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THE TREATMENT OF GONORRHŒAL RHEUMATISM WITH A VACCINE.
1498 disease in the feet, the most striking feature when at the legs, is unusual, I believe. Derby.
one
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of air on Feb. 25th, ten days after the first onset of symptoms, although he was still in a weak condition.
The unusual cerebral symptoms in this case make it The patient had complained worth recording. these of slight coryza simulating an ordinary SIMULTANEOUS FRACTURE OF THE PATELLÆ. cold. His cyanotic condition was congenital, as was also BY H. BETHAM ROBINSON, M.S. LOND., F.R.C.S. ENG., the irregularity of the heart’s action, and he was a subject SURGEON TO ST. THOMAS HOSPITAL. whom the invasion of microbic disease would be likely to affect more seriously than another having greater resisting IN the last issue of THE LANCET Mr. William Sheen describes a case of this injury and draws attention to the power constitutionally. rarity of its occurrence. The following case will be found to bear upon the paper just mentioned. TREATMENT OF GONORRHŒAL RHEUMATISM A woman, aged 30 years, who had met with this accident, was admitted under my care into St. Thomas’s Hospital in WITH A VACCINE. November, 1903. She was walking (or running) downstairs BY J. McOSCAR, L.R.C.P. LOND., M.R.C.S. ENG. with a tray in her hands when she slipped down about three stairs ; she fell forwards and was "quite sure she did not fall THE treatment of various diseases with vaccines being now on her knees," but tried "to throw herself back." There was no sign of any local bruising over the knees as might fully recognised by the profession the following case may be be due to a direct blow. Both patellas were fractured trans- of interest. On August 6th, 1908, a young patient was sent to me versely, the right at the junction of the upper and middle His trouble was thirds and the left across the middle. There was fluid suffering from gonorrho3al rheumatism. that time he had contracted the and from were in both knees. sixth both On the June, previous day patel]a3 (blood) wired and she made an uninterrupted recovery with firm suffered with a continuous discharge. For the last month he had been confined to bed with rheumatism. The usual line union. In this case the fractures apparently were due to indirect of treatment had been followed out, salicylates and violence. injections given, with no curative result. I found the third metacarpo-phalangeal joint of his left hand very W. Upper Wimpole-street, much swollen and intensely painful; in fact, he was nursing his left hand in a sling with his right. The same A NOTE ON A CASE OF INFLUENZA WITH MARKED evening when he had retired to bed I injected 25 cubic centimetres of antigonococcus vaccine (Burroughs, Well come, CEREBRAL SYMPTOMS. and Co.) in the mid-scapular region on his left side, BY H. V. MC MAHON DILLON, L.R.C.S. IREL., both to the skin and strict
probably prior to
THE
I
using aseptic precautions syringe. On my visit the next morning I found he had passed an excellent night with no pain. The site of the injection was showing a slight blush and fulness with a
L.R.C.P. IREL., L.M.,
LATE DEMONSTRATOR OF
ANATOMY, CATHOLIC UNIVERSITY,
DUBLIN.
I WAS called to see a young man, aged 20 years, at 8 A.M. little tenderness on pressure. There was no rise of temFeb. 15th, 1908. I found him lying on his bed in a semior perature constitutional symptoms. I ordered him to conscious condition, unable to be roused ; the teeth were get up out of his bed and recommended Dowsing electric tightly clenched, the face was cyanotic, and the breathing light and heat bath as hot as he could bear it for 15 The heart’s was stertorous and accompanied by groaning. minutes, the joint being previously painted at the bath action was fast, tumultuous, and occasionally intermitting, with liquor iodi fortis by myself. The joint was to the pulse being 100 per minute, wanting in tone, small, and be massaged by a trained hand afterwards for gently also intermitting. The pupils were irregular but dilated. He 15 no dressings minutes, applied, but a sling used. was capable of being roused temporarily by being spoken to second day this was repeated for three baths. On Every in a loud tone of voice ; the temperature was 101° F. I was 10th, or four days following my first interview, theinformed that he had risen earlier and on walking to the Augustwas in less pain, and he was able to bend it. On the finger door he felt giddy and so lay down again, and subsequently 14th another 10 cubic centimetres of the vaccine wera the symptoms just narrated gradually supervened. He was injected over the same area, the patient being in bed. From given the following draught soon after I saw him at 8 A.M. : the 15th until the 21st the baths and massage were continued Aromatic spirit of ammonium, 2’0 minims ; liquor strychnine, every second day, but without any iodine application. On the 3 minims; and water, l ounces. Soon after this he was 22nd the joint could be freely flexed into the palm and all’ removed to hospital. He remained in the same unconscious the had disappeared. No other joint was affectedY. swelling state till 10 A.M. When spoken to in a loud tone of voice the ceased ; treatment was discontinued. He discharge and stimulated by a gentle slap over the bare chest and cheek himself up to the present time in excellent health. reports he was roused temporarily again, and opening his eyes -Remar7es.-Tbese cases are as a rule of long duration and responded incoherently on being questioned, again relapsing to difficult to treat successfully-at least, I have always found a semi-conscious condition but less marked than at first. He them so. My patient was under treatment for 16 days, and was given another draught similar to the first. He remained in left in less than three wesks. The vaccine has also proved’ a dreamy condition for the next few days and gradually of great benefit in other cases. Many patients have been under treatment regained his usual mental state, said to be treated by me for gonorrhoeal rheumatism with mineral generally of a reserved type. waters, baths, mineral and electric, and massage, but in On Feb. 18th his face presented a cyanotic and scorbutic no case have I found such gratifying results as when givingcondition. His lungs on auscultation revealed slight sym- vaccine. ptoms of congestion at the bases, the air causing roughened Buxton. sounds on inspiration and expiration, as is frequently noticed in connexion with cases of influenza. The temperaBRITISH FIRE PREVENTION COMMITTEE.—The ture varied between 101° and 102° for five days, falling work of the British Fire Prevention Committee for the session as has to to been noticed 97° and occasionally rising normal, in influc’nza and other microbic diseases, as malarial fevers, that has just commenced includes the preparation and issue when they affect the nerve centres. He was treated with of reports in respect to a number of doors and rollersulphate of quinine, 22grains three times a day, and was shutters that have been recently tested by the committee and given an expectorant mixture as follows : Compound tinc- will be embodied in five reports. We understand that anture of camphor, 3 drachms ; carbonate of ammonium, 16 elaborate report is also about to be issued by the committee grains ; and infusion of senega, 8 ounces. A tablespoonful on the flannelette question, which has been the subject of anevery fourth hour. An aperient pill with half a grain of extensive series of tests comprising some 450 specimens, and. podophyllin resin added was given as required. The diet that two reports are in preparation on fire extinguishers, consisted at first of lemco daily; later, as he became including a petrol extinguisher. The tests to be undertaken able to take them, he had milk puddings and fish, and during the next month include a final series of door tests on the temperature becoming normal he was placed on mainly relating to composite doors, whilst the matter of solid meat diet. He received no stimulants. He wasroofing materials will shortly occupy the attention of the allowed to sit up on the seventh day, and left for changecommittee. on
I
one
looks
I
of air on Feb. 25th, ten days after the first onset of symptoms, although he was still in a weak condition.
The unusual cerebral symptoms in this case make it The patient had complained worth recording. these of slight coryza simulating an ordinary SIMULTANEOUS FRACTURE OF THE PATELLÆ. cold. His cyanotic condition was congenital, as was also BY H. BETHAM ROBINSON, M.S. LOND., F.R.C.S. ENG., the irregularity of the heart’s action, and he was a subject SURGEON TO ST. THOMAS HOSPITAL. whom the invasion of microbic disease would be likely to affect more seriously than another having greater resisting IN the last issue of THE LANCET Mr. William Sheen describes a case of this injury and draws attention to the power constitutionally. rarity of its occurrence. The following case will be found to bear upon the paper just mentioned. TREATMENT OF GONORRHŒAL RHEUMATISM A woman, aged 30 years, who had met with this accident, was admitted under my care into St. Thomas’s Hospital in WITH A VACCINE. November, 1903. She was walking (or running) downstairs BY J. McOSCAR, L.R.C.P. LOND., M.R.C.S. ENG. with a tray in her hands when she slipped down about three stairs ; she fell forwards and was "quite sure she did not fall THE treatment of various diseases with vaccines being now on her knees," but tried "to throw herself back." There was no sign of any local bruising over the knees as might fully recognised by the profession the following case may be be due to a direct blow. Both patellas were fractured trans- of interest. On August 6th, 1908, a young patient was sent to me versely, the right at the junction of the upper and middle His trouble was thirds and the left across the middle. There was fluid suffering from gonorrho3al rheumatism. that time he had contracted the and from were in both knees. sixth both On the June, previous day patel]a3 (blood) wired and she made an uninterrupted recovery with firm suffered with a continuous discharge. For the last month he had been confined to bed with rheumatism. The usual line union. In this case the fractures apparently were due to indirect of treatment had been followed out, salicylates and violence. injections given, with no curative result. I found the third metacarpo-phalangeal joint of his left hand very W. Upper Wimpole-street, much swollen and intensely painful; in fact, he was nursing his left hand in a sling with his right. The same A NOTE ON A CASE OF INFLUENZA WITH MARKED evening when he had retired to bed I injected 25 cubic centimetres of antigonococcus vaccine (Burroughs, Well come, CEREBRAL SYMPTOMS. and Co.) in the mid-scapular region on his left side, BY H. V. MC MAHON DILLON, L.R.C.S. IREL., both to the skin and strict
probably prior to
THE
I
using aseptic precautions syringe. On my visit the next morning I found he had passed an excellent night with no pain. The site of the injection was showing a slight blush and fulness with a
L.R.C.P. IREL., L.M.,
LATE DEMONSTRATOR OF
ANATOMY, CATHOLIC UNIVERSITY,
DUBLIN.
I WAS called to see a young man, aged 20 years, at 8 A.M. little tenderness on pressure. There was no rise of temFeb. 15th, 1908. I found him lying on his bed in a semior perature constitutional symptoms. I ordered him to conscious condition, unable to be roused ; the teeth were get up out of his bed and recommended Dowsing electric tightly clenched, the face was cyanotic, and the breathing light and heat bath as hot as he could bear it for 15 The heart’s was stertorous and accompanied by groaning. minutes, the joint being previously painted at the bath action was fast, tumultuous, and occasionally intermitting, with liquor iodi fortis by myself. The joint was to the pulse being 100 per minute, wanting in tone, small, and be massaged by a trained hand afterwards for gently also intermitting. The pupils were irregular but dilated. He 15 no dressings minutes, applied, but a sling used. was capable of being roused temporarily by being spoken to second day this was repeated for three baths. On Every in a loud tone of voice ; the temperature was 101° F. I was 10th, or four days following my first interview, theinformed that he had risen earlier and on walking to the Augustwas in less pain, and he was able to bend it. On the finger door he felt giddy and so lay down again, and subsequently 14th another 10 cubic centimetres of the vaccine wera the symptoms just narrated gradually supervened. He was injected over the same area, the patient being in bed. From given the following draught soon after I saw him at 8 A.M. : the 15th until the 21st the baths and massage were continued Aromatic spirit of ammonium, 2’0 minims ; liquor strychnine, every second day, but without any iodine application. On the 3 minims; and water, l ounces. Soon after this he was 22nd the joint could be freely flexed into the palm and all’ removed to hospital. He remained in the same unconscious the had disappeared. No other joint was affectedY. swelling state till 10 A.M. When spoken to in a loud tone of voice the ceased ; treatment was discontinued. He discharge and stimulated by a gentle slap over the bare chest and cheek himself up to the present time in excellent health. reports he was roused temporarily again, and opening his eyes -Remar7es.-Tbese cases are as a rule of long duration and responded incoherently on being questioned, again relapsing to difficult to treat successfully-at least, I have always found a semi-conscious condition but less marked than at first. He them so. My patient was under treatment for 16 days, and was given another draught similar to the first. He remained in left in less than three wesks. The vaccine has also proved’ a dreamy condition for the next few days and gradually of great benefit in other cases. Many patients have been under treatment regained his usual mental state, said to be treated by me for gonorrhoeal rheumatism with mineral generally of a reserved type. waters, baths, mineral and electric, and massage, but in On Feb. 18th his face presented a cyanotic and scorbutic no case have I found such gratifying results as when givingcondition. His lungs on auscultation revealed slight sym- vaccine. ptoms of congestion at the bases, the air causing roughened Buxton. sounds on inspiration and expiration, as is frequently noticed in connexion with cases of influenza. The temperaBRITISH FIRE PREVENTION COMMITTEE.—The ture varied between 101° and 102° for five days, falling work of the British Fire Prevention Committee for the session as has to to been noticed 97° and occasionally rising normal, in influc’nza and other microbic diseases, as malarial fevers, that has just commenced includes the preparation and issue when they affect the nerve centres. He was treated with of reports in respect to a number of doors and rollersulphate of quinine, 22grains three times a day, and was shutters that have been recently tested by the committee and given an expectorant mixture as follows : Compound tinc- will be embodied in five reports. We understand that anture of camphor, 3 drachms ; carbonate of ammonium, 16 elaborate report is also about to be issued by the committee grains ; and infusion of senega, 8 ounces. A tablespoonful on the flannelette question, which has been the subject of anevery fourth hour. An aperient pill with half a grain of extensive series of tests comprising some 450 specimens, and. podophyllin resin added was given as required. The diet that two reports are in preparation on fire extinguishers, consisted at first of lemco daily; later, as he became including a petrol extinguisher. The tests to be undertaken able to take them, he had milk puddings and fish, and during the next month include a final series of door tests on the temperature becoming normal he was placed on mainly relating to composite doors, whilst the matter of solid meat diet. He received no stimulants. He wasroofing materials will shortly occupy the attention of the allowed to sit up on the seventh day, and left for changecommittee. on
I