A text-book of the practice of medicine.

Anders, James M. (James Meschter), 1854-1936

Date:: 1913

Credit: A text-book of the practice of medicine. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

112/1390 page 104

$Flexner and Joblinix' present a report on 393 patients treated with Flexner's curative i^erlnn. Of these. -\)b, or 75 per cent., recovered and 98, or 25 jier cent., died. The serum is injected directly into the sub- arachnoid space after the withdrawal of an equal amount of cerebro-spinal fluid by means of lumbar puncture. The injections should be repeated daily for three or four days. When the Macewen percussion-note, however slight, is obtained, Koplik proceeds to puncture. Cantas ^ advocates the injectinii: of the serum into the lateral ventricle. Wasserman^ reports 1<>2 cases treated with antimeninirococcus seruu) ; it had a curative effect when injected early (dose, 5 to 10 c.c. ie])eated two or three times a day). McKenzie and Martin have introduced an autogenous serum ; they with- draw blood-serum of a patient suffering from meningitis and inject it into the spinal canal of the same or another meningitis patient. Such a serum is an actively bactericidal fluid. For the tonic contraction of the muscles and violent cerebral symp- toms, cannabis indica should be tried. Convulsions call for hot baths (105° F.) or ether inhalations. Mercury has been, and still is, advocated (mercuric chlorid, gr. -^^—0.002, every four hours to an adult; calomel, gr. yVt^g—0.005-0.004, every four hours to children). Belladonna and ergot have been employed in the early stages to diminish the congestion of the cerebro-spinal capillaries. Stimulants are required if signs of heart-exhaustion apjiear. They may be freely exhibited in accoi'dance with the customary rules. After effusion of the exudate has taken place, the narcotics are to be replaced by agents that promote absorption, as potassium iodid. The local means are also important. When tub-baths are not avail- able, cold should be used locally, since it is both of value and very grate- ful to the patient. An ice-bag is to be put on the head, and, if possible, long ice-bags placed along the spine. In rare cases of sthenic type we may employ small blisters at the nape of the neck or over the mastoids; they are u.-eful during the stage of effusion. In the usual form of the disease it is better to apply the thermocautery lightly over the mastoid region. A small amount of blood may be withdrawn by means of leeches or by a few wet cups placed behind the ears. Quincke's lumbar puncture and laminectomy with free drainage have been practised, and lumbar puncture should, if necessary, be repeated, but only in case benefit follows first puncture. The principal effect is the relief of the pressure upon the central nervous system. In cases in which lumbar puncture only brought 2 to 20 c.c. of fluid, Cantas* obtained 40 to 120 c.c. from the lateral ventricle. Convalescence is prolonged, and requires to be diligently and judi- ciously treated. We must rely upon the generally accepted tonics—iron, cod-liver oil, arsenic, and strychnin ; the potassium iodid and the mer- cury also being continued for their influence in promoting the absorption of the exudate. Special attention is, however, to be paid to the hygienic management of this period. An abundance of fresh air, sunshine, and easily assimilable food must be furnished at all hazards, and electricity and massage, judiciously employed, will hasten recovery. » Jour. Amer. Med. Assoc, July 25, 190S. - Bulletin de I'Acadernie de Medeaine, Paris, January .30, Ixxvi., No. 5. 3 Deutsche medizinische Wochenschrift, .Sept. 26, 11)07. * Loc. cit.$

A text-book of the practice of medicine.

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