Habitual constipation causing malformation of the colon. Illustration shows hypertrophy of transverse muscular coat, infiltration of areolar tissue, degeneration of the mucosa; to the right, destruction of tissue down to the muscular coat (Concetti, in Arch. f. Kinderheilk., Bd. XXVII, Hefte 5 u. 6). J. P. C. Griffith 1 reports a case of congenital idiopathic dilation of the colon in a boy 3 years old, who had been constipated from birth, with distention of the abdomen from 5 months of age. On admission to the hospital, diarrhea was present, but the tympany was so excessive that laparotomy was necessary to form an artificial anus; the child was in such wretched general condition that he did not survive; only a partial autopsy was allowed, the colon being found tremendously dilated, while the ileum was contracted just above the cecum. The author collects 23 cases from the literature, which he considers are idiopathic, showing that boys are more often affected than girls, in the proportion of 5 to 1. The most prominent symptoms are abdominal distention and obstinate constipation, with, at times, attacks of diarrhea, the last, if persistent, being an unfavorable sign; vomiting is rare, but the distention often causes dyspnea. Of the patients, 18 of the 24 died in childhood, but only 3 are positively known to have lived to adult life. Ulceration of the mucosa was found in all the cases with severe diarrhea. The treatment should be directed to the chronic constipation, and if relief is not prompt, surgical measures should be adopted. A. Johannessen 2 reports 3 cases, one dying at the age of 30 months, the others still living at the ages of 14 months and of 3 years; the author reviews the literature bearing on the etiology, and takes the ground that the condition is the result of excessive length of the sigmoid, which is kinked. F. T. Stewart and Alfred Hand, Jr.,3 report a case in a boy 6 years old, terminating fatally. Liver.-Moncorvo 4 reports a case of abscess of the liver occurring in a boy and following traumatism. E. Terrien, after examining a number of fetal livers with reference to the collections of small round-cells (embryonic infiltration) and their disappearance, found that they normally disappeared in the first few days after birth, a persistence being pathologic, and that they are recognizable from the infiltrations which occur in gastro-enteritis-the so-called false fetal masses. The number of observations was too small to determine the significance of the embryonic infiltrations. In children with gastro-enteritis 6 there may be these infiltrations, which are probably intravascular, other changes being seen in the connective-tissue and the parenchyma (fat); the author describes the lesions of the liver which may occur in gastro-enteritis, detailing the steps leading up to cirrhosis. R. G. Freeman 7 describes a number of lesions of the liver found at autopsy. His summary is as follows: (1) Descent of the liver down the right side of the abdomen, so that the right lobe reaches below the crest of the ilium, occurs not very rarely in infants, and particularly in those in whom the liver is enlarged. (2) Fatty livers occur very frequently in the infants and children which die at the Foundling Hospital, or in about 41% of all cases. (3) The condition of nutrition of the 1 Am. Jour. Med. Sci., Sept., 1899. 3 Arch. of Ped., Mar., 1900. 2 Rev. mens. des Mal. de l'Enfance, Feb., 1900. 7 Arch. of Ped., Feb., 1900. child, as expressed by the absence of fat in general and wasting of tissue, apparently has no connection with the fatty condition of the liver, the condition of nutrition in the cases having fatty livers averaging about the same as in the whole number of cases. (4) Fatty livers occur rarely in the following chronic wasting diseases: Marasmus, malnutrition, rachitis, and syphilis, unless such condition be complicated by an acute disease. (5) With tuberculosis fatty livers occur not more often than with other conditions. (6) Fatty livers occur most often with the acute infectious diseases and gastro-intestinal disorders. (7) The two cases of cirrhosis of the liver examined by the writer ran a comparatively acute course. On section the livers showed a marked hyperplasia of the so-called new-formed bile-ducts. (8) Focal necrosis of the liver may be a lesion of measles. Diaphragmatic Hernia.-Cases of congenital diaphragmatic hernia are reported by S. W. Kelley 1 and by I. A. Abt.2 In both cases there was a deficiency of the left part of the diaphragm, so that the left lobe of the liver, the stomach, the duodenum, the small intestine and a part of the colon were in the left half of the thorax ; cyanosis was intense at birth and resuscitation was impossible. Abt's case also presented a congenital goiter. Intestinal Parasites.-G. F. Still 3 urges, in the treatment of threadworms, a large injection-12 to 18 ounces or more-in order to reach the real habitat of the parasites, which is not the rectum, as is popularly supposed, but the cecum and vermiform appendix; even large injections sometimes fail, so the use of santonin by the mouth is recommended. The author holds that it is possible for the ova to be hatched in the appendix without first being swallowed, and they may sometimes set up a catarrhal condition of the appendix simulating appendicitis. It may be added, in view of the case reported by C. H. Frazier, that the oxyuris is a cause of appendicitis in some instances. DISEASES OF THE CIRCULATORY SYSTEM AND BLOOD. Von Starck 5 quotes the opinion of Hochsinger and others, who have stated that cardiac murmurs in the first 3 years of life are always organic, and while in his experience accidental murmurs are very rare, yet he has seen 4 cases, which he reports, in which the murmurs were heard repeatedly, the autopsies revealing nothing abnormal in the hearts. The author also discusses the diagnosis of congenital heart lesions. 6 C. W. Townsend, after a study of 30 cases of congenital heart disease, arrived at the following conclusions: (1) Duration of life: Of 19 cases kept under observation, 13 have died at an average of 3 years, the youngest being 3 hours, the oldest 9 years; of 6 living cases, the youngest is 4 months, the oldest is 28 years. (2) Cyanosis: This was present in all cases with one exception. (3) Cardiac signs: These 1 Arch. of Ped., Aug., 1899. 2 Ibid., April, 1900. 3 Brit. Med. Jour., No. 1998, 1899; Arch. of Ped., Aug., 1899. 4 Univ. Med. Mag., Mar., 1900. 5 Arch. f. Kinderh., Bd. XXVIII, Hefte 3 u. 4. 6 Arch. of Ped., Sept., 1899. were absent in one-third of the cases, 2 of these coming to autopsy and showing marked cardiac malformation. In two-thirds murmurs were present, generally diffuse and systolic in time, with or without a thrill, and loudest at either the base or the apex. (4) Blood count: The number of red corpuscles in the blood was increased in all but 1 of 14 cases examined, as is found to be the case in cyanosis from other causes. The exception occurred in the only case devoid of cyanosis. The average red blood count in 13 cases was 7,573,585 cells per cubic millimeter. J. P. C. Griffith 1 reports the case of an 8-months-old boy who had experienced attacks of cyanosis from the age of 5 months; death followed an attack of pneumonia, and the autopsy showed a transposition of the viscera and of the great vessels, with pulmonary stenosis and perforate septum ventriculorum, but without a true dextrocardia, as the auriculoventricular valve on the left was composed of 2 leaflets, while that on the right had 3. L. Vervaeck reports a congenital malformation of the heart, consisting of deficient auricular and ventricular septa, absence of the tricuspid orifice and valves, malformation of the aortic and pulmonic valves, and incomplete development of the right ventricle and pulmonary artery; death occurred at 4 years, a murmur having been present throughout life, but cyanosis developing only shortly before death. The author describes the course of the blood and discusses the production of the anomalies, and also the question of the cause of cyanosis in congenital heart disease, explaining its absence in this case, in which there was pulmonary stenosis with a mixture of arterial and venous blood, by hyperoxygenation of those red blood-cells which passed through the lungs. Vervaeck 3 nevertheless thinks that the most plausible explanation of cyanosis is the admixture of arterial and venous blood, and that the influence of pulmonary stenosis can not be invoked as a cause, inasmuch as in 50% of the cases of cyanosis pulmonary stenosis is absent, and it is often present without causing cyanosis. 4 A. C. Cotton reports a case of pulmonary stenosis and infective endocarditis in a boy 11 years old, noma starting several weeks before death. The autopsy showed a congenital malformation of the heart, consisting of stenosis of the pulmonary conus, malformation of the pulmonary valve (2 cusps), and perforate ventricular septum; in addition, there were acute mural endocarditis and an aneurysm of the right ventricular wall, streptococci being obtained in cultures from the vegetations in the heart. The author also 5 observed a new-born infant, dying on the fourth day, having passed only 1 cc. of urine during life; the autopsy revealed a defective septum between the pulmonary artery and the aorta, a patent ductus arteriosus and foramen ovale, and general infection with Bacillus mucosus capsulatus. 6 T. Escherich gives the notes of a prematurely born infant, cyanotic 1 Arch. of Ped., Aug., 1899. 2 Arch. de Méd. des Enfants, June, 1900. Jour. méd. de Bruxelles, Feb. 1, 1900; Arch. de Méd. des Enfants, June, 1900. 4 Arch. of Ped., Dec., 1899. 5 Ibid., Oct., 1899. 6 Jacobi's Festschrift; Phila. Med. Jour., May 26, 1900. |