1960年 · 第11卷第01期

In a measles epidemic which occurred from December 1958 to March 1959, 1,086 cases were admitted to the hospital. Of these, 107 cases had laryngitis, an incidence of 9.9%. In the first two months, the incidence was about 5%, while in the second two months it increased to about 20%. No satisfactory explanation was found for this increase. Of the laryngitis cases, 31.6%occurred under 2 years of age, 77.5% under 5years and 22.5% over 5 years. Only 2,8% cccurred during the prodromal period. 51.4% occurred during the eruptive period and 45.8% after the eruptive period. Most of the patients had severe cough and 64.5% had respiratory difficulty. 74.3% had leucocytosis. The case fatality rate was as high as 28% because many patients were admitted late. Two-thirds of the deaths occurred within 24 hours after admission. Novocain block seemed to help in relieving the symptoms. In 4 cases, the croup and the respiratory difficulty became much milder ten minutes after the procedure. The novocain therapy consisted of the injection of 8-10 ml of 0.5% novocain into the submental triangle.

From March 1956 to December 1958, 555children with bronchopneumonia were treated. 224 cases were found to have rickets and 42 cases malnutrition.

This paper discusses the effect of rickets and malnutrition on pneumonia.

1. The mortality of pneumonia was 2.6times higher in children with rickets than in those without (9.8% and 3.9% respectively) . The effect of first degree rickets was rather mild, but the more severe the rickets the higher the mortality of pneumonia (the mortality in second degree rickets was 14.8% and third degree rickets 42.9%) .

2. The mortality of pneumonia was 2.6times higher in children with malnutrition than in those normally nourished (14,33% and 5.7%respectively) . The effect of first degree malnutrition is rather mild, but the more severe the malnutrition the higher the mortality of pneumonia (the mortality in second degree malnutrition was 22.2% and in third degree malnutrition 33.3%) .

3. The intoxicated type of bronchopneumonia is more often found in children with rickets than in those without (the incidence being 16.5% and 9.4% respectively) .

4. The intoxicated type of bronchopneumonia is more often found in children with malnutrition than in those normally nourished.

Bronchopneumonia is an important factor in death of children. Rickets and malnutrition may not only increase the incidence of bronchopneumonia but also interfere with its clinical type, process and prognosis. Besides, in the presence of pneumonia, rickets would usually become worse.

The authors thus concluded that in treating bronchopneumonia, rickets, if found, should be treated simultaneously.

All the 51 cases were children aged from 6 months to 12 years, 39 being under 7 years. 4 cases were severe, 46 moderately severe and 1 was mild. Aside from the usual supportive and palliative treatment, specific drugs used included sulfadiazine and penicillin. For ordinary cases, only sulfadiazine was used. The dose was 100-250 mg/kg body weight per day, divided into four equal doses given by mouth in the daytime. The first was a double dose. After 72 hours of treatment, if the patient's condition improved, sulfadiazine was discontinued even though the patient might still be febrile. For patients with petechiae, 100,000 units of penicillin were given intramuscularly once every 12 hours. For those with more profuse petechiae, 100,000 units of penicillin were given intramuscularly once every six hours. If the patient's condition improved penicillin was stopped after 72 hours of treatment. All the patients were cured except one who had residual facial paralysis of the left side. The average duration of fever was 2.4 days; the symptoms disappeared in 3.6 days and the spinal fluid returned to normal in 6.3 days. These figures compared favorably with those of the ordinary course of treatment. The author concluded that the course of treatment could be shortened to three days in light cases. Even for severe cases, if the patient should survive the first one or two days, the course of treatment could also be shortened.

1,363 cases of meningococcal meningitis of children aged 9 days to 14 years were admitted from January to June 1957. They were mostly given a short course of 2-3 day sulfa drug treatment (mainly sulfadiazine) . The initial dose was 75-100 mg/kg body weight given intramuscularly, intravenously or orally. The maintaining dose was 200 mg/kg per day given orally or intramuscularly in four divided doses. The total fatality rate was 6.74%. When the fever subsided and the general condition improved treatment was discontinued without further check-up of cerebrospinal fluid. 305 cases in the series were treated for 48 hours and 396 cases for 72hours. All of them recovered and no relapse was found. No sequelae were discovered in 116 cases out of 117 cases followed up arbitrarily six months later.

98 cases were treated with sulfathiaz 1e. No appreciable difference in the therapeutic results was found between the sulfathiazole group and sulfadiazine group. The incidence of hematuria in the sulfadiazine group was 13 5%, while only 2 cases with hematuria were seen in the sulfathiazole group.