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BIRMINGHAM AND MIDLAND EYE HOSPITAL.
378 PROVINCIAL HOSPITAL REPORTS. BIRMINGHAM AND MIDLAND EYE HOSPITAL. HYSTERICAL CLOSURE OF RIGHT EYELIDS CURED BY GALVANISM.
(Communicated by Mr. FRANK H. HODGES, House-Surgeon.) servant, aged sixteen, was brought here from a country town on the 17th February, by her mistress, suffering from inability to raise the right upper eyelid. On inquiry, it was found to have existed upwards of six weeks, and to have resisted a variety of both external and internal remedies; the former consisting of large blisters across the brows, which were still unhealed, and, according to the patient’s account, of galvanism to the temples. The mistress had been alarmed by the surgeon in attendance giving I it as his opinion that the affection was due to disease of the brain. The appearance and age of the patient, with the absence of any other implication of the third I nerve, suggested hysteria as the cause; and this diagnosis was borne out by the fact that on raising the affected lid with the finger whilst the patient’s attention was attracted ’, by an examination of the sound eye, and then removing the support, the eyelids remained open until the patient, suddenly recollecting herself, again closed them. My friend Mr. Maberly, a student of the Queen’s Hospital, who saw the case with me, and who had about a month previously witnessed the immediate cure of hysterical aphonia by the sudden galvanic shock applied directly to the vocal cords by Dr. Morell Mackenzie’s apparatus, suggested that similar treatment would be applicable in this case, which was carried out as follows. The patient having been previously told that an immediate cure would result from the operation, one conducting wire of the galvanic battery was applied to the outer canthus, and, the instrument having been wound up to its full strength, the other wire was brought down upon the inner canthus. The effect was startling, the patient screaming and clutching at her eye; and when the hand was removed the eyelids were found to have regained completely their natural action. To ensure a lasting impression upon the patient’s mind, the operation was repeated, and she went away, having returned many thanks for regaining the power she had lost for so many weeks. Nothing has since been heard of the girl, and, as her mistress promised to bring her at once to the hospital should the symptoms recur, it is concluded that she continues well. A
FEMALE
together I,
FOREIGN HOSPITAL REPORTS.
anthematica), accompanied by high fever, a pulse of 110 to 160, great prostration, and delirium; but in small-pox these hmmorrhages precede the characteristic eruption, so that a patient may be covered with them without yet having any eruption, while in scarlet fever and measles they follow it. A case of purpura, with preceding rigor, high fever, and delirium, is a case of small-pox. Unfortunately we are unable to watch these ecchymoses to their end, as such cases of small-pox are fatal. There is an extreme variation in the ratio of such hæmorrhagic cases to the non-hæmorrhagic ; sometimes 1 in 125, sometimes 10 per cent., sometimes 100 per cent. may be hsemorrhagic. Purpura is sometimes associated with Bright’s disease. A case of Professor Hebra’s, for example, which was under his care for a purpuric eruption on the skin, was attacked with pleuro-pneumonia while in the hospital, and was, therefore, handed over to Professor Oppolzer. Not long
afterwards a " splendid" nephritis developed itself. Hypertrophy and dilatation of the right heart in men are sometimes accompanied by purpura. Purpuric relapses are very liable to occur. These are
sometimes attended with colic of the intestines and with no hæmorrhage takes place from the bowel. The prognosis of purpura in old women is bad, but favourable in young women and in men. As to treatment, the vertical position does as much harm as the horizontal does good. Cold douches, recommended by Schonlein, are injurious, because the patient has to sit up for their employment. The patient was ordered to rub her limbs gently twice a day with vinegar and water. Treatment of Acne Faciei.-Prof. Hebra is now using emplastrum hydrargyri in cases where the patients have business to attend to in the daytime. The plaster is applied to the affected skin at bedtime, and allowed to remain on all night. The next morning, on rising, it is removed, and the face is powdered with a mixture of equal parts of subnitrate of bismuth and Venetian talc. In the evening the plaster is
diarrhoea, but
reapplied.
Eczema of the Hands.-Prof. Hebra treats those cases which are due solely to local irritation-e.g., in bakers, from flour-by covering the hands with gloves made of mackintosh cloth, and tied round the wrist with a handkerchief or bandage. The patient only takes them off (by pulling them at the wrist, so as to turn them inside out) at meal times, when he is directed to wash his hands and the insides of the gloves with cold water. By this plan the skin is effectually protected from injurious influences, while at the same time it is kept in a sort of bath by the perspiration retained by the impervious glove. Carbolic Acid in Lepra.-Prof. Hebra says he finds that the only use of the so-called carbolic oil in lepra is to make the patients, as he expresses it, stink." They do as well if rubbed with cod-liver oil or any fat. Ulcer of the Tongue.-In the case of a woman of thirty, who consulted him for a single ulcer on the side of her tongue, Prof. Hebra said that multiple ulcers speak for syphilis, and single ones against it, and for epithelioma. The only test is to give iodide of potassium for a month, using caustic applications to the ulcer at the same time, if thought fit. He ordered ten grains of the iodide twice a day. The patient had no syphilitic history, and no enlarged "
GENERAL HOSPITAL, VIENNA. PROFESSOR HEBRA’S CLINIQUE. C’asc of the so-called Peliosis Rheumatica.-A girl of fourteen was sent to the hospital on account of an eruption on her legs and thighs, which now are mottled over in front with a number of small, irregular, bluish, and slightly raised patches, between which the skin is normal. Fifteen days ago she had pain and slight swelling in her knees and ankles, and was obliged to lie up, but was not seriously ill. She has now only a slight pain in her left hip-joint. The eruption on her legs was discovered accidentally by her mistress. The spots have never " burnt" nor itched. Her nose has not bled, nor have her gums been sore. Professor Hebra observed: We have here to do with a form of purpura which neither has (a) a scorbutic origin, nor (b) arises from weakness and delicacy of the walls of the bloodvessels; but (c) whose cause, equally with the cause of the rheumatism with which it is associated, is at present an enigma. It may possibly depend on a momentary blood stasis in the venous circulation. The patients only have their attention called to the eruption by the pain which their joints give them at the time. The spots, which are at first rose-red, run through the course of ordinary ecchymoses, with their well-known changes of colour. In small-pox, scarlet fever, and measles, purpuric patches sometimes make their appearance on the skin (purpura ex-
lymphatic glands. HOSPITAL, VIENNA.
CHILDREN’S PROFESSOR
WIDERHOFER’S CLINIQUE.
Diffential Diagnosis of Slight Cases of Rickets and of Chronic Hydrocephalus.-Dr. Widerhofer remarked that while the diagnosis of even moderately well-marked examples of these two diseases is generally unattended with difficulty, there are often instances in which, even with the help of the following indications, it is nearly impossible, without keeping the patient under observation for some time, to say which we have to do with. The points to be attended to are briefly In rickets the form of the head is more or less anbut there is no special disproportion between the head and the face. The anterior fontanelle may be large, but the sagittal suture is generally closed at eight or nine months in such cases as we are considering. The orbits are
these.
gular,
normal, and there is
no
prominence ofthe
cornea.
Further,
(Communicated by Mr. FRANK H. HODGES, House-Surgeon.) servant, aged sixteen, was brought here from a country town on the 17th February, by her mistress, suffering from inability to raise the right upper eyelid. On inquiry, it was found to have existed upwards of six weeks, and to have resisted a variety of both external and internal remedies; the former consisting of large blisters across the brows, which were still unhealed, and, according to the patient’s account, of galvanism to the temples. The mistress had been alarmed by the surgeon in attendance giving I it as his opinion that the affection was due to disease of the brain. The appearance and age of the patient, with the absence of any other implication of the third I nerve, suggested hysteria as the cause; and this diagnosis was borne out by the fact that on raising the affected lid with the finger whilst the patient’s attention was attracted ’, by an examination of the sound eye, and then removing the support, the eyelids remained open until the patient, suddenly recollecting herself, again closed them. My friend Mr. Maberly, a student of the Queen’s Hospital, who saw the case with me, and who had about a month previously witnessed the immediate cure of hysterical aphonia by the sudden galvanic shock applied directly to the vocal cords by Dr. Morell Mackenzie’s apparatus, suggested that similar treatment would be applicable in this case, which was carried out as follows. The patient having been previously told that an immediate cure would result from the operation, one conducting wire of the galvanic battery was applied to the outer canthus, and, the instrument having been wound up to its full strength, the other wire was brought down upon the inner canthus. The effect was startling, the patient screaming and clutching at her eye; and when the hand was removed the eyelids were found to have regained completely their natural action. To ensure a lasting impression upon the patient’s mind, the operation was repeated, and she went away, having returned many thanks for regaining the power she had lost for so many weeks. Nothing has since been heard of the girl, and, as her mistress promised to bring her at once to the hospital should the symptoms recur, it is concluded that she continues well. A
FEMALE
together I,
FOREIGN HOSPITAL REPORTS.
anthematica), accompanied by high fever, a pulse of 110 to 160, great prostration, and delirium; but in small-pox these hmmorrhages precede the characteristic eruption, so that a patient may be covered with them without yet having any eruption, while in scarlet fever and measles they follow it. A case of purpura, with preceding rigor, high fever, and delirium, is a case of small-pox. Unfortunately we are unable to watch these ecchymoses to their end, as such cases of small-pox are fatal. There is an extreme variation in the ratio of such hæmorrhagic cases to the non-hæmorrhagic ; sometimes 1 in 125, sometimes 10 per cent., sometimes 100 per cent. may be hsemorrhagic. Purpura is sometimes associated with Bright’s disease. A case of Professor Hebra’s, for example, which was under his care for a purpuric eruption on the skin, was attacked with pleuro-pneumonia while in the hospital, and was, therefore, handed over to Professor Oppolzer. Not long
afterwards a " splendid" nephritis developed itself. Hypertrophy and dilatation of the right heart in men are sometimes accompanied by purpura. Purpuric relapses are very liable to occur. These are
sometimes attended with colic of the intestines and with no hæmorrhage takes place from the bowel. The prognosis of purpura in old women is bad, but favourable in young women and in men. As to treatment, the vertical position does as much harm as the horizontal does good. Cold douches, recommended by Schonlein, are injurious, because the patient has to sit up for their employment. The patient was ordered to rub her limbs gently twice a day with vinegar and water. Treatment of Acne Faciei.-Prof. Hebra is now using emplastrum hydrargyri in cases where the patients have business to attend to in the daytime. The plaster is applied to the affected skin at bedtime, and allowed to remain on all night. The next morning, on rising, it is removed, and the face is powdered with a mixture of equal parts of subnitrate of bismuth and Venetian talc. In the evening the plaster is
diarrhoea, but
reapplied.
Eczema of the Hands.-Prof. Hebra treats those cases which are due solely to local irritation-e.g., in bakers, from flour-by covering the hands with gloves made of mackintosh cloth, and tied round the wrist with a handkerchief or bandage. The patient only takes them off (by pulling them at the wrist, so as to turn them inside out) at meal times, when he is directed to wash his hands and the insides of the gloves with cold water. By this plan the skin is effectually protected from injurious influences, while at the same time it is kept in a sort of bath by the perspiration retained by the impervious glove. Carbolic Acid in Lepra.-Prof. Hebra says he finds that the only use of the so-called carbolic oil in lepra is to make the patients, as he expresses it, stink." They do as well if rubbed with cod-liver oil or any fat. Ulcer of the Tongue.-In the case of a woman of thirty, who consulted him for a single ulcer on the side of her tongue, Prof. Hebra said that multiple ulcers speak for syphilis, and single ones against it, and for epithelioma. The only test is to give iodide of potassium for a month, using caustic applications to the ulcer at the same time, if thought fit. He ordered ten grains of the iodide twice a day. The patient had no syphilitic history, and no enlarged "
GENERAL HOSPITAL, VIENNA. PROFESSOR HEBRA’S CLINIQUE. C’asc of the so-called Peliosis Rheumatica.-A girl of fourteen was sent to the hospital on account of an eruption on her legs and thighs, which now are mottled over in front with a number of small, irregular, bluish, and slightly raised patches, between which the skin is normal. Fifteen days ago she had pain and slight swelling in her knees and ankles, and was obliged to lie up, but was not seriously ill. She has now only a slight pain in her left hip-joint. The eruption on her legs was discovered accidentally by her mistress. The spots have never " burnt" nor itched. Her nose has not bled, nor have her gums been sore. Professor Hebra observed: We have here to do with a form of purpura which neither has (a) a scorbutic origin, nor (b) arises from weakness and delicacy of the walls of the bloodvessels; but (c) whose cause, equally with the cause of the rheumatism with which it is associated, is at present an enigma. It may possibly depend on a momentary blood stasis in the venous circulation. The patients only have their attention called to the eruption by the pain which their joints give them at the time. The spots, which are at first rose-red, run through the course of ordinary ecchymoses, with their well-known changes of colour. In small-pox, scarlet fever, and measles, purpuric patches sometimes make their appearance on the skin (purpura ex-
lymphatic glands. HOSPITAL, VIENNA.
CHILDREN’S PROFESSOR
WIDERHOFER’S CLINIQUE.
Diffential Diagnosis of Slight Cases of Rickets and of Chronic Hydrocephalus.-Dr. Widerhofer remarked that while the diagnosis of even moderately well-marked examples of these two diseases is generally unattended with difficulty, there are often instances in which, even with the help of the following indications, it is nearly impossible, without keeping the patient under observation for some time, to say which we have to do with. The points to be attended to are briefly In rickets the form of the head is more or less anbut there is no special disproportion between the head and the face. The anterior fontanelle may be large, but the sagittal suture is generally closed at eight or nine months in such cases as we are considering. The orbits are
these.
gular,
normal, and there is
no
prominence ofthe
cornea.
Further,