Complete Text (Part 27)

relief of pain. PLEUBODTNIA.— See Neuralgia. 848 * Hand-Book of Modem TreatmrnU, PNEUMONIA. I^ Potassii ci trails, 3vj. Spiritus setheris nitrosi, 3iv. Tinct. opii camphoratse, 3iv. Liq. potassii citratis, q. s. ad Jvj. Misce. Sig. : Dessertspoonful every three hours. Indication: Early cough and fever of pneu* monla. The treatment of pneumonia as pursued in four great hos- pitals in New York City — Bellevue, New York, Boosevelt, and Presbyterian — ^was recently outlined by H. P. Loomis before the Medical Association of the Greater City of New York. In such institutions as these the most advanced therapeutic sug- gestions are tried, weighed, discarded or adopted; and accu- rate records are kept by which reliable and impartial conclusions may be reached. There was much uniformity in the treatment of the disease in these four hospitals. Upon admission the patient was usually given calomel in small, repeated doses, fol- lowed by a saline the next morning. Local applications to the chest were usually restricted to cases where intense pain and distress were felt; none were made as a routine practice. An exclusive milk diet — ^plain or modified — was adopted during the height of the disease. A temperature of 104 and over was not regarded necessarily as an indication for special treatment un- less nervous symptoms, marked restlessness or delirium accom- panied the fever. At tlie Presbyterian, when the degree was above 104, cold packs were applied to the anterior portion of the chest; in the New York, alcohol sponging was resorted to, and, failing that, the cold pack; at Bellevue, sponging with tepid water (80 to 85 degrees) was done; and at Roosevelt, alcoholic sponges or anterior packs. Only in the New York and the Presbyterian were tub baths given, and then only in cases of toxaemic pyrexia or in alcoholic cases with nervous symp- toms. Codeine was given to control cough, in doses from one- quarter to one grain every four hours; sometimes heroin (V12 grain) and perhaps morphine. Trional, veronal, and codeine were given for insomnia. Pulmonary oedema was treated by Hand-Book of Modem Treatment, 349 hypodermic injections of adrenalin; also by atropine, cupping, and stimulation. The use of oxygen was restricted to cases of cyanosis and dyspepsia. The oxygen tank seemed still to hold its place as the forerunner of the end. The three cardiac stim- ulants were alcohol, strychnine, and digitalis; of these, the first named was also the most used and the most relied upon. The indications for these stimulants naturally varied in differ- ent cases. Only in Roosevelt was the last used to any great extent. Nitroglycerine had but occasional use. At Roosevelt rectal saline injections were used, especially in alcoholics and when nutrition was failing. Eight ounces of a normal salt solution were introduced every four hours through a funnel attached to the end of a catheter; these injections were well retained and seemed to be of decided benefit. Dr. Loomis paid a glowing and certainly well-deserved tribute to the interne staffs of these hospitals, by whose industry and zeal these conclusions were made possible; and he empha- sized three points: Morphine should be used more hypodermically in the invasion of pneumonia, which is oftentimes characterized by shock to the nervous system from a sudden and overwhelming toxaemia, and by distressing pain, often amounting to the agony of a pleurisy. If any criticism could be offered of our treatment of pneumonia during the recent past, it must be upon the injudicious and often unwar- ranted use of alcohol. Lastly, Dr. Loomis believes that more patients are damaged than helped by the promiscuous drugging which is still too prevalent. I^ Ammon. iodidi, 3ss. Strychninse sulphatis, gr. %. Creosoti (beech wood), mxx. Glycerini, 5j- Liq. ammonii acetatis, q. s. ad f^iv. Misce. Sig.: A teaspoonful every two hours. This is for a child five years old. Indication: Creosote combined with ammo- nium iodide, which is a good stimulating ex- pectorant, and strychnine to safeguard the heart. 350 Hand-Book of Modem Treatment, IJ Tinct. veratri viridis, m xxiv. Vini antimonii, 3j. Ammonii bromidi, Siiss. Liq. ammonii acetatis, ^iiss. Syr. limonis, q. s. Jiij- Misce. Sig.: One teaspoonful every hour in water until easier, then every two hours. I^ CodeinsB, gr. ij. Liq. ammon. acetatis, 3iv. Spiritus chloroformi, 3iv. Syr. lactucarii, q. s. ad 5ij. Misce. Sig.: One teaspoonful every hour. Indication: To relieve cough and pain in pneumonia. For the last seven years H. J. Robson has treated all cases of pneumonia — ^whether broneho-pneumonia or lobar pneumonia — ^by iron acetate, and severe cases by alternate doses of iron acetate and strychnine, with surprisingly good results. The prescriptions used are: — I^ Liquor ferri perchlor., m xv. Liquor ammon. acetatis, 3ij. Aquse chloroformi, q. s. ad 3ss. Sig.: Take every four hours in water when given alone; take every six hours alternately with the strychnine mist, when this latter is needed. It is administered every six hours until the patient is well over the crisis; then it is given every eight hours, and later every twelve hours alternately with the strychnine. I^ Liquor strychninse, m v. Aquae chloroformi, ad Sss. Sig.: Take every six hours in water alter- nately with the ferri mist, and as above stated (in severe cases onlv). I^ Pine oil, for dry inhalation on a clean handkerchief. Hand-Book of Modem Treatment. 351 Pneumonia in young children can be diagnosticated from other diseases by the following sign : There is a lack of expan- sion of the subclavicular region independent of the location of the pneumonia lesion. On placing the fingers upon the sub- clavicular region they are lifted as by a wave on the sound side, while on the other the lack of expansion is evident even in early stages of the disease. In pleurisy and pneumothorax the lack of expansion corresponds with the site of the lesion. I^ Potassii iodidi, 3j. Ammonii chloridi, 3iss. Misturse glycyrrhizse comp., Jvj. Misce. Sig.: A tablespoonful four times daily. Indication: Useful in delayed resolution in pneumonia. C. E. de M. Sajous states that as a febrile process advances, the alkaline salts are consumed, and being inadequately renewed, the vital and defensive functions are increasingly hampered until life ceases. After referring to the experimental bacteri- ology of an alkaline reaction of the blood fluids in disease, and the more advanced teachings in the same direction by Jacques Loeb, he concludes that in febrile diseases there exists a close relationship between a deficiency of sodium and death. The author states that even under normal conditions nearly one-half ounce of sodium chloride is excreted each day with the urine, but that the altered conditions during toxaemias, etc., greatly diminish the intake, and unless measures be taken to compen- sate for this, the defensive functions are increasingly hampered and the chances of death are correspondingly increased. Sajous also states that the opposition to the use of saline solution in pneumonia and other diseases has been based on the fact that the sudden elimination of waste-products tends to cause inflam- matory renal lesions, or to augment them if present; whereas such lesions occur, he says, because the toxic wastes are allowed to accumulate in the organism, and on being suddenly liber- ated when the saline solution is used, they overtax the kidneys, but this is prevented when the saline solution is administered from the start. The formula of Dr. Todd is one admirably ad- justed to this purpose and is as follows : — 352 Hand-Book of Modem Treatment. I^ Sodii chloridi, gr. cccxx. Potassii bicarbonatis, gr. cxl. Fluidextracti aromatici, (U. S. P.), m xxx. Aquse, q. s. ad ^iv. Misce. Sig.: Teaspoonful in six to eight ounces of water every two hours with a teaspoonful of lemon juice. The patient is also allowed to drink water at will. A writer lays particular stress on the efficacy of hypoder- moclysis, but that it is usually employed as a last resort, and that the only way to obtain good results is to use the saline so- lution early, which can be done by the above method, so that the alkalinity of the blood is insured from the start in all febrile toxaemias. IJ Mild chloride mercury, gr. v. Salol, gr. X. Sodii bicarbonatis, gr. x. Powdered ipecac, gr. ij. M. Divide in five capsules. Sig.: One every hour, followed by salts or sodium phosphate two hours after last powder, if patient's bowels have not moved freely. Indication: Form of treatment for lobar pneumonia. Also tinct. aconite, gtt. x, in water, 3x. A teaspoonful to be given every hour until pulse becomes soft. A tablet or two of acetanilid comp., with five grains of Dovers powder every two or three hours for pain. Mustard plaster to affected lung until sur- face is red, then a thick application of antiphlogistine hot, to be repeated every ten to fourteen hours until gray hepatization sets in. The second visit we order an emulsion containing fifteen drops of creosote carbonate to the dose every four hours, to be continued until convalescence is completed. After the first purge we keep the bowels open with sodium phosphate. About the third day we order strychnine sulphate ^/^q grain every four hours per orem, unless pulse becomes weak, when we give it more often. Also, we begin hot toddies twenty-four hours before the expected crisis, to be given between doses of Hand-Book of Modern Treatment, 368 strychnia. A fluid diet and a tonic composed of equal parts of Fellows' hypophosphites and elix. lactated pepsin, two teaspoon- fuls after meals, complete the treatment. I^ Eucalyptoli, m xlv. Ammon. iodidi, 'Siiss. Vini picis liq., 5j- Syrupi tolutani, Sj. Misce. Sig. : One teaspoonful in water every three hours. Indication: Good in clearing up stage. Avoid ammon. iodidi if phthisis is developing. Dr. Gustav Schirmer states that he never gives either narcotics, antipyretics, nor heart-tonics in the treatment of this disease. He administers the simple expectoratnts, urotropin, and cathartics, and disinfects mouth and throat. The heart he ex- amines daily, but the chest only very little, and then with the patient lying on his side. The patient's position is occasionally shifted, but he himself must not stir a limb. Always fresh air and even temperature. Light diet, but no urging. From the very first he vaporizes in the sick-room a mixture as follows: — IJ Acidi thymic, gr. xv. Olei gaultherise, f^ij. Olei eucalypti, f^ij. Camphorse, gr. xv. Misce. Sig. : Use in atomizer. Eectal injections, under low pressure, of 1 pint of 0.85 per cent, saline solution, are made every two hours as long as fever is high and toxic symptoms present. On the first day 1 ounce of unguentum Crede is thoroughly inuncted into the skin ; on the second day ^/g ounce, and this is reduced daily, so that severe cases get in all 5 ounces. Iron he employs early. Even after the crisis patients must stay in bed quietly for ten days. He ascribes his good results to the inhalations and the silver treatment. When this therapy is instituted only late, the per- centage of cures is less. It is an error to wait with the treat- 23 354 Hand-Book of Modem Treatment. ment until the cases are severe; the best time has then been passed. When he began it on the first day every ease was cured. I^ Morphinse sulphatis, gr. j. Syr. ipecacuanhse, fjss. Syr. tolutani, f^iiiss. Misce. Sig.: A teaspoonful every three hours to a child of five years. Indication : In the stage of hepatization. ■ I^ Potassii iodidi, 3iss. Aquse destillatse, f^ij. Misce. Sig.: A tablespoonful every two hours. Indication: DouUe pneumonia complicated with pleurisy. I^ Ammonii carbonatis, gr. xl. Infusi serpentarise, fjiv. Misce. Sig.: A tablespoonful every three hours. Indication: Useful in the crisis. I^ Tinct. strophanthi, fSiv. Sig.: Five drops in water every six hours. Indication: In circulatory depression. B Liq. potassii citratis, fjv. Sig.: Two teaspoonfuls in water every two hours. Indication: Used if urine is scant and spe- cific gravity high. In pneumonia, Dr. T. J. Mays says : "Don^t lose sight of the great value of tincture of capsicum in relieving great nervous depression, delirium, dry black-coated tongue, picking at the bedclothes, etc. Give it in from ^/a to 1 teaspoonful doses, in water, every two or three hours, or oftener, in alcoholic pneu- monia.'^ Hand-Book of Modern Treatment. 355 poisoNma. The Carnegie Institute has granted an appropriation in aid of the investigation of snake-poisons now going on in the pathological laboratories of the University of Pennsylvania. The investigation is conducted along lines suggested by Dr. S. Weir Mitchell, who has made a thorough study of the subject. Many experiments are being made with rattlesnakes, cobras, cop- perheads, and other venomous snakes, and the effect of their poison on animals is closely noted, the object being to find an autidote in each case. The experimenters find that alcohol is useful as a stimulant, but is not an antidote in any sense, as many people believe it to be. The best remedial agent is what they call the "intermittent ligature,^^ provided it can be used in time. This consists of a band around the wounded limb, which is loosened for an instant at stated intervals, so that the poison can enter the system only in small quantities. Under this treatment the victim of the bite is enabled gradually to resist the effects. In the treatment of ivy poisoning: — I^ Sodii hyposulphite, 5j* Mentholis, gr. v. Alcoholis, 5j. Spiritus setheris nitrosi, ^j. Aquse destiUatfie, q. s. ad Oj. Misce. Sig. : Apply locally with a soft sponge or on sterilized gauze. It is said that there is nothing better for ivy poisoning than the old prescription of calomel, 16 grains, and lime-water, 4 ounces, to be mixed and applied three times a day. Borate of sodium mixed with milk is said to be the best general antidote after the stomach has been emptied. For vegetable poisons permanganate of potassium in 1-per-cent. solution. For carbolic acid, vinegar. This is said to act well also externally. . 356 Hand-Book of Modern Treatment. Dr. T. J. Daniel recommends: — I^ Quininse sulphatis, 3ij. Aquse, fjvj. Misce. Sig.: Apply locally as a specific for rhiis- ' poisoning. The way in which he came to use it was this. While in company with Dr. Strange, they were talking about rhus- poisoning. Dr. Strange told Dr. Daniel that quinine was his remedy, and said that he had tried it in a large number of cases and that it never failed to cure, and cured quickly. He said one time a man who had been poisoned with it came to his (Strange's) brother, who is also a physician, for treatment. His brother did not have what he wanted to give him, and to make the patient believe he was doing something for him he prepared a solution of quinine and gave it to him and told him to apply it thoroughly, and if he was not much better by the • next morning to come back, and he would have the other remedy. He never came back; but in a few days he sent back for some medicine just like that given him, that another person was poisoned, and it cured him so quickly he wanted the same kind for him. The doctor sent it and it cured the patient at once. Since that time he has treated many cases, used nothing else, and every case was cured quickly. The doctor said he has never thought of using anything else since, and that it had never failed to cure. Dr. Daniels has had as good success and recommends it as a specific for rhus-poisoning. I^ Sol. hydrarg. perchloridi, mxx. Potassii iodidi; gr. v. Chloral is hydra tis, gr. v. Acidi carbol., gr. j. Spiritus ammon. aromat., m xx. Aquse ehloroformi, q. s. ad ^ss. Misce. Sig.: One dose every three or four hours till eflfects are gone. Indication: Useful in meat and fish poison- ing. Hand-Book of Modem Treatmefit 357 L. Rogers describes a practical method of treating any kind of snake poison, which promises to be of great value in all cases seen early. It is so simple that any intelligent person can carry it out. The use of permanganate of potassium, as shown by Blyth, is the best-known substance as a practical antidote for snakebite. The fact that the results have not always been satis- factory is probably due to improper administration. Brunton and Fayrer have recently suggested a more radical method of using permanganate. They advise ligation above the inocula- tion, then incision of the wound, followed by rubbing in of the pure crystals of the salt. It is positively established that the salt will destroy in vitro nearly its own weight in every class of snake-venom. It is possible that the free pouring out of lymph in the neighborhood of the woimd will sufficiently retard the absorption of the venom so that a half hour or more may elapse between the infliction of the bite and the rubbing in of the per- manganate. At the suggestion of Sir Lauder Brunton a lance has been made, surrounded by a sheath, in the base of which permanganate crystals are kept, the whole outfit being easily carried in the vest pocket. I^ Sodii Bulphitis, 3j. Glycerin!, Sss^ Aqu» camphors, Siv. Misce. Sig. : Apply locally to affected part on gauze. Indication: Useful in ivy poisoning. T^ Ammonia, 3ij. Aquffi, 3iv. Misce. Sig.: Apply to parts affected two or three times a day. Indication : Useful in rhus poisoning. If case presents soon after tumefaction of the skin, the following is of value: — I^ Glyco-phenique, Aquae, Misce. Sig. : Apply often on lint. 358 Hand-Book of Modem Treatment, If the case is two or three days old, one may use with advantage : — I^ Glyco-phenique, Olei olivse, Misce. Sig. : Apply often on lint. Dr. W. C. Whiting writes as follows : —