615

back beyond the perpendicular line without distress or

danger, coupled with the difficulty of finding any supportfor the head and elbows in front which shall not continu-

ally slip away when the weight of the patient is thrown

upon it; and this couch has been devised to meet these re-quirements, and to support the head and arms in a positionfavourable for obtaining a certain amount of comfort and apassing chance of sleep.

CLINICAL SOCIETY OF LONDON.FRIDAY, APRIL 26TH, 1872.

DR. OWEN REES, F.R.S., VICE-PRESIDENT, IN THE CHAIR.

DR. GREENHOW related tb e history of a case of Diphtheria which was followed by Paralysis. The patient, !brass-finisher, aged thirty-two, was admitted into thMiddlesex Hospital on May 27th, 1871, with all the wellmarked symptoms of diphtheria. Under treatment he sfar recovered that, at his own desire, he left the hospital oiJune 27th. His voice had still a nasal twang, and he ha(difficulty in swallowing solids. The left side of the sofpalate acted imperfectly, and he had some asthenopia, s(

that he was only able to read for a few minutes at a timeOn August 9th, he was readmitted into the hospital wittsymptoms of paralysis rapidly coming on. He had thtsensation of pins and needles up the legs as high as thEknees, and in the hands and arms up to the elbows. For atime the loss of sensation and power increased until hecould scarcely grasp with his hands or walk without assist-ance. The two symptoms, however, which gave specialinterest to this case were the slowness of pulse (which onlyset in as the throat symptoms began to subside, the pulsefalling as low as fifty-six), and a remarkable tenderness onpressure of the large nerves of the extremities. Firm

pressure on the ulnar, radial, and crural nerves producedgreat pain, sufficient to make the man call out and to causehis face to flinch. The patient ultimately recovered, andwas discharged from the hospital in the following October.

Dr. BROADBENT remarked on the importance of the paper,inasmuch as the pathology of these disorders was exceed-ingly obscure.Mr. TIMOTHY HoLnzES exhibited a patient from whom he

had excised the whole of the second metatarsal bone, andafterwards the whole row of the tarso-metatarsal joints, thelatter operation being undertaken as a substitute for Lis-franc’s amputation. The original disease in the secondmetatarsal bone depended on a traumatic cause; and theaffection of the tarso-metatarsal joints was due probably toviolence done in removing the head of that bone from thebox in which it is embedded between the cuneiform bones.The man recovered, and the foot, though hardly yet quitesound, promises to be perfectly useful. The case was ex-hibited partly as an interesting example of a probablyunique operation, but chiefly to show the success withwhich excision may be substituted for amputation in affec-tions of the bones of the foot due to traumatic causes.

Dr. DycE DUCKWORTH exhibited three patients sufferingfrom Molluscum Contagiosum, which had occurred in mem-bers of the same family; thus affording strong evidence ofthe contagious nature of the disease. The tumours beganthree years ago in the first child of a healthy woman; themother was next affected about the face and breast; andthe second child presented numerous tumours shortly afterbirth. The first child was taken to St. Bartholomew’sHospital, the tumours were removed, and no more subse-quently appeared. Lastly, the grandmother, who had sleptwith the eldest child, and had often nursed the baby, be-came affected. Dr. Duckworth wished to glean opinionsfrom dermatologists as to the contagious nature of thedisease, inasmuch as in many cases no history of contagioncould be obtained. The pathological anatomy of thetumours in these cases had been thoroughly worked out.Dr. TIL]Bupy Fox exhibited a patient, aged eleven, suffer-

ing from tubercular leprosy, in whom a marked ameliora-tion had been induced by the use of large and continueddoses of quinine. Dr. Fox brought the case forward asillustrating the fact that leprosy could be greatly relievedby proper treatment, and not merely by the Beaupurtheyand Bhau Dji plans recently extolled. This was thefourth case which Dr. Tilbury Fox had treated recentlyin a similar manner. The child has a well-marked I

leonine expression of countenance, caused by thickeningfrom deposit of leprous granulative tissue in the skin of £various parts of the face. There was also much discoloura-tion of the whole skin, with a few anaesthetic spots aboutthe conjunctiva and the mucous membrane of the palate, &c.The general thickening, however, of the integuments of theface and body had diminished, the voice was clear, thesnuffling from thickening of the nasal mucous surface haddiminished, and altogether the child had greatly improved.The oil of cashew had been applied for the first time a fewdays before the meeting, in order that the members might.see its action. Dr. Tilbury Fox stated that not only theoil of cashew, but carbolic acid and arsenious acid, usedlocally, dispersed the tubercular formations; but the oil ofcashew in his hands had been very successful in this respect,though it required to be used with care.

Dr. ANSTIE exhibited a case of Lepra Anoesthetica. Thepatient was a gentleman aged twenty-nine, who had beenexposed to malaria, want of food, bad lodging, and otherhardships in India. The symptoms were-(1) the usualeruption of patches-brown at the edges, white, shiny, andarsesthetic in the centre-on both arms and on one leg;(2) wasting of certain muscles; (3) great nervous andmental depression. The case was not one of the mostsevere grade: still the prognosis was gloomy. Underquinine, cod-liver oil, and faradisation of the affected skinand muscles, a great improvement took place, and he wasable to return to his occupation. Dr. Anstie said this casereminded him of three others which were curiously ana-logous to it, and which he detailed. One of them had beenbrought before the society by Dr. Buzzard. The generalinference which he was inclined to draw was, that leprosywas by no means so perfectly and typically isolated fromother diseases as some persons supposed. Probably itwould be found hereafter that leprosy might be developed’from a great variety of factors, of which only one (possiblya hereditary degenerative tendency in the central nervoussystem, closely allied to that which produces Cruveilhier’sdisease) was constant and indispensable, and privation offood was the next most common.

,t Dr. TILBURY Fox had noted the contagious nature ofmolluscum conta.giosum some years ago, in a woman whole was affected with it from the forehead of a child while

d suckling. He mentioned the fact that seven children were

Le brought to him all suffering from the same disorder, which3-

had commenced in all at one and the same time.

d The CHAIRMAN remarked that the nomenclature of leprousdiseases was very imperfect; that all tuberculated cases

0had anaesthesia, and that hence the Committee appointedeby the College of Physicians divided the cases into the3. tuberculated and non-tuberculated varieties. He would

g like to know if any member had ever seen a tuberculated. case without anaesthesia ?

Mr. BRUDENELL CARTER asked if it was true that the

b. Committee referred to had reported a case not to be leprosy-

because muscular wasting existed. He had seen manysuch cases in the hospital at Christiania, and believed that

y muscular wasting was a characteristic phenomenon of thedispase.

for. BUZZARD said that his patient, who was drowned.1some weeks ago, had the right median nerve much thick-ended. The case during life was declared by two experienced*authorities to be identical with Oriental leprosy, but the-. patient had never been out of London. According to his own; belief all evidence as yet adduced as to so-called Oriental. leprosy went to prove that it was a condition of mal-

; nutrition not peculiar to any particular climate or locality.,

It prevailed largely in England between the tenth and six-teenth centuries, as evidenced by the fact that no less thanthree lazar- or leper-houses existed at that period in thiscountry. He believed that the disease still lingered amongstus in so slight a form_as to be easily overlooked, being re-presented perhaps by a slight discolouration of skin, or anunexplained localised atrophy of muscular tissue.

Dr. TILBURY Fox had no doubt whatever that Dr. Anstie’scase was one of genuine leprosy. He remarked thathe had never seen tubercular leprosy without anaesthesia.The CHAIRMAN remarked that no doubt was now raised

as to the existence of genuine leprosy in England.

MR. J. H. LowE has been appointed Medicalj Officer of Health for Wolverhampton.