Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 NIMINONIME MENENE ME MEMEMEMEME MEME MEME MEME MEMEMEME MEME MEME MEMEME Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MEMEMEME MEMEMEMEME MEMEMEMEMEMEMENENGNGMEMEMEMEMEMEMENEMEMEMEN Child poorly nourished, was under weight at birth ( 4 lbs. 2 oz.) and development had been slow. Vomiting on 6th, 7th and 8th. found to be thin, usually greenish (depending upon the diet of the child), although sometimes of a brown or yellowish color, usually offensive and slightly acid in odor, and as a general rule, turns green if left standing for from one to four hours, if not that color when expelled. These stools frequently contain shreds of Pulse rapid. laxis in this condition, more than the regular laws of hygiene, which should be observed with every patient. The clothing is, without doubt, an important item, which should be taken into serious consideration. The more the infant suffers from the heat, the less power of resistance it will have. When the temperature Day 1 23 Sex Female. Age4 Mos. 2 ks Diet when seen Cow's Milk. TEMPERATURE 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 CENENBNBGMEN ENEMEMBNEMCHEME MEMEMEMEMEMEMEMEMEMEMEMEMEMEME MEMEME 106 105 104 103 102 101 100 99 98 Child weak and poorly nourished. Pronounced rickets. Pulse weak, rapid. great. We are told by most pediatricians that it is advisable to discontinue nourishment entirely for from twenty-four to forty-eight hours. In the cases that I have had, I have always thought that the child's vitality was low enough, as a result of the disease, without depriving the I do not believe in the prolonged use of irrigations, with the exception of perhaps during the first twenty-four hours of treatment, in fact irrigating the colon once. or twice with sterile water, at a temperature of 100° Fahr. will accomplish all that is possible and when this procedure is con } ORIGINAL ARTICLES tinued for any length of time, the muchneeded strength of the child is unnecessarily exhausted. There is little to be said for drugs in this condition, with the exception of perhaps small doses of salol or calomel, and one or two dram doses of castor oil every , 1913 , Vol. VIII In conclusion, I wish to say that this method of treatment is not original with me, but has been taught for some considerable time, by Seibert and Fischer of New York, many foreign authorities, and has been used successfully by many of the leading pediatricians of this country. Age 7 Nos. 2 Wks Diet when seen Cow's Milk TEMPERATURE Day 1 2 3 4 5 6 "7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 NEMEMEME MEMBER MEMBLEMEMEMEMEME MEMBMBNB MELEMEMEME MEME MEME MEMB 106 105 104 103 102 101 100 99 98 97 Number of Stools in 24 Hours 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 Child was poorly nourished, weak and scorbutic. Pulse Stools on Sept. 4th, 5th and 6th morning, depending on the age of the patient. The charts attached will show the results in several of the worst cases which I had during the summer of 1912; and, as will be noted, the rapid loss of weight which is usual in these cases, was entirely eliminated, and in some a slight gain was noted. I advise the continuance of the diet until the hot weather is over. In an injury to the wrist tenderness just distal to the radius and in the "anatomical snuff box" is significant of fracture of the scaphoid. If a patient with the signs and symptoms of chronic appendicitis is unduly anemic and has lost weight, be prepared for the possibility of a more serious lesion, e. g., neoplasm, ileocecal tuberculosis.Amer. Jour. of Surgery. THE ROLE OF THE SURGEON IN CERTAIN FORMS OF NOSE AFFEC TIONS. BY WILLIAM H. NEWCOMB, M. D., Attending Physician, Nose and Throat Dept., Post-Graduate Hospital, New York City. The great importance of oral and nasal hygiene has deeply impressed itself on the minds of the medical profession and laity for some considerable time. The general public has become, or is becoming, educated to the fact that it is a question of the first moment to keep the mouth and nose in a healthy condition. Evidence has accumulated and is accumulating rapidly that the mouth is a fertile breeding ground for diseases of various kinds and it must ever be borne in mind that there is such a close connection between the mouth and nose, that if the nose be in a bad state, the mouth will inevitably be infected therefrom. Of course, the mouth is a veritable hot-bed for the propagation of germs. Even when the mouth is in a normal condition, germs harmful and innocuous abound therein, but so long as it is clean there is little or no fear of infectious microorganisms incubating and developing. But if the mouth be unclean and especially if the teeth and gums be in a bad condition, such a condition is a constant menace to health. Moreover, as stated before, in order to retain the mouth in a healthy state, it is essential that the nose be normal. That is to say, that the orifices are clean and unobstructed, and that there is no collection of more or less purulent matter which may obtain entrance to the throat and work incalculable mischief. The three main functions of the nose are olfactory, respiratory and vocal. The nose is likewise endowed with highly important powers for the de fence, not only of the air passages, but of the system generally. The nose, when in a normal state, filters off all dust and microorganisms from the air before these can reach the larynx. Such germs as gain access to the nasal cavity proper, are expelled by the action of the ciliated epithelium, assisted by the trickling of the lachrymal secretion in which they become enmeshed. Before their expulsion is arrested by the nasal mucus which is probably inhibitory if not actively anti-bacterial and leaves them open to attack by phagocytes, hence while microorganisms are abundant at the entrance of the nose, their presence is scanty in its interior and they are practically all filtered off before the air reaches the nasopharynx. Thus it is plainly evident that it is in the highest interests of health that the nose should be kept in the best condition possible. But there are an immense number of noses which are not normal, and it is really extraordinary to observe that a goodly proportion of the population suffer from one form or another of deformity of the nose. In the Nose and Throat Clinic of the Post Graduate Hospital, I have exceptionally favorable opportunities for judging of the remarkable number of instances in which deformities of the nose occur. Perhaps there are few clinics in the world with a larger attendance than that of the Nose and Throat Clinic of the Post Graduate, nor in which the patients, owing to their conditions of life and cosmopolitan nature, present better material from the clinical standpoint than does this clinic. It goes without saying that in proportion as the individuals suffer from nasal deformities, so do these deformities affect their general health. Grave deformities will, as a rule, seriously, injuriously prejudice a person's |