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PKDIATMC8 


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negative within two to seven days after starting treatment. In the 
2 nasal cases it was ineffective. This method should not be employed 
except in the late stage of convalescence and it is best to confine it to 
chronic carriers. It offers the best form of treatment but entails some 
degree of discomfort. Among the previous investigators no com¬ 
plications were noted except Lorenz and Ravenel who mention coryza, 
very mild laryngitis, and nasal furuncles occurring among their cases. 


Acute Acid Intoxication in Children.— Thomas C. McLeave (Jour. 
Amcr. Med. Asaoo., 1913, lxi, 1764) reviews the theories of production 
of acid intoxication and gives the symptoms and treatment. This 
condition may occur in children aged from eight months to ten years. 
It may usher in an acute infectious disease or the attacks may be 
recurrent. Some chronic focus of infection is probably always present, 
such as an inflamed appendix or more commonly diseased tonsils or 
adenoids. The toxins from whatever source cause a condition in the 
liver function which- produces faulty metabolism of carbohydrates and 
especialty of fats and proteins. As a result, toxic bodies such as acetone 
and diacetic acid appear in large quantities in the urine and acetone 
is markedly noticeable on the breath. The nervous element is undoubt¬ 
edly a factor in producing the condition, and a catarrhal condition of the 
nasopharynx is usually present. Characteristic symptoms are anorexia, 
coated tongue, a bluish pallid ring around the mouth and eyes with 
flushing of the cheeks, coryza with variable cough, pallor, sunken 
eyes, dry and cracked lips, foul breath with odor of acetone, vomiting 
of large amounts of fluid, rapid emaciation, scanty urine, constipation, 
and moderate fever. The duration of the attack is from two to seven 
days but deaths from this cause are very rare. The treatment consists 
of eliminating any possible focus of infection, a dietary low in fats 
with ample amounts of carbohydrate. Citrus, fruit juices, and grape- 
juices are also valuable. Fatigue and undue excitement should be 
avoided. Sodium bicarbonate in ono to . two dram doses weekly, 
and periodic emptying of the large bowel tend to abort the attacks. 
During the attack sodium bicarbonate can be given in 60-grain doses 
every three or. four hours by mouth or rectum. Sugar must be given, 
preferably dextrose, in 4 per cent, solution with alkali, either by mouth 
or rectum. Both the sodium bicarbonate and the dextrose can be 
given in solution intravenously if the case is urgent. Saline infusions 
are given for the drying-out of the tissues, and opium, chloral, and 
the bromides control the nervous manifestations. 


Some Unusual Phases of Child Hygiene.— Maky Sutton Macy 
(Archie /. Pediatrics, 1913, xxx, 848) points out the importance of 
protecting the child (from infancy to adolescence) from the ill effects 
of psychic trauma, which are not by any means all sexual. The epi¬ 
demic of Freudism in this country threatens to restrict the term 
"psychic trauma” in its meaning to the sexual character. Macy 
mentions a large number of cases in children from ten to eighteen 
years initiated by a psychic trauma, which closely simulated a begin¬ 
ning Basedow’s disease. In none of these cases has the initial shock 
been in nny way sexual. She also mentions 30 cases of chorea having 
a history of psychic trauma, in no way sexual, ns the point of origin 



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PROGRESS OF MEDICAL SCIENCE 


for the neurotic symptoms. She calls attention to contributory effects 
of nervous shock in initiating both of these nervous conditions. She 
defines psychic trauma ns a term embracing all nervous shocks which 
arrest or retard mental processes, and includes under the term acute 
shock from fright, anger, grief, joy, fear, etc., and chronic shock from 
repeated disappointment and mentat fatigue from uncorrectcd defects 
of vision, hearing, etc. In public schools a crowded curriculum and 
forcing children forward at a fast rate is a detriment to health and tends 
to product! mental and physical inadequacy. Both diseases mentioned 
above arc aggravated, if not more or less indirectly caused by psychic 
trauma. Therefore, all obvious causes of nervous strain within control 
of public school authorities should be prevented. The majority of 
those in immediate charge of our schools are absolutely unintelligent 
on this vital subject of earing for the health of the child. Medical 
school inspection has done practically nothing to control and prevent 
disability from over-pressure, crowded curriculum, and nervous strain 
during puberty and early adolescence. 


OBSTETRICS 


UNDER THE CHAKOE OK 

EDWARD P. DAVIS, A.M., M.D., 

PKOrtJSOIt OP OD3TLT1UC8 IN THE JEPPERSON MEDICAL COt.LEOE, PHILADELPHIA, 


Imidasclylathylamln in Obstotric Practice.— Jaeger ( Zentralbl. f. 
Gynak., 1013, viii) reports the results of this agent in obstetric prac¬ 
tice. It is a preparation derived from ergot and from histidin by the 
action of nitric acid. It is supposed to stimulate unstriped muscular 
'fibers. It acts upon the muscular fibers of the uterus, the muscular 
tissue in the bronchial tubes, the iris, and the bladder. It probably 
has some action upon the unstriped muscle of the bowel, the arterioles, 
and the spleen. It does not seem to affect the heart, directly. On 
blood preisure, it produces a differing action in different animals. In- 
some, the blood pressure rises; and, in others, sinks. The action of 
the salivary glands and pancreas is increased by the hypodermic 
injection of this substance, while the secretion of urine is not influenced. 
This agent was tried in the case of a puerperal woman, in doses of 30 
drops of a solution 1 to 1000, given three times daily. This agreed 
with the patient, and produced no disagreeable effects. It was com¬ 
pared with other preparations of ergot. Involution seemed to proceed 
more efficiently, and the after-pains were less frequent, and shorter. 
It was used to increase the vigor of uterine contractions in 25 cases, 
13 primipane and 12 multipart. It was given by intramuscular 
injection in the gluteal region, or subcutaneously in the arm or upper 
portion of the thigh. These injections were not painful, but produced 
redness at the point where the needle entered. Varying doses were