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Korper stammt, auf. Sehr oft ist dieses Leiden doppelseitig, nament- lich wenn es metastatischen Ursprungs ist, jedoch in nicht wenigen Fallen wie in dem vorliegenden ist es'einseitig. Hier ware es wohl anzunehmen, dass die Krankheit als metastatisch aus der leichten Angina, die der Patient einige Tage vor Anfang der Augensymptornen warscheinlich gehabt hat, herzuleiten ware.

Was die Behandlung betrifft, werden warme Umschlige empfohlen. Sollte Abscess entstehen, wird Incision von der Conjunctivalseite vorgenommen. Dadurch wird der Symptomverlauf abgekiirzt, aber der Abscess perforiert oft von selbst. Im Pus findet man am ofte- sten Staphylokokken, auch aber Pneumokokken und Influenzabazil- len. In dem vorliegenden Falle schwanden die Symptome schnell vermBge der epitheniata tepida ohne Abscessbildung, und seitdem - 3 Monate sind jetzt verflossen - halt sich das Auge vollstiindig normal.

A CASE OF SPASML'S NUTANS ( S A L A A M CONT'ULSZOA'S)

RY

EJLER HOLM

This rare affeclion is of interest to the oculist on account of the concomitant ocular nystagmus, and I shall therefore relate a case Ihave seen at the Children's Hospital at Fuglebakken (Chief: Dr. med. Valdetnar Poulsen).

Kai A., born 31. XII.26. An only child of healthy parents. He was born about 3 weeks before full term; breast-fed for 3 weeks, then on the usual diet of milk mixtures. When he was 6 weeks old he had, for a fortnight, an attack of purulent outflow from both ears. 18. I. 28, a little over a twelvemonth old, he was admitted to the hospital, because the mother had observed, for about a week, that he would continually turn his head towards the right and that, on being prevented from doing so, he had horizontal nystagmus,

The family lived in an attick, in a very old house where the rooms were extremely dark and the child's affection had commen- ced after they had removed to that place.

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On admission the child was very restless and cried much and violently, although it was in a good state of nutrition. There was nothing remarkable about the cranium. The left half of the face was slightly flattened in proportion to the right. The child lay steadily in a position with the head rotated to the left, making, now and again, jerky movements towards the left. There was almost inces- santly horizontal nystagmus. He was able to sit up in bed without support, but the rotatory movements described became then inces- sant.

The fontanel was closed and there were no signs of rickets. Ste- thoscopic examination revealed nothing abnormal, and the abdomen was normal.

Examination of the ears showed normal relations. Examination of th eyes: pronounced head-nystagmus of the irregu-

lar type, now to one side, now to the other. Now and again nod- ding movements. On the day of the examination the child preferred having his head turned to the right, while he gazed towards the left. There was no squint, but a typical undulatory nystagmus, which was considerably more marked on the right than on the left eye being further accentuated in side glances towards the right. The eyeballs were normal in size, the relations of irides and pupils were also normal. The eye-ground was very weak pigmented, though otherwise normal. Refraction almost emmetropic.

Lumbar puncture showed: 7 C.C. clear spinal fluid: cells s / ~ , albu- min 10, globulin 0. No bacteria were found, neither by direct mi- croscopy, nor by cultivation. Wassermann reaction negative in blood and spinal fluid Examination of urine: negative.

Neurological examination (Dr. med. K. Krabbe): The child has in- termittent rotatory movements of the head, now and again nodding movements. Nystagmus as described. Apparently the patient moves arms and legs in a natural manner corresponding to his age. Joints and muscular tonus are normal. Patellar reflexes lively. No Babinski reflex. Abdominal reflexes normal. Conclusion: the case resembles very much spasmus nutans; at any rate, it may undoubtedly be conceived as such, if it subsides when the child has for some time lived in better conditions of light.

Observation on 20. IZ. 28: The rotatory movements are no longer incessant; they cease when the child is lying down and when he is excited.

1. 111: The shaking of the head has diminished, as have also the movements of the eyes.

3. IV: The shaking has almost totally subsided and nystagmus is observed only occasionally. The patient’s head is still rotated a little towards the right, the face slightly upwards.

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28. IV: There is now no nystagmus, neither in upward-glances, nor in side-glances. No squint. The child now keeps his head and eyes in a natural position, without side rotation. A s a trace of his head-nystagmus a slight checking on turning the head, giving the movement a somewhat jerky character, is occasionally observed.

In its appearance and mode of occurrence this case presents so many of the characteristics of spasmus nutans as scarcely to leave any doubt about the diagnosis: for instance the age of the child, his living in very dark rooms, the association with ocular nystagmus, and the course: recovery after some time’s stay at the hospital. Fur- ther, it may be noted as a characteristic feature that, although not unilateral, the ocular nystagmus was distinctly more pronounced in the one eye than in the other, and again, the nystagmus occurred, or became more accentuated (according to the mother’s statement), when the child’s head was held firm. - On the other hand, the head-movements continued to be mainly rotatory, though now and again combined with or replaced by nodding movements, so as to suggest the designation of head-nystagmus. By this feature, as by the preferred position of the head rotated a little to one side and the eyes to the opposite, the case presents a certain similarity with many cases of optical or hereditary nystagmus and with some cases of strabismus associated with head-nystagmus.

This analogy seems to indicate that bad conditions of light, ren- dering vision uncertain, may be a causative factor in the occur- rence of spasmus nutans, as has also been maintained, specially by Haudnilz, while the case is against the theory of Stamm’s that rickets should be the cause