In connection with the malarial treatment of general paralysis of the insanein thishospital, we have endeavouredto producea secondseriesof malarialrigorsin such casesas had not shown sufficient mental or physical benefit after a first infection terminated six or more months ago.
The 6 per cent, of cases that ultimately develop signs of general tuberculosis could be accounted for by an infection with the human type of tubercle bacilli.The common symptoms of acidosis may be explained by the interference with the supply of fats to the liver. The child's metabolism is easily disturbed. Frew showed that the urine of most children suffering from any acute disease contained acetone. The lower ileum and the appendix are great absorbers of fat; appendical concretions are chiefly fat. A calcification and fibrosis of the glands of the ileocaecal angle must to a great extent interfere with the supply of fat to the liver, and set up acidosis. It seems to me that this acidosis has some relation to the onset of the acute attack of pain in the right iliiac region. A dietetio inidiscretion, a period of nervous strain, or muscular exertion often starts an attack. Many organisms lie latelnt till an acid is piesented to them. In children first come the symptoms of acidosis, headache, drowsiness, and then pain.The pain has been attributed to different causes by different observers. Corner thought it was due to the reflex action on the appendix. Carson attributed the pain to the irritation of the mesenteric nerves causing enterospasm. This, he thinks, explains the colicky nature of tho pain, and its sudden onset and cessation. He tictually saw an intussusception occurring when he was bperating on a case of lymphadenitis. Probablv Carson's oxplanation holds good in many cases. It would explain the colicky pain at the umbilicus at the beginning of an attack. The shifting of the pain to the right must be explained by the local inflammatory lesion.It is easy to understand how a calcified gland in the mesentery with no recent inflammation can, on exercise, cause acute pain. The site of the pain will depend on the part of the mesentery affected. Its irritating presence will also give rise to pylorospasm or enterospasm by reflex nervous action, or its bony hard spicules may irritate a ureter and give rise to renal colic and haematuria. The movemenits of the intestine after eating will readily cause the calcified gland to act as an irritant, and bring about pain after food, simulating that due to digestive ulcer.The treatment, then, will resolve itself into preventing the condition by a clean milk supply, and in the established cases according to the type. If the child appears to be getting worse under this treatinent the abscess should be evacuated and wiped out with bipp, with as little disturbance as possible to the surroundings, for the intestines are likely to separate, leaving holes in their lumen. In cases where future obstruction seems to be pretty certain, a side-to-side anastomosis, from above the lesion to below it, will save many a life and hasten convalescence.In cases of calcified glands I think tle evidence is anl in favour of their removal. Their close relation to the mesenteric blood vessels should be noted and the blood 8upply. of the adjacent bowel not interfered with. If on accouft: of the close ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.