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INTESTINAL OBSTRUCTION DUE TO ASCARIDES.
INTESTINAL OBSTRUCTION DUE TO ASCARIDES.
346
as supplied in ampoules by Parke Davis and Co., Clin of Paris, and others, diluted with an equal volume of warm sterile water. The results are simply marvellous and we have never had the least trouble or accident. So sure, safe, and efficient do we consider this method to be that we employ it now even in cases showing no signs of perniciousness. The patients merely complain of tinnitus, deafness, transient nausea, and a sense of heat spreading all over the body within one to ten minutes after the withdrawal of the needle. In all cases of pernicious fever we have found the worst symptoms, such as amaurosis, convulsions, algidity, and collapse, to disappear from three to six hours after the injections, though cases have occurred in which the patient was out of danger within the hour. The dose we employ is from 10 to 25 or even 50 centigrammes, according to the age, state, condition, and symptoms of the patient. Children are also subjected, when the veins are accessible, to the same treatment. In fact, in children it works wonders. Now, as it may be asked why we have not used Baccelli’s formula, we will frankly state that in this town there are no pharmacies really reliable in which such solutions might be aseptically prepared, a fact which has led us to give preference to solutions which, acid though they be, are most certainly aseptic and exactly dosed. The technique we employ is as follows: We mix the solution within the syringe with an equal amount of sterile warm water, taking care that no precipitate or coagulum is formed as the blood comes in contact with the solution. It has been observed at times, especially when time is lost in inserting the needle, that a kind of flocculent precipitate is formed very similar to that of "aluvine" when injected intravenously; but, as in that case, experience has shown it to be perfectly safe, it being a sort of emulso-suspenoid.
quinine,
The authors add that at first their procedure was severely criticised by their local colleagues, and in the daily press, until continued experience showed its safety. They offer no explanation of the noncoagulability of the blood by the acid non-isotonic solution, but commend other workers to test the fact for themselves. --
INTESTINAL OBSTRUCTION
DUE TO ASCARIDES.
Dr. J. M. Perret and Dr. H. T. Simon have reported in the Journal of the American Medical Association of Jan. 27th a case of intestinal obstruction due to a very unusual cause-a mass of round worms. During the latter half of the nineteenth century opinion was divided as to the possibility of ascaris lumbricoides being the cause of intestinal obstruction. Thus, Leichtenstern and Sir Frederick Treves opposed this view, while Trousseau, Bretonneau, and Stutz upheld it, each having been among the first to report cases. Bordoroni and Stepp in 1887 reported two cases, both of which were confirmed post mortem. Simon in 1892, while holding a necropsy in a case of intestinal obstruction, found the cause to be a mass of round worms. Botoff in 1897 reported a case of obstruction, perforation, and peritonitis, in which the necropsy revealed the presence of 500 round An American surgeon, Van Meter, reported worms. the case of a child, aged 5 years, with a sausagelike mass above and to the left of McBurney’s point in which operation revealed in the lower part of the ileum a coil of round worms causing complete obstruction. The patient recovered. In this country Mr. D. H. Vickery reported the case of a woman with symptoms of intestinal obstruction and a history of vomiting several round worms. After a dose of santonin, followed by castor oil, she vomited 12 round worms. The symptoms of obstruction disappeared, and excepting for the sudden termination of gestation she made an uneventful recovery. Dr. Perret and Dr. Simon report the following case. A girl, aged 8 years, was sent to hospital for operation with the diagnosis of acute intestinal obstruction. The family history was of interest, as the patient’s five sisters and brothers had passed round worms on many
occasions. The child herself had frequently passed round worms since the age of 2 years. Five days prior to admission she was seized with a pain in the right lower abdominal quadrant, accompanied by slight elevation of temperature. On the second day she began to vomit clear watery fluid, and this continued up to the time of admission. A dose of castor oil was given the second day, but only a small stool was passed. On admission the temperature was 101° F. The child was poorly developed and nourished. The skin was of a slight sallow tint. The glands in neck and groin were enlarged. The eyes were sunken, with dark hollows The tongue was dry and under the orbits. Coarse mucous rales were heard over coated. the lower half of the right lung, both anteriorly and posteriorly. The abdomen was distended and tympanitic. In the left lower abdomen, in the region of the sigmoid, a mass the size of a large lemon An enema was given, and returned was felt. coloured with faecal matter and containing a mass the size of a child’s closed fist consisting of approximately 40 round worms, coiled and interwoven together. A second enema was given, and returned highly coloured with faecal matter. The distension was relieved, and excepting for a rise in tempera. ture for 8 hours the patient improved, and in 12 hours the temperature was only 99’6°. She continued to improve, and except for an acute bronchitis, which she developed about the seventh day, recovery was uninterrupted. Most cases of intestinal obstruction due to round worms have been diagnosed at the necropsy or on the operating table. Only seldom has the mass of worms been expelled through the natural channels, as in the
present
case. ---
PROHIBITION AND THE DRINKING OF METHYLATED SPIRIT IN RUSSIA.
IN recent discussions on the drink question referhas frequently been made to certain untoward results which are alleged to have followed the prohibition of the sale of vodka in Russia, the most serious of these results being the increasing use, in lieu of the prohibited beverage, of such ence
dangerous substitutes
as
methylated spirit and
The extent to which this pernicious practice has developed is, from* the nature of the case, somewhat difficult to determine, but that it is sufficient to justify considerable anxiety is clear from the rise in the number of deaths from alcoholism in the larger towns, and also from the increasing frequency of cases of toxic amblyopia due to methyl alcohol poisoning since the enforcement of the new policy. In his " Self-Discovery of Russia (Constable and Co., 1916) Professor J. Y. Simpson quotes some striking data to both these points from a report on referring " The Results of Compulsory Prohibition and New Forms of Drunkenness," made by Dr. Alexander Mendelson to the Russian Society for the Preservation of National Health in March, 1915. Dr. Mendelson gives the number of deaths from alcoholic poisoning in the Obukhov City Hospital of Petrograd for the several months from July, 1914, to March, 1915, as follows : 52, 25, 27, 29, 33, 46, 56, 53, 36. The higher rates in the later months coincide with a great increase in the sale of denatured spirit and with a rise in the number of methyl alcohol drinkers in the hospitals. In the Eye Hospital in Petrograd there were treated 72 cases with impaired vision due to this specific
varnish.
"
346
as supplied in ampoules by Parke Davis and Co., Clin of Paris, and others, diluted with an equal volume of warm sterile water. The results are simply marvellous and we have never had the least trouble or accident. So sure, safe, and efficient do we consider this method to be that we employ it now even in cases showing no signs of perniciousness. The patients merely complain of tinnitus, deafness, transient nausea, and a sense of heat spreading all over the body within one to ten minutes after the withdrawal of the needle. In all cases of pernicious fever we have found the worst symptoms, such as amaurosis, convulsions, algidity, and collapse, to disappear from three to six hours after the injections, though cases have occurred in which the patient was out of danger within the hour. The dose we employ is from 10 to 25 or even 50 centigrammes, according to the age, state, condition, and symptoms of the patient. Children are also subjected, when the veins are accessible, to the same treatment. In fact, in children it works wonders. Now, as it may be asked why we have not used Baccelli’s formula, we will frankly state that in this town there are no pharmacies really reliable in which such solutions might be aseptically prepared, a fact which has led us to give preference to solutions which, acid though they be, are most certainly aseptic and exactly dosed. The technique we employ is as follows: We mix the solution within the syringe with an equal amount of sterile warm water, taking care that no precipitate or coagulum is formed as the blood comes in contact with the solution. It has been observed at times, especially when time is lost in inserting the needle, that a kind of flocculent precipitate is formed very similar to that of "aluvine" when injected intravenously; but, as in that case, experience has shown it to be perfectly safe, it being a sort of emulso-suspenoid.
quinine,
The authors add that at first their procedure was severely criticised by their local colleagues, and in the daily press, until continued experience showed its safety. They offer no explanation of the noncoagulability of the blood by the acid non-isotonic solution, but commend other workers to test the fact for themselves. --
INTESTINAL OBSTRUCTION
DUE TO ASCARIDES.
Dr. J. M. Perret and Dr. H. T. Simon have reported in the Journal of the American Medical Association of Jan. 27th a case of intestinal obstruction due to a very unusual cause-a mass of round worms. During the latter half of the nineteenth century opinion was divided as to the possibility of ascaris lumbricoides being the cause of intestinal obstruction. Thus, Leichtenstern and Sir Frederick Treves opposed this view, while Trousseau, Bretonneau, and Stutz upheld it, each having been among the first to report cases. Bordoroni and Stepp in 1887 reported two cases, both of which were confirmed post mortem. Simon in 1892, while holding a necropsy in a case of intestinal obstruction, found the cause to be a mass of round worms. Botoff in 1897 reported a case of obstruction, perforation, and peritonitis, in which the necropsy revealed the presence of 500 round An American surgeon, Van Meter, reported worms. the case of a child, aged 5 years, with a sausagelike mass above and to the left of McBurney’s point in which operation revealed in the lower part of the ileum a coil of round worms causing complete obstruction. The patient recovered. In this country Mr. D. H. Vickery reported the case of a woman with symptoms of intestinal obstruction and a history of vomiting several round worms. After a dose of santonin, followed by castor oil, she vomited 12 round worms. The symptoms of obstruction disappeared, and excepting for the sudden termination of gestation she made an uneventful recovery. Dr. Perret and Dr. Simon report the following case. A girl, aged 8 years, was sent to hospital for operation with the diagnosis of acute intestinal obstruction. The family history was of interest, as the patient’s five sisters and brothers had passed round worms on many
occasions. The child herself had frequently passed round worms since the age of 2 years. Five days prior to admission she was seized with a pain in the right lower abdominal quadrant, accompanied by slight elevation of temperature. On the second day she began to vomit clear watery fluid, and this continued up to the time of admission. A dose of castor oil was given the second day, but only a small stool was passed. On admission the temperature was 101° F. The child was poorly developed and nourished. The skin was of a slight sallow tint. The glands in neck and groin were enlarged. The eyes were sunken, with dark hollows The tongue was dry and under the orbits. Coarse mucous rales were heard over coated. the lower half of the right lung, both anteriorly and posteriorly. The abdomen was distended and tympanitic. In the left lower abdomen, in the region of the sigmoid, a mass the size of a large lemon An enema was given, and returned was felt. coloured with faecal matter and containing a mass the size of a child’s closed fist consisting of approximately 40 round worms, coiled and interwoven together. A second enema was given, and returned highly coloured with faecal matter. The distension was relieved, and excepting for a rise in tempera. ture for 8 hours the patient improved, and in 12 hours the temperature was only 99’6°. She continued to improve, and except for an acute bronchitis, which she developed about the seventh day, recovery was uninterrupted. Most cases of intestinal obstruction due to round worms have been diagnosed at the necropsy or on the operating table. Only seldom has the mass of worms been expelled through the natural channels, as in the
present
case. ---
PROHIBITION AND THE DRINKING OF METHYLATED SPIRIT IN RUSSIA.
IN recent discussions on the drink question referhas frequently been made to certain untoward results which are alleged to have followed the prohibition of the sale of vodka in Russia, the most serious of these results being the increasing use, in lieu of the prohibited beverage, of such ence
dangerous substitutes
as
methylated spirit and
The extent to which this pernicious practice has developed is, from* the nature of the case, somewhat difficult to determine, but that it is sufficient to justify considerable anxiety is clear from the rise in the number of deaths from alcoholism in the larger towns, and also from the increasing frequency of cases of toxic amblyopia due to methyl alcohol poisoning since the enforcement of the new policy. In his " Self-Discovery of Russia (Constable and Co., 1916) Professor J. Y. Simpson quotes some striking data to both these points from a report on referring " The Results of Compulsory Prohibition and New Forms of Drunkenness," made by Dr. Alexander Mendelson to the Russian Society for the Preservation of National Health in March, 1915. Dr. Mendelson gives the number of deaths from alcoholic poisoning in the Obukhov City Hospital of Petrograd for the several months from July, 1914, to March, 1915, as follows : 52, 25, 27, 29, 33, 46, 56, 53, 36. The higher rates in the later months coincide with a great increase in the sale of denatured spirit and with a rise in the number of methyl alcohol drinkers in the hospitals. In the Eye Hospital in Petrograd there were treated 72 cases with impaired vision due to this specific
varnish.
"