MENINGITIS TREATED BY INTRATHECAL INJECTIONS OF THE PATIENT'S BLOOD SERUM
Authors: R. Waterhouse
Journal: BMJ (1920)

A sehQolgirW,.age 12I came to the Skiw Dep rt of the Royal Soutbern Hospital in February, 1919.She displayed ,at that time a white glistening ivory-like patch situated in the lower .third.of the eft arm on its extensor'-suxface.It was hard; and the skin could not be raised in folds; there was no itchirg; no pain, and no disturbance of sensation.There was impaired movement of theelbow, but the wrists and digits were freely movable and the, skin in these regions apparently 'normad.A similar change.in the skin was noticed iu the left foot implicating the two outer toes and extending along the dors.umpedis to some four to five inches above the external maieolus.HEr' mother stated tbat-;the child first notieed this.condition duriug.the slummer.holidays, July and AugVuat 1918.She thouglt she bad.spraiued her.arm when.p;%ying .wi#4 the may.polc..The co4dition of the toes and outer margin of the foot and 'ankle was not, noticed 'untll Noyvember, 1918; but neither the patient nor-mother can* a dedniWy state wien or how the discase begsz, wnd.these data am.nto t-Werefore quite trust' worthy.From Feruary, 1919, .toth present .tiaseLeroderiniahas,slowly extind,ed, implicating the whole.oI the extensor region, of the upper extremity.The flexor aspect of the limb is not Involved, andover the biceps and flexor-sof the wrist and hand the skin is-supple and apparently,normal.The hand itsel .showstypical sciroactyly.The scapular region is also involved,,and here appeare(l.slight ulceration, of.which the cause could not, be ascertained.This;is now healed, leaving a scar like that of a burn.In April,! 1919, two circumscribed patehes, one in the left bypochon Iri-um and the second in the umbidical region, were discovered, and have since undergone a ,oert4in degree of invol!tion.This fact hA, been nated by various observers.intha circumscribed type.The present redness: of tihe skin of the .1and-andfingers is;referwble-to tlhe cold weather; and does not suggest any consexios with Raynaud's-disease, which some writers would appear to support.Thle niorbid h istology is.briefly thatof atrophy of the fibrous el6ments of the true skin and subi.utaneoustissue, The elastic element is not involved.The' lood vessls are atrophiied, thie-result' of' interstiti.A inflammation of thei walls.'he, giandularappa- ratIs, as well as thehbair follicl's, show.'seeoudaryatrophic changes.The epidermis.isdiminisled in deptlh, but other- wise normal.I hope to shiow a. microscopic specimen of these chianges at a forthcomingpathological-meeting.Tle' pathology of seleroderroia is unknown, and equially so its-etiology.Of couse, hypotleses are forthcoming, but no facts to support their validity.There is-an a-ngio- neurotic bypothesi;s, a.oe4tra1 nervous hypothesis, and an autatoxie; lhypothesiw I have no extra one to -ofer, and cannot explain scleroderrnia.It cannot be retorred to malnutrition, althoughi tihe-parents think that the food ratiopig in the early part of 1918 may, have had some- thingA-o do with is appearance.I have not read of any inorein lscerodermia among the inhabitants of Central Europe wiho have suffered immeasurably more from mal- nutrition thlan we.Tripatment lwcally and constitutionaJly.baa signally faile.ItUhas not.previeLed the progress of the disease.Locally, linimentum potassii iodidi ic sapone, beloved of the Wrgeons, ,has beeu vig-orously.rubbed into -the affecttd regio for, a -moth, or 5o.This.was followed by more stimulating liniments--turpentine.and am Ionia equal parts-for another month.Then sucoessively thoi fol.lowia& oiptments were used, bat,: with no benefit: Un- guentum acidi salicylici, unggeaturu hydrargyri.com.positum, At present, more frotn.a .aAssagestandpoinit of view,-olive oil is being vigorously rubbed, into; the withered limb.Internally fibrolysin was given hypodermically every week-for three months.It made not the slightest impression.. Fibrolysin is another name for thiosina- mine, which is an orgn4uic darivative from oleaumsinapis.It was intmouded as. a solvent or discutient of fihrou.%and especially cicatricial, tissue in tuberculides and hyper-