Pylorus, So That the Name " Pylorospasm" Seems Tive Procedures
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826 effect is wanted. Dr. Case’s work is a very elaborate made use of the serum of patients with measles attempt to provide a large number of stereoscopic who had not been treated by drugs, had no clinical skiagrams of actual instances of disease and disorder complication, and were in early convalescence. The of the alimentary canal, and we can unreservedly best results were obtained from a polyvalent serum, praise the results which have been obtained. consisting of equal parts taken from three patients. There are in all 100 stereoroentgengrams, as the The amount injected varied, according to the case author calls them, of which four deal with the and severity of the disease, from 15 to 20 c.c., and apparatus and not with disease, but these are the injections were practised-5, 10, 20 c.c.-every very helpful, as they assist us to appreciate the 24 hours. The cases treated were eight in number, accuracy of the stereoscopic effect. The stereo- the majority about 9 years of age. There was no grams are best examined, as Dr. Case says, with instance of serum disease, the duration of the fever a Wheatstone’s stereoscope, which was indeed the was shortened-four to five days, the eruption original instrument, but the more common form faded early, and no complication occurred in any of is more the of such the cases. portable. By help skiagrams ____ as these the practitioner and student will be enabled to obtain a much better idea than in any THE IMMEDIATE PLATING OF COMPOUND other way of those affections of the alimentary FRACTURES. tract which can be examined in this manner, IN another of our issue we an and will also assist the in the inter- part present print they surgeon article in which the author, Lieutenant Vernon of of cases under his own pretation skiagrams Pennell, R.A.M.C., urges that the best treatment for care. No. 76 shows gall-stones more satisfactorily the compound fractures which are so common in war than we have ever yet seen in a skiagram. Every is the immediate application of some form of internal is an of the picture accompanied by explanation he advises this in all cases of shown. We cannot doubt that the value splinting; compound appearances fracture in which an incision is needed for of the work is enhanced the fact that the ample by and efficient cleaning and where skia- who took the is also a drainage roentgenologist skiagrams shows malposition with conservative treat- surgeon. graphy ment. In some cases he affixes a plate and in others he sutures the fragments with silkworm A HABITUAL CRIMINAL. gut, and in other cases when there is much loss of " You will undergo three years’ penal servitude," bone he employs a bone graft from the tibia or Mr. Wallace, K.C., said to William Saunders, a fibula. As to his results, Mr. Pennell tells us that prisoner at the London sessions recently, " and they are all he could wish, and that the position of probably you will spend the time in the prison the fragments is much better than could have been infirmary." The man upon whom he was passing obtained by any other treatment. We will hardly sentence was 69 years of age, and since 1861 had venture on a definite expression of opinion at been condemned to 23 periods of imprisonment, present until the method has been employed more including ten years’ penal servitude meted out to widely, but we must mention that the results he him in 1881, when he was convicted for stealing has obtained are not in accordance with those boots. He must then have been out of prison obtained by men who have attempted the early for some time, as the sentence which imme- operative fixation of septic compound fractures. diately preceded was one of seven years passed In this connexion we have heard of some most in 1867. Since 1890, however, when he was unfortunate results. The matter is ripe for dis- sent to prison for 21 days, he had under- cussion, as individual experiences must now be gone 14 periods of incarceration, including one very numerous and opinions appear to be of five The chairman’s that discordant. years. prophecy ____ he would spend the next three years in the prison infirmary may have been prompted by his obvious PYLOROSPASM IN INFANTS. physical incapacity, but it is to be hoped that the THE etiology of the disease sometimes known mental as well as the condition of the physical as congenital hypertrophic stenosis of the pylorus convict will receive serious consideration, and that in infants is not known. It is believed that it means be if he to his may found, survives, prevent is not a congenital state of affairs in many cases, release. Whether defective or he is mentally not, and that there is no stenosis of the pylorus in not to remain honest if turned loose likely again many cases also; in all, however, there is spasm when over 70 years of age, and it must be re- of the hypertrophied circular muscle of the membered that on 24 occasions honest citizens have pylorus, so that the name " pylorospasm" seems had to at his hands and to face undergo robbery to have advantages, and in addition to be non- the trouble and inconvenience of to appearing committal. The cause of this muscular hyper- prosecute. -- trophy is not clearly known. Some hold that it is the result of unduly rapid but otherwise normal THE TREATMENT OF MEASLES BY SERUM. developmental processes. Others attribute it to over- A SEVERE epidemic of measles at Ancona in 1914 exercise secondary to excessive nervous stimulation, resulting in a mortality of 2’89 per cent. induced of a reflex character. The literature of the subject Dr. U. Majoli 1 to try the effect of treating some of is very extensive, and is discussed by Dr. Delprat1 the cases with the serum of patients who were con- at some length, as is the treatment. Of the opera- valescent from the disease. Of the 1938 cases tive procedures, whether anterior gastro-entero- occurring in the town 58 were admitted into the stomy, stretching of the pylorus, or, most commonly, hospital, for the most part between 2 and 10 years pyloroplasty, Dr. Delprat says little. Treatment by of age, and among these the mortality was dieting has varied considerably in the hands of 25’86 per cent. The reason of this high mortality different experts. Some lay stress on the adminis- was due to the fact that only the severe and com- tration of small quantities of food at short plicated cases were sent to the hospital. Dr. Majoli intervals, others do not ; some insist on the 1 Il Policlinico, Sept. 12th, 1915. 1 Nederl. Tijdschr. v. Geneesk., Amsterdam, 1915, ii., 1316. 827 importance of washing out the stomach to There could be little doubt of its rancidity get rid of irritating matter that causes the since the analyst reported that it contained pylorospasm, while others think this unnecessary ; 3’16 per cent. of fatty acids compared with a the administration of warm water enemas is often figure for fresh butter of well under 0’5 per cent. advised. In Germany the passage of sounds or The magistrate, after hearing chiefly chemical and catheters through the contracted pylorus to dilate practically no physiological evidence, decided that it mechanically has been widely advocated during the butter was fit for human consumption, and so the last five years. Hess argues that if a No. 15 no order was made under the regulations and the catheter will pass the pylorus there is no organic consignment was released. It does not appear to be stenosis. Dr. Delprat has tried this mode of treat- disputed that the butter was rancid, the question to ment several times, but could not make sure of decide being whether in that case it was unfit for passing the sound into the duodenum within 15 food. Its destiny was presumably cooking purposes,in minutes, and appears to think ill of the method. which its rancidity would become more or less Finally, the treatment of pylorospasm by drugs is obscured. Having regard to the nature of the process discussed. Among the drugs used have been opiates of rancidity, we may be wise in entertaining a and antispasmodics, such as cocaine, atropine sul- suspicion that rancid butter is not a wholesome phate, or novocaine (1 milligramme five times a day food. It appears that though air plays a part in before food), dionine (1 milligramme every three this process the change is due not directly to air, hours), anoesthesin (5 centigrammes before each feed), but to the stimulus of oxygen given to certain and papaverine hydrochloride (5-10 milligrammes micro-organisms, amongst which are included subcutaneously or by the mouth half an hour oldium lactis, B. fluorescens liquefaciens, and before food). Papaverine, one of the alkaloids of cladosporium butyri. The fact that such a butter opium, relieves the spasm of involuntary muscle, would be objectionable and unpalatable in the and has been used extensively to treat the pyloro- ordinary way self-condemns it. Any food, generally spasm of infants. Dr. Delprat gives an account speaking, that excites nausea must be regarded as of its use in 5 cases-in 3 with success, in 2 unwholesome. ____ without it; and the conclusion reached is that paperavine is not a specific for the treatment GANGRENOUS EPIPLOIC APPENDIX SIMULATING of pylorospasm. Details of 16 more cases of APPENDICITIS. pylorospasm treated in other ways are given; IN the Boston Medical and Surgical Journal Dr.