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NOTE ON A CASE OF CONGENITAL LARYNGEAL STRIDOR.
1147 In this way the wound almost completely closed. The skin wound closed by interrupted sutures and a drainagetube inserted down to the wound in the kidney. Beyond a urinary fistula which developed on the fifth day, and lasted for 18 days, the convalescence was uneventful, and the patient left completely healed in five weeks.
substance would allow.
was was
Buenos Aires.
A CASE OF INTRAUTERINE RUPTURE OF THE UMBILICAL CORD. BY HAROLD E.
BLOXSOME, M.R.C.S. ENG.,
L.R.C.P. LOND., SURGEON
TO
FAIRFORD COTTAGE HOSPITAL; MEDICAL OFFICER AND VACCINATOR, CIRENCESTER AND NORTHLEACH UNIONS.
present, both sleeping and waking. It disappeared for short periods (half an hour) during sleep and for shorter periods while the child lay awake quiet and with his attention fixed, and while taking the bottle. The sound produced was for the most part a hoarse and low-pitched crowing of varying loudness, but generally heard at a distance of some When the child was excited the stridor I was became loud and shrill (high pitched). informed that the noise was not noticeable when the child cried. During a quiet period the shape of the chest was almost normal, though the sternum was slightly prominent and indications of a trans- . There was no paraverse lateral sulcus were seen. sternal grooving. During periods of stridor each
yards.
inspiration was accompanied by great recession of the lower ribs and costal margin opposite the THE patient was a primipara supposed to have ensiform cartilage, and the formation of a deep been pregnant ten months. When I was sent for transverse sulcus extending out from the costal she had been in labour for 12 hours. Per vaginam margin almost to the anterior axillary line. The the os was nearly fully dilated, the head was alas nasi dilated with each inspiration. The presenting by the vertex, and the pains were inspiratory murmur during stridor was interrupted severe, the patient describing them as being and subdivided sometimes into two, sometimes three almost continuous, though there was no distress. separate and distinct sounds. Expiration was unThe nurse was sure no liquor amnii had come altered. There were no adventitious sounds. away, but no bag of membranes could be felt. I Reading. I waited an hour and a half and the os was then fully dilated, though the head had not descended much. Chloroform was given and the forceps applied. As the face swept over the perineum after a moderately hard pull the cord fell out divided in two. There was a large blood ROYAL SOCIETY OF MEDICINE. clot on each severed end. The child was large and stillborn. There was no sign of pulsation in either SECTION OF OPHTHALMOLOGY. part. The placenta subsequently came away in a normal manner. The head had been firmly Exhibition of Cases. -Cysts in the Anterior Chamber. engaged in the pelvis, and I felt all round the os, A MEETING of this section was held on Nov. 4th, Mr. so it would have been difficult to have missed a PRIESTLEY SMITH, the President, being in the chair. Dr. A. HUGH THOMPSON showed a young girl who had prolapsed cord. Dr. Herbert Williamson takes the case to be one Dilated Pupil of Argyll Robertson type, with well-marked of a short cord round the child’s neck delaying contraction on closure of lids. The condition was not descent and subsequently rupturing. The rarity congenital in her, because two years ago her pupils were of such cases is my excuse for bringing it under normal and she had only slight myopia. The knee-jerks were normal. He also exhibited a case of One-sided Internal notice. The man was invalided two PUBLIC
____________
Medical Societies.
Fairford.
Ophthalmoplegia. acoount of supposed aneurysm. found, though he was carefully
years ago No aneurysm had been examined by Sir John Broadbent.-Mr. W. C. ROCKCLIFFE spoke of two cases in his experience with mydriasis and iridocycloplegia. In one there was a strong family history of retinitis pigmentosa, but in the patient there was no retinal or pigmentary change. One patient’s end was in an asylum as a general on
NOTE
ON A CASE OF CONGENITAL LARYNGEAL STRIDOR.
BY J. H.
CASES of
sufficiently
SHELDON, M.B. LOND., &C.
congenital laryngeal stridor uncommon
to warrant the encountered in
seem
to be
paralytic. Mr. N. BISHOP HARMAN showed
a case
of
Congenital
following Entropion. The lashes in the lower lid were permanently erect nearly 17 and the child was born with the condition. The meibomian
notes of the first case years of general practice. The patient, seen in February, 1914, was a wellnourished male Madrassee infant, 5 months of age, born prematurely in the eighth month of the mother’s first pregnancy and hand-fed from birth. The infant’s medical history was good and he presented no signs of syphilis or rickets. One tooth Was almost through. He was bright and intelligent. The family history indicated nothing except the occurrence of asthma in the children of an aunt of the patient’s father. The chief features of the case were: (1) stridor present from birth; (2) transverse furrowing of the lower chest wall; (3) certain auscultatory signs ; (4) absence of cyanosis ; (5) absence of laryngeal excursion ; (6) a heart-rate uninfluenced by respiratory movements; and (7) the excellent health of the child. The stridor accompanied each inspiration. and, with the exceptions to be given, was always
glands seemed deficient. The mother was normal, but the grandmother was said to have had a double row of lashes. He proposed to split the lid, so as to separate the lashes from the glands, and graft between the two a strip of mucous membrane. If that succeeded he expected the lashes would be prevented from reaching the cornea again.-Mr. M. S. MAYOU referred to three similar cases which he had had. He operated upon them by taking out a narrow band of skin on the outer side of the lid. There had been no recurrence, five years ago. Mr. BISHOP HARMAN read notes of a case of High Myopia in an infant. Mr. W. H. H. JESSOP showed a case of Tumour of the A Lower Lid which he regarded as a lymphangioma. former term applied to it was elephantiasis nostras. Skiagrams showed nothing abnormal about the bones, and skilled nasal investigation was negative.-Lieutenant-Colonel R. H. ELLIOT, I.M.S., mentioned a similar case which he saw in India, and which was found to be sporotrichosis ochonelia.-Mr. LESLIE J. PATON said he had seen a similar case following the extensive
though one was operated upon
substance would allow.
was was
Buenos Aires.
A CASE OF INTRAUTERINE RUPTURE OF THE UMBILICAL CORD. BY HAROLD E.
BLOXSOME, M.R.C.S. ENG.,
L.R.C.P. LOND., SURGEON
TO
FAIRFORD COTTAGE HOSPITAL; MEDICAL OFFICER AND VACCINATOR, CIRENCESTER AND NORTHLEACH UNIONS.
present, both sleeping and waking. It disappeared for short periods (half an hour) during sleep and for shorter periods while the child lay awake quiet and with his attention fixed, and while taking the bottle. The sound produced was for the most part a hoarse and low-pitched crowing of varying loudness, but generally heard at a distance of some When the child was excited the stridor I was became loud and shrill (high pitched). informed that the noise was not noticeable when the child cried. During a quiet period the shape of the chest was almost normal, though the sternum was slightly prominent and indications of a trans- . There was no paraverse lateral sulcus were seen. sternal grooving. During periods of stridor each
yards.
inspiration was accompanied by great recession of the lower ribs and costal margin opposite the THE patient was a primipara supposed to have ensiform cartilage, and the formation of a deep been pregnant ten months. When I was sent for transverse sulcus extending out from the costal she had been in labour for 12 hours. Per vaginam margin almost to the anterior axillary line. The the os was nearly fully dilated, the head was alas nasi dilated with each inspiration. The presenting by the vertex, and the pains were inspiratory murmur during stridor was interrupted severe, the patient describing them as being and subdivided sometimes into two, sometimes three almost continuous, though there was no distress. separate and distinct sounds. Expiration was unThe nurse was sure no liquor amnii had come altered. There were no adventitious sounds. away, but no bag of membranes could be felt. I Reading. I waited an hour and a half and the os was then fully dilated, though the head had not descended much. Chloroform was given and the forceps applied. As the face swept over the perineum after a moderately hard pull the cord fell out divided in two. There was a large blood ROYAL SOCIETY OF MEDICINE. clot on each severed end. The child was large and stillborn. There was no sign of pulsation in either SECTION OF OPHTHALMOLOGY. part. The placenta subsequently came away in a normal manner. The head had been firmly Exhibition of Cases. -Cysts in the Anterior Chamber. engaged in the pelvis, and I felt all round the os, A MEETING of this section was held on Nov. 4th, Mr. so it would have been difficult to have missed a PRIESTLEY SMITH, the President, being in the chair. Dr. A. HUGH THOMPSON showed a young girl who had prolapsed cord. Dr. Herbert Williamson takes the case to be one Dilated Pupil of Argyll Robertson type, with well-marked of a short cord round the child’s neck delaying contraction on closure of lids. The condition was not descent and subsequently rupturing. The rarity congenital in her, because two years ago her pupils were of such cases is my excuse for bringing it under normal and she had only slight myopia. The knee-jerks were normal. He also exhibited a case of One-sided Internal notice. The man was invalided two PUBLIC
____________
Medical Societies.
Fairford.
Ophthalmoplegia. acoount of supposed aneurysm. found, though he was carefully
years ago No aneurysm had been examined by Sir John Broadbent.-Mr. W. C. ROCKCLIFFE spoke of two cases in his experience with mydriasis and iridocycloplegia. In one there was a strong family history of retinitis pigmentosa, but in the patient there was no retinal or pigmentary change. One patient’s end was in an asylum as a general on
NOTE
ON A CASE OF CONGENITAL LARYNGEAL STRIDOR.
BY J. H.
CASES of
sufficiently
SHELDON, M.B. LOND., &C.
congenital laryngeal stridor uncommon
to warrant the encountered in
seem
to be
paralytic. Mr. N. BISHOP HARMAN showed
a case
of
Congenital
following Entropion. The lashes in the lower lid were permanently erect nearly 17 and the child was born with the condition. The meibomian
notes of the first case years of general practice. The patient, seen in February, 1914, was a wellnourished male Madrassee infant, 5 months of age, born prematurely in the eighth month of the mother’s first pregnancy and hand-fed from birth. The infant’s medical history was good and he presented no signs of syphilis or rickets. One tooth Was almost through. He was bright and intelligent. The family history indicated nothing except the occurrence of asthma in the children of an aunt of the patient’s father. The chief features of the case were: (1) stridor present from birth; (2) transverse furrowing of the lower chest wall; (3) certain auscultatory signs ; (4) absence of cyanosis ; (5) absence of laryngeal excursion ; (6) a heart-rate uninfluenced by respiratory movements; and (7) the excellent health of the child. The stridor accompanied each inspiration. and, with the exceptions to be given, was always
glands seemed deficient. The mother was normal, but the grandmother was said to have had a double row of lashes. He proposed to split the lid, so as to separate the lashes from the glands, and graft between the two a strip of mucous membrane. If that succeeded he expected the lashes would be prevented from reaching the cornea again.-Mr. M. S. MAYOU referred to three similar cases which he had had. He operated upon them by taking out a narrow band of skin on the outer side of the lid. There had been no recurrence, five years ago. Mr. BISHOP HARMAN read notes of a case of High Myopia in an infant. Mr. W. H. H. JESSOP showed a case of Tumour of the A Lower Lid which he regarded as a lymphangioma. former term applied to it was elephantiasis nostras. Skiagrams showed nothing abnormal about the bones, and skilled nasal investigation was negative.-Lieutenant-Colonel R. H. ELLIOT, I.M.S., mentioned a similar case which he saw in India, and which was found to be sporotrichosis ochonelia.-Mr. LESLIE J. PATON said he had seen a similar case following the extensive
though one was operated upon