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•410 NORTH CAROLINA MEDICAL JOURNAL July,. 1947 vocate this treatment, although other workers have obtained good results by the enteral and parenteral administration of water, physiologic saline solution, crude or pure glucose, and sodium bicarbonate. The rationale of the brandy treatment is that tremetol is partially detoxified by esterification with the alcohol(1). Certainly nausea is alleviated by the induction of an alcoholic stupor. It remains to be proved, however, that vomiting is a local rather than a central effect of tremetol, or that a significant amount of unfixed toxin is present in the stomach by the time treatment is instituted. It would appear reasonable that similar improvement might be obtained by heavy barbiturate narcosis. Evacuation of the bowels is generally recommended. The therapeutic regimen employed by Hardin at this hospital consisted in the administration of brandy and honey to the point of intoxication, duodenal drainage, proctoclyses of sodium chloride and sodium bicarbonate, hypodermoclyses of glucose solution, enemas, and magnesium sulfate catharsis. After alcoholic intoxication was maintained for twenty-four to seventy-two hours, the patient was usually able to tolerate a liquid and later a soft diet without vomiting, and to leave the hospital within a week. Since Hardin's death in 1937, treatment has consisted solely of honey and brandy given if necessary by gavage, intravenous infusions, and emptying of the bowel as it is deemed necessary. Equally good results have been attained. Prevention is, of course, the ultimate goal of all treatment, and the history of milk sickness indicates that elimination of the poisonous plants has led to the virtual disappearance of the disease. It persists in remote rural areas because of prejudice, ignorance, and indifference. Since these phenomena are not regional, it may be safely assumed that milk sickness will continue to occur sporadically. Fortunately the disease has not been known to occur in urban communities (where it would probably be un-diagnosable), since commercial pooling of milk renders the toxin innocuous by dilution. Summary Milk sickness is now a medical curiosity, although a century ago it was a formidable disease. The primary intoxication in cattle is caused by the ingestion of white snakeroot or rayless goldenrod, and is transmitted in milk to man. The disease is characterized by anorexia, weakness, fatigability, constipation, nausea, and pernicious vomiting in acute, relapsing, and probably chronic forms. The acute phase is marked by profound dehydration and acidosis, and a fatal termination is common. Fever and leukocytosis do not occur. The toxic principle contained in white snakeroot and rayless goldenrod is a secondary alcohol called tremetol. The mode of action of tremetol is unknown. Treatment is nonspecific and is directed toward correction of dehydration and acidosis. Empirically, the use of intoxicating doses of alcohol apparently improves the prognosis. Convalescence is prolonged, and relapse often follows premature physical exertion. Milk sickness has virtually disappeared as white snakeroot has been eliminated from the pasture land of the eastern United States. DIPHTHERITIC MYOCARDITIS A Case Report Weston M. Kelsey, M.D. Winston-Salem Myocarditis is a serious complication of diphtheria. Because of the decreasing incidence of diphtheria in the past few years, patients with diphtheritic myocarditis are seen only rarely. The case reported below illustrates many of the problems which arise in the diagnosis and treatment of this disease. Report of Case e. H., a 13-year-old boy, was referred to the North Carolina Baptist Hospital on December 21, 1945, with the diagnosis of pharyngeal diphtheria. The history obtained was unsatisfactory, since he lived with a foster mother who knew little about him. As almost all North Carolina school children are immunized against diphtheria, he probably had received prophylaxis. His present illness began about six davs nrior to admission, with general mnlais^. Five days before admission the right side of his neck became "enormous." Two days later a right peritonsillar abscess was incised at the local hospital. He remainpd in that hospital for three days, during which time he received 240,000 units of penicillin. When a virulent diphtheria organism was obtained from the throat, he was given 25,000 units of diph- From the Department of Pediatrics of the Bowman Grav School of Medicine of Wake Forest College, and the Pediatric Service of the North Carolina Baptist Hospital. Winston-Salem, North Carolina.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1947 |
Identifier | NCHH-17-008 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 8 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-008.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-008 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Description
Fixed Title * | Page 412 |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1947 |
Identifier | NCHH-17-008-0422 |
Form General | Periodicals |
Page Type | all; article; article title |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed81947medi_0422.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 8 |
Issue Number | 7 |
Page Number | 412 |
Health Discipline | Medicine |
Full Text | •410 NORTH CAROLINA MEDICAL JOURNAL July,. 1947 vocate this treatment, although other workers have obtained good results by the enteral and parenteral administration of water, physiologic saline solution, crude or pure glucose, and sodium bicarbonate. The rationale of the brandy treatment is that tremetol is partially detoxified by esterification with the alcohol(1). Certainly nausea is alleviated by the induction of an alcoholic stupor. It remains to be proved, however, that vomiting is a local rather than a central effect of tremetol, or that a significant amount of unfixed toxin is present in the stomach by the time treatment is instituted. It would appear reasonable that similar improvement might be obtained by heavy barbiturate narcosis. Evacuation of the bowels is generally recommended. The therapeutic regimen employed by Hardin at this hospital consisted in the administration of brandy and honey to the point of intoxication, duodenal drainage, proctoclyses of sodium chloride and sodium bicarbonate, hypodermoclyses of glucose solution, enemas, and magnesium sulfate catharsis. After alcoholic intoxication was maintained for twenty-four to seventy-two hours, the patient was usually able to tolerate a liquid and later a soft diet without vomiting, and to leave the hospital within a week. Since Hardin's death in 1937, treatment has consisted solely of honey and brandy given if necessary by gavage, intravenous infusions, and emptying of the bowel as it is deemed necessary. Equally good results have been attained. Prevention is, of course, the ultimate goal of all treatment, and the history of milk sickness indicates that elimination of the poisonous plants has led to the virtual disappearance of the disease. It persists in remote rural areas because of prejudice, ignorance, and indifference. Since these phenomena are not regional, it may be safely assumed that milk sickness will continue to occur sporadically. Fortunately the disease has not been known to occur in urban communities (where it would probably be un-diagnosable), since commercial pooling of milk renders the toxin innocuous by dilution. Summary Milk sickness is now a medical curiosity, although a century ago it was a formidable disease. The primary intoxication in cattle is caused by the ingestion of white snakeroot or rayless goldenrod, and is transmitted in milk to man. The disease is characterized by anorexia, weakness, fatigability, constipation, nausea, and pernicious vomiting in acute, relapsing, and probably chronic forms. The acute phase is marked by profound dehydration and acidosis, and a fatal termination is common. Fever and leukocytosis do not occur. The toxic principle contained in white snakeroot and rayless goldenrod is a secondary alcohol called tremetol. The mode of action of tremetol is unknown. Treatment is nonspecific and is directed toward correction of dehydration and acidosis. Empirically, the use of intoxicating doses of alcohol apparently improves the prognosis. Convalescence is prolonged, and relapse often follows premature physical exertion. Milk sickness has virtually disappeared as white snakeroot has been eliminated from the pasture land of the eastern United States. DIPHTHERITIC MYOCARDITIS A Case Report Weston M. Kelsey, M.D. Winston-Salem Myocarditis is a serious complication of diphtheria. Because of the decreasing incidence of diphtheria in the past few years, patients with diphtheritic myocarditis are seen only rarely. The case reported below illustrates many of the problems which arise in the diagnosis and treatment of this disease. Report of Case e. H., a 13-year-old boy, was referred to the North Carolina Baptist Hospital on December 21, 1945, with the diagnosis of pharyngeal diphtheria. The history obtained was unsatisfactory, since he lived with a foster mother who knew little about him. As almost all North Carolina school children are immunized against diphtheria, he probably had received prophylaxis. His present illness began about six davs nrior to admission, with general mnlais^. Five days before admission the right side of his neck became "enormous." Two days later a right peritonsillar abscess was incised at the local hospital. He remainpd in that hospital for three days, during which time he received 240,000 units of penicillin. When a virulent diphtheria organism was obtained from the throat, he was given 25,000 units of diph- From the Department of Pediatrics of the Bowman Grav School of Medicine of Wake Forest College, and the Pediatric Service of the North Carolina Baptist Hospital. Winston-Salem, North Carolina. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-008.pdf |
Document Sort | all; nchh-17 |
Article Title | Diphtheritic Myocarditis |
Article Author | Weston M. Kelsey |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-008 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
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