G. French S. Cary
1913 Journal of the American Medical Association (JAMA)  
and metal syringe fitted with a mineral-wool-packed plunger; one two-way stop-cock which is fitted to the end of the syringe; one two-way Y stop-cock which controls the fluid coming from each of the bottles; four pieces of rubber tubing and two rubber stoppers; and a specially made needle with a slip-on joint which fits a small glass handle which has one end ground to fit the needle. A simple aluminum stand with clips to hold the bottles completes the outfit. The whole apparatus may be placed
more » ... a sterilizer and boiled, and is so compact that it can be carried easily in one's grip if necessary. The salvarsan or neosalvarsan solution may be made directly in either one of the graduated bottles, thus saving the use of extra glassware, such as graduates, pipets, mixing flasks, etc. The aluminum stand allows change of position of the apparatus during the, administration of the drug, which is often necessary. The slip-on needle does away with washers, and allows the operator to expel all the air from his tube after the needle has been introduced into the vein, while the glass handle acts as a guide for tho operator; as blood will appear in this handle as soon as the needle is in the lumen of the vein. One of the bottles may be used for either sterile wnter or saline solution, thus enabling the operator to wash out the vein before, during or after the injection of the drug. SU'M MARY The advantages that suggested themselves to ine in work¬ ing with this apparatus ¡ire ¡is follows: 1. The glass handle fitted with a slip-on needle is of groat advantage because just as soon as the needle bus properly entered the. vein the blood will How buck into the ghishanille, which saves the injection of Huid into the tissues until the operator is certain he is in the vein. 2. Since the salvarsan and distilled water are in separate bottles, both connected directly with the syringe and con¬ trolled by a two-way Y slop-cook, the operator can Use solution from cither bottle at will. II. The fact, (hat the bottles are graduated in units of 40 e.e. each permits the drug to be mixed in the bottle, as each unit of 40 c.c. of water is sufficient for 0.1 gin. of salvarsan. 4. Tho compactness of the, apparatus makes it, possible to carry it. in a small space. 410 Professional Building. Syringe tor Injection of Balvarsan, Glass bandle guides operator. Two hoiilos enable alternate use o£ drug or water. I wish to present the following report not so much because of the diagnostic interest attached as because of pathologic findings of rather unusual rarity and variety. Patient.\p=m-\Mary R., negress, aged 21, entered the service of Dr. F. A. Besley in Cook County Hospital, Feb. 22, 1913. No history could be obtained, at the time of admission, because of the altered mentality of the patient, who was brought in by the police, unaccompanied. The following facts were obtained twenty hours later from a relative. History.\p=m-\Tendays before admission the patient had been seized with a sudden severe attack of abdominal pain, confined to the right side. She became nauseated and vomited repeatedly for twenty-four hours. The pain persisted, the nausea ceased at this time, and two physicians who then saw the case made a diagnosis of acute appendicitis. Five days later when the abdominal pain had lessened in severity, and the patient felt well enough to leave her bed, she was seized with severe pain in the right thigh, accompanied by repealed chills and a feeling of feverishness. On the following day considerable swelling of the thigh was noticed, and became progressively greater until admission to the hospital. In the past she had always been in good health; no pregnancies. Examination on Admission.-The patient was a young negress of large stature and well-developed musculature; intensely septic-looking. The body was covered with fine drops of perspiration; respirations very rapid and shallow. The pupils were widely diluted and rcactionlcss, the eyes presenting u peculiar stare, while the mental condition was that of alternating stupor and a low muttering delirium. Chest: Lungs entirely negative. Heart rate rapid, but otherwise negative. Abdomen: Moderately distended and tympanitic; rigidity moderate and apparently equal on both sides. Palpation in lower right quadrant aroused patient and caused her to cry Out. lu no other way (save that mentioned below) could a response be obtained, Extremities: The right thigh was enormously swollen from hip to knee. The skin, smooth, tense and glossy, indented on digital pressure. The knee-joint was distended with fluid. The entire thigh was exquisitely tender, and touching any part of it caused the patient to cry out. Ten¬ don reflexes were barely present. Vaginal Examination: Cervix hard mid freely movable* fundus ret reverted. No other palpatory findings. Rectal Examination: Negative. A colonie Hushing given at this time resulted in a small amount of llnlus. Temperature: On admission 97.0; rose steadily to lll'i.6 during the next I weiity-four hours. Pulse: At, first. 120, very weak and snappy; in the course of from twelve to sixteen hours became imperceptible at the wrist. Respirations: (in admission 32; in a few hours hovered between 60 a ml' 80. Laboratory Findings: Leukocytes 15.000; polymorphonuclears !H per cent. Urine showed a faint ring of albumin; nothing else. By the time a history anil consent for operation could he obtained, the condition of the patient excluded such pro¬ cedure. Death occurred twenty-nine hours after admission. Necropsy,-On opening the abdominal cavity the following conditions presented : The small bowel was moderately distended with gas; tie' visceral peritoneum lusterless. There were no adhesions. 110 fluid nor other exúdale in the general peritoneal cavity. The parietal peritoneum presented its normal luster. The edge of the liver projected just below the costal border. In exert ing slight traction on the ceciiin in order to bring it into vi Vf,
doi:10.1001/jama.1913.04340230028013 fatcat:ojz7n5mjcbbupa3qd7sjgzytja