12 Proceedings oJ the Royal Society qf Medicine 2

bacilluria did not seem an adequate explanation for the pyrexia. The hlimoglobin rose
gradually with the help of further transfusions and anahaemin and she eventually made
a complete recovery. She is now in very good health with a blood-count of R. B.C.
3,770,000; Hb. 85%; C.I. 1[1; W.B.C. 5,900. Normal blood calcium 10-4 mg.%. Faecal
fats 37-3 %.
This case is of interest because of the severity of the anaemia with temporary inactivity
of the bonie-marrow and high pyrexia.

Chronic Miliary Tuberculosis.-Sir ADOLPIIE ABRAHANIS, O.B.E., M.D., F.R.C.P.

Female, aged 19.
History.-The patient comes from a non-tuberculous family. Her parents and three
sisters and a brother are well. Apart from jaundice at the age of 13 she was healthy
until three years ago, since when she has attended Moorfields under Mr. Juler for relapsing
iridocyclitis. In June 1941 she had transient pain in the right lower chest and a skiagram
revealed miliary tuberculosis. She is free from cough, has continued to gain weight and
was at work until admission.
Examination onl admission (28.7.41).-General condition good. Weight 7 st. 5 lb.
Apyrexial. Pulse 80. Blood-pressure 90/55. No definite signs in chest. Spleen palpable,
not tender. No enlarged glands in neck, axillie or groins. Signs of old iritis.
She was under observation for five weeks, felt perfectly well throughout, and main-
tained her weight. There was no pyrexia and the pulse averaged 80.
Investigations.-Skiagrams of chest: (30.6.41), (28.7.41), (21.8.41), no appreciable (liffer-
ence.
Sedimentation rate: (29.7.41) 20 mm. in one hour; (22.8.41) 14 mm. in one hour.
Blood-count: R.B.C. 4,750,000; Hb. 88%; C.I. 0 9; W.B.C. 9,300 (polys. 68%, lymphos.
30%, monos. 1%, basos. 1%).
Blood Wassermann reaction and Kahn test negative.
Stomach contents showed no T.B. on direct examination and culture.
Mantoux test positive to 1:100, negative to 1:1,000. Two " patch" tests negative.

Fracture of the Skull in an Infant Associated with Hematoma Formation and Followed
by Development of an Encephalocele.-G. H. MACNAB, F.R.C.S.
History.-On 18.10.40 an infant aged four months was blown out of its mother's arms
by blast from a bomb, and admitted to hospital unconscious, suffering from severe shock.
On- examination a hematoma about 2 in. in diameter was found over the right parietal
bone. Child severely shocked; pulse-rate 170.
20.10.40: Child no longer unconscious, but very drowsy. Heematoma had spread
forward to the orbit, back to the occiput and up to the mid-line of the vault.
24.10.40: H1ematoma had spread over mid-line involving the whole skull, so that the
head looked almost twice its normal size. Child vomiting, but not in relation to the
taking of food. Right facial weakness present.
The chjld's general condition gradually improved; the haematoma subsided after
remaining over the right parietal bone for a long period. The facial weakness cleared up.
1.10.41: A perfectly healthy child. No evidence of disturbance of the central nervous
system. There is a deficiency in the right parietal bone 1 %2 in. in diameter and a
hydroencephalocele is present.
X-ray examination.-21.9.40: Fracture of right parietal bone. 12.12.40: Appearances
suggest absence of portion of parietal bone. 15.9.41: Large deficiency in rig t parietal
bone.

Exophthalmic Ophthalmoplegia (Unilateral) with Papilledema.-S. P. MEADOWS, Mi.D,

F.R.C.P.
R. S., male, aged 37.
History.-About nine months' history of increasing exophthalmos of right eye, with
occasional blurring of vision and diplopia, but without pain. He attributes the onset