HARVEIAN SOCIETY OF LONDON. THURSDAY, MAY 15TH, 1873.

736

pysemio abscesses, pointing out that nothing had been advanced in the paper to invalidate the views entertained by Dr. Dickinson and by pathologists on this subject. MEDICAL SOCIETY OF LONDON. MONDAY, APRIL 28TH, 1873. DR. S. O. HABERSHON, PRESIDENT, IN THE CHAIR. MR. J. S. STREETER mentioned

a case

TWO CASES OF PERITYPHLITIS IN WHICH RECOVERY TOOK PLACE. was seen in consultation with Mr. H. Hemsted, of Whitechurch, who furnished the following notes:—T.H——j aged twenty, a farmer, had an attack of colic, followed on the third day by severe pain and tenderness; gradually lessened under leeches, calomel, and opium. At the end of a fortnight pain in the back was complained of, and some

The first

fulness

was

detected in the risht loin : the svmntoms be-

coming urgent, pulse and temperature high, with frequent of twins having vomiting, a grooved needle was introduced to the depth of the weight of the two inches midway between the last rib and crest of the

child being double other. Both were born alive. The smaller one drew in air ilium; a dark fetid matter escaped; a trocar and canula and fully inflated the chest, but the larger and more power- were then used, and half a pint of horribly offensive matter ful child did not breathe at all. He also showed drawings escaped. The wound was plugged with oiled lint twice a of still-born infants where the heads were enlarged and the day. The lint was removed, and for several weeks a pint necks much elongated, and other pictures showing the um- and a half of matter was discharged daily. Several frag. ments of vegetable marrow, and on two occasions grape. bilical cord twisted around the neck in various ways. stones, were discharged (shown), showing that an undoubted a in WATSON showed Mr. SPENCER patient, aged fifty, whose vitreous humour an ophthalmoscopic examination communication existed with the bowels. No pus passed discovered a long dark filament of lymph floating freely per anum. Eventually the discharge ceased, and the wound healed after having been open for nine weeks. The about. second case was seen in consultation with Mr. Marshall, of Dr. SANSOM communicated the following Mitcham, who is also a Fellow of the Society. W. J-, CASE OF CONGENITAL HYDROCEPHALUS. aged forty-two, was attacked when in bed with violent Kate T-, aged eleven weeks, came under his care as out- griping pain in the abdomen, with vomiting, tenderness for Children on the increased on pressure, especially in the right iliac fossa, patient at the North-Eastern 9th April last. The father died of phthisis. The child was where the percussion note was dull, the abdomen being elsewell developed, but never took any notice, and the head was where tympanitic. There was a decided fulness and hardpersistently retrojected. The fontanelles were distended ness, giving the impression of an elongated tumour the and fluctuant, and progressively the parietal bones became size of a hen’s egg. The patient had eaten nothing to separated. There was no vision. Progressive languor oc- account for the attack, but about a week before, while curred; and the child died on April 20th. The post-mortem eating a piece of bread, some sharp substance, which may showed all the organs healthy except the encephalon. The have been a pin, scraped his pharynx, leaving a sense of brain was pale, and puncture at the base caused a gush of soreness for several days. Calomel and opium were preserous fluid with flocculi to the extent of half a pint. The scribed, and linseed poultices applied. The pain in the cerebellum was distended with this fluid, as well as the region of the cseoum continued very severe; opiates and lateral ventricles, the brain-substance forming a thin in- leeches were employed. There was great prostration of vestment of the fluid. strength, with rapid pulse. At the end of a week the abdominal tenderness abated, and the patient gradually Dr. CROMBIE showed a Heart, the pericardiac system of for many weeks the lump in the iliac which was covered with fibrinous flocculent deposits of rallied, although threatened to suppurate; this eventually dispersed, region lymph much resembling granulations, apparently the re- and the patient is now well. A perceptible hardness, howsult of repeated attacks of pericarditis. It was taken from ever, remains in the region of the csecum. Dr. Thompson a woman aged forty-five, who had never suffered from said that it was not easy to distinguish between colic, inrheumatism, and in whom pericardial friction-sounds were tussusception or other obstruction, peritonitis, and inflamma. not detected. The pericardial cavity was distended with tion in or around the csacum; but the diagnosis must be fluid at the time of death. made before treatment, for unrelieved fxcal Dr. WILTSHiRE suggested the use of the aspirator in cases accumulation commencing was a cause of inflammation, and so were like this for the removal of the fluid, the pericardium violent purgatives. In the first case the colic, impaction, having been punctured several times with marked benefit. and inflammation about the caecum led to the escape of the Dr. SANSOM said, should he have occasion to tap a hydro- contents of the bowel into the subperitoneal tissues, with cephalic head, he should certainly employ this instrument, consequent formation of matter in the most dependent which Dr. Broadbent had employed on several occasions In the second case it seemed impossible to decide part. with benefit. whether the peritonitis with subperitoneal thickening Mr. JoHN HAINWORTH said that the idea of tapping the abscess was due to the escape of any foreign threatening pericardium was not new, for as early as 1826 he knew a body from the bowel. The history of the case favoured case in which this operation had been performed by an this without dis. but the subsidence of the

only

one

chorion,

one

Hospital

English

view,

surgeon.

Mr. SPENCER WATSON read

a

short paper

charge

on

SUBJECTIVE SYMPTOMS OF EYE DISEASE.

of matter

appeared

to

swelling negative it.

Drs. Habershon, Carr, and Routh, and Mr. de Meric spoke in the discussion which followed, and the meeting ad-

some forms of muscae were merely physio- lourned. logical, and seen only under certain peculiar circumstances. HARVEIAN SOCIETY OF LONDON. Spectral images were sometimes caused by floating films on the vitreous, and when the patient so affected was fanciful THURSDAY, MAY 15TH, 1873. or superstitious, definite forms were described as appearing BROADBENT IN THE CHAIR. DR. a no this uneasiness of kind was before him, though, as rule, occasioned beyond the anxiety incidental to the prospect of DR. THOMAS ]BALLARD, President, read a paper on rapid failure of sight. Coloured spectra and double images

He showed how

described and various theories for their appearance and the formation of multiple images in a’ single eye was demonstrated by means of lenses. Various instances of remarkable subjective symptoms of disease were related, and a case of cataract in a myopic patient in whom the physical signs indicated a mature cataract, while the vision remained perfectly good for near objects. This was not unfrequent with myopia, and the author remarked that the subjective symptoms in such cases were very important as a means of connecting the conclusions drawn from ophthalmoscopic investigations. were

given,

Dr. E. SvmES THOMPSON then

brought forward-

WHAT ARE THE SIGNS OF CONGENITAL SYPHILIS?2 The author craved the indulgence of the Society for submitting to them a familiar subject from a new point of view. He had been taunted at this Society and elsewhere for professing never to have seen a case of congenital syphilis, and, in vindication of the position he had assumed with regard to this subject, he had accepted a sort of challenge to submit his reasons for holding such heterodox views to the criticism of his fellow members. The idea that syphilis might be transmitted to the offspring was of ancient date, but to identify a special set of symptoms as proof of such an accident having occurred was principally

737 the work of the present century. No allusion was made to puration is established; from this absorption takes place, the works of Mr. Hutchinson, as the present observations and erysipelatous symptoms of great variety and intensity arise. (A case quoted to illustrate this.) It is probable were limited to the inquiry, "What are the signs of conthat many cases of the supposed appearance of congenital genital syphilis in infancy ?" Dr. Ballard claimed the privilege of drawing his own syphilis at or soon after birth are of this nature, and that inferences from his own observations. He had practised the interval between the birth and the appearance of the his profession for thirty years, and had been accustomed symptoms has been overlooked or forgotten. The erysito keep a record of his patients’ ailments; so he possessed a pelatous affections are of course very severe and generally medical history of a large number of persons. Many had fatal, hence it may be that Trousseau said that conbeen born, grown, and remained under his observation. genital syphilis is nearly always mortal if it show itself Many had had syphilis, and it was in them he had watched within the first fortnight after birth." Hence the third conits effects, and had failed to trace any evidence of its trans- clusion :-That pemphigus and other forms of erysipelatous mission to offspring. The transmission of syphilitic poison disease which may occur within a fortnight after birth, and to the child by an infected parent is said to be mani- have been regarded as syphilitic accidents, are pysemic fested either before birth, at birth, or some time after affections resulting from an unhealthy suppuration of the birth. Dr. Ballard endeavoured to show that the condi- umbilicus which is produced by the child being subjected tions at these periods, which are supposed to depend upon to certain unfavourable conditions. The main task is to invite attention to a more simple exthe taint of syphilis, can be explained by simpler and more obvious means. planation of those appearances which are generally recogIt is well established that a woman who has been infected nised as indicating congenital syphilis, and which are deby syphilis is apt to abort, and to bring forth dead children. veloped from three weeks to three months after birth. These The generally accepted view is that the foetus dies in utero are inflammations of the mucous membranes and skin; but from the direct effect of the virus upon its organism. if these symptoms are due to a virus in the child, why should Trousseau supports this, and says he is unacquainted with their appearance be delayed until the parts affected have any lesion of the placenta attributable to syphilis." Ex- been exposed to external conditions powerfully able to proception was taken to this because it is known how seriously duce them ? Take coryza, about which so much is said by the economy of the mother suffers by the disease, how French authors. Why should ophthalmia, liable to occur deeply seated and how persistent are its deleterious effects, in the newly-born, delay its appearance until after the fifth so that it seems only reasonable that a function such as re- or seventh day if it depended either upon an intrinsic production is prejudiced by it. If the cause of death disease or even upon the contact of an irritating fluid resided in the germ, it surely would not grow. The during the act of birth ? How much more reasonable to defective state of the soil seems sufficient to account for the attribute it to some external cause operating upon the deliblight of the young creature, which is so dependent on it for cate eyes. A newly-born infant kept exposed to the light will certainly have ophthalmia; darken the room and it nourishment. Assuming the foetus to be contaminated, observers have will recover; or kept in the shade it will escape ophthalmia. looked for evidence on the bodies of still-born children, and The Schneiderian membrane of a young infant is likely to be have thus interpreted the decomposition of the cuticle more susceptible of atmospheric influences than that of an which is often seen. But the foetus dying a considerable i, adult ; it is not, then, surprising that it should become the time before it is expelled, maceration of the body in the subject of a catarrh. Why, then, should snuffles be regarded liquor amnii explains this. Similar abortions and premature as evidence of a loathsome disease ? (A bad case of snuffies deliveries occur in those suffering with other forms of quoted, which lately occurred to an infant one month old in - cachexia, especially chronic Bright’s disease, and the same a family where it was known that there was no syphilis.) appearances have been observed in these cases as in those Otorrhcea, occurs, and is sometimes obstinate, but can always known to have been syphilitic. In either case, when a be cured by local means. The mouth may become the seat of disorder, and much living child is born it appears to have a fair chance of living, and of making up in its growth all that it may have is made of this in favour of a theory of syphilis. A young infant must feed by suction, and, being entirely dependent lost by its parent’s defect. Several cases were here read illustrative of the above upon its nurse for the source of nourishment, is it surargument, hence the first conclusion :-That the death of prising if it should make its mouth sore by efforts to satisfy the foetus in utero is the consequence of some defect in its cravings when difficulties are opposed ?P The French are the maternal system, resulting from its contamination by accustomed to farm out their children, and it is usual for a the syphilitic virus, and that,it is not necessary to infer, nurse to undertake to suckle two or more children. It is neither is there evidence to prove, that the organism of the no wonder, then, that these children’s mouths, and the child is intrinsically affected by it. The partial decomposi- nurse’s nipples, become sore. This is the true nature of tion of the cuticle observed on the bodies of still-born thrush and other kindred inflammations of the mucous children is satisfactorily accounted for by their maceration membrane of the mouth. A hard india-rubber teat, or any badly-arranged medium for sucking, will cause an infant’s probably for some weeks after death in the liquor amnii. If the death of the foetus in utero is due to the direct mouth to be sore; and attention paid to the cause will at effect of the syphilitic virus upon its organism, and it is once suggest the remedy. Why, then, should a sore mouth true that congenital syphilis is exceedingly prevalent and or some soreness of the lips be attributed to a constituleads to a large number of deaths annually, why is not the tional disease when there is such a cause operating to prodisease more commonly evident at the time of birth? That duce the malady ? The manifestation most relied upon as syphilis is not often then observed is admitted by all who diagnostic of congenital syphilis is some form of cutaneous have written on the subject. M. Huguier observed but one eruption. M. Caillant says : " The cutaneous phenomena at Lourcine; M. Cullerier has never seen one at the same constitute the whole disease in infants ; the mucous patch institution; MM. Trousseau and Las4oue have never seen is the true pathognomonic symptom of congenital syphilis congenital syphilis at the time of birth; Dr. West has of which it constitutes the whole external manifestation." never seen an infant at birth present evidence of the Other writers are more comprehensive in their views of the venereal taint; and the experience of Dr. Ballard coincided skin eruptions, and include every form which an inflamed with this. On the other hand, Sir A. Cooper mentions a skin can assume, from a simple erythema to a decided ulThere is no case, but this seems open to objection. Hence the second ceration and a growth from the base of it. conclusion :-That the records of cases of living children difference of opinion as to the situation of these characterhaving been born with manifestations of syphilitic disease istic cutaneous inflammations ; all concur in fixing them are so few as to allow of the supposition that they are not about the buttocks and thighs (" les f esses et les cuisses "), which necessarily include the genitals and anus; and this trustworthy. Pemphigus is a form of disease which sometimes occurs fact seems, by a strange perversion of reasoning, to weigh to infants within a fortnight of birth, and has been re- heavily in the argument in favour of the malady being garded as a manifestation of congenital syphilis. Dr. venereal. Inflammation of the skin caused by the contact of moist Tilbury Fox says, " Pemphigus is of the same nature as erysipelas." This is no doubt the true explanation of it, woollen materials must be observed by all; and the erupand it occurs in the following manner :-The infant becomes tions about thighs and buttocks of infants depend on this weak before the umbilicus has healed; an unhealthy supKeeping on a napkin, and wrapping the thighs and 11

"

cause.

738

I

of the child in flannel to absorb the urine, is sufficient simply due to erysipelatous or other forms of inflammation to account for all the cutaneous phenomena observed in thesespringing from neglect of sanitary conditions. Mr. OwEN showed a boy with Paralysis of the Serratus regions. The evidence of the truth of this is to treat such cases by directing the napkin and all flannel to be left off, and Magnus on both sides, causing the scapulae to project in an any eruption or ulceration to be covered with an ointment extraordinary and characteristic manner. made with equal parts of lead and zinc ointment. With Mr. MILTON showed a specimen of syphilitic fungus I this treatment recovery is rapid, and there is no necessity testis. Mr. CRIPPS LAWRENCE exhibited some colourless tincture for a long course of mercury with chalk. Cases were detailed and others shown to illustrate this. One woman of iodine. had remarked that 11 after her child had taken mercury with chalk for many weeks without benefit, it quickly got well CLINICAL SOCIETY OF LONDON. after being short-coated." The use of macintosh sheeting FRIDAY, MAY 9TH, 1873. as an outside napkin, or to protect the child’s bed, is a cause of cutaneous eruptions, which are sometimes thought MR. PRESCOTT HEWETT, PRESIDENT, IN THE CHAIR. to be syphilitic. One case shown was of ulceration by the side of the anus, which had been twelve months under DR. TILBURY Fox brought forward, for Dr. GUSTAVUS treatment as syphilis, but got quite well in a few weeks FRITSCHE, of Czenstochowa, the particulars of two unusual by use of the ointment and removal of the napkin. cases of The appearance of miniature decrepitude which is thought DERMATOLYSIS, OR TACHYDERMATOCELE, to be so very characteristic of congenital syphilis may illustrations. Case 1 was that of a easily be accounted for by the unfavourable conditions with photographic under which such a child has doubtless been placed. It beggar, in the Island of Madeira, the whole right side of has certainly been a sufferer with diarrhoea, and probably whose face resembled an empty bag, which, on handling, from deficient food. No such case has ever been encountered was found to be not a growth which weighed down the skin, consisted of a remarkable hypertrophy of the skin and by Dr. Ballard where the child has had plenty of food, and but of the bag-like process was twotissue. The been kept to two alvine discharges in the course of the day. cellular and a half. The inches external is more the the appearance of the mass not than poorer frequent among Syphilis better classes of society; yet the cases of supposed con- was that of healthy skin. The right nostril was thick and The opening of the right eye was on the same genital syphilis are principally observed among the poor elongated. and dirty people, who take their children to hospitals. Dr. level as the opening of the nose. On lifting up a thick and Ballard begged those of his audience who saw these poor lengthened eyelid, the eyeball was seen to be atrophied and people at hospitals to think of the subject from his point of changed, so as not to be easily recognised, and it hungfrom view, and thus try to spare the infants from the effects of the optic nerve, proportionately lengthened and thinned, an apple hanging on its pedicle. The sight was lost. long courses of mercury, and the mothers the labour and like loss of time from taking their infants to and fro for long The left eye was normal. The corner of the mouth, on the side, was very much drawn down. The act of eating periods. Hence the last conclusions :-That the symptoms right which are developed some weeks after birth, and are relied was executed with difficulty. The speech was unintelligible. upon as pathognomonic of syphilitic contamination of the The right half of the tongue was greatly enlarged in all its was hypertrophied, but system of the child, are mere accidents, arising also from parts. The helix of the right ear certain unfavourable conditions to which the child is the skull-bones were normal. The disease appeared in exposed, and that they are all preventable or easily cured young life, and was idiopathic in character. Case 2 was when the cause producing them is recognised: and, con- that of a girl, aged twenty-five. The disease appeared in when she was eight years old ; it began with two very sequently, That the practice of administering mercury with her chalk to infants for long periods of weeks or months is not; small outgrowths, one on the face, and the other on the clavicle, like fibroma molluseum. When Dr. Fritsche saw necessary, and is prejudicial to their healthy growth. Three living specimens were introduced by Dr. Ballard the case, from the right edge of the under jaw there hung lax ten or eleven flabby folds of skin, like empty bags, each to illustrate his paper. being distinct, with its own base and apex. The tumour in Mr. MILTON considered the symptoms of congenital the chest consisted of a fold of the skin, eight inches broad at the base, four inches at the apex, and ten inches and a syphilis quite unmistakable, and not to be accounted for by half in length. The external aspect was that of healthy ask and would Dr. Ballard to the other cause ; explain any occasional transmission of syphilis from sucklings to their skin, but it felt thicker than normal. There were other smaller growths, the size of hazel-nuts, about the body. nurses. Mr. DE MÉRIC strongly believed in the value of mercury Dr. Fritsche removed the large tumour with complete sucboth to the children themselves and to eradicate the virus cess, but then lost sight of the case. Dr. Tilbury Fox made from their parents. He thought Dr. Ballard was bound to some comments upon the pathological relations of such furnish some information as to the real cause of that group cases as these. Mr. BARWELL referred to Mr. Pollock’s case, read at a of symptoms usually described as due to congenital syphilis, and would like to know the treatment he pursued for such. meeting of the Royal Medical and Chirurgical Society, and Mr. de Meric said the theory that unhealthy intra-uterine pointed out a symptom recorded which was not menand constitutional influences are responsible for the sym- tioned by Dr. Fritsche-viz., an offensive odour from the I ptoms, is quite disposed of by the fact that an unaffected glands. Dr. DUFFIN thought that the cases were probably conmother may give birth to a syphilitic child. Mr. HENRY LEE did not think Dr. Ballard’s first two cases genital nsevi, and quoted the case of a girl with a similar syphilitic. He preferred the old plan of inunction to the affection, in which the clue to the nature of the disease was administration of grey powder, which he thought was often afforded by the presence of a naevus on the leg. In this injurious to children; and mentioned a case in which a long case a naevoid mass existed over the right temple, and another tumour, apparently an aborted nsevus, was found course of abortions was checked by use of the calomel vapour over the pectoral muscle. bath. Dr. TILBURY Fox thought these cases different from Mr. GANT said syphilis was undoubtedly a blood disease, and that the most valuable evidence is the concurrence of those of Mr. Pollock, and remarked that fibroma originated about the sebaceous glands presenting microscopical nests special symptoms. Mr. CRIPPS LAWRENCE inquired if Dr. Ballard had ex- of cells, whereas dermatolysis was usually localised, not examined after death any of the class of cases alluded to, and hibiting the cellular characters of fibroma. if so, whether he had observed any alteration in the spleen Mr. W. SPENCER WATSON read the report of a case of

legs

__

length

.

or

thymus gland.

Mr. OwEN made some remarks controverting the views expressed in the paper. In reply, Dr. BALLARD stated that he had made no postmortem examinations-that he had no objection to mercury, but was convinced that all those appearances usually noted by authors as dependent on congenital syphilis were

INTRA-ORBITAR NaeVUS TREATED BY LIGATURE AND ACTUAL CAUTERY,

in

child who, at the commencement of the treatment, was months old. The eyeball was thrust aside by the growth, but not protruded. It was evidently increasing, and two attempts to strangulate its nutrient vessels by a

eight