INTRODUCTORYThe case we are to report is of interest both to the clinician and to the surgeon. Our main reasons for presenting same are twofold: first, on account of the rarity of these cases, and, second, because there were no objective manifestations of trauma.Kuster, in 7,741 injuries at the clinics of Baser and Berlin, tabulates only 10 cases of injuries to the kidney, or a little more than 1: 1,000. Of these 10 only one was similar to the case now to be presented. Of 2,610 autopsies under his supervision, there was only one of a penetrating nature. Israel reports only one operative case, notwithstanding his large experience in renal surgery. REPORT OF CASEFamily History.\p=m-\IreneC., aged 11 years, was the fifth child of six living children. Her father and mother give a negative history in every detail, and her family history with reference to tuberculosis, malignancy and insanity was negative.Previous History.\p=m-\Born at 9 months, normal delivery. Breast fed entirely for one year, and with soft food until she had reached the age of 32 months. From that time on she had received full diet. Prior to her present illness she had never needed the attention of a physician. Present Illness.-In the forenoon, Aug. 5, 1915, while the patient was stand¬ ing on the edge of a wagon, with one foot balanced on a swinging gate, her little brother pulled the gate in the opposite direction, causing her to fall. In falling it is evident that she traumatized the middle and left lower quadrants of her body. Following this, she fell from the wagon to the ground, a distance of about 3% feet. She was unconscious for a few minutes, and after regaining her senses, complained of a "pain in her stomach" and about fifteen minutes later vomited. At 8 p. m., on the same date, she voided "a black urine," and at 9 p. m. had about 1 degree elevation of temperature. During the night she voided three times, the urine becoming clearer as time progressed. The follow¬ ing morning, Aug. 6, 1915, she had "frequent desire to urinate," however, unaccompanied by pain. She complained of a "drawing down pain" radiating from the region of the stomach to the vicinity of the kidney.
These studies were undertaken ( 1 ) to demonstrate the capacity of the animal organism to utilize the calcium contained in these compounds as compared with the utilization of calcium from other sources.(2) To compare bone-forming properties of refined "pure" dicalcium phosphate, t unrefined dicalcium phosphate,$ and other calcium compounds. ( 3 ) To determine the availability to the organism of various sources of calcium after their incorporation with alimentary fluids.To determine the relative efficiency of different calcium compounds, feeding experiments were conducted with the albino rat.When calcium is provided not to include phosphorus, i. e., the carbonate or citrate, the retention is seriously interfered with. Whatever phosphorus is supplied as a constituent of the other ingredients of the diet, is not satisfactorily utilized. On the other hand, when the calcium is supplied as calcium phosphate, the phosphorus retention is greatly improved. In spite of this, however,' the efficiency with which the calcium is utilized appears to be more depencl'ent on the form of the calcium phosphate. The average calcium retention observed during the periods of feeding tricalcium phosphate was 30.9%, the retention values observed in the unrefined dicalcium phosphate and refined dicalcium phosphate periods averaged 46.8% and 41.2%, respectively. The superiority of the latter substances to tricalcium phosphate probably is related to their greater availability, i. e., solubility in the digestive fluids.1. The calcium contained in unrefined and refined dicalcium phosphate is utilized much more efficiently than are equivalent quantities of calcium supplied in the form of carbonate or citrate. 2. That this is not due solely to the fact that phosphorus is a limiting factor in these diets is demonstrated by the fact that the calcium of refined dicalcium phosphate is utilized about 70% more efficiently than is the calcium in tricalcium phosphate. 3. Unless adequate quantities of phosphorus, as well as of calcium, are assured, progressive changes take place resulting in the decalcification CoiicZusz'onx t Diealfos,
In reviewing literature relative to this subject, the writer has found a total absence of any authentic conclusions regarding the blood in infectious diarrhea. Starr,1 Whipham2 and Keating3 make no mention of the blood whatsoever. Taylor and Wells,4 Ashby and Wright,5 Carmichael6 and Oppenheim7 also failed to mention this important point. The textbooks of Donkin,8 Smith,9 Carr10 and Cotton11 have left unsaid all matters pertaining to this subject. Even the most recent works on pediatrics, by such authorities as Koplik,12 Hutchinson,13
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