The Medical Clinics of North America Volume 4, Nos. 1-3

Book excerpt: This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1921 edition. Excerpt: ...must be exercised in the differentiation, but if from the previous history and from the characteristic attacks, and from the acetonuria at the very onset of symptoms, we form a correct diagnosis, we will not make the mistake of treating the case as if it were primarily gastric indigestion with constipation, nor will we make the fatal mistake of doing an exploratory laparotomy on a child who is free from obstruction and who is the worst of surgical risks because of the condition of acetonuria. True acidosis does occur in infants and young children with which the condition of cyclic vomiting must not be confused. Acidosis rarely develops even in protracted cases of cyclic vomiting. When it does occur it is pratically always preceded by some primary exciting cause which our history and examination should determine. Nephritis, diabetes, severe intestinal infections, or some severe acute respiratory diseases may have as their late and final manifestations the typical picture of acidosis, the red lips, extreme pallor of the skin, persistent vomiting and air-hunger, with diminished carbon dioxid tension of the alveolar air, and increased tolerance to bicarbonate of soda. These cases are usually fatal, but the cyclic vomiting which we have in mind, which is recurrent and due to obscure disturbances of metabolism, fortunately has an entirely different prognosis. Diseases of the central nervous system are generally ushered in by vomiting. The localizing symptoms at first may be so slight as to be overlooked, except in severe acute inflammatory conditions, such as meningitis, encephalitis, etc. The more slowly developing diseases, such as tuberculous meningitis, internal hydrocephalus, and brain tumors, are not easily diagnosed in their incipient...