726

ducing simple endocarditis and has collected twenty casesof ordinary cardiac disease in patients who have had ague, butwith no history of rheumatism.8 It is difficult to believe that inthe above case malaria eleven or twelve years previously canhave had anything to do with the fatal character of the heartlesions, but since there was no history of rheumatism I supposeDr. Duroziez would claim the case in support of his view. Thatthe patient was invalided for cardiac disease soon after havingsuffered from malaria is certainly singular. One cannot, how-ever, lay stress upon a negative history of rheumatism.

Medical Societies.MEDICAL SOCIETY OF LONDON.

.Aphasia due to a Fall on the plead.-Croupous Pneumonia inChildren.

pous Pneitntonia in

AN ordinary meeting of this Society was held on March 27th,Dr. De Havilland Hall, Vice-president, in the chair.

Dr. C. E. BEEVOR gave the details of a case of Aphasiadue to a Fall on the Head. The patient was a carpenteraged fifty, who fell from a scaffold fourteen feet on to the leftside of his head. He was unconscious for fifteen minutes,but soon afterwards he walked home, where he complained ofpain in the head and kept repeating the sentence, I I Had afall." The next day he was drowsy and could notanswer questions. There was no definite paralysis. Four

days later he came under observation, when the fol-

lowing symptoms were noticed as regarded his speech. Hecould speak voluntarily, but imperfectly, and talked a gooddeal of nonsense ; he could understand spoken commands andwrite spontaneously, but could not understand written com-mands, or repeat spoken words, or pick out objects named tohim, or write from dictation, or copy printed charactersin writing, and could not name objects shown to him, thoughhe could recognise their use. The patient recovered inabout three weeks. The nature of the lesion was probablymeningeal haemorrhage or simple concussion and was situatedprobably over the visual word-centre in the supra-marginaland angular gyri.-Dr. DE HAVILLAND HALL asked whetherthe sense of smell had been tested. If anosmia were presentand were unilateral it would probably not be discovered by thepatient.-Mr. SPENCER WATSON asked whether there were anyabnormal subjective sensations of smell andremarked that opticneuritis sometimes supervened in these cases. He inquired towhat Dr. Beevor attributed the recovery.—Dr. WALTER CARRcommented on Dr. Beevor’s remarks on the inability of theright hemisphere to discharge the functions of the left in casesof aphasia, and asked if an exception might not happen inthe case of very young children.-Dr. BEEVOR, in reply, said ’,that owing to the difficulty the patient had in expressing him- ’,self it was impossible to be sure about absence of smell; he ifnever complained of any perversion of that sense. There was Ino change in the optic discs. The recovery, he believed,followed on absorption of effused blood. He did not thinkthat even in children the right hemisphere was capable ofassuming the functions of the damaged left side.

Dr. FRANCIS HA WRINS read a paper on Croupous Pneu-monia in Children. The communication was based on theinvestigation of 220 cases, and the conclusions at which hearrived were fully illustrated by diagrams. He showed thatmost cases occurred during March, May and July; the fewestin January, August and December. They occurred as a ruleindependently of antecedent disease, and in the greatmajority the onset could not be attributed to any definitecause. Fifty of the cases occurred under the age of fiveyears, 120 between five and ten, and fifty between ten andfourteen. The disease was most frequent at the ages of fiveand nine respectively. Connecting his table with a furtherseries of over 700 cases occurring mostly in adults, compiledby Drs. Hadden, Mackenzie and Ord, he found that thefrequency of the affection gradually rose from the fifth to thetwentieth year. Its onset was usually sudden and the mostprominent symptoms of invasion were vomiting, cough andpain ; whilst rigors and convulsions were very infrequent andhemoptysis was extremely rare. An arrangement of symptomsinto groups showed that the nervous system was the onemost frequently affected. The average daily temperaturebefore crisis was 103° to 104° F., and in about one-seventhof the cases the fever assumed the hectic type, though

8 Gazette des Hôpitaux, 1870.

in only three was this found to be associated with the

presence of pus. The sixth was the commonest day ofcrisis, it being very frequent also on the seventh andJ

eighth days ; in basic pneumonia it was rather later thanin apical. He regarded the coarser signs of the disease, such3as dulness, tubular breathing &c., as of value more for esti-

mating the gravity of the case than for the mere recognitionof the disease; a dull tympanitic note was often presentbefore any marked variations in the breath sounds were dis-cernible. Out of 146 cases the base of the lung was attacked ir,69, the apex in 45, and in the remainder the primary Eeat of the-disease was at other points. The most rapid respiration noticed’was 68; typical rusty expectoration was present in sevencases, the youngest being aged six. Pleurisy coexisted insixteen cases, pus being removed from the chest in three.Pulmonary gangrene occurred once. An endocardial bruitoriginated during the course of the disease in six casesand pericarditis in one. Albuminuria supervened in sevencases and herpes in thirty-six, the latter affection being inone case on the arms. Delirium was rather more frequentlyassociated with apical than with basic pneumonia. As te.treatment he thought that ice if used in a left-sided pneumonia.might so slow the heart as to give rise to dangerous sym-ptoms. With regard to alcohol, discretion was required ir,selecting those cases in which its exhibition was needed andthose from which it should be withheld.-Dr. DE HAVILLAND>HALL asked Dr. Hawkins whether he had any figures showingthe relative frequency of croupous and catarrhal pneumonia .in many of the croupous cases there was cerebral complica-tion.-Dr. ALEXANDER MORISON thought that in some caseshe had seen pneumonia develop as a metastasis. To controlthe heart, it was of equal efficacy to apply the ice to the’forehead as to the chest. He considered that the admini-’stration of alcohol required great care, as it blunted the’reflex sensibility of the nerve centres. The action of digitalis.in this malady was less unfavourable in children than it was.in adults.-Dr. PASTEUR spoke of the difficulty in discrimi-nating some of the less marked cases from lobular pneu-monia.-Dr. BRAIDWOOD asked if there were any distinctive-clinical symptoms which would aid the separation of the-catarrhal cases. The onset, he thought, was usually gradual.Cough was not a valuable symptom, as children repressed it,and the temperature was not of much help. Assiduous.

poulticing was better than ice as a measure of treatment,and alcohol was of value chiefly as a sedative.-Dr. W. CAREremarked on the variations in type seen in children and onthe very rapid fall of temperature which often accompaniedthe crisis. As the prognosis was so good, only expectantr,treatment was needed.-Dr. HAWKINS briefly replied.

CLINICAL SOCIETY OF LONDON.

Pserdo-bulbar Paralysis. -Epithelioma if -Lip.-Modifiet?Pirogo$’’s Operation.-Patent Meckel’s Divertieulumc.--Fracture of b’kull-Exeeptional cases of PeripheralNellritis.-’1reatment of xShocla by Transfusion.A CLINICAL meeting of this Society was held CD

March 24th, the President, Sir Dyce Duckworth, in the-chair.

Dr. NEWTON PITT showed a case of Pseudo-bulbar

Paralysis in a man ; it was probably of cerebral origin.Mr. BARKER showed an exceptional case of Epithelioma of

the Lip. The disease, starting at the angle, had spread alongboth the upper and lower lips and there were no signs ofsimilar growth commencing at the opposite angle. Theman had been the subject of syphilis and was very muchaddicted to chewing tobacco. There were some patches ofleucoplakia on the tongue. Its malignant nature was provedmicroscopically.Mr. BARKER likewise brought a man on whose foot he-

had operated according to Le Fort’s Modification of Pirogoff’sMethod. The advantage was the early date at which the-patient was able to bear his weight upon the stump, it beingonly seven weeks since the operation.Mr. BATTLE exhibited a female infant with a Polypoid-

Extrusion at the Umbilicus. At its apex was a minuteorifice from which escaped a small quantity of faecal matter.The protruded portion proved to be the mucous membrane ofMeckel’s diverticulum. The bowels acted normally, showingthat the gut below the diverticulum was properly developed.The existence of this condition in the female had been