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INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED FEB. 8TH, 1930.
406
radiograms
at night, and in addition she suffered from and a diagnostic pneumothorax was performed. Further sweats and an apparently genuine lassitude. At (see Figures) revealed the fact that the mass was times she became very breathless and cyanosed and was extra-pulmonary and quite free from the chest wall. The absent from school for prolonged periods. At other times provisional diagnosis of a cyst, either dermoid or hydatid, was .he would be almost free from symptoms. After a period made and permission to operate was obtained, the child then during WhICh she did not improve, the family doctor called being handed over to Mr. Bruce Dick for operation. in the tuberculosis officer for Kircudbrightshire, in which On Oct. 26th Mr. Dick, under local anaesthesia, removed Tuberculosis was rightly about one incli of the second and third ribs posteriorly, county the child resided. nxea wgeuner me pected, and the visceral and Fariesputum, which was tal pleura in the occasionally
which
was worse
night
sus-
copious,
neighbourhood
was
examined. No tubercle bacilli were found, but there was an increase of albumin in the sputum and it was therefore decided to send her to the sanatorium for period of observation. She was
and made
a
pre-
liminary investigation of the mass.
Rather to everyone’s surprise it was discovered to be a tumour of a lipomatous nature situated outside the lung and com-
pletely
encapsu-
lated. The wound adwas then stitched .accordingly mitted to Lochup and the child maben on July left for a week. Seven days later 7th, 1929. the wound was The child was well - nourished reopened under a and looked quite general anaesthetic for the removal of healthy apart from a rather the tumour. The marked sallowness removal was not as ’of the skin. Physithe easy, cal examination of tumour was large the chest revealed and had a small a pronounced dullpedicle attached ness over the to the mediasLateral and anterior radiograms of the chest, showing position of the tumour. In the tinum. Eventuupper lobe of the films the border of the lung could be traced through it-i.e., the tumour projected it right lung and in ally, however, on all the lung aspects. beyond this area the was removed breath sounds successfully after were considerably diminished posteriorly, but were being freed from its capsule. The child ran a temperature fora bronchial in nature in front. No adventitious sounds were few days, but after that she made an uninterrupted recovery audible at any time and there was no marked change in vocal and within three weeks of the operation was up and about The child’s voice was harsher than normal. and ready to go home. Further radiograms have shown resonance. She was observed over a short period and the temperature that the lung has fully re-expanded. A certain harshness was found to be perfectly normal, while the pulse-rate was of the voice which was present before the operation quite steady. The Pirquet test was mildly positive. disappeared. An X ray film of the chest was taken and revealed a most The sections of the tumour showed that it was composed of peculiar condition. A large mass, of a circular shape and ganglionic nerve-cells and non-myelated nerve-fibres. The with a well-defined margin, was seen to be filling up the whole stroma consisted mainly of fatty tissue. of the upper lobe of the right lung. The mass was conAs there are very few cases of mediastinal tumours tiguous as far as could" be seen, with the chest wall dorsally, and was causing a this one appears to have some kinking " of the trachea. It was of this nature on very difficult to tell from the radiogram whether the mass interest. A feature of the case was the difficulty in was extra- or intra-pulmonary in origin, and the film was diagnosis since the symptoms and, to a certain extent, accordingly sent to Dr. Woodburn Morrison, radiologist, the signs simulated hilar tuberculosis rather closely. for his Dr. Morrison Royal Infirmary, Edinburgh, opinion. sent back word that he could not make up his mind on the Indeed, even when tuberculosis had been excluded, the point in question, and suggested that the child should be diagnosis was not finally cleared up until exploratory sent to Edinburgh for further investigation. This was done thoracotomy was performed.
record,
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED FEB. 8TH, 1930.
fever, 76 (32) from measles, 12 (2) from scarlet fever, 31 (6) from whooping-cough, 61 (12) from diphtheria, 60 (18) from diarrhoea and enteritis under two years, and 89 (18) from influenza. The figures in parentheses are
those for London itself.
Notifications.-The following cases of infectious Fatal cases of measles were concentrated at Manchester 10, ,disease were notified during the week :-SmalJ-pox, Portsmouth 9, West Ham 8. Deaths from whooping-cough 374 (last week 354) ; scarlet fever, 2727 ; diphtheria, were much more widely distributed, with a maximum of 1975 ; enteric fever, 34 ; pneumonia, 1332 ; puerperal 4 at Bradford. Diphtheria claimed 7 victims at Liverpool fever, 45 ; puerperal pyrexia, 111 ; cerebro-spinal and 4 at Cardiff. No great town recorded more than 3 fever, 9 ; acute poliomyelitis, 12 ; encephalitis deaths from influen za. lethargica, 20 ; dysentery, 12 ; ophthalmia neona- The number of stillbirths notified the week torum, 87. No case of cholera, plague, or typhus fever was 302 (corresponding to a rate during of 45 per 1000 was notified during the week. births), including 50 in London. The number of cases in the Infectious Hospitals of the Metropolitan Asylums Board on Feb. llth-12th was as follows :-Small-pox, 571 under treatment, 26 under observation (last week 558 and 28 respectively) ; scarlet fever, 2310 ; diphtheria, 2786 ; enteric fever, 16 ; measles, 1003 ; whoopingcough, 95 ; puerperal fever, 22 (plus 13 babies) ; encephalitis lethargica, 120 ; other diseases, 15. At St. Margaret’s i Hospital there were 12 babies (plus 3 mothers) with
ophthalmia
neonatorum.
Deaths.-In the aggregate of great towns, including London, there was no death from small-pox or enteric
COUNTY NuRSiNG ASSOCIATIONS.—At
a
meeting of
the Committee of the County Nursing Associations last week those bodies were recommended to apply to the new Public Assistance Committees for the continuance of the grants hitherto given by boards of guardians for the nursing of necessitous cases. An inquiry is being made into the schemes adopted by hospital leagues to provide hospital treatment for their members with the view of adapting them to the district nursing service in the hope of lessening the pressure on the hospitals.
radiograms
at night, and in addition she suffered from and a diagnostic pneumothorax was performed. Further sweats and an apparently genuine lassitude. At (see Figures) revealed the fact that the mass was times she became very breathless and cyanosed and was extra-pulmonary and quite free from the chest wall. The absent from school for prolonged periods. At other times provisional diagnosis of a cyst, either dermoid or hydatid, was .he would be almost free from symptoms. After a period made and permission to operate was obtained, the child then during WhICh she did not improve, the family doctor called being handed over to Mr. Bruce Dick for operation. in the tuberculosis officer for Kircudbrightshire, in which On Oct. 26th Mr. Dick, under local anaesthesia, removed Tuberculosis was rightly about one incli of the second and third ribs posteriorly, county the child resided. nxea wgeuner me pected, and the visceral and Fariesputum, which was tal pleura in the occasionally
which
was worse
night
sus-
copious,
neighbourhood
was
examined. No tubercle bacilli were found, but there was an increase of albumin in the sputum and it was therefore decided to send her to the sanatorium for period of observation. She was
and made
a
pre-
liminary investigation of the mass.
Rather to everyone’s surprise it was discovered to be a tumour of a lipomatous nature situated outside the lung and com-
pletely
encapsu-
lated. The wound adwas then stitched .accordingly mitted to Lochup and the child maben on July left for a week. Seven days later 7th, 1929. the wound was The child was well - nourished reopened under a and looked quite general anaesthetic for the removal of healthy apart from a rather the tumour. The marked sallowness removal was not as ’of the skin. Physithe easy, cal examination of tumour was large the chest revealed and had a small a pronounced dullpedicle attached ness over the to the mediasLateral and anterior radiograms of the chest, showing position of the tumour. In the tinum. Eventuupper lobe of the films the border of the lung could be traced through it-i.e., the tumour projected it right lung and in ally, however, on all the lung aspects. beyond this area the was removed breath sounds successfully after were considerably diminished posteriorly, but were being freed from its capsule. The child ran a temperature fora bronchial in nature in front. No adventitious sounds were few days, but after that she made an uninterrupted recovery audible at any time and there was no marked change in vocal and within three weeks of the operation was up and about The child’s voice was harsher than normal. and ready to go home. Further radiograms have shown resonance. She was observed over a short period and the temperature that the lung has fully re-expanded. A certain harshness was found to be perfectly normal, while the pulse-rate was of the voice which was present before the operation quite steady. The Pirquet test was mildly positive. disappeared. An X ray film of the chest was taken and revealed a most The sections of the tumour showed that it was composed of peculiar condition. A large mass, of a circular shape and ganglionic nerve-cells and non-myelated nerve-fibres. The with a well-defined margin, was seen to be filling up the whole stroma consisted mainly of fatty tissue. of the upper lobe of the right lung. The mass was conAs there are very few cases of mediastinal tumours tiguous as far as could" be seen, with the chest wall dorsally, and was causing a this one appears to have some kinking " of the trachea. It was of this nature on very difficult to tell from the radiogram whether the mass interest. A feature of the case was the difficulty in was extra- or intra-pulmonary in origin, and the film was diagnosis since the symptoms and, to a certain extent, accordingly sent to Dr. Woodburn Morrison, radiologist, the signs simulated hilar tuberculosis rather closely. for his Dr. Morrison Royal Infirmary, Edinburgh, opinion. sent back word that he could not make up his mind on the Indeed, even when tuberculosis had been excluded, the point in question, and suggested that the child should be diagnosis was not finally cleared up until exploratory sent to Edinburgh for further investigation. This was done thoracotomy was performed.
record,
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED FEB. 8TH, 1930.
fever, 76 (32) from measles, 12 (2) from scarlet fever, 31 (6) from whooping-cough, 61 (12) from diphtheria, 60 (18) from diarrhoea and enteritis under two years, and 89 (18) from influenza. The figures in parentheses are
those for London itself.
Notifications.-The following cases of infectious Fatal cases of measles were concentrated at Manchester 10, ,disease were notified during the week :-SmalJ-pox, Portsmouth 9, West Ham 8. Deaths from whooping-cough 374 (last week 354) ; scarlet fever, 2727 ; diphtheria, were much more widely distributed, with a maximum of 1975 ; enteric fever, 34 ; pneumonia, 1332 ; puerperal 4 at Bradford. Diphtheria claimed 7 victims at Liverpool fever, 45 ; puerperal pyrexia, 111 ; cerebro-spinal and 4 at Cardiff. No great town recorded more than 3 fever, 9 ; acute poliomyelitis, 12 ; encephalitis deaths from influen za. lethargica, 20 ; dysentery, 12 ; ophthalmia neona- The number of stillbirths notified the week torum, 87. No case of cholera, plague, or typhus fever was 302 (corresponding to a rate during of 45 per 1000 was notified during the week. births), including 50 in London. The number of cases in the Infectious Hospitals of the Metropolitan Asylums Board on Feb. llth-12th was as follows :-Small-pox, 571 under treatment, 26 under observation (last week 558 and 28 respectively) ; scarlet fever, 2310 ; diphtheria, 2786 ; enteric fever, 16 ; measles, 1003 ; whoopingcough, 95 ; puerperal fever, 22 (plus 13 babies) ; encephalitis lethargica, 120 ; other diseases, 15. At St. Margaret’s i Hospital there were 12 babies (plus 3 mothers) with
ophthalmia
neonatorum.
Deaths.-In the aggregate of great towns, including London, there was no death from small-pox or enteric
COUNTY NuRSiNG ASSOCIATIONS.—At
a
meeting of
the Committee of the County Nursing Associations last week those bodies were recommended to apply to the new Public Assistance Committees for the continuance of the grants hitherto given by boards of guardians for the nursing of necessitous cases. An inquiry is being made into the schemes adopted by hospital leagues to provide hospital treatment for their members with the view of adapting them to the district nursing service in the hope of lessening the pressure on the hospitals.