Images de page
PDF
ePub
[blocks in formation]

Hourly dissipation before drug........ 100.650 Hourly production of heat after drug............. 248.825

[blocks in formation]

decrease.

decrease.

[blocks in formation]

(No. 13) we have a gain of both functions, but that dissipation being increased more than was production, temperature was decreased thereby. In No. 14 both functions were decreased, but that production was decreased far more than was dissipation, thereby permitting a fall of temperature.

Again, in No. 15 dissipation was not influenced, while production was decreased.

In No. 16 there was loss of both functions, dissipation being more decreased than production.

In No. 17 the same condition of affairs also held.

These results are much more discordant than those obtained on normal temperature, and agree with the experiments already given, showing that the drug does not have any positive power over fever.

Thus, in one instance, the fall of temperature depended on increased dissipation, and in two others on decreased production, while in the remaining experiments there was a rise in temperature due to a greater failure of dissipation than production.

Experiment 13.-Dog; weight, 12 pounds.

3.45 Rec. temp. 105°.

12.10

[blocks in formation]

Gave I grm. pepsin

107.15°

63.35°

[blocks in formation]
[blocks in formation]
[blocks in formation]

Α.Μ.

2.37 6 grs. salicylic acid into jugular.

[blocks in formation]

Hourly dissipation of heat before drug............ 24.400 Hourly dissipation of heat after drug

Hourly production of heat before drug............ 48.550 Hourly production of heat after drug ............ 46.300

61.000

[blocks in formation]

Hourly loss of production after drug...... 2.250 Result.-Loss of production. Dissipation not affected. Experiment 16.-Dog; weight, 221⁄2 pounds.

Time.
P.M.

Rec. temp.

Box temp.

3-45

4.45

104.5°
104.8°

63.55°

64.55°

.3°

1.00°

4.47 Injected 6 grs. salicylic acid.

4.50

104.5°

64.00°

5.50

104.9°

64.85°

.4°

.85°

[blocks in formation]

Experiment 17.-Dog; weight, 191⁄2 pounds. T

10.15 Rec. temp. 103.7°. Injected 3 grms. of

[blocks in formation]

A SUMMARY OF THE ACTION OF SALICYLIC ACID ON BODILY TEMPERATURE.

1. Salicylic acid has the power to reduce slightly normal bodily heat.

2. Salicylic acid, according to the writer's experiments, has but little power over pyretic temperature.

3. Salicylic acid, when acting on either normal or abnormal temperature, does not seem to have much influence on the circulation either in regard to pulse-rate or arterial pressure. Any change, when it occurs, seems to be an increase of arterial pressure rather than a decrease, and this increase occurred more markedly in the normal than in the pyretic animal.

4. Salicylic acid, in reducing normal tem

BY LOUIS STARR, M.D.*

HOUGH the histories of isolated cases are, as a rule, unread, and therefore useless, I cannot but believe that the following details of a case of apicial pneumonia will be of interest to all students of pediatrics, as they present a symptom that has certainly never occurred before in my somewhat extended experience with this peculiar form of pneumonitis, and which, so far as I know, has never been recorded.

Percy P., a well-nourished English boy of 4 years, was admitted to my wards in the Children's Hospital on April 15, 1887. There was no history of tuberculosis, and, with the exception of an attack of scarlatina sixteen months before, the child had enjoyed perfect health. On the day before admission he was at school, though while there he was in a febrile state and drank freely of water, afterwards vomiting and complaining of pain in his head. That night he was restless and feverish, and had short and rapid breathing, the expiratory movement being attended by a grunt or complaint of pain.

When first seen the little patient's condition was as follows: face drowsy in expression, a slight herpetic eruption on lips, and a bright circumscribed flush on the right cheek; decubitus right lateral, with the head markedly retracted, the neck stiff, the spine arched forward, the arms pressed close to the sides and folded across the chest, the thighs drawn up towards the abdomen, the legs flexed on the thighs and the feet crossed, -a decided en chien de fusil position in fact; tongue heavily coated, breath offensive, no vomiting, bowels active, and abdomen rather distended; respiration 40 per minute, with active nostrils, grunting expiration, and frequent hacking cough; pulse 140, regular and quick; skin dry; axillary temperature 104° F.; no tache cérébrale nor hyperæsthesia; urine scanty and

* Clinical Professor of Diseases of Children in the Hospital of the University of Pennsylvania.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

The peculiar decubitus, -the special feature of the case, together with the other general symptoms, continued unchanged in character throughout the illness, and the former did not diminish until the temperature began to fall on the ninth day, and did not disappear entirely until the temperature settled to the normal line on the fourteenth day.

The treatment consisted of a liquid diet,milk and beef-tea in small quantities at short intervals, quinine (by suppository) and whiskey to maintain the general vigor, digitalis to slow and strengthen the action of the heart, counter-irritation, and a cotton jacket over the right lung. Bromide of potassium was administered in small but repeated doses for several days during the height of the attack, on account of the marked cervico-spinal rigidity, and carbonate of ammonium at the end to aid in stimulating the heart.

prodromal period, no obstinate vomiting nor constipation, no retraction of the abdomen, no slowing of the pulse, no irregular, sighing respiration, no tache cérébrale, no squinting or irregularity of the pupils, and no absolute unconsciousness. Should these points strike the observer, and he remember that there is such a disease as cerebral pneumonia, an examination of the chest will follow and the key to a diagnosis be found.

In the case I have reported there were quite enough symptoms to at once direct examination to the lungs, at the same time the drowsiness of cerebral pneumonia and the peculiar decubitus of tubercular meningitis were prominent. Having examined the lungs little difficulty was experienced in reaching a conclusion, proved to be correct by the subsequent course of the disease. This, then, was an easy case, but it is none the less instructive. It carries a warning that may save future anxiety and delay, and prevent the embarrassment of a mistake.

ACUTE CEREBRO-SPINAL MENINGITIS.

BY JOSEPH X. ZITÉKE, M.D., BATESVILLE, IND. Tis

[ocr errors]

a fact well known to the general profession that in the course of yearssometimes after a lapse of half a centurythere are seasons in which cerebro-spinal meningitis appears suddenly and unexpectedly even in the farthest districts from large cities in an epidemic form, spreading rapidly over a certain district of the territory, and after a stay of some weeks or months disappears again as suddenly as it had come in.

During the last twelve years of my practice I had occasion to observe three such epidemics of this dreadful disease, and I must confess that the mortality of two of them was rather more than distressing to me to contemplate. The last one was, perhaps, not of the most virulent type, hence, perhaps, the more satisfactory results observed and obtained.

In ordinary cases of cerebral pneumonia there is little to draw attention to the lungs. In place of flushed cheeks, active nostrils, rapid breathing, frequent hacking cough, and high fever, the face is pale, the nares passive, the cough slight or absent, the breathing quiet, and the fever moderate in degree. On Besides this form of cerebro-spinal meninthe other hand there are vertigo, muscular gitis, there appears, also, another one (a less twitchings, and marked and persisting drowindependent form), complicating other dissiness sometimes approaching stupor; all eases, and thus lessening the at best dubious pointing to cerebral disease. Without care a chances of recovery. It is this latter form mistake is easy. Suspicion is first excited by of the disease that seems to me to have noting the absence of certain prominent feacaused a considerable confusion in the patures of tubercular meningitis. Thus there thology of the disease, for many of the best is no history of an insidious and protracted | authors seem to consider meningitis as the

primary, and the accompanying disease as the secondary, pathological state of the body, whilst other writers, and perhaps the more profound thinkers of the profession, consider meningitis as a secondary pathological process following in the wake of another one, the primary.

This question, however unimportant it may seem, has nevertheless a great significance and importance in general practice, to which I shall return again when considering the eti- | ology and nature of cerebro-spinal meningitis. |

That cerebro-spinal meningitis is by no means one of the new diseases of the nineteenth century, as some of our medical authorities would try to convince us, can be easily proven by the study of ancient medical records, and by the symptomatological history of the many epidemics which devastated Europe during the latter period of the middle ages and during the first centuries of the new era. Thus, if we consider the most important symptoms of the historically recorded plagues of the past centuries, we shall find it specially mentioned by Simon de Lovicka, "De preservatione a pestilentia," vol. i. parsi., folio edition. Pragensis, 1537.

Other authors of those years give the same symptoms of the fatal plague which scourged Europe so dreadfully in those times. Another but very little differing account can be found in the work of the same author, entitled "Enchiridion Medicinæ," Krakau edition, 1537.

Johanes Agricola gives the history of the pest in a work entitled "Historia Pestis Nigræ," which was published in Prague in 1535, at which time the university had the greatest reputation as to medical studies. Soon after the work of Master Agricola, another professor of the same university published a book on the same subject. It was Magister Udalricus Leonorus a Cauba (1535), a graduate of Padua, who opposed quite earnestly all bloodletting and violent administration of salts in the disease, and advised chiefly rest and "regimen corroborans naturam debilitatam." He also compounded a bolus, which he called "bolus pestilentiæ," and which he prescribed to some noble lord, and vouched for its action as "qui operat sedative, dolorem mitigat, somnum excitat, et sic per quietem cerebri totum corpus sanatur." (How is that for 1535?) He seems to have been a rather stout man of considerable adipose tissue, and both his success in treating the plague and his colossal, fat figure gave origin to the following couplet:

"Tam desperanti devit hanc*- Leonorus nicerte Excellens medica-corpore crassus homo."

From which it is evident that even in the sixteenth century professional reputation was considerably united with the exterior of the doctor.

Another writer on the same subject is Petrus Andreas Mathioli (1552), an Italian, a graduate of Padua, Paris, and Prague, who wrote the celebrated work "Epistolarum Medicinalium libri quinque" (Pragæ, 1561), which work was later translated both into German and Bohemian, though it met with a great opposition at first from the medical faculty of the university, chiefly on account of the author's opposition to blood-letting and salts in the plague, which latter disease he calls "morbus maculatus," or for the first time, "pestilentia cerebri maculata nigra."

It would be too long and too tedious if I should try to introduce here even the names of all the authors of the middle ages who wrote about the celebrated plagues of Germany, Italy, and England, however barren English literature may be on that subject. From their writings, however, and from the symptoms enumerated and so clearly stated, we can hardly doubt that the celebrated plagues of the middle ages and the pestilent, acute, and malignant form of cerebro-spinal meningitis, if not the same disease, were surely very consanguineous, and of a very near and true relationship.

Thus the well-known pestilence which followed the bloody, ambitious war of Charles V., of Germany, and Francis I., of France, had so many characteristic symptoms of our cerebro-spinal meningitis, that it is very hard to doubt their identity of nature. Though very little is said about this renowned plague in the works of Master Ambrosius Parrè, or in those of Magister Amboise, yet an old volume which for many years was preserved in the monastic libraries of Ossegg, and which was attributed to the celebrated perfumer, astrologer, and poisoner of Queen Catharine de Medici, Renée, the Florentine, gave such accurate descriptions of the symptoms of the pestilence that they hardly differ from those given by other writers of more professional character and respectability, and thus indirectly confirm, which directly to do they should perhaps never be called on.

The further progress of the cerebro-spinal meningitis during the last two centuries all over the world is ably traced in Pepper's

* Sanitatem.

1

« PrécédentContinuer »