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

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366 THE CHARLOTTE MEDICAL JOURNAL.
and back of hand. Analysis at this stage ture, the patient has had an attack of t}'showed
IICl, 18; total acidity, 40; ferments, phoid fever some time previous to the benormal;
mucus, no excess. ginning of his gall bladder trouble. We
Case 9.— Mrs. B., age 29; native of are all familiar with the digestive troubles
N. C. Hereditary specific history. Nursed which so frequently follow typhoid fever,
a sister who died of pellagra. Six months and I believe that a great number of these
ago developed red tongue, distress in stom- so-called digestive troubles are due to a
ach and nervousness, with despondency, cholecystitis produced by the typhoid
At present has still the above symptoms bacilli.
and beginning eruption on knuckles. An- Gall bladder disease is much more frealysis;
HCl, 20; total acidity, 50, mucus, quent in women than 'men, and is much
no excess; motility, normal. This case may more likely to affect women who are fat,
clear up under specific treatment and prove over forty and who have borne numbers of
not pellagra. children. I am inclined to believe that gall
Case 10.—Mrs. M., age 39; native of bladder disease in men is rare. I remem-
N. C. Has had diarrhoea and indigestion
for two years. In April of this year develber
seeing but a few cases,
Symptoms.— The most constant and charoped
marked diarrhoea, gastric distress and acteristic symptoms of gall bladder disease
a red mouth and tongue, and case was pro- are pain or colic, chronic digestive troubles,
nounced pellagra by consulting physician,
At present time she is a typical pellagrin,
chi'.ls, fever and sweats; jaundice and tumor
may also be present. The pain of gall
Analysis; no IICl nor total acidity; excess bladder disease comes on suddenly without
of mucus; bile present. regard to diet, exercise or time of day. It
Summary
is very severe and lasts from a few moments
Cases 1, 2, 4, 6, 7 and 10 show a marked ^^ six or eight hours, or even longer, and
diminution in the acid factors of the gastric
^^ a rule disappears as suddenly as it comes
o"juice
in the late stage of the disease.
^^ >.« l°^fed m the epigastric or mid
l»>e region,
Cases 1, 2, 4, .5 and 10 show
from two to four niches
excess
below
of
mucus during
ensiform cartilage and radiates
the pellagrous upward and
periods.
Cases3, 4, 5, 6, 8 and 9 show normal
backward to back and shoulder blades,
especially to the right,
motility, while in 1, 2 and
dtf^enng from the
10 motility test
was not made P'^'" °' appendicitis, which radiates down-
Cases 1, 2, 4 and 10 show
ward rather than upward In some
presence
cases
of bile
^he
during severe vomiting pam is in the region of the gall bladder,
periods.
This series of cases is too small to allow
^^t not so frequently as we would suppose,
considering the
us to draw any
pathology of the disease,
definite conclusions, but the
indications are that in pellagra, as in all
^^1^^ P^'" '" some cases is located at Mcadynamic
and asthenic diseases, the HCl
Burney s point. This was so incase No.
and
which I
ferments of gastric juice progressively am reporting today, and made the
diagnosis impossible until
diminish
an exploratory
laparotomy was done.
Gall Bladder Disease, With Report of The pain of gall bladder disease is ac-
Two Cases. companied or followed by nausea
Dr. L. A. Crowell, Lincolntou, N. C. vomiting. We have those same symptoms
in appendicitis, but in gall bladder disease
The term gall bladder disease is used
these symptoms of nausea and vomiting are
preference to gall stone disease in this paper
'''^'^^^- C^;'"^, fever
because the writer believes that we
and sweats are
have "^l'^ other symptoms that sometimes appear, es-
infectious conditions of the gall bladder
and Pecially in those cases where the infection
bibary passages accompanied by. a
°''
formation of plugs
«'°"e 's located
of mucous and m the common or hepatic
insipis-
^^^^s.
ated
In those cases in vvhich the trouble
bile as a result of said infection which
^^ confined to the gall bladder, the consti-
give rise to the same obstructive symptoms
tut'onal
as gall stones and demand the same
symptoms are likely to be very
opera-
'^'^^tive
procedures
I" ^^^^t, the patient may have no
for their relief.
Etiology. ~l believe that all gall bladder
symptoms except pain, which may not be
severe,
trouble, stone formation and
with slight tenderness m region of
dust trouble
^^'^ have their origin in an
ladder. t is well alvvays to look with
infection of the gall
bladder from
suspicion
bacteria of the colon group
on all cases of chronic digestive
and in the vast majority of cases from
doubles which have resisted all ordinary
the
typhoid bacilli. In all the cases I have
methods of treatment, for a great many of
^l^ese
seen, and in most of those found
symptoms have been found to ongin-
in literaate
from gall bladder disease.
*Read before the Lincoln County Medical Society Jaundice at one time was considered
November ist, 1909. very important symptom in arriving at
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