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was impaired, and by the seventh day and in spite of treatment the recovery eyesight was lost, and action of the was slow. He complained of severe sphincters became uncertain. Blind, headache, and of seeing double at times. deaf, and powerless for self-help this During the spring and summer he poor child for five weeks kept up an seemed to be tolerably well, excepting idiotic cry, with irregular swinging and headache, from which he suffered freaimless motion of arms and legs. The quently. In July, 1885, his headaches special senses gave some objective evi- increased At times his head seemed to dences of such a grave condition. The be drawn either backward or to one eye-ground showed the arteries tortuous; side, the paroxysms lasting four or five veins full; disk seemed to be choked in minutes, after which he would complain either eye. of seeing double. On closing the left Dr. Lautenbach, who is skilled in the eye, vision improved; at times vomited use of the ophthalmoscope, assured me, his food with glairy mucus. The lad however, that the condition was that of improved under treatment. Spells of a swollen disk from active inflammation, headache became less frequent. As he and not a true choked disk. Membrana complained of his eyes, examination tympani of both ears normal. From a showed hypermetropia of 1 D. right eye, hyperesthesia of the reflexes there re- 2 D. left eye, with astigmatism in left sulted a condition of impaired sensation, eye. The optic disk of left eye swollen, with subnormal temperature, as a rule. right less so. Glasses given in NovemAfter five weeks under the use of absorber improved vision, but headache was bent alteratives, and counter-irritation still persistent at intervals. He got to spine, the child began to improve, along tolerably well until February, and after twelve weeks commenced to 1887, when headache returned with inwalk and see; hearing was slow to re- creasing violence; his gait became unturn. The reflexes of bladder and rec- steady, and double vision increased, betum also became normal. Yet the child coming almost constant. continued nervous, irritable, howling with raneous voice when disturbed or denied any of her wishes.

In

In April he was taken to a specialist, who added prisms to his glasses, which, for a time, improved his vision. During the summer she has gradually May his headaches became violent improved; now walks with gait some- again; he suffered from attacks of what wabbling. She eats well, sleeps nausea; his gait became more uncerwell, and nourishes well. Her temper tain; he stiffened his feet in walking, is irascible; she drags the right foot, and staggered with uncertain moveand falls easily. The motion and use of ments, frequently falling, but seemed in the upper extremities appear to be nor- good spirits; temperature subnormal. mal. Hearing nearly normal. Eye- Urine pale, passed in large quantities, ground shows evidences of some struct- but neither sugar nor albumen detected. ural changes; vessels still small and Since July the lad has lost flesh; loses tortuous, some choroiditis remains. Vision his food by vomiting frequently; often has improved so that she can distinguish the matters vomited are undigested food objects, but my last attempt to test it accurately resulted in ignominious fail

ure.

with glairy mucus, of yellowish tinge. Pain in head always present before vomiting; head thrown backward; Urine has shown neither albumen nor belches, often has hiccough. Temperasugar. Specimens examined were of ture subnormal; hands feet usually normal specific gravity, and deposited cold. Generally sleeps well. phosphates on standing.

The following case presents some peculiar conditions:

The condition of his eyes as I have seen them, and confirmed by Dr. Isett, who is practised in the use of the ophCASE IV.-Edward L., aged nine thalmoscope, shows both disks swollen; years, had measles in March, 1886. the arteries small and tortuous; choroid The attack was severe for four days; congested. Dr. Isett adds, "no doubt

there is pressure on the brain some-portunity of making a post-mortem exwhere." The treatment of this lad has amination in a case of typhoid fever been tonic, alterative, and dietetic. where nervous symptoms had been well The case presents a peculiar outcome from measles.

I report these to elicit further reports of such cases, and for the sake of calling attention to the effects of measles on the nervous system, which, in these cases, seems to have suffered severely.

DISCUSSION.

marked from the second week onward. The patient had always been regarded as an hysterical individual. There was spasm of the muscles of the back of the neck, with retraction of the head to the right side. Also spasm of the right arm, with contraction of the muscles, and the right leg was similarly affected. The pupils always responded to light, Dr. William B. Atkinson said: and there was no paralysis of any During the last epidemic of measles I muscle. The patient died, and in my saw more cases of inflammation of the absence the post-mortem was made by lungs than in any previous epidemic Dr. Musser. The only abnormal conwithin the last thirty-five years. Catar-dition found in the brain was the presrhal sequelae were extremely common. ence of two cyst, one in each fissure of I have not met with the eye troubles, Sylvius. These were about the size of a nor have I seen any evidences of brain af- walnut. They contained clear fluid. fection. There was no evidence of inflammation or of the presence of hydatids. It is a question whether or not these cysts were congenital. This case shows that there may be marked nervous symptoms without special lesions, and at the same time may we not imagine that some of these cases of severe nervous symptoms in the course of the specific fevers may occur in consequence of imperfect development of the cerebral substance? The only case in which I can recall symptoms similar to those described by Dr. Collins was in a child four years of age, and the result of this case was permanent insanity.

I recall two cases, some fifteen years ago, in which the eyes and the brain were so affected that vision was entirely lost. In one case the vision returned after a period of fifteen months, and the child recovered perfectly. In the second case, that of a child eighteen months of age, the vision was perfectly restored at the end of eight or ten weeks. I attribute the restoration of vision, in the first case, largely to the use of phosphorus, which, with intervals of rest, was continued for a year.

Dr. Wm. Welch said: I have never met with the sequelæ referred to by Dr. Collins, but I believe that reference is made to them in elaborate text-books. ANTIFEBRIN IN ENTERIC FEVER.-Dr. Such sequelæ are, I think, more frequent J. Solis-Cohen states that his experience after smallpox than after measles. I with this drug during his present term have seen the hearing and speech during at the German Hospital has shown that recovery from smallpox, but never from it is more likely to produce collapse than measles. The author of the paper re- he has ever found antipyrine to do. In ferred to subnormal temperature after doses of seven and a half grains it has defervescence took place. I have reduced evening temperature from 105° noticed this, and also unusual slowness of pulse. In adults, I have frequently found the pulse under fifty, when in the recumbent posture.

to 96.5°, with a return wave to 102° and over by early morning. He has found three grains in some instances quite as effective as larger doses, while much Dr. E. T. Bruen said: The ques- less dangerous. He urges that physition whether or not in these cases, where cians should see their patients within an nervous symptoms have been prominent, hour or two after administration of the there is any lesion of the nervous sys- first dose of antifebrin, in order to detem, has always been an interesting termine by results the propriety for its question to me. I recently had the op- repetition.-Polyclinic.

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give it an accurate description. This body is apparently tree in the serum and by its very active lashing and twirling movement causes a current of sufficient strength to result in a visible. passive movement in the neighboring corpuscles. As yet, Councilman has published only what he has seen and has made no attempt to say whether these bodies are or are not living organisms. In fact, Marchiafava and Celli have themselves no further evidence than this to justify them in drawing their conclusions.

Without stating in so many words that it is in support of this latter idea that his contribution is made, yet a careful perusal of the article by Dr. Pfeiffer can lead to no other conclusion.

The evidence from these two sources is probably the strongest positive argument in favor of the disease being dependent upon a lower organism. The most common opinion held by the oppoTHE PRESENCE OF MARCHIAFAVA AND nents of the theory is, that these structCELLI'S PLASMODIUM IN THE BLOOD OF ures are not organisms but are vacuolaPATIENTS SICK OF VACCINIA AND OF tions produced by mechanical alterations SCARLET FEVER. Under the above title in the protoplasm of the corpuscles there appears in the August number of themselves. They also claim that these the Zeitschrift für Hygiene an article bodies are not exclusively confined to from the pen of Dr. Pfeiffer, of Weimar. malarial blood but are found in the blood In the present stage of the discussion of other diseases as well. upon the pathology of malarial fever this contribution is not without interest. Since the publication by Marchiafava and Celli of their discovery, in the blood of persons suffering from malarial fever, of a body which they suppose to He states that he has found in the be a living organism and to which, on blood of patients suffering from vaccinia the strength of their evidence, they have and from scarlet fever bodies which he given the name of "Plasmodium Ma- considers identical with the plasmodium lariæ," numerous other contributions of Marchiafava and Celli. He was unupon this subject have been received. able to demonstrate any of those changes Most prominent among these are from upon which Marchiafava and Celli based Councilman, who in an extended series their theory for the development stages of observations, under most favorable of the organism. circumstances, has been able to demonstrate these bodies in the blood of all cases of malarial fever that it has been his privilege to examine. He has not only found them in the dried and stained specimens of blood but has likewise observed them in fresh specimens, and has not only demonstrated the ameloid movement of those bodies as found within the red blood-corpuscles but has also proven the presence of a body In his closing paragraph especially, it which is apparently outside the blood is easy to interpretate his ideas as to the disk and which has such a rapid and nature of these bodies, for he says-"It active movement that it is impossible to has often been observed that in

He describes the bodies observed by him as being of an irregular shape and easily stained. They sometimes contained pigment granules and in general had the appearance of vacuolations.

He refers to the publications from other observers who claim to have also found these bodies in the blood of per sons suffering from scarlet fever, vaccinia, measles and parotiditis.

the blood of these diseases the red their patients to use hot-water vaginal blood corpuscles take on a prickled ap- injections without giving explicit and pearance due to the adhesion to their positive directions how they should be surface of small moving bodies that one used, the temperature, length of time sees in the serum, and that coincident and number of times each day the agent with the appearance of this prickling should be employed. The general indoes the formation of Marchiafava and convenience attending the use of hotCelli's bodies begin, and it continues in water injections and the discomfort they proportion as the prickling developes." may occasion will often induce the paHe also states that in proportion as tient to go through with an outward pressure upon the serum is increased the form without a conscientious observance number of these vacuole-like bodies is of a rational and systematic method of also increased. From an inspection of administration. There are many pahis plates illustrating his article, it is tients who will attempt to persuade very difficult for one to rid one's self of themselves and will persuade their phythe idea that at least some of the bodies sician that they are really employing observed by him were the ordinary this agent as they are directed, yet when blood tablets or third blood corpuscle of their methods are investigated they are Bizozzers as they are sometimes called, entirely faulty. To secure the full beneand that the serrated appearance that fit of hot water the following rules seem he describes as occurring in the red to be advisable. First, the temperature blood corpuscles was only the ordinary change that blood corpuscles commonly undergo after withdrawal from the vessels.

This is hardly the place to enter into the technique of his work on this subject, but it will suffice to say that in his investigations, his method of maintain ing an equable temperature was somewhat unique and might be of interest to those proposing to conduct like observations in which it is essential to keep the blood at the body temperature.

should range from 110° to 130° or 140°. Many patients will not endure such great heat as is here indicated. Such cases must be encouraged to employ it at a temperature as high as it can be borne. Second, the recumbent posture is the one usually deemed best, but the position of Sims, or one somewhat more prone, as recently advised by F. P. Foster, of New York, will secure a deeper penetration of the water than is possible in the dorsal posture, and for this reason is more serviceable. Third, the water should be injected slowly into the vagina aud should HOT WATER VAGINAL INJECTIONS.-be permitted to remain in contact with The great value of hot-water vaginal the tissues just as long as practicable, injections in the treatment of uterine say at least from fifteen to thirty minand pelvic inflammation has been so utes. The injections given in the sqatwell shown by numerous observers that ting position should be discouraged it might seem wholly unnecessary to in- rather than employed. The great insist upon the use of this agent in con- convenience of the dorsal and seminection with the treatment of the prone positions is fully recognized, but female pelvic organs. The good service when the aim of the administration is of the agent will hardly be questioned to shrink up the vessels going to the conby anyone who has given it a fair trial. gested or inflamed uterus and pelvic We are satisfied, however, that hot-water tissues the necessity for direct contact of vaginal injections do occasion disap- the agent with these tissues over-weighs pointment and are often discarded as ab- other considerations. It is much better solutely worthless. We are disposed to that hot-water injections should be adassign this disappointment and conse- ministered by a competent nurse, but quent abandonment of the use of the where this is not possible the physician agent to faulty methods of applica- should be quite sure the patient is emtion rather than to the fault of the ploying the agent in a manner from agent itself. Many physicians direct which she will derive a benefit,

Miscellany.

CONTUSION OF THE ABDOMEN, WITH RUPTURE OF THE INTESTINE.-The operative treatment of trumatic peritonitis, and of the injuries which cause it, is a subject of universal interest at present. In the October issue of The American Journal of the Medical Sciences, Dr. B. Farquhar Curtis, of New York, has studied the general subject by the aid of a series of 44 experiments upon dogs, and an analysis of 116 cases of rupture of the intestine, and of 33 cases of contusion of the abdomen terminating in recovery, with especial attention to the symptoms of the first hours after injury, in the hope of rendering an early diagnosis possible, and to indicate the most promising methods of treatment.

The practical results of the inquiry may be summed up as follows:

ring in children before puberty of which he has been able to collect the records. As the result of this analysis he finds:

1st. That most of the established causes of the disease in adults obtain also in children, more especially the use of alcohol, present in 15.8 per cent. of the whole number; syphilis, chiefly hereditary syphilis, present in 11 per cent.; tuberculous disease of other organs than the liver, in 11 per cent.; also, but much less frequently than these, venous congestion of the liver, peritonitis, and a general tendency to connective tissue formation in the system.

2d. That syphilis occasionally tends to a diffuse interstitial hepatitis or cirrhosis, by first inducing an adhesive inflammation of the portal vein.

3d. That a general arterio-capillary fibrosis is not proved by these cases to be the usual, and probably not even a frequent, cause of hepatic cirrhosis in childhood.

4th. That more than half of the cases of hepatic cirrhosis in children do not appear to be produced by the abovementioned well-established cause of that

The treatment of contusion of the abdomen should be purely expectant in the early stage, until symptoms of internal injury have appeared, or until the full extent of time in which they may be expected has passed. Explorative laparotomy at this time is in admissible. affection. When symptoms of uncontrollable internal hemorrhage, or serious visceral injury appear, laparotomy is indicated; but, when the diagnosis is uncertain, the operation should always be begun as an exploration.

5th. That there is some evidence that cirrhosis of the liver may be very exceptionally induced by the acute infectious diseases-cholera, typhoid fever, measles, scarlatina, but that proof of this is wanting.

Great collapse is an absolute contra- 6th. That the habitual use of a stimuindication to all operative interference. lating diet, or the absorption of the proWhen rupture of the intestine is found, ducts of faulty digestion, are probably the best method of treatment is to secure fruitful sources of hepatic cirrhosis in the injured gut in the abdominal wound, children.

and form an artificial anus. This can 7th. That it is in harmony with what be easily relieved by a later operation, is known of the causes of hepatic cirwhen the patient has recovered his rhosis to believe that the bodies known strength. as ptomains may be capable of exciting a cirrhotic condition, and that investigaHEPATIC CIRRHOSIS IN CHILDREN.-tion of this subject deserves attention. Dr. R. Palmar Howard, of Montreal, 8th. That the period of childhood reports in the October number of The most liable to cirrhosis of the liver is American Journal of the Medical from the ninth to the fifteenth year inSciences, two cases of this rare affection clusive, but that it may be congenital, in children, in which neither the use of and may occur at any age after birth. alcohol nor the virus of syphilis can be 9th. That it is twice as frequent in assigned as the cause. Dr. Howard male children as in female. then presents a very careful study of the clinical histories of the 63 cases occur

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10th. That its symptoms are essenti-
ally the same in childhood as adult life.

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