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

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THE CHARLOTTE MEDICAL JOURNAL.
Gastric Digestion In Inlants.-Clarke secting forceps. The patient must be pre- ;
(Dublin Med. journal I savsthat many and Pared by a preliminary visit to the dentist, !
contradictory results have been obtained; so that no operation in the oral cav, y is
;
a few facts, however, seem to be pretty de- performed until all carious teeth have been ,
finitely proved. In the first place, it may stopped or removed The patient is placed ,
be said that all the factors present in the m a recumbent position with a sandbag beadult
are found in a weaker form in the "^.^\\^^^
shoulders, with the head falling
young infant. In the newborn child on shghtly backward, so that the nasopharynx
breasUnilk the stomach usually empties slopes backward and dowmvard thus en- ,
abhng the small quantity of blood which ,s ;
in from an hour to an hour and a half; as
the child grows older this time becomes s >ed to trickle toward the nosrils rather
longer. The few drops of gastric juice tl'^n toward the larynx, whilst the slope is -
found in the empty stomach are the re- »ot so great as to cause engorgement of the ;
mains of that secreted during the last meal, pliaryngeal venous plexus A loop of silk .
and are not due to a secretion into the is passed through the top of the tongue for i
empty stomach. The motility is more rap- the purpose of retraction, and a gag ,sin- |
sorted between the last molar teeth. The i
id inbreast fed children than in those on
cows' milk or artificial food, and more rapid tonsil is then seized in the ring forceps and
in the healthy than in the ill child. The gently dra^yn toward the middle line, so
acidity immediatelv after a meal is nil, but that the imbedded part of the gland bulges ,
steadily increases during digestion, and is beneath its normal coxering of the anterior j
lessinthe verv young than in the older.
piUar of the fauces. Immediately external
On a barley water diet free hvdrocloric to the internal margin oi the anterior pillar,
acid appears in the stomach in a'few min- J^^st where it blends with the surface of the ^
utes, but on a milk diet it does not show it- tonsil, an incision is made with the finely .
selfforanhourormore, due to the fact that toothed forceps, parallel to and extending ,
the casein absorbs it or combines with it in ^°^ the whole length of the tree margin of ;
someway, and the free acid does not apthe
anterior pillar. Ihis incision reveals
pear until the casein has taken up all re- the capsule of the tonsil which now ap- .
iiuiredforits complete digestion. The free pears as a glistening smooth bluish white ;
acid appears later in disease than in health, surface. Ihe ease and success of the op- j
due to the increased amount of food in the oration depend upon this incision display- |
stomach and to the slower secretion of the "^^^ the capsule of the tonsil and not enter- ,
acid; in cases of pvlorospasm the acidity is "'"-'ts substance. This mistake is easily ,
increased. Opinions differ as to the oc- "^^^^ ^^y keeping too near to the free sur- I
currence of lactic and volatile fatty acids. ^^^^ °^ the tonsil, and it is the common
but these probably do not occur in healthy
cause of difficulty and .sailure for begmbreast
fed infants, "^""S- while in those ill or on T^i^ ""^ forceps is then readjusted
cows' milk they are fairly common. Part ''^ ^^ ^^ -^t a firm hold upon the tonsil and I
of the acidity is probably due to a fat ^^^ anterior pillar is drawn outward by ,
splitting enzyme in the infant's stomach, means of the fine toothed forceps. The jl
Pepsin is present at all ages
t°"sil is and then practically dislocated from its h
in all
kinds of health, and acts in the infant
^^^' ^"'^ ^''^ separation of the rest of the ,
stomach though to a less degree than in the ^^^^^ °^ ^"^ cellular tissue, intervening be- ,!
adult. The pepsin digestion goes on to the tween the capsule of the tonsil and the (
stage of peptones, but not beyond muscular wall of the pharynx, is easily ef- '|
that,
fected either by the finely toothed forceps »!
The fact that the stomach contents will no
not fibrin in thermostat is due to the fact ^^^^ ^ ^^'^^^^^ P^''' °^ curved blunt ended ';
that all the hydrochloric acid is combined scissors which fit in behind the whole of 1
with the casein, and while the protein with the tonsil and push the pharyngeal wall I
,
which it is combined will be acted upon by ^^^^^ ^"^ ''• ^'"'^^ the tonsillar vessels I
;
the pepsin, a foreign protein without the ^^^ thereby torn across and are able to re- :
addition of more acid will resist the enzyme ^^^'^^ within the muscular wall of the I
i
Rennin occurs in the stomach after the first Pharynx, there is practically no bleeding— i
few weeks of life; whether during the first '" ^^^^' *^^ absence of bleeding forms a |
week is a question. striking contrast to the sharp hemorrhage i
^
which ensues after the tonsil has been cut
Removal ol the Tonsils.—Waugh, in the across by a guillotine. The time occupied
j j
(ilasgow .Medical '
Journal reports nine hun- in the complete removal of both tonsils and |
dred cases of complete removal of the ton- adenoids is, on an average, three minutes. ;
j
sils. The instruments required are two A brief, deep anjesthesia ' with chloroform I
Martman's ring conchotomes, a useful se- is necessary, and the coughing reflex i
i
cretion to the margin of the lower, one pair should be abolished. I'or the after treat- j
of curved scissors, and a finely toothed dis- ment a simple mouth wash is provided and
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