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

ABSTRACTS 409
Certain Bacillus Coll Inlcctlons.-Bris- doubtedly best to employ a vaccine precoe,
in The London Medical Lancet, states pared from the organism which is attackthat
in treating Bacillus coli infections it is ing the patient, and a vaccine can easily
necessary to discriminate between the severe be prepared in the course of three days,
and milder types of cases. Because the Inoculations should be given every seven
bacilli are found in the urine it is not neces- or eight days. The initial dose for an adult
sary at once to rush to vaccines, and even of 50,000,000 of dead organisms (e.stimated
in the more chronic forms where vaccina- according to the method ad\ ised by Sir
tion will be the best remedy, it is inexpedi- Almroth Wright) will be comfortably tolerent
to neglect all other measures and rely ated. The second dose should be half as
on this alone. Many such cases must have much again, and so on. It is also advisoccurred
in the past when the condition able to have a fresh vaccine prepared each
was less well recognized and the patients month, better results being obtained than
have recovered, and no doubt many cases when the same vaccine is employed conof
unexplained febricula may have been tinuously. This may be explained on one
instances of this condition. Therefore each or two grounds. Either the vaccine loses
patient ought to be treated according to the some of its potency or the organism is able
severity and duration of tlie disease. The to develop power to protect itself from the
milder forms will yield lo the well recog- alttibodies produced by the host as a result
nized treatment of an ordinary febrile at- of the vaccination. It will be remembered
tack, a uot bath, a mercurial page, rest in
bed, and reduced diet. Should the condition
not clear up at the end of a weekorten
days, then the sooner more radical meas
that this latter occurs in the case of trypa-
nosomes against which atoxyl is adminis-
tered. Whichever explanation is correct,
the fact remains that greater improvement
ures are adopted the more likely is the con takes place when the vaccine is freshly predition
to resolve. It should Ise remembered
that the Bacillus coli is an inhabitant of the
pared every month. It must always lae re-
membered that the condition, when once
intestine and in cases of constipation flour- well established, is very refractory, and it
ishes to a marked degree. Therefore it is is well to start treatment early and to carry
important to promote a fairly free evacua- it out energetically. The general health
tion of the bowels daily. Without such an must also be seen to and any abnormality
evacuation all other treatment will be un- should be rectified.
satisfactory. In the second place it is well
Tbe Treatment of Irreducible Intus-
to give some intestinal antiseptic to hinder
the growth of the organism, such as creo- susceptlon by Lateral Anastomosls.sote
or small doses of calomel (1-20 of a Parry (British Journal of Children's Disgrain
) after each meal. This latter drug eases) says that the method of treatment
in such doses has in his hands proved fairly was said in the text-books to be only apsatisfactory,
but some prefer to try to re- plicable to chronic cases. Two acute cases
place the Bacillus coli with a lactic acid were referred to, one of Mr. Parry's and one
bacillus by means of artificially soured of Dr. Rutherford's. On the tenth day in
milk. Seeing that many of the prepara- Mr. Parry's case, no trace of a tumor could
tions of lactic acid organisms contain no be felt, and this was verified by examinaliving
bacilli this is less certain than it ap- tion. Mr. Parry put forward, firstly, the
pears. The Bacillus coli flourishes in an simplicity aid safety of the method as comacid
medium; it is therefore advisable to pared with excision; secondly, fliat an al-
alter the reaction of the urine, which should ternative line of treatment was afforded to
be rendered alkaline by the administration that of severe manipulation in irreducible
of the drugs usually employed to this end, intussusception; and, thirdly, the disappearto
which urotropine in .S or 10 grain doses ance of the tumor. Mr. H. Stiles said the
may be added. This relieves the patient of paper was a landmark in the treatment of
many uni)leasant svmptoms and hinders irreducible intussusception. lie had bethe
proliferation of the organism. The come pessimistic on the subject. Patients
urine should be tested from time to time to had died after resection where he thought
see that enough alkali is being given, and recovery would take place. He had been
it is sometimes advisable to give rather more agreeably surprised that a good many cases
than the usual dose the last thing at night, had recovered where there had been ex-
This will often be successful in procuring a treme difficulty in reducing the intussusgood
night's rest without the use of ano- ception, and even after splitting the peridynes.
Should this treatment not be sue- toneal coat. The gangrenous cases were
cessful in diminishing the numbers of the very difficult, and his only criticism of the
microorganisms in the urine and relieving paper was that the treatment was hardly
symptoms it is advisable that inoculation applicable to those. He had had better reshould
at once be resorted lo. It is un- suits when he operated as quickly as possi-