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

XXVI THE CHARLOTTE MEDICAL JODRNAl
Januarj' 23 irrigations of the bowel with ice also furnish a guide. If the amount sliould
water were begun. Encouraged by the become too profuse, the dosage of the dnio; j
favorable results in other cases, five-grain should be diminished in accordance. i
capsules of A-S-phen were ordered every A point frequently made against mam- of i
two hours. The rapidity of the pulse in- the various plienetidin derivatives is that |
creased, ranging from 100 to lOS, but the they unduly depress the circulatory system, j
highest point reached in temperature after In Case II it was feared that A S phen was I
the administration of the drug Tas begun depressing in the effects from the indication '
was 102, and the expected gradual decrease of cyanosis observed on the extremities of ;
in the daily averages of temperature by a the patient's fingers. Discontinuance uf :
few tenths of a degree began. Normal the drug with continued observation poinled
temperature was reached January 31, and unerringly to the fact that this cyanosis had
the pulse thereafter soon slowed to 72, and no relation whatever to the use of A-S-plien, j
from that time improvement was rapid, but was caused by the baths administered j
without any complications whatever until to the patient in the routine treatment.
February 11, 190'->, when bacteriologic re- A valuable indication may be observed i
port showed absence of the typhoid bacilli in the slight effect upon the pulse rate in the i
from the urine, and the patient was pro- use of A-S phen, even in the weak circula- ,
nounced cured and discharged from the tion of the patient who exhibited the symp- |
hospital. torn of cyanosis. This slight effect was
In the cases recited above diagnosis was especially noticeable in view of the fact that i
established not only by the clinical symp- the temperature showed steady decline un- |i
toms of rose spots, characteristic tempera- der its administration. An agent having ^\
ture, etc., but laboratory methods establish- so conservative a mode of action, conjoined ,!
edthe Widal reaction and also the presence with the remarkable bactericidal power, as
of the typhoid bacilli in the urine. Later shown in the rapid disappearance of the 'i
laboratory examinations showed the rapid typhoid bacilli from the urine, would seem .
decrease of the typhoid bacilli from the of great value in this disease. The cases <
specimens of urine submitted, and in each quoted as typical show milder and shorter i
instance their eventual disappearance, courses under the conditions of very high ]
There would seem here the possibility of temperature and great prostration upon adan
agent invaluable in preventing the mission. They are reported in the hope of i
establishing of "typhoid carriers" who are stimulating further investigation in this most i
becoming recognized as no inconsiderable interesting line of research,
factor in the spread of the disease. If there [This is another item in the rapidly ac- >.
is available a sure and ready means of cumulating evidence from the practice of i
eliminating the bacilli from the secretions, closely observing, scientific physicians,
a great danger will be obviated. This is showing the great usefulness of this drug in ;
ventured as a suggestion for investigation typhoid fever, pneumonia, and certain other i
in this line of preventive medicine. The systemic germ infections —Ed. Medical i
rapid elimination of the bacilli from the Council.] _^ I
urine in Case I is a remarkable confirma- Tlie Standardization of Digitalis.
tory point. This man was at the point of Houghton, in a recent issue of The Lou- '
death, but improvement followed in quick don Medical Lancet, reaches the following I
relation to the clearing up of the urine. conclusions: .
The gradual but steady reduction of the 1. It has been shown by numerous labora-
temperature curve must be noted. There tory workers that it is impossible to deterj
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was no possibility of harm, such as might mine the value of the heart tonics of the ,
have followed the abrupt reduction. The digitalis series by chemical assays. !
entire effect of the drug seemed to be in the 2. It is a well-recognized fact that the ,
line of assisting the forces of nature to bat- toxicity of these products warrants that ;
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tie with the invading bacilli. This result
encouraged me to use the drug in various
febrile cases in my private practice, in inevery
effort should be made to present preparations
of them of as uniform value as
possible.
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creased dosage. I'rom m}' experience, I
am led to recommend the plan of a steady,
3. Experiments upon animals have demonstrated
conclusively that the variation in
even increase of the daily amount of the the physiological action of some of these i
A-S-phen administered. Within three days products is extremely great.
I believe that the system should be able to 4. It is urged that there be appointed an
accommodate 120 grains a day. Particular international committee to determine and I
attention should be given to the evidence of recommend the best method of physiologi- i
shock from a too sudden reduction of ex- cal assay of the heart tonics of the digitalis <
cess of temperature in reaching this daily series and an international standard "heart
amount. The amount of perspiration will tonic unit," to express the physiological .j
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