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PRIMARY CARIES OF THE MASTOID PROCESS AS A CAUSE OF MASTOID ABSCESS IN YOUNG CHILDREN.
PASTEURISED MILK AND INFANT FEEDING.
24 hours. On the following day there was slight eye pain, with considerable reduction of the visual acuity. The pupils were of medium size and the reaction was normal. I advised her to remain in a darkened room, to have the eyes gently massaged, and to take a hot bath. I gave internally bromide of ammonium. She wore tinted glasses for some days and is cow quite recovered. The condition produced by exposure to excessive light is sometimes spoken of as blindness of the retina, anaesthesia " Retinal of the retina, and neurasthenic asthenopia. electrocution " is the term Darier uses when writing of the cerebral and retinal shocks produced by the passage of an electric current through the upper part of the body and the head. This suggests to me the term " retinalcinematocution " for the condition produced by the intense Those who have witnessed these flashes of white light. must have experienced that peculiar tiredness " of the eyes caused by exhaustion of the retina, and how gratifying it was to close the eyelids and thus relieve the strain. Until some improvement takes place in the mode of exhibiting these pictures and in rendering less intense the light the public should be warned of the danger and advised to wear tinted glasses when looking at them, and each display should not exceed one minute. I am, Sirs, yours faithfully, EDWARD MAGENNIS, M.D. R.U.I. Dublin, May 5th, 19G6.
living-picture displays "
PASTEURISED MILK AND INFANT FEEDING. To the Editors
of THE LANCET.
1349
The second case was that of a boy, aged nine years. He with a swelling behind the left ear, which continued to increase in size under assiduous poulticing. I saw him after six weeks of this treatment and found a large fluctuating abscess, extending over the mastoid and beneath the temporal fascia, pushing the ear markedly forwards. This boy never had earache or otorrhoea and during all the time he was under my care his temperature never ranged above 990 F. I incised as in the former case and found a sinus which from its high and anterior situation I thought opened into the attic, not into the antrum proper. This I enlarged and packed the cavity daily. At the end of seven weeks it was completely healed. The membrane at the present time is perfectly normal in appearance and the boy can hear a watch distinctly at 88 inches. These two cases agree with Mr. Gamgee’s in the following points : (1) absence of constitutional disturbance ; (2) there never was otorrhæa ; and (3) the swelling came on gradually with an absence of pain. They differ in the following : (1) the ear was pushed markedly forwards in both ; and (2) there was hardly any destruction of bone. There was no caries except at the margin of the sinus itself. I am, Sirs, yours faithfully, STBWART. J. STEWART. Leeds, May 7th, 1906.
began
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APPENDICITIS AND PERFORATED DUODENAL ULCER. To the -Editors of THE LANCET. SIRS,-In THE LANCET of May 5th, p. 1262, in "Annotations," under the heading of "Apptndicitis and Perforated Duodenal Ulcer," you say: "No case appears
to a prevalent and growing to have been recorded of the association of inflammation of evil the letter of Dr. G. A. Sutherland in THE LANCET of the appendix with duodenal ulcer." May I venture to call May 5th, p. 1280, is a highly important and valuable one. As your attention to the fact that in THE LANCET of Nov. 2nd, far as the evidence of my cases quoted by him is con- 1901, p. 1194, I published notes of a case of appendix cerned, he might have materially strengthened his position abscess that I opened and that died from a perforated ulcer by mentioning the chief feature that was the main point of the second part of the duodenum 11 days later. I also of interest in each. The "extraordinary course " referred to in the same note gave details of two other cases of per in my paper was not the mere delay in the resolution of forated duodenal ulcer associated with a septic condition of the peritoneal cavity. a subperiosteal clot but the formation of new bone in the I am, Sirs, 3 ours faithfully, detached periosteum in each of three consecutive cases F. BOLTON CARTER. In one of scurvy inadvertently fed on pasteurised milk. Leicester, May 7th, 1906. case where the change of milk instituted by the dairy comTHE EPIDEMIOLOGICAL SOCIETY. pany was not discovered and the infant died the newly formed periosteal bone was of remarkable extent, being To the Editors of THE LANCET, thicker in places than the femur it surrounded. In the sucon should whilst a thin of bone be much obliged if you would kindly SIRS,—I ceeding two, pasteurised milk, layer formed in the periosteum detached from the femur-a con- permit me to make a few corrections in the account pubdition that was verified by skiagrams taken by Dr. G. H. lished in THE LANCET of May 5th of a paper which I had the Graham. On a change being made from pasteurised to fresh honour of reading before the Epidemiological Society on milk the new bone formation ceased in each and in the course April 20th last on the subject of the meningococcus. In the of time that already formed was slowly absorbed. These first place, Elser of New York cultivated the meningococcus three cases would seem apt illustrations of the dangers of from the blood in 24 per cent. of the cases of cerebropasteurised milk pointed out by Dr. Sutherland in his timely spinal fever which he examined, not in 7 per cent. as stated. letter. I am, Sirs, yours faithfully, Colonies in broth" should read " colonies " on nasgar," and "acetic"agar should read "ascitic" J. A. J. A. COUTTS. COUTTS. London, May 7th, 1906. I Instead of saying that both the meningococcus agar. and micrococcus catarrhalis were liable, as indeed were PRIMARY CARIES OF THE MASTOID PRO- all micrococci, to occur as staphylococci and streptococci, I stated that they were all apt to occur as diplococci. CESS AS A CAUSE OF MASTOID Lastly, the disinfection experiments quoted were made ABSCESS IN YOUNG against saliva, not against cultures of the meningococcus. CHILDREN. I fear that I myself am in great part to blame for these " terminological inexactitudes," because I failed to bring an To the Editors of THE LANCET. abstract with me on the occasion in question. SIRS,—I should like to supplement Mr. L. P. Gamgee’s I am, Sirs, yours faithfully, cases of caries of the mastoid (recorded in THE LANCET of M. H. GORDON. 1906. Blackheath, 8th, May May 5th, p. 1237) with two cases which have been recently under my care. My cases have many points in common THE NOTIFICATION OF PULMONARY TUBERCULOSIS. with his, but not all. The first was that of a child, 15 months old, with a swelling behind the ear of six weeks’ -The Barnstap e (Devon) rural district council xecently duration. The child never had running earor any of forwarded a resolution to the Local Government Board the symptoms of pain usually associated with mastoid urging that pulmonary tuberculosis should be included abscess. There was a large fluctuating swelling behind the amongst the list of notifiable diseases. At the meeting of right ear pushing it forwards. I incised this down to the the council held on May 4th a letter was read from the Local bone, and after mopping away blood and pus found a sinus Government Board stating that pulmonary tuberculosis was leading into the antrum. This I enlarged sufficiently to not a disease to which compulsory notification could with allow the antrum to be easily packed with gauze. I removed advantage be app id, but as many authorities had made very little bone and only very gently used a small curette to arrangements with locil medical practitioners for the It was packed daily, and in five voluntary notification of this disease the BAri2staple rural scrape out the antrum. weeks the cavity was completely closed. I had an oppor- district council could follow this course without the sanction tunity of examining the membrana tympani afterwards and of the Loca’ Government Board and pav a reasonable fee for such notification, found that it differed in no respect from the other side,
SIRS,—In calling attention
24 hours. On the following day there was slight eye pain, with considerable reduction of the visual acuity. The pupils were of medium size and the reaction was normal. I advised her to remain in a darkened room, to have the eyes gently massaged, and to take a hot bath. I gave internally bromide of ammonium. She wore tinted glasses for some days and is cow quite recovered. The condition produced by exposure to excessive light is sometimes spoken of as blindness of the retina, anaesthesia " Retinal of the retina, and neurasthenic asthenopia. electrocution " is the term Darier uses when writing of the cerebral and retinal shocks produced by the passage of an electric current through the upper part of the body and the head. This suggests to me the term " retinalcinematocution " for the condition produced by the intense Those who have witnessed these flashes of white light. must have experienced that peculiar tiredness " of the eyes caused by exhaustion of the retina, and how gratifying it was to close the eyelids and thus relieve the strain. Until some improvement takes place in the mode of exhibiting these pictures and in rendering less intense the light the public should be warned of the danger and advised to wear tinted glasses when looking at them, and each display should not exceed one minute. I am, Sirs, yours faithfully, EDWARD MAGENNIS, M.D. R.U.I. Dublin, May 5th, 19G6.
living-picture displays "
PASTEURISED MILK AND INFANT FEEDING. To the Editors
of THE LANCET.
1349
The second case was that of a boy, aged nine years. He with a swelling behind the left ear, which continued to increase in size under assiduous poulticing. I saw him after six weeks of this treatment and found a large fluctuating abscess, extending over the mastoid and beneath the temporal fascia, pushing the ear markedly forwards. This boy never had earache or otorrhoea and during all the time he was under my care his temperature never ranged above 990 F. I incised as in the former case and found a sinus which from its high and anterior situation I thought opened into the attic, not into the antrum proper. This I enlarged and packed the cavity daily. At the end of seven weeks it was completely healed. The membrane at the present time is perfectly normal in appearance and the boy can hear a watch distinctly at 88 inches. These two cases agree with Mr. Gamgee’s in the following points : (1) absence of constitutional disturbance ; (2) there never was otorrhæa ; and (3) the swelling came on gradually with an absence of pain. They differ in the following : (1) the ear was pushed markedly forwards in both ; and (2) there was hardly any destruction of bone. There was no caries except at the margin of the sinus itself. I am, Sirs, yours faithfully, STBWART. J. STEWART. Leeds, May 7th, 1906.
began
i
APPENDICITIS AND PERFORATED DUODENAL ULCER. To the -Editors of THE LANCET. SIRS,-In THE LANCET of May 5th, p. 1262, in "Annotations," under the heading of "Apptndicitis and Perforated Duodenal Ulcer," you say: "No case appears
to a prevalent and growing to have been recorded of the association of inflammation of evil the letter of Dr. G. A. Sutherland in THE LANCET of the appendix with duodenal ulcer." May I venture to call May 5th, p. 1280, is a highly important and valuable one. As your attention to the fact that in THE LANCET of Nov. 2nd, far as the evidence of my cases quoted by him is con- 1901, p. 1194, I published notes of a case of appendix cerned, he might have materially strengthened his position abscess that I opened and that died from a perforated ulcer by mentioning the chief feature that was the main point of the second part of the duodenum 11 days later. I also of interest in each. The "extraordinary course " referred to in the same note gave details of two other cases of per in my paper was not the mere delay in the resolution of forated duodenal ulcer associated with a septic condition of the peritoneal cavity. a subperiosteal clot but the formation of new bone in the I am, Sirs, 3 ours faithfully, detached periosteum in each of three consecutive cases F. BOLTON CARTER. In one of scurvy inadvertently fed on pasteurised milk. Leicester, May 7th, 1906. case where the change of milk instituted by the dairy comTHE EPIDEMIOLOGICAL SOCIETY. pany was not discovered and the infant died the newly formed periosteal bone was of remarkable extent, being To the Editors of THE LANCET, thicker in places than the femur it surrounded. In the sucon should whilst a thin of bone be much obliged if you would kindly SIRS,—I ceeding two, pasteurised milk, layer formed in the periosteum detached from the femur-a con- permit me to make a few corrections in the account pubdition that was verified by skiagrams taken by Dr. G. H. lished in THE LANCET of May 5th of a paper which I had the Graham. On a change being made from pasteurised to fresh honour of reading before the Epidemiological Society on milk the new bone formation ceased in each and in the course April 20th last on the subject of the meningococcus. In the of time that already formed was slowly absorbed. These first place, Elser of New York cultivated the meningococcus three cases would seem apt illustrations of the dangers of from the blood in 24 per cent. of the cases of cerebropasteurised milk pointed out by Dr. Sutherland in his timely spinal fever which he examined, not in 7 per cent. as stated. letter. I am, Sirs, yours faithfully, Colonies in broth" should read " colonies " on nasgar," and "acetic"agar should read "ascitic" J. A. J. A. COUTTS. COUTTS. London, May 7th, 1906. I Instead of saying that both the meningococcus agar. and micrococcus catarrhalis were liable, as indeed were PRIMARY CARIES OF THE MASTOID PRO- all micrococci, to occur as staphylococci and streptococci, I stated that they were all apt to occur as diplococci. CESS AS A CAUSE OF MASTOID Lastly, the disinfection experiments quoted were made ABSCESS IN YOUNG against saliva, not against cultures of the meningococcus. CHILDREN. I fear that I myself am in great part to blame for these " terminological inexactitudes," because I failed to bring an To the Editors of THE LANCET. abstract with me on the occasion in question. SIRS,—I should like to supplement Mr. L. P. Gamgee’s I am, Sirs, yours faithfully, cases of caries of the mastoid (recorded in THE LANCET of M. H. GORDON. 1906. Blackheath, 8th, May May 5th, p. 1237) with two cases which have been recently under my care. My cases have many points in common THE NOTIFICATION OF PULMONARY TUBERCULOSIS. with his, but not all. The first was that of a child, 15 months old, with a swelling behind the ear of six weeks’ -The Barnstap e (Devon) rural district council xecently duration. The child never had running earor any of forwarded a resolution to the Local Government Board the symptoms of pain usually associated with mastoid urging that pulmonary tuberculosis should be included abscess. There was a large fluctuating swelling behind the amongst the list of notifiable diseases. At the meeting of right ear pushing it forwards. I incised this down to the the council held on May 4th a letter was read from the Local bone, and after mopping away blood and pus found a sinus Government Board stating that pulmonary tuberculosis was leading into the antrum. This I enlarged sufficiently to not a disease to which compulsory notification could with allow the antrum to be easily packed with gauze. I removed advantage be app id, but as many authorities had made very little bone and only very gently used a small curette to arrangements with locil medical practitioners for the It was packed daily, and in five voluntary notification of this disease the BAri2staple rural scrape out the antrum. weeks the cavity was completely closed. I had an oppor- district council could follow this course without the sanction tunity of examining the membrana tympani afterwards and of the Loca’ Government Board and pav a reasonable fee for such notification, found that it differed in no respect from the other side,
SIRS,—In calling attention