A case of Still's disease treated with Cortisone is reported. The response was very good and transformed an ill, bedridden child into a happy, mobile little girl. Cure has not been effected; only temporary symptomatic relief. Relapses have occurred during intermittent therapy, but have been controlled by an increase in dosage. Treatment did not prevent the onset of pericarditis. The investigations, treatment and response are reported in a chart.
Surgery in the aged should be attempted only in cases where the operation is considered essential. All surgery in this age group is dangerous and should not lightly be undertaken. The physician should try to convert a poor surgical risk into a reasonable one. He should not confine himself to stating the difficulties of the case and warning of the consequences. The physician, having satisfied himself that the operation is essential, must be prepared to produce the patient for operation in the best physical and mental state, and must be prepared to deal with all complications which may arise. A calculated risk is not as frightening as an unexpected one. The pre- and post-operative treatment of surgery in the aged is presented and certain important points are discussed. Constant care and attention is imperative if the results are to be successful.
The preponderance of the human strain of the tubercle bacillus in skeletal infection is indicated. The theories of haematogenous and lymphatic spread to vertebral foci are discussed. The various pathological types of involvement and their consequences are descriptionbed. A plan for the use of antibiotics and chemotherapy is submitted. The case is argued for conservative and against operative treatment in the evolutionary stage of the disease. The principles of after-care are discussed. The treatment of complications is detailed. The care of paraplegics is descriptionbed and the necessity emphasized for radical operative measures when indicated.