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shuffiing, gait waddling. She was easily thrown off herbalance, and never ventured to cross the street. Movementswere slow, but brisker in warm weather. The least chillwas acutely felt. The temperature of the left side of thebody was lower than that of the right, observations foreighteen consecutive days showing variations from 934° to97’80 on the left side, and 94° to 99 4° on the right. Theswelling began three or four days ago. She had led an un-happy life with a brutal husband, and been much exposedto blows and ill-usage. Seven years since she was in Guy’sHospital suffering from paresis of the right leg, with anses-thesia about the ankle. She improved under electricaltreatment and tonics. During her stay at St. Bartho-lomew’s Hospital she suffered much from cold, and wasalways dull and morose. Stimulants readily stupefied her.She took various tonics and arsenic, and as much good foodas possible, but no improvement resulted. There was noalbuminuria at any time. Case 2.-A married woman,aged forty-six, born at Retford, but had lived for twentyyears in Clerkenwell. She was well grown, with dark hair,sallow complexion, vascular patches over malar bones, andpuffiness about the eyelids. The facial aspect denotedchronic nephritis. There was one mole on the left cheek.The expression was dull and languid. The thyroid bodyseemed natural. The hands were "spade-like." There wereslight bronchial catarrh and constipation. Pulse 80. Legsoedematous, the right pulting more than left. Urine:sp. gr. 1005, acid, not albuminous. The catamenia hadbecome irregular this year. She had noticed herself be-
coming stouter for eight years. Two or three years ago shefound she could not ply her needle so freely as formerly.Her speed and general movements have become slower.She could walk fairly well if not hurried, but was verytimid in the streets. Sometimes she fell down, and haddifficulty in preserving her balance. She took a long timeto dress herself. There was marked susceptibility to coldand changes of temperature. Temperature : in right axilla99’4°; in left 97’2°. She complained that her food did nottaste properly. She had good health till eight years ago.There was no family predisposition. The case presentedmany of the well-recognised features of the disorder, andseemed to be progressing slowly. No treatment appeared tocontrol or modify the cachexia in any noteworthy degree.Dr. Duckworth added that the connexion of acquiredmoles in such cases was interesting. He had foundthem now in eight or nine cases, and pointed out theconcurrence of defective mental conditions with mol-luscum fibrosum as suggestive of the association of moleswith the defective mental powers in myxo3derna. -Dr. SEMON had brought a case of myxoedema to show tothe Society. In addition to the typical symptoms she pre-sented a marked falling off of hairs from all parts of thebody. Her teeth also showed a tendency to break off, andthere was a puffy condition of the gnms. She suffers fromloss of memory and hallucinations. The history of the casepointed to a central rather than peripheral nerve-disorder-the symptoms starting from an injury, followed by pain inthe head. In this case, as in so many others, there hadbeen frequent pregnancies. She had had fourteen childrenand seven miscarriages. Dysphagia had been noted in somecases. In this one there was no difficulty in passing ancesophageal bougie. There was no diminution of sensationin the palate or pharynx. The laryngeal mucous membranehad a glistening appearance, and the vocal cords werenotably anaemic.—Dr. HADDEN had brought a case at therequest of Dr. Ord. This patient showed a brittle conditionof the nails. The quantity of urea excreted was also deficient.He had recently seen a case in a male subject, all others onrecord being females. He thought the condition pointed tosome profound lesion of the sympathetic.-Dr. DUCKWORTHsaid that he had come to the conclusion that the diseasewas one of central origin, due to trophic derangement. Inreply to Dr. Theodore Williams, he said that a few of thetemperature-observations were taken with the surface-ther-mometer ; but most of the temperatures recorded wereaxillary.-The PRESIDENT suggested that Drs. Semon andHadden should put their cases on record in the Society’sTransactions.
Dr. T. COLCOTT Fox described to the Society, and ex-hibited drawings of, two unique cases of Persistent GyrateErythema, affecting the two elder members of the samefamily in a precisely similar manner, in whom it had existedfourteen and sixteen years respectively—i.e., since they wereabout four years of age. The patients were never entirely
free from eruption, but every few months they were subjectto acute outbursts, lasting from ten days to six weeks,which covered the greater part of the trunk and upper limbs,but especially affected the shoulders, the buttocks, andthighs, and the eruption was always associated with intoler-able irritation. There was no clue to the cause in the familyor personal history. The festooned eruption always beganby erythematous papules of the size of millet seeds. Thesequickly subsided, leaving an enlarging annular erythematousbordering, which always preserved an equal brealth as theerythema subsided within the border in equal ratio to theadvance of its outer border. These circles fuse with neigh-bouring ones, to form the gyrate figures, which gradually dieaway in a week or ten days, leaving a good deal of pigmen-tation. The desquamation is peculiar, inasmuch as it is veryrapid and is quickly thrown off, leaving ouly a raggedwhite bordering attached to the inner edge of the erythema-tous rings. The eruption was clearly of the erytlmmatonstype, and such festooned figures are quite in keeping withwhat we know of the evolution of many erythemata. Therewas no fungus present, and no evidence of hereditarysyphilis. The aspect presented by the eruption was a mostunusual one, and had excited much interest in severalskin cliniques of the metropolis. The great pecu-liarity in the case, however, was its extreme persit-tence.—Dr. CAREINGTON had recognised the male patient as havingbeen under Dr. Pye-Smith’s care at Guy’s Hospital. Manyremedies were tried, and finally arsenic, which led to markedimprovement; and Dr. Pye-Smith thought the eruptiontherefore a form of psoriasis.-Dr. F. TAYLOR said the casehad also been under his care at Guy’s Hospital about fouryears ago. The eruption then appeared rather more highlycoloured than as represented in the drawing hy Dr. Fox.Only temporary relief was given by treatment.—Dr. CAVAFYthought the subsidence of the rash under arsenic lost in im-portance as an element of diagnosis from the fact stated byDr. Fox, that it had occasionally subsided spontaneously.He agreed with Dr. Fox as to the chronicity of some of theerythemata, one instance of which is that of the so-called"urticaria pigmentosa. "-Dr. Fox said he had only thepatient’s statement to go upon as to the effects produced bydifferent remedies. Urticaria pigmentosa was a good in-stance of a chronic erythematous rash.-The PRESIDENTmentioned a case of urticaria pigmentosa which persisted forfive years, and was unaffected by treatment.The Society then adjourned.
MEDICAL SOCIETY OF LONDON.
Recurrent Epistaxis. - Diagnosis and T1’eatment of bTlhoopin-eough.-Pa2rper Lunacy Laws and MedicaljBe/!e/.AT the meeting on the 15th inst., F. J. Gant, Esq.,
President, in the chair-Mr. SPENCER WATSON read a paper on a Case of Re-
current Epistaxis of twenty months’ duration. The patientwas twenty-nine years old. He suffered from headacheand marked constipation ; he had no gouty tendencies orother constitutional disease. The headaches and epistaxiswere attributed to the breathing consumed air over and overagain in the ill-ventilated room in which he slept, and to thestraining at stool consequent on the difficulty of defeca-tion. The change to a well-ventilated bedroom, and the useof perchloride of iron solution as a douche, were followedby very rapid improvement, and at length by the totalcessation of the habitual bleeding. Ergot administered in-ternally had entirely failed, though given in large doses.-Mr. PEARCE GOULD remarked on the difficulty often metwith in treating these cases, and inquired whether bella-donna (which, given in small doses, had cured a case thathad resisted plugging and perchloride of iron) had been triedinternally. He thought better success attended pluggingof the anterior nares with a piece of sponge steeped insolution of perchloride of iron, than the more common andless acceptable method of plugging the posterior nares.-Mr. WORDSWORTH referred to a case in which he had in-
effectually plugged both posterior nares in an elderly gen-I tleman. The haemorrhage was subsequently arrested by the
administration of the oil of turpentine in small doses.-Dr. JAGIELSEI advocated the more frequent use of internalremedies. He had found small doses of nux vomica fre-
quently repeated to be of service.Dr. R. J. LEE then read a paper on the Diagnosis and
Treatment of Whooping-cough. The early history of thissingular malady was briefly traced from the year 1678, whenfor the first time the name appeared in the bills of mortality,to the present time ; and the question was raised whetherthe disease had really increased of late, or had only recentlybeen more accurately diagnosed. His own observations ex-tended over several years, and the chief points of diagnosisworthy of attention were the frequency with which youngchildren and infants were attacked without the symptom ofthe "whoop" occurring, so that many infantile disordersreally due to whooping-cough were referred ti some othercause. The infectious nature of the malady and the periodof incubation, deduced from a series of twenty-one cases,were shown to be easily estimate,l in hospital practice, andthe conditions under which adults contracted whooping-cough a second time were pointed out. The train ofsymptoms in infants was detailed, and the frequency withwhich serious and often fatal diarrhoea occurred was men-tioned. As to treatment, it was urged that there were pro-bably good reasons for inquiry into the popular belief, thatthe waste products of the distillation of coal had a beneficialeffect in relieving the cough. Singularly good results wereobtained by the inhalation of carbolic acid. The trial ofturpentine, creasote, &c., was recommended, as the use ofthese drugs was stated to have been attended with consider-able success. No specific value could be claimed for any ofthe numerous remedies which had been at different timesextolled; he said that circumstances must direct the appro-priate use of them in different stages of the disease. Therewas little need to discuss the view that the symptomswere referable to nervous derangement, while the ques-tion of law to prevent the spread of the disease re-
mained unanswered. - Dr. JAGIELSKI had found droseraa valuable remedy, especially in those cases which wereaccompanied by vomiting and dyspeptic symptoms.-Mr.SPENCER WATSON asked whether diet was important inthe treatment, for he had seen great improvement follow thesubstitution of milk diet for an ordinary diet of meat.-Dr.MAIR had found quinine combined with belladonna useful,and also a blister to the nape of the neck in many cases.He confirmed the statement as to the frequent absence ofthe whoop in the cough, which, however, had other charac-teristic features.-Mr. NAPIER testified to the value of theantiseptic treatment advocated by Dr. Lee, which was alsoof advantage as limiting the spread of disease.-Dr. LEE,in reply, said he thought belladonna superior to drosera,but would give this remedy a fair trial. The question ofdiet was important, but in the case of young children therewas little choice; and in infants he never departed fromsimple milk food. The peculiarity of the cough in infantswas of value in diagnosis, and was characteristic althoughthe whoop might be absent. The best method of volatilis-ing carbolic acids and other agents would be the subject ofa future communication.
Dr. BOYD read a paper on Pauper Lunacy Laws andMedical Relief, having reference to the delay under thePauper Lunacy Act in the admission of patients to asylums,to the facilities given by the Acts to crowding them withaged, infirm, and incurable paupers, and to the necessity oíreversing the law, and instead of having the asylums, as atpresent, auxiliaries to union infirmaries, applying portionsof workhouses and vacant prisons (after making suitablealterations in them and placing them under the jurisdictionof the justices) for the reception and classification of incur-able cases of insanity, thereby saving the expense of furtheradditions to those costly institutions, lunatic asylums.Medical relief to be separated from poor relief, and given tothe poor of the working classes, without pauperising them,as so efficiently done in France (where no poor law exists)-
e.g., at Le Salpetriere and La Bicetre, which the parochialinfirmary of St. Marylebone very much resembled before ijwas put under the Poor-law Board and at the time that ijwas recognised as a medical hospital. Such an institu.tion, affording an opportunity of studying every form ojdisease, should be opened to pupils for clinical instructionand to medical practitioners engaged in pathological investi.gations.-Dr. CHRISTIE (Ealing) thought a full discussion 01this subject to be much required; it had a political andpublic aspect as well as a medical.
A sub-committee upon the question-composed of Dr. R.Boyd, Dr. R. J. Lee, Dr. Christie, and the hon. sees.-wasrecommended to the consideration of the Council.
Reviews and Notices of Books.Osteotomy>’ witlt an Inquiry into the Etiology and Pathology
of Knoj7c-7,nee, Bow-leg, and other Osseous Deformitiesof the Lower Limbs. By WILLIAM MACEWEN, M.D.,Surgeon and Lecturer on Clinical Surgery, GlasgowRoyal Infirmary. London : J. and A. Churchill. 1880.FOR Dr. Macewen there is but one disease producing the
bony deformities in childhood and early life, and that isrickets. He refuses to recognise other causes of soften-ing of bones, or irregularity in growth. From his ownobservation he gives three examples of well - markedrickets occurring at puberty, and he considers that thedisease may be induced at any time during the growthof the body by any causes of general malnutrition. Of allthe bony deformities of the lower limbs knock-knee is for
many reasons the most interesting, and it receives the fullestand most careful treatment at Dr. Macewen’s hands. Fromhis measurements he concludes that the deformity is usuallythe product of many factors, the most constant of which isan inward curve of the lower end of the diaphysis of thefemur, noted 120 times out of 166 observations ; next in fre-quency and importance is abnormal elongation of the internalcondyle of the femur, in 84 per cent. of cases, the increase inlength varying from one-half to one inch and a quarter; thecondyle is often also enlarged inwards; in about 30 per cent.of cases there is an irregular growth of the tibia also,but this is usually of much less influence in determiningthe deformity. The different and now rather numerous
operations for its cure are described and discussed, and thereasons why supracondyloid osteotomy is preferred are fullystated. The main advantages of this method are, that itdoes not open nor interfere with the articulation of the kneein any way, and that it deals directly with the most constantalteration in the shape of the femur. Dr. Macewen is a
disciple of Professor Lister, and is at pains to point out thatosteotomy cannot be done so thoroughly subcutaneously astenotomy, and that antisepticism has done for it what sub-cutaneous surgery did for tenotomy. Although in manyinstances air is effectually excluded from the wound, yetthere are others where this cannot be done ; and the resultsof compound fractures teach us that even where the woundin the soft parts is a clean incised one antiseptic surgeryholds out the most certain hope of perfect success. At anyrate, Dr. Macewen’s success, from the point of view of reco-very from the operation (the enly results given in the book),has been signal. He has operated on 330 patients, perform-ing 835 osteotomies, and has had three deaths, one fromtubercular meningitis, one from diphtheria, and one frompneumonia, which had set in prior to the operation ; in
eight cases only was there any suppuration, and in sevenof these the cause was known to be avoidable. Whereseveral osteotomies are demanded in the same patient-andDr. Macewen speaks of having made ten-they have allbeen done at one and the same time. The book mighthave been with advantage relieved of repetition in severalplaces, but we confidently recommend it to the study of allinterested in the removal of these common but often dis-astrous deformities.
1-ndex-C,atalogue of the Library of the Surgeon-General’sOffice, United States Army. Authors aud Subjects.Vol. 1. A-Berlinski. With List of Abbreviations ofTitles of Periodicals indexed. Washington: GovernmentPrinting Office. 1880.IN 1873 Dr. J. S. Billings published a catalogue of the
Library of the Surgeon-General’s Office (United States