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DEFORMITY OBSERVED TEN YEARS AFTER AN ACCIDENT.
1012 40 per cent. at the periodical military levy, that the medical candidatures in question are most numerous and most actively promoted. Southern Italy, notably the Neapolitan provinces and Calabria, are the regions indicated, no fewer than five medical candidates courting as many of their constituencies. Some of these gentlemen hold university chairs, besides being in consultant practice, and the question arises, How can they possibly find time to do justice to their pupils their patients, on the one hand, and to their constituents, the other ? The answer is that what would be next to impossible in England is quite possible in Italy, means where attendance in the House is by no or
on
The peculiarity in this zone is not uncommon. is the interval of ten years between the injury and the observation of the deformity. Both the boy and his parents were persons of high intelligence.
epiphyseal case
DIABETES
IN
INFANCY.
IT is well recognised that diabetes may occur in infancy, at the age of a few days, but the cases are very rare. Of 6496 fatal cases of diabetes which occurred in England and Wales in the decade 1861-1870 the age was under one year in only 8. The following case, which is recorded in the even
Johns Hopkins Hospital B2lletan for September by Dr. J. H. M. Knox, is therefore of interest. A highly strung in the Mother of Parliaments. The Chamber of nervous woman gave birth, after a normal labour, to a Deputies in Rome does not commence business till late female child. Two years before she had a severe attack of in the afternoon, seldom before 3 P.M., and its business jaundice. The father, though in good health, limped from is invariably over in what in England would be regarded healed tuberculosis of the hip. There were an elder sister, as the early evening, between 6 and 7. As a matter and a brother who died at health in 4 good aged years, of fact, there have been physicians and surgeons enough 4 months from some gastro-intestinal disorder. There was in the Italian Chamber who have combined the two rôles, no of history malignant disease, syphilis, or diabetes in the that of practitioner and that of Parliamentarian, to justify family. The child was breast-fed but also given diluted each and all of the many medical candidates now before the cows’ milk. At four months she had a severe attack of constituencies in embarking on the twofold career. Lanza, bronchitis, during which the urine was found to contain pus a Piedmontese consultant, honourably refused all official cells, which disappeared under urotropin. Several examinasalary as Prime Minister on the ground that his professional tions during the following months showed not a trace of honoraria sufficed for all his wants, while he found time sugar in the urine. At five months the child was put on a not only to earn the said honoraria, but to lead up to malt soup mixture for some digestive disturbance. She the events which brought his illustrious client King thrived for a time and rapidly gained in weight. She Guido Baccelli is was first seen Victor Emanuel in 1870 to Rome. by Dr. Knox at the age of seven months, another of the consultants who hold a university when she appeared to be perfectly well, but she was chair and a seat in Parliament with conspicuous taking an unusually large amount of malt soup. This efficiency in both capacities. The eminent patriot and was discontinued, and a simple milk mixture, containing sanitary reformer, Agostino Bertani, surgeon-general in two-thirds milk and 4 per cent. dextrimaltose, was substiGaribaldi’s revolutionary force, is yet another exemplar of tuted. She did well for a month and then was seen on the compatibility of the medical with the political career ; May 26th, 1912, because she was not gaining weight. She while as to the senators who have been promoted from the was bright but rather irritable. Her weight was 19 Ib. Lower to the Upper House while keeping in touch as On May 30th, at the age of 8 months, she was found to teachers and practitioners with medical science and practice have a temperature of 1010 F. and a fruity odour in the their name is legion. Italy, indeed, has everything to gain breath. The urine contained between 4 and 5 per cent. by the presence in her legislature of public-spirited con- of glucose and acetone. On May 31st she was put sultants and practitioners, who, with no ambition for office, on "eiweiss"milk. Her weight had fallen to 18 lb. are yet prepared to give their thought and experience to the and her temperature was 99’4. Under this diet the sugar body politic, claiming as that body does, a serious, a in the urine fell to 1’5 per cent., but the general condition systematic rehabilitation, in the sanitary sense, to which no was not satisfactory, and on June 7th she was admitted into Italian with any sense of citizenship can now remain the Johns Hopkins Hospital. She apparently tired of the ., indifferent. eiweiss" milk, and was put on a mixture of 32 per cent. cream, albumin, and water (the mixture having a composiDEFORMITY OBSERVED TEN YEARS AFTER AN tion of 3 per cent. fat, 4 per cent. sugar, and 2 per cent. ACCIDENT. proteid). The amount of sugar in the urine rose, and a week IN the Australasian Medical Gazette of June 21st Dr. after admission she became drowsy and increased amounts Max Herz has reported a remarkable case in which deformity of acetone and diacetic acid were found. Sodium biwas not observed until many years after the injury which carbonate was administered, but she became more produced it. A boy, aged 15 years, discovered one day that and more drowsy, comatose, and died 11 days after his left hand did not run in the long axis of the forearm admission, having shown signs of pulmonary involvement. but had grown at an angle towards the thumb. On exa- The necropsy revealed broncho-pneumonia and cloudy mination he was well built and healthy. The left wrist was swelling of viscera. The pancreas was of normal size and in the position of manus valga, the hand forming an angle of an iron-grey colour. The lobules were homogeneous in with the forearm opening on the radial side. There was appearance, and here and there were small spots, apparently no pain or discomfort or disability. The left forearm islands of Langerhans. On microscopic examination the measured4 inch less than the right. A history of an lobules were seen to be separated by rather broad septa. In accident 10 years before was obtained. During a game the interstitial tissue were many small round cells, which in he jumped from the roof of a shed and fell on his some places seemed to replace the acini. The connective left hand. The wrist became slightly swollen and was tissue and the islands of Langerhans were diminished in painful for a few days. A skiagram revealed the cause of size and number. The capsule was thickened. The diabetes, the deformity. The outer side of the radial epiphyseal therefore, appeared to be of pancreatic origin. In this case it is noteworthy that thirst and appetite were not zone had ossified prematurely, retarding growth; the ulnar side had developed into a spur, the growth of which pushed greatly increased and that polyuria was moderate. Dr. the hand into a valgus position. A disturbance of growth Knox has collected 16 recorded cases of diabetes in children with resulting deformity due to injury of one side of. an under the age of one year (including his own). In 3 so
frequently required,
so
prolonged,
___
or
so
exacting
as
on
The peculiarity in this zone is not uncommon. is the interval of ten years between the injury and the observation of the deformity. Both the boy and his parents were persons of high intelligence.
epiphyseal case
DIABETES
IN
INFANCY.
IT is well recognised that diabetes may occur in infancy, at the age of a few days, but the cases are very rare. Of 6496 fatal cases of diabetes which occurred in England and Wales in the decade 1861-1870 the age was under one year in only 8. The following case, which is recorded in the even
Johns Hopkins Hospital B2lletan for September by Dr. J. H. M. Knox, is therefore of interest. A highly strung in the Mother of Parliaments. The Chamber of nervous woman gave birth, after a normal labour, to a Deputies in Rome does not commence business till late female child. Two years before she had a severe attack of in the afternoon, seldom before 3 P.M., and its business jaundice. The father, though in good health, limped from is invariably over in what in England would be regarded healed tuberculosis of the hip. There were an elder sister, as the early evening, between 6 and 7. As a matter and a brother who died at health in 4 good aged years, of fact, there have been physicians and surgeons enough 4 months from some gastro-intestinal disorder. There was in the Italian Chamber who have combined the two rôles, no of history malignant disease, syphilis, or diabetes in the that of practitioner and that of Parliamentarian, to justify family. The child was breast-fed but also given diluted each and all of the many medical candidates now before the cows’ milk. At four months she had a severe attack of constituencies in embarking on the twofold career. Lanza, bronchitis, during which the urine was found to contain pus a Piedmontese consultant, honourably refused all official cells, which disappeared under urotropin. Several examinasalary as Prime Minister on the ground that his professional tions during the following months showed not a trace of honoraria sufficed for all his wants, while he found time sugar in the urine. At five months the child was put on a not only to earn the said honoraria, but to lead up to malt soup mixture for some digestive disturbance. She the events which brought his illustrious client King thrived for a time and rapidly gained in weight. She Guido Baccelli is was first seen Victor Emanuel in 1870 to Rome. by Dr. Knox at the age of seven months, another of the consultants who hold a university when she appeared to be perfectly well, but she was chair and a seat in Parliament with conspicuous taking an unusually large amount of malt soup. This efficiency in both capacities. The eminent patriot and was discontinued, and a simple milk mixture, containing sanitary reformer, Agostino Bertani, surgeon-general in two-thirds milk and 4 per cent. dextrimaltose, was substiGaribaldi’s revolutionary force, is yet another exemplar of tuted. She did well for a month and then was seen on the compatibility of the medical with the political career ; May 26th, 1912, because she was not gaining weight. She while as to the senators who have been promoted from the was bright but rather irritable. Her weight was 19 Ib. Lower to the Upper House while keeping in touch as On May 30th, at the age of 8 months, she was found to teachers and practitioners with medical science and practice have a temperature of 1010 F. and a fruity odour in the their name is legion. Italy, indeed, has everything to gain breath. The urine contained between 4 and 5 per cent. by the presence in her legislature of public-spirited con- of glucose and acetone. On May 31st she was put sultants and practitioners, who, with no ambition for office, on "eiweiss"milk. Her weight had fallen to 18 lb. are yet prepared to give their thought and experience to the and her temperature was 99’4. Under this diet the sugar body politic, claiming as that body does, a serious, a in the urine fell to 1’5 per cent., but the general condition systematic rehabilitation, in the sanitary sense, to which no was not satisfactory, and on June 7th she was admitted into Italian with any sense of citizenship can now remain the Johns Hopkins Hospital. She apparently tired of the ., indifferent. eiweiss" milk, and was put on a mixture of 32 per cent. cream, albumin, and water (the mixture having a composiDEFORMITY OBSERVED TEN YEARS AFTER AN tion of 3 per cent. fat, 4 per cent. sugar, and 2 per cent. ACCIDENT. proteid). The amount of sugar in the urine rose, and a week IN the Australasian Medical Gazette of June 21st Dr. after admission she became drowsy and increased amounts Max Herz has reported a remarkable case in which deformity of acetone and diacetic acid were found. Sodium biwas not observed until many years after the injury which carbonate was administered, but she became more produced it. A boy, aged 15 years, discovered one day that and more drowsy, comatose, and died 11 days after his left hand did not run in the long axis of the forearm admission, having shown signs of pulmonary involvement. but had grown at an angle towards the thumb. On exa- The necropsy revealed broncho-pneumonia and cloudy mination he was well built and healthy. The left wrist was swelling of viscera. The pancreas was of normal size and in the position of manus valga, the hand forming an angle of an iron-grey colour. The lobules were homogeneous in with the forearm opening on the radial side. There was appearance, and here and there were small spots, apparently no pain or discomfort or disability. The left forearm islands of Langerhans. On microscopic examination the measured4 inch less than the right. A history of an lobules were seen to be separated by rather broad septa. In accident 10 years before was obtained. During a game the interstitial tissue were many small round cells, which in he jumped from the roof of a shed and fell on his some places seemed to replace the acini. The connective left hand. The wrist became slightly swollen and was tissue and the islands of Langerhans were diminished in painful for a few days. A skiagram revealed the cause of size and number. The capsule was thickened. The diabetes, the deformity. The outer side of the radial epiphyseal therefore, appeared to be of pancreatic origin. In this case it is noteworthy that thirst and appetite were not zone had ossified prematurely, retarding growth; the ulnar side had developed into a spur, the growth of which pushed greatly increased and that polyuria was moderate. Dr. the hand into a valgus position. A disturbance of growth Knox has collected 16 recorded cases of diabetes in children with resulting deformity due to injury of one side of. an under the age of one year (including his own). In 3 so
frequently required,
so
prolonged,
___
or
so
exacting
as