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RAT-BITE FEVER.
1051
Anaphylaxis has long been considered in the light general conclusions are summarised in the statement of a curious accident. The Lyon school regards anaphy- that " radical phrenicotomy is especially advantageous laxis, idiosyncrasy, and intolerance as essentially the in conjunction with artificial pneumothorax and extrasame
thing,
and has
of this class of
greatly enlarged phenomenon.
our
and is the primarily indicated surgical procedure in unilateral phthisis with predominantly basal lesions." Of 62 cases treated, 35 were operated on as an independent procedure ;
conception pleural thoracoplasty,
50 per cent. of these were improved, and 10 per cent. markedly improved. An interesting report of a case of persistent hiccough treated by injections of novocaine into the phrenic nerve appeared in the Indian Medical Gazette for March. The patient was a girl and her hiccough had persisted for nearly four months, by the end of which
RAT-BITE FEVER. THE bite of a rat infected with the specific spirillum may give rise to the curious chronic relapsing fever with certain general and local symptoms known as sodoku in Japan, where it is very common, or more generally as rat-bite fever. The wound caused by the bite of the infected rat heals quite normally but breaks down at the end of an incubation period of usually two to six weeks, the local condition becomes that of an acute inflammation, while general symptoms The disease appears to be fairly widesoon set in. spread and has been reported in this country by T. J. Horder and others,! but although common in Japan it does not appear to have been often recorded The question of its in China until recently. prevalence in that country is beginning to attract considerable attention, however, and a case described this year2 buy Dr. E. S. Curtis, of Funing, Fukien, is of some interest. The patient was bitten on the right index finger and too vigorous home treatment resulted in gangrene of the skin of the affected finger. With fomentations and removal of the loosened skin the condition quickly healed up, but exactly 14 days after the bite the finger again became swollen and a gland appeared in the right axilla. The temperature rose to 104° F., the patient complained of pains all over, but with simple antipyretic remedies this quickly settled down and the local condition of the finger began to subside. Ten days later a similar flare-up occurred with some lymphangitis of the dorsum of the hand, and three purplish-red erythematous patches also appeared in this neighbourhood. This acute attack again subsided, but a third flare-up occurred a week later and a fourth a week after that. Each attack lasted about two days and they got progressively slighter, the fourth one being unaccompanied by any local exacerbation in the local condition of the finger. the fourth attack three small doses of ’Following " 914 were given and no further attacks developed. This case appears to differ from the usual description in certain details. For example, the duration of the first attack-namely, two days-was very short as compared with the usual six or eight days. Again, the purplish-red papular rash appears only to have been represented by three spots on the affected hand. The spirillum was not observed in this case, but certain features suggest that possibly the disease in China is not of exactly the same nature as elsewhere and possibly due to a slightly different organism.
time even ice could not be retained, and she was in a state of profound exhaustion and suffered great pain in the region of the diaphragm. Other remedies having failed, D. M. Ghose, who reports the case, infiltrated the phrenic nerves with 2 to 4 c.cm. doses of a t to 1 per cent. solution of novocaine. Six injections were given once daily, and apparently on alternate sides. The hiccough subsided completely and eight months later there had been no relapse. Ghose used the technique of Krogh, inserting the needle two fingers-breadth above the clavicle close to the outer border of the sternomastoid muscle, and thrusting it vertically towards the scalenus anticus for a distance of 2 to 4 cm. (according to the amount of fat). When the nerve is reached the patient complains promptly, as a rule, of transitory pain in the shoulder and region of the heart, and sometimes also in the upper abdomen. Ghose states that perineural infiltration is adequate. A NEW TREATMENT
gastro-intestnal symptom-recur indefinitely, and for no apparent reason, and are especially troublesome at night. Therapeutic measures include a revision of the dietary, administration of stomachics, aperients, lactate of calcium, and bicarbonate of soda, and a These variety of baths and local applications. remedies are all useful, but lay no claim to effect a cure. The frank physician counsels patience, and assures parents that eventually their child will grow out of the trouble. The Paris Medical, of April 24th contains the experience of Dr. Pasteur Vallery-Radot and Dr. Blamoutier in the treatment of lichen strophulus with peptone by the mouth, and if their claims should be confirmed this treatment marks a distinct advance in therapeutics. They state that of 20 cases treated and observed for periods of from three to ten months, 10 were cured by one or two courses of ten days each ; 4 were cured after a month ; 2 were cured in more than a month. Of the 4 remaining, 1 reported cured after a year’s treatment, 1 in 15 months, and the other 2 were lost sight of. The method is very simple and obviously harmless, but the details, say the authors, must be very strictly carried out in eyery case. The first point in the instructions In infants of about concerns the number of meals. 1 year they must be reduced to four in the 24 hours -viz., at 8 A.M., noon, 4 P.M., and 8 P.M. Nothing, except small drinks of water, is allowed in the intervals. The diet may consist of milk, milky foods, purees of potato or French beans, peas, and lentils, bananas (which are always forbidden in England), orange juice, and compotes of fruit. Older children take three meals only per day : at 8 A.M., 1 P.M., and 7 P.M. Their régime may include bread, biscuits. cakes, eggs, fish, meat (except pork) once daily, sweetbreads, soups,
SURGERY OF THE PHRENIC NERVE. A BRIEF account of the history of phrenicotomy and of the modern radical operation for ensuring hemidiaphragmatic paralysis has lately been published in the Journal of the American Medical Association (March 20th). The writer, W. H. Thearle, describes evulsion of the phrenic nerve as a minor and relatively simple procedure easily performed under local anaesthesia. The possible complications and accidents associated with the operation are, he says, relatively infrequent, but he repeats the warning given by Felix against completing the evulsion in far advanced cases with extensive pleural adhesions if cardiac or respiratory disturbances reach any degree of severity. I, Thearle’s experience is in accord with that of other observers-namely, that cough and the bringing up I of sputum are made easier by the hemiparalysis of the diaphragm. He issues a warning, however, against the independent use of phrenicotomy as a curative measure in advanced pulmonary tuberculosis, and his cauliflower, tomatoes, &c.
i
Journal of Medicine, 1910, iii. 121 2 China Medical Journal, February, 1926.
STROPHULUS.
THE troublesome ailment of infants and young children up to the age of 6 years, alternatively known as lichen urticatus or strophulus, is generally believed to have a direct relation to errors of digestion. The crops of intensely irritable papules-often associated with diarrhoea, constipation, vomiting, or other
"
1 Quarterly
FOR
Sweets, especially between
meals, are strictly proscribed. The peptone is given exactly one hour before each meal and the granular form of the
product will
be found the best.
The time
Anaphylaxis has long been considered in the light general conclusions are summarised in the statement of a curious accident. The Lyon school regards anaphy- that " radical phrenicotomy is especially advantageous laxis, idiosyncrasy, and intolerance as essentially the in conjunction with artificial pneumothorax and extrasame
thing,
and has
of this class of
greatly enlarged phenomenon.
our
and is the primarily indicated surgical procedure in unilateral phthisis with predominantly basal lesions." Of 62 cases treated, 35 were operated on as an independent procedure ;
conception pleural thoracoplasty,
50 per cent. of these were improved, and 10 per cent. markedly improved. An interesting report of a case of persistent hiccough treated by injections of novocaine into the phrenic nerve appeared in the Indian Medical Gazette for March. The patient was a girl and her hiccough had persisted for nearly four months, by the end of which
RAT-BITE FEVER. THE bite of a rat infected with the specific spirillum may give rise to the curious chronic relapsing fever with certain general and local symptoms known as sodoku in Japan, where it is very common, or more generally as rat-bite fever. The wound caused by the bite of the infected rat heals quite normally but breaks down at the end of an incubation period of usually two to six weeks, the local condition becomes that of an acute inflammation, while general symptoms The disease appears to be fairly widesoon set in. spread and has been reported in this country by T. J. Horder and others,! but although common in Japan it does not appear to have been often recorded The question of its in China until recently. prevalence in that country is beginning to attract considerable attention, however, and a case described this year2 buy Dr. E. S. Curtis, of Funing, Fukien, is of some interest. The patient was bitten on the right index finger and too vigorous home treatment resulted in gangrene of the skin of the affected finger. With fomentations and removal of the loosened skin the condition quickly healed up, but exactly 14 days after the bite the finger again became swollen and a gland appeared in the right axilla. The temperature rose to 104° F., the patient complained of pains all over, but with simple antipyretic remedies this quickly settled down and the local condition of the finger began to subside. Ten days later a similar flare-up occurred with some lymphangitis of the dorsum of the hand, and three purplish-red erythematous patches also appeared in this neighbourhood. This acute attack again subsided, but a third flare-up occurred a week later and a fourth a week after that. Each attack lasted about two days and they got progressively slighter, the fourth one being unaccompanied by any local exacerbation in the local condition of the finger. the fourth attack three small doses of ’Following " 914 were given and no further attacks developed. This case appears to differ from the usual description in certain details. For example, the duration of the first attack-namely, two days-was very short as compared with the usual six or eight days. Again, the purplish-red papular rash appears only to have been represented by three spots on the affected hand. The spirillum was not observed in this case, but certain features suggest that possibly the disease in China is not of exactly the same nature as elsewhere and possibly due to a slightly different organism.
time even ice could not be retained, and she was in a state of profound exhaustion and suffered great pain in the region of the diaphragm. Other remedies having failed, D. M. Ghose, who reports the case, infiltrated the phrenic nerves with 2 to 4 c.cm. doses of a t to 1 per cent. solution of novocaine. Six injections were given once daily, and apparently on alternate sides. The hiccough subsided completely and eight months later there had been no relapse. Ghose used the technique of Krogh, inserting the needle two fingers-breadth above the clavicle close to the outer border of the sternomastoid muscle, and thrusting it vertically towards the scalenus anticus for a distance of 2 to 4 cm. (according to the amount of fat). When the nerve is reached the patient complains promptly, as a rule, of transitory pain in the shoulder and region of the heart, and sometimes also in the upper abdomen. Ghose states that perineural infiltration is adequate. A NEW TREATMENT
gastro-intestnal symptom-recur indefinitely, and for no apparent reason, and are especially troublesome at night. Therapeutic measures include a revision of the dietary, administration of stomachics, aperients, lactate of calcium, and bicarbonate of soda, and a These variety of baths and local applications. remedies are all useful, but lay no claim to effect a cure. The frank physician counsels patience, and assures parents that eventually their child will grow out of the trouble. The Paris Medical, of April 24th contains the experience of Dr. Pasteur Vallery-Radot and Dr. Blamoutier in the treatment of lichen strophulus with peptone by the mouth, and if their claims should be confirmed this treatment marks a distinct advance in therapeutics. They state that of 20 cases treated and observed for periods of from three to ten months, 10 were cured by one or two courses of ten days each ; 4 were cured after a month ; 2 were cured in more than a month. Of the 4 remaining, 1 reported cured after a year’s treatment, 1 in 15 months, and the other 2 were lost sight of. The method is very simple and obviously harmless, but the details, say the authors, must be very strictly carried out in eyery case. The first point in the instructions In infants of about concerns the number of meals. 1 year they must be reduced to four in the 24 hours -viz., at 8 A.M., noon, 4 P.M., and 8 P.M. Nothing, except small drinks of water, is allowed in the intervals. The diet may consist of milk, milky foods, purees of potato or French beans, peas, and lentils, bananas (which are always forbidden in England), orange juice, and compotes of fruit. Older children take three meals only per day : at 8 A.M., 1 P.M., and 7 P.M. Their régime may include bread, biscuits. cakes, eggs, fish, meat (except pork) once daily, sweetbreads, soups,
SURGERY OF THE PHRENIC NERVE. A BRIEF account of the history of phrenicotomy and of the modern radical operation for ensuring hemidiaphragmatic paralysis has lately been published in the Journal of the American Medical Association (March 20th). The writer, W. H. Thearle, describes evulsion of the phrenic nerve as a minor and relatively simple procedure easily performed under local anaesthesia. The possible complications and accidents associated with the operation are, he says, relatively infrequent, but he repeats the warning given by Felix against completing the evulsion in far advanced cases with extensive pleural adhesions if cardiac or respiratory disturbances reach any degree of severity. I, Thearle’s experience is in accord with that of other observers-namely, that cough and the bringing up I of sputum are made easier by the hemiparalysis of the diaphragm. He issues a warning, however, against the independent use of phrenicotomy as a curative measure in advanced pulmonary tuberculosis, and his cauliflower, tomatoes, &c.
i
Journal of Medicine, 1910, iii. 121 2 China Medical Journal, February, 1926.
STROPHULUS.
THE troublesome ailment of infants and young children up to the age of 6 years, alternatively known as lichen urticatus or strophulus, is generally believed to have a direct relation to errors of digestion. The crops of intensely irritable papules-often associated with diarrhoea, constipation, vomiting, or other
"
1 Quarterly
FOR
Sweets, especially between
meals, are strictly proscribed. The peptone is given exactly one hour before each meal and the granular form of the
product will
be found the best.
The time