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A CASE OF ENCEPHALO-MENINGOCELE
659 June 24th : Both fundi absolutely normal, vision with glasses 6/9. Sept. 23rd : Can now read part of 6/6 with glasses and J.5 well. In course of time the refiexes became normal and the
improved.
Medical Societies.
strabismus disappeared. The condition, then, pointed to the effects of a drug which, owing to the probable presence of some cardiorenal affection, had exerted a powerful action on the It has been noted that in cases of nervous system. veronal poisoning, nuclear ophthalmoplegia is an occasional concomitant symptom. I therefore suggested that search should be made, and in one of the patient’s boxes were found powders of veronal, each containing 7 gr. The patient’s mental state improved, though slowly, and after several weeks she informed me that the night before she was taken ill the last thin g she remembered was taking two of these powders (14 gr. in all) to give her sleep. Dr. P. N. Panton, to whom I owe the pathological examination of specimens, thought it probable that the veronal may have been excreted as a carbamide, but it was impossible to determine this fact. I have examined the urine of patients who have taken medinal (a preparation allied to veronal), but have been unable to confirm the above. The patient has apparently recovered, after several weeks’ nursing-home treatment. The blood pressure has dropped to 160, and her urine is normal. I have recorded this case as Mr. Clarke considered the eye condition of great interest and undoubtedly due to the veronal. Portland-place, W.
ROYAL SOCIETY OF MEDICINE.
A CASE OF ENCEPHALO-MENINGOCELE BY EMILY G.
STUART, M.B.LOND.,
OF QUETTA.
THE following
case
of
encephalo-meningocele
in
an
unusual situation-seems worthy of record. In October, 1923, I attended a Sindhi woman in her third confinement.
She had had
a
normal pregnancy, and both
previous children are aliveand healthy. This third confinementwas quite easy and short, though the patient complained that it was longer than her previous labours. The child, a
girl, was born by vertex
presentation, was well nourished and healthy, but had a fluid swelling growing from the nose, and covering the inner side of each eye ; the nostrils could be seen below the lower border of the tumour ; there was not any nasal discharge, and the baby could breathe through her nose. She could open her eyes slightly and could take the From photograph taken immebreast and move her diately before operation. limbs naturally. The tuxnourwas lightly bandaged to save the mother’s feelings, but on the third or fourth day it had grown larger and was covering the eyes more. I aspirated and drew off clear fluid, after which it was evident that about one-third of the swelling I The swelling soon filled up again was of solid consistency. and the anterior fontanelle became prominent. I aspirated z’ the swelling several times, at intervals of two or three days, and after aspiration the fontanelles became less prominent. The tumour was increasing in size in spite of aspiration, and after consultation with Dr. Holland, Major Haughton, 1.M.8., and Captain Fry, I.M.S., it was decided to operate. The operation was performed by Dr. Holland, assisted by Captain Fry, and after incision in the mid-line of the tumour the fluid escaped from a very thin-walled cyst. The sac ,
wall could not be separated from the underlying tissues, so part of the wall was removed and an attempt was made to close the sac, the root of which came from inside the cranial cavity through an opening above the nasal bones. The optic thalami were found to be in the tissue removed. The thin outer skin was sewn up and dressings applied. After five days the wound opened up and fluid oozed through. The child gradually sank and became unconscious and died three weeks after the operation.
NON-SPECIFIC DISTURBANCES OF HEALTH DUE TO VITAMIN DEFICIENCY. THE resumed discussion on this subject took place on March 23rd, the President of the Society, Sir STCLAIR Tr3oMSON, occupying the chair. The PRESIDENT, in a brief reintroduction, quoted a letter which the late Sir Clifford Allbutt wrote to the Times in his eighty-eighth year in criticism of the white bread usually sold, and calling public attention to the great value of vitamins in food. The openers of the original debate, Dr. LEONARD WILLI.A1.1S, Lieut.-Colonel R. McCABRisoN, Dr. W. CRAMER, and Dr. G. M. FINDLAY, briefly reminded the meeting of their contentions, the three last-named showing again the slides with which they supported their theses. Dr. WILLIAM HUNTER said the very able opening by the four speakers had raised the subject beyond the region of mere hypothesis, for it was now clear that when vitamins were withheld from the diet the health of the animal suffered at once, and if this deficiency were continued over a long period actual disease, such as beri-beri, ensued. This lack certainly predisposed to infections of various kinds. He stressed the importance of the lymphopenia as a feature in cases in which there had been deficiency of vitamin B in the food, this vitamin havinga direct influence on the blood-forming tissues. The bone changes which Dr. Findlay so well demonstrated were, Dr. Hunter said, identical with the aplastic marrow changes which he had so frequently found associated with what he termed aplastic anaemia, and as a cause of which he usually expected to find some streptococcal sepsis. Dr. ROBERT IIUTCI-1-1.-3oN agreed with the discussion being limited to the three accessory food factors A, B, and C. Tt was contended, he said, that a deficient supply in the food of these specific vitamins was a cause of widespread disorders of health, and mainly the evidence brought was experimental. But it was very difficult to be sure that disturbances of health in animals fed on a vitamin-less diet were solely due to the absence of vitamins, as such diets were usually very abnormal in other respects also. Some were " synthetic " diets, others were deficient in
proteins
of
high
biological value,
or
in
a
proper
balance of the inorganic salts. But granting, for the purposes of argument, that the disorders referred to were usually caused only by vitamin deficiency, was there reason for supposing that disorders comparable to those in the animals experimented upon were being produced by a similar cause in the community as a whole ? This he doubted. If the contention of the openers were true, why did not more people show the final link in the chain ? In 25 years’ work at the London Hospital he had never seen a case of adult scurvy, nor one of beri-beri unless it had been imported from the East. The case of vitamin A, however, was somewhat different, as it was fairly clear that deficiency of this in the diet resulted in interference with growth and a lessened power to resist infections, though there was evidence that at the same time there was a shortage of calorie value in the food given during the growingyears. He quoted with approval the following extract from food, Health and Growth," by the late Prof. Emmett Holt :-. The physician can fall into no greater error than to assume that vitamin deficiency is the chief cause of all chronic nutritive disorders ; just as not very long ago these were all referred to auto-intoxication The use of vitamins without definite indications will be popular for a period, but, like other fads, it will pass. 1 THE LANCET, Feb. 21st, p. 385. "
..
>
improved.
Medical Societies.
strabismus disappeared. The condition, then, pointed to the effects of a drug which, owing to the probable presence of some cardiorenal affection, had exerted a powerful action on the It has been noted that in cases of nervous system. veronal poisoning, nuclear ophthalmoplegia is an occasional concomitant symptom. I therefore suggested that search should be made, and in one of the patient’s boxes were found powders of veronal, each containing 7 gr. The patient’s mental state improved, though slowly, and after several weeks she informed me that the night before she was taken ill the last thin g she remembered was taking two of these powders (14 gr. in all) to give her sleep. Dr. P. N. Panton, to whom I owe the pathological examination of specimens, thought it probable that the veronal may have been excreted as a carbamide, but it was impossible to determine this fact. I have examined the urine of patients who have taken medinal (a preparation allied to veronal), but have been unable to confirm the above. The patient has apparently recovered, after several weeks’ nursing-home treatment. The blood pressure has dropped to 160, and her urine is normal. I have recorded this case as Mr. Clarke considered the eye condition of great interest and undoubtedly due to the veronal. Portland-place, W.
ROYAL SOCIETY OF MEDICINE.
A CASE OF ENCEPHALO-MENINGOCELE BY EMILY G.
STUART, M.B.LOND.,
OF QUETTA.
THE following
case
of
encephalo-meningocele
in
an
unusual situation-seems worthy of record. In October, 1923, I attended a Sindhi woman in her third confinement.
She had had
a
normal pregnancy, and both
previous children are aliveand healthy. This third confinementwas quite easy and short, though the patient complained that it was longer than her previous labours. The child, a
girl, was born by vertex
presentation, was well nourished and healthy, but had a fluid swelling growing from the nose, and covering the inner side of each eye ; the nostrils could be seen below the lower border of the tumour ; there was not any nasal discharge, and the baby could breathe through her nose. She could open her eyes slightly and could take the From photograph taken immebreast and move her diately before operation. limbs naturally. The tuxnourwas lightly bandaged to save the mother’s feelings, but on the third or fourth day it had grown larger and was covering the eyes more. I aspirated and drew off clear fluid, after which it was evident that about one-third of the swelling I The swelling soon filled up again was of solid consistency. and the anterior fontanelle became prominent. I aspirated z’ the swelling several times, at intervals of two or three days, and after aspiration the fontanelles became less prominent. The tumour was increasing in size in spite of aspiration, and after consultation with Dr. Holland, Major Haughton, 1.M.8., and Captain Fry, I.M.S., it was decided to operate. The operation was performed by Dr. Holland, assisted by Captain Fry, and after incision in the mid-line of the tumour the fluid escaped from a very thin-walled cyst. The sac ,
wall could not be separated from the underlying tissues, so part of the wall was removed and an attempt was made to close the sac, the root of which came from inside the cranial cavity through an opening above the nasal bones. The optic thalami were found to be in the tissue removed. The thin outer skin was sewn up and dressings applied. After five days the wound opened up and fluid oozed through. The child gradually sank and became unconscious and died three weeks after the operation.
NON-SPECIFIC DISTURBANCES OF HEALTH DUE TO VITAMIN DEFICIENCY. THE resumed discussion on this subject took place on March 23rd, the President of the Society, Sir STCLAIR Tr3oMSON, occupying the chair. The PRESIDENT, in a brief reintroduction, quoted a letter which the late Sir Clifford Allbutt wrote to the Times in his eighty-eighth year in criticism of the white bread usually sold, and calling public attention to the great value of vitamins in food. The openers of the original debate, Dr. LEONARD WILLI.A1.1S, Lieut.-Colonel R. McCABRisoN, Dr. W. CRAMER, and Dr. G. M. FINDLAY, briefly reminded the meeting of their contentions, the three last-named showing again the slides with which they supported their theses. Dr. WILLIAM HUNTER said the very able opening by the four speakers had raised the subject beyond the region of mere hypothesis, for it was now clear that when vitamins were withheld from the diet the health of the animal suffered at once, and if this deficiency were continued over a long period actual disease, such as beri-beri, ensued. This lack certainly predisposed to infections of various kinds. He stressed the importance of the lymphopenia as a feature in cases in which there had been deficiency of vitamin B in the food, this vitamin havinga direct influence on the blood-forming tissues. The bone changes which Dr. Findlay so well demonstrated were, Dr. Hunter said, identical with the aplastic marrow changes which he had so frequently found associated with what he termed aplastic anaemia, and as a cause of which he usually expected to find some streptococcal sepsis. Dr. ROBERT IIUTCI-1-1.-3oN agreed with the discussion being limited to the three accessory food factors A, B, and C. Tt was contended, he said, that a deficient supply in the food of these specific vitamins was a cause of widespread disorders of health, and mainly the evidence brought was experimental. But it was very difficult to be sure that disturbances of health in animals fed on a vitamin-less diet were solely due to the absence of vitamins, as such diets were usually very abnormal in other respects also. Some were " synthetic " diets, others were deficient in
proteins
of
high
biological value,
or
in
a
proper
balance of the inorganic salts. But granting, for the purposes of argument, that the disorders referred to were usually caused only by vitamin deficiency, was there reason for supposing that disorders comparable to those in the animals experimented upon were being produced by a similar cause in the community as a whole ? This he doubted. If the contention of the openers were true, why did not more people show the final link in the chain ? In 25 years’ work at the London Hospital he had never seen a case of adult scurvy, nor one of beri-beri unless it had been imported from the East. The case of vitamin A, however, was somewhat different, as it was fairly clear that deficiency of this in the diet resulted in interference with growth and a lessened power to resist infections, though there was evidence that at the same time there was a shortage of calorie value in the food given during the growingyears. He quoted with approval the following extract from food, Health and Growth," by the late Prof. Emmett Holt :-. The physician can fall into no greater error than to assume that vitamin deficiency is the chief cause of all chronic nutritive disorders ; just as not very long ago these were all referred to auto-intoxication The use of vitamins without definite indications will be popular for a period, but, like other fads, it will pass. 1 THE LANCET, Feb. 21st, p. 385. "
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