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DIPHTHERITIC ENDOCARDITIS.
912 clean them and to renew the vacuum but the bandage was not removed during the hour. Some cases did well from the beginning. In others the sinuses closed only to reopen. In two cases the method had to be abandoned on account of the occurrence of considerable hoemorrhage. Histologically there were observed dilatation of the capillaries and lymphatics and increased migration of leucocytes. At first the amount of discharge considerably increased but later it diminished. In some cases, however, the increase persisted andthis seemed to impair the patient’s general condition so much that the method had to be abandoned. The following are some examples. A boy, aged eight years, had had tuberculosis of the hip and a sinus for five years. After .a month’s treatment the discharge diminished steadily and the child gained 11 pounds in weight. A boy, aged three years, had tuberculosis of the knee. A plaster apparatus was applied and a compression bandage was - used daily for six months. During this time the child ’Walked about as before the onset of the disease. Marked decrease in pain and increase in movement of the joint occurred although in the upper part of the joint an abscess developed which opened spontaneously three months after ’the onset of the disease. The treatment was continued .and a sterile dressing was applied. Then the suction treat,ment was begun and the sinus closed 16 weeks later. The fpatient had about 15° of motion in the joint and con,tinued to wear a knee-splint for protection. A boy, aged nine years, had for four years tuberculosis of the spine and -for nine months a sinus which followed incision and drainage -of a psoas abscess. The discharge was profuse. Suction treatment was begun. In about five weeks the discharge greatly diminished and the general condition much improved. Of 16 cases treated, marked improvement or healing took place in eight. In five there was no local improvement but weighb was gained and the colour index of the blood rose. HUMAN TERATOLOGY. To
Gaoffroy Saint-Hilaire science owes the first really -systematic study of monstrosities and anatomical malformations and his" Philosophie Anatomique" needs little more ’than supplementing to maintain the authority which it has ,hardly lost since its publication in 1818-20. No nationality is -exempt from what the older investigators called " Lusus Naturae," the British Isles being not the least prolific in I these phenomena. Scotland in the first decade of the sixteenth century anticipated China in the second decade of the nineteenth in producing " twinslike those called from their birthplace "Siamese." Buchanan in the thirteenth book of his " History of Scotland describes this "monstrum novi generis in Scotia natum" as in the lower part of its body resembling a male child in no wise differing from the normal ; but above the umbilicus the trunk and all the members were double, representing Jboth sexes. "Id Rex," he tells us, "diligenter et educandum et erudiendum curavit; ac maxime in musicis, ,qua in re mirabiliter profecit." Nay (he proceeds), it .mastered various languages, while the two bodies betrayed "
,diverse wills and would sometimes fall out with each other. When they agreed they would hold a consultation in the interests of both. This, too, was remarkable, that any hurt to the legs or loins below was felt by both but when the hurt was inflicted above the pain evoked response in one body only. One of the bodies, he adds, died several days before the other, but the survivor gradually pined away. "Vixit id monstrum,"he concludes, " annos XXVIII. Hac de re scribimus eo confidentius quod adhuc supersunt homines honesti complures qui haec viderint." In all this we seem to be reading an account of the Siamese twins"who died in 1874, aged 63 years. Among contemporary nationalities Italy (as THE LANCET, in
bodies,
correspondence, has from time to time put in contributes the most numerous, as well as the evidence) most bizarre, specimens to the repertory of teratology. In the day now passing her professional journals record the following: In the Island of Sardinia a peasant woman, after prolonged labour lasting three days, was delivered of a gruesome monstrosity. The head of the child (male), normal in size and oval in contour, is without hair; the face is "framed," so to speak, with long hair; the eyes are in the middle of the forehead; the ears are absolutely wanting. In the middle of the thorax there is a "croce" " (cross) formed of hair which covers the backbone, the legs, and the arms, and is at once very long and fine. The hands are wanting. This monstrosity is still alive and the mother, who, it appears, has not yet been allowed to see it, is doing well. From the physical to the moral and intellectual monstrosity, says one of the commentators on the above, there is but a step-how short and how frequently taken let the criminal-lunatic asylums of Italy bear witness. its Italian
-
COÖPERATION
FOR ASYLUM NURSES.
DURING the past two months there have been several notes in the Nursing Times on the subject of asylum nurses. Attention has been drawn to the fact that there is no cooperative nursing home for these nurses similar to those staffed by nurses who have been trained in general hospitals. We are aware that at least one nursing cooperation has asylum-trained nurses on its staff, but it would appear both in the interests of the public and for the better recognition of fully-qualified asylum nurses that a home should be started which shall only supply properly trained nurses who in return shall have the advantages of working under a coöperative system in the matter of their remuneration. We a as that the nurses so presume, guarantee supplied have attained a certain degree of efficiency, that they will be expected to hold some recognised certificate such as that granted by the Medico-Psychological Association of Great Britain and Ireland. We are informed that Miss Jean Hastie is starting early in October a " Mental Nurses’ Cooperation " which, we understand, has the sympathy and support of several consulting physicians in psychological medicine, and if properly managed the scheme should prove a successful one. ___
DIPHTHERITIC ENDOCARDITIS. IN THE LANCET of
Sept. 21st,
p.
826,
we
published
an
unusually interesting case of malignant endocarditis of diphtheritic origin recorded by Dr. J. T. C. Nash. The patient was a child between three and four years of age. The clinical history of the case is worthy of notice. The primary disease (diphtheria) was of so slight a nature that it had passed practically unnoticed. It was only on crossexamination of the parents of the child after a post-mortem examination had been made that it was ascertained that he had suffered from ear-ache and a discharge from the ear three weeks previously ; sore throat, however, had never been complained of. Doubtless such slight cases, owing to nonrecognition, may be the starting-points of severe epidemics. When brought under medical notice the boy had headache, loss of appetite, furred tongue, constipation, and a fugitive erythematous rash. The later symptoms of occasional delirium, restlessness, and tenderness along the back with a continuance of drowsiness, headache, and fever, had suggested the possibility of malignant endocarditis. 36 hours before death retraction of the head and strabismus, and later a petechial rash and slight opisthotonos, led to a suspicion of cerebro-spinal meningitis. At the necropsy on examination of the heart vegetations were found on the aortic and mitral valves. On bacteriological examination a
913 copious growth
of Klebs-Lofller
diphtheria
bacillus
was spreading a disease, whereas the closing of a day-school may be a salutary precaution. Finally, it is recommended that in natural history lessons pupils should be given instruction
obtained from the cerebro-spinal fluid and almost a pure culture of the same organism from the material obtained from the heart. The diphtheria bacillus had evidently
invaded the central nervous system and embolic plugs laden with diphtheria bacilli would be sufficient to account for the .symptoms resembling cerebro-spinal meningitis. As Dr. Nash points out, this case suggests that isolated cases of
,death preceded by symptoms of cerebro-spinal meningitis should not be attributed to epidemic cerebro-spinal fever without adequate bacteriological proof. We agree with him when he says that to justify the diagnosis of epidemic cerebro-spinal fever it would appear to be quite necessary that the presence of the diplococcus intracellularis of Weichselbaum should be demonstrated. There are many interesting points in connexion with this case that are worthy of careful consideration, and Dr. Nash ,duly discusses some of them. Dr. W. Bulloch, who conducted the bacteriological examination, remarks that cerebro-spinal symptoms in association with malignant endocarditis have been formerly observed, but he is not aware that the diphtheria bacillus has previously to this instance been ’demonstrated as the infecting organism.
THE INTERNATIONAL STOMATOLOGICAL ASSOCIATION.
in the treatment and care of infectious diseases. In the modern reading-books for continuation classes instruction in the simpler matters of hygiene is becoming a prominent characteristic and the children often carry the information to the parents whose aid the school is advised to seek in enforcing the new instructions.
THE ROYAL SOCIETY OF MEDICINE: THE library of the society will reopen for the use of Fellows and members of sections on Tuesday, Oct. 1st. During the recess a considerable amount of work has been done, shelving for nearly 20,000 additional volumes has been provided, and the libraries of the societies which have combined have been brought together and conveniently arranged. A large portion of the premises hitherto let off to tenants has been taken over for the use of the society and many changes in the internal arrangement of the library have been made.
meeting of the South-Eastern division of the Medico-Psychological Association will be held, by the courtesy of Mr. Reginald J. Stilwell, at Moorcroft, Hillingdon, Uxbridge, on Tuesday, Oct. 8th. Communications will be made by Dr. R. H. Cole on a Short Account of Moorcroft, Past and Present, and by Dr. W. H. B. Stoddart on Babinsky’s Conception of Hysteria. The members will dine together after the meeting at the Cafe Monico, Piccadilly-circus, at 7 P.M. THE autumn
THE inaugural meeting of the International Stomatological Association was held in Paris on August 6th and 7th, immediately after the first French Congress of Stomatology. The officers of the association are as follows: Honorary Presidents: Professor E. S. Talbot (Chicago) and A GENERAL meeting of the Association Internationale Dr. L. Cruet (Paris). President: Professor J. von Arkovy d’Urologie will be held on Tuesday, Oct. 8th, at 10 A.3,1., at (Budapest). Vice-Presidents :Professor C. Redard (Geneva), the Hospital Necker, Rue de Sevres, Paris, to decide upon Professor C. Platschick (Milan), Dr. Otto Zigmondy (Vienna), the final constitution of the association. Delegates of the .and Dr. Johan Rygge (Christiania). Secretary-General : Dr. national committees alone have the right to take part in H. Allecys (Antwerp). Secretaries : Dr. J. Sim Wallace or all of the members of one committee can be this. .(London), Dr. J. Breitbach (Dresden), and Dr. D. Nicoleacu presentAny at the meeting and can take part in the deliberations, (Bucharest). Treasurer: Dr. F. A. Meyer (Amsterdam). In but each nation will only have one vote. addition there is a representative council consisting of 20 members, each representing a different country. The officers THE winter session of lectures and demonstrations at the and representatives are each elected for three years. The for Sick Children, Great Ormond-street, London, .next meeting of the association will take place at Budapest Hospital will begin on Oct. 10th at 4 P.M., when Dr. A. E. Garrod will in August, 1909, immediately after the Sixteenth Intergive a lecture on Diabetes in Children. On Oct. 17th at the national Congress of Medicine. same hour Mr. H. Stansfield Collier will lecture on Experiences of the Opsonic Method in Surgical Cases. Lectures HYGIENE IN PRUSSIAN SCHOOLS. will be given every Thursday at 4 P.M. and are free to all THE Prussian Minister of Education has recently issued medical practitioners. - new instructions, in extension of those of July 14th, 1884, THE centenary of the Geological Society was held on relating to the treatment of infectious diseases in schools. If are observed the will become one of the school Thursday, Sept. 26th, when an address was delivered by premises they least likely sources of infection, for as a result of the war Dr. M. Grabham, as the representative of the Royal College waged on microscopic germs cleanliness in the class-rooms of Physicians of London. To-day (Friday) the society visits and the lavatories and purity in the drinking water will be St. Paul’s Cathedral. We hope to publish Dr. Grabham’s -
assured. The number of notifiable diseases has been increased by the inclusion of tuberculosis of the throat and lungs "so long as bacilli are present in the sputum." Teachers and pupils who have any doubt as to their health are earnestly requested to consult a medical man for the purpose of having their sputum examined. All pupils suffering from infectious disease are to be excluded from schools. Isolation is imposed on all who have been in contact with a patient and it extends to public places, playgrounds, and parks, in addition to school premises. When diphtheria breaks out in a school all who have been in contact with the patients are advised to submit themselves for treatment with serum. Daily disinfection of the throat and nose is recommended to persons who have been in contact with cases. In boarding-schools modifications of these rules are introduced, for it is felt that the closing of a boarding-school is an effective method of
address in
a
future issue. ___
THE first Hunterian lecture of the Hunterian Society will be delivered on Wednesday, Oct. 9th, at 8.30 P.M., by Dr. F. M. Sandwith, Gresham professor of medicine. The subject is Dysentery. The meeting will be held in the London Institution, Finsbury-circus, and all members of the medical profession are invited. -
THE annual
presidential
address will be
given by
the
new
President, Mr. R. Lake, F.R.C.S. Eng., before the West London
Medico-Chirurgical Society on Oct. 4th at 8.30 P.M. Hospital, the subject being the of Disease of the Ear, Nose, and Larynx to Relationship at the West London
General Medicine. ___
THE winter session of the West London Post-Graduate College will commence on Monday, Oct. 7th.
Gaoffroy Saint-Hilaire science owes the first really -systematic study of monstrosities and anatomical malformations and his" Philosophie Anatomique" needs little more ’than supplementing to maintain the authority which it has ,hardly lost since its publication in 1818-20. No nationality is -exempt from what the older investigators called " Lusus Naturae," the British Isles being not the least prolific in I these phenomena. Scotland in the first decade of the sixteenth century anticipated China in the second decade of the nineteenth in producing " twinslike those called from their birthplace "Siamese." Buchanan in the thirteenth book of his " History of Scotland describes this "monstrum novi generis in Scotia natum" as in the lower part of its body resembling a male child in no wise differing from the normal ; but above the umbilicus the trunk and all the members were double, representing Jboth sexes. "Id Rex," he tells us, "diligenter et educandum et erudiendum curavit; ac maxime in musicis, ,qua in re mirabiliter profecit." Nay (he proceeds), it .mastered various languages, while the two bodies betrayed "
,diverse wills and would sometimes fall out with each other. When they agreed they would hold a consultation in the interests of both. This, too, was remarkable, that any hurt to the legs or loins below was felt by both but when the hurt was inflicted above the pain evoked response in one body only. One of the bodies, he adds, died several days before the other, but the survivor gradually pined away. "Vixit id monstrum,"he concludes, " annos XXVIII. Hac de re scribimus eo confidentius quod adhuc supersunt homines honesti complures qui haec viderint." In all this we seem to be reading an account of the Siamese twins"who died in 1874, aged 63 years. Among contemporary nationalities Italy (as THE LANCET, in
bodies,
correspondence, has from time to time put in contributes the most numerous, as well as the evidence) most bizarre, specimens to the repertory of teratology. In the day now passing her professional journals record the following: In the Island of Sardinia a peasant woman, after prolonged labour lasting three days, was delivered of a gruesome monstrosity. The head of the child (male), normal in size and oval in contour, is without hair; the face is "framed," so to speak, with long hair; the eyes are in the middle of the forehead; the ears are absolutely wanting. In the middle of the thorax there is a "croce" " (cross) formed of hair which covers the backbone, the legs, and the arms, and is at once very long and fine. The hands are wanting. This monstrosity is still alive and the mother, who, it appears, has not yet been allowed to see it, is doing well. From the physical to the moral and intellectual monstrosity, says one of the commentators on the above, there is but a step-how short and how frequently taken let the criminal-lunatic asylums of Italy bear witness. its Italian
-
COÖPERATION
FOR ASYLUM NURSES.
DURING the past two months there have been several notes in the Nursing Times on the subject of asylum nurses. Attention has been drawn to the fact that there is no cooperative nursing home for these nurses similar to those staffed by nurses who have been trained in general hospitals. We are aware that at least one nursing cooperation has asylum-trained nurses on its staff, but it would appear both in the interests of the public and for the better recognition of fully-qualified asylum nurses that a home should be started which shall only supply properly trained nurses who in return shall have the advantages of working under a coöperative system in the matter of their remuneration. We a as that the nurses so presume, guarantee supplied have attained a certain degree of efficiency, that they will be expected to hold some recognised certificate such as that granted by the Medico-Psychological Association of Great Britain and Ireland. We are informed that Miss Jean Hastie is starting early in October a " Mental Nurses’ Cooperation " which, we understand, has the sympathy and support of several consulting physicians in psychological medicine, and if properly managed the scheme should prove a successful one. ___
DIPHTHERITIC ENDOCARDITIS. IN THE LANCET of
Sept. 21st,
p.
826,
we
published
an
unusually interesting case of malignant endocarditis of diphtheritic origin recorded by Dr. J. T. C. Nash. The patient was a child between three and four years of age. The clinical history of the case is worthy of notice. The primary disease (diphtheria) was of so slight a nature that it had passed practically unnoticed. It was only on crossexamination of the parents of the child after a post-mortem examination had been made that it was ascertained that he had suffered from ear-ache and a discharge from the ear three weeks previously ; sore throat, however, had never been complained of. Doubtless such slight cases, owing to nonrecognition, may be the starting-points of severe epidemics. When brought under medical notice the boy had headache, loss of appetite, furred tongue, constipation, and a fugitive erythematous rash. The later symptoms of occasional delirium, restlessness, and tenderness along the back with a continuance of drowsiness, headache, and fever, had suggested the possibility of malignant endocarditis. 36 hours before death retraction of the head and strabismus, and later a petechial rash and slight opisthotonos, led to a suspicion of cerebro-spinal meningitis. At the necropsy on examination of the heart vegetations were found on the aortic and mitral valves. On bacteriological examination a
913 copious growth
of Klebs-Lofller
diphtheria
bacillus
was spreading a disease, whereas the closing of a day-school may be a salutary precaution. Finally, it is recommended that in natural history lessons pupils should be given instruction
obtained from the cerebro-spinal fluid and almost a pure culture of the same organism from the material obtained from the heart. The diphtheria bacillus had evidently
invaded the central nervous system and embolic plugs laden with diphtheria bacilli would be sufficient to account for the .symptoms resembling cerebro-spinal meningitis. As Dr. Nash points out, this case suggests that isolated cases of
,death preceded by symptoms of cerebro-spinal meningitis should not be attributed to epidemic cerebro-spinal fever without adequate bacteriological proof. We agree with him when he says that to justify the diagnosis of epidemic cerebro-spinal fever it would appear to be quite necessary that the presence of the diplococcus intracellularis of Weichselbaum should be demonstrated. There are many interesting points in connexion with this case that are worthy of careful consideration, and Dr. Nash ,duly discusses some of them. Dr. W. Bulloch, who conducted the bacteriological examination, remarks that cerebro-spinal symptoms in association with malignant endocarditis have been formerly observed, but he is not aware that the diphtheria bacillus has previously to this instance been ’demonstrated as the infecting organism.
THE INTERNATIONAL STOMATOLOGICAL ASSOCIATION.
in the treatment and care of infectious diseases. In the modern reading-books for continuation classes instruction in the simpler matters of hygiene is becoming a prominent characteristic and the children often carry the information to the parents whose aid the school is advised to seek in enforcing the new instructions.
THE ROYAL SOCIETY OF MEDICINE: THE library of the society will reopen for the use of Fellows and members of sections on Tuesday, Oct. 1st. During the recess a considerable amount of work has been done, shelving for nearly 20,000 additional volumes has been provided, and the libraries of the societies which have combined have been brought together and conveniently arranged. A large portion of the premises hitherto let off to tenants has been taken over for the use of the society and many changes in the internal arrangement of the library have been made.
meeting of the South-Eastern division of the Medico-Psychological Association will be held, by the courtesy of Mr. Reginald J. Stilwell, at Moorcroft, Hillingdon, Uxbridge, on Tuesday, Oct. 8th. Communications will be made by Dr. R. H. Cole on a Short Account of Moorcroft, Past and Present, and by Dr. W. H. B. Stoddart on Babinsky’s Conception of Hysteria. The members will dine together after the meeting at the Cafe Monico, Piccadilly-circus, at 7 P.M. THE autumn
THE inaugural meeting of the International Stomatological Association was held in Paris on August 6th and 7th, immediately after the first French Congress of Stomatology. The officers of the association are as follows: Honorary Presidents: Professor E. S. Talbot (Chicago) and A GENERAL meeting of the Association Internationale Dr. L. Cruet (Paris). President: Professor J. von Arkovy d’Urologie will be held on Tuesday, Oct. 8th, at 10 A.3,1., at (Budapest). Vice-Presidents :Professor C. Redard (Geneva), the Hospital Necker, Rue de Sevres, Paris, to decide upon Professor C. Platschick (Milan), Dr. Otto Zigmondy (Vienna), the final constitution of the association. Delegates of the .and Dr. Johan Rygge (Christiania). Secretary-General : Dr. national committees alone have the right to take part in H. Allecys (Antwerp). Secretaries : Dr. J. Sim Wallace or all of the members of one committee can be this. .(London), Dr. J. Breitbach (Dresden), and Dr. D. Nicoleacu presentAny at the meeting and can take part in the deliberations, (Bucharest). Treasurer: Dr. F. A. Meyer (Amsterdam). In but each nation will only have one vote. addition there is a representative council consisting of 20 members, each representing a different country. The officers THE winter session of lectures and demonstrations at the and representatives are each elected for three years. The for Sick Children, Great Ormond-street, London, .next meeting of the association will take place at Budapest Hospital will begin on Oct. 10th at 4 P.M., when Dr. A. E. Garrod will in August, 1909, immediately after the Sixteenth Intergive a lecture on Diabetes in Children. On Oct. 17th at the national Congress of Medicine. same hour Mr. H. Stansfield Collier will lecture on Experiences of the Opsonic Method in Surgical Cases. Lectures HYGIENE IN PRUSSIAN SCHOOLS. will be given every Thursday at 4 P.M. and are free to all THE Prussian Minister of Education has recently issued medical practitioners. - new instructions, in extension of those of July 14th, 1884, THE centenary of the Geological Society was held on relating to the treatment of infectious diseases in schools. If are observed the will become one of the school Thursday, Sept. 26th, when an address was delivered by premises they least likely sources of infection, for as a result of the war Dr. M. Grabham, as the representative of the Royal College waged on microscopic germs cleanliness in the class-rooms of Physicians of London. To-day (Friday) the society visits and the lavatories and purity in the drinking water will be St. Paul’s Cathedral. We hope to publish Dr. Grabham’s -
assured. The number of notifiable diseases has been increased by the inclusion of tuberculosis of the throat and lungs "so long as bacilli are present in the sputum." Teachers and pupils who have any doubt as to their health are earnestly requested to consult a medical man for the purpose of having their sputum examined. All pupils suffering from infectious disease are to be excluded from schools. Isolation is imposed on all who have been in contact with a patient and it extends to public places, playgrounds, and parks, in addition to school premises. When diphtheria breaks out in a school all who have been in contact with the patients are advised to submit themselves for treatment with serum. Daily disinfection of the throat and nose is recommended to persons who have been in contact with cases. In boarding-schools modifications of these rules are introduced, for it is felt that the closing of a boarding-school is an effective method of
address in
a
future issue. ___
THE first Hunterian lecture of the Hunterian Society will be delivered on Wednesday, Oct. 9th, at 8.30 P.M., by Dr. F. M. Sandwith, Gresham professor of medicine. The subject is Dysentery. The meeting will be held in the London Institution, Finsbury-circus, and all members of the medical profession are invited. -
THE annual
presidential
address will be
given by
the
new
President, Mr. R. Lake, F.R.C.S. Eng., before the West London
Medico-Chirurgical Society on Oct. 4th at 8.30 P.M. Hospital, the subject being the of Disease of the Ear, Nose, and Larynx to Relationship at the West London
General Medicine. ___
THE winter session of the West London Post-Graduate College will commence on Monday, Oct. 7th.