CONGENITAL HYPERTROPHIC PYLORIC STENOSIS AND ITS TREATMENT BY ATROPIN
Authors: SIDNEY V. HAAS
Journal: JAMA (1922)

sion resonance is exaggerated throughout.Auscultation reveals many coarse, vibrating, snoring mucous rales, most numerous and intense over the lower right chest behind.Mucous sounds over the left side seem muffled, as if mainly transmitted from the opposite lung.Toward the inferior margin of the right lung there are fine, crackling rales which clear on coughing.The breath sounds are coarse, but other¬ wise unchanged.Roentgen-ray examination does not detect any upper lobe consolidation; toward the bases there is only a moderate thickening in the distribution of the structures emanating downward from the hilum.On each side the hilum structures are definitely increased.The radiations from the hilum out¬ ward and upward are not thickened.There are a few rather insignificant nodules of calcification in relation to the right hilum, but certainly less than might be expected from the history of frequent stone expulsions.From the standpoint of bronchiectasis, the roentgen ray discloses less pulmonary consolidation than might be expected from the quantity of expectoration.No real cavities are shown.Within two weeks after the plate reproduced in Figure 2 was made, the patient coughed up the largest stone expelled.It weighed 0.52 gm., was rough and was somewhat branched.It will be seen that the roentgen ray failed to detect this concretion, although it undoubtedly was present in the chest at the time of examination.Progress of Case.-During the ten months since the patient came under observation, twelve calculi of varying size have been expelled.The cough is persistent and unabated, and the character of the sputum unchanged.The body weight has increased by 8 pounds (3.6 kg.), with some improvement in general health and endur¬ ance, enabling the patient to pursue his professional activities without interrup¬ tion.The physical signs remain unchanged in character, and a roentgenogram, made later, gave no additional information.COMMENT This case of broncholithiasis appears to constitute an instance of multiple calculi of glandular origin which pen¬ etrate the bronchi by ulcération and are expelled singly with characteristic phe¬ nomena of stone asthma or bronchial colic.Chills, fever, hemoptysis and chest pain accom¬ pany each expulsion.There appears to be no bone disease present; tuberculosis is excluded, and blood calcium concentration does not exist.The primary etiologic factor remains a matter of doubt.Pneumonia at the age of 8 and "influenzai bronchopneumonia" seven months before the first stone expulsion may be concerned in the pathogenesis.There appears to be in this case, as in other chronic forms of pathologic calcification reported, a morbid constitutional tendency to the laying down of calcium salts at a point least capable of holding them in solution.30 North Michigan Avenue.Cinchona Bark in the British Empire.-Thespecial com¬ mittee on cinchona bark of the Imperial Institute Committee for India in a recent report stated that during the five years ending 1916-1917, Indian exports of cinchona bark averaged 600,000 pounds per annum; in [1917][1918], they fell to 40,000 pounds, and in the following two years were 27,000 and 198,000 pounds, respectively.These exports consist chiefly of druggists' bark, that is, barks of cinchona succirubra, officinalis and robusta.The annual requirements are 8,000,000 pounds, of which nearly 7,000.000pounds are now derived from foreign sources, principally from Java.