Complete Text (Part 17)

relieving it by so simple a means is not to be thrown away. If the process of teething is going on quite naturally, no interference, medical or other, is necessary or proper. GLANDS, ENLARGED AND INFLAMED. IJ Syr. ferri iodidi, 5j- Sig. : Five to ten drops in water after meals. Indication: Useful in scrofula and anaemia. I^ Ichthyoli, 3j. Ung. hydrarg., 3j. Ung. belladonnse, 3j. Ung. petrolati, 3vj. Misce. Sig.: Apply locally night and morning. Indication: Where surgical interference is unadvisable in enlarged glands this is splendid. I^ Emulsi olei morrhuae, 5xvj. Sig.: One teaspoonful in milk and increase, given one hour after meals. Indication: Useful in anaemic and scroiu- lous patients. IJ Tinct. iodi, f5j. Sig.: Paint over gland. Indication: In earliest stages of inflamma- tion or in chronic enlargement. IJ Phenolis, 2 per cent. sol. Sig.: Inject ten drops into gland with a hypodermic syringe. Indication: Useful when gland threatens suppuration. 14 210 Hand-Book of Modern Treatment, J^ Liq. plumbi subacetatis, 5j« Tinct. opii, 5j- Misce. Sig.: Add one pint of water and apply freely on soft cloth. Indication: Useful in early stage to abort inflammation. I^ Calcii sulphurate, gr. ij. Pone in granulas no. xx. Sig.: One every three hours. Indication: Useful to prevent suppuration. GLAUCOMA. I^ Eserinse sulphatis, gr. j. Aquse destillatse, f^j. Sig.: One drop in eye every three hours. Indication: Useful in acute attack. I^ Pilocarpinse hydrochlor., gr. ij. Aquae, 5j. Sig.: One drop in eye once daily. Indication: Useful when operation is de- layed. GLOTTIS (EDEMA. I^ 'Aluminis, gr. Ixv. Tannin, gr. Ixv. Extraeti kramerise, .^iiss. Aquae, Oj. Misce. Sig.: Used as a spray in the throat five or six times daily. OOITEB. Roy gives the following plan : — First, in the case of each goiteroiis patient the author ad- vised him, if possil)le, to leave tlie affected circle, and if not, he was advised to take his drinking water after boiling. Hand-Book of Modern Treatment. 211 Much good result was obtained with the use internally of any preparation of iodine with thyroid or thymus gland extract. The author prescribed internally:— I^ Potassii iodidi, gr. v. Synipi ferri iodidi^ 3ss. Spiritus ammonise aromatici, mxv. Liquor, thyroide^, mv. Aqufie, q. s. ad Sj* Misce. Sig. : This dose three times a day. The dose of potassium iodide was raised gradually from 15 grains to 1 drachm daily, if the patient did not show any dis- tinct signs of improvement in a few weeks. He also prescribed tincture of iodine, 5 to 15 minims, three to four times a day, administered in a capsule. n lodoformi, gr. cxx. Pulv. ferri reduct., gr. xl. Ext. gentian., q. s. Misce et fiant massa in pil. no. xl div. Sig.: One pill three times daily after meals. I^ lodoformi, gr. cxij. CoUodii, 3iv. Misce. Sig.: Shake well; paint on swelling night and morning. Should the skin become too sen- sitive and sore, omit for a day or two, then re- sume the painting once daily at bed time. For the nervous, irritable, and sleepless condition the follow- ing is recommended: — I^ Sodii bromidi, gr. ij. Potassii bromidi, gr. ij. Ammon. bromidi, gr. ij. Liq. potassii arsenitis, m ij. Tinct. nucis vomicae, m iv. Aquae camphorse, q. s. ad 3j. Misce. Sig.: Give half an ounce of such a solution well diluted three to four times a day. 212 Hand-Book of Modern Treatment. The following formula has also been recommended for ex- ophthalmic goiter with irregular and rapid heart and nervous- ness : — I^ Potassii bromidi, 3ij. Infusi digitalis, q. s. ad 5viij. Misce. Sig. : Tablespoonful in water every six hours. Indication: Useful in exophthalmic goiter. William Cuthbertson says that the different forms of treat- ment of the various tumors of the thyroid gland are about as numerous as the writers on the subject. With the exception of the surgical cases, the treatment of goiter seemed to have been purely empirical, no definite classification, with its appro- priate treatment, apparently having been attempted, with the exception of the iodides and iodine having been recognized as specifics. Cuthbertson found in one case that hydrastis proved efficacious in effecting a cure in a goiter of preg- nancy, and this led him to the investigations which he has detailed. In each case of twenty-five cases of goiter of puberty and pregnancy which came under his care, a cure was effected in from six weeks to three months by the administration of hydrastis Canadensis, three times daily, after eating. He was well aware that some of these cases might have got well with- out treatment, but he made no selection of them, taking them as they presented themselves. One of the cases which was cured by this means had been treated with iodine and the iodides and with thyroid extract, becoming much worse under both forms of treatment. Immediately on instituting the hydrastis treatment the patient began to improve and was cured in six weeks. He presented hydrastis Canadensis as a new and successful remedy in the goiter of puberty and pregnancy. I^ Hydrarg. iodidi rubri, gr. xx. Atropinse, gr. j. Adipis, 5j- !Misce. Sig.: Apply with a spatula made of soft wood, by rubbing the salve well into the skin; after which expose tlie part to the sun during twenty to thirty minutes so as to drive the reinedv well in. Uand-Book of Modern Treatment. 213 The remedy, when applied, will smart for a short time, es- pecially after it has caused the skin to chap or crack ; but if too severe the patient may omit the application two or three days, but should persist in the use of the remedy until cured. The salve should be rubbed only over the upper half of the goiter, as it will run down over the other portion sufficiently, and it is desirable not to give it over any more of the skin than is actually necessary. Internally give IJ Potassii iodidij 3ij. Tinct. strophanthi, 31 j. Tinct. iris versicolor, 3ij. Elixiris aromatici, q. s. ad 5iv. Misce. Sig. : A teaspoonful in water three times a day. Follow this up and it will give cure in any case of goiter in from four to ten weeks. IJ lodoformi, 3j. Spt. setheris, 5 v. Misce. Sig.: Fifteen minims injected into the en- larged gland every second or third day. By this mode of treatment improvement was noted in the headache, polypuria, and neuralgic pains, as well as a reduction in the rapid heart-action and the tremor. Indication: Useful in exophthalmic goiter. IJ Sodii salicylatis, S-ij. Ext. glycyrrhizae, Sij. Aquae dest., q. s. ad fjv. Misce. Sig.: Tablespoonful well diluted every three hours. 214 Hand-Book of Modern Treatment. I^ Tinct. iodi, 5j. Sig. : Apply with brush and repeat when skin exfoliates. Indication; Used in simple goiter. IJ Glandulae suprarenalis siccse, 3iij. Pone in capsulas no. xxx. Sig.: One or two three times daily. Indication: I'sed in exophthalmic goiter with lowered arterial tension and cardiac pal- pitation. IJ Glandulae thyroideae siccse, Siij. Pone in capsulas no. xxxvj. Sig.: One capsule three times daily. Indication: I'sed in simple hypertrophic en- largement of the thyroid. GONOBBHCEA. IJ Zinci sulphatis, gr. xvj. Bismuthi subnitratis, 3iv. Glyceriti acidi tannici, 3iv. Fluidextracti hydra stis, 3iv. Mucilaginis acaciae, 3ij. Aquae, q. s. ad 5vj. Mi see. Sig.: Use locally two or three times daily. Inject two teasi)oonfuls and allow to remain in urethra but a sliort time. Indication: This is the best injection ever used in acute and subacute and chronic stages of gonorrhoea. IJ Iodi, gr. XV. Potassii iodidi, gr. xv\ Argj'rol, gr. Ixxv. Aqute dest., q. s. ad ^u]. Mi see. Sig.: Inject three times daily. Indication: Used in acute, subacute, and chronic stages. Hand-Boole of Modern Treatment. 215 ft Copaibae para^ 3iv. Saloli, 3iv. Oleoresinse cubebse, 3ij. Pepsini, gr. xxiv. Mi see et pone in capsulas no. xxiv. Sig. : One capsule three times daily after meals. Indication: Used in subacute and chronic gonorrhoea. ft Ung. belladonnsBj 3j. Ichthyoli, 3j. Ung. hydrargyri, 3ij. Petrolati, q. s. ad 5j» Misce. Sig.: Apply externally. Indication: Used as triple ointment for &ubo. The treatment proper is given in the following manner: After the patient empties his bladder completely the urethra is irrigated with a hot solution of potassie permanganate, about 1 to 3000. For this purpose use the Valentine irrigator, though, if nothing better is at hand, the urethra may be flushed out sev- eral times with the ordinary rubber-tipped hand-syringe. The packer is then dipped in a bottle of the solution used on the dressing, or glycerine may be used instead, after which the penis is grasped with the fingers of one hand and the packer intro- duced slowly and carefully into the urethra with the other hand. It is passed back al)out four inches in anterior gonorrhoea, and back to the neck of the bladder in posterior gonorrhoea and pros- tatic troubles. Force is never used in introducing the packer. The urethra" is then lightly packed with one-inch continuous gauze strips, or, better, a loosely-spun cotton cord, saturated with one of the following solutions : — ft Todoformi, gr. xcv. Balsami peruviani, 3iv. Olei ricini, q. s. ad 5iv. Sifj. : Rub iodoform in castor oil, then add balsam of Peru. You will notice that the odor of iodoform is practically masked in this solu- tion. 216 Hand-Book of Modern Treatment, ft Ichthyoli, gr. xl. Resorcini, gr. xl. Balsami peruviani, 3iv. Olei ricini, q. s. ad SW. Misce et fiat solutio. The instrument is gradually withdrawn as the dressing is pushed through, and when it emerges from the meatus the cord dressing is clipped with scissors, leaving about one-eighth inch of the cord outside of the meatus, which can be taken between the fingers when the cord is to be removed. A small piece of cotton is placed over the head of the penis and treatment is complete. The patient is now instructed to go as long as he possibly can before urinating, when the cord is slowly removed. Use the following liniment from the beginning. Its action is exceedingly rapid and effective : — ft Ammonii chloridi, 5ij. Potassii iodidi, 3ij. Alcoholis, f^ij. Aquae dest., f^ij. Misce. Sig. : Apply with a small camel's-hair brush four times daily. Indication: Useful in gonorrhoeal epididy- mitis. ft Guaiacoli, 3ij. Lanolini, 3iij. Resorcini, Siij. Misce et fiat unguentum. Sig.: Apply locally on gauze. Indication: Useful in gonorrhoeal epididy- mitis. The following prescription is a most excellent, eflBcient, and bland antiphlogistic, possessing powerful properties in the sup- pression of the discharge, which it will almost invariably check in three days without any untoward symptoms whatever : — Hand-Book of Modern Treatment. 217 I^ Colorless hydrastis, 5iij- Potassii chloratiS; gr. xx. Or sol. sat. Aquae, q. s. f^iv. Misce. Sig. : Inject a small syringeful four times daily. IJ Tinet. aconiti, 3j. Tinct. gelsemii, 3ij. Antipyrini, 3ij. Fluidextracti ergotae, 5j» Aquse, q. s. ad 5vj. Misce. Sig.: A dessertspoonful every two or three hours in a wineglassful of water. Indication: Useful in prostatic pain follow- ing gonorrhoea. The latest thing which is vouched for as a sure destroyer of the gonococcus is picric acid. It is claimed by those who have used this method that it exerts almost a specific action in chronic urethritis. In using the remedy, a solution of from 1 to 2 per cent, is employed, and it is always used by instillation. The soft or hard catheter is introduced into' the urethra as far as the cut-off muscle, and the injection is slowly made until the fluid flows from the anterior urethra. It is claimed that many cases have yielded to this treatment that have resisted protargol, nitrate of silver, and permanganate of potassium. ft Acidi borici, Siss. Tinct. iodi, 3ij. Glycerini, 5j. Aquse dest., 5iv. Misce. Sig. : Use as an injection morning and even- ing. DIAGNOSIS OP GONOERHCEAL VAGINITIS. It is said that the pus of gonorrhoeal vaginitis is always alkaline. If for any reason a microscopical examination can- not be made, the use of a strip of litmus paper will, therefore, give a fairly accurate decision. 218 Hand-Book of Modern Treatment, Hirsch reports the prompt cure of a threatening case of gonorrhoeal inflammation of one eye from auto-infection. He commends the technique following as promising surprising re- sults for such cases. He made a single subcutaneous injection of a 1 to 5000 solution of hydrargyrum oxycyanate to which a little acoin had been added. There was considerable irritative reaction, but the process was arrested and three days later the cure was completed by a repetition of the injection. ft Methyl salicylatis, 3ss. Petrolati, 3v. Misce. Sig. : Give warm baths, copious draughts of Vichy water, and anoint the penis with this ointment. Then apply a thin layer of wadding to the member, and cover the whole with adhe- sive taffeta. An editorial in the Journal of the American Medical Asso- ciation says that Popper was led to make urethral injections of a solution of nitric acid in order to avoid the generation of heat caused by the chemical decomposition of silver nitrate. Cocaine or eucaine may be added to the solution for anaesthetic purposes. In cases of acute gonorrhoeal urethritis a 10- or 15-per-cent. solution of pure concentrated nitric acid was injected from three to ^xe times daily, the fluid being permitted to remain in the urethra for one or two minutes. In the course of from i:wenty-four to forty-eight hours the character of the copious discharge will have changed. The urine becomes clear, and contains only fibers. The secretion is viscid and considerably diminished. In the course of five or six days at times only a small drop can be expressed; later only in the morning. In th^ course of a week in most instances the discharge is even still less. The gonococci also rapidly diminish in number in the course of a day, and disappear wholly in from five to eight days. For three or four days after the gonococci have no longer been demonstrable the injections are made but twice a day, and then but once a day. After from twelve to fourteen days as- tringents are prescribed for the purpose of causing the disappear- ance of any filaments that may yet be present. If the discharge Hand-Book of Modern Treatment, 219 is not increased following a seminal emission, or gonococci do not appear, the injections are gradually discontinued; so that the treatment shall be concluded in from fifteen to thirty days. In chronic cases or in the presence of posterior urethritis, a 25-per-cent. solution of nitric acid is injected once daily by means of Guyon^s syringe. S. Chandler, Philadelphia, advocates the use of lactic acid for the treatment of gonorrhoea of the cervix as preferable to other methods. He has employed it in 3-i cases, which are tabu- lated. His method is as follows: Cleanse the vagina and cer- vix thoroughly with warm water and cotton soaked in a water solution (4 to 6 ounces) of pyroligneous acid. Expose the cer- vix by drawing it downward and into view by an ordinary long tenaculum; then take an ordinary hypodermic syringe loaded with pure lactic acid, and inject just beneath the membrane a few drops of the acid. Continue this until the whole of the cervix is exposed as the superior and inferior lip is injected. It may be done at one sitting or, in a nervous case, if desired, in two or three sittings. He concludes from his experience with this and other methods that lactic acid cures gonorrhoea, has no ill effects, and prevents the spread of the disease into the body of the uterus if used sufficiently early. Ordinary douches and painting of the cervix give only temporary relief; it is better to destroy the cervical glands, and this should be done as soon as a positive diagnosis is secured. Both the discharges and the cervi- cal membrane should be examined before excluding gonococci, which are the cause of most chronic discharges. This method of injecting the cervical glands with lactic acid, he believes, is the best prophylactic against future disease of the tubes, etc. A too deep injection of the lactic acid may cause an annoying, though not a dangerous, slough, lessening the good result. Caution against this is, therefore, advisable. Johannes von Tiling has secured excellent results from Bier's method of damming back the circulation with elastic bands in several painful cases of gonorrha?al arthritis. He advises the use of a thin, pliant rubber bandage, whicli should be applied so as not to cause discomfort, but sufficient to pro- duce very perceptible liypergemia. Blueness and coldness of the limb, white or vermillion spots, and pain or paraesthesia indi- 220 Hand-Book of Modem Treatment. cate that the bandage is too tight and should be loosened. Properly applied, the most marked first effect is relief of pain, but this is not all; damming, he claims, has a bactericidal ef- fect, and dissolves away the adhesions, which are completely removed by massage after the removal of the bandage. At first the bandaging should be of short duration, a few hours at a time, but later it should be increased until it reaches ten hours a day and ten hours at night. After removal of the bandage, massage lightly, then have the patient stand and move the joints. He claims that this method gives better results in most cases of gonorrhoeal arthritis tending to stiffness of the joints than any other. I^ Acidl carbolici, .gr. x. lodi, gr. V. Olei olivae, 3ss. Lanolini, q. s. ad 5j' Misce et fiat unguentum. Sig. : To be used, with or without prelimi- nary irrigations, by means of a Guyon catheter syringe, or a small silver tube with a short ter- minal curve screwed on to a hypodermic syr- inge, passed through the compressor muscle into the posterior urethra. The instillations may be performed every second, third, or fourth day,