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in the medulla, thus giving rise to the functional imperfections
seen in nodding spasm. Its frequent association with other
disorders of maldevelopment, such as rickets and the like, would
help on this h3rpothesis. The partial recurrence of the head
movement in the eldest child caused by fright might be looked
upon as a choreiform disorder induced in a congenitally weak
coordination mechanism. It would be interesting to note
whether infants once affected with nodding spasm more com*
monly develop chorea later in life. This observation would be
doubly interesting in this instance as all the children shown
here are from the colored race, one commonly supposed to be
infrequently attacked by chorea.


Dr. Ward Bryant Hoag presented a girl, eight years old.
Her birth was normal and easy. She was breast-fed and was
considered to be a normal child up to the age of fourteen months,
at which time the mother acknowledged that she had been fed
indiscretely. From sixteen to twenty months of age she was
very ill most of the time. It was then noticed that her heart
bear very forcibly and she was taken to a physician. She was
very short of breath, had moist r^les in her chest, a certain
amount of edema of the lungs, and she could scarcely walk
across the floor. She was allowed to do as she wished. Finally
she was put to bed and confined there for a number of weeks.
When she was allowed to be up, her activities were very carefully
supervised and she became very much improved. For instance,
when going up stairs, she was required to count ten on every
step. Her fingers were not clubbed, she was now not suffering
from any shortness of breath, and she was having a good time
generally. A loud thrill was heard over the heart, there was but
little hypertrophy, the apex being very near the normal point.

Dr. Roland G. Freeman believed this to be a case of con-
genital heart disease which had not caused any manifestations
until the child had become sick.

Dr. William P. Northrup said that there was no doubt in his
mind but that this was a case of congenital heart disease; it had
all the characteristics, with all the signs but without the cyanosis.
He had made autopsies upon nine similar cases, three of which
had been under observation at the Foundling Hospital. In each
case there was a narrowing of the pulmonary orifice with a
defective septum ventriculorum.

friedrich's ataxia: two cases.

Dr. Edward Livingston Hunt presented two patients,
sisters, daughters of Russians. The mother had three brothers
and sisters, and the father was one of nine children. All had

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lived mostly out of doors. The ages of these two daughters
was eleven and three and a half years. The history of the
pregnancy and labor was absolutely normal in each case. There
was no history of tuberculosis, alcoholism or syphilis. The
older child began to walk late and since the age of about five
years walked with difficulty. The difficulty in walking had
greatly increased and now she could not walk alone. There
was no knee-jerk. There was a lateral curvature of the spine.
She had very marked choreiform movements. She had no
nystagmus. The younger child began to have difficulty in
walking a few months ago and this was the only symptom
present. The unusual feature in this case was the early age at
which the disease appeared; when two and a half years of age
she developed ataxia. The mentality of both children was very
good. In the older child there was clubbed feet, with a marked
prominence of the instep. Dr. Htmt said that there had been
only about two hundred of these cases reported.

Dr. L. Pierce Clark said that the chief interest to him in the
subject under presentation and discussion was that we were now
in a position to refute the theory propounded by Oppenheimer
and his school that Friedrich's ataxia was an hereditary luetic
affection. The Wassermann and Noguchi blood tests in these cases
are entirely negative. The theory of Edinger and Gowes was
that abiotrophy best explained the disorder here as in muscular
dystrophy, where blood tests for hereditary lues were also
negative. The theory maintains that certain parts of the body,
such as special muscle groups, nerve tracts, and gangli, have not
only a defective development, but also meet with an untimely

Dr. Richard B. Kruna believed that it would be reasonable
to attempt some forms of exercise in these cases, starting with
having the child instructed again as to the use of the muscles;
in fact, a system of reeducation.

Dr. Henry W. Frauenthal believed that this instruction
should be given with the child in front of a mirror; they should
to taught too to concentrate their minds on the work they were

Dr. Hunt said that the prognosis in these cases was not good,
for such patients generally died before they attained the age
of twenty-five years.


Dr. Godfrey R. Pisek said that this case, a girl of six years,
had been referred to him by Dr. Wynkoop, of Syracuse. There
was a younger child who was said to be in good health. The
patient was bom prematurely and weighed three and one-half
pounds at birth. With the exception of pneumonia at the age
of nine months and pertussis at the age of three years she had
had no serious illnesses until the present. A year ago she had a

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convulsion, and two months later, after a walk of a mile, she had
another, after which she was lame. Five months ago she had
another convulsion, after which she seemed to be in good health
except for the lameness. Questioning of the mother elicited
the fact that about three weeks after the birth of the child there
had been scaling of the palms of the hands and soles of the feet,
which promptly disappeared imder treatment. Prior to the
first convulsion the mother had noticed both mental and physical
deterioration. The mother learned that the father had a luetic
history and was treated on the advice of her physician during
her second pregnancy when she gave birth to a healthy, robust
boy. Physical examination of the child showed a fairly well
developed girl of six years. Her nutrition was not impoverished,
but there were marked circulatory disturbances, cyanosis of the
hands and feet, the skin of the feet being dry and atrophic.
When in the erect posture she assumed a leaning position from
the hips. She could stoop and walk alone, but preferred a help-
ing hand. In the sitting posture she had a relaxed spine. She
also had inguinal adenitis. The left median incisor tooth was
notched and loose and the lower median incisors notched. There
was general caries of the teeth. The heart sounds were normal,
liver one inch beneath the right costal margin. The spleen was
not palpable. There was spasticity of the lower extremities,
exaggerated knee-jerk and Kemig's sign was present and posi-
tive. There was some hyperesthesia bver the body; no anesthetic
zones found. The language was repetitional and somewhat
incoherent. Examination of the eyes showed a peppery granular
appearance around the macular region and a pale disc. The
condition was descending atrophy of the optic nerve due to
degeneration compression. A tentative diagnosis of gumma of
the base of the brain was made based upon clinical symptoms
as at that time neither the father nor the mother admitted luetic
infection. Later the father admitted having had syphilis. The
Noguchi reaction was negative for the father, but the mother was
distinctly positive. The diagnosis was made upon the complex
multiform character of the symptoms, both motor and sensory,
with physical changes which were startling. From the m6tor,
sensory and ocular symptoms one could conclude in this case that
there was a diffuse gummatous infiltration of the meninges.
The question of the relation of the mother to the condition was
interesting and important. It was not yet clearly established
whether a syphilitic child could be born of a mother who was
herself free of lues. Thomsen and Boas had examined a suf-
ficiently large number of cases of hereditary syphilis to make
their conclusions of some value and they conclude that a positive
Wassermann reaction in the mother lessens the possibility of the
child being bom sound. Latent syphilis in children might give
a faintly positive reaction and the reaction might wholly fail
during the first month. The mothers who bore syphilitic
children were themselves to be looked upon as syphilitic if their

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blood gave a positive Wassermann reaction. Knoepfelmacher
concludes that the serum of mothers having syphilitic children,
whether they have had symptoms or not, whether they have been
treated for syphilis or not, give a very high percentage of comple-
ment fixation and that the mothers of children having syphilis
gave as high a percentage of positive Wassermann reactions as
did men who had reached the latent stage of the disease. A
positive Wassermann, if leprosy be excepted, must always mean
syphilis; but a negative or faintly positive Wassermann carried
with it no such weight. Furthermore, it was almost certain that
syphilis, and especially latent syphilis, might occasionally give
a negative result. Hence it would not be at all unexpected to
find that 40 per cent, of mothers, whether they have had symp-
toms or not, fail to show complement fixation. While it was too
soon to draw absolute conclusions serious doubts were thrown
on the correctness of the CoUes' law, and it might fairly be claimed
that it was only a question of time before the incorrectness of
the law would be established. At present it seemed highly
probable that the mothers of children with hereditary syphilis
were syphilitic also.

Dr. William P. Northrup said he was not so sure that this
was a case of gummatous infiltration of the meninges as it was
a proliferation of the connective tissue. He had seen many of
these cases with a thickened dura and pia but with no gummatous

intestinal infantilism of herter.

Dr. Roland G. Freeman referred to five cases reported by
Dr. Christian A. Herter in 1908, in which the symptoms were
arrested development of the body, marked abdominaJ distention
often with dilation of the abdominal veins over the upper part of
the abdomen. There was usually very marked fatigue and
moderate anemia. There was a tendency to looseness of the
bowels with occasional attacks of diarrhea, often with fatty
stools, though there might be but little fat in the food. These
cases were apt to have an excessive appetite and thirst, increased
secretion of urine and cold hands and feet. Symptoms of
rickets might be present. Herter found an absence of the
ordinary bacterial flora of the intestines of young children.
The organisms present were Gram positive, the prevailing organ-
ism being the bacillus bifidus of Tissier together with the bacillus
acidophilus and the bacillus infantilis. The bacillus coli and the
bacillus lactis aerogenes were infrequently found during the
active stage of this disorder. The amount of urine passed was
large; there was a rise in the ethereal sulphates, a pronounced
indicanuria and an excessive phenol and the presence of aromatic
oxyacid3. Herter found gelatine particularly useful in increasing
the weight in these patients. Dr. Freeman reported three cases
of this condition which he had seen recently. The first case

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had been under his care for eight months. She was three and
a half years old and had had frequent attacks of bowel trouble
and was greatly debilitated. No food had been found which
appeared to increase her weight until about a month ago when
she began taking buttermilk. She had gained two pounds and
there was an improvement in the character of her movements.
There has been a general improvement in her condition, though
an examination of the urine and feces shows the characteristic
condition described by Herter, and the administration of in-
testinal antiseptics had had no influence on the bacteria of the
intestines. The second case, a child of nineteen months, showed
the classical symptoms of this condition, and there were also
some colon baciUi present in the feces. This child had not
gained on any modification of milk that had been tried. She did
best on a preparation of dried skimmed milk to which a moderate
amount of fat was added in the form of cream. The third case
was a child seventeen months old who did well until last July,
when she had an attack of vomiting, diarrhea and fever;
similar attacks followed at intervals and she did not gain in
weight. Although many different foods had been tried and a
wet nurse had been secured there had been practically no increase
of weight since last July. This case approached the type of
intestinal infantilism described by Herter but was not char-
acteristic. The feces showed the characteristic bifidus which
was very abundant as well as the coli communis and some cocci.


Dr. John J. Moorehead presented a boy, seven years old.
He had been under Dr. Pisek's case before Dr. Moorehead saw
him. It was very difficult to obtain a satisfactory previous
history, the father not having a very definite knowledge of the
child's early history. It was learned, however, that the boy
appeared to be well until he was two years of age; he appeared
to be well although he had never walked. When the child
entered the hospital he had a typical spastic condition which
was most marked in the lower extremities, especially on the
left side. There was some spasticity of the upper extremities.
He was mentally active and bright. There was the character-
istic irritative condition of the reflexes, very marked knee-jerks,
ankle clonus and Babinski's. At the November meeting of the
Section on Pediatrics he heard of the technic employed by
Dr. Clark and Dr. Taylor in such cases, and decided that this
was a case for a similar operation. Accordingly, on February 5
a laminectomy was performed at the Red Cross Hospital, follow-
ing the technic laid down by Dr. Taylor. Because of the
little space between the transverse processes it was found
impossible to expose a sufficient amount of the cord to do a
hemilaminectomy; therefore they had to resort to a bilateral

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laminectomy. Digitation of the second, third and fourth left
lumbar posterior roots, and three upper right lumbar roots were
divided. There was nothing of interest in the postoperative
history of this case except that there was a rise of temperature
to 104, rapid respirations, and it was feared for a time that
pneumonia would develop. Four days after the operation,
however, the temperature was loi, and a satisfactory con-
valescence from the pneumonia, as well as from the operation,
followed. The spasticity became markedly lessened within
three days after the operation; the reflexes disappeared abso-
lutely and had not returned; this was true of the knee-jerks, the
ankle clonus and the Babinski. The postoperative history was
really unimportant. The operation had, without doubt, relieved
the spasticity to a considerable degree, and placed the boy in a
position for further orthopedic and educational means. The
general nutrition and tone of the lower extremities especially
had been much benefited by the work done.

Dr. Pisek said that when the boy entered the hospital he
knew that he was a fit case for operation, especially as the spastic
paraplegia was associated with a good mental condition. The
spasticity was very marked; the boy could walk only on his
toes, holding on to the bed or some other furniture.

Dr. Clark thought that Dr. Moorehead was to be con-
gratulated on the excellent clinical outcome in this case. Ortho-
pedic training could now be employed with great advantage.
He would advise a further resection of half of the* dorsal nerve
roots of the first and second sacrals in a year from the first
operation. His owji series of operated cases were making
excellent progress under physical training and would be presented
at a future meeting.

A "congenital FREAK."

Dr. Henry W. Frauenthal presented a child with con-
genital double club feet and hands, a congenital dislocation of
the hip on one side, and a knee which was at right angles to the
normal axis. As he termed the case, it was a "congenital

new signs of meningitis from FRENCH AUTHORS, WITH

Dr. William P. Northrup spoke of the new signs that he had
read from French journals and their application which he had
employed in three cases. He illustrated his remarks with
pictures. These were called ** identicale reflexes'* and ''contra-
lateral reflexes."

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Studies of the Diarrhea of Infants. — Elie Metchnikoff (Gaz,
mSd, de Paris, Jan. i, 1910) believes that bacteria are of great
importance in the causation of diarrhea in infants. To prove
this he has experimented on rabbits, causing diarrhea in them,
and later in chimpanzees, by injecting then with the infectious
material from a case of cholera infantum. These animals were
fed on the same materials which they had eaten with impunity
before the experiments, and we may conclude that the food had
nothing to do with the diarrhea; hence the bacteria must have
caused the disease. It is the Gram-negative organisms that
are found in these stools. The bacillus proteus is the most
frequent. In rabbits and chimpanzees this bacillus was found
in the stools and also in the blood. It is a tndy pathogenic
organism whose r61e it the diarrhea of infants connot be doubted.
We must now consider how it reaches the intestine of the child.
It is rarely found in cow's milk, but is present in the feces of
most animals, the upper layer of meats and cheese, and most
vegetables, fruits, and salads. From these it reaches the intes-
tines of adults and by contact with them is commtmicated to
infants. Flies aid in this dissemination upon food. Proteus
is well tolerated by adults, but causes diarrhea in infants.
Preventive measures include not only pasteurization of milk, but
sterilization of the hands of attendants, and careful washing of
fruits and vegetables in boiling water which kills this bacillus.
The cleansing of streets and destruction of flies are also important.

The Systematic Treatment of Infantile Bronchopneumonias
by Inhalations of Oxygen. — Weill (Lyon mid., Jan. 2, 1910) gives
the results of cases of bronchopneumonia in young children
treated with large and almost continuous inhalations of pure
oxygen; it is used not as a symptomatic treatment but as a
remedy for the specific infection, as an antiseptic for the air
passages. The technic is simple, without danger, and the
therapeutic results are claimed to be remarkable. Broncho-
pneumonia is a descending infection of the air passages from
infections of the nasopharynx, which are usually saprophytic.
The lesion is treated locally by the oxygen and the same time
the system is protected against the effects of the infection. The
author creates a veritable atmosphere of oxygen for the Itmgs,
the inhalations being repeated every hour or half hour. It may
also be used in bronchitis as a prophylactic against pneumonia,
and in fully developed pneumonia it should be continued some

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time after resolution is going on. The course of the disease is
shortened, and defervescence is rapid. Temperature is lowered,
pulse slowed, dyspnea relieved, and sleep induced by the in-
halations. They are given from rubber bags of oxygen with a
mask that covers nose and mouth.

Roseola Infantilis. — Doubtless many will recognize a type of
case discussed by John Zaliorsky (Pediatrics, Jan., 1910) who
feels convinced that there is a symptom-complex, a febrile
erythema, occurring mostly in infants, which deserves a place
outside of the erythema group of skin diseases, and to which
the name roseola infantilis was given by the older writers who,
however, did not differentiate this disease from rubella and
other skin diseases. The patient is almost always a child tmder
three years of age who is suddenly taken sick with high fever,
which continues for from two to five days. During this time
examination shows nothing else abnormal. The fever usually
ends by crisis on the fifth day and the child who has been drowsy
or very irritable sits up and commences to play. Coincident
with the drop in the temperature a morbilliform rash appears
on the face and neck and rapidly spreads over the body. The
eruption disappears in twenty-four to forty-eigth hours. There
are no sequelse. No desquamation follows the disappearance
of the rash. The temperature usually ranges between 102° and
105°, is continuous, with slight morning remissions, and is ac-
companied by extreme resUessness at night and drowsiness
during the day. The fever may disappear a few hours be-
fore the rash is observed. The morbilliform eruption is most
marked on the trunk, less so on the face. There is no crescentic
arrangement and the lesions are generally not elevated. There
are no catarrhal symptoms except congestion of the fauces.
Vomiting or diarrhea is only occasionally observed. The super-
ficial cervical lymph nodes are usually slightly enlarged. All
the writer's patients were artificially fed in whole or in part.
The disease is not contagious. Its active cause is tmknown,
but it is possible that it is intestinal intoxication.

The Cerebrospinal Fluid in Cerebrospinal Meningitis. — Ch.
Dopter (Prog, mid., Jan. 25, 1910) says that the special char-
acteristics of the cerebrospinal fluid in cerebrospinal meningitis
are of the utmost importance in the diagnosis of the disease.
The ideas given by the cytological, bacteriological, biological,
and chemical examination of the fluid should be considered as
evidence of the reactional phenomena going on in the cerebro-
spinal meninges. They give an exact idea of the anatomical
condition, the degree of the meningeal inflammation, the number
of microbes present, the course of the disease and the effects of
treatment, and show the necessity and value of further inter-
vention or the reverse. Dopter's investigations have shown the
following conditions in the acute stage; the liquid is turbid, the
intensity of the turbidity depending on the amotmt of inflam-
mation present; its color is gray or yellowish; microscopically

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it contains many cellular elements, most of them being poly
nuclears of all shapes, the protoplasm vacuolated, the nucleus
altered. There are some mononuclears, a few lymphocytes,
and large cells resembling endothelial cells. Bacteriologically
there are seen meningococci, single and in twos, some of them in-
tracellular. On the other hand, in some cases no meningococci
are foimd, and this negative evidence does not positively disprove
the presence of the disease. The precipito-reaction consists in
adding to centrifugalized cerebrospinal fluid antimeningococcic
serum and placing it in the incubator; after eight to fifteen hours
it becomes turbid through formation of a precipitate. The
deviation of the complement gives further information. The
fluid contains albumin. As the disease regresses, when treated
by the usual means, the fluid clears, polynucleosis lessens and
the germs disappear. When serum is injected these changes
occur much more quickly. There are many atypical cases in
which some of these phenomena are not present.

Double Infection with Measles and Scarlatina in Children. —
Brudzinski (Arch, de mid, des en/., Jan., 1910) considers the
consecutive occurrence of measles and scarlatina, more than
three days apart, and generally during convalescence from one
of the diseases, as simultaneous infections. The organism being
weakened by the disease which has already occurred is in some
instances more severely infected with the second disease, there
being apparently no protection by one against the other. There
is a great difference of opinion as to whether the second infection
is always more severe, and as to whether there are more com-
plications than usual in this case. The author reports and
analyzes the histories of cases seen at the Hospital in Lodz, where

Online Libraryof Rhodes. Spurious works AndronicusThe American journal of obstetrics and diseases of women and children → online text (page 106 of 109)