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A CASE OF EXOMPHALOS.
976
Clinical and
condition began gradually at 18 months of by left elbow becoming tender and painful and the child restless and fretful. After the condition persisted for three weeks a physician saw the child for the first time and he thought an injury had occurred to the elbow, but after
History.-The
Laboratory Notes.
age
A CASE OF EXOMPHALOS. BY FRANK BLAKE, M.R.C.S. ENG. THE following case of of interest :-
exomphalos
is recorded
as
being
On June 24th, 1923, I was called to attend a primipara I found, that the membranes had ruptured prematurely, and that there was pracFIG.1 tically no dilatation of the os. The head
aged 31.
..
________________________
free from tuberculous or specific disease. farmers, Condition on Admission.-Absolute ankylosis of left elbowhigh up, but able to pass the joint. Left wrist-joint swollen and stiff and impossible to brim of the pelvis. dorsiflex, but easily flexed with no tenderness or pain in Both knees flexed beyond a right angle and By abdominal pal- these two joints. in this position with swelling and slight tenderness. ankylosed I had already Both pation ankle-joints swollen and stiff with very limited movediagnosed a first ment. Other joints normal. General health good except for vertex presentation. I left the case a chronic constipation. The child had always been constipated, taking a mixture until the next of Epsom salts and soda for months before admission, and I when morning, found that almost cascara and liquid paraffin after admission to hospital. The was
very
diet has been liberal and nutritious, and there
no progress had been very badly borne. I administered small doses ofmorphine and hyoscine subcutaneously, and waited. Late in the evening I saw the patient again and found that progress towards dilaFIG. 2. tation was very slight. The temperature had risen to 100.2° F. and the pulse-rate to 101. Much against my principles, I decided to dilate the cervix manually and apply forceps. The fœtal heart was heard. I administered chloroform and proceeded. After traction (with axis - traction N e v i ll’s for handle on forceps) about one and a half hours 1 delivered a full-term, plump but dead child with exomphalos, an abnormality I have never seen before. There was a defect in the middle line of the body from the umbilicus to the sternum, and the liver,
made, and that the pains
infection from the tonsils and auto-intoxication from the bowel. The tonsils were removed, and a buried abscess found in one. The constipation was overcome with medicinecascara 1 drm., liquid paraffin 1 drm.-night and morning. The pain was relieved by sodium salicylate ionisation. The joints were limbered up with sodium chloride ionisation, radiant heat, and massage, and the deformity corrected by forcibly breaking down adhesions under general anaesthesia and fixing the knee-joints in the corrected position by means of plaster of Paris. This operation was repeated on three different occasions with intervals between for massage and passive movement. After six months’ treatment the child was able to walk with straight limbs partially movable, and with the full use of the left arm. The cause in this case is considered a combined one, an infection from abscess in tonsil and auto-intoxication from the bowel.
The result in this
case up to the present has been. in other deforming diseases treatment should be maintained for months or years to
satisfactory, but, as
prevent recrudescence, especially regarding deformity.
colons were outside the body cavity and merely covered with amnion. The mother made an uneventful recovery without running any temperature after the day of delivery. The placenta was normal and quickly followed the child. The accompanying snapshot (Fig. 1) gives some idea of the condition. The dark object on the infant’s right is the liver. Fig. 2 is a diagrammatic verse
VENEREAL DISEASE
representation.
I find in Tweedy and Wrench, and also in Ten Teachers," only a few lines on this condition. East Harling, Attleborough, Norfolk.
the
A CASE OF
OSTEO-ARTHRITIS IN CHILDHOOD.1 BY
PHILIP
WEATHERBE, M.B., CH.B. EDIN., CHILDREN’S
HOSPITAL,
NOVA
SCOTIA.
Osteo-arthritis in childhood is of interest on account of its rarity and doubtful pathology. Deformity may be prevented by timely splinting of the affected joints in their most useful position, and the cause should be sought early and removed if possible. Such cases, if left to continue without treatment, become very grave. A well-nourished
girl, aged 4, was admitted
to
hospital with
abedridden chronic since 18 months havingofbeen crippling the deformity of theatjoints, age. deformity began 1 Exhibited before the Halifax Medical Society, in April, 1923.
other
General examination was conducted with the object of trying to find some focus of infection. A blood culture was negative. The blood was normal, so were the urine and faeces. The chest and abdomen revealed nothing by physical examination. Constipation was marked and the tonsils were under suspicion. X ray examinations of the joints revealed nothing definitely abnormal. Treatment.-Treatment was based upon the possibility of
gall-bladder, jejunum, ileum, ascending and trans-
SURGEON, HALIFAX
was no
history of disease.
were
.. ’
"
X ray examination the diagnosis still remained doubtful. Shortly after this the knee-joints became swollen and painful. followed by the other joints of the limbs. There were exacerbations of pain and swelling in the joints from time to time flitting from one joint to the other. The knees were always the most markedly affected and the most painful. The pain was severe enough to waken the child nightly, causing it to cry. The pain at night was present to some extent on admission. This child is the youngest of a healthy family of 11, who was first breast-fed and then bottle-fed until 13 months of age. The parents are healthy an
I
IN
WESTERN AUSTRALIA.-In
his report for the two years ending Dec. 31st, 1922, Dr. R. C. Everitt Atkinson, Commissioner of Public Health in Western Australia, states that the total number of new cases of venereal disease notified during the year 1921 was 1115, an increase of 132 upon the previous year. This increased incidence appears in the case of both sexes, 73 being males and 59 females ; but whilst in the case of the former it represents an increase of only 8-4 per cent., in the case of the latter an increase of 50-8 per cent. is shown. The proportion of males to females affected was 5-3 to 1, as against 7-5 to 1 last year. It is probable, he points out, that this discrepancy represents, not an actual increase in the prevalence of venereal disease amongst the female population, but a greater willingness on the part of women to seek medical attention and an increasing knowledge of the subject and of the benefits to be derived from early recognition of the disease and early treatment of it. It is possible, he says, that the increase in tertiary cases is due directly to the more sensitive ice-box method of performing the Wassermann test having brought to light cases previously not diagnosed as syphilitic. Legal proceedings were taken against 24 persons consistently refusing to resume venereal treatment, 23 being males and one female. In ten cases a conviction was recorded. During 1922 the total number of new cases of venereal disease notified to the department was 727, which shows a reduction of 384 on the previous year. This reduction was evident in th& case of both gonorrhoea and syphilis and in both sexes, and, provided it actually represents a diminished incidence, is extremely encouraging, justifying as it does the measures that have been adopted to cope with the problem of these diseases.
Clinical and
condition began gradually at 18 months of by left elbow becoming tender and painful and the child restless and fretful. After the condition persisted for three weeks a physician saw the child for the first time and he thought an injury had occurred to the elbow, but after
History.-The
Laboratory Notes.
age
A CASE OF EXOMPHALOS. BY FRANK BLAKE, M.R.C.S. ENG. THE following case of of interest :-
exomphalos
is recorded
as
being
On June 24th, 1923, I was called to attend a primipara I found, that the membranes had ruptured prematurely, and that there was pracFIG.1 tically no dilatation of the os. The head
aged 31.
..
________________________
free from tuberculous or specific disease. farmers, Condition on Admission.-Absolute ankylosis of left elbowhigh up, but able to pass the joint. Left wrist-joint swollen and stiff and impossible to brim of the pelvis. dorsiflex, but easily flexed with no tenderness or pain in Both knees flexed beyond a right angle and By abdominal pal- these two joints. in this position with swelling and slight tenderness. ankylosed I had already Both pation ankle-joints swollen and stiff with very limited movediagnosed a first ment. Other joints normal. General health good except for vertex presentation. I left the case a chronic constipation. The child had always been constipated, taking a mixture until the next of Epsom salts and soda for months before admission, and I when morning, found that almost cascara and liquid paraffin after admission to hospital. The was
very
diet has been liberal and nutritious, and there
no progress had been very badly borne. I administered small doses ofmorphine and hyoscine subcutaneously, and waited. Late in the evening I saw the patient again and found that progress towards dilaFIG. 2. tation was very slight. The temperature had risen to 100.2° F. and the pulse-rate to 101. Much against my principles, I decided to dilate the cervix manually and apply forceps. The fœtal heart was heard. I administered chloroform and proceeded. After traction (with axis - traction N e v i ll’s for handle on forceps) about one and a half hours 1 delivered a full-term, plump but dead child with exomphalos, an abnormality I have never seen before. There was a defect in the middle line of the body from the umbilicus to the sternum, and the liver,
made, and that the pains
infection from the tonsils and auto-intoxication from the bowel. The tonsils were removed, and a buried abscess found in one. The constipation was overcome with medicinecascara 1 drm., liquid paraffin 1 drm.-night and morning. The pain was relieved by sodium salicylate ionisation. The joints were limbered up with sodium chloride ionisation, radiant heat, and massage, and the deformity corrected by forcibly breaking down adhesions under general anaesthesia and fixing the knee-joints in the corrected position by means of plaster of Paris. This operation was repeated on three different occasions with intervals between for massage and passive movement. After six months’ treatment the child was able to walk with straight limbs partially movable, and with the full use of the left arm. The cause in this case is considered a combined one, an infection from abscess in tonsil and auto-intoxication from the bowel.
The result in this
case up to the present has been. in other deforming diseases treatment should be maintained for months or years to
satisfactory, but, as
prevent recrudescence, especially regarding deformity.
colons were outside the body cavity and merely covered with amnion. The mother made an uneventful recovery without running any temperature after the day of delivery. The placenta was normal and quickly followed the child. The accompanying snapshot (Fig. 1) gives some idea of the condition. The dark object on the infant’s right is the liver. Fig. 2 is a diagrammatic verse
VENEREAL DISEASE
representation.
I find in Tweedy and Wrench, and also in Ten Teachers," only a few lines on this condition. East Harling, Attleborough, Norfolk.
the
A CASE OF
OSTEO-ARTHRITIS IN CHILDHOOD.1 BY
PHILIP
WEATHERBE, M.B., CH.B. EDIN., CHILDREN’S
HOSPITAL,
NOVA
SCOTIA.
Osteo-arthritis in childhood is of interest on account of its rarity and doubtful pathology. Deformity may be prevented by timely splinting of the affected joints in their most useful position, and the cause should be sought early and removed if possible. Such cases, if left to continue without treatment, become very grave. A well-nourished
girl, aged 4, was admitted
to
hospital with
abedridden chronic since 18 months havingofbeen crippling the deformity of theatjoints, age. deformity began 1 Exhibited before the Halifax Medical Society, in April, 1923.
other
General examination was conducted with the object of trying to find some focus of infection. A blood culture was negative. The blood was normal, so were the urine and faeces. The chest and abdomen revealed nothing by physical examination. Constipation was marked and the tonsils were under suspicion. X ray examinations of the joints revealed nothing definitely abnormal. Treatment.-Treatment was based upon the possibility of
gall-bladder, jejunum, ileum, ascending and trans-
SURGEON, HALIFAX
was no
history of disease.
were
.. ’
"
X ray examination the diagnosis still remained doubtful. Shortly after this the knee-joints became swollen and painful. followed by the other joints of the limbs. There were exacerbations of pain and swelling in the joints from time to time flitting from one joint to the other. The knees were always the most markedly affected and the most painful. The pain was severe enough to waken the child nightly, causing it to cry. The pain at night was present to some extent on admission. This child is the youngest of a healthy family of 11, who was first breast-fed and then bottle-fed until 13 months of age. The parents are healthy an
I
IN
WESTERN AUSTRALIA.-In
his report for the two years ending Dec. 31st, 1922, Dr. R. C. Everitt Atkinson, Commissioner of Public Health in Western Australia, states that the total number of new cases of venereal disease notified during the year 1921 was 1115, an increase of 132 upon the previous year. This increased incidence appears in the case of both sexes, 73 being males and 59 females ; but whilst in the case of the former it represents an increase of only 8-4 per cent., in the case of the latter an increase of 50-8 per cent. is shown. The proportion of males to females affected was 5-3 to 1, as against 7-5 to 1 last year. It is probable, he points out, that this discrepancy represents, not an actual increase in the prevalence of venereal disease amongst the female population, but a greater willingness on the part of women to seek medical attention and an increasing knowledge of the subject and of the benefits to be derived from early recognition of the disease and early treatment of it. It is possible, he says, that the increase in tertiary cases is due directly to the more sensitive ice-box method of performing the Wassermann test having brought to light cases previously not diagnosed as syphilitic. Legal proceedings were taken against 24 persons consistently refusing to resume venereal treatment, 23 being males and one female. In ten cases a conviction was recorded. During 1922 the total number of new cases of venereal disease notified to the department was 727, which shows a reduction of 384 on the previous year. This reduction was evident in th& case of both gonorrhoea and syphilis and in both sexes, and, provided it actually represents a diminished incidence, is extremely encouraging, justifying as it does the measures that have been adopted to cope with the problem of these diseases.