Vol. 60, 1909 - University of North Carolina at Chapel Hill

130
THE CHARLOTTE MEDICAL JOURNA]
erto used in the treatment of labor in con- tongue being absent. The stools are infre"
tracled pelvis should be looked upon as quent and of an ochre color. Meteorism
atypical. Craniotomy on the dead child and abdominal pain are generally absent,
may be indicated in a conjugate under 9>^ Hemorrhages and perforation of ulcers are
cm. Craniotomy on the living child may very exceptional. The Peyer's patches are
become necessary if the mother is in a state not much swollen or deeply ulcerated,
of in 'ection or refuses to undergo any of the There is rather a septicemia than a true
typical operations. Artificial induction of typhoid condition. Rose-spots are not alpreniature
labor may also have to be per- ways present, one-third of the cases never
formed in cases in which the mother is suf- showing them. Sometimes they appear earfering
from illness and Cesarean section or Her and are more abundant than in the
hebosteotomy at the normal term would be adult. Relapses are more frequent than in
too dangerous, or where it is positively the adult, and the rose-spots return with the
known that the children are abnormally fever. There is generally a desquamation
large or the mother absolutely refuses an which is distinguishable from that of scarlet
operation. The application of forceps above fever only by the absence of the large
the brim and prophylactic turning should, plaques of skin that appear in the latter
if possible, be entirely removed from the disease. There are two distinct forms of
list of methods of treatment in contracted typhoid fever; a very slight one, of short
pelvis. The application of forceps above duration, and a severe form, more curable
the brim might exceptionally be tried before than in adults. The causes of the less secraniotomy
on the living child is resorted verity are perhaps the good digestion the
to, and it will probably be possible occa- development of the lymphatic system, and
sionally tosave a child. Before craniotomy the general good condition of heart, kidon
the living child is undertaken, prophy- neys, and liver. Frequent complications
lactic turning may be justified in certain are meningitis, paralysis, and otitis,
degrees of contraction in a simply flat pelvis, Pneumococcus Vaccines in the Treatwhen
Cesarean section of hebosteotomy, on ment ol Pneumonia and ol Some of Its
account of illness of the mother, is out of Complications.— Harris in The British Medthe
question, and a trial with the forceps ical Journal states that, clinically, death in
affords little hope of success on account of this disease usually comes from cardiac
the high position and mobility of the head, failure, especially in those virulent cases
Forceps above the brim and prophylactic terminating about the fourth day of the
turning we find their indication in such attack. Under these conditions the vaccine
atypical cases as a last attempt to save the treatment in many instances will indeed re-
life of the child before craniotomy is resorted duce the fever but fails to avert a fatal
to— forceps when the head is fixed, turning result. The toxemia already induced is too
when it is movable. In a conjugate under profound for merely the arrest of the infect-
6/-2 cm., Cesarean section is absolutely in- ing process to be successful. Hence the
dicated: if the case be aseptic, with suture vaccines should be used at the earliest posof
the uterus; if septic, with total extirpa- sible moment and be accompanied by the
tion or supravaginal hysterectomy. use of a antitoxin. It is not improbable
that in the case of the pneumococcus the
Typhoid Fever in Children.— Marfan success of a vaccine is due not simply to the
(Jour, de Med. et de Chir.) describes ty- fact that it should be autogenous, but the
phoid fever as it occurs in children. It is fact of a vaccine being autogenous narrows
more infrequent in children than in adults, down the issue to (1 ) the right organism
and is rarely seen before the fifth year, being selected, and (2) the vaccine being
The youngest patient attacked by typhoid prepared, if not unduly subcultured, from
.seen by the author was nine months old. an organism of requisite virulence. Fraenk-
The general methods of infection in infants el's pneumococcus is, however, as far as
ore by milk diluted with impure water, the we know, invariable; it is not like the strepuse
of unsterilized milk, and the washing of tococcus (Gordon) an inclusive term for
milk containers in bad water. A wet-nurse several varieties. On the other hand, we
may give the fever to her nursling. At birth know from the staphylococcus and colon
a child may bring with it into the world the bacillus that these may be so subcultured as
germ which has attacked the mother dur- to lose their original virulence, and that
ing pregnancy. The onset of the disease is vaccines so prepared are of little use, theramoresudden
than in the adult and it reaches peutically. If, then, a potent and reliable
its acme sooner. From the second day the stock pneumococcus vaccine is to be obtaintemperature
is very high. Diarrhea is ab- ed, it should be make from as virulent a
sent, and constipation the rule. There is strain as possible. There is unhappily no
an exaggerated hypothermia and very few difficulty in the early months of the year in
digestive troubles, anorexia and the typical obtaining as much as is wanted. The truth
.