MECKEL'S DIVERTICULUM AS THE CAUSE OF ACUTE SYMPTOMS
Authors: A. H. Baker
Journal: BMJ (1931)

MECKEL'S DIVERTICULUM[MTIgBRITISH anaemias2" its results may be brilliarit, as the following case will show: D. R., female, aged 7, was quite healthy till ten days before admission, wlhen she had what was apparently aln acute toilsillitis with swvelling of the cervical lymph glanids.Her parents lhal noticed her to be very pale for tlhree days.On admission she was very collapsed, and had a vaxy pallor.The blood count showed red corpuscles 680,000 per emtr., white corpuscles 33,000 per c.mm., polvmorphs 75 per cent.A transfusion of 500 c.cm. was given.She made a steady recovery, was discharged fit three months later, and is now perfectly well, two years after the onset of the disease.I am not sure that chronic infections do not provide the largest field for the use of transfusion.In low-grade septicaemias, empyemas, and similar conditions it may often make the difference between life and death, especially in children.However, it must be admitted that it is imnpossible to give absolute proof that the improvement seen after it would not have occurred without it.In acute infections the general opinion seems against transfusion.I have had no experience of its action, and should welcome any information about it.It often does very definite good in athrepsia anid mal- outrition of infants, as in the case given below.G. G., male, aged 3 weeks.Admitted sufferinig from pyloric stenosis.WN'eight 5 lb., " big baby at birth," passing blood per rectum, and looking absolutely moribund.Transfusion 50 c.cm., Rammstedt's operation under local anaesthesia tielve hours later; uninterrupteU recovery.Tranisfusion seems the logical treatment for coal-gas poisoning, to replace the haemoglobin that has been put out of action by the CO, and in burns it helps both in the early shock and in the later toxaemia.Nephritis is usually given as a contraindication to it, but I have had two extremely interesting cases in which it seemed to avert certaini death from uraemia.I give the histories without attempting to draw definite .conclusionsfrom them.B. W., inale, aged 10.September 6th: Admissioni, sufferinig from acute haemorrhagic nephritis.Blood and casts in urine, w^rith large amount of albumin; blood urea 160 mg. to 100 c.cm. October 6th: Going dow-nhill in spite of treatnment; uirinary output diminishing; vomiting; blood urea 250; transfusion 500 c.cm. October 10th: Much improved; passing more urine, with less blood and albumin in it; blood urea 140.October 31st: Blood urea 60.November 5th: Septic tonsils removed, as being probably the cause of the inephritis; " flare-up " of the nephritis, Nvith blood urea rising to 120.January 1st, 1929: Sent out much improved; blood urea 40.E. R., female, aged 7. May 2nd, 1927: Adnmission, suffering fr-om acute haemorrhagic nephritis.Improved under treat- Inent and was sent to country branch of hospital.August 9th: readmitted in uraemic coma; unconscious, dusky, andI apparentlv dying; blood urea 122 mg. to 100 c.cm. Blood was withdrawn to the amount of 200 c.cm., and a transfusion of 500 c.cm. was performed.The effect was almost biblical, as she recovered consciousness onI the operating table, ancl returned to the ward talking cheerfully.Auguist 30th: blood urea 56.The patient was sent out much improved.. I have been able to find very little work on this subject,28 and of course the action of the transfusion was not a simple dilution.Mv thanks are due to the honorary staff of the Hospital for Sick Children, Great Ormond Street,