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929 and the coroner refused to allow the solicitor to pursue this line further without notice. The solicitor called another practitioner (Dr. W. H. Cooke), who said that he considered that a person dying from sudden cardiac failure would not get up after having fallen down. In the end the jury returned a verdict of death from disease of the heart, but whether accelerated by shock of any kind there was no evidence to show. We think everyone will agree that the coroner deserves the thanks of the profession for the way in which he conducted this inquiry. Here were two medical men giving evidence on the same questions and taking an apparently opposite view, but, as the coroner said in summing up the case, Dr. Cooke had not attended the post-mortem examination, but simply gave his evidence on generalities. As to the verdict, he said, they might return one absolutely in accordance with the evidence of Dr. Heathcote. This the jury proceeded to do and we think everyone will agree with it. SMALL-POX IN CYPRUS. According to a communication from Reuter’s agent at Larnaca, published in the Tinzes of the 2nd inst., an epidemic of small-pox broke out towards the end of last month in Cyprus and was especially severe in the Turkish quarter of Larnaca, other parts of the town having been likewise attacked. The appearance of the disease in Larnaca was soon followed by an exodus of people from that place to other towns and villages in the island, and it is feared that the disease disseminated in this way may soon become widespread unless prompt and stringent precautions are taken. The disease is stated to have been introduced by a Turkish family from B6iifit. Very inadequate means for the isolation of the sick, and those of the most primitive kind, exist in Cyprus as may well be imagined; there is a paucity also of medical attendance ; and we know next to nothing of the condition of the popula- tion of Cyprus as regards vaccination. It seems probable that the island will furnish another object lesson of what the ravages of small-pox may effect among an unprotected population. There are some advantages in living under British rule under such circumstances as these, for we do possess laws for the repression of contagious disease and the machinery for practically applying them. VARICELLA GANGRÆNOSA. OUR knowledge of varicella gangraenosa is still so incom- plete that every well-recorded case is of interest. In the September number of the Archives of Pediatrics are given two good examples of the disease. The first is described by Dr. William F. Lockwood, of Baltimore, and is accompanied by a photograph. A well-nourished female child, aged two years, exhibited the eruption of varicella. Next day a wide zone of dusky red dermatitis occupied nearly the whole surface of the trunk. Rapid ulceration of the spots within this area ensued. The contents of many of the vesicles became hasmorrhagic. Bleeding from the mouth and nose occurred and blood was extravasated in the skin over the pubes and about the genitals. The gangrenous spots varied in depth, and in size from a pea to a surface measuring 1 in. by 2 in..They often occurred where there were no varicella vesicles. On the trunk were large patches where the epidermis only was removed, exposing purplish dry surfaces. These were due to the dermatitis, and did not radiate from the chicken-pox vesicles. The deeper spots showed a dry, hard, black eschar in the centre, an ulcerating border, and an elevated inflamed edge. The left eye was closed from swelling and ulceration of the upper lid, and there was free purulent discharge from between the lids. The child emitted an extremely fetid odour. Death took place on the eighth day, apparently from broncho-pneumonia ; but satis- factory examination of the chest was not possible. The second case, described by Dr. Lewis Mann Silver, of New York, was that of a boy in good condition, aged two years. The illness began with diarrhoea, which was followed by a temperature of 103° F., lethargy, and a convulsion. On the fourth day the body was covered with the characteristic rash of varicella. The mucous membranes of the mouth and conjunctiva were congested. On the third day of the eruption circles of congestion from 4 in. to t in. in width were noticed around several of the spots, which had become black and depressed in the centre. Next day three gangrenous areas, measuring from 1 in. to 22 in. across, appeared on the neck. On the following day both eyelids were so much swollen that they could not be opened, and there was a profuse discharge of blood and serum from the mouth and nose. The urine contained abundant albumin and numerous granular casts. The child died in the evening soon after a convulsion. It is curious that varicella, the mildest of all the infectious diseases, should present such a grave complication. What explanation can be offered ? Mr. Hutchinson, who first described the disease, attributed the occurrence of the gangrene to idio- syncrasy, as it usually occurred in healthy children. Dr. Barlow, however, denies this and asserts that in none of his cases were the children healthy. A second infection by some microbe supervening on the varicella has also been offered as an explanation, but evidence on this point is wanting. ___ EXACT LOCALISATION AND MEASUREMENT BY THE X RAYS. As most workers with the Roentgen rays know it is often very difficult to ascertain by the photographs they produce the exact locality of foreign bodies embedded in the tissues. The x ray photograph fails to give any definite information as to the exact position and size of the foreign body, and the surgeon when exploring for it has met with dis- appointment and dissatisfaction because he may have caused his patient pain without discovering the locale of the foreign body. This has detracted very considerably from the value of x rays in surgical work. A method, therefore, which ensures the exact localising of the foreign body in both a vertical and a horizontal plane and the exact determination of its size will be of immense service. We hope shortly to bring to the notice of our readers an account of this method which hag been carefully elaborated by Dr. W. S. Hedley and Mr. Mackenzie Davidson. For the present all we need say is that the method of measurement employed renders the x rays a really accurate means of locating the position and size of foreign bodies in the tissues. At a demonstration at which we were present the results were satisfactory and convincing both as to the practicability and utility of the method, while it relieves the patient of any unnecessary inconvenience and detention. SURGICAL SYMPTOMS IN CONNEXION WITH FILARIA SANGUINIS. AT a recent meeting of the Bombay Medical and Physical Society Surgeon-Lieutenant-Colonel W. K. Hatch called attention to the enlargement of various lymphatic glands and the varicose state of the lymphatics of the spermatic cord which are met with in cases of filaria sanguinis. A full description of the former of these conditions has hardly, he said, been given by any writers with the exception of Dr. Patrick Manson and the late Dr. Vandyke Carter. The gland usually affected are those in the groin, and next in order of frequency the axillary, then the iliac glands, and very rarely those of the neck. The glands have usually a soft, doughy feel and when small can be made almost to disappear, but when the pressure is removed they gradually resume their
Transcript of EXACT LOCALISATION AND MEASUREMENT BY THE X RAYS.
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and the coroner refused to allow the solicitor to pursue thisline further without notice. The solicitor called another
practitioner (Dr. W. H. Cooke), who said that he consideredthat a person dying from sudden cardiac failure wouldnot get up after having fallen down. In the end the juryreturned a verdict of death from disease of the heart, butwhether accelerated by shock of any kind there was noevidence to show. We think everyone will agree that thecoroner deserves the thanks of the profession for the way inwhich he conducted this inquiry. Here were two medicalmen giving evidence on the same questions and taking anapparently opposite view, but, as the coroner said in summingup the case, Dr. Cooke had not attended the post-mortemexamination, but simply gave his evidence on generalities.As to the verdict, he said, they might return one absolutelyin accordance with the evidence of Dr. Heathcote. This the
jury proceeded to do and we think everyone will agree with it.
SMALL-POX IN CYPRUS.
According to a communication from Reuter’s agent atLarnaca, published in the Tinzes of the 2nd inst., anepidemic of small-pox broke out towards the end of last
month in Cyprus and was especially severe in the Turkishquarter of Larnaca, other parts of the town having beenlikewise attacked. The appearance of the disease in
Larnaca was soon followed by an exodus of people fromthat place to other towns and villages in the island, andit is feared that the disease disseminated in this waymay soon become widespread unless prompt and stringentprecautions are taken. The disease is stated to have beenintroduced by a Turkish family from B6iifit. Veryinadequate means for the isolation of the sick, and thoseof the most primitive kind, exist in Cyprus as may well beimagined; there is a paucity also of medical attendance ;and we know next to nothing of the condition of the popula-tion of Cyprus as regards vaccination. It seems probablethat the island will furnish another object lesson of what theravages of small-pox may effect among an unprotectedpopulation. There are some advantages in living underBritish rule under such circumstances as these, for we dopossess laws for the repression of contagious disease and themachinery for practically applying them.
VARICELLA GANGRÆNOSA.
OUR knowledge of varicella gangraenosa is still so incom-plete that every well-recorded case is of interest. In the
September number of the Archives of Pediatrics are given twogood examples of the disease. The first is described by Dr.William F. Lockwood, of Baltimore, and is accompanied by aphotograph. A well-nourished female child, aged two years,exhibited the eruption of varicella. Next day a wide zone ofdusky red dermatitis occupied nearly the whole surface ofthe trunk. Rapid ulceration of the spots within this areaensued. The contents of many of the vesicles became
hasmorrhagic. Bleeding from the mouth and nose occurredand blood was extravasated in the skin over the pubes andabout the genitals. The gangrenous spots varied in depth,and in size from a pea to a surface measuring 1 in. by2 in..They often occurred where there were no varicellavesicles. On the trunk were large patches where theepidermis only was removed, exposing purplish dry surfaces.These were due to the dermatitis, and did not radiatefrom the chicken-pox vesicles. The deeper spots showed adry, hard, black eschar in the centre, an ulcerating border,and an elevated inflamed edge. The left eye was closedfrom swelling and ulceration of the upper lid, and there wasfree purulent discharge from between the lids. The childemitted an extremely fetid odour. Death took place on theeighth day, apparently from broncho-pneumonia ; but satis-factory examination of the chest was not possible. The
second case, described by Dr. Lewis Mann Silver, of NewYork, was that of a boy in good condition, aged two years.The illness began with diarrhoea, which was followed by atemperature of 103° F., lethargy, and a convulsion. On thefourth day the body was covered with the characteristic rashof varicella. The mucous membranes of the mouth and
conjunctiva were congested. On the third day of the
eruption circles of congestion from 4 in. to t in. in widthwere noticed around several of the spots, which hadbecome black and depressed in the centre. Next daythree gangrenous areas, measuring from 1 in. to 22 in.across, appeared on the neck. On the following dayboth eyelids were so much swollen that they could notbe opened, and there was a profuse discharge of blood andserum from the mouth and nose. The urine containedabundant albumin and numerous granular casts. The childdied in the evening soon after a convulsion. It is curiousthat varicella, the mildest of all the infectious diseases,should present such a grave complication. What explanationcan be offered ? Mr. Hutchinson, who first described the
disease, attributed the occurrence of the gangrene to idio-
syncrasy, as it usually occurred in healthy children.Dr. Barlow, however, denies this and asserts that in
none of his cases were the children healthy. A second
infection by some microbe supervening on the varicella hasalso been offered as an explanation, but evidence on this
point is wanting. ___
EXACT LOCALISATION AND MEASUREMENT BYTHE X RAYS.
As most workers with the Roentgen rays know it is oftenvery difficult to ascertain by the photographs they producethe exact locality of foreign bodies embedded in the tissues.The x ray photograph fails to give any definite informationas to the exact position and size of the foreign body, andthe surgeon when exploring for it has met with dis-
appointment and dissatisfaction because he may have causedhis patient pain without discovering the locale of the
foreign body. This has detracted very considerably fromthe value of x rays in surgical work. A method,therefore, which ensures the exact localising of the
foreign body in both a vertical and a horizontal plane andthe exact determination of its size will be of immenseservice. We hope shortly to bring to the notice of our
readers an account of this method which hag been carefullyelaborated by Dr. W. S. Hedley and Mr. MackenzieDavidson. For the present all we need say is that the
method of measurement employed renders the x rays a reallyaccurate means of locating the position and size of foreignbodies in the tissues. At a demonstration at which we were
present the results were satisfactory and convincing bothas to the practicability and utility of the method, whileit relieves the patient of any unnecessary inconvenience anddetention.
SURGICAL SYMPTOMS IN CONNEXION WITHFILARIA SANGUINIS.
AT a recent meeting of the Bombay Medical and PhysicalSociety Surgeon-Lieutenant-Colonel W. K. Hatch calledattention to the enlargement of various lymphatic glandsand the varicose state of the lymphatics of the spermaticcord which are met with in cases of filaria sanguinis. A full
description of the former of these conditions has hardly, hesaid, been given by any writers with the exception of Dr.Patrick Manson and the late Dr. Vandyke Carter. The glandusually affected are those in the groin, and next in order offrequency the axillary, then the iliac glands, and very rarelythose of the neck. The glands have usually a soft, doughyfeel and when small can be made almost to disappear, butwhen the pressure is removed they gradually resume their
