Stanley Graham

Bronchiectasis in Childhood: Its Symptomatology, Course and Cause.

INTRODUCTION. There are three conditions, viz: bronchiectasis, chronic or unresolved pneumonia, and pulmonary tuberculosis, which have always given, and still do give rise to difficulty in their differentiation. Until recently the finding of the tubercle bacillus has been our chief, if not our only aid, in this differentiation , though from a knowledge that such is not always positive many cases of bronchiectasis and simple chronic pneumonia, at least in childhood, have been certified as cases of pulmonary tuberculosis and admitted to Sanatoria. It might be thought that with the advent of radiology great assistance would have been rendered in this direction, but when we recall that any consolidation of lung tissue will obstruct the passage of the X-rays and cast a shadow the limitations of this method of examination will be apparent. Nevertheless, if one appreciates the usual course of pulmonary tuberculosis during childhood, X-ray examination of the chest does givc considerable help. Pulmonary tuberculosis as it is met with by the paediatrician is on the

The aetiology of convulsions in early infancy.

Prof. C. NOEGGERATH, Freibnrg i. Br., hat, bei Anwendung der ketomen Kont in einer Anzahl von Fallen den Eindruck einer voriibergehenden Besserung Aufhoren der gehiiuften Anfiille gesehen. Bei anderen Kindern war keine Beeinflassung zu beobachten. Eirie symptomatische Einwirlrung scheint in den erstgenannten Fiillen doch sehr wahrscheinlich. Allerdings Yind die Einwande MONRAD’S sehr beachtlich; aiich kenn von einer dauernden Heiliing nicht gesprochen w-erden. Wiihrend es ferner nicht ganz selten gelang, dt~rch forcierte Atmung Anfiille hervorzurufen, neiin sie nur lange genug diirchgefuhrt~ wurde, mislang bisher wenigstens der Versuch der Auslosung durch Kochsalz.

Two Cases of Varicella Encephalitis

Non-suppurative lesions of the nervous system in association with the common infectious fevers have been recognized as a rare occurrence for many years. Although described clinically on several previous occasions, Barlow an(l Penrose1 were the first to demonstrate pathologically the existence of such a lesion. They described the picture of a disseminated myelitis in a fatal case of measles which they had had under their care. Since then small groups of cases have been reported from time to time, not only in measles but in many other infections. Valentin2 in 1905, collected from the literature 79 cases of paralysis occurring in whooping-cough. In addition, encephalitis or ecicephalo-myelitis has been described as a complication of smallpox, chickenpox, scarlet fever, diphtheria, mumps, influenza, typhoid fever, typhus fever, syphilis and tuberculosis. Measles and whooping-cough an(d, more recently, vaccination have, however, accounted for the majority of the cases. That the condition may occur at any stage of the disease, or even as a sequela after convalescence, appears to have been established. Because varicella is one of the commoner of the infectious diseases and in the majority of instances runs a benign course, it was considered worth while to report the following cases which occurred about the same time and in which the most prominent synmptom was ataxia, although sigIls of pyramidal tract involvement were also present.

The Indirect Determination of the pH of the Blood in Children.

It has long been known that the tension of CO, in arterial blood is approximately the same as that of the alveolar air. Thus, by obtaining samples of alveolar air, one can readily calculate the CO2 tension in the blood and, by usinig Bohrs coefficient, arrive at the figure for the free CO, content (H2CO ,). The total CO2 contenlt less this figure will then represent the combined CO2 (BHCO3) of the blood.

Observations on the Chloride Metabolism in Congenital Pyloric Stenosis

A fall in the chloriine content of the blood in cases of high intestiiial obstruction is a well-recognized biochemical finding. The opinion is genierally held that the diminution in the level of the blood chlorine is due primarily to the loss of chlorine by the vomitus. Accompanying this decrease in chlorine there is ani increase in the CO2 content, resulting in a non-gaseouis alkalosis ww ith a diminution in the respiratory exchange. This increase in CO2 Mould appear to be the result of the bodys effort to maintain the ionic concentration of the blood at the normal level, and simultaneously, to compensate the deficienicy in the acid radicle. Very strong experimental proof has been brought forward by Gamblel and others in favour of the truth of this hypothesis. In a previous communication2 we have shown that the blood chlorine tends to be low in congenital pyloric stenosis, the diminution being roughly related to the severity of the vomiting. But we have seen cases in which there was present a typical picture of alkalosis, as indicated by the raised blood CO2 content and the depressed breathing, either duiring a period in which no vomiiitinig occurred or, as in one instance, when there u-as a complete absenlce of vomiting. In Table 1 examples are given in which the depressed breathing was a feature despite the comparatively normal valuie for the blood chlorine. lIncidenitally, it shows that there is iiot necessarily a correlation betweeni the

The role of acidosis and phosphate retention in the pathogenesis of rickets and rachitic tetany of infants.

There is no evidence that acidosis is either a causal or associated factor in infantile rickets. There is an increased urinary output of ammonia but the fact that it is associated with a diminution in the titratable acidity of the urine renders it unlikely that there is a condition of acidosis present. This conclusion is further strengthened by the fact that healing of rickets as evidenced by increased retention of minerals and X‐ray signs, may take place during prolonged administration of an acid‐producing substance.