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DUODENAL LAVAGE IN THE TREATMENT OF JAUNDICE COMPLICATING THE TREATMENT FOR SYPHILIS

DUODENAL LAVAGE IN THE TREATMENT OF JAUNDICE COMPLICATING THE TREATMENT FOR SYPHILIS Abstract Since the introduction of the duodenal tube by Gross, in 1911, many indications for its use have been proposed. Like all innovations in the medical world, it soon became a panacea. It was used in the treatment of diabetes, chronic duodenal catarrh, cholelithiasis, chronic icterus,1 malnutrition, gastroptosis, persistent vomiting, duodenal ulcer,2 gastric ulcer,3 indicanuria, seborrhea of the face, spasms of the larynx, chronic bronchitis, chronic gastro-enteric catarrh, constipation,4 chronic intestinal parasitic disease, oxyuris, achylia pancreatica,5 amebic dysentery, sciatica, melancholia, dementia, ptomaine poisoning, exophthalmic goiter, paroxysmal tachycardia, mucous colitis, psoriasis,5 chronic arthritis,6 pylorospasm, hypersecretion, hyperemesis gravidarum, gastric atony, arteriosclerosis, epilepsy, nephritis, neuralgia, neuritis, anemia, insomnia, anorexia, and catarrhal jaundice,7 in all of which it was employed with a measure of success. Lyon,8 Einhorn,9 and Weilbauer10 emphasize its indication as a diagnostic aid in the more direct examination of fresh duodenal References 1. Gross, M. H.: Direct Lavage of the Duodenum , New York M. J. 93: 171-172, 1911. 2. White, F. W.: Observations on the Use of the Duodenal Tube for Diagnosis and Treatment , Boston M. & S. J. 174:710-715, 1916. 3. Aaron, C. D.: The Therapeutic Value of the Duodenal Tube , New York M. J. 116:648-651, 1922. 4. Rosenberger, F.: Ueber Duodenaltherapie , Med. Klin. 9:1249-1251, 1913. 5. Jutte, M. E.: Transduodenal Lavage. Treatment and Report of Some Cases of Chronic Diseases , J. A. M. A. 60:586-587 ( (Feb. 22) ) 1913 6. Autointoxication Treated by Duodenal Lavage , Am. J. M. Sc. 153:732-738, 1917. 7. Levin, A. L.: Transduodenal Lavage , New Orleans M. & S. J. 72: 263-270, 1920. 8. Simon, S. K.: The Direct Aspiration of the Contents of the Biliary Tract Through the Duodenal Tube. Clinical Application and Therapeutic Possibilities of the Method , South. M. J. 14:447-455, 1921. 9. Churchill, J. F.: The Use of the Duodenal Tube , J. Iowa State M. Soc. 6:17-21, 1916. 10. Lyon, B. B. V.: The Treatment of Catarrhal Jaundice by a Rational, Direct and Effective Method , Am. J. M. Sc. 159:503-512, 1920 11. Non-Surgical Drainage of the Gall-Tract , Philadelphia, Lea & Febiger, 1923. 12. Einhorn, M.: The Duodenal Tube as a Factor in the Diagnosis and Treatment of Gallbladder Disease , J. A. M. A. 66:1908-1910, 1916. 13. Weilbauer, A.: Praktisches und Kritisches zur duodenal Sondiering , Klin. Wchnschr. 1:2512-2515, 1922. 14. Hopkins, A. H.: The New and Direct Method of Treating Catarrhal Jaundice , New York M. J. 115:710-711, 1922. 15. Ousley, J. W.: Duodenal Lavage in Treatment of Catarrhal Jaundice . Case Report, South M. Jour. 12:597-599, 1919 16. Levin, A. L.: Medical Treatment of Gallbladder Diseases Versus Surgical , New Orleans M. & S. J. 73:252-258, 1921. 17. Meakins, J.: Duodenal Tube in Biliary Diseases , Brit. M. J. 1:983-987, 1922. 18. Rehfuss, M. E.: Medical Treatment of Biliary Affections , M. Clin. N. Am. 2:815-828, 1918-1919. 19. Stokes, J. H.; Ruedemann, R., Jr., and Lemon, W. S.: Epidemic Infectious Jaundice and Its Relation to the Therapy of Syphilis , Arch. Int. Med. 26:521-534 ( (Nov.) ) 1920. 20. The tip of the tube is placed on the tongue, close to its base and the patient is told to swallow. During the act of swallowing, the tube is gently started down the esophagus, and is passed until a level of about 50 cm., midway between the first and second markings, is reached. At this level the stomach is washed with sterile water until the return is clear. The patient is then instructed to lie on his right side, extending his right leg and acutely flexing his left knee and hip. He is told to pass the tube at the rate of 1 inch every five minutes until the third mark (75 cm.) is reached. We know that the tube is in the duodenum by a change in reaction of the aspirated fluid from acid to alkaline; by the character of the duodenal juice, which is usually a pearly viscid fluid in which floccules are suspended; sometimes by the presence of bile; by a slight tug when the tube is pulled gently, and by seeing the tip beyond the pylorus at fluoroscopic examination. The tube is removed by withdrawing it gently until the tip reaches the nasopharynx; the patient is then told to swallow, and the tip is easily recovered. 21. Eppinger, H.: Weitere Beiträge zur Pathogenese des Ikterus , Beitr. z. path. Anat. u. z. allg. Path. 33:123-157, 1903 22. Ikterus, Ergebn. d. inn. Med. u. Kinderh. 1:107-156, 1908. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology and Syphilology American Medical Association

DUODENAL LAVAGE IN THE TREATMENT OF JAUNDICE COMPLICATING THE TREATMENT FOR SYPHILIS

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Publisher
American Medical Association
Copyright
Copyright © 1924 American Medical Association. All Rights Reserved.
ISSN
0096-6029
DOI
10.1001/archderm.1924.02360280093014
Publisher site
See Article on Publisher Site

Abstract

Abstract Since the introduction of the duodenal tube by Gross, in 1911, many indications for its use have been proposed. Like all innovations in the medical world, it soon became a panacea. It was used in the treatment of diabetes, chronic duodenal catarrh, cholelithiasis, chronic icterus,1 malnutrition, gastroptosis, persistent vomiting, duodenal ulcer,2 gastric ulcer,3 indicanuria, seborrhea of the face, spasms of the larynx, chronic bronchitis, chronic gastro-enteric catarrh, constipation,4 chronic intestinal parasitic disease, oxyuris, achylia pancreatica,5 amebic dysentery, sciatica, melancholia, dementia, ptomaine poisoning, exophthalmic goiter, paroxysmal tachycardia, mucous colitis, psoriasis,5 chronic arthritis,6 pylorospasm, hypersecretion, hyperemesis gravidarum, gastric atony, arteriosclerosis, epilepsy, nephritis, neuralgia, neuritis, anemia, insomnia, anorexia, and catarrhal jaundice,7 in all of which it was employed with a measure of success. Lyon,8 Einhorn,9 and Weilbauer10 emphasize its indication as a diagnostic aid in the more direct examination of fresh duodenal References 1. Gross, M. H.: Direct Lavage of the Duodenum , New York M. J. 93: 171-172, 1911. 2. White, F. W.: Observations on the Use of the Duodenal Tube for Diagnosis and Treatment , Boston M. & S. J. 174:710-715, 1916. 3. Aaron, C. D.: The Therapeutic Value of the Duodenal Tube , New York M. J. 116:648-651, 1922. 4. Rosenberger, F.: Ueber Duodenaltherapie , Med. Klin. 9:1249-1251, 1913. 5. Jutte, M. E.: Transduodenal Lavage. Treatment and Report of Some Cases of Chronic Diseases , J. A. M. A. 60:586-587 ( (Feb. 22) ) 1913 6. Autointoxication Treated by Duodenal Lavage , Am. J. M. Sc. 153:732-738, 1917. 7. Levin, A. L.: Transduodenal Lavage , New Orleans M. & S. J. 72: 263-270, 1920. 8. Simon, S. K.: The Direct Aspiration of the Contents of the Biliary Tract Through the Duodenal Tube. Clinical Application and Therapeutic Possibilities of the Method , South. M. J. 14:447-455, 1921. 9. Churchill, J. F.: The Use of the Duodenal Tube , J. Iowa State M. Soc. 6:17-21, 1916. 10. Lyon, B. B. V.: The Treatment of Catarrhal Jaundice by a Rational, Direct and Effective Method , Am. J. M. Sc. 159:503-512, 1920 11. Non-Surgical Drainage of the Gall-Tract , Philadelphia, Lea & Febiger, 1923. 12. Einhorn, M.: The Duodenal Tube as a Factor in the Diagnosis and Treatment of Gallbladder Disease , J. A. M. A. 66:1908-1910, 1916. 13. Weilbauer, A.: Praktisches und Kritisches zur duodenal Sondiering , Klin. Wchnschr. 1:2512-2515, 1922. 14. Hopkins, A. H.: The New and Direct Method of Treating Catarrhal Jaundice , New York M. J. 115:710-711, 1922. 15. Ousley, J. W.: Duodenal Lavage in Treatment of Catarrhal Jaundice . Case Report, South M. Jour. 12:597-599, 1919 16. Levin, A. L.: Medical Treatment of Gallbladder Diseases Versus Surgical , New Orleans M. & S. J. 73:252-258, 1921. 17. Meakins, J.: Duodenal Tube in Biliary Diseases , Brit. M. J. 1:983-987, 1922. 18. Rehfuss, M. E.: Medical Treatment of Biliary Affections , M. Clin. N. Am. 2:815-828, 1918-1919. 19. Stokes, J. H.; Ruedemann, R., Jr., and Lemon, W. S.: Epidemic Infectious Jaundice and Its Relation to the Therapy of Syphilis , Arch. Int. Med. 26:521-534 ( (Nov.) ) 1920. 20. The tip of the tube is placed on the tongue, close to its base and the patient is told to swallow. During the act of swallowing, the tube is gently started down the esophagus, and is passed until a level of about 50 cm., midway between the first and second markings, is reached. At this level the stomach is washed with sterile water until the return is clear. The patient is then instructed to lie on his right side, extending his right leg and acutely flexing his left knee and hip. He is told to pass the tube at the rate of 1 inch every five minutes until the third mark (75 cm.) is reached. We know that the tube is in the duodenum by a change in reaction of the aspirated fluid from acid to alkaline; by the character of the duodenal juice, which is usually a pearly viscid fluid in which floccules are suspended; sometimes by the presence of bile; by a slight tug when the tube is pulled gently, and by seeing the tip beyond the pylorus at fluoroscopic examination. The tube is removed by withdrawing it gently until the tip reaches the nasopharynx; the patient is then told to swallow, and the tip is easily recovered. 21. Eppinger, H.: Weitere Beiträge zur Pathogenese des Ikterus , Beitr. z. path. Anat. u. z. allg. Path. 33:123-157, 1903 22. Ikterus, Ergebn. d. inn. Med. u. Kinderh. 1:107-156, 1908.

Journal

Archives of Dermatology and SyphilologyAmerican Medical Association

Published: Oct 1, 1924

References

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