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cous membrane, hence the danger of treating young children in this way is greater than the good which may result from it. The round-worm and the tape-worm are to be attacked by way of the patient's mouth; the seat-worm by way of the anal opening.
On the 19th of last June, Ruby J., mulatto, aged 20 months, was brought to me for treatment. Her mother gave the following history: About a month previous she was taken suddenly ill with high fever and swelling of the limbs and face, with considerable distention of the abdomen. The fever and swelling were worse in the afternoon, and disappeared during the night. As the child grew continually worse she became dissatisfied with her medical attendant, and gave the child "Dead Shot," which, as she expressed it, "liked to have killed her."
When I saw the child the fever had subsided and the swelling in the limbs and face had disappeared. The abdomen was tympanitic, and hard masses or knots could be distinctly felt in the colon. She was emaciated, nervous, restless, no appetite, and took no interest in surrounding objects. The mother stated that the child had sneezed out a worm while at table the day previous.
I directed that the child be required to fast until the next morning, taking only a little milk during this time. I prepared two powders, each containing, santonin, grs. iii, calomel, grs. iss, powdered jalap, grs. iss. These were ordered to be given before breakfast at 4 and 6 o'clock, followed by a dose of castor oil at 10, and later in the day by high enemata of salt and water.
Either the calomel or the increased amount of bile which is present is apparently peculiarly abhorrent to these worms. The oil is given to dislodge the intruder while he is paralyzed and has lost his hold. The salt and water is given by enema after a passage to wash out any worms which may have lodged in the rectum.
The mother reported that at 12 o'clock 305 round-worms passed in a lump. She gave an enema at 2 o'clock in the afternoon, which yielded 400 at one time. During the afternoon and night, two more enemata were administered, which yielded 74 and 54 respectively.
The next morning I was sent for in hot haste to view the result. The mother had carefully saved them for me and exhibited them with considerable pride. While I did not count them I was fully prepared to believe she was correct. There was nearly a basin full, and I saw worms until I hoped I could
never look another one in the face. These worms were of the ascaris lumbricoides variety, and ranged in length from one inch to eight or nine inches.
The next morning I sent the following:
M. Ft. Emulsio. Sig. Teaspoonful three times daily.
The next morning she passed 315, and during the afternoon of the same day 319. She passed small numbers with each enema for several days until July 4th, when I saw her for the last time. I put her on a stomachic tonic, and the child is now well and hearty.
Departure from type in this case: first, age of child, 20 months; second, number of worms, 1992. I think, gentlemen, that for a child of that age to pass nearly 2000 worms in so short a time is, at least, unique.
BOUGIE IN ABDOMINAL CAVITY FOR FIVE DAYS.* E. E. HAYNES, M.D.
I SHALL OCCUPу your valuable time but a very few moments in reporting this case, which I consider one of much interest to the profession, as I will not encumber the report with any frills of theory or new-hatched ideas as to how to manage such cases. I shall only give you the facts and history of the case, and I am confident that they will suffice to be of interest.
On the evening of March 26, 1903, I was called to see Mrs. D., a young woman married only a few months, and was told by her husband that she was pregnant and at about the fifth month of gestation. I was also told that she had been vomiting most of the five months' time, and that on account of the depression and inability to retain food it was thought advisable to bring on a miscarriage, and to do this a bougie was introduced into the uterus, and that the instrument had passed into the uterus and that he wished me to remove the bougie. I found the woman suffering with an acute general peritonitis, the abdomen greatly distended and tender, pulse rapid and feeble, with a bad, pinched facial expression, temperature subnormal, and a slight fetid, bloody vaginal discharge. The * Read before Tri-State Med. Assn. (Miss., Ark. & Tenn.), Memphis, Nov. 18, 1903.
woman did not, from a casual inspection, appear to be so far advanced in pregnancy, and the picture before me was one that I did not like, and I felt considerable hesitancy in accepting the case. I realized, however, that unless some one did something for the woman she would soon die. I therefore advised that she be taken to the city hospital, where proper facilities could be had for operating and nursing my patient. I was fearful that an attempt at abortion had been made, and that I was to become the one to shoulder the responsibility after infection had taken place. I was sure that there was no instrument in the uterus. I felt that one had been introduced to produce the abortion, but that it was not there then. Her condition was so bad, pulse so weak, that I did not dare to attempt any operation when I first saw her. I began the administration of strychnia hypodermically, and on the afternoon of the following day I had her taken to the operating room and anesthetized. The cervix was dilated so that I could inspect the uterine cavity. She was not pregnant, nor had she been so. I found at the right cornu of the uterus a hole I could almost get my index finger in. I immediately scrubbed my hands and had the abdomen cleansed, and then proceeded to open the abdomen. I found the bougie, which I present to you for inspection, down under the abdominal viscera; closed the rent in the uterus and then closed the abdominal wound in two layers. I first closed the peritoneum with intestinal silk, and then the skin, muscles and fascia with silkwormgut. I do not think the peritoneum should ever be anchored to the abdominal wall by a through and through suture. The patient's condition was indeed very serious; when she was placed upon the operating table her pulse was 130 and very feeble, and when ready to take off the table her pulse was 160. Had I not done the work very rapidly the patient would have died upon the table. By having competent assistants I was enabled to do the operation, close the wounds and put on the dressings in just twenty minutes. The following morning at 7 o'clock her pulse was only 80, with fair volume, and the pulse rate never did go as high as 100 after the first night following the operation. Her recovery was rapid, and on the 9th day of April, just fourteen days after the operation, she was able to go home, and has since been a well woman. The bougie had been in the abdomen five days.
This case shows how much infection and traumatism the peritoneum will stand, and by proper surgical interference permit the patient to live.
Dr. W. T. Black, my associate, ably assisted me in performing the operation. The internes and nurses of the city hospital also rendered me valuable assistance, and I must not fail to mention that to a great degree the success of abdominal surgery depends as much upon competent assistants as upon competent operators.
PROGRESS OF MEDICINE.
UNDER CHARGE OF B. F. TURNER, M.D.
Pneumonia in Children.
Nothing is generally more difficult, says Variot (Medical Press & Circ., vol. 77, no. 3378), than the diagnosis of pneumonia in children. The classics say that it is a rare affection, that broncho- pneumonia is more generally observed. The fact is true for broncho-pneumonia, but not absolutely exact as regards pneumonia, which often passes unperceived.
A child, æt. 10, entered the hospital for supposed typhoid fever; high temperature, prostration, loaded tongue, diarrhoea; the symptoms were all those of typhoid. Examination of the lungs revealed sub-crepitant râles at the base. However, by percussion Variot discovered a dull zone at the apex of the right lung and behind which awakened his attention; nevertheless, the treatment ordered was that of typhoid fever: baths at 86° every three hours as long as the temperature remained above 102°, and quinin given by the mouth.
On the sixth day the fever fell suddenly, and at the same time the signs of pneumonia became evident, souffle and fine sub-crepitant râles.
In commenting on the case, Variot stated that in such cases the signs afforded by auscultation were very uncertain; pneumonia in children attacked the center of the lung, and as a large layer of healthy tissue separated it from the ear, nothing very abnormal could be heard. Weyle, of Lyons, claimed he had discovered a new sign of pneumonia: absence of expansion of the chest in inspiration on the affected side; but that
sign was inconstant and could be found in other affections. The radioscope constituted a much better means of diagnosis, as the diseased part was represented by a shadow on the screen.
Practitioners, in presence of pneumonia in children, should eliminate from their mind, by careful and repeated percussion of the lung, the idea of typhoid fever. The same prudence should be observed with meningitis, a malady which naturally threw a family into despair. It was true that meningitis could succeed pneumonia as purulent pneumococcic meningitis, but it was a very rare affection, and was always fatal. On the other hand, pneumonia was a very benign affection in children. The Dietetic Treatment of Arteriosclerosis.
T. L. Coley (Med. News, vol. 84, no. 7) gives the following, as an epitome of the necessary restrictions for patients suffering from arteriosclerosis: 1. The quantity of food should be greatly reduced, not more than one-half or two-thirds the general average for body-weight being required. This amount in detail should be estimated according to the general rules laid down. 2. The quality of the food is important. Proteid foods. are to be reduced, but not excluded. Meat should not be taken more than once daily and then in small quantity. It should be our effort to see that the patient obtains well-cooked food, especially avoiding large amounts of fat or other substances difficult of digestion. Alcohol, tea, coffee and cocoa, as well as tobacco, are to be forbidden or used with extreme moderation. Excessive water drinking, or drinking large quantities of any fluid must be curtailed. 3. The regulation of meals is important. Breakfast should consist of fruit, a cereal with cream and perhaps an egg, poached or soft-boiled. There should be an interval of five or six hours between breakfast and dinner, and the heaviest meal should be taken in the middle of the day. It is not advisable to place too many restrictions upon what the patient shall have for his dinner. It may consist of soup, fish, meat, and vegetables, but overfeeding is to be strenuously avoided. Between dinner and supper five or six hours should also elapse, and this meal must be light and consist, as breakfast, mainly of fruit and cereals.
In general, a comparatively dry diet is indicated and the