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tion of the bowel with a saturated solu under consideration before referring to tion of boric acid in water. If the in its treatment. Cases going to autopsy, fant be much prostrated, irrigation will of which I regret to say I have seen hasten the end. Iced champagne and many, reveal certain lesions of the bowel, iced brandy may be given to quiet the and for the consideration of which I stomach. Mustard papers should be ap must refer you to works on pathology. plied to the abdomen often and long These cases have a continued fever not enough to keep the skin red. Fever high except in acute attacks at times. should be combatted by baths ; cold ex When the intestinal secretions are tremities and subnormal temperature by locked up or became scanty, we usually hot bottles. The severe symptoms last see a rise of fever. There is as a rule about twenty-four hours. With abate no vomiting. The nervous symptoms ment of vomiting, all stimulation may are manifest, but not so violent as in be by mouth. Food must be tried cholera infantum. The tongue soon beslowly and in small quantities. One of comes glazed, red and cracked. Emathe best for this purpose is Valentine's ciation is steady. The stools are charmeat juice. I have had it retained acteristic. They contain much detritus when the stomach would accept nothing in the form of undigested food : are else. Continuance of diarrhea after quite frequent, from four to twenty a subsidence of other untoward symptoms day ; they are not, as a rule, particularly is regarded an entero-colitis, under offensive ; much mucus is found in which head the treatment will be fur them, at times streaked with blood or ther considered. The writer wishes, containing blood clot. Nothnagel makes in conclusion, to emphasize that noth a good point, the less the mucus is ing must be given by mouth, not even mixed with the feces, the lower down champagne or brandy, unless they exert in the bowel it comes from. The same a modifying influence, when the stomach remark may apply to blood. There is is irritated; that the hypodermatic form much tenesmus and occasionally proof medication is the only one applicable lapsus ani. The color ranges from yelto these cases; that whiskey and strych low to grass green. The green color of nine hypodermatically are the most ef the stools has never received a generally fective agents at our disposal for keep- satisfactory explanation. The addition ing up the strength ; lastly, that no an of lime water to a yellow passage will tipyretics should be administered, but cause it to turn green in three to twentyrely upon baths to reduce fever. It is four hours. This fact leads me to the needless to add, an experienced nurse conclusion that the green color is due should always be in attendance, when to the conversion of bilirubin into bilipossible. Do not use ice caps to con verdin, either directly or indirectly by trol convulsions and thereby increase some special micro-organism acting in the anemia of the brain, to which they an alkaline medium. That the action are largely due.

is an indirect one, requiring special conEntero-colitis.- We have just seen ditions, seems the most rational explanathat cases of acute dyspeptic diarrhea, tion to me. and cases recovering from an acute Treatment.-Simple diarrheas should attack of cholera infantum, may ter not be allowed to run on to an enterominate in an entero-colitis. On the colitis. Opium when the stools are freother hand, cases of cholera infantum quent and temperature not very elevated. may develop from an entero-colitis. On the other hand, when stools are There may be an acute, subacute and a scant and the fever rises, castor oil is indysenteric form. The forms are easily dicated. Bismuth and salol in combinadistinguishable when we once gain clear tion are invaluable. Extract of pancreas conception of what constitutes an entero should never be given by the mouth. colitis. From the nature of my paper, It is destroyed in the stomach by the I shall have to content myself with giv combined action of pepsin and hydroing but a few symptoms of the trouble chloric acid. Some authorities claim

that but little digestion goes on in the The practice of giving opium and astrinstomach of sucklings, that its function gents to confine the bowels one day and is largely that of a reservoir. Judging an aperient or purge the next, or vice from the nature of the food and from versa, must be condemned as unscienthe known activity of the pancreatic tific. Nature's tonics in the form of juice in infants, I am inclined to the fresh air and proper sanitary surroundsame opinion. I am therefore opposed ings, united to a suitable food, are our to the administration of digestive fer mainstays. Irrigation of the bowel does ments to infants. I have seen on the good in infants not too much weakened autopsy table, in marasmatic infants, by the disease. If we have reason to more than one stomach wall in various suspect an ulcerative condition, the nistages of digestion. In view of the trate of silver injection will likely do fact that those infants were greatly good. Theoretically, the fluid extract emaciated, in most cases, and immedi of coto bark seems to be the drug for ately sent to the dead-house, and there these cases, exerting, as it does, an antifore soon cooled below the point when fermentative action and, at the same artificial digestion is most active, I can time, bringing a healthy supply of blood not satisfy myself that the extensive to the intestines, by causing an active changes found were due to post-mor dilatation of their vessels. It has been tem self-digestion.

tried and found wanting. The best we It is in these cases that predigested and can do in these cases is to pay due atprepared foods are particularly valuable. tention to the rules of hygiene; adminThe kind to use must be determined by ister antifermentatives as indicated, the experience and by an examination of best of which is salol ; avoid the routine the passages for fat aud casein.

use of astringents; and lastly, give suitIrrigation gives good results. My able tonics where indicated. preference has been stated. Tannic acid In conclusion, I would say that the when stools are frequent, boracic acid treatments I have endeavored to outline when scarce. In cases of dysenteric for these affections are not new, nor are nature high irrigation with about one they the only ones. Still, after much pint of a nitrate of silver solution (gr. j experimentation on many hundred cases, to zj) followed, without withdrawing coupled with no little study of the subthe tube, by a copious weak saline solu- ject, the treatments outlined appealed to tion, does good. Once a week is suffi me as giving the best results. Drugs ciently often to use this. I have also must take a secondary place to dietary obtained good results with nitrate of sil in these cases. “Shot-gun" prescripver, in pill form, by the mouth in these tions are to be avoided. Understand cases when the small bowel is more af the conditions you are to combat and fected. The great drawback to this select the best drug for that purpose. way of using the drug is the difficulty Drugs that do no good do harm. It is in getting an infant to swallow even the much easier to upset a child's stomach smallest pill, though they can swallow than to quiet the same. Leave new pins readily.

drugs and proprietary preparations for Chronic Diarrhea.-It is unnecessary your neighbor to experiment with. for me to go into detailed description of Bearing these facts in mind, working the manifold phases of chronic diarrhea. systematically, plainly and carefully and Treatment must be regulated by the success will crown our efforts where sucpractitioner to meet individual cases. cess is possible.

SPINAL CORD DISTURBANCES AFTER as to whether these disturbances are ocTYPHUS FEVER.— Dr. S. Terzykowski casioned by the typhus bacilli or by their (Universal Medical Journal) has exam toxic products has not yet been solved. ined three cases of nervous disturbances The noxious factors reach the nervous after typhus fever. One case recovered, centers through the lymphatics, bloodbut the others did not. The question vessels and the peripheral nerves.

UREMIC COMA. .
READ BEFORE THE BALTIMORE MEDICAL, AssociATION, NOVEMBER 26, 1894.

By John I. Pennington, M, D.,

Baltimore. The case that I am about to relate is, of vomiting once during the day. She in my experience, unique. In a practice retired about 9.30 P. M., but before reof twenty-five years I have seen nothing tiring she placed a wash bowl on a chair like it. On November 14, about eleven beside the bed, which would give the o'clock P. M., I was called to see a young impression that she must have felt naulady, who, I was told by the messenger, seated at that time. When her sister, was thought to be dying. On arriving who slept with her, retired about 10 at the bedside, I too thought her dying. o'clock, she was sleeping quietly, but in She was lying in a state of complete a short

a short time, perhaps a half-hour, her relaxation, profoundly comatose. Her sister was aroused by her breathing peface, lips and finger ends were cyanosed; culiarly. She could not be awakened respiration abnormal, of the Cheyne- by calling or shaking. On making a Stokes character. The inspiration was

light her

sister saw that she was short, a mere jerk. The expiration was alarmingly ill and called assistance. I prolonged, the air escaping by a collaps was then sent for and found her in the ing of the lungs. At short intervals the condition as above described. respiration would be suspended, and at Diagnosis.—The question as to the times for so long a period that one would causes of all this disturbance was not at think she had breathed her last. The once easily answered, and it was especipulse varied both in frequency and force. ally difficult under the existing circumOccasionally it was intermittent. The stances. The coma appeared to me like nervous system, both motor and sensory, that occurring from uremic poisoning, was for the time being paralyzed. The but the absence of all symptoms except reflexes were gone excepting a very the nausea and coma made this conclu. slight closing of the eyelid on touching sion doubtful. I could learn of no the cornea. No amount of slapping or symptoms preceding the attack indicattickling would excite the slightest move ing disease of the kidneys. There was ment. The muscular system was in a no edema, and as far as we know the state of complete relaxation. I do not coma was not preceded by convulsions. think she made the slightest movement The usual picture of uremic poisoning is in the seven hours during which the somewhat like this : Edema, vomiting, coma lasted.

convulsions and coma, with a history of The history, as learned from the fam an acute attack, or of failing health for ily, was unsatisfactory, and threw but some time previous. However, I belittle light as to the cause upon the case lieved that I had to deal with a case of beyond the fact that they were quite uremia, presenting unusual symptoms, sure she could not have taken any poi. or I may say better, with the absence of son which would have produced the con some of the usual symptoms. dition in which I found her. She was Treatment. The cyanosed condition twenty-one years old, unmarried, and of the skin, the character of the respirathought to be in fairly good health. She tion, with the weakened and irregular had for a few weeks been suffering from action of the heart, suggested to my indigestion, for which she had consulted mind that whatever the cause, nitroher physician, Dr. Aronsohn.

glycerine hypodermically was the remOn the day of the attack she had as edy indicated, and I accordingly gave usual assisted in the household duties Too of a grain, repeating the dose in and seemed to be well with the exception one hour and also giving an occasional

hypodermic of whiskey when the action her condition of extreme relaxation, we of the heart became very weak. After thought best to rely upon the nitroworking with her about one hour and glycerine and the digitalin. a half, Dr. Aronsohn, the family physi She remained in about the same concian, came. I then went home for a dition until about 7 o'clock A. M., when catheter and tests for the urine. On in she commenced to show signs of improvetroducing the catheter we could get only ment, and by eight o'clock she could be two or three drachms of urine, which aroused to partial consciousness. About upon examination was found to contain this time she improved rapidly, and at albumen. A third dose of nitro-gly 10 o'clock, when I again saw her, she cerine was now given, and in an hour we had sufficiently recovered to answer gave a hypodermic of digitalin. We questions intelligently, but could give had little hope of our patient recovering, no account of her attack. She had passed for notwithstanding what we had done for urine in good quantity, which also conher, there were no signs of improvement tained albumen. except perhaps that the cyanosis was I did not see her after this, but Dr. not so marked. About 3 A. M., we again Aronsohn informed me that the improveintroduced the catheter and drew off ment had been uninterrupted, and that two or three ounces of urine, which also albumen had disappeared entirely from contained albumen.

her urine. The question of giving a hot bath I shall not attempt to explain the was suggested, but the patient was on pathological condition, trusting that the third floor of the house while the some one in the discussion will bring bath was on the second, and her condi out this point. The points to which I tion was so precarious that we did not wish to call special attention are the think it advisable to attempt to carry her absence of symptoms of albumen predown. We did apply heat to the back. ceding the attack, the suddenness with Pilocarpine was also thought of, and which it came, and the violence of the the propriety of using it was discussed attack, and the most remarkable thing by Dr. Aronsohn and myself. But in to my mind in the case was her recovery.

RESULTS OF PARTIAL RESECTION OF and resistant objects and could use the THE HUMERUS FOR SARCOMA. - Heur limb with sufficient precision to play on taux (British Medical Journal) has re the piano. The left forearm and hand cently reported a case in which eleven were as well developed as those on the years ago he resected the upper half of right side, but the arm was much wasted, the left humerus for a large and rapidly being not more than eight inches in growing tumor which after removal was length, whilst the right arm measured proved by very competent authority to nearly thirteen inches. The portion of be a true sarcoma developed at the ex the left limb between the shoulder and pense of the medulla. According to the elbow was composed chiefly of soft parts, report of Malherbe, which was subse as the remaing portion of the humerus, quently confirmed by Ollier, the malig the upper part of which was very thin, nity of the growth was placed beyond measured only four inches in length. doubt. The patient, who at the time of this bone, since the operation, had unoperation was six years of age, was last dergone atrophy both in length and seen by the author in the autumn of thickness. Notwithstanding this de1894. Then he found that there was formity the limb has proved so useful not only a total absence of any indi to the patient that the author holds that cations of relapse, but also that the he is justified in advocating in cases of mutilated limb had proved a very useful malignant growths of the head of the one. Even when the arm was free, and humerus a free resection of the upper not supported by any apparatus, the pa part of this bone as a measure preferable tient was able to lift and drag heavy to removal of the whole limb.

case.

SOCIETY REPORTS.

than baths. Pilocarpine is a drug of great danger. It causes great secretion

of mucus. In regard to the alimentary BALTIMORE MEDICAL

canal, we cannot avail ourselves of this ASSOCIATION.

emunctory. Hypodermics of Epsom MEETING HELD NOVEMBER 20, 1894.

salt may be used, but they are not

prompt enough. Dr. E. D. Ellis, Second Vice-Presi Dr. John D. Blake asked if the eyes dent, in the chair.

of this patient had been examined. Dr. John 1. Pennington reported a Dr. Pennington replied that they had case of UREMIC COMA. (See page 224.) not. There was no microscopic exami

Dr. J. Edwin Michael opened the dis nation of the urine. The pupils were cussion of this case. Uremia is but lit neither contracted nor dilated ; they tle understood. The term is based upon did not respond to light. an error.

Often we have these symp Dr. Blake : This case presented some toms when no urea can be discovered. of the features of hysteria. The case But something (we know not what) ex was peculiar. The rapid recovery was ists to cause the trouble. Dr. Penning also remarkable. The presence of albuton's case was unique. But we often men during this short period without have such a condition in pregnant microscopic examination is not of much women. He is unable to give the cause diagnostic significance. of the affection in Dr. Pennington's Dr. David Streett: The patient had

He referred to a paper by Hughes probably had nephritis previously. Such and Carter in recent numbers of the cases are frequently mistaken for hysAmerican Journal of the Medical Sciences, teria. Nephritis may exist for several in which a case similar to Dr. Penning years without any evidence. He has ton's is related. In the paper by many times seen patients who were inHughes and Carter experiments are sane, the condition being due to a nementioned of using blood taken from phritis. He thinks that if Dr. Michael uremic patients to inoculate animals. will look up the question, he will find The result was a nephritis produced in that the experiments mentioned by him the animals. The blood of meat-eating and considered to be new are in reality creatures (man and the dog) will pro rather old. Pilocarpine does produce duce nephritis when introduced into the considerable diaphoresis and salivation, herbivora. Experiments of this char but it does not give better results than acter are of great importance in the eti hot-air baths. This is one of the best ology of Bright's disease. This leads methods of causing elimination, but it to the subject of vegetarianism which should be conjoined with the adminishe is now investigating. He is now tration of fluids. Changes of temperaexperimenting in his own person with ture are a frequent exciting cause of vegetable diet to relieve neuralgic at nephritis. tacks, and with much benefit. In re Dr. Blake : One of the best things gard to treatment, the most important to be done in cases like this is to inject consideration is the elimination of the from a quart to a quart and a half of hot materies morbi by the various emuncto saline solution, with hot bottles applied. ries. The kidneys can be less relied This plan together with venesection upon for this purpose than any other or would be an ideal mode of treatment. gans. The most thorough elimination Dr. Michael reported the case of a is obtained by venesection. Even it young lady who he thought at his first the pulse is feeble, bleed, and often the visit was in hysterical coma. The urine pulse will improve under the operation. was loaded with albumen. Everything To counteract depression we can inject was tried but venesection, and the pasaline solutions into the cellular tissue. tient died. He also reported a case of The skin is the next most important uremic convulsions in a pregnant woman, emunctory. Hot packs are more useful from whose urine albumen disappeared

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