NORTHERN HOSPITAL, LIVERPOOL.

731 unusual exercise, as a Another fact to be considered was that the patient had Fits had occurred at had one or two attacks of lead colic, and as encephalopathic home and at work ; the first fit lasted forty-five minutes. affections, accompanied with intense headache and epileptiThey have been more severe lately. In no case had the fits form convulsions, are not uncommon in connexion with been associated with the symptoms of plumbism. When he lead poisoning, the question was whether there was any The facts did reason to suspect anything of this nature. felt a fit coming on he called for wet bags for his head. The last fit came on on June 9th, in the usual way. He not give much support to this hypothesis. The symptoms had never coincided with any other signs of lead poisoning, was paralysed in the left arm and leg for two days after the fit. Was speechless after the fit, and had only spoken once and the total absence of a blue line in the gums showed that since up to the time of admission, saying, " Fetch me the there was no impregnation of the system with lead. We had, however, a sufficient cause of the phenomena in teapot." He was very violent during the fit, requiring two the history of a severe blow on the head from a fall six men to hold him, and was very excited afterwards. He was given a large dose of chloral and bromide of potassium, weeks before the occurrence of the first epileptiform attack. whichquieted him. He had no difficulty in micturition or The present condition of the scalp did not quite corroborate the patient’s account of the severity of the injury ; but even defecation. The arm got well before the leg. On admission he had a slight scar on the forehead, to the without this, the injury was no doubt sufficiently grave to right of the middle line, under the hair. None other to be have set up a superficial meningo-encephalitic irritation, detected. He complained of great pain in the right side of for such a result may occur without marked external lesion. An unusual feature in the case was the occurrence of the head (parietal region, where he said the cut was received in the first fall), increased on slightest pressure or percussion. absolute aphasia with left-sided hemiplegia in a rightThe left angle of the mouth was slightly lower than the handed man. The case was a typical instance of pure right. There was very slight difference in action of the sides ataxic aphasia unaccompanied by amnesia or agraphia. of the face. The facial sensibility was perfect. There was Here only the power of utterance was abolished, and this in no paralysis whatever of the left arm, and sensibility was the most absolute manner, while words spoken and written intact. Tendon-reflex was well marked in both knees. were clearly comprehended, and the patient could think There was no appreciable difference between the two. When intelligently and consecutively, and express his ideas in he held his legs in the horizontal position the left gave way graphic symbols. first. Abduction and dorsal flexion were deficient in the left It is not common in aphasia, with right hemiplegia, defoot; sensibility was normal. The tongue movements were pending on affection of the left hemisphere, to have such perfect ; the lip movements were also perfect; he could a clear separation as in this case between word-execution, whistle and swallow well. When asked whether he had and word-memory, together with the expression of ideas in headache he nodded assent, and when asked where he written symbols. Though there are innumerable shades in pointed to the right side of the forehead. On ophthalmic the degrees in which these faculties are respectively imexamination the retinal veins of the right eye were large, plicated, yet word-execution and word-memory are usually the disc pinkish, and the margin defined. With Gelee’s affected together, though the defects in word-memory may tube he heard a watch twenty-two inches from the right ear not be such as to appreciably impair the simpler forms of and sixteen inches from the left. Understood perfectly ideation. The defect, however, becomes apparent when questions put to him, but could not utter a single word ; more complex trains of thought are demanded. In this case could not make any of the vowel sounds. He could write on there was a total absence of intellectual deficiency, and the a slate an intelligent reply to questions, and write names of patient could follow without difficulty, and give precise objects shown him, as well as words spoken to him; but he answers to questions involving considerable thought and was quite unable to pronounce the words. He complained discrimination. Here merely the power of word-execution chiefly of vertigo. Heart and lungs were normal. There was defective, and the very facts of this case, though appawas no blue line on the gums. Urine sp. gr. 1010, alkaline, rently not conforming to the rule that the left hemisphere is no albumen; excess of phosphates. the principal one concerned in speech, in reality confirm it. On the 24th he had slept well, and taken food well. He The affection of the right hemisphere caused speechlessness, still complained of slight vertigo. No pain; felt "strange."" probably merely by disturbance of the accustomed synWas told to practise vocal sounds. Ordered ten grains of energy of the hemispheres in this volitional act ; whereas iodide of potassium, three times daily. the complete retention of the memory of words and their On the 25th, after dinner, he first uttered letters : 0, R, associations, internal speech, and the power of expressing and A, and several others. He could not articulate a single ideas in the graphic equivalents of articulate symbols, all word, and soon gave up trying, as he said it caused him to indicated the greater preponderance in respect to these perspire, and brought back the pain in his head. Still had faculties of the sound left hemisphere.

fit two, he said, had come on after long walk, lifting heavy weights, &c.

slight vertigo.

On the 26th he said, " Better this morning," in a low NORTHERN HOSPITAL, LIVERPOOL. voice. Spoke several sentences, but could not go on for reasons given above. In the evening read short extracts CASE OF DISEASE OF RECTUM (SYPHILITIC?); STRICTURE ; from a newspaper. Next day he spoke freely, but still in a COLOTOMY ; DEATH, AFTER SIX WEEKS, low voice. Got up for a short time. FROM EXHAUSTION. On the 28th he had slight pain in the head; but on the 29th the care of Dr. W. MACFIE CAMPBELL.) (Under he spoke in his natural voice. No vertigo, no headache. FOR the notes of this case we are indebted to Dr. James On July 7th he was improving; and on the 9th, tested with dynamometer, the right hand was 110, lett 100. Allen, late house-surgeon. On 14th he was discharged, recovered. Mary C-,aged forty - five, widow, was admitted Remarks by Dr. FERRIER.-Dr. Ferrier remarked that 22nd, 1878. She had suffered for more than a year Aug. there could be little doubt that the symptoms in this case defrom some disease of the rectum; had thin watery discharge, on a cortical lesion of in the the pended right hemisphere region of the fissure of Rolando. This was indicated (1) by lumpy motions, occasional constipation, varied with loosethe localised pain, intensified by percussion, especially over ness, with slimy and bloody stools. Was treated by supthis area; (2) the occurrence of unilateral spasms, beginning positories and dilatation. In July, 1878, had a Nhiver, fulalways in the left hand, and followed by loss of consciousness lowed by high temperature and diarrhoea. Had great abwhen they became general; succeeded, after several attacks, dominal and rectal pain, which subsided under poultices and by loss of power without loss of sensibility in the parts opium. From that time till her admission she had several especially attacked by the spasms. The fact that the leg returns of this watery, foul-smelling diarrhœa. remained paralysed longer than the arm indicated a greater On admission she was very much emaciated ; was in ecrnconcentration of the distinctive effect of the lesion in the stant pain, with frequent watery stools aud tenesmus. The countenance was pinched and distressed. On examining the upper extremity of the ascending convolutions. As to the etiology, the first, and considering the character rectum by the finger a rough tubercular surface was found of the affection, most likely hypothesis, was a syphilitic stretching from the sphincter to a contraction about three lesion of the cortex. Syphilis, however, was denied, but inches distant. The strictured portion would barely admit denial was by no means synonymous with disproof. In any the point of the index-finger. A thin sanious f’ml cae the treatment adapted for specific lesions was that most followed the withdrawal of the finger. She was ordeted likely to be beneficial—viz., full doses of iodide of potassium, suppositories of mercurial ointment kind morphia. which was prescribed. The pain remained constant, and the attacks of diarrhoea

discharge

732 and constipation were very distressing. She was evidently sinking, therefore, upon Sept. 5th, a consultation was held with a view to deciding whether colotomy should be performed. On the morning, however, the temperature was 103’6°. She had passed a very bad night, and the operation PATHOLOGICAL SOCIETY OF LONDON. was postponed. Next day the temperature was lower, but her general condition remained as before, the pain especially Multiple Exostoses.-Sebaceous Tumour of Leg.-Cancer of being very great, and on the day following, after consultaLung.-Blood in Diabetes.—Tumour of Knee-joint.— tion with Mr. Manifold and Mr. Puzey, colotomy was proRecurrent Epithelioma in Lung.Mucous Polypus of ceeded with under ether. Some difficulty was experienced Ataxic Arthropathy. Unabilicacs. Hemiatrophia in laying hold of the bowel owing to its emptiness and deep Facialis.—Telostitis.—Morphœa. situation. The edges of the cut colon was secured to the THE ordinary meeting of the Pathological Society was skin by four silk sutures, and carbolic catgut was used to the intermediate portions. These catgut sutures were quite held on Tuesday, Nov. 2nd, the President, J. Hutchinson, useless, and gave way in less than ten hours. The tempera- Esq., in the chair. Several cases and specimens of interest ture rose the same evening to 102’8°. The President announced that fresh and were exhibited. On the following day the temperature was 103’2°. There of living specimens interest, and that were urgent, would be was considerable alvine evacuation from the artificial anus, and only purulent discharge from the rectum, with great welcomed at the meetings devoted to the discussion on rickets. Drs. Moore, Barlow, Lees, and Gee, and Messrs. relief to the pain. On Sept. 12th there was occasional faecal discharge by the Holmes, Howard, and Parker, had signified their intention rectum. The artificial anus had greatly receded, some of of taking part in the debate, and lie hoped that Sir W. the silk sutures having given way. Fresh silk sutures were Jenner and Dr. Dicidnson would also speak. applied. The secretary read a report by Messrs. Howse and Taylor On the 16th the wound was glazed, indolent looking, and there was absence of granulations. There was occasional on Mr. Gay’s specimen of Recurrent Tumour of the Mamma. faecal discharge from the rectum, with decidedly less purulent The growth consisted of three parts, which differed slightly discharge. The tongue was aphthous; the tonsils ulcerated; in appearance, but were all composed of spindle-shaped cells, and there were ulcers on the sides and angles of the mouth, either without any stroma at all, or with a small amount of which were relieved by touching with nitrate of silver. structureless intercellular material. It was therefore a On the 20th the aphthous state of the mouth still continued. Glycerine and lime-water were given, with seeming spindle-celled sarcoma. The PRESIDENT showed photographs of a case of Multiple benefit at first. The further progress of the case was bad. On Oct. 2nd Exostoses sent to him by Mr. Windsor of Manchester. The diarrhcea set in. On the 12th there was burrowing of pus tumours exist around both shoulders, elbows, knees, and from the wound towards the sacrum underneath the superare quite symmetrical in position, but are ficial muscles. Bedsores formed. There was an entire ankles ; they on the right than the left side. There is a distinct larger absence of any union about the wound. On Oct. 23rd she died exhausted. history of heredity, the father having similar outgrowths in Necropsy.-The most important points in the examination the same situations, and exostoses being found in four genewas some pneumonia at the apex of the right lung. The rations, at least, chiefly about the knee. In the museum of kidneys and liver were amyloid, the latter having a large the Newcastle Infirmary the President had found a skeleton white cicatrix (?) on its upper surface. The stomach and small intestines were empty, and the mucous membrane was with a large number of exostoses. Mr. Price of Margate had covered by a catarrhal coat. The splenic flexure of the also published a similar case in THE LANCET, and ten transverse colon was bent down abruptly in front of the years ago he himself had had a lad in the London Hospital descending colon, and at the level of the artificial anus it under his care with exostoses growing near the large joints; bent acutely upwards again. The descending colon was he removed the largest of these, which was near the knee, collapsed, lying along the spine. The artificial anus was in and he nearly lost the patient from inflammation. He had the angle of the descending loop of the transverse colon never seen these multiple exostoses in the female sex.-Dr. above described. AdhesioDs were extremely slight, and PAYNE had made the autopsy on a case shown to this easily broken down. The mucosa of the rectum was hyper- Society by Mr. Arnott-a woman about eighteen years of trophied. There were two strictures, both admitting the age, from whom a large exostosis near the knee-joint was point of the forefinger-one near the anus, the other higher removed, death resulting from inflammatory complicaand out of reach from below. There was slight ulceration, tions. Exostoses were found on every bone in the body exbut signs of cicatrisation going on. The disease seemed to cept the skull, pelvis, and ribs. He did not know the be confined to the submucous tissue. family history.-Dr. POORE had published in THE LANCET Remarks by Dr. CAMPBELL.-No history of syphilis was a case of a little girl under his care at the Charing-cross made out, and her character was good. The operation was Hospital, who had several exostoses. No hereditary bistory undertaken for the purpose of giving rest to the inflamed known.-Mr. BARKER had seen a case at University Col. rectum, and so giving time for cicatrisation to commence, lege Hospital of a girl aged seventeen, with symmetrical when perhaps dilatation might have restored some available exostoses on the bones of the fingers, wrists, elbows, and potency to the bowel. The complete absence of action about femora. No history known.—Dr. STURGE mentioned the the wound disappointed our hopes in this direction, the case of a man forty years of age with remarkably symmepatient dying from deficient vitality. The relief, however, trical exostoses growing from the humeri, ulnæ, radii, metaof pain, absence of straining, and freedom from the constant carpal bones, scapulæ, and clavicles.-Mr. PEARCE GOULD discharge, gave great comfort to the patient, and made the had seen a few years ago twin brothers, about five years of operation so far a success. A remarkable feature in the case age, each presenting exostoses on the upper and lower ends was the position of the transverse colon, its splenic flexure of the humerus, which were symmetrical and alike in both lying anterior to the descending colon at the point im- except that one humerus had no exostosis on its upper end. mediately opposite the outer edge of the quadratus lumborum, There were also rickety " spines" on the tibiae in each leg. at the usual distance from the crest of the ilium. The case was of interest as showing some hereditary influence.-Mr. EvE remarked that the specimens of such ex-

Medical Societies. -

-

’

ostoses in St. Bartholomew’s Museum showed all the out-

STATISTICAL SOCIETY.-The title of the essay

to

which the Howard Medal will be awarded by this Society in November, 1881, is " On the Gaol Fever, from the earliest Black Assize to the last recorded Outbreak in recent times." The successful competitor will be granted the sum of jE20 in addition to the medal.

ST. MARY’S HOSPITAL MEDICAL SCHOOL.—Mr. A. P. Luff has obtained the open scholarship of J. Holdsworth Fisher that of 9125.

£150, and Mr.

from the epiphysial line. He showed lower jaw-bone on which was a large exostosis springing from the inner alveolar wall on each side at the level of the bicuspid and molar teeth, exactly symmetrical.-The PRESIDENT was glad to have elicited so many examples in females. In the family of the case he specially brought forward there had been a close intermarriage—two first cousins, three generations back-which may have had some influence in the production of the condition. The PRESIDENT also showed a Tumour which he had

growths springing a

!