PÆDIATRICS.

IN CHARGE OF

W. B. THISTLE, M.D., L.R.C. P., Lond.,

ecturer on Clinical Medicine and Diseases of Children, University of Toronto; Physician to Victoria Hospital for Sick Children; Clinical Lecturer on Diseases of Children in the Woman's Medical College

AND

W. J. GREIG, B.A., M.D.

SECTION IN PEDIATRICS, BRITISH MEDICAL ASSOCIATION. Discussion on Rheumatic Heart Disease in Children. D. B. Lees (London). The fatal result is not generally due to endocarditis. This is usually found post-mortem in these cases, yet the damage to the valve is slight. Pericarditis is a much more striking phenomenon, p.m., and has more to do in producing a fatal result. This result is rarely produced by the effusion of large amounts of serum into the pericardial cavity, but by an adhesive pericarditis which injures the heart muscles, in some cases making it soft and pale, in others fibroid, and in others fatty. Dilatation is apt to be produced in this way, and in 150 post-mortems Dr. Paynton found 92 cases. The main causes of the large mortality are in rheumatism, Ist, adhesive pericarditis, 2nd, dilatation. Dilatation is especially worth study, because it may be present also in rheumatism without pericarditis or endocarditis in sub-acute first attacks with slight fever and little arthritis. This may be demonstrated by light percussion, by the diffuse impulse, and by extension outwards of the apex beat. This acute dilatation appears to be due to a toxic action of the rheumatic poison in the heart, similar in character to that of influenza. In the treatment of rheumatism it is very important to remember that the extension of dullness is due,not to effusion, but to dilatation. It is doubtful whether an adhesion of the two pericardial layers does much harm except to render permanent the dilatation present. Very little attention need be paid to the presence of mumurs in forming an opinion on prognosis. Prognosis depends on the amount of dilatation present; more importance may be at

tached to mitral diastolic murmurs when the second sound is doubled. This third sound is produced by the sudden tension of the stiffened mitral valves in diastole of the ventricle. The sounds produced nay be symbolized as whoo-ta-ta or whoo-ta-who.

Conclusions-Prognosis depends on, 1st, amount of dilatation present, 2nd, adhesive pericarditis, 3rd, the evidence of fresh rheumatic toxæmia, such as sore throat, erythema, nodules, etc.

Dr. Osler complimented the writer of this paper and pointed out three important factors in prognosis :

(a) Adhesion between the pericardium and the different layers of the pleura and the mediastinum; 2nd, the persistent recurrence of rheumatism. He referred to Dr. Rotch's sign of dulness in the fifth right intercostal space as an evidence of effusion.

Drs. Broadbent and Ewart both claimed that this dulness was due to dilatation as stated by the essayist.

TREATMENT OF HYDROCEPHALUS BY INTRACRANIAL DRAINAGE.

(G. A. Sutherland and Watson Cheyne, Brit. Med. Journal, Oct. 15th, '98.)

This refers only to the treatment of those cases present at birth, or which have developed during early life without apparent cause. It is assumed that the hydrocephalus is due to the closure of the channel by which naturally the fluid secreted in the ventricles drains into the sub-arachnoid space. Leonard Hill has shown that the tension of the cerebio-spinal fluid is the same as that in the cerebral veins. Therefore if the pent-up secretion of the ventricles could be drained into the sub-arachnoid space the injurious pressure on the brain substance would be relieved. Three cases are reported:

Ist. An infant 6 mos. old with progressive hydrocephalus from birth. The vertex was represented by a large membranous space 9 in. x 9 in. An opening was made at the left lower angle of the anterior fontanelle and the dura incised for 1/4 of an inch. There was no fluid in the sub-dural space. One end of a catgut drain, 2 inches long, was pushed into the space and the other end through the brain substance (which was very thin) into the lateral ventircle. In 5 days there was a distinct lessening of the size of the head and tension was absent. The diminution continued until, at 3 months, the cranial bones were overlapping. At this time, the child sickened and died with symptoms of basilar meningitis. There was no mental improvement.

2nd. This was an advanced case of 3 mos. of age. An exactly similar operation was performed. The size of the head diminished very much, but asymmetry was marked. Two and a half months after the operation the head was shaved, and it was then seen that the asymmetry was due to the disappearance of the fluid from one ventricle (the one drained) and the other was still distended. Evidently the foramen of Munroe had become occluded. The other side was then operated on in the same manner. Six months after the first operation the cranial bones were overriding, the child was well and gaining in weight. But there was no evidence of mental development.

3rd. The result in this case was not so fortunate, as shortly after the operation the child developed measles, with bronchopneumonia, and died.

Further investigations are promised.

WE

Editorials.

JOURNAL AMALGAMATION.

E have to make the important announcement that the proprietors of THE CANADIAN PRACTITIONER and The Medical Review have agreed to an amalgamation. On and after January, 1899, the name of the new journal will be The Canadian Practitioner and Medical Review. We hope by a combination of the energies of the two different staffs to be able to publish a journal which will be much better, both for our subscribers and advertisers, than either has ever been in the past. THE PRACTITIONER has existed for twenty-two years and The Review for eight years. Dr. W. H. B. Aikens, the editor-in-chief of The Review, was for some years one of the editors of THE PRACTITIONER, and the success of the journal at that time was largely due to his efficient work. The chief aim under the new management will be to make the journal acceptable to all classes of physicians in Canada and the United States.

BANK BILLS AND CONTAGIOUS DISEASES.

DON

ON, in Saturday Night, in referring to various means by which contagion and infection might occur, spoke of bank bills as a medium whereby contagious diseases were frequently spread. There is no doubt that he is quite right in his contention. In fact we presume no one will deny that the dangers connected with the handling of dirty bills are somewhat serious. In another issue of the same paper Don prints a letter from a bank clerk, which we think so good that we quote the greater portion of it as follows:

"Now, I would like to see this matter taken up, and if possible force the Government to keep clean their own issue of legal tender, and also force the different banks holding charters from them to give more attention to the cleanliness of their circulation. As a bank teller I may say that the bills kept in circulation by some of

the banks are so filthy that it is not only dangerous to handle them, but as well most disagreeable and sickening. Now, there is no reason why we should not have a fairly clean bank circulation if some pressure were brought to bear on the banks who try to make a bill wear for ten years when perhaps it is unfit for circulation after one year's use. You shall be conferring a favor on many bank tellers and on a suffering and patient public if you will bring this matter before them in your usual fearless and forceful manner."

THE VICE-CHANCELLOR OF THE UNIVERSITY OF TORONTO.

THE

HE re-election of the Hon. Wm. Mulock as Vice-Chancellor of the University of Toronto by an unanimous vote of the Senate at the regular meeting held November 11th afforded much satisfaction to his friends. Mr. Mulock has occupied this position since 1880, and has always been elected without opposition or by a very large majority. We believe that the confidence which has been shown by this remarkably strong and influential educational body towards this distinguished graduate of the University has not been in any sense misplaced.

Mr. Mulock has been the leading spirit in the various negotia tions which took place between the University authorities and the various institutions which were considering federation or affiliation, viz., Knox College, St. Michael's College, Victoria University, the Agricultural College, the College of Pharmacy, the School of Practical Science, the Royal College of Dental Surgeons, the Toronto College of Music, and the Conservatory of Music; and the successful issue of such negotiations was chiefly due to his great prudence and tact.

From our point of view the most important work done by him was that which resulted in the re-establishment of the Medical Faculty, in 1887. The great interest he took in this Faculty, and the enormous amount of work he did for it are pretty well understood, and very highly appreciated by the great body of medical graduates, and also by the non-medical friends of the University. His devotion to this Faculty was said to be one of the chief causes of that attack in his general University policy in recent years, which resulted in the establishment of pronounced partyism in the Senate.

We can scarcely say now that this partyism has ceased to exist, but we hope that a great portion of the bitterness has gone out of it. It is surely a matter of course that the Vice-Chancellor was correct in saying, while he was returning thanks for the honor