Complete Text (Part 35)

June 20, 1900), the patient, besides other treatment, was given 0.5 gramme (V/^ grains) of urotropin in tablet form three times daily. He took altogether nearly 60 grammes (2 ounces) of urotropin; and though the amount of nourishment which could be administered was but very small, he never ob- jected to the tablets. By-eifects which could be attributed to the drug were never seen; but, of course, it would have been difficult to demonstrate them in view of the severe general dis- ease and the apathy of the patient. Even in so short a time as eight days after beginning the treatment no more pus was voided bv the urethra, and catheterization could be effected more easilv. The post-mortem notes included the observation : — "Diagnosis as to the urinary organs: Urocystitis without serious lesions; punctiform hremorrhages in the pelvis of the kidney, but no other signs of pyelonephritis. 466 Hand-Book of Modern Treatment, "These post-mortem findings speak for themselves, and re- quire no further elucidation. They show more plainly than any clinical symptoms that the dangers which threatened the urin- ary passages from various sides were entirely warded off, prac- tically until the very end. It is the universal experience that patients suffering from paralysis and anaesthesia of the lower half of the body mostly succumb to the severe cystitis and rapidly-consecutive pyelitis. The kidneys are usually severely affected. That this was not the case here, that the post-mortem revealed that the urinary apparatus was not to any great degree involved, must necessarily be attributed to the action of the urotropin." The proper kind of milk must be prescribed for young in- fants, and older children should be forbidden to eat meat. To relieve the itching the following is recommended: — IJ Liq. carbonatis detergens, gr. Ixxv. Zinci oxidi, 3v. Amyli, 3v. Glycerini, 5j. Aquse destillatse, Siiiss. Misce. Sig. : Apply to the itching surface with a brush three times a day. A warm bath should be given twice weekly. The following as an internal antiseptic: — IJ Menthol is, gr. xv. Olei amygdalae dulcis, gr. iv. Misce et fiant capsulse no xxx (gelatin). Sig.: One capsule three times a day. Brewer's yeast, a teaspoonful in milk once or twice daily, may be substituted. In prurigo of infants the skin should be kept clean and the diet and digestion regulated. Internally intestinal antiseptics, iodine, and codliver-oil or dilute sulphuric acid. Sponge the parts affected with a 2-per-cent. solution of hux- sal (antiseptic salt) or apply as compresses to allay itching. Allow the body to dry and then apply some friction. Hand-Book of Modem Treatment. 457 B Pulv. calamin, 3ij. Liq. calcis, 5viij. Phenolis, Sss. Misce. Sig. : Use as a lotion, and if not sufficient to allay irritation and the burning is extreme, the following ointment is advised: — B Mentholis, gr. x. Adipis lanae hydrosi, 5j» Misce. Sig.: Apply locally. B Mentholis, 3j. Spiritus vini rect., Bj* Betul-ol ( oleo-methyl-salicy. comp.), 3iv. Misce et fiat applic. Sig.: For external use only. Indication: Used in urticaria of arms and chest. Phosphate of soda in supersaturated solution and in drachm doses. Locally : — B Pulv. calamin., Siss. Zinci oxidi, 3iss. Acidi carbolici, Sss. Aquse calcis, 3ij. Aquse rosse, 5iv. Misce. Sig.: Apply frequently and freely. 3 Hydrarg. chloridi corrosivi, gr. ij. Chloroformi, m xx. Glycerini, Jij. Aquae rosse, 5vj. Misce. Sig.: Poison. Apply locally twice daily. Ichthyol in from 1- to 2-grain doses to children, and 5- to 6-grain doses to adults, relieves and cures. At the same time an ointment should be applied to the affected parts, or even all over the body. The strength of the ointment should be about 2 drachms of ichthyol to an ounce of petrolatum in children, and ^/g ounce of ichthyol to 1 ounce of petrolatum for adults. 458 Hand-Book of Modern Treatment, B Phenazoni, 3j. Fiant chartulse no. xij. Sig. : One powder before meals. Indication: Used in lithsemic subjects and also in intestinal fermentation. I^ Sodii biboratis, 5ss. Aquae destillatse, fjviij. Misce. Sig.: Use locally. Indication: Used also in chloasma or liver spots. I^ Acidi benzoic!, gr. viij. Aquae, fjiv. Misce. Sig.: Apply locally as a wash. I^ Salopheni, 3j. Fiant chartulse no. xij. Sig.: One powder before meals. Indication: Used in lithsemic subjects and also in intestinal fermentation. I^ Sodii bicarbonatis, 5ij- Sig. : A tablespoonful in a cup of water and apply freely with a sponge. Indication: Used to allay pruritus. 3 Liq. potassii arsenitis, fSj. Sig. : One to two drops in water after meals. Indication: Used in cases in which the at- tacks continue to recur. To be employed for a long period. vAGnnsMus. I^ Stront. bromidi, 3i%. Potassii bromidi, 3i%. Ammon. bromidi, 3i%. Aquae destillatae, q. s. ad 5viij. Misce. Sig.: Tablespoonful twice a day. Hand-Book of Modem Treatment 459 I^ Zinci valerianat.; gr. ^/^. Quininse valerianat., gr. iss. Extract! opii, gr. Ve- Extracti belladonnse, gr. V«. Misce et fiat pilula no. j. Sig. : Three to six pills daily. I^ Ext. kramerise, gr. iss. Morphinse hydrochloratis, gr. ^/g. Olei theobromat., 3j. Misce et fiat suppositorium no j. Sig.: Insert in vagina at night. Q Cocainse hydrochloratis, gi. ij. Ext. belladonnse, gr. iss. Strontii bromidi, gr. iv. Olei theobromat., 3i%. Misce et fiat suppositorium no. j. Sig. : Insert in vagina at night. I^ Morphinse hydrochloratis, gr. j. Olei theobromat., Siiiss. Misce et fiant suppositoria no. iij. Sig.: Insert one in vagina when required. Indication: Used in vaginismus. VAGINITIS. ]^ Acetanilidi, gr. xv. Acidi tannici, gr. viiss. Ext. hydrastis Canadensis, gr. iv. Sacch. lactis, Siiss. Olei theobromat., q. s. Misce et fiat suppositorium no. j. Sig.: One to be inserted every other day. Q "Resorcini, gr. Ixxx. Acidi salicylici, gr. viij. Betanaphtholis, gr. j. AquflB, q. s. ad Sviij. Misce. Sig.: Add one tablespoonful to a quart oi warm water and use as a douche. 460 Hand-Book of Modern Treatment. ]^ SaloliS; gr. xlv-3ij. Glycerini, 5viij. Misce. Sig. : To be applied locally on a tampon every second day. ^ Pulv. aluminis, 5j. Zinci sulphitis, 5j« Sodii biboratis, 5j. Acidi carbolici, 5j. Aquse, gvj. Misce. Sig. : A teaspoonful to a quart of lukewarm water, as a vaginal douche, twice daily. In most cases of vaginismus, if the surgeon looks carefully, he will find some lesion of the mucous membrane which seems to bear a causative relation to the existence of the trouble It is either red and erythematous or there are little fissures or tears, or protruding spots made by inflamed papillae. Forced dilata- tion of the vagina, with local treatment for the lesions, will give the best results. For gonorrhoea! vaginitis, John Cooke Hirst advises the occasional use of silver nitrate, 10 or 20 grains to the fluidounce, filling a cylindrical speculum with the solution and gradually withdrawing the instrument; also douches of mercuric chloride 1 to 4000. I^ Glyceriti acidi tannici, 5j. Sig.: Apply locally or diluted as an injec- tion. Indication: In chronic vaginitis of children. I^ Argenti nitratis, gr. xl. Aquae destillatse, fSj. Misce. Sig.: Apply on a cotton pledget within the cervical canal and over the vaginal mucous membrane. I^ Potass!! permanganatis, Jv. Sig.: Half a teaspoonful in two quarts of water; as vaginal douche night and morning. Indication: Used in gonorrhoea 1 vaginitis. Hand-Book of Modem Treatment, 461 I^ Hydrastinae, gr. vj. Boroglycerini, 3iij. Misce et fiant suppositoria no. vj. Sig. : Insert a suppository after hot douche twice or thrice daily. I^ Phenolis, gr. xv. Bismuthi subnitratis, Siss. Glycerini, Svi^A. Aquse, q. s. ad Oij. Misce. Sig.: Inject a small quantity after irrigat- ing the vagina with boric acid solution. VAGINAL DOUCHES. Powdered borax, 1 drachm to the quart of water, is a mild cleansing douche; zinc sulphate, 2 drachms to the quart, is as- tringent and disinfectant; alum, 1 drachm to the quart, is an efficient astringent; mercuric chloride, 1 to 3000 to 1 to 5000, is commonly employed. Tannic acid, potassium permanganate, and fluid extract of hydrastis all stain the clothing and are sel- dom prescribed. VALVULAR DISEASE.— See Heart Disease. VARICELLA. ]^ Spiritus setheris nitrosi, 3iv. Potassii citratis, 3ij. Syrupi limonis, f3v. Aquse, q. s. ad ^iij- Misce. Sig. : Teaspoon! ul in water every two hours. I^ Sodii bicarbonatis, Jv. Sig.: Tablespoonful in a pint of water as a local application. Indication: Used as a wash to relieve itch- ing. 462 Hand-Book of Modem Treatment, VARICOSE VEINS. Q Liq. plumbi subacetatis, fSiv. Aquae, q. s. ad f^viij. Misce. Sig. : Apply on cotton saturated with lotion. I^ Fluidextracti hamamelidis, fSiij* Sig.: A teaspoonful three or four times daily with compresses applied externally. • I^ Barii chloridi, gr. xxx. Aquse destillatae, q. s. ut ft. sol. Adipis lanse hydrosi, gr. ccxxv. Olei amygdalse dulcis, mlxxv. Misce et fiat unguentum. Sig.: Use three times daily, with friction where blue veins shine through the skin. VARIOLA.— See Small-pox. VERTIGO, 3 Tinct. physostigmatis, 3ij. Tinct. nucis vomicae, 3ij. Tinct. belladonnae foliorum, 3ij. Misce. Sig.: Thirty drops in water morning and evening. Indication: Used to relieve headache that occurs at the change of life. IJ Pulv. serpentariae, gr. iiss. Pulv. camphorae, gr. ^Z^. Asafoetidae, gr. ^/^. Extracti opii, gr. Vw Misce et fiat capsula no. j. Sig.: From three to six pills, to be taken at intervals during the twenty-four hours. Indication: Used in vertigo following gas- tritis. Hand-Book of Modem Treatment, 463 3 Potassii bromidi, 3iv. Syrupi aurantii corticis, 3iv. Aquae, q. s. ad 3iij< Misce. Sig.: Teaspoonful three times a day. Indication: Used in aural vertigo, and also in vertigo from insomnia and overwork. 3 Spiritus glycerylis nitratis, 3j. Sig.: One drop in water three times a day, to be gradually increased until temporal head- ache. Indication: Used in aural vertigo. 3 Sodii bromidi, 3ij. Antipyrini, 3j. Misce et fiant tabellse compress® no. xij. Sig.: One tablet three times a day. Indication: Used in aural vertigo. Quinine will be more effectual when it is combined with strychnine, blue mass, and capsicum than when given alone. The usual formula employed is : — I^ Quininse sulphatis, 3iiss. Pil. hydrarg., gr. iv. Pulv. capsici, gr. ij. Strychnin® sulphatis, gr. j. Misce et fiant capsulse no. xxxvj. Sig.: One capsule four or five times a day. Indication: Used in malarial vertigo. After the attacks have subsided smaller doses of quinine are to be administered in connection with strychnine and iron, in- terspersed occasionally with a dose of blue mass or calomel, the aim now being to enhance the digestive powers and to maintain the strength of the body. Any fresh manifestation of vertigo is to be counteracted with the larger doses of quinine and its com- bination given in the above formula. 464 Hand-Book of Modern Treatment. 3 Tinct. gelsemii, f^j. Sig. : Ten minims three times daily. Indication: Used in aural vertigo. B Pulv. jalapse, gr. xij. Hydrarg. chloridi mitis, gr. iij. Potassii sulpha tis, gr. vij. Misce et fiat chartula no. j. Sig. : To be taken at bedtime. Indication: Used in bilious vertigo. The special treatment should be directed to the different causes of vertigo, when they can be traced to affections of which vertigo is but one of the symptoms, such as syphilis, malarial fever, gout, gastric affections, etc. As regards general treatment, potassium iodide, 10 to 20 grains a day for months, with periods of rest, during which quinine is administered. However, the quinine should be given only when other methods fail, as it affects the hearing and leads, if prolonged, to absolute deafness. About six or eight 2-grain pills should be given daily for one week and then suspended for one week, after which the drug should be resumed for eight days, when a notable improvement takes place. Treatment should be continued in this manner until a cure is effected. Vertigo due to arteriosclerosis should be treated with small doses of potassium iodide as follows : — I^ Potassii iodidi, 3j. Aquae, 5x. Misce. Sig.: Two tablespoonfuls daily for three weeks in the month. At the same time 3 drops of a solution of nitroglycerine — 1 to 100 — might be given morning and evening, and a milk diet be prescribed for eight days every month, while laxatives should be given frequently. If tachycardia be present, one or two of the following pills should be ordered daily: — I^ Ext. convallarise, gr. ij. Sparteinse sulph., gr. j. Misce et fiat pilula no. j. Sig.: One such daily. Hand-Book of Modem Treatment, 465 The insomnia is best treated with trional and oedema of the limbs by theobromine, 10 grains four times a day. If in spite of this treatment the oedema persists and increases, digitalis should be given and a milk diet instituted. A purgative of jalap and scammony should be prescribed once a week. VOMITING. B MentholiSj^gr. v. Tinct. opii, Siiss. Liq. pepsinse^ 5j. Misce. Sig. : Ten to twenty drops before each meal. Indication: Used in vomiting of uterine origin. I^ Mentholis, gr. j. Sodii bicarb., 3iss. Misce et iiant capsulse no. x. Sig.: One capsule three times a day. Indication: Nervous vomiting without any anatomical reason. Pernicious vomiting may be relieved by the hypodermic ad- ministration, in epigastric region, of ^/^ grain of cocaine hydro- chlorate. This was successful in five cases after administration bv mouth had failed. Chloral dissolved in peppermint-water will promptly check vomiting in children. The dose varies from Vo to 2 grains, according to age. The following mixture is valuable in the vomiting of preg- nancy, and also in various cases of gastritis : — I^ ^lentholis. gr. iss. Tinct. opii, in xv. Tinct. belladonnip. m xv. Tinct. hyoscyami, m xv. Alcoholis, SVa. Misce. Sig. : Five drops in a little water every houf. 30 466 Hand-Book of Modern Treatment, REFLEX VOMITING. This type of emesis is often apparently causeless, with prominent symptoms referable to other organs. The tongue is usually clear. By way of general remedies may be mentioned bromides and chloral, cerium oxalate, quinine, acids, and min- ute doses of ipecac. For persistent cases William F. Mitchell recommends the application to the epigastrium of ice-cold com- presses changed every minute. For such obstinate cases Thorn- ton employs a mustard poultice over the abdomen, and gives a rectal injection of 20 grains of chloral hydrate and 1 drachm of potassium bromide in starch-water. In hepatic attacks it is well to wash out the stomach freely with warm water. 3 Phenolis, gr. v. Syrupi acacise, fjiss. Aquse cinnamomi, fjiss. Misce. Sig. : One teaspoonful before meals. Indication: Irritable vomiting. The following formula will be found useful for the relief of vomiting, even in the vomiting of pregnancy. I^ Cocainse hydrochloratis, gr. iij. Hydrarg. chlor. mitis, gr. j. Cerium oxalate, gr. xxx. Pepsini, aseptic ( P. D. ) , gr. v. Bismuth! subnitratis, gr. xxx. Misce et fiant chartulse no. x. Sig.: One pro re nata. I^ Vini ipecacuanhse, fSj. Sig.: One drop every hour to thrice daily. Indication: Suitable in all cases. IJ Sodii bicarbonatis, gr. xv. Acidi hydrocyanici diluti, m iss. Aquse camphorse, f3x. Misce. Sig.: To be taken three times daily after meals. Indication: When due to acidity. Hand-Book of Modern Treatment, 467 3 Phenolis, gr. iv. Bismuthi subnitratis, 3ij. Mucilaginis acacise, f^j. Aquse menthse pip., f^iij* Misce. Sig. : A tablespoonful every two, three, or four hours. Indication: Used when due to acute gastric and intestinal disorders. I^ Bismuthi subnitratis, 3ij. Acidi hydrocyanici diluti, fSss. Mucilaginis acacise, fjij. Aquse menthse pip., f^ij* Misce. Sig.: A tablespoonful thrice daily. Indication: Used with gastric ulcer. Q Tinct. aconiti, gtt. xxx. Bismuthi subnitratis, 3iij. Misce et fiant chartulse no. x. Sig.: One powder every half-hour. Indication: Used in vomiting due to ex- citability of gastric mucous membrane. B Tinct. nucis vomicse, m ij. Aquse laurocerasi, f5j. Misce. Sig.: Ten drops night and morning. Indication: Used in pregnancy. B Liq. potassii arsenitis, f5ij. Sig.: One drop in water three times daily. Indication: Used in vomiting of pregnancy, ulcers of stomach, or morning vomiting of drunkards. B Menthol is, gr. ij. Cocainse hydrochloridi, gr. iij, Syrupi simplicis, 5j- Spiritus vini rect., Jij- Misce. Sig.: Teaspoonful every hour. Indication: In sea-sick vomiting. 468 Eand-Book of Modern Treatment. I^ Orexini, gr. xxx. Fiant chartulse no. xv. Sig. : One powder three times daily. Indication: Used in vomiting of pregnancy. Q Bismuthi salicylatis, 3j. Cerii oxalatis, 3j. MentholiS; gr. x. Cocainse muriatis, gr. iij. Spiritus vini rect., 3j. Elixiris aurantii, q. s. ad 5vj. Misce. Sig. : Teaspoonf ul every three to four hours. Indication: Used in the vomiting of preg- nancy. Monin has been struck by the resemblance which the symp- toms presented by certain pregnant women bear to those of hy- persecretion. Gastric pain, heart-bum, acidity, nausea, and vom- iting, occurring especially in the morning and relieved by taking food, are all symptoms commonly observed both in hypersecretion and during pregnancy. Monin believes that in both conditions the stomach, instead of excreting only at the digestive periods, does so more or less continuously, although Kaltenbach and Jaffe state in the pregnant cases no excess of hydrochloric acid is present in the gastric juice as in hypersecretion. Satisfactory results have been obtained in the case of pregnant women by administering daily five doses of sodium bicarbonate, each con- sisting of 2 grammes given in a capsule. B Chloralis, gr. xx. Potassii bromidi, 3j. Mucilaginis amyli, fjiv. Misce. Sig.: Warm gently and use as a rectal in- jection after first using enema to unload the bowel. Indication: Used in obstinate reflex vomit- ing. Mustard poultices over abdomen. IJ Liq. calcis, f^iv. Sig.: A tablespoonful every two hours. Indication: Used in vomiting with acidity. Hand-Book of Modem Treatment. 469 I^ Phenol is or creosoti (beech wood), gtt. x or XX. Bismuthi subnitratis, 5iij. Misce et fiant chartulse no. iij. Sig. : One powder every hour. Indication: Used in vomiting due to active fermentation. For the vomiting of pregnancy and bilious vomiting the following are given: — IJ Acidi carbolici, gr. i-iv. Chloroformi,