THE USE OF THE FARADIC CURRENT IN THE TREATMENT OF PERSISTENT APHONIA FOLLOWING LARYNGITIS; TWO CASES
Francis Hernaman-Johnson
1910
The Lancet
1340 urine was normal. (The urine had been examined on several occasions since her attack of nephritis 20 years ago and had always been normal.) During that day she had the same diet and felt better, sleeping pretty well. On the next day she felt still better in the morning and had some bacon for breakfast and some chicken at her midday meal. During the afternoon, however, the headache returned and gradually increased in severity, and she became drowsy but did not have continuous sleep. On the
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... 5th the headache was " crushing " and she was quite drowsy and apathetic. On the 16th and 17th she was constantly sick and the bowels did not act; she could only take fluids. On the 18th she became slightly delirious, and was wandering all night. Her bowels acted well after a small dose of calomel ; the urine was still normal. On the 20th she was practically unconscious, but could be roused occasionally ; Dr. R. Hutchison kindly saw her with me, and he gave a very bad prognosis, expecting she would not survive many days. From then until Dec. llth she never recovered consciousness, on some days being so deeply comatose that she would not respond to any stimulus, food placed in her mouth remaining unswallowed. For three days (Dec. 2nd to 5th) there was well-marked Cheyne-Stckes respiration. On those days she vomited several times, the vomit being very acid ; she was not quite so deeply unconscious afterwards, and with much care about three pints of nourishment were able to be administered daily. On Dec. 10th she began to be less deeply unconscious, gradually improved, and made an uninterrupted recovery, being able to sit out of bed by the 20th and to go downstairs on Christmas Day, and now, a year afterwards, she feels as well as ever she did, except perhaps a little less vigorous. The diagnosis of this case was difficult. It was evidently a toxasmia and appeared to rest between ursemia, an intestinal infection, and acidosis, but at first there was nothing to enable a differential diagnosis to be made. The urine, which was examined nearly every day, gave no definite reaction until Nov. 22nd-13 days from the onset of the condition. Then diacetic acid was found to be present and the condition was shown to be one of acid intoxication, and a line of treatment was framed to meet the condition. In order to keep up the store of glycogen the diet was entirely limited to carbohydrates, and with a view of neutralising as far as possible the acid condition bicarbonate of soda was introduced into the system as freely as possible. It was given in every feed and by slow introduction into the rectum, according to Murphy's plan, of continuous rectal infusion as long as the bowel would tolerate it, and afterwards by occasional I I enemata. Bearing in mind the striking results obtained by Young and Williams, which have proved that acetonsemia varies with the amount of oxygen intake during anassthetisation, oxygen was administered freely day and night, and one of the first recollections of the patient is the extremely refreshing sensation produced by its inhalation. Strychnine was commenced when the heart began to fail, and was kept up until recovery was assured ; 1/60th grain was given every four hours at first, and subsequently twice a day. The administration of food was extremely difficult, and the patient's recovery must be largely attributed to the great care and patience exercised by her daughter and the nurse, 20 minutes frequently being required to adminster a few ounces of food. The consideration of the etiology of this case is interesting, The exciting cause appears to have been the extreme cold experienced on Nov. 9th. This probably so interfered with the digestive processes that an intestinal toxaemia was induced ; and subsequently, by their work in dealing with the resulting toxins, the liver cell.s were so damaged that they were incapable of performing their normal function of transforming the carbohydrates into glycogen. Moreover, as this particular patient has always been a very small eater, and is always pale and has a very small amount of adipose tissue, it is possible that her store of glycogen is always very small; and as extreme cold is one of the causes which produce loss of glycogen, it is probable that this store of glycogen became exhausted during the first few days of her illness. This view is supported by the fact that, after a temporary recovery, she became rapidly worse when acidproducing foods were introduced on Nov. 14th. The original toxasmia appeared to be passing off, but in consequence of the impaired action of the liver cells and the exhaustion of her store of glycogen, the fatty acida were not fully oxidised, and the organic acids, combining with the alkaline bases of the blood, reduced its alkalinity until the acidosis" was produced. The diacetic reaction disappeared from the urine on Dec. 9th and the urine has remained normal ever since. She is now taking her ordinary diet and leading her usual life. Great Berkhal11sted.
doi:10.1016/s0140-6736(00)52739-1
fatcat:u73jv7be4rdynfsbcqv74zoxoa