Remarks on the Tuberculous Nature of the So-Called Simple Pleuritic Effusion
Authors: A. G. Barrs
Journal: BMJ (1890)

in most cases it was observed repeatedly, and in 1 it was almost continuously present for 3 months; in 14 cases there was hiema- temesis without any mention of melemna, and in 3 meleena was present without htematemesis, thus showing the importance of a careful and continuous inspection of the motions in every sus- pected case of ulceration.Complications.-ln 15 cases the ulceration of the stomach was primary and uncomplicated, while in 20 there were complications.One patient was suffering from abdominal aneurysm; 1 was hemiplegic, 2 had bronchitis, and 1 of these had pleurisy in addi- tion; 2 were scrofulous, 7 were antemic, and 7 were chlorotic.I believe that several of those described in the reports as anaemic were really chlorotic, but, at any rate, the statistics show that, in women, chlorosis is a very common accompaniment of ulceration.This fact must be carefully kept in view, else the pain of the ulceration may be mistaken for neuralgia of the stomach, which is so frequently met with in chlorosis, all the more as these are the very cases which are most apt to terminate fatally by per- foration.Results.-Of the 35 cases 2 only remained for a week or two in hospital, and 1 insisted on leaving on the twenty-fifth day, being "much improved."One patient was "improved ' when dismissed, 7 were "much improved," and 23 were cured.Only 1 patient, a male, died, as the result of heamorrhage from the stomach and bowels, and on post-mortem examination an ulcer was found at the pylorus, which had perforated a large vessel.These results correspond pretty closely with the result of Brinton's observa- tions, which show 1 death in 20 to 30 cases, males succumbing to the disease nearly four times as often as females.Treatment.-Having recently directed your attention to the treatment of ulceration of the stomach in connection with cases in the wards, it is only necessary now to indicate briefly the lines which were followed in connection with the cases comprised in the foregoing tables. 1.The patients were always strictly con- fined to bed--a point which, 1 have reason to believe, is not always insisted upon, as not only does the ulceration heal more readily, but the danger of profuse hmemorrhage and perforation is lessened.2. The dieting was generally the main point in the treatment.Hard, hot, stimulating, and irritating food was rigidly excluded: soft and fluid food, in small quantities, frequently repeated, being the rule; and, in the majority of cases, unless there was some contraindication, milk, in combination with a little potash or lime water, was prescribed.In some instances peptonised meat pre- parations were given, especially Carnrick's beef peptonoids, to the extent of a teaspoonful every four hours.The patient was directed to suck the powder, so as to mix it thoroughly with the saliva before swallowing it.In some instances a slight modification of Debove's meals was administered.This consists of 25 grammes of Carnrick's beef peptonoids, 1 gramme of burnt magnesia, 2 of prepared chalk, and 1 of saceharated lime.The gastric juice is thus neutralised, and no peptones are formed in the stomach.It was found, however, that three of these meals per day sometimes produced diarrhea, so that latterly three half meals were pre- -7