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for a slight shuffling in his gait. The tendon reflexeshad returned.

It is to be regretted that a more thorough examina-tion of the nose was not made sooner ; had it beenmade the duration of the illness would have beenshortened. Failure to isolate Bacillus tetani fromcultures was disappointing, but I am confident ofthe correctness of the diagnosis, quite apart fromthe control of the symptoms obtained by adminis-tration of the appropriate serum; 21,000 units weregiven and no rash followed.The points which make the case worth recording

are: (1) Age of the patient. According to mostauthorities the chances of recovery at the age of 3are few. (2) Site and vehicle of inoculation.

Although children will insert all sorts of foreignbodies into the nostrils I can find no other recordof tetanus arising in this manner. (3) The incompletepicture of cephalic tetanus. Stiffness of the neck andjaws were present but there was no paralysis of themuscles supplied by the facial nerve. This, whenpresent, is supposed to be due to compression of theswollen nerve in its bony canal. The site of inocu-lation was in the area of supply of the second divisionof the fifth nerve, and the only effect on the facialnerve was one of stimulation, shown by twitching ofthe nose and angle of the mouth before spasm becamegeneral, and narrowing of the palpebral fissure bystimulation of the orbicularis palpebral. (4) Com-plete cessation of symptoms after removal of thecause. (5) Absence of nasal discharge which wouldhave pointed more clearly to it.

A CASE OF PULMONARY SARCOMA.

BY 0. W. ROBERTS, M.D., M.S. LOND., F.R.C.S. ENG.,ASSISTANT MEDICAL SUPERINTENDENT, ST. GILES’S

HOSPITAL, CAMBERWELL.

A MARRIED woman, aged 35 years, was admittedto St. Giles’s Hospital on Dec. 27th, 1929. She had

enjoyed normal health until a fortnight beforeadmission, when she had felt " run down " and hadbegun to have headaches. On admission she com-plained of severe headaches, general weakness, andimpairment of memory ; apart from these she had nosymptoms. Clinical examination suggested a right-sided cerebral tumour associated with rapidlyincreasing intracranial pressure. A decompressionoperation was suggested, but the onset of signs of

pulmonary oedema and the presence of dullness onpercussion with absent breath sounds over theposterior part of the right lower lobe contra-indicatedsurgical interference. Intracranial symptoms increasedand the patient died on Jan. 12th, 1930, one monthafter the onset of the first symptom.Poat-motem examination.-The whole brain was oedematous

and the convolutions were flattened. On section the cerebraland cerebellar hemispheres were found to be studded withnumerous nodules varying in size from a pea to a plum.The nodules were situated in the white matter of the brain,being separated from the cortex by a narrow zone of whitematter. Macroscopically they appeared to consist of softvascular tissue which could be shelled out quite easilyfrom the white matter, leaving a smooth depression. Thelarger nodules contained pus-like fluid from which a

pneumococcus was cultured.The lower lobe of the right lung was adherent to the

diaphragm and to the chest wall posteriorly ; on sectiona hard mass of new growth having irregular edges wasfound in the posterior part of the right lower lobe. Dilatedbronchi containing purulent material were found in thetumour, and the macroscopic appearance suggested bronchialcarcinoma. The other organs were apparently normal,and although a careful search was made no other deposits

of new growth were found. Microscopic examination ofspecimens from the brain and lung showed a round-celledsarcoma.’ The interesting points in this case are : the extremelyshort clinical history, the absence of any lungsymptoms, and the distribution of the metastases.Intracranial abscesses complicating intrathoracicsuppuration usually show a similar distribution tothe metastases found in this tumour.

CEREBRAL HÆMORRHAGE FOLLOWING

MENINGITIS IN A CHILD.

BY L. I. M. CASTLEDEN, M.D. LOND.,ASSISTANT MEDICAL OFFICER, HIGHGATE HOSPITAL.

" BEFORE the fifth decade cerebral haemorrhage israre," observes Osler, who further states that Holthad seen only one case under 10 years of age. In an

investigation recently undertaken at the Hospital forSick Children into cerebral haemorrhage in childrenunder 12, Sheldon was able to find only 50 cases inhis analysis of 10,150 consecutive autopsies. The

comparative rarity of the condition therefore seems

Temperature and pulse chart from admission tohospital on April 20th.

to justify the publication of the following notes ofcerebral haemorrhage in a child 1 year of age, addi-tional interest being lent to the case by the fact thatmeningococcal meningitis was the possible precursor..

ACCOUNT OF THE CASE.

A boy, aged 1 year, was admitted to Highgate Hospitalon April 20th, 1930, with a history of persistent vomitingand obstinate constipation for three weeks. During thepreceding few days the child had frequently put his righthand to the right side of his head. On the day beforeadmission there had been twitching of the left side of theface and of the left arm. There had been no vomiting orconvulsions.The birth had been Caesarean. There had been no previous

illness and the child had been quite well up the onset ofvomiting. There was no family history of tuberculosis orvenereal disease.On examination the child was conscious, well-developed,

and pale, but not dehydrated. The head was retracted andturned to the right. The frontal veins were somewhat,

1 Sheldon, W. P. H.: Quart. Jour. Med., 1926-27, xx., 353.