1907 Journal of the American Medical Association (JAMA)  
With aqueous solutions of glucose ranging from 0.25 to 6 per cent, the results obtained with the authors' method and with the polariseope are identical. With diabetic urines, however, variations of from 0.03 to 0.25 per cent, are occasionally found-differences that are too small to be of clinical significance. These variations are explicable on two grounds. First, substances other than glucose (creatinin, uric acid, glycuronic acid) reduce copper and give too high a reading with FehKng's
more » ... ith FehKng's solution; secondly, levorotating substances (albumin, lévulose, /?-oxybutyric acid) may coexist with the glucose in the urine, giving too low a percentage with the polariseope. To estimate properly the quantity of dextrose in any given specimen, therefore, it is necessary to make determinations both with the copper solution and with the polariseope. Should the former indicate a higher percentage than the latter, lévulose should be suspected and tested for with the Seliwanoff resorcinhydrochloric acid method. In the absence of lévulose the most probable disturbing factor is /?-oxybutyric acid, as albumin and other levorotators are precipitated when the nrine is cleared with lead acetate for the polariseope. Although with undiluted urines containing large amounts of dextrose satisfactory results have been obtained with the authors' method, the extreme care necessary in titrating under these conditions makes it advisable to dilute such nrine from five to ten times. It is preferable to examine specimens when fresh, but should it become necessary to employ preservatives, toluol, salicylic acid or carbolic acid may be added in small quantities without markedly interfering with the reaction. Chloroform, on the other hand, must be avoided as even in minute traces its presence vitiates the test. The following is a simple method of finding the ova of Uncinaria americana: Mix thoroughly one-third of a teaspoonful of hard feces in about a pint of water. After this has stood for about five minutes the ova will have settled to the bottom. Pour off the clear liquid, leaving about one ounce in the bottom of the graduate. Wash the sediment in this manner for three or four times and then strain through cheese cloth or gauze. If the mass does not run through freely, press it with a glass rod. After rinsing, let it settle for a few minutes and then draw up a small quantity from the very bottom of the graduate with a medicine dropper. In a few minutes the ova will have settled at the bottom of the dropper. Put a drop on a slide and cover with a slip. By gentle pressure on the cover slip the drop will become thin enough to be examined. The ova are readily recognized under a 2/3 inch objective. The following trial showed the superiority of this method over those ordinarily employed. Four slides were made from the same specimen of feces. The first was made by taking a small piece of solid feces and spreading it on the slide with a drop of water. Not a single ovum was found on this slide. The second slide was prepared by washing and settling as described above, but was not stained, and the drop was obtained with a platinum loop instead of the pipette. Only three ova were found. The third was made by using the dropper instead of the loop. Ten ova were found. The fourth slide was made as described above, and 113 ova were counted. CHEYNE-STOKES RESPIRATION. Patient.\p=m-\B. P., aged 4, had always been a healthy boy, but not very robust. He had had an occasional "cold" and measles. History.\p=m-\Onthe night of October 25, he had a severe chill lasting one-half hour. He was restless all night, complained of slight pain in the right side; fever developed. In the morning the temperature was 102 F. A cathartic was given. He did not seem to be very ill until October 28, when I was called. The symptoms at that time were rather marked restlessness, rapid breathing, but no pain. The temperature had varied from 100 to 104 F. Examination.\p=m-\Examinationshowed a fairly well-developed boy. His face was flushed, breathing rapid but not labored, and he seemed rather dull mentally. The eyes showed cloudiness of the sclera, the pupils were even and responded to light; there was no photophobia. There was slight herpes labialis, the tongue was heavily coated with a brown coat, and there was some redness of the pharynx. Heart : The pulse rate was 120, all sounds were normal, but louder than usual, except some accentuation of the second pulmonic. Lungs : The middle lobe of the right lung was the only part involved and showed the classic signs of a lobar pneumonia. Respiration was 36. The abdomen was rather typmanitic. The urine was heavily colored, specific gravity 1026; there was no albumin, but there was diminution of chlorids; the exact amount of diminution was not determined. Course of Disease.-Everything went well for a few days, when the lung symptoms grew less prominent, and marked toxemie symptoms appeared. The breathing became quieter and the boy passed a pseudo-crisis on Oetober 30, or five days after the initial chill. The temperature dropped to 97.6 F., the pulse to 60, and respiration to 16. October 31: Marked meteorism developed, the breathing increased to 24, and was irregular, the temperature rose to 102 F., and delirium developed. The pulse varied between 90 and 130 and was very weak. Calomel and salines were used, as well as increased stimulation. The meteorism was very troublesome and frequent high colonie flushings were necessary to control it at all. The next few days were stormy ones. Meningeal symptoms were marked, but the character changed from time to time. November 1: There were marked stiffness of the muscles of the neck, and at times a transient opisthotonos, photophobia, dilated pupils, and almost constant crying. I feared a meningitis, but early on November 2 there was a change in the symptoms. The crying ceased, the photophobia lessened, but the stiffness of the neck remained. At 2 a. m. there set in a new symptom, which I thought was of fatal prognosis. The breathing which had been regular, and rapid only when interfered with by the marked meteorism, developed the Cbeyne-Stokes type. From one complete pause to another there were usually seven breaths taken. A few times there were as few as five, and at others nine in the cycle. The heart seemed very weak. This condition lasted for about 16 hours, when there occurred a gradual change. From this time on there was a slow but gradual improvement. It was a week, however, before the boy was considered safe. He is now in good condition. I would direct attention to several factors in this case. As in a number of other pneumonia cases I have seen this autumn, the toxemie symptoms were of more prominence and importance than those due to the lung involvement. Even from the first there was not that classic symptom-a steady temperature. All through the course of sickness the temperature varied. From 102 to 104 F.
doi:10.1001/jama.1907.25220300053002a fatcat:ymdnszlo5nexneywfwxnpovxxe