These changes are due partly to a swelling of the delicate reticulum, in which the splenic pulp is immediately contained, and partly to an increase in the cellular and corpuscular contents of the meshes. The latter change, however, is not always present, since the corpuscles in some cases become atrophied, the spleen then being hard but not necessarily increased in bulk. The absorbent glands are often considerably enlarged, owing to an increase in their cellular and corpuscular contents. The kidneys become large and pale owing to an increase of the epithelium in their convoluted tubes. None of the organs affected as described give any reaction with iodine. The change in the viscera is due not to the presence of any formation foreign to their structure, but to an irregular hypertrophy which alters the natural proportion of their tissues. The epithelial and corpuscular element is generally increased, while in the liver the capsule of Glisson, and in the spleen the trabecular tissue, is abnormally developed. It appears (so far as an analysis of the spleen can be taken as a guide to the general condition) that in the viscera, as in bones, there is a deficiency of earthy salts. The condition of viscera which has been described belongs especially to the first four years of life. It usually occurs in connection with the external signs of rickets, though sometimes the visceral precede the osseous changes; and it not seldom happens that the visceral change may be extreme when the modification in the skeleton is but slight. The rickety state of the viscera, like the alteration in the texture of the bones, is transient in its nature. Under favorable circumstances the affected organs have a strong tendency to recovery, and, even when swollen to the utmost, will occasionally return to their natural dimensions. The change in the viscera appears to interfere comparatively little with their functions. The swelling of the spleen, indeed, when considerable, is often accompanied by much anæmia; but the change in the liver is unaccompanied either by ascites or jaundice, and, though the kidneys may be decidedly enlarged, the urine remains free from albumen. When the visceral change has taken place to a considerable extent the child is usually emaciated and anæmic, and is especially liable to be attacked by the diarrhoea, bronchitis, or pneumonia, to which rickety children are prone. These affections constitute the chief danger to which it is exposed. The treatment found to be beneficial is that ordinarily called for in cases of rickets. The diet should be nutritious and carefully adjusted, consisting of milk, beef-tea, meat, and wine, according to the age and state of the patient, while, medicinally, cod-liver oil is a prime necessity, and iron and quinine seldom fail to be advantageous. The rickety change which has been described differs both pathologically and clinically from the lardaceous or amyloid change on the one hand, and on the other from the enlargement of the spleen and absorbent glands which has been associated with the name of Hodgkin. VII. A Second Communication on the Endemic Hæmaturia of the Cape of Good Hope and Natal. By JOHN HARLEY, M.D., F.R.C.P., &c. (Received June 8, 1869.) (Abstract.) More than five years have elapsed since the author called attention to the above-mentioned affection, and proved it to be due to a nematoid worm-a species of Bilharzia. During this time he has obtained further information respecting the disease. Through his friend Mr. Dunsterville, of Port Elizabeth, he has had opportunities of examining the urinary excretions of those other patients suffering from the disease. In all, the ova of Bilharzia were readily detected. In one case the parasite extended to the kidney, and renal calculi were occasionally passed. Other medical men of the Cape Colony have sought to increase our knowledge of the prevalence of the disease and its mode of communication. Dr. Spranger, of Alice, in a letter to Mr. Henry Lee, relates a case which occurred in that locality. Dr. Rubidge, of Port Elizabeth, in a letter to the author, concludes, after extensive inquiries, that the parasite gains access to the body in the act of bathing in the rivers. But the chief interest which attaches to the present communication, consists in the demonstration of the disease in Natal, and in more than one locality. A resident of the colony is under Dr. Harley's care at the present time, and is daily passing hundreds of the characteristic ova. The gentleman who is the subject of the disease states that he is personally acquainted with five Europeans, resident in the County of Victoria, all of whom are affected in various degrees with the characteristic hæmaturia. The coolies imported by him from Madras and Bombay become affected after a residence of five or six months in the colony, and in such numbers that it is not uncommon for three or four of them together to present themselves to him complaining of inability to work, and bearing on castor-oil leaves the characteristic stings of blood-stained mucus in which the eggs of the parasite are embedded as a proof of their malaise. native Kaffirs in his employ are quite free from the disease. The As in the Cape, the disease appears to be confined to certain localities, and these are situated near the coast of the two known habitats of the parasite, one is the Sterk Spruit, a tributary of the Umlazi, situated about twenty miles from the sea; and the other the Umhlanga, a tributary of the Umgeni, distant about ten miles from the coast. How far the contamination of these two principal rivers of Natal extends inland remains to be determined, but the more elevated regions of the interior appear to be free from the parasite. One gentleman, aged twenty-eight, who is now a great sufferer from the disease, was entirely free from it until quite lately, when, leaving the interior, where he had dwelt all his lifetime, he came down to the coast, near Verulam, and contracted the hæmaturia. The symptoms of the disease and the condition of the urine in all the cases referred to are identical with those described by Dr. Harley in his first paper. With regard to treatment, Dr. Harley believes that we are restricted to the use of those remedies which, being eliminated by the kidneys, pass out unchanged in the urine. Of these, he thinks that Belladonna and Hyoscyamus may exercise 15 VOL. VI.NO. IV. an injurious influence on the parasite, and by stunting its growth in time overcome it. Henbane has so far proved beneficial in the present case. Dr. Harley appeals to our colleagues at the Cape and Natal for help in the elucidation of the mode of propagation of a disease, which is in its nature so thoroughly preventible. VIII. Completion of the Case of Congenital Hydronephrosis reported in the 48th volume of the 'Transactions' of the Society. By the late THOMAS HILLIER, M.D., F.R.C.P.; Physician to the Hospital for Sick Children, and to the Skin Department in University College Hospital. (Received October 7, 1868.) (Abstract.) The history in the previous report was carried on till the patient had reached the age of five years. When eight years and five months old he was attacked by acute tuberculosis, and died with cerebral symptoms after three weeks' illness. The abdomen remained till the last much distended and fluctuating. On post-mortem examination the right kidney was found converted into an enormous cyst twenty-seven inches in circumference, which contained eighty-three fluid ounces of very dilute urinous fluid. The right ureter was found to be abnormally constricted, especially near its vesical extremity, so that fluid did not escape from the cyst into the bladder until a fine probe had been passed through it. The pelvis of the left kidney contained some uric acid deposit and was dilated; the ureter on this side was also distended at its upper portion by an accumulation of sandy matter, which was adherent to its walls, but not very firmly. |