Clinical Notes: from to the Afternoon
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1503 through a large series of monkeys. Two hours after inocu- destruction of the cells of the anterior cornu, and small lation the infected monkey was exposed to the bites of about haemorrhages in the anterior and posterior cornu. 300 stomoxys recently collected in Washington. Thereafter These results, in confirmation of those announced by Dr. until death, on Oct. 8th, this animal was exposed daily Rosenau, would seem to demonstrate conclusively that polio- for about two hours to the bites of the same flies, plus myelitis may be transmitted to monkeys through the agency additional fresh stomoxys added from time to time as caught. of the stable fly (Stomoxys calcitrans). It remains for further This monkey (No. 242) developed characteristic complete work to decide whether this is the usual or the only method paralysis on the afternoon of Oct. 7th and died at 2 A. M. of transmission in nature. on Oct. 8th. Another monkey (rhesus No. 246), similarly inoculated on Oct. 5th, was then exposed daily to the bites of the same flies, beginning on Oct. 7th. This monkey developed paralysis on the morning of Oct. 9th, soon becoming completely paralysed and dying that Clinical Notes: from to the afternoon. Thus, Oct. 4th 9th, inclusive, AND flies used had access to two monkeys inoculated with polio- MEDICAL, SURGICAL, OBSTETRICAL, myelitis, first, rhesus No. 242, then rhesus No. 246. THERAPEUTICAL. It may be noted that the incubation period in both these monkeys was very short-four days from inoculation to the development of paralysis. A CASE OF APPENDIX ABSCESS IN A HERNIAL SAC. Oct. two fresh No. 243 Beginning 4th, monkeys (rhesus BY H. W. WEBBER, M.S., M.D. LOND., F.R C.S. EDIN., and Java No. were for about two hours 241) exposed daily SURGEON TO THE SOUTH DEVON AND EAST CORNWALL HOSPITAL, to the bites of these same flies ; and beginning Oct. 5th a PLYMOUTH. third fresh monkey (rhesus No. 244) was similarly exposed. All three of these animals subsequently developed sym- THE of the in a hernial sac is not ptoms of poliomyelitis, as follows : Java No. 241 was presence appendix uncommon, and it has even been found on the left side, but found completely paralysed on the morning of Oct. 12th, an abscess as far as I can and died a few hours later. At necropsy tubercles were appendix is, ascertain, decidedly found in the lungs, liver, and spleen. Rhesus No. 244 rare. The following are the notes of the case. A man, 80 was admitted on 29th, showed paralysis of the hind legs on the same day aged years, Sept. 1912, with a in the 12th), but was, nevertheless, to the bites painful, tender, elongated swelling right groin, (Oct. exposed again his 99° F. and 82. He had been of the from 10 A.M. till 2 P.M. At 3 P.M. the temperature being pulse stomoxys ill for three with in the and animal, being almost completely paralysed, was chloro- days pain right inguinal region the of a from the external formed. At tubercles were found in the development swelling extending necropsy downwards to the scrotum. lungs, liver, and spleen ; however, apparently not ring On admission he was anaesthetised and an sufficient to have been the cause of death. Rhesus immediately incision made into the which was found to be No. 243, which had appeared well on the morning of swelling, of nature, downwards to and Oct. 13th, was found at 4 o’clock that afternoon to have a inflammatory extending partial paralysis of the right hind leg. The following apparently involving the testicle. On deepening the incision two or three drachms of thick were found. the hind and fore were almost com- pus morning legs right leg The nature of the condition of not pletely paralysed. By 3.30 P.M. the neck also was pai alysed things being apparent, and the intercostal muscles somewhat affected. The animal it was decided to remove the testicle and cord with the them and on was then chloroformed. At necropsy the internal organs thickening involving complete, dissecting up the cord it was found that the was in the appeared normal, except the spinal cord, which was oedema- appendix present middle of the mass and was the source of the Its base tous, the grey matter being congested. Sections of the cord, pus. divided and in caecum in examined, showed well-marked lesions was, therefore, inverted the the histologically typical usual mass testicle of round-cell infiltration, foci of manner, the inflammatory and removed, poliomyelitis, perivascular and the canal closed with mattress sutures. dense infiltration in the grey matter of the anterior horn, and inguinal catgut A was inserted and out the destruction of some of the motor neurons. The drainage-tube brought through histologic scrotum. The of the wound was somewhat examination of the cords of Nos. 241 and 244 has healing delayed monkeys by the infection of the tissues which had taken not been but it it believed, on the clinical necessarily yet completed, but was Oct. 21st. evidence, that they died from poliomyelitis. place, finally completed by To summarise, three monkeys exposed daily to the bites of Plymouth. several hundred which at the same time were stomoxys, A CASE OF KELOID OF THE EYELIDS ASSOCIATED allowed daily to bite two intracerebrally inoculated monkeys, developed quite typical symptoms of poliomyelitis eight, IN ITS ONSET WITH MEASLES. seven, and nine days respectively from the date of their first BY JAMES ALEXANDER WILSON, M.D. GLASG., .exposure. ASSISTANT SURGEON, OPHTHALMIC DEPARTMENT, ROYAL INFIRMARY, In order to confirm the diagnosis of poliomyelitis in rhesus GLASGOW. No. 243, 1 c. c. of an emulsion of the cord of this monkey was injected intracerebrally on Oct. 14th into a healthy A BOY, aged 4 years, was admitted to Belvidere Fever monkey (rhesus No. 250). This animal recovered promptly Hospital on March 14th, 1912, suffering from measles. The from the operation and remained apparently quite well illness is said to have begun on the 6th with the usual till the morning of Oct. 17th, when a partial paralysis symptoms-sneezing, sore eyes, &c. Dr. J. J. Sinclair, of the right fore leg was noted, progressing somewhat resident assistant physician, reports: "The condition on during the day. On the morning of Oct. 18th both fore admission was as follows :-Left eye : eyelids greatly swollen, legs were completely paralysed and the hind legs weak. so that they could only be opened with difficulty. Both In the afternoon of the same day the right hind leg eyelids and the upper part of the cheek were raw, as if was completely paralysed, the left very weak, and the neck from the application of an irritant. The conjunctiva was paralysed. The monkey died at 10.30 P.M., and was imme- chemotic and there was a purulent discharge. The right diately placed on ice until necropsy could be made at 9 A. M. on eye showed the same condition, but it was less marked." Oct. 19th. At the necropsy there was found some congestion On April 9th there is a note as follows: I I For the past of the lower lobe of both lungs, most marked on the left three or four days the patient has opened the right eye side, upon which the animal had been lying after paralysis voluntarily. The left eye is still kept closed and no proper developed. The meninges of the cord were markedly con- view can be obtained ; the conjunctiva, however, is con- gested. On section, the cord appeared oedematous and the gested and some opacity of the cornea is seen." The grey matter congested, showing minute haemorrhages. The patient seems to have progressed favourably, and on dis- site of inoculation appeared normal except for a slight clot. missal the parent was recommended to seek advice at an " Cultures from this site have shown no growth. The other eye hospital." organs were normal in appearance. Histologic examination The boy was brought to the Ophthalmic Institution on of the cord showed lesions characteristic of poliomyelitis, July lst, 1912, and came under my care. There is a hori- intense congestion and perivascular infiltration, foci of zontal band 1 inch in length along the right upper lid. It is round-cell infiltration here and there in the grey matter, red, raised, and looks like a scar produced by a recent burn. 1504 There are one or two small round patches on the right cheek and one on the right ear just behind the meatus externus. The left eyelids are much worse than the right. There is a Societies. red, fleshy-looking band which begins at the inner canthus Medical and curves outwards in the upper lid. It sends three short arms upwards into the eyebrow, and there is some ROYAL SOCIETY OF MEDICINE. irregular scarring at the outer part of the lid. On the lower lid there is a band 11 inches long extending from the cheek upwards and outwards to the outer canthus, connecting SECTION OF THE HISTORY OF MEDICINE. with the scarring on the upper lid. There is also a band Election of Oeers.-1 DowmS’icrz-e llaa2cseritof William - Py.—CoMiMMs/?’<?/? History of uledicine to Problem of Transmission of Tyh2cs.-Contenporccry Portra.2ts of John Banister and William Iarzey.-E’x7cibiti.oa of Itrcli.an Diplomas.. ’ THE inaugural meeting of the Section of the History of Medicine was held in the West Hall of the Royal Society of Medicine on Nov. 20th. The chair was taken by Sir FRANCIS CHAMPNHYS, Bart., President of the society, who declared the section duly constituted.