it is met with Perception, attention, inhibition, and in particular memory between the ages of two and six or eight years. It is seen a and association, are enfeebled. The animal has no longer little more frequently in boys than in girls. Sometimes the power of profiting by experience. Sometimes stereoseveral members of the same family are attacked in turn. A typed movements and tics are observed. 5. As a result its neuro-arthritic heredity is present in many cases. He had psychical tone is lowered: it lacks initiative, courage, and noticed (as pathological conditions preceding the vomiting)spirit. -
throat, adenoids, dyspepsia, a tendency to vomit, entero-colitis, and appendicitis. It has been ascribed to the liver and fatty acid poisoning, acidosis, and acetonasmia. If sore
in fatal cases a fatty condition of the liver has been found it is very evident that it has not been primary but secondary to digestive troubles. It is necessary to look for lesions of the The Pathogeny of Rickets. appendix. The symptoms consist of uncontrollable vomiting He said that the pathogeny of rickets is still obscure. The with rapid wasting, which suggests meningitis, peritonitis, theories put forward to explain it are many, but most of internal strangulation, or appendicitis. Constipation, fever, them have the fault of being too exclusive. A study of the and acetonuria are frequent. The prognosis is generally cartilaginous and periosteal ossifications, and especially of favourable, but at least ten fatal cases have been published. the formation of bone in the medullary cavity, can serve as It is necessary to think of appendicitis which is often the the basis of a wider explanation. At the beginning of the cause of periodical attacks of vomiting. After having disease the cartilage at the line of junction of the epiphysis eliminated indigestion, the ingestion of some poisonous and the diaphysis is thickened (chondroid tissue, as it may substance, migraine, intestinal obstruction, and peritonitis, be called), and between it and the cancellous bone appears a the appendix should be examined by an operation. Medical new structure, sometimes in islets and partly in thin bands, treatment consists of the administration of alkalies, a which may be called " cancelloid tissue." When the disease vegetarian diet, hydrotherapy, and saline injection. Surgical is most marked the lesions become more accentuated and treatment is comprised in appendicectomy in an interval. In then nodes are formed at the site of the epiphyses. The 50 per cent. of his own cases he has found chronic thickening of the I I chondroid " tissue is great, and between appendicitis. it and the cancellous bone the " cancelloid " tissue forms a wavy band. Sometimes the diaphysis of the long bones has SECTION XI.—NEUROLOGY. an interleaved appearance. In the "I chondroid" tissue the President, M. E. JENDRÁSSIK. cartilaginous cells have multiplied in a tumultuous manner, and the intercellular substance forms a kind of network Managing Secretary, M. CH. SCHAFFER. between the groups of cells. The cancelloid tissue is Dr. B. SACHS (New York) read a paper on composed of islets of cartilaginous tissue of which The the intercellular substance has undergone an imperfect Pathology of Hereditary Diseases of the Nervous System. these vessels islets are enclosed calcification ; The term "family diseasesis, he said, preferable to "herediseparated by " in connective tissue. The chondroid" " zone, the cancelloid tary diseases," since very few diseases are conveyed directly zone, and even the cancellous tissue are intermingled, from parent to child, whereas the morbid tendency exists in especially in severe cases. The new subperiosteal bony one or both parents which leads to the development of a tissue is composed of alternations of layers of bone and of family disease. There is a very marked difference between connective tissue. The marrow is more abundant than in the cerebral and the spinal groups ; the family diseases of health; at first it exhibits a proliferation (sometimes cerebral origin are due to changes in the highest nerve enormous) of the myeloid tissue. It enlarges the lacunas of elements-viz., the ganglion cells; the spinal affections are the cancellous bone and transforms them into hollows com- due largely to disease of, or mal-development of, one municating with the medullary cavity, and it leads to or more systems of white fibres. The one exception to absorption of the layers of bone which surround the cavity. this group is the spinal form of progressive muscular Histological examination shows evidence of a great cellular atrophy, and that is only rarely inherited. Family diseases activity; the fatty areolæ disappear ; sometimes there is of cerebral origin include hereditary diplegia, hereditary some sclerosis, especially round the arterioles. Often there optic nerve atrophy, and amaurotic family idiocy, the are to be seen islets of lymphoid tissue. The quantitative infantile form the juvenile form (Spielmayer (Tay-Sachs) and changes are even more important than the qualitative ; it is and Vogt). In both types of the latter disease the ganglion not, however, the marrow which breaks through the line of cells of the entire nervous system exhibit a marked swelling ,ossification : this is caused by the processes composed of of the cell body and of the dendrites, while the axones connective tissue and blood-vessels. Are these lesions of in- remain intact. The active cytological factor is an abnormal flammatory natureIt seems more reasonable to say that they swelling of the hyaloplasm and not a degeneration of the In fact, in addition to the reactions which fibrillæ. are dystrophic. The occurrence of the disease among Hebrews are truly inflammatory there are others which are of a that in the members of a race whose nervous suggests regressive nature If in rickets the dystrophic action system is prone to deterioration children are born with the manifests itself especially in the bony tissue, it does not highest nerve cells so defective that they are entirely unequal limit itself to that tissue ; for often it attacks the to the ordinary vital functions, and at a very early perform tissues of other organs, especially when they are developperiod undergo a typical disintegration. It is not the function ing. This idea assimilates rickets to other dystrophies that unfits them, but they are ab ovo defective. which are seen in children during the most active Professor BIANCHI (Naples) read a paper on periods of development. When the patient is very young the troubles of assimilation affect all the tissues, causing The Function of the Frontal Lobes, a kind of general atrophy; when the patient is older certain organs show more resistance, and the organs affected of which the following is an abstract: 1. For experithe only satisfactory are those with least power of resistance. Later still are mental work on the frontal lobes animal is the ape, since in it these structures are seen forms of anasmia which resemble chlorosis in their well developed and their architectonic structure corresponds hæmatological characters. Other children show a lymphatic to that of the human cerebrum. The psychical activities of condition the characters of which vary according to the each must be carefully studied both before and after ape age of the child. These various morbid manifestations appear area (Rolandic) is an to be allied to rickets ; they occur in analogous conditions operation. 2. In front of the motor from the mesial excitable zone extending electrically and can coexist with rickets in variable proportions. These of the over the outer aspect to where margin hemisphere can at of but occur all periods childhood, dystrophies apart with the orbital from the early years they show themselves again at puberty. that surface becomes continuous the frontal lobe of It is an integral surface. part Chlorosis, bony deformities, and the status lymphaticus of and fissure. From this to the prefrontal corresponds adolescents have certainly points of contact with the area the muscles of the neck, eyes, and ears can be dystrophies of young children. stimulated. 3. The extirpation of the frontal lobes never Dr. J. COMBY (Paris), in a paper on produces permanent motor or sensory defects. Visual Cyclic V omiting in Children, defects, similarly, are fugitive. 4. The whole intellectual said that periodic or cyclic vomiting occurs in attacks lasting life of the ape is altered after removal of the frontal lobes. two or more days with variable intervals ; it is met with Perception, attention, inhibition, and in particular memory between the ages of two and six or eight years. It is seen a and association, are enfeebled. The animal has no longer little more frequently in boys than in girls. Sometimes the power of profiting by experience. Sometimes stereoseveral members of the same family are attacked in turn. A typed movements and tics are observed. 5. As a result its neuro-arthritic heredity is present in many cases. He had psychical tone is lowered: it lacks initiative, courage, and noticed (as pathological conditions preceding the vomiting)spirit. -