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WINDSOR ROYAL INFIRMARY.
66 30th.-The incisions are now only superficial. The patient is in no pain and feels in good health. Sept. 3rd.-Flexion of the right foot impaired; cannot get the foot to a right angle. Leg much wasted; back splint with foot-piece applied. Left leg wounds doing well. 18th.—Hardly any discharge from wounds. Nov. 19th.-The left knee quite healed. Dec. 1st.—Went out. He could walk without crutches, but could not bend the left knee properly. The right leg was natural, although there was an absence of pulsation both in the posterior tibial and dorsalis pedis arteries.
system, and no symptom referable to the malformation could be expected. The connexion of the old knee-joint disease and the partially amyloid liver was a specially interesting question. We all know that even gross. amyloid disease often disappears after the suppuration that caused it has ceased. When departing does it linger longest about the region of the suspensory ligament as it did in this case ? The question can only be arrived at after further observations. WINDSOR CEREBRAL
ROYAL
INFIRMARY.
TUMOUR; DEATH; NECROPSY; REMARKS.
(Under the care of Mr. HOLDERNESS.) E. C-, aged seventeen, was admitted into hospital on MENINGO-CEREBRITIS; DEATH; NECROPSY; ABSENCE OF THE LEFT KIDNEY AND URETER ; REMARKS. April 10th, 1885. Her parents are both living; father deliFoR the following notes we are indebted to Mr. W. Piercy cate. Has nine brothers and sisters, three of them deaf and dumb. No history of consumption. Her present illness, th& Fox, assistant medical officer, Liverpool Parish Infirmary. E. W-,aged thirty-four, was admitted into the Liver- first of any kind she has had, commenced seven months ago,. pool Parish Infirmary on April 23rd, suffering from the when she was obliged to leave service and come home. Sh& effects of drink, and also with a wound over the left parietal complained of being faint and ill. She took to her bed and eminence, about an inch long, which penetrated to the bone. remained there fifteen weeks, during which time the prinThe policeman who brought him in stated that the woman cipal symptoms were occasional vomiting, pain at the back with whom he was living threw him against the fender, and of the head, and throbbing pain at the top of the head; and thus caused the injury to the head. He presented the usual when she attempted to walk gave way at the knees. Three appearance of one suffering from delirium tremens, although weeks before admission she had a sort of fit, in which she he looked somewhat more stupid. He complained of great is described as becoming stiff and cold. The patient was led pain across his head, and he walked to his ward with some into the hospital, being unable to walk alone; the moment LIVERPOOL WORKHOUSE HOSPITAL.
assistance.
It
stated that he had vomited before never appeared afterwards. On April 25th his left arm and leg became paralysed, and very soon after he lapsed into a semi-comatose condition, ’, from which he never rallied. He right arm seemed also to become paralysed two daysbefore death; his pupils were unequal, the right being much larger than its fellow ; the tongue lay like a sodden mass in his mouth, and he was unable to protrude it. He had to be fed for five days before his death. His pulse was feeble throughout, and his temperature remained normal, or thereabouts, till the day of his death, when it mounted up to 105.4°. He died on April 29th. Necropsy thirty-four hours after death.—The dura mater Abnormal was somewhat more congested than normal. adhesion of the pia mater to the convolutions, the membrane taking portions of brain substance with it on its removal. There was partially organised lymph adhering to the pia mater all over the surface of the brain, being more distinct over the posterior lobes. The convolutions were perceptibly softened, the brain matter being paler than normal. A thrombus was detected in the left middle cerebral artery, partially blocking up the vessel. The heart was healthy and the lungs only somewhat congested. The liver presented amyloid disease, most marked in the neighbourhood of the suspensory ligament and probably connected with old and prolonged suppuration in the right knee-joint, which was found at the post-mortem in a disorganised condition ; the cartilages ulcerated and the joint partially ankylosed by fibrous adhesions. The left kidney was found There was no trace of a ureter or to be totally absent. vascular supply. There was also no opening in the bladder for the left ureter, the little ridge and fold of mucous membrane in which it should have been met with being absent. The right kidney was healthy, and of much larger size than was
admission, but this symptom
usual. -Remar4-s.-This
case is interesting in the first place on medico-legal question involved. Did the meningo-cerebritis arise from drink, or from the injury, or from both combined? He had complained of pain in his head for three weeks previous to the accident, which might
account of the
lead us to suspect the presence of the inflammation before the receipt of the injury. In this case the disease would be accelerated by the injury, as it probably was. Had the wound been inflicted with homicidal intent, the perplexities of the case might have become of great importance to those engaged for the defence. Happily, no suspicion of homicide rested upon anyone, the coroner’s jury returning an open verdict. Complete absence of the kidney is sufficiently rare to be worthy of record. In most cases a dwarfed, shrunken kidney can be found embedded in the connective tissue of the renal area. In this case not a single trace of its existence could be discovered, and even no provision had been made in the bladder for the entrance of a ureter. The opposite kidney was sufficiently large to excrete the necessary material for the
support was removed she gave way at the knees, and would have fallen. She complained of continuous pain at the back of her head. Shortly after admission she was sick, which sickness continued at intervals until her death, eight days. after admission. Her sight was impaired ; the optic discs could not be well defined. There was no paralysis, local or otherwise, and no loss of or variation from normal sensation. Urine: sp. gr. 1033, acid, no albumen; with the copper test it gave a slight trace of sugar ; nothing more definite. Lungs. healthy. From this time the patient’s condition got rapidly worse. Complete optic neuritis developed. The pupils became’ very dilated and remained so, and she lay in a semi-comatose condition, interrupted by cries of pain, and placing her hand to the back of her head. On the 16th the nurse of the ward, when changing the patient’s night-dress, happened to raise her slightly the hand under her neck. She immediately became stiff and convulsed; the convulsion The coma was general, lasted a few seconds, and passed off. became more and more complete, and death ensued onthe 18th. On post-mortem examination of the brain the membranes were found healthy, and showed no signs of inflammation. The cerebrum and cerebellum were likewise healthy. On, the under surface of the brain, in the floor of the third ventricle, and situated between the crura cerebri, covering the corpora albicantia, and touching the optic commissure and tuber cinereum anteriorly and the pons Varolii posteriorly, was an opaque, yellowish, cheesy-looking tumour,, about the size of a racquet-ball, well defined from the surrounding brain substance, and undoubtedly tubercular in character. -Remarks.-The points of interest appear to be :-lst. The way in which the symptoms seemed to point to cerebellar disease without the cerebellum being directly involved. 2nd. No paralysis of the eye muscles was present, although the third nerve was pressed upon. 3rd. What was thecause of the marked ataxia ? Does this case support the view that the crura cerebri and pons are associated with the cerebellum in co-ordinating movement ?
by placing
NORTH-WESTERN
AND
YORKSHIRE ASSOCIATION
OF’
MEDICAL OFFICERS OF HEALTH.—On the 2nd inst. a conference of members of these Associations was held at Bradford, under the presidency of Dr. Hime, borough medical officer. The Destruction of Town Refuse having formed the subject of a lengthy and animated discussion, papers were read by Dr. Hime on "The Artificial Cultivation of Microbes and exhibit Cultures of Cholera, Anthrax, and other Microbes in various Nutrient Media"; by Mr. F. Vacher (Birkenhead), on Dr. Jaeger’s Sanitary Woollen System of Dress, illustrated by exhibits" ; by Mr. C. Willis, (Mansfield), " Desirable Reform in the Laws relating to Public Health"; and by Dr. Byles (Eccleshill), on " A new design for Middens,. by which automatic drainage and emptying can be effectually
secured."
system, and no symptom referable to the malformation could be expected. The connexion of the old knee-joint disease and the partially amyloid liver was a specially interesting question. We all know that even gross. amyloid disease often disappears after the suppuration that caused it has ceased. When departing does it linger longest about the region of the suspensory ligament as it did in this case ? The question can only be arrived at after further observations. WINDSOR CEREBRAL
ROYAL
INFIRMARY.
TUMOUR; DEATH; NECROPSY; REMARKS.
(Under the care of Mr. HOLDERNESS.) E. C-, aged seventeen, was admitted into hospital on MENINGO-CEREBRITIS; DEATH; NECROPSY; ABSENCE OF THE LEFT KIDNEY AND URETER ; REMARKS. April 10th, 1885. Her parents are both living; father deliFoR the following notes we are indebted to Mr. W. Piercy cate. Has nine brothers and sisters, three of them deaf and dumb. No history of consumption. Her present illness, th& Fox, assistant medical officer, Liverpool Parish Infirmary. E. W-,aged thirty-four, was admitted into the Liver- first of any kind she has had, commenced seven months ago,. pool Parish Infirmary on April 23rd, suffering from the when she was obliged to leave service and come home. Sh& effects of drink, and also with a wound over the left parietal complained of being faint and ill. She took to her bed and eminence, about an inch long, which penetrated to the bone. remained there fifteen weeks, during which time the prinThe policeman who brought him in stated that the woman cipal symptoms were occasional vomiting, pain at the back with whom he was living threw him against the fender, and of the head, and throbbing pain at the top of the head; and thus caused the injury to the head. He presented the usual when she attempted to walk gave way at the knees. Three appearance of one suffering from delirium tremens, although weeks before admission she had a sort of fit, in which she he looked somewhat more stupid. He complained of great is described as becoming stiff and cold. The patient was led pain across his head, and he walked to his ward with some into the hospital, being unable to walk alone; the moment LIVERPOOL WORKHOUSE HOSPITAL.
assistance.
It
stated that he had vomited before never appeared afterwards. On April 25th his left arm and leg became paralysed, and very soon after he lapsed into a semi-comatose condition, ’, from which he never rallied. He right arm seemed also to become paralysed two daysbefore death; his pupils were unequal, the right being much larger than its fellow ; the tongue lay like a sodden mass in his mouth, and he was unable to protrude it. He had to be fed for five days before his death. His pulse was feeble throughout, and his temperature remained normal, or thereabouts, till the day of his death, when it mounted up to 105.4°. He died on April 29th. Necropsy thirty-four hours after death.—The dura mater Abnormal was somewhat more congested than normal. adhesion of the pia mater to the convolutions, the membrane taking portions of brain substance with it on its removal. There was partially organised lymph adhering to the pia mater all over the surface of the brain, being more distinct over the posterior lobes. The convolutions were perceptibly softened, the brain matter being paler than normal. A thrombus was detected in the left middle cerebral artery, partially blocking up the vessel. The heart was healthy and the lungs only somewhat congested. The liver presented amyloid disease, most marked in the neighbourhood of the suspensory ligament and probably connected with old and prolonged suppuration in the right knee-joint, which was found at the post-mortem in a disorganised condition ; the cartilages ulcerated and the joint partially ankylosed by fibrous adhesions. The left kidney was found There was no trace of a ureter or to be totally absent. vascular supply. There was also no opening in the bladder for the left ureter, the little ridge and fold of mucous membrane in which it should have been met with being absent. The right kidney was healthy, and of much larger size than was
admission, but this symptom
usual. -Remar4-s.-This
case is interesting in the first place on medico-legal question involved. Did the meningo-cerebritis arise from drink, or from the injury, or from both combined? He had complained of pain in his head for three weeks previous to the accident, which might
account of the
lead us to suspect the presence of the inflammation before the receipt of the injury. In this case the disease would be accelerated by the injury, as it probably was. Had the wound been inflicted with homicidal intent, the perplexities of the case might have become of great importance to those engaged for the defence. Happily, no suspicion of homicide rested upon anyone, the coroner’s jury returning an open verdict. Complete absence of the kidney is sufficiently rare to be worthy of record. In most cases a dwarfed, shrunken kidney can be found embedded in the connective tissue of the renal area. In this case not a single trace of its existence could be discovered, and even no provision had been made in the bladder for the entrance of a ureter. The opposite kidney was sufficiently large to excrete the necessary material for the
support was removed she gave way at the knees, and would have fallen. She complained of continuous pain at the back of her head. Shortly after admission she was sick, which sickness continued at intervals until her death, eight days. after admission. Her sight was impaired ; the optic discs could not be well defined. There was no paralysis, local or otherwise, and no loss of or variation from normal sensation. Urine: sp. gr. 1033, acid, no albumen; with the copper test it gave a slight trace of sugar ; nothing more definite. Lungs. healthy. From this time the patient’s condition got rapidly worse. Complete optic neuritis developed. The pupils became’ very dilated and remained so, and she lay in a semi-comatose condition, interrupted by cries of pain, and placing her hand to the back of her head. On the 16th the nurse of the ward, when changing the patient’s night-dress, happened to raise her slightly the hand under her neck. She immediately became stiff and convulsed; the convulsion The coma was general, lasted a few seconds, and passed off. became more and more complete, and death ensued onthe 18th. On post-mortem examination of the brain the membranes were found healthy, and showed no signs of inflammation. The cerebrum and cerebellum were likewise healthy. On, the under surface of the brain, in the floor of the third ventricle, and situated between the crura cerebri, covering the corpora albicantia, and touching the optic commissure and tuber cinereum anteriorly and the pons Varolii posteriorly, was an opaque, yellowish, cheesy-looking tumour,, about the size of a racquet-ball, well defined from the surrounding brain substance, and undoubtedly tubercular in character. -Remarks.-The points of interest appear to be :-lst. The way in which the symptoms seemed to point to cerebellar disease without the cerebellum being directly involved. 2nd. No paralysis of the eye muscles was present, although the third nerve was pressed upon. 3rd. What was thecause of the marked ataxia ? Does this case support the view that the crura cerebri and pons are associated with the cerebellum in co-ordinating movement ?
by placing
NORTH-WESTERN
AND
YORKSHIRE ASSOCIATION
OF’
MEDICAL OFFICERS OF HEALTH.—On the 2nd inst. a conference of members of these Associations was held at Bradford, under the presidency of Dr. Hime, borough medical officer. The Destruction of Town Refuse having formed the subject of a lengthy and animated discussion, papers were read by Dr. Hime on "The Artificial Cultivation of Microbes and exhibit Cultures of Cholera, Anthrax, and other Microbes in various Nutrient Media"; by Mr. F. Vacher (Birkenhead), on Dr. Jaeger’s Sanitary Woollen System of Dress, illustrated by exhibits" ; by Mr. C. Willis, (Mansfield), " Desirable Reform in the Laws relating to Public Health"; and by Dr. Byles (Eccleshill), on " A new design for Middens,. by which automatic drainage and emptying can be effectually
secured."