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CHRISTCHURCH HOSPITAL, NEW ZEALAND.
PATHOLOGICAL SOCIETY OF LONDON
1296
Returning now to the throat condition this continued to and manoeuvred the wandering organ into its natural position, get worse ; the temperature reached 105°, and on Feb. 6th, where it was fixed by three deep silk sutures passed through four days from the onset and two days after the erythema the kidney substance and secured to the lumbar muscles. had appeared, both tonsils were found to be covered with Both wounds were then closed. In two days the jaundice membrane. Simultaneously a discharge was reported from had disappeared and a week later the wounds were found to the vagina and on examination a small patch of membrane, be well healed. The patient was discharged six weeks later of about the size of
a split pea, was discovered on one labium and when seen two months after the operation was in perfect majus. This readily stripped off, leaving a raw surface. On health and of normal complexion. Remark by Dr. FENWICK.-In a country where almost separating the labia the fossa navicularis and entrance to the vagina were found to be plugged with similar membrane. every tumour in the hepatic region proves to be of hydatid The parts were inflamed and acutely tender. The origin I thought that this case was of peculiar interest. case having all the clinical characters of diphtheria, the
child
was
transferred to
an
isolation ward and 3000 units of
diphtheria antitoxin were injected, followed four and a half hours later by another dose of 1500 units. A cover-glass preparation and a cultivation on blood serum were made in the
usual way from the membrane removed from the vulva and a cultivation was also made from the membrane from the tonsils. Some bacilli of a doubtful nature were seen in the cover-glass preparation but no bacilli of any kind could be obtained from the cultivations incubated at blood heat. Repeated cultivations on blood serum and agar-agar were made from both the vagina and the tonsils but nothing in the least resembling the bacillus diphtbeiise could be found. On each occasion a practically pure growth resulted of an organism apparently identical with the staphylococcus pyogenes aureus. Thepatient gradually improved and by Feb. 14th the temperature had fallen to normal, the fauces were clean, and all signs of vaginitis and of the peculiar rash had disappeared. Two days later, however, albuminuria appeared and persisted for ten days. There were no symptoms of paralysis and the patient made a good recovery. Remarks by Dr. MILLARD.-The above case appears to me to be sufficiently interesting to justify recording. The clinical symptoms, apart from the peculiar erythema, were exactly those of faucial diphtheria following scarlet fever, with auto-infection of the vulva and vagina, and the improvement following the administration of the antitoxin and the subsequent albuminuria both help to confirm this diagnosis. On the other hand, it was certainly remarkable, if the case really was diphtheria, that no L6ffier’s bacilli could be found. The method which I followed in searching for them was the usual one, of which I had had considerable experience, and I made repeated cultivations, about six or more, at different dates, some with actual membrane and The constant some with swabs, but all with similar results. presence, in almost pure culture, of the staphylococcus pyogenes aureus suggests that it may have been the true cause of the condition and may possibly explain the peculiar erythema. I have seen many adventitious rashes following scarlet fever and many of purely septic origin, but I have The never seen anything quite like the one in question. subsequent albuminuria may quite well have been a sequela of the scarlet fever and independent of the (?) diphtheria.
CHRISTCHURCH HOSPITAL, NEW ZEALAND. A CASE OF JAUNDICE DUE TO FLOATING FIXATION; RECOVERY.
(Under
the
care
KIDNEY;
of Dr. P. CLENNELL
LUMBAR
FENWICK)
FLOATING kidney may give rise to much discomfort and may simulate many forms of tumour, but it is very rarely that it causes any really important pressure symptoms, as in the following case, where it pressed on the biliary passages and caused obstructive jaundice. The result of the fixation
operation was very satisfactory. A woman, aged 25 years, was admitted into the Christchurch Hospital, New Zealand, suffering from severe jaundice, having had several previous attacks. On examination there was a large, hard tumour lying under the right costal margin, only slightly moveable and apparently connected to the liver. An exploratory incision was made to determine the nature of the mass and it was immediately seen to be the right kidney which was lying close to the costal margin and apparently pressing on the gall-bladder and the bile-ducts. The abdominal incision was left open and the patient having been turned on to the left side an incision was made in the lambar region down to the kidney. Dr. Thacker (the physician by whom the case was transferred to Dr. Fenwick) then inserted his hand through the abdominal wound
Medical Societies. PATHOLOGICAL SOCIETY OF LONDON. LABORATORY MEETING.
Diphtkeria-like Organism found in Pigeon Canker.-The Bacillt18 of Pseudo-tuberculosis.-Haemolytic Action of Method Tetanus Toxin. of Standardising Antipneumococoic Ser1l1n.- Ohromocyte aumving.-Diphtheria Imm2cnity.-Tetanzs Immunity. A MEETING of this society was held at the laboratory of the Jenner Institute of Preventive Medicine, by the -
invitation of the council of the institute, on Nov. 7th, Mr. WATSON CHEYNE, President, being in the chair. There was an unusually large attendance of members and among those present was Lord Lister, chairman of the council of the institute. Dr. ALLAN MACFADYEN and Dr. R. T. HEWLETT made a communication upon a Diphtheria-like Organism found in Pigeons illustrated by lantern slides and microscopic specimens. A swabbing was sent in the usual way to the Jenner Institute of Preventive Medicine by Dr. Sharman of Rickmansworth to be examined for the presence of the diphtheria bacillus. The report sent to him stated that the Kiebs-Lomer bacillus had been found. Dr. Sharman then informed Dr. Macfadyen and Dr. Hewlett that the swabbing had been taken from a pigeon’s throat suffering from a disease known as "pigeon canker." This interesting fact led them to follow the matter up. For this purpose they obtained a number of diseased birds, two of which were shown. The disease appeared in two forms, either attacking the scalp or the throat and fauces. It might attack the eyelids, the appearance being that of a warty growth of about the size of a pea, which might increase in size and close the eye. There was no evidence of the eye itself being affected. The growth might drop off, leaving the subjacent tissues quite healthy. It was a strictly local disease. In the throat the disease usually attacked the maxilla and might become as large as a small nut, presenting in appearance a yellowish, dry, and caseous mass. On the palate a membrane might appear and was very adherent. In all these phases of the disease the diphtheria-like organism was found in large numbers and usually mixed with cocci. The bacilli presented the KlebsLofner appearance as regards size, parallel arrangement, and polar staining. The bacilli were non-motile and stained by the Gram method. Apparently two strains were obtained, No. 1 giving a dry and adherent growth on serum like the xerosis bacillus and also a pellicle on broth like the Parkes diphtheria bacillus, and No. 2 more closely resembling in growth, &c., the diphtheria bacillus as usually met with. The first strain was obtained from the scab and gave a feeble indol reaction ; the second was obtained from the throat and gave a good indol reaction. Both strains produced acid in fluid cultures like the diphtheria bacillus. Cultures and microscopic specimens were exhibited showing the similarities between these organisms and the Klebs-Löffi.er bacillus. The organisms were stained by Neisser’s method. The disease could be inoculated directly from pigeon to pigeon, but all attempts had hitherto failed to reproduce the disease in pigeons with pure cultures. With guinea-pigs and mice solid and fluid cultures had given negative results as regards infection or intoxication. Dr. Macfadyen and Dr. Hewlett then proceeded to examine the throats of healthy pigeons and in every case they found the "throat" strain of the same
1296
Returning now to the throat condition this continued to and manoeuvred the wandering organ into its natural position, get worse ; the temperature reached 105°, and on Feb. 6th, where it was fixed by three deep silk sutures passed through four days from the onset and two days after the erythema the kidney substance and secured to the lumbar muscles. had appeared, both tonsils were found to be covered with Both wounds were then closed. In two days the jaundice membrane. Simultaneously a discharge was reported from had disappeared and a week later the wounds were found to the vagina and on examination a small patch of membrane, be well healed. The patient was discharged six weeks later of about the size of
a split pea, was discovered on one labium and when seen two months after the operation was in perfect majus. This readily stripped off, leaving a raw surface. On health and of normal complexion. Remark by Dr. FENWICK.-In a country where almost separating the labia the fossa navicularis and entrance to the vagina were found to be plugged with similar membrane. every tumour in the hepatic region proves to be of hydatid The parts were inflamed and acutely tender. The origin I thought that this case was of peculiar interest. case having all the clinical characters of diphtheria, the
child
was
transferred to
an
isolation ward and 3000 units of
diphtheria antitoxin were injected, followed four and a half hours later by another dose of 1500 units. A cover-glass preparation and a cultivation on blood serum were made in the
usual way from the membrane removed from the vulva and a cultivation was also made from the membrane from the tonsils. Some bacilli of a doubtful nature were seen in the cover-glass preparation but no bacilli of any kind could be obtained from the cultivations incubated at blood heat. Repeated cultivations on blood serum and agar-agar were made from both the vagina and the tonsils but nothing in the least resembling the bacillus diphtbeiise could be found. On each occasion a practically pure growth resulted of an organism apparently identical with the staphylococcus pyogenes aureus. Thepatient gradually improved and by Feb. 14th the temperature had fallen to normal, the fauces were clean, and all signs of vaginitis and of the peculiar rash had disappeared. Two days later, however, albuminuria appeared and persisted for ten days. There were no symptoms of paralysis and the patient made a good recovery. Remarks by Dr. MILLARD.-The above case appears to me to be sufficiently interesting to justify recording. The clinical symptoms, apart from the peculiar erythema, were exactly those of faucial diphtheria following scarlet fever, with auto-infection of the vulva and vagina, and the improvement following the administration of the antitoxin and the subsequent albuminuria both help to confirm this diagnosis. On the other hand, it was certainly remarkable, if the case really was diphtheria, that no L6ffier’s bacilli could be found. The method which I followed in searching for them was the usual one, of which I had had considerable experience, and I made repeated cultivations, about six or more, at different dates, some with actual membrane and The constant some with swabs, but all with similar results. presence, in almost pure culture, of the staphylococcus pyogenes aureus suggests that it may have been the true cause of the condition and may possibly explain the peculiar erythema. I have seen many adventitious rashes following scarlet fever and many of purely septic origin, but I have The never seen anything quite like the one in question. subsequent albuminuria may quite well have been a sequela of the scarlet fever and independent of the (?) diphtheria.
CHRISTCHURCH HOSPITAL, NEW ZEALAND. A CASE OF JAUNDICE DUE TO FLOATING FIXATION; RECOVERY.
(Under
the
care
KIDNEY;
of Dr. P. CLENNELL
LUMBAR
FENWICK)
FLOATING kidney may give rise to much discomfort and may simulate many forms of tumour, but it is very rarely that it causes any really important pressure symptoms, as in the following case, where it pressed on the biliary passages and caused obstructive jaundice. The result of the fixation
operation was very satisfactory. A woman, aged 25 years, was admitted into the Christchurch Hospital, New Zealand, suffering from severe jaundice, having had several previous attacks. On examination there was a large, hard tumour lying under the right costal margin, only slightly moveable and apparently connected to the liver. An exploratory incision was made to determine the nature of the mass and it was immediately seen to be the right kidney which was lying close to the costal margin and apparently pressing on the gall-bladder and the bile-ducts. The abdominal incision was left open and the patient having been turned on to the left side an incision was made in the lambar region down to the kidney. Dr. Thacker (the physician by whom the case was transferred to Dr. Fenwick) then inserted his hand through the abdominal wound
Medical Societies. PATHOLOGICAL SOCIETY OF LONDON. LABORATORY MEETING.
Diphtkeria-like Organism found in Pigeon Canker.-The Bacillt18 of Pseudo-tuberculosis.-Haemolytic Action of Method Tetanus Toxin. of Standardising Antipneumococoic Ser1l1n.- Ohromocyte aumving.-Diphtheria Imm2cnity.-Tetanzs Immunity. A MEETING of this society was held at the laboratory of the Jenner Institute of Preventive Medicine, by the -
invitation of the council of the institute, on Nov. 7th, Mr. WATSON CHEYNE, President, being in the chair. There was an unusually large attendance of members and among those present was Lord Lister, chairman of the council of the institute. Dr. ALLAN MACFADYEN and Dr. R. T. HEWLETT made a communication upon a Diphtheria-like Organism found in Pigeons illustrated by lantern slides and microscopic specimens. A swabbing was sent in the usual way to the Jenner Institute of Preventive Medicine by Dr. Sharman of Rickmansworth to be examined for the presence of the diphtheria bacillus. The report sent to him stated that the Kiebs-Lomer bacillus had been found. Dr. Sharman then informed Dr. Macfadyen and Dr. Hewlett that the swabbing had been taken from a pigeon’s throat suffering from a disease known as "pigeon canker." This interesting fact led them to follow the matter up. For this purpose they obtained a number of diseased birds, two of which were shown. The disease appeared in two forms, either attacking the scalp or the throat and fauces. It might attack the eyelids, the appearance being that of a warty growth of about the size of a pea, which might increase in size and close the eye. There was no evidence of the eye itself being affected. The growth might drop off, leaving the subjacent tissues quite healthy. It was a strictly local disease. In the throat the disease usually attacked the maxilla and might become as large as a small nut, presenting in appearance a yellowish, dry, and caseous mass. On the palate a membrane might appear and was very adherent. In all these phases of the disease the diphtheria-like organism was found in large numbers and usually mixed with cocci. The bacilli presented the KlebsLofner appearance as regards size, parallel arrangement, and polar staining. The bacilli were non-motile and stained by the Gram method. Apparently two strains were obtained, No. 1 giving a dry and adherent growth on serum like the xerosis bacillus and also a pellicle on broth like the Parkes diphtheria bacillus, and No. 2 more closely resembling in growth, &c., the diphtheria bacillus as usually met with. The first strain was obtained from the scab and gave a feeble indol reaction ; the second was obtained from the throat and gave a good indol reaction. Both strains produced acid in fluid cultures like the diphtheria bacillus. Cultures and microscopic specimens were exhibited showing the similarities between these organisms and the Klebs-Löffi.er bacillus. The organisms were stained by Neisser’s method. The disease could be inoculated directly from pigeon to pigeon, but all attempts had hitherto failed to reproduce the disease in pigeons with pure cultures. With guinea-pigs and mice solid and fluid cultures had given negative results as regards infection or intoxication. Dr. Macfadyen and Dr. Hewlett then proceeded to examine the throats of healthy pigeons and in every case they found the "throat" strain of the same