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

180 THE CHARLOTTE MEDICAL JOURNAL. ;
had no effect on them, and death ensued, the ansesthetist rather than the surgeon,
These hypertoxic cases required large doses and especially so since at times its appliof
serum by intravenous injections. The cation may fail from various causes and -
best method of treating heart failure attacks necessitate the administration of a general |
was by the use of adrenalin. In cases that anaesthetic. _;
were diagnosticated late and treated after The Need lor More Prompt and Tlior- %
severe attacks had taken place intravenous ough Treatment of Children Suffering
^
injections of serum were beneficial, and f ««" Rheumatism or Chorea—Lees. .'.
large doses were indicated. Heart changes (British Journal of the Diseases of Children ),
in diphtheria were prevented by the use of mentions the great responsibility of the
serum, and post-diphtheritic cachexia was medical man called upon to treat a rheuprevented
or was benefited when it had matic or choreic child. He has the chance
occurred. From these experiments it would to arrest in its earliest stage a morbid proseem
that large doses of serum injected in- cess, which if uncheeked, may be fatal,
travenously were indicated in all severe and if inadequately treated may relapse
casesof diphtheria in man. and again, and irreparably damage the
child's heart. Most of the heart disease,
Spinal Analgesia.— McGavin and Wil- which exists in patients under thirty, is the
liams (Edinburgh Medical Journal ) report result of a rheumatic infection in childhood,
2.50 cases of spinal analgesia by the use of which was either unrecognized or ineffectstovaine
glucose solution. They observe ively treated. Thorough phj'sical examithat
spinal analgesia is a method which has nation should be made and when the cona
definite place and use in modern surgery, dition has been accurately diagnosed thorand
of which the future is no longer in ough treatment will be necessary if the
doubt. Stovaine is admirably suited to the process is to be arrested and lamentable
purposes of spinal analgesia, and is prob- cardiac injury to be avoided. The fate of
ably as safe as any other analgesic at pres- the patient depends upon the action or incut
in use. The risk of infecting the spinal
meninges is, in proper hands and where
action of the physician.
Every child who complains of sore throat
proper precautions are taken, very slight,
The method of spinal analgesia is unsuited
or pains in his joints, muscles or tendinous
structures,—every child who suffers from
to the Trendelenburg position. Failure to malaise, and unexplained pyrexia, whose
reach to reach the spinal theca is usually skin shows spots of erythema or has subcudue
to faulty technique, while failure to taneous nodules on his tendons, or about
obtain sufficiently high analgesia is com- his joints, or who has pains in the chest,
monly due to insufficient d^jsage, and is to or shortness of breath, or marked pallor, or
be met in most cases by a second injection, exhibits slight choreic movements, should
The attempt to push the analgesia to a be put to bed and his heart should be most
higher level than the fourth dorsal area is, carefully examined. The earliest evidence
in the present state of our knowledge, un- of cardiac rheumatism is obtained, not by
wise. The lateral position, although ren- oscultation, but by percussion, for the eardering
the injection rather more difficult liest cardiac rheumatic phenomenon is an
that the sitting position, is less likely to be acute dilatation of the left ventricle. In a
followed by disquieting symptoms, and first attack of rheumatism the duliiess of
commonly gives better results. The great the left ventricle is always increased tomajority
of patients are in favor of the wards the left; almost always to the nipple
method, preferring to retain consciousness line. Along with this evidence of dilataso
long as the area of operation is screened tion there will be a weakened cardial
from their view. In support of this many pulse, a weaker pulse wave in the arteries
patients have elected to have spinal anal- and a shortened and enfeebled first sound
gesia for second operations. The contra- at the apex, and a distict accentuation of
indications hitherto summarized by various
writers must be accepted with reserve.
the pulmonary second sound,
There may be a murmur at the apex,
owing to the lack of detals supplied, and The pulse rate is abnormally frequent, and
the great variety of methods, analgesics, is further increased upon slight exertion,
and doses employed. Sepsis, syphilis, and The acute dilation of the left ventricle is
old age do not appear to influence the re- present even in the mildest attacks of subaction
of the patient to stovaine. The ac- acute rheumatism. Thus the importance|
tion of stovaine is purely one of surface
effect resulting in the blocking of nervous
of complete rest, even in the mildest cases.
He advocates large doses of the salicylate!
impulses, and probably affecting only the of soda and to eeach dose should be added|
anterior and postertor nerve roots. The twice as much of sodium bi-carbonate.
method being but a special branch of the Every case of chorea in childhood ought
science of anaesthetics, its administration to be considered as presumably rheumatici
and investigation should be undertaken by and treated vigorously as for rheumatism.l
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