Scurvy in a child ten months old

Medical Times and Gazette. 248 MEDICAL AND SURGICAL PRACTICE. March S, 1873. tion of the scrotum, prepuce, and nates, from sitting on waterclosets on which carbolic acid had been spilled. While fully recognising its value as a disinfectant, it is evident that it should be only prescribed or applied under skilled supervision, and that it is highly dangerous for general use. Professor Wanklyn says truly—“ In selecting a disinfectant for general use, the point is to select a substance which shall be both effective and unobjectionable in other respects. Corro¬ sive sublimate is very effective, but it is very poisonous, and is on that account not fit for general use. The same remark applies to chloride of zinc and to carbolic acid, the poisonous qualities of which ought to exclude them from general use.” In the Lock Hospital of St. George’s Union, Westminster, I have used chloralum freely in sloughing sores and bad venereal discharges, and find that nothing surpasses it for cleansing the sores and destroying the very offensive smell peculiar to such diseases. It is particularly effective when used as a spray while dressing offensive wounds, or for removing all smell from fetid, discharges. The air of a sick-room can be perfectly deodorised by it without substituting a more power¬ ful smell, as with carbolic acid. Chloralum is similar in its effect to chloride of lime, minus the unpleasant smell. It has, undoubtedly, been injudiciously advertised and puffed; but I consider it, nevertheless, to be the best disinfectant for general use. It is effective, free from smell, non-poisonous, and cheap. Parliament-street, S.W. SCURVY IN A CHILD TEN MONTHS OLD. By W. IT. JALLAND, M.E.C.S., L.E.C.P. Lond., Besident Medical Officer, Lincoln’s-inn-fields Dispensary. Edwin R., aged 10 months, was brought to the Dispensary on Tuesday, January 7, 1873. The mother states that she only suckled the child for three weeks, when her milk entirely left her. She then fed it upon condensed milk and water, alio win oit two tins of. milk weekly until it was six months old. Up to this time it did well, and. got fat. When the infant had passed the sixth month she fed it upon Chapman’s entire wheat flour, condensed milk, and water, giving it six teaspoonfuls of the flour, with three of the milk, together with water, in the twenty-four hours. Eor two months after using this diet nothing was noticed, but since then she says it has been gradually wasting. Three weeks before coming 1 to the Dis¬ pensary she observed the child cried very much upon its knees and ankles being moved, and that its gums were swollen and bled very easily. Finding it got worse she brought it here, when it was found to present the following appearances :_ ■ The trunk and limbs generally wasted, with sallow-coloured skm; on both legs were small petechias, which did not dis¬ appear upon pressure; upon looking into the mouth the gums on the upper jaw were found to be in a spongy condition, bleeding readily upon being touched ; teeth, of which six ™ e not lf >ose; tongue clean, and breath not offensive. The child was quiet and sleepy, but cried immediately upon its ankles or knees being moved, which appeared swollen. The mother also says lately it has had diarrhoea, but she has not seen any blood in the motions. It was ordered—IT. Syr. ferri iodid. inxv.., ol. morrh.um “,j. 4tis horis; also to drink plenty of cow s milk, and a little lemon-juice. January 14.—Gums have resumed their normal state; petechias have entirely disappeared; there is no pain upon moving the ankles or knees, and the child appears quite cheerful. . Remarks .—One peculiar feature in this case is the early age in which the disease appeared. On referring to Copland’s “ Dictionary of Medicine.” I find it is stated that scurvy may occur at any age from childhood upwards ; and again, Billroth, m his “ Surgical Pathology,” says that this disease is very common m children ; but I cannot find any case mentioned in which the patient was so young as the above. What was the cause of it m this instance ? Dr. Aitken, in his « Practice of Medicine (vol. ii., page 74), gives the causes of scurvy as follows “ 1. Deficiency of absolute nourishment. 2. Improper adjudication or the nutrient and respiratory principles of the diet; its monotony. 3. Bad quality of the diet; im¬ proper cooking, or none at all. 4. Exposure to cold, combined with imperfect clothing and labour beyond the strength of the best-fed men. 5. The persistent pernicious influence of residence m a paludal district.” For the first six months according to the mother’s statement, the child was fed upon condensed milk and water alone, and did well; so I do not think that the cause can be put down to this diet, but rather to what followed, and then not so much to the diet given as to the short supply of. it. Three teaspoonfuls of condensed milk together with six of the flour in the twenty-four hours would certainly not be sufficient for a child of that tender age - T and yet the mother expressed her belief to me that the diseasewas due to over-feeding ! In a week the child was free from the disease; but I fully believe the result is to be attributed to.the good supply of cow’s milk rather than to the lemonjuice or the iron, although they all may have had their sharein the cure. REPORTS OE HOSPITAL PRACTICE IN MEDICINE AND SURGERY. ■ -—-© ■ —- MIDDLESEX HOSPITAL. INFLAMED CYSTIC TUMOUR IN ANTERIOR TRIANGLE OF THE LEFT SIDE OF THE NECK. (Under the care of Mr. MOBBIS). [For notes we are indebted to Mr. Pitts, House-Surgeon]. William A., aged 44, a general porter, applied at the cancerout-patient department of the Hospital on April 11, 1872-, with a swelling on the left side of the neck of large size, and which had become inflamed and painful. Thehistory he gave was the followingSix years ago he first noticed a small lump the size of a filbert in front of the stemomastoid muscle, and one inch and a half above the sterno¬ clavicular joint. It was quite soft and doughy; it increased: slowly in size, and two years ago was twice as large as when first noticed. Eighteen months ago it was only half its present size. For many months he has been unable to wear a collar to his shirt. Never felt any pain in the swelling till six days ago,, when he was carrying a carpet upon the left shoulder. It soon afterwards became inflamed, and he ha,s been quite unable to Work since. At the time he presented himself at Hospital he .was in good general health, but complained of pain and twitching in the tumour. This was of a globular form and bulging from the surface, very elastic and fluctuating, and filled the whole space on the left side of the neck between the clavicle below and the level of the hyoid bone above, and extended from a line corresponding with the anterior border off the sterno-mastoidmuscle at its lower end (which could he dis¬ tinctly felt to the median side of the swelling) to a vertical: line drawn from a point three inches behind the ear. It measured twelve inches and a half at its circumference, and four and a half from its base above to its most prominent point. It.pulsated bodily with the cervical vessels. The skincovering it was very red and somewhat cedematous, and injected with a number of minute distended capillary vessels,, and here and there the epithelium had been desquamated,, leaving the cutis, of a deep purple colour, exposed. A small opening of the size of a pinhole existed at the upper part, through which could be pressed some thin brownish and very offensive fluid. As he was suffering a good deal of pain in the swelling, and was in consequence unable to work; as it wasacutely inflamed, threatening to suppurate, and the contentswere beginning to. decompose, owing to the admission of air through the opening in the sldn; as, too, from its mode o£ : origin and its position (superficial to the stemo-mastoid muscle,, excepting at its lower and internal extremity), it was certainly quite unconnected with the deep cervical vessels, although pulsating synchronously with them,—Mr. Morrisdeter¬ mined to lay open the cyst and then to remove the cvstwall. This was done without any difficulty after evacuating the contents through a free opening through the skin and cyst-wall. A vein of some size that ran from the deepsurface of the tumour had to be divided. The large, abundant flaps of skin were left untouched, and were brought together by three or four sutures. The patient was kept in bed a few days, and a pad and water dressing applied to the wound. When he left the Hospital, on May 3, the wound wasquite healed; but at the lower angle there was some thickening of the parts, though the cicatrix was much contracted,, and was at this time two inches in length. He marks .—The importance of dividing the large veinwith; care was remarked during the removal of the cyst. It isin the- Medical Times and Gazette. * June 28, 1873. THE Jftqdipl iJimp and JOURNAL OF MEDICAL SCIENCE, LITERATURE, CRITICISM, AND NEWS. VOLUME I. FOR 1S73. LONDON: PUBLISHED BY J. & A. CHURCHILL, 11, NEW BURLINGTON-STREET; AND SOLD BY ALL BOOKSELLERS. MDCCCLXXIII.