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

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XXVI THE CHARLOTTE MEDICAL JODRNAl<br />

Januarj' 23 irrig<strong>at</strong>ions <strong>of</strong> the bowel with ice also furnish a guide. If the amount sliould<br />

w<strong>at</strong>er were begun. Encouraged by the become too pr<strong>of</strong>use, the dosage <strong>of</strong> the dnio; j<br />

favorable results in other cases, five-grain should be diminished in accordance. i<br />

capsules <strong>of</strong> A-S-phen were ordered every A point frequently made against mam- <strong>of</strong> i<br />

two hours. The rapidity <strong>of</strong> the pulse in- the various plienetidin deriv<strong>at</strong>ives is th<strong>at</strong> |<br />

creased, ranging from 100 to lOS, but the they unduly depress the circul<strong>at</strong>ory system, j<br />

highest point reached in temper<strong>at</strong>ure after In Case II it was feared th<strong>at</strong> A S phen was I<br />

the administr<strong>at</strong>ion <strong>of</strong> the drug Tas begun depressing in the effects from the indic<strong>at</strong>ion '<br />

was 102, and the expected gradual decrease <strong>of</strong> cyanosis observed on the extremities <strong>of</strong> ;<br />

in the daily averages <strong>of</strong> temper<strong>at</strong>ure by a the p<strong>at</strong>ient's fingers. Discontinuance uf :<br />

few tenths <strong>of</strong> a degree began. Normal the drug with continued observ<strong>at</strong>ion poinled<br />

temper<strong>at</strong>ure was reached January 31, and unerringly to the fact th<strong>at</strong> this cyanosis had<br />

the pulse thereafter soon slowed to 72, and no rel<strong>at</strong>ion wh<strong>at</strong>ever to the use <strong>of</strong> A-S-plien, j<br />

from th<strong>at</strong> time improvement was rapid, but was caused by the b<strong>at</strong>hs administered j<br />

without any complic<strong>at</strong>ions wh<strong>at</strong>ever until to the p<strong>at</strong>ient in the routine tre<strong>at</strong>ment.<br />

February 11, 190'->, when bacteriologic re- A valuable indic<strong>at</strong>ion may be observed i<br />

port showed absence <strong>of</strong> the typhoid bacilli in the slight effect upon the pulse r<strong>at</strong>e in the i<br />

from the urine, and the p<strong>at</strong>ient was pro- use <strong>of</strong> A-S phen, even in the weak circula- ,<br />

nounced cured and discharged from the tion <strong>of</strong> the p<strong>at</strong>ient who exhibited the symp- |<br />

hospital. torn <strong>of</strong> cyanosis. This slight effect was<br />

In the cases recited above diagnosis was especially noticeable in view <strong>of</strong> the fact th<strong>at</strong> i<br />

established not only by the clinical symp- the temper<strong>at</strong>ure showed steady decline un- |i<br />

toms <strong>of</strong> rose spots, characteristic tempera- der its administr<strong>at</strong>ion. An agent having ^\<br />

ture, etc., but labor<strong>at</strong>ory methods establish- so conserv<strong>at</strong>ive a mode <strong>of</strong> action, conjoined ,!<br />

edthe Widal reaction and also the presence with the remarkable bactericidal power, as<br />

<strong>of</strong> the typhoid bacilli in the urine. L<strong>at</strong>er shown in the rapid disappearance <strong>of</strong> the 'i<br />

labor<strong>at</strong>ory examin<strong>at</strong>ions showed the rapid typhoid bacilli from the urine, would seem .<br />

decrease <strong>of</strong> the typhoid bacilli from the <strong>of</strong> gre<strong>at</strong> value in this disease. The cases <<br />

specimens <strong>of</strong> urine submitted, and in each quoted as typical show milder and shorter i<br />

instance their eventual disappearance, courses under the conditions <strong>of</strong> very high ]<br />

There would seem here the possibility <strong>of</strong> temper<strong>at</strong>ure and gre<strong>at</strong> prostr<strong>at</strong>ion upon adan<br />

agent invaluable in preventing the mission. They are reported in the hope <strong>of</strong> i<br />

establishing <strong>of</strong> "typhoid carriers" who are stimul<strong>at</strong>ing further investig<strong>at</strong>ion in this most i<br />

becoming recognized as no inconsiderable interesting line <strong>of</strong> research,<br />

factor in the spread <strong>of</strong> the disease. If there [This is another item in the rapidly ac- >.<br />

is available a sure and ready means <strong>of</strong> cumul<strong>at</strong>ing evidence from the practice <strong>of</strong> i<br />

elimin<strong>at</strong>ing the bacilli from the secretions, closely observing, scientific physicians,<br />

a gre<strong>at</strong> danger will be obvi<strong>at</strong>ed. This is showing the gre<strong>at</strong> usefulness <strong>of</strong> this drug in ;<br />

ventured as a suggestion for investig<strong>at</strong>ion typhoid fever, pneumonia, and certain other i<br />

in this line <strong>of</strong> preventive medicine. The systemic germ infections —Ed. Medical i<br />

rapid elimin<strong>at</strong>ion <strong>of</strong> the bacilli from the Council.] _^ I<br />

urine in Case I is a remarkable confirma- Tlie Standardiz<strong>at</strong>ion <strong>of</strong> Digitalis.<br />

tory point. This man was <strong>at</strong> the point <strong>of</strong> Houghton, in a recent issue <strong>of</strong> The Lou- '<br />

de<strong>at</strong>h, but improvement followed in quick don Medical Lancet, reaches the following I<br />

rel<strong>at</strong>ion to the clearing up <strong>of</strong> the urine. conclusions: .<br />

The gradual but steady reduction <strong>of</strong> the 1. It has been shown by numerous labora-<br />

temper<strong>at</strong>ure curve must be noted. There tory workers th<strong>at</strong> it is impossible to deterj<br />

|<br />

was no possibility <strong>of</strong> harm, such as might mine the value <strong>of</strong> the heart tonics <strong>of</strong> the ,<br />

have followed the abrupt reduction. The digitalis series by chemical assays. !<br />

entire effect <strong>of</strong> the drug seemed to be in the 2. It is a well-recognized fact th<strong>at</strong> the ,<br />

line <strong>of</strong> assisting the forces <strong>of</strong> n<strong>at</strong>ure to b<strong>at</strong>- toxicity <strong>of</strong> these products warrants th<strong>at</strong> ;<br />

!<br />

j<br />

!<br />

i<br />

i<br />

tie with the invading bacilli. This result<br />

encouraged me to use the drug in various<br />

febrile cases in my priv<strong>at</strong>e practice, in inevery<br />

effort should be made to present prepar<strong>at</strong>ions<br />

<strong>of</strong> them <strong>of</strong> as uniform value as<br />

possible.<br />

i<br />

creased dosage. I'rom m}' experience, I<br />

am led to recommend the plan <strong>of</strong> a steady,<br />

3. Experiments upon animals have demonstr<strong>at</strong>ed<br />

conclusively th<strong>at</strong> the vari<strong>at</strong>ion in<br />

even increase <strong>of</strong> the daily amount <strong>of</strong> the the physiological action <strong>of</strong> some <strong>of</strong> these i<br />

A-S-phen administered. Within three days products is extremely gre<strong>at</strong>.<br />

I believe th<strong>at</strong> the system should be able to 4. It is urged th<strong>at</strong> there be appointed an<br />

accommod<strong>at</strong>e 120 grains a day. Particular intern<strong>at</strong>ional committee to determine and I<br />

<strong>at</strong>tention should be given to the evidence <strong>of</strong> recommend the best method <strong>of</strong> physiologi- i<br />

shock from a too sudden reduction <strong>of</strong> ex- cal assay <strong>of</strong> the heart tonics <strong>of</strong> the digitalis <<br />

cess <strong>of</strong> temper<strong>at</strong>ure in reaching this daily series and an intern<strong>at</strong>ional standard "heart<br />

amount. The amount <strong>of</strong> perspir<strong>at</strong>ion will tonic unit," to express the physiological .j<br />

.<br />

;<br />

|<br />

(<br />

|

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