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496 


PROGRESS .OF MEDICAL SCIENCE. 


the second case the wrists and the tibio-tarsal articulations were quite pain¬ 
ful. In the third patient the lesions were confined to the distal phalanges of 
the fingers, but were well marked. Tn these cases the lesions resembled 
those described by Marie under the name of ostto-arthropathie kyperlrophianie 
pneumique; but a like explanation could not here be invoked, since In the 
second case these lesions were very marked, while the hypertrophy of the 
liver and spleen was too slight to interfere sufficiently with the activity of 
respiration. 

A third point to which attention is directed is the retardation in develop¬ 
ment manifested by Buch patients. This was especially noticeable in a youth 
of nineteen years, whose disease began at seventeen years of age; his height 
and weight were much inferior to those of most young men of his age, be¬ 
ing about the average of a boy of fourteen or fifteen years; he was beardless, 
and upon the pubes and in the axilla? the hair was rudimentary; the limbs 
were slender and the muscular system weak. 

Baynaud'b Disease in a Child with Hereditary Sypott.tr 

Krisowski ( JahrbuchJKinderkeilk., 1895, Bd. xl. S. 57) reports a case of 
local asphyxia and symmetrical gangrene in a child of three years of age 
suffering from hereditary syphilis. For three months previous to his first 
observation local asphyxia of the fingers and tips of the ears occurred when¬ 
ever he was taken out into the open air. The parts became cadaveric in hue 
during the exposure, and then, after returning to the house, took on a 
violaceous tint, which after some hours gradually gave place to the normal 
coloring. The reaction was, as is usual, attended with considerable pain. 
These paroxysms had occurred for two months, when, after an exposure, the 
discoloration of the ears did not subside, and vesicles appeared upon the 
superior border, to be succeeded by plaques of gangrene the size of a bean, 
occupying upon each ear a symmetrical area of the superior border and ex¬ 
tending upon the concave face of the pinna. The skin alone was in¬ 
volved. Taking into consideration the diathesis of the patient, the author 
began specific treatment (mercurial inunctions and potassium iodide), which 
produced a rapid cure. 


Hydronephrosis of Congenital Origin in a Child. 

Martin, of Geneva {Revue de Chirurgie, 1895, No. 4, p. 324), reports the 
observation of a boy of two and one-half years brought to the hospital for 
a progressive enlargement of the abdomen. A rounded tumor occupied 
the left hypochondriac, umbilical, and hypogastric regions, and extended 
several fingers’ breadths beyond the median line. The growth appeared dis¬ 
tinctly limited and separated from the liver by a furrow. Fluctuation was 
distinct. Puncture with the aspirator-needle gave issue to 600 grammes of 
clear, transparent fluid containing urea and cellular elements of the kidney. 
Nephrectomy was accordingly done. The cystic tumor, about the size of a 
child’s head, contained about a litre of liquid. The opening of the ureter 
was found at the lower portion of the sac. It was exceedingly narrowed, 
scarcely permitting the passage of a very fine probe, and passed very obliquely 



PEDIATRICS. 497 

through the wall of the sac. To this excessive narrowing of the ureter the 
author attributes the causation of the hydronephrosis. 

Multiple Angiosarcomata in a Newborn Infant. 

Kaeewski ( Revue Mensuclle dcs Maladies dc VEnfance, July, 1895) reports 
the unique case of a newborn infant that presented over the entire surface 
of the body small, soft, subcutaneous tumors, which had no connection with 
the bloodvessels or nerves. These growths gradually increased in size until 
at the age of four months they reached the size of the infant’s fist; the skin 
covering them was marked with dilated bloodvessels. One of the tumors, 
extirpated for examination, rapidly recurred; sections of the growth showed 
the structure of an angiosarcoma. Though the child had developed nor¬ 
mally up to this age, a marked degree of leucocytosis had existed for some 
time, the white corpuscles numbering three times the normal. The author 
regards the case as demonstrating that sarcoma may take its point of origin 
from the adventitious tunic of the bloodvessels, a question which up to the 
present has been in dispute. 

Retropharyngeal Abscess subsequent to Mumps. 

Hand (Archives of Pediatrics, July, 1895) reports a case of mumps in a boy 
of twenty-two months, the subsidence of the parotid inflammation being fol¬ 
lowed by enlargement of the lymphatic glands at the angles of the jaw, by 
an extremely irregular fever, and by intense anaemia. No cause could be 
assigned for the persistent temperature-elevation, which followed the hectic 
type, until about two weeks after the onset of the parotitis, when the pre¬ 
sumptive diagnosis rested between tuberculosis and retropharyngeal abscess. 
Physical signs of either disease, however, were wanting, but attacks of cyano¬ 
sis and trouble in swallowing now began to be noticed. The pharynx, ex¬ 
cept for slight catarrh, exhibited no abnormality, and continued so for eleven 
days longer, when after an interval of forty-eight hours between visits a 
fluctuating swelling was observed nearly occluding the pharynx. Incision of 
the abscess was followed by rapid subsidence of symptoms, convalescence 
being interrupted only for a day by incipient mastoiditis. 

The case is noteworthy for the slow development of .the abscess, since the 
process in children is rarely prolonged beyond a week. In Hand’s case a 
hectic type of fever was recorded for fully three weeks, and no cause for it 
could be assigned until the abscess rather suddenly made its appearance. 

Suppression of Urine in Diphtheria. 

Wilde (British Medical Journal , May 11, 1895) records three cases of 
pharyngeal and nasal diphtheria in which death resulted from suppression of 
urine. The observation is of interest as bearing upon one of the objections 
recently raised against antitoxin, since two of the cases were treated before 
antitoxin was in general use, and the third, although clinically indistinguish¬ 
able from true diphtheria, was not bacterioscopically confirmed, and the 
patient therefore was not injected. 

Few deductions, the author remarks, can be made from such a small series