Search

The important features in this case were: (1) a marked cardiac irregularity of a variable type which was noted intra utero during the last month of gestation; (2) after birth, a tachycardia with a rate of 180 to 192 beats a minute with periods of marked irregularity involving both rate and rhythm of the ventricular beat—the deeper respiratory movements, as with crying, markedly influenced these irregularities; (3) return to normal of the heart rate and rhythm on the tenth day after birth, with no recurrence of the abnormality; (4) establishment of the diagnosis of auricular flutter by electrocardiogram made about twenty-six and one-half hours after birth.

It is common knowledge that the movement of the abdominal wall during respiration may be restricted in acute appendicitis. This study was undertaken to determine by an objective method the relative frequency of this restriction, and its value and limitations as an adjunct in the diagnosis of acute appendicitis in children. PROCEDURE For some years, patients presenting abdominal signs or symptoms suggesting the presence of appendicitis were studied. Other patients also were observed as controls. The respiratory movements of the abdomen and of the chest with the child in the supine position were recorded simultaneously on a smoked drum, and the heights of the two curves were compared. The pneumograph which I employed was made from a light coil spring 1 inch (2.5 cm.) in diameter and about 6 inches (15 cm.) long, wrapped closely and sealed in thin rubber sheeting. The resulting tube was then closed at one end

Persistent vomiting in infancy is usually attributable to one of two general causes, viz.: 1. Inability of the stomach to digest the food. 2. Malformation of, or partial obstruction in the esophagus or stomach. In the first-named condition there is obtainable in practically every case, a history of incorrect feeding. The most common errors are: 1. Improper food. a. High fat. b. High sugar. c. Solid food at a too early period. 2. Too frequent feeding. 3. Too much food. Vomiting is usually not the only symptom in these cases of gastric indigestion. Intestinal disturbances, as shown by presence of constipation or diarrhea, follow. The appetite is usually poor, but the reverse may be true. The vomiting may occur at any time after feeding and is frequently accompanied by repeated regurgitations of small amounts of food and eructations. The vomitus is usually sour and contains an excessive amount of mucus.

A knowledge of the changes that occur in the water content of the blood during the development and subsidence of edema of the renal type should help to disclose the mechanism of the production of the edema. For example, if the edema is due to an insufficient elimination of water by the kidneys, and this is believed by von Noorden 1 to be a factor at least in some cases, a high content of water in the blood might be expected during the development of edema. If the edema is due to retention of water by the body tissues, as Fischer 2 believes, the water content should presumably be low during the developmental stage (unless one conceives of a concurrent edema of the blood), and should approach a normal or higher than normal level just preceding and during diuresis and loss of edema. Likewise, if Epstein's 3 theory is correct

In July, 1923, we published a preliminary report 1 of observations on the time required for the disappearance of intradermally injected salt solution in six children having edema, and in a small group of control cases including three normal adults. We found that the elevation produced by the injection of 0.2 c.c. of 0.8 per cent, sodium chlorid solution disappeared much more rapidly in the patients with edema than it did in the control cases. We stated that our results suggested that the test might be of value, first, in the detection of disturbed water balance in the tissue, and, secondly, as a means of following the progress of a case in which the presence of such a disturbance had been established. At present we consider that in normal children over 1 year of age the lower limit of the disappearance time is above sixty minutes, when the technic given

If 0.2 c.c. of an 0.8 per cent, aqueous solution of sodium chlorid is injected intracutaneously in a normal child, a circumscribed snow-white elevation, in which the pores are accentuated, is immediately produced at the point of injection. Although the extreme whiteness disappears in from one half to one minute, the elevation persists for a considerable time. In some instances there is an area of erythema about the raised area which usually disappears in a few minutes. It occurred to us that a study of the time required for the disappearance of the elevation, which we assume to be largely the injected salt solution, might give an indication of the tissue's avidity for water. We tested this out in a number of normal and diseased persons, most experiments being carried out under the observation of two. TECHNIC Two-tenths cubic centimeter of an 0.8 per cent aqueous solution of sodium chlorid