DISEASES OF CHILDREN.

510 did not act

uniformly on the tetra-chromatic, for there was the pus from an ulcer, for the organism may not be discovercertainty of their acceptance or rejection under the condi- able, but a culture should always be made. In the treatHe pointed out their special ment large doses of iodide of potassium exert, a very tions of the examination. difficulty in dealing with blues, and demonstrated how beneficial effect. tests could be arranged which determined their exact visual Dl. R. CRANSTON Low (Edinburgh) showed a wax model of defect and eliminated the large element of chance which a case of Sporotrichosis, and also a culture which had been no

present in the common forms of colour-blindness tests. Professor HAYCRAFT and Professor ANDERSON discussed the paper, and Dr. EDRIDGE-GREEN replied. was

DERMATOLOGY.

FRIDAY, JULY 28TH.

President, Dr. JAMES GALLOWAY (London). Among the cases of dermatological interest shown before the meeting were the following ;Dr. A. DOUGLAS HEATH (Birmingham) : Chronic Lichen Planus in a man 25 years of age ; Sycosiform Lupus in a man of 62 years, who had had it for 20 years; Molluscum Contagiosum of the Forehead in a girl, 19 years old, of six months’ duration ; Bazin’s Disease on the legs of a girl (von Pirquet’s test had been positive) ; and Ichthyosis Verrucosa in a boy 9 years old. Mr. E. GILBERT SMITH (Birmingham): Lupus Vulgaris in a man of 23, who had had it for three and a half years (he had had 1/10000th of a minim of tuberculin weekly since Christmas, and he had much improved) ; Lupus Erythematosus in a woman, 73 years old, who had had it for 20 years ; another case of the same disease in a woman of 28 of two years’ duration, growing worse ; and a case also in a woman of 44 years who had been benefited by X rays. Dr. G. H. LANCASHIRE (Manchester) read a paper on An Unusual Case of Cutaneous Pigmentation.

The patient was a woman, aged 31 years, who had had since She was a childhood a pigmented area on the neck. brunette. About last Christmas pigmented freckles appeared round this area, and in the course of the next four months spread down the neck to the left shoulder and upper part of the left arm in the deltoid region, and also on to the front of the chest wall to just beyond the middle line. Lancinating pains came on frequently during both the day and the night, and each paroxysm of pain appeared to be succeeded by the deposit of freckles in a fresh area. The patient appeared to A be in good health, with no signs of organic disease. medicine containing bromide was prescribed, and locally menthol oil was applied. The pains soon subsided, and fresh pigment ceased to be deposited. Fairly rapid absorption of the pigment which had previously been deposited soon set in. Dr. Lancashire pointed out the resemblance in the general features of this case to herpes zoster. Dr. H. G. ADAMSOX (L3ndon) suggested that the condition was in part congenital. Dr. J. H. SEQUEIRA (London) suggested that the pigmentation might have been due to some hot applications to the

part. Dr. ADAMON read

a

paper

A Case

on

of Sporotri.chusis.

He mentioned that the disease was very little known in this country, though it was not unlikely that it was more common than might be thought, for it was by no means improbable that many cases were undiagnosed, as it gives rise to ulcerations which have a very great resemblance to those resulting from gummata. He gave a résumé of the literature of the subject, and he pointed out that the lesions were not confined to the skin, but in some cases might also be found affecting the mucous membrane of the throat; it might affect the eye and deposits might occur in the testis. The organism is easily grown and can then be recognised readily, but it is rarely possible to find the organism in smears. The disease occurs in the rat and in the dog, and it is much more For a long common in North America than in this country. time the disease has been known there, and it was called pseudo-glanders, and it was recognised that it could be caught from horses. Cultures grow readily on glucose-agar or on potato. The swelling is made up mainly of mycelium, singly or in bundles, and giant cells are present. The size of the nodules is generally about that of a marble or a little larger. The nodules break down and form ulcers. The diagnosis must not be allowed to depend on examination of

made from the pus from the same case. He also exhibited several lantern slides showing the appearance of sections of the nodules. In appearance a culture of sporotrichosis is midway between ringworm and actinomycosis. The patient inoculated his finger a year ago, and in a week the condition had commenced to spread upwards, the lower lesions having a tubercular appearance, while the upper lesions had a syphilitic appearance. The diagnosis is really made from the culture, but it is important to take the culture before any iodide of potassium has been administered, for a single dose of the iodide may be sufficient to destroy the fungus. Dr. R. STOPFORD TAYLCR (Liverpool) read a paper on

Some Practical Observations on the Treatmcnt of Eczerracc. He considered that eczema was due to the action of a local irritant, but that it was frequently associated with disease of one or other internal organ, and it was kept up by the original or another irritant. He described the form of dressing which he employed. Ha takes a piece of wetted lint, and then puts the ointment or paste on the smooth side of the lint and covers it with a piece of butter-cloth, which is placed next the skin, and sometimes a piece of guttapercha tissue is placed outside all. In acute cases this dressing may need changing twice daily, but in chronic cases less frequent dressing will be quite sufficient. He laid stress on the importance of not allowing any interval to elapse between one dressing and another. The wet lint and the butter-cloth are employed because they allow drainage. Dr. LOW expressed the opinion that many eczemas are seborrhoeic in origin, and therefore he had a high opinion of the value of sulphur in the treatment of these forms of the disease. Dr. ADAMSON did not consider that eczema was microbic in origin. In treatment the main point was to protect the part from external irritants. The PRESIDENT showed some lantern slides illustrating some interesting cases. The first case was that of a woman who had suffered from syphilis in early life. She developed gangrene of the finger-tips of both hands ; the gangrene followed a syphilitic affection of the bloodvessels. A section of the posterior tibial artery from a similar case was exhibited showing the thickened wall. The vein in a similar condition was also shown ; it is often not recognised that the veins are affected equally with the arteries. The President also showed a slide of a case of Dermatitis Repens in which he had found that there was very definite disease of the wall of the blood-vessels. Dr. J. GOODWIN TOMKINSON (Glasgow) read a paper on Pr1wit1fS ViÛvae. He referred especially to a case of a pregnant woman who suffered very severely from pruritus of the vulva. He maintained that the disease is not merely a neurosis, and that this is shown by the pigmentation of the skin which is present. In the case mentioned the itching was so intense as to interfere with sleep, and it was affecting her mind. The ordinary sedatives had no effect in relieving the itching. At last he applied X rays, with the result that the itching was completely cured. -------

DISEASES OF CHILDREN. FRIDAY, JULY 28TH.

President, Dr.

OTTO J. KAUFFMANN

proceedings in this interesting demonstration on The

section

(Birmingham). opened with a most

The Trcatment of Scoliosis Mr. PAUL B. ROTH by (London), who stated that there were six different kinds of curves occurring in scoliosis which might be represented graphically by certain signs. He exhibited several cases of different varieties of scoliosis and demonstrated on a patient the particular exercises employed. There were ten different exercises, the actual carrying out of which took about 20 minutes. In a paper read later Mr. Roth gave further details of a series of 1000 consecutive cases of scoliosis, from a study of which he had formed the

511 1. Scoliosis was almost essentially a disease of females, 84 per cent. of the cases having occurred in that sex. 2. It was a disease of adolescence ; 86 per cent. of cases were between 6 and 20 years old. 3. The frequent occurrence of scoliosis in members of the same family pointed to hereditary transmission. 4. The bad position assumed in writing, a delicate constitution, and too rapid growth were largely responsible for very many cases. 5. Difference in the iength of the leg was not a common cause of scoliosis, having been present in only 21 of the 1000 6. Pain was a frequent symptom. 7. Flat-foot was a cases. 8. Attention to dress before very frequent complicaB ion. any treatment was commenced was absolutely essential. 9. Treatment should never be commenced until a record of 10. Treatment by the osseous deformity had been made. posture and exercise entirely arrested the increase of bony deformity in all but 5-55 per cent. of observed cases, and in 3’ 3 per cent. slightly decreased it. Cure of the bony deformity could not be expected, but in 83 per cent. of cases He did not a permanent practical cure was brought about. use mechanical supports of any kind. In the discussion which followed Mr. G. HEATON (Birmingham) asked how far bicycles could be regarded as a cause of scoliosis in young women, and whether instruments should ever be employed. Dr. R. B. MCVITTIE (Dublin) emphasised the importance of medical supervision of school children. Mr. ROTH replied that he regarded bicycling as useful in scoliosis, and that he had never met with a case in which instrumental supports were necessary. Dr. F. E. BATTEN (London) read a paper on

following conclusions :

The

Aoute Poliomyelitis, forward four propositions : 1. That brought poliomyelitis was an infective disease, transmissible from man to monkey and from monkey to man. The virus had not yet been stained nor seen under the highest It was obtained from the power of the microscope. mucous membrane of the nose of a monkey which had suffered from the disease, and was obtained in an active condition six months after the date of infection. The 2. That virus was strikingly similar to that of rabies. poliomyelitis was an epidemic disease was proved by the numerous epidemics recorded dming the last 30 years in Sweden, Norway, Germany, Austria, France, America, and Australia. In the northern hemisphere epidemics always had the greatest prevalence during July, August, and September, and children during the second and third year of life were Infection through schools had most commonly affected. occurred, but by no means frequently. 3. That the disease occurred in an epidemic form in England was shown by the report of an epidemic of 8 cases at Upminster in 1908 (F. Treves) and an epidemic of 37 cases at Bristol in 1909 (Parker). During 1910 epidemics were reported at Carlisle, where the disease had been made notifiable, and at other places. 4. Poliomyelitis being an infective disease should be treated as such, and the infected person as well as the contacts should be isolated. The period of incubation was probably less than six days ; the period of isolation of the infected should not be less than three weeks. The disease was not so infective as scarlet fever or diphtheria, and the isolation of contacts should have a marked effect in diminishing its incidence. There was some experimental evidence to show that the administration of urotropin tended to prevent infection and diminish the virulence, if not to destroy the virus. Dr. R. D. RUDOLF (Toronto) commented on the tendency of the disease to vanish with the appearance of cold weather, arguing the probability of an animal agency in carrying the disease. Dr. L. G. PARSONS (Birmingham) described an epidemic of 32 cases observed in London in 1909, and stated that the cold weather of that summer had proved no bar to the spread of the disease. Dr. R. H. MILLER (London) asked how far epidemics should

Epidemiology of

in which he

be

regarded as water-borne. Dr. BATTEN replied to the various speakers. Professor STOELTZNER (Halle) read a short paper Oxypathy and oxypathy

in which he stated that as

gout

was rare.

Uric

(London) read a paper on the Employment of Spinal An6esthesia in Abdominal S1wgery. He considered that the value of spinal acsesthesia lay largely in the fact that its employment was an adaptation of the principle of " nerve blocking" over a large area. Experience had shown that with proper selection and in competent hands spinal anxsthesia was as safe as general anaesthesia. The question at issue was, not the relative merits of the two methods as anesthetics, but rather a consideration of which principle-that of nerve blocking or of the suspension of the activity of the higher centres-was the best suited to any particular case. A few general principles were considered. (a) Age. In early life spinal anaesthesia was of the greatest It might be accepted that the assistance to the surgeon. younger the child the more suitable was the case for spinat anaesthesia. (b) The physique of the child was an important factor in deciding between the methods. (0) State of health of the patient. The following conditions peculiar to the abdomen were dwelt on. With spinal anaesthesia muscular relaxation was so complete that thorough access to the different regions of the abdomen was possible with a far smaller incision than under general anaesthesia. The intestines were found comparatively collapsed, and did not exhitit the same tendency to protrude from the wound as under general anaesthesia. Manipulation was consequently minimised, the rapidity of operation increased, and there was less tendency to resulting distension. This latter was a most important point. It was in acute abdominal lesions that spinal a[1aesthesia was most often These lesions were roughly indicated in young children. classified into three groups : 1. Infective lesions of the peritoneum. Here the chief indications for spinal anaesthesia. were the degree of toxaemia, the age and physique of the patient, the degree of intestinal distension, and the degree of urgency for maximum speed with the minimum exposure and violence. 2. Intestinal obstruction. In most such cases, especially in intussusception, operation in children below two years of age should be done under spinal anaesthesia. 3. Injuries. If collapse from baemorrhage was profound, spinal anaesthesia was usually contraindicated. This did not apply to collapse from shock. The frequent necessity for extensive exploration in these cases In perwould often render spinal anassthesia advisable. forating injuries, the main indications for its use were based on the situation of the wound, the nature of the instrument, and the condition of the intestine. Mr. S. G. BARLING (Birmingham) dwelt on certain of the risks and uncertainties of the method, which had been tried in Birmingham but given up. Dr. R. MILNE (London) read a paper on lndiecatinnsfor

Measles:its Treatment and Prevention.1 His method consisted in destroying the germs of the disease by sterilising the pharynx, mouth, and nose with carbolic oil, and inunction of the whole body with eucalyptus oil. The method was equally applicable to scarlet fever. Dr. Milne described the success of his treatment at Dr. Barnardo’s Homes. Dr. J. BRUCE-BAYS (Peterborough) questioned the utility of preventing school children catching measles. Dr. W. P. KENNEDY (Bath) and Dr. A. CANT (Coleshill) having spoken, Dr. MILXE, in reply, said that in over 800 cases of measles and scarlet fever treated he had had no complications and no deaths. The business of the section concluded with a paper by Mr. F. W. GOYDER (Bradford) on

I

in children

and Extensions

of Orze-n’s Operation for Hare-lip, in which he described the various steps of this operation, which had been devised in order to supersede the vertical scar operation, which he considered to have many disadvantages. The ideal to be aimed at, in his opinion, was to have symmetrical nostrils, the lip must be even, thick, and longer at its free border than at its attachment, the scar should be inconspicuous, and the line of suture broken and The modifications he recommended were not straight. believed to result in these improvements, and were performed - /!0
on

Aoid,

was as common

Mr. H. TYRRELL GRAY

If,

without any loss of tissue whatever. 1

See THE LANCET,

April 22nd, 1911,

p. 1070.