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A CASE OF INFANTILE SCURVY.
246 T ON THE
A CASE OF INFANTILE SCURVY. BY EDMUND OWEN, F.R.C S,
SMALL-POX HOSPITALS. BY EDWARD T. WILSON, M.B.OXON., F.R.C.P.,
INFLUENCE
SURGEON TO ST. MARY’S HOSPITAL AND TO THE HOSPITAL FOR SICK CHILDREN, GREAT ORMOND-STREET.
FANNY T-,a miserably nourished infant, a year and nine months old, was admitted to the Children’s Ward of St. MarysHospital on March 26th last. She was anaemic and had a strange leaden aspect. She lay helplessly on her back and moaned incessantly. A few weeks previously the right leg suddenly swelled, and at the time of admission the whole limb looked half as large again as the other, the skin being osdematous, shiny, and tense, but its temperature was not perceptibly raised nor was its surface at any time reddened. The limb was somewhat everted and quite motionless; the knee was extended. The gums were swollen,
OF
PHYSICIAN TO THE CHELTENIIAM GENERAL HOSPITAL.
THE publication of Dr. Dudfield’s Report on the Sanitary Condition of the Parish of St. Mary Abbott, Kensington, and recent comments upon it, seem to afford a suitable occasion for reopening a question which cannot be considered as finally settled. That question, stated broadly, is the influence of the aggregation of small-pox cases in hospitals on the patients themselves, as well as on the neighbourhoods in which these hospitals are placed. I shall deal with the latter of these first. Mr. Power, in his laborious and ably argued report on Fulham Hospital, has arrived at conclusions so novel, so spongy, and discoloured with capillary haemorrhages, and they bled at the slightest touch; the abdomen was largee startling, so opposed to all previous experience, and so far. and tympanitic ; and the spleen was increased in size. reaching in their effects, that it is no exaggeration to say The carpal ends of the radii were enlarged and the ribss that their general acceptance would revolutionise our ideas were beaded, but the thorax was not misshapen. Nine regarding small-pox intection, as well as our present modes months after its birth the mother died of phthisis, and thee of dealing with the disease. If the " particulate poison" of infant was brought up on condensed milk, Ridge’s food,, small-pox, rendered "different in quality, intensity, and Chapman’s wheat-meal, and bread-and-butter ; fresh cow’ss potency," as Mr. Power suggests (by a not easily undermilk and water had at no time formed an important elementt stood process of cross fertilisation) in the wards of a hospital in the diet. In fact, for all the fresh food that the infantt can be carried through windows and ventilating openings had had she might as well have been in an ill-found ship ini into a still air or a London fog, aud be wafted by occa. the arctic regions. The was no reason for suspecting the 3 sional light airs from nearly all points of the compass" over a circle having one mile for its radius, and infect the inmates existence of a syphilitic taint. The patient was placed in a cot near the fire and twice at of houses in a direct ratio to their distance from the hosday the body was rubbed over with cod-liver oil ; three timess pital, it is time indeed that energetic measures were taken, not in the metropolis only, but by every sanitary authority a day she was made to take half a grain of quinine in The diet consisted of a liberal in the kingdom. It takes but two primroses to produce some syrup and water. and who shall say, on Mr. Power’s quantity of cow’s milk and water, some fresh vegetables, as; a cross fertilisation, what two cases of small-pox may produce ? If mashed with and some sweetened hypothesis, up gravy, orangepotato juice. The limb was raised and firmly compressed with a one-tenth of the dangers here hinted at were accepted as soft roller. A puncture through the thickest part of the thigh proved, and were generally realised by the public, a reaction with a cannula and trocar found the femur bare in all the against infectious hospitals of all kinds would set in, with surface over which the instrument could sweep ; a few drops! results nothing short of disastrous. It is true, indeed, that of blood escaped. During the six weeks that the patient was the able medical officer of the Local Government Board and in the hospital there was no marked elevation of tempe- some of his colleagues " see no choice but to accept the conrature, and at the end of that time she was sent home looking elusions" in Mr. Power’s report, it is also true that THE LANCET has expressed an opinion that that report is "in the probably better than she had ever done in her life. main unanswerable," yet I venture to think that these concluhas THE : reference been made at various times in Frequent LANCET to the somewhat recently discovered disease infantile sions have not been generally accepted by sanitarians, and scurvy, the first being by Dr. Cheadle, 1878, the last by Mr. that the arguments adduced so ably by Dr. Dudfield, not Godlee a few weeks back. The present report is interesting only in his evidence before the Commission on Small-pox chiefly from its being another illustration to the masterly and Fever Hospitals, but also in his recent report, are essay upon the subject which was contributed by Dr. Barlow worthy of the most careful attention, dealing as they do to the Transactions of the Medical and Chirurgical Society with the facts on which mainly the report of Mr. Power was for last year. How it is that such cases are not more founded. The space at my disposal will not allow of more than a recorded in London, where the use of condensed frequently milk and of the many speciously advertised patent foods mere sketch of the main points at issue, with a clearance as far as possible of irrelevant matter, and points about which seems ever on the increase, is, I confess, a matter of surprise It will be necessary, however, for to me. Dr. Cheadle has suggested, however, that infantile there is no dispute. scurvy may at times present itself in the shape of bleeding clearness to recall the facts as nearly as possible in the order and spongy gums in ill-nourished children. I have myself of their occurrence. During the years 1880-81 Dr. Thorne met with two instances in which this condition of the mucous Thorne was engaged in making inquiry concerning the use membrane was directly associated with a scurvy diet. and influence of hospitals for infectious diseases, and seventy Perhaps it is also that the fresh milk and the fresh mashed such hospitals used by urban, rural, and port authorities in potato which these wretched hand-fed children get from time all parts of the country were examined, yet (a fact which to time prevent the cachexia advancing to the stage of sub- cannot be too strongly insisted upon), in two instances only could the extension be traced of small-pox from a hosperiosteal haemorrhage and epiphysial separation. The opinion which I have been compelled to form in my pital "in a way that suggested conveyance of the infected work in the out-patient rooms of the Children’s Hospital is matter through the atmosphere rather than by means of that the worst nourished of thehand-fed infants are those persons and things." And what were these two instances? that have been reared upon condensed milk and the various " In both," I quote Dr. Thorne, " the hospitals in question which ought never to have been used byasanipatent food stuffs ; and that whenever an infant cannot have were buildings for the isolation of cases of infectious disease, human breast-milk, the best substitute will be found in fresh tary authority forming part, as each one did, of a row of dwelling-houses, and cow’s milk prepared and administered secundum artem. being in each case so situated that the patients had to be1 Seymour-street, W. removed from the ambulances in the public thoroughfare." At Leeds, where the house of recovery lies within a distance GERMAN HOSPITAL, DALSTON.--The thirty-eighth varying from 66 to 200 feet of neighbouring houses, 118 cases annual meeting of this charity was held on the 30th ult., of small-pox were admitted in 1871, and "although the hos. when it was announced that the expenditure during the year pital authority would gladly have availed themselves of had been £10,003 and the income £9427, the balance remain- even a suggestion as to the spread of infection to the surrounding in the bankers’ hands on Dec. 31st being £119, against iug dwellings, in order to close their hospital against smallX723 on Jan. 1st, 1883. During the year a convalescent pox, no rumour of such an event was even heard oi." Again, at home containing 17 beds had been added, and 317 patients 1 Report, p. 40. had already been admitted.
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A CASE OF INFANTILE SCURVY. BY EDMUND OWEN, F.R.C S,
SMALL-POX HOSPITALS. BY EDWARD T. WILSON, M.B.OXON., F.R.C.P.,
INFLUENCE
SURGEON TO ST. MARY’S HOSPITAL AND TO THE HOSPITAL FOR SICK CHILDREN, GREAT ORMOND-STREET.
FANNY T-,a miserably nourished infant, a year and nine months old, was admitted to the Children’s Ward of St. MarysHospital on March 26th last. She was anaemic and had a strange leaden aspect. She lay helplessly on her back and moaned incessantly. A few weeks previously the right leg suddenly swelled, and at the time of admission the whole limb looked half as large again as the other, the skin being osdematous, shiny, and tense, but its temperature was not perceptibly raised nor was its surface at any time reddened. The limb was somewhat everted and quite motionless; the knee was extended. The gums were swollen,
OF
PHYSICIAN TO THE CHELTENIIAM GENERAL HOSPITAL.
THE publication of Dr. Dudfield’s Report on the Sanitary Condition of the Parish of St. Mary Abbott, Kensington, and recent comments upon it, seem to afford a suitable occasion for reopening a question which cannot be considered as finally settled. That question, stated broadly, is the influence of the aggregation of small-pox cases in hospitals on the patients themselves, as well as on the neighbourhoods in which these hospitals are placed. I shall deal with the latter of these first. Mr. Power, in his laborious and ably argued report on Fulham Hospital, has arrived at conclusions so novel, so spongy, and discoloured with capillary haemorrhages, and they bled at the slightest touch; the abdomen was largee startling, so opposed to all previous experience, and so far. and tympanitic ; and the spleen was increased in size. reaching in their effects, that it is no exaggeration to say The carpal ends of the radii were enlarged and the ribss that their general acceptance would revolutionise our ideas were beaded, but the thorax was not misshapen. Nine regarding small-pox intection, as well as our present modes months after its birth the mother died of phthisis, and thee of dealing with the disease. If the " particulate poison" of infant was brought up on condensed milk, Ridge’s food,, small-pox, rendered "different in quality, intensity, and Chapman’s wheat-meal, and bread-and-butter ; fresh cow’ss potency," as Mr. Power suggests (by a not easily undermilk and water had at no time formed an important elementt stood process of cross fertilisation) in the wards of a hospital in the diet. In fact, for all the fresh food that the infantt can be carried through windows and ventilating openings had had she might as well have been in an ill-found ship ini into a still air or a London fog, aud be wafted by occa. the arctic regions. The was no reason for suspecting the 3 sional light airs from nearly all points of the compass" over a circle having one mile for its radius, and infect the inmates existence of a syphilitic taint. The patient was placed in a cot near the fire and twice at of houses in a direct ratio to their distance from the hosday the body was rubbed over with cod-liver oil ; three timess pital, it is time indeed that energetic measures were taken, not in the metropolis only, but by every sanitary authority a day she was made to take half a grain of quinine in The diet consisted of a liberal in the kingdom. It takes but two primroses to produce some syrup and water. and who shall say, on Mr. Power’s quantity of cow’s milk and water, some fresh vegetables, as; a cross fertilisation, what two cases of small-pox may produce ? If mashed with and some sweetened hypothesis, up gravy, orangepotato juice. The limb was raised and firmly compressed with a one-tenth of the dangers here hinted at were accepted as soft roller. A puncture through the thickest part of the thigh proved, and were generally realised by the public, a reaction with a cannula and trocar found the femur bare in all the against infectious hospitals of all kinds would set in, with surface over which the instrument could sweep ; a few drops! results nothing short of disastrous. It is true, indeed, that of blood escaped. During the six weeks that the patient was the able medical officer of the Local Government Board and in the hospital there was no marked elevation of tempe- some of his colleagues " see no choice but to accept the conrature, and at the end of that time she was sent home looking elusions" in Mr. Power’s report, it is also true that THE LANCET has expressed an opinion that that report is "in the probably better than she had ever done in her life. main unanswerable," yet I venture to think that these concluhas THE : reference been made at various times in Frequent LANCET to the somewhat recently discovered disease infantile sions have not been generally accepted by sanitarians, and scurvy, the first being by Dr. Cheadle, 1878, the last by Mr. that the arguments adduced so ably by Dr. Dudfield, not Godlee a few weeks back. The present report is interesting only in his evidence before the Commission on Small-pox chiefly from its being another illustration to the masterly and Fever Hospitals, but also in his recent report, are essay upon the subject which was contributed by Dr. Barlow worthy of the most careful attention, dealing as they do to the Transactions of the Medical and Chirurgical Society with the facts on which mainly the report of Mr. Power was for last year. How it is that such cases are not more founded. The space at my disposal will not allow of more than a recorded in London, where the use of condensed frequently milk and of the many speciously advertised patent foods mere sketch of the main points at issue, with a clearance as far as possible of irrelevant matter, and points about which seems ever on the increase, is, I confess, a matter of surprise It will be necessary, however, for to me. Dr. Cheadle has suggested, however, that infantile there is no dispute. scurvy may at times present itself in the shape of bleeding clearness to recall the facts as nearly as possible in the order and spongy gums in ill-nourished children. I have myself of their occurrence. During the years 1880-81 Dr. Thorne met with two instances in which this condition of the mucous Thorne was engaged in making inquiry concerning the use membrane was directly associated with a scurvy diet. and influence of hospitals for infectious diseases, and seventy Perhaps it is also that the fresh milk and the fresh mashed such hospitals used by urban, rural, and port authorities in potato which these wretched hand-fed children get from time all parts of the country were examined, yet (a fact which to time prevent the cachexia advancing to the stage of sub- cannot be too strongly insisted upon), in two instances only could the extension be traced of small-pox from a hosperiosteal haemorrhage and epiphysial separation. The opinion which I have been compelled to form in my pital "in a way that suggested conveyance of the infected work in the out-patient rooms of the Children’s Hospital is matter through the atmosphere rather than by means of that the worst nourished of thehand-fed infants are those persons and things." And what were these two instances? that have been reared upon condensed milk and the various " In both," I quote Dr. Thorne, " the hospitals in question which ought never to have been used byasanipatent food stuffs ; and that whenever an infant cannot have were buildings for the isolation of cases of infectious disease, human breast-milk, the best substitute will be found in fresh tary authority forming part, as each one did, of a row of dwelling-houses, and cow’s milk prepared and administered secundum artem. being in each case so situated that the patients had to be1 Seymour-street, W. removed from the ambulances in the public thoroughfare." At Leeds, where the house of recovery lies within a distance GERMAN HOSPITAL, DALSTON.--The thirty-eighth varying from 66 to 200 feet of neighbouring houses, 118 cases annual meeting of this charity was held on the 30th ult., of small-pox were admitted in 1871, and "although the hos. when it was announced that the expenditure during the year pital authority would gladly have availed themselves of had been £10,003 and the income £9427, the balance remain- even a suggestion as to the spread of infection to the surrounding in the bankers’ hands on Dec. 31st being £119, against iug dwellings, in order to close their hospital against smallX723 on Jan. 1st, 1883. During the year a convalescent pox, no rumour of such an event was even heard oi." Again, at home containing 17 beds had been added, and 317 patients 1 Report, p. 40. had already been admitted.
c. n
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