Nitrous Oxide Anaesthesia Without Hypoxia
Authors: W. Neff, E. C. Mayer, R. Thompson
Journal: BMJ (1950)

DIARRHOEA AND VOMITING BmnJ general condition gradually deteriorated and the stools became still looser and more frequent.As B.C.N. was found to be present in them, aureomycin was given.During the first four days there was still some loss of weight, but thereafter rapid improvement ensued with a satisfactory daily gain in weight.Case 4.-This patient, a twin sister of Case 3, was also admitted for debility.Her development was at first normal, but after two weeks there was a sudden acute onset of gastroenteritis with frequent watery motions, vomiting, and a loss of weight.B.C.N. was isolated on culture and aureomycin therapy was started on the second day.After 24 hours the stools were of half-firm consistency and the loss of weight ceased.From the fourth day of treatment there was a satis- factory daily gain in weight and the stools were firm in consistency.Case 5.-An 18-day-old baby girl had suffered from vomiting and trequent mucous or watery motions for a week before admission to hospital.At the onset of the illness she was in a home for post-natal care.B.C.N. was found in the faeces on the day of admission.At first streptomycin and penicillin were given as well as fluids by the intravenous route.There was an initial improvement for a few days, but thereafter a marked exacerbation with vomiting and increasingly abnormal motions.Aureomycin therapy was started, and as soon as 48 hours later the stools were half- firm and a satisfactory gain in weight was noted.Improvement continued and the faeces rapidly became normal.Case 6.-A 2-day-old boy was admitted to hospital for dyspepsia and mucous defaecations.Examination revealed delayed emptying of the stomach, but repeated cultures failed to demonstrate the presence of B.C.N. in the faeces.Penicillin was administered as well as fluids subcutaneously.There was gradual improvement, but after 14 days an acute exacerbation occurred with vomiting and loose stools.Culture then revealed B.C.N. in the faeces, and aureomycin therapy was therefore started.The stools rapidly became normal, but frequent vomiting still occurred and the loss of weight continued.Only after persistent plentiful administration of fluids intra- venously did the general condition improve and an increase in weight take place.The protracted course of the illness is presumably to be ascribed to the basic disorder.Case 7.-A 22-day-old boy had suffered from vomiting and mucous defaecations for one week before admission with an appreciable loss of weight from 3,430 g. to 2,790 g.During the first week of life he was at another hospital for children.On admission he was pale and dehydrated, and there was slight peripheral cyanosis.Oidium was present in the oral cavity.The abdomen was distended and blood oozed from the umbilicus.There was violent watery diarrhoea and vomiting.Fluids were administered intravenously, but he got worse and the loss of weight continued.The presence of B.C.N. was demonstrated already on the day of admission, but aureomycin was not given until the seventh day of illness.After 48 hours the stools became normal and the increase in weight satisfactory.Improvement continued.Case 8.-A 1-day-old boy was admitted because of pre- maturity.Apart from the difficulty of keeping his tempera- ture up, there was nothing of note the first week.On the eighth day he became acutely ill with vomiting and watery diarrhoea.The abdomen was distended and his colour was ashen-grey.B.C.N. was present in the stools and aureomycin therapy was started next day.After 24 hours a definite improvement could be noted, and after three days' treatment the stools were normal and the gain in weight satisfactory. SummaryAn investigation at the Sachs Hospital for Children in Stock- holm revealed the presence of a special strain of Bact.coli- that is, Bact. coli neapolitanum (B.C.N.)-in the stools and at times in the respiratory tract of babies suffering from infantile diarrhoea and vomiting.This agrees with the findings of other authors.Eight of the patients were treated with aureomycin.Its effect was marked.Even after a few doses the B.C.N. present in the stools before the inception of treatment could no longer be found.Only in a few cases did it persist some- what longer in the respiratory tract.Parallel with this bacteriological effect there was an improvement in the clinical condition.