Document 15rod551gV94wMQ25ba8oZ0ro

.. . . . . . . . . . . . . . . . . . . . , . .. ]a\ m i-st a tte n tio n tn n n - l o ai:* 1 j )r >rt d :ie r h : !VlV{. Hi-- d K \V* t l v e \ a r e e N c e ! ! < ; H t . o n i T ' f 't > a p e a d i . ! '. l i t ' i n r d t t i u n k < e v e r d ! j u s t i c e u ? a n t a n .' \ \ v r k w h e n r k e < i )iiit C ' M u p e t e n T tr a c t n i v w t . r k . r . !!\ias. Jacksonville: i a;n v e r y a n x io u s to h a v e D r. T fti.tr p u t in tilt s lid e s **i i n t e r f c m a t c a m e u n d e r tn v o h - o r vat!"n that D r. Fort <o excellently handled. T h e r e are a few points 1 w o u ld like in b rin g uiu t i '. a t m a d e a v e r y w o n d e r f u l i m p r e s s i o n . i n n i v m i n,,,d,. f l his ca se w a op erated b v toy associate. D r. \\ . K . S c h n a u ss. a> i wn.- o u t o f the citv at the y tim e. T ile tiling 1 w o u ld h a v e d on e w a s exactly w h a t D r. S ch n a ttss d id -- p u t in a h o n e plate. A H er reduction under anesthesia, he could not jtet a n y p osition at all. so h e d e c id e d to o p e r a te ^ a n d pu t in a b on e plate. A s y o u see. the align - m e m is v e ry n early p erfect in e v e n ' w a y i d e m "_a o n s t r a t i n g w i t h s l i d e s ) . L int, u n f o r t u n a t e l y , w e got no union even thou gh everything w as abso lutely perfect. S h e d evelop ed evid en ce o f infec5 n o n . so 1 w e n t in m y se lf a n d to o k the plate out. -2 T h e m istak e that I m a d e w a s in not pu ttin g ^--* t r a c t i o n o n a f t e r r e m o v a l o f t i l e p l a t e . 1 f e l t OCD! t h a t t h e p l a s t e r w o u l d h o l d i n p o s i t i o n , h u t t h e > , patient w as a non-cooperative patient, very hard to c o n tro l, a n d that. 1 th in k , is w h a t c a u s e d th e O h a d r e s u l t s t h a t w e h a d . A t t h e t i m e t i '. a t D r . > , F o r t w a s called in o n the case, w e w e r e th in k in g o f (loins a sliding b on e graft. w h ich, to m y m in d , w as the w ay I w ou ld have handled this ease. H ut the case w as turned over to Dr. Fort, and this (d em on stratin g) just sh o w - w h at traction will do. W h e n w e w e n t in a n d to o k th e plate* out. w e trot s o m e d isp la cem en t.. 1 b e lie v e th a t it w e h a d put traction on w e w ou ld probably have been abie to set the sam e result that D r. Fort had. I w a n t to c o m m e n d D r . F o rt, b e c a u s e this is o n e case that T w atched alm ost through, and I m ust sav the results are w on d erfu l from a traction standpoint. coN cr.rsiox. P r . F . [.. Fort. Jacksonville: A s to the plaster cast. I don't think you can lay d o w n a n y definite rule. N e v e r u s e a p la s te r c a st in t h e b e g i n n i n g as. th ere is to o m u c h sw ellin g . T h e r e a r e o th e r m eth od s hv w hich vou can im m obilize fractures. 1iiu ev venieni i 11 ! i **; )<' an* a hi' t j w . . , , .. a n d i> ; a.itgc*; u -e th e m , in n nn-t ; > .1 r o u t i n e i s n * n e v e : s v ; "(" r 'c e a . I.T- p..-.r p.-h c; b-- ii:'.::-'. c i . i d u n k . i > u n i t e r i g h t i n s a y n i g t o e X - r a y ;> e - u * .t j u s t i c e t o t h e e m ] m the A -r.r . poor result, w a v e x c e l l e n t p i u . - i . ' i o g i c a i . i r f t m c t i . ' u a i re-- u i t ; a t i t t h a t a f t e r all is w h a t w e a r c s t r i v i n g fo r . '.n,| a s ! M ated in th e p ap er, if h v this tr a ctio n n ctk-T y o u ca n get then', h ack .m their feet w ith .-m i>. l o r m i t y y o u c a n l u c u a p p l v pbvsio-thera.r.-- w h i c h v o u c a n n - .t d o in n p i a s t e r c a s t . I w ish to th an k Dr. W aa; for exp lain in g in case. also. I . H A D !'< d s n x i x o I X C H I L D R E N : L. W . H o l l o w a y . M.D.. !acksonviile. . E v e r y p h y sic ia n is fa m ilia r w ith th e tv p e of c h i ld w h o ha.-- a jie r v e r t e d o r c a p r i c i o u s a p p etite for articles w hicii are not natu ral foods. T h is c o n d itio n is k n o w n a; p ic a o r p arorexia. R u d d o c k 1 in a v erv illu m in a tin g article ha- called a tten tio n to tile h a z a r d o f lead p oison in g t o c h i l d r e n who s u f f e r f r o m p i c a . T h e se children g n a w a n d eat a n y article with w h ic h th ey c o m e in contact. A ll painted objects su ch as certain toys, white fu r n itu r e , rails o f k id d ie -c o o p s. ]to r c h railings, w i n d o w siils a n d j w w d c r c a n s m a y a f f o r d t h e m e a n - h v w iiich little c h ild re n b e c o m e th e sub j e c t s ...i c h r o n i c l e a d p o i s o n i n g . L ead gains entrance to the organ ism through th e 'astri'- in t e s t i n a l T h is beer th o u g h t to he tite m a in a v e n u e o f in trod u ction . H o l t . - i n l ! ' -' :!. r e p o r t e d a c a s e o f l e a d p o i ' - on in g due to the inhalation of dust containing lead. A it f v M in o t. F airhall a m i R ezn ik o ft. in a re p o r t o f - t u d i e s . m a d e i n t h e l a b o r a t o r y . >t p h y s i - o lo g v at I farvard l niverstty. o n the absorption a n d e x c r e t i o n o f le a !. s t a t e " t h a t l e a d g i v e n tv c a t s h v s t o m a c h t t t i 'e i s s o o n r e c o v e r e d m l a r g e a m o u n t s f r o m t h e fe ce s. L a t e r it b e c a m e clear th a t th is o c c u r s p a r t l y b e c a u s e m o s t o f t h e tn* '` Rend lietnre the 53rd A n n u a l M e etin g of the HnridJ Medical Assncianon, ( tainesville, Fla., Mat'. 19gs. ''in <axt!; . l:\ r>fisp .. i h e e ^ - u p r . a L T . i ' r; in t o rI H reathrd. i'ftnr.vr: i*w: : .. cann>r enrer vcarl)n:?iir<: under these r r ' ror lend. Imc::: r. ; che rj-v- rtj'prrat-irr irav. m iestin ai e\r." jf on!v hv ;!;e m ; by the rap id a; tiler c h a r a c t e r - - I w iil r: 1' i v e p a t e r ! ' Ti 'n e i i L i c - r a a c vear> r All g a v e !v-: r r,n d a r v a t i e m i . i . nv per cent, total red c o tm t t T i'lllli-t . ' l l i - r U.s . -s- , piirtg o f n te re i t- '\\ r ':' -A`Ulit-r'nc p e n o t i f e . m a c k s C o H e t Cfce>\ F i v e h a d ,*::: *< l e a d , H a d i e c object-' rno.L-'" ^JontiK. p. .1<C W- , i' ;l r ; [VkyPkyp .;p. vi c. '. . .V . anti :? sal :? * : \ :::= i n P i e t y p e : i t i >:* p a n T e x i a . a n i s i c iia- ir.'U i jM!" !I!!5'f :i\ a r t i c l e a :t:i I ain. - \ a iv.ic ra:*.:-!-. p a y a i f " ! * * 1 :i'x '.'ll!!!' - p i- .ani-P : tiir e-c h i - h a - 'w.\ ! ! ! r-- > h . U P > - a < f l e u * I ii;^t r n p i a h ia u n ik '-tf. rr- *:it* * r y ! tlu- a!i-**rii:ia le a p yiv--:i vere-i in kir^* :t I x - c n ip e ar ir i;ost 11 t!'.f !!'H-it Iht* !' '> . M :i\, P 'Jv :'e r e -: f r i p . - y :r:. ': - v e r y r ; i { ; ! i a n * 1 T i r p - r *. - . i v : . .*- r k ' . r - y h . ; : p i - h i 1 m f r a * . .r\ . a i r i ' p i *A r : i p . r h o u r - . ; r * - i : i r i v * l \ l a r ^ * - M ; e : i i c - p u i h h e : i : ; p r P .'A ;'. - :--i * ;'c:i *::e -.any pat:; - i rjiity w a . t h e m a m i :r. - t n i i . T h i s h e i i h :> v t v k . c ' 'V iia* r v .:n h a ^ :i> in o a t s . a m i in i n - p n k 'c; .i e a i :m * ' lie r r a c i i e a . l i i r - a i y i ! w h i c h ip .e a n i ti breath e*!. it* -itch a y iv p a r a : : as tile rs a . i . : n f : i a h e r w v e : i r i l e n a * > - p h a r . :>. a n - ! h i ? h a i C - ' T ti:* -t a t t a c h . a n a i i - h a l c b - *; b - o n : o r ?!*.: -ca-T r* - i n l o r i n ; . ; - m e t . i s ' : i n M n a !. e `- i n - : . e \ c n a s * - - u ^ i i a c - p i l e i n - * - r a n ;* !!;, ai*-* > r:.trl w i . e e - T a v e ' i i*H -t t h e ... a r v i r r f h o - o e** *t i i i t . i * ! - . { a m o v a n t * e l c r * o t ! h a- ity a n a iy a in j- th e vari* - -k h.-.h ' v !ea s. *:i!:e'.'t i . : U:a! nil** h i e ir a . :?:; a m i -< ;.:P - t'K- " i t h e a p p p a i - y r e ; :iv: *i ; Ia - *.\:p. T-n* 1- a * n u h i a r r e - i i h - . ip -lev -; a - p p i c p 'l a 1 h e ii >-- T h e * : r r - - e : * - p e i p i e t p h ' P :!; .v-pirai* t v tru e* ai n o *!a*. ">- ::--p : ii;** e :> : " i?: - ! P : a ! e \ p * : a - ` ;p y - e r - . v r - ' - n i r a v y v a ; - r \ >)) ! ' . c . c u c . - ni*' i.v ihe *ii:;;;;:: . 1 ;.V;; : i. ', v !:e a p p r a r a n o - * * a* *'ia-r i:a:*:u**cr: - l i e :v.p;* i ? i !t !* * ; : - > !P iie v i : a v e ' e v e ' :*i*. e ;-.ar:e*!!- i - *.\ i m a e - r a n e - *1 n r e !e** ..... t i'. f " . .' a r c i f . , c i ! , . : : ;i ; r i ' !**:, a i .. 'VC 1'!; Cc'l! . -c 'a a- a "c:: ' tai vc ! r a :; c ':: u 'V- : vr-'!f*!> !\\ -I:;-. .i-i<!*. i ::i<- ;- : i r . \c rr l^ n i ..iic a t t a c k - !* iia r r in c a . 'in- a;i- a :ir<.n;iiH*!'it :> i .a;-.i in i'li 'Ii... . r a n Hi.a:::-. i i i i l e : ! >r? :i !'.i . n - n i'.'e - M m - p r e r.*U;lP. T h e e y i.t - : p -iip te h i rr.-pi f :r iP' i p :i' : -i.M eeP - n ; r . c c n r t n c n : ... ' *.? ; - : -ertev " " - r e ' : v ... : a c -u. in ec p' *i i . i-'>i i n : t !4 : : t i i a t a t i < - ; : : ; c a , i j u s c r - . - j * i ' '! i c . - '.'.r a t ! . n. ' v - c > r a c t n r c : t i c a u c ! '. C " i a i a I ,. ! i - ! : : : > -r T*;.p. v : . e <; v n; 1 - t h e ! H - r v . .1! , . ' U - : ; : . : : i ' C > t r t ' . t s ? \ j ' c i '. a . i fo r t\v-. i n `i : r e . ' i i i y p a n n e d . T l i i > i i c c i r r e d i u r n i e j a m t a r v P i e r s ; '. v a * v s - r v I | * r i o v : s r r ; . : ; : i ; e c h i M i n i i a i e d a : c a ; i - ' ; cr. . i ic csrcanw ; v i.a e n r iy n:r.:.-<-- v'.-. - v " ' r a : i : p > m m e a b - .lt i n : o r . v >::arp cr:e> \ 'uninne; en.-ued a n d e i y : u : !! i T i - t r - . v a s f '. * -'.c.i ir. m ."ac'ai:;:c'i r i-jiv n i- if - n ' w iiich ia-: r - ! ' : "c-.-n ; . - ; > : : t v n ii- n t r * . . it; -'-.'ini -.'arc n i ' i a i e d l e a d - i n . : -.v in ie in ' n . v . i ' . c ' e p a m t \v:i.. l i e i n c . c r a p e : . a n * i - c v e d s-;.<n: h n n 'ie r w iiic ii i'.ad iit'en p rev if.i'i* . cini-i h a d y e n e T a iia v d c- n i v n i d i m < h i - n r . a n d i n i h e i m e r v a i s h e t w c o : : i >.. n i d r e m a i n i n a . ( a l e t.r c t i r . a . D f i i i i l e it- b . d d i-./- ...e re tii-L-'fiit h i i'n .. c a m . ! : a * f : r e a : i . - l i e 11 i i l f ' C c a : ier ^ *v:a : f .' i i r e . Tilt: r y * t - n r e : ie id h e l p s : i - i i :** * i : h * n ; i ' - r . - i i n `. i n n . r e h r . i i h o p r p t i i . i y c a - i d inner a : - . T h e h n d i n u ' >: l e a d in ;i:e u r i n e a n d i: -: r . r - ' . e n c e ! - t i p n l c r e* ! !>!<<'I c e 'i* T h e 'pinai ; :e. t t ;e*: i r a - a L r-iin ea j ; h : - > e : r :: ii!- :; Tile a *A ' -ie' :: v- ;. ar* : : i r e e j .lia .- e - t*. : l i e ` T h e v . - l i n ; ; T T i i m i> :!* ] .i:ie M a r e n i-* '! :::e h a z n n i -f ; P i e e iiiitir ep . \ 'a r n i s i i i n e a! h hie- c o m e in i-ontac! will iiv in- V . !'. ] ( i t e - C f n v s i i . ' i f i i s i u n i i i a r | u : : i c . i : r e i ' . a < r^iiove:! :!:e J lP eP P a Ti'Ilic \iei-or ' T ( >nt' *ie r e n i i . m . T ; i i ~ i . n o w b e l i e v e d " h e d a n g e r ' ' ! ' f. -.i-tc' '............... " a m .some cases oy causing an a^^ravaiiun oi Vni`,l.*.*1U> aS M.K* It'Ll*I *r*'V,s*its art'* 1 f:***Ts' tiie har'i coitions of the .skeleton. Anh et al recommend tile me of ammonium chlorine in a dose of eight to twelve grams a <iav or twenty to twenty-three c.c. of tiinto phosphoric acid sweetened like lemonade as the best elimmaiu of lead, they also recommend the use of sodium bicarbonate in a dose of forty grams it; twenty- four hours to hasten the elimination of lead. They state that twice as much lead is eliminated with the use of the add as when the alkali is used. A diet with a Sow calcium content furthers the release of the deposited lead. Miik is con traindicated owing to its high calcium content. A diet such as meat, potatoes, rice, macaroni, apples, bananas, sugar, salt and milk-free bread, is recommended for these cases. Miik and e g g s and other articles not included in this iist should not be considered in the dietary. CO N CLU SIO N S. 1. Lead is a hazard to small children. Many cases of lead poisoning are over looked. '>. Education of parents through public health agencies as to the likelihood of lead poisoning in children is suggested. B tliL IO O R A l'H Y . `John C. Ruddock: Lead Poisoning in Children with Special Reference to Pica. J. A. M. A., May 24, 1924. L. E. Holt, J r . : Lead Poiso ning in Infancy. Am. Jr . Dise ases of C hildren, M a rch , 1923. M. C. Aub, M . D . ; A. S. Minot, P . H . D . ; L. F. F airhall, P.H.D., and Paul Reznikoff, M.D., Boston: Absorp tion a n d Secretion of Lead. J. A. M. A., A ugust 23, 1924. TEST FOR LEAD. Considerable urine is evaporated to drvness. and 50 c.c. of fuming nitric acid is added: after the reaction lias subsided, it is allowed to simmer over the free flame for one-half hour, and then - a c.c. more acid is added three times each fif teen minutes. The fluid is then evaporated to a small volume, neutralized with sodium hydrox ide. filtered and the lead tested with hydrogen sulphid. which will give a brown precipitate. DISCUSSION Dr. IT. If. Kirk. Jacbsnnxillc: I think that Or. IToliowav is to he commended for bringing to the attention, as Dr. Osincup remarked, of the profession to this condition of lead poisoning in children. In the larger industrial centers it is a very common thing to find lead poisoning in adults-- so com m on tnat ail m e n \g te m c p r ct -lor attention is paid to it by then;. I think that lead poisoning :n children :- condition that is sporadic everywhere. bec-v.:-: the supply is ever present. Lead in very -ni&l quantities can give trouble to susceptible indi vidual'. Regarding the laboratory end of this poisoning proposition: As you probably krmv. the man who is associated with the labora: r. and is given a number of different specimens ygive some definite and reliable answer on to tb awaiting surgeon or internist is called on v^metimes to do a great deal. And we are called to give very definite answers as a ruie. i fee; the condition, lead poisoning, is suspected, that tiiis is one of the condition* m which the r>athiiic,gist can render reai service, because die ter-; for lead is not difficult. It is present both in the feces and the urine. The blood picture, although not absolutely distinctive, is quite characteristic. There is a good deal of talk about stippling of tile red cells in lead poisoning. Stippling of the red ceils is found in practically any severe blood disturbance, particularly in severe per nicious anemia cases and at times in leukemic conditions. It is one of the commonest things that is found in lead poisoning. The red ceils easily become stippled and we quite often find fifteen or twenty points to each cell. The red ceil count is not particularly helpful as you hardly ever have iess than four million, hemo globin from 50 to TO per cent. In our malaria districts in Florida, where, the resistance is quite low, I think we often find routinely hemoglobins of 50 to TOper cent. The point of coming to a final diagnosis : This would rest more upon the demonstration oi lean oxide in the urine and feces. The lead sait : also found in the bony substance. Sometimethe lead deposit is distinct: however, the lead i> onlv eliminated from tiie bone when it is a great deni in excess and natural hardening of the -alt takes a long time for elimination. It is not necessary to go into technical diet-.:! -as to localizing and detecting of the lead =a!t. That i.- a very technical thing. I want to empha size one thing: If you are just going to te-u ti'-e urine or feces once, you will probably get a negative report in these cases. It is more less like a tuhercular condition in this regar-:. (C iin th iu cd mi /'ug.' ro o t