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September, 1941 BACILLARY DYSENTERY—KEITER 483 the toxic properties of sulfanilamide, assuming that those who use it in this treatment are fully aware of them. The subject has been discussed quite fully in all the current literature. Summary To summarize our concept of therapy we repeat that now wre have a specific therapeutic agent, if used in conjunction with adequate fluid administration, starvation, and vitamin restoration. Measures which cause intestinal stasis are counter to nature's efforts for proper drainage of the bowel. Therefore we give no opiates. We feed none of the special foods used in diarrhea because they do not really nourish the patient and simply are so much foreign matter for ejection in the stools. At the same time they promote the excessive secretion of digestive juices, giving greater volume to the stools and increasing their dehydrating tendency. Blood transfusion is used as indicated for shock, anemia, or serum protein deficiency. 4bstract of Discussion Chairman Roberts: Dr. Keiter, we have certainly enjoyed your paper. Is there any discussion or questions ? Dr. A. S. Root, Raleigh: I am glad that Dr. Keiter selected this subject. When we think that there are between five hundred and eight hundred babies under two years of age who die of diarrheal disease in North Carolina each year, we realize that it is a subject that should be discussed, particularly in view of chemotherapeutic agents being used now. Dr. Bugg and I tried sulfanilamide about four years ago on these cases of bacillary dysentery. We got no results so far as we could tell. We used sulfapyridine the following year, but it was unsuccessful because the children were usually already nauseated and its tendency was to make them more so. The last part of last summer, when sulfathiazole was available, we treated about a half dozen cases with it with dramatic results. Since that time, the papers of several doctors have been published on the use of sulfathiazole in dysentery in children, and their experience has been the same as ours. We have already had this year a few cases which we have treated with sulfathiazole with the same dramatic results. It is remarkable how these children who suddenly become ill, with frequent bloody stools, respond after forty-eight hours of sulfathiazole treatment. The temperature comes down and the number of stools returns to three or four a day. I think this drug is going to reduce the mortality and the long illnesses in these cases. Sulfanilamide enters the red blood cells and may cause a hemolytic anemia; sulfapyridine is nauseating and toxic, and there is a tendency toward crystal formation in the tubules of the kidneys. With s'ulfa-thiazole there is a definite tendency toward the formation of crystals in the glomeruli of the kidneys, so in giving it, the all-important thing is to see that the child gets plenty of fluid. The drug should not be given otherwise. The other consideration in the treatment with sulfathiazole is that it should not be kept up for a long period of time. Usually forty-eight, hours is long enough, for after this time these children will take and retain appropriate milk mixtures, and clinically they are convalescent. A good way to give sulfathiazole is to powder it and put it in a. couple of teaspoonfuls of mashed banana, applesauce or prunes, and follow it with as much orange juice or other fluid as you can get in the child. A grain per pound of body weight in twenty-four hours is an appropriate dose for infants and young children. We feel that in forty-eight hours of treatment, if you can get a pint of fluid a day in the child, you will be safe, insofar as sulfathiazole crystallization is concerned. We find that treatment with sulfathiazole will produce dramatic results and shorten the sickness of these patients. Until we get the new drug, sulfaguanidine, which will be on the market soon, I believe we can do wonders with the sulfathiazole treatment of bacillary dysentery. Dr. Charles F. Williams, Raleigh: An 8 month old child, weighing fifteen pounds, who came into Rex Hospital, had been treated by a doctor in the county for otitis media. He was getting 33/4 grains of sulfathiazole every three or four hours, and had been for a period of a week. He was sent to the hospital with a diagnosis of meningitis. He did not have it. His urine was blood red, and when it dried, it formed crystals. I thought the child was going to die. We gave him sodium lactate solution subcutaneously until diuresis was established. It saved the child. On the second or third day the sulfathiazole content began to drop and the blood nonprotein nitrogen was down. The remainder of the child’s stay was uneventful. I want to emphasize the fact that Dr. Root emphasized: In giving sulfathiazole sufficient fluids are very important. It is very difficult to get fluids into a child with pneumonia or other infections. A way that will work pretty well is to tell the parents that if they do not get so many ounces of fluid in the child, it will be necessary to stop the pills. Dr. C. P. Jones, Jr., Snow Hill: I am a country practitioner. I have had about 70 cases of dysentery in the last eighteen months. Our greatest problem is treating these cases in the home. I think one of the most important points to be stressed is the maintenance of the fluid balance. Most of our patients are indigent. Treatment in the hospital is out of the question. I try to get between 1000 and 2000 cc. of Ringer’s solution into the baby by mouth. A good many children do not like it. I find that a little Pepsi-Cola or Coca-Cola makes them take it more readily, and the little caffeine the latter contains acts as a stimulant. I have been using sulfanilamide and am still convinced that it is a very good drug. I use the method of starvation for forty-eight to seventy-two hours. Out of more than seventy cases, we have not lost a case yet. One of our problems is that the parents want to give children food too soon. I had one case which I referred to Dr. Keiter. For aporoximately thirteen weeks we kept the baby on fluids by mouth. Toward the end of three weeks I did one transfusion because of anemic edema. I want to stress the point that you can maintain the baby very adequately on fluids. It is remarkable how long they can go without food other than vitamins and fluids. I think the period of starvation and maintenance of fluid balance by lactate solutions or Ringer’s solution by mouth are very important, irrespective of the chemotherapy used. Dr. Jean McAllister, Greensboro: I gave sulfathiazole last summer in Greensboro. We did find' that
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 | 1941 |
Identifier | NCHH-17-002 |
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 | 2 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-002.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-002 |
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 |
Revision History | done |
Description
Fixed Title * | Page 483 |
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 | 1941 |
Identifier | NCHH-17-002-0497 |
Form General | Periodicals |
Page Type | all; article |
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 | northcarolinamed21941medi_0497.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 | 2 |
Issue Number | 9 |
Page Number | 483 |
Health Discipline | Medicine |
Full Text | September, 1941 BACILLARY DYSENTERY—KEITER 483 the toxic properties of sulfanilamide, assuming that those who use it in this treatment are fully aware of them. The subject has been discussed quite fully in all the current literature. Summary To summarize our concept of therapy we repeat that now wre have a specific therapeutic agent, if used in conjunction with adequate fluid administration, starvation, and vitamin restoration. Measures which cause intestinal stasis are counter to nature's efforts for proper drainage of the bowel. Therefore we give no opiates. We feed none of the special foods used in diarrhea because they do not really nourish the patient and simply are so much foreign matter for ejection in the stools. At the same time they promote the excessive secretion of digestive juices, giving greater volume to the stools and increasing their dehydrating tendency. Blood transfusion is used as indicated for shock, anemia, or serum protein deficiency. 4bstract of Discussion Chairman Roberts: Dr. Keiter, we have certainly enjoyed your paper. Is there any discussion or questions ? Dr. A. S. Root, Raleigh: I am glad that Dr. Keiter selected this subject. When we think that there are between five hundred and eight hundred babies under two years of age who die of diarrheal disease in North Carolina each year, we realize that it is a subject that should be discussed, particularly in view of chemotherapeutic agents being used now. Dr. Bugg and I tried sulfanilamide about four years ago on these cases of bacillary dysentery. We got no results so far as we could tell. We used sulfapyridine the following year, but it was unsuccessful because the children were usually already nauseated and its tendency was to make them more so. The last part of last summer, when sulfathiazole was available, we treated about a half dozen cases with it with dramatic results. Since that time, the papers of several doctors have been published on the use of sulfathiazole in dysentery in children, and their experience has been the same as ours. We have already had this year a few cases which we have treated with sulfathiazole with the same dramatic results. It is remarkable how these children who suddenly become ill, with frequent bloody stools, respond after forty-eight hours of sulfathiazole treatment. The temperature comes down and the number of stools returns to three or four a day. I think this drug is going to reduce the mortality and the long illnesses in these cases. Sulfanilamide enters the red blood cells and may cause a hemolytic anemia; sulfapyridine is nauseating and toxic, and there is a tendency toward crystal formation in the tubules of the kidneys. With s'ulfa-thiazole there is a definite tendency toward the formation of crystals in the glomeruli of the kidneys, so in giving it, the all-important thing is to see that the child gets plenty of fluid. The drug should not be given otherwise. The other consideration in the treatment with sulfathiazole is that it should not be kept up for a long period of time. Usually forty-eight, hours is long enough, for after this time these children will take and retain appropriate milk mixtures, and clinically they are convalescent. A good way to give sulfathiazole is to powder it and put it in a. couple of teaspoonfuls of mashed banana, applesauce or prunes, and follow it with as much orange juice or other fluid as you can get in the child. A grain per pound of body weight in twenty-four hours is an appropriate dose for infants and young children. We feel that in forty-eight hours of treatment, if you can get a pint of fluid a day in the child, you will be safe, insofar as sulfathiazole crystallization is concerned. We find that treatment with sulfathiazole will produce dramatic results and shorten the sickness of these patients. Until we get the new drug, sulfaguanidine, which will be on the market soon, I believe we can do wonders with the sulfathiazole treatment of bacillary dysentery. Dr. Charles F. Williams, Raleigh: An 8 month old child, weighing fifteen pounds, who came into Rex Hospital, had been treated by a doctor in the county for otitis media. He was getting 33/4 grains of sulfathiazole every three or four hours, and had been for a period of a week. He was sent to the hospital with a diagnosis of meningitis. He did not have it. His urine was blood red, and when it dried, it formed crystals. I thought the child was going to die. We gave him sodium lactate solution subcutaneously until diuresis was established. It saved the child. On the second or third day the sulfathiazole content began to drop and the blood nonprotein nitrogen was down. The remainder of the child’s stay was uneventful. I want to emphasize the fact that Dr. Root emphasized: In giving sulfathiazole sufficient fluids are very important. It is very difficult to get fluids into a child with pneumonia or other infections. A way that will work pretty well is to tell the parents that if they do not get so many ounces of fluid in the child, it will be necessary to stop the pills. Dr. C. P. Jones, Jr., Snow Hill: I am a country practitioner. I have had about 70 cases of dysentery in the last eighteen months. Our greatest problem is treating these cases in the home. I think one of the most important points to be stressed is the maintenance of the fluid balance. Most of our patients are indigent. Treatment in the hospital is out of the question. I try to get between 1000 and 2000 cc. of Ringer’s solution into the baby by mouth. A good many children do not like it. I find that a little Pepsi-Cola or Coca-Cola makes them take it more readily, and the little caffeine the latter contains acts as a stimulant. I have been using sulfanilamide and am still convinced that it is a very good drug. I use the method of starvation for forty-eight to seventy-two hours. Out of more than seventy cases, we have not lost a case yet. One of our problems is that the parents want to give children food too soon. I had one case which I referred to Dr. Keiter. For aporoximately thirteen weeks we kept the baby on fluids by mouth. Toward the end of three weeks I did one transfusion because of anemic edema. I want to stress the point that you can maintain the baby very adequately on fluids. It is remarkable how long they can go without food other than vitamins and fluids. I think the period of starvation and maintenance of fluid balance by lactate solutions or Ringer’s solution by mouth are very important, irrespective of the chemotherapy used. Dr. Jean McAllister, Greensboro: I gave sulfathiazole last summer in Greensboro. We did find' that |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-002.pdf |
Document Sort | all; nchh-17 |
Article Title | Treatment Of Bacillary Dysentery In Infants |
Article Author | W Eugene Keiter |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-002 |
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 |
Revision History | done |
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