Diseases of the larynx / by Dr. J. Gottstein ... trans. and added to by P. M'Bride.

  • Gottstein, Jacob, 1832-1895.
Date:
[1883]
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the larynx / by Dr. J. Gottstein ... trans. and added to by P. M'Bride. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    but the former is the more important, and may, by itself, lead to cure. We cannot here discuss the merits of the various forms of antisyphi- litic treatment, but will only remark that treatment by iodides acts much more rapidly than mercury, especially in advanced forms (infil- trations and gummata), and that we should therefore always begin with iodide in the treatment of a condition which every day may produce additional morbid changes. We use the following prescription :— * P°taf- J^f * \ or approximately gr. 10 ad. ji Aq. destillat 200. j A tablespoonful three times a day. Or, Potass. Iodidi. Extract, et. pulv. rad. gentian ^ q. s. ut. f. pil. 100. From three to six pills three times a day. We prefer solutions to pills, and in ulceration of the upper part of the larynx the latter cannot well be swallowed. Either at the same time, or after threatening symptoms have dis- appeared, a mercurial treatment may be begun, and we should recom- mend inunction from -i-6 grammes being used daily [15*43 grains = 1 gramme]. Lewin prefers rapid mercurialisation by means of subcutaneous injections of corrosive sublimate. Each dose is from -02-O25 of a gramme, and, according to the severity of the case and the con- dition of the patient, this is repeated at intervals of from four to eight hours until the danger to life has passed. Afterwards he uses injec- tions containing the usual dose (-01--012) until all syphilitic manifes- tations have subsided. When these large doses are used we must be prepared for symptoms of poisoning : the latter may be gastric, pro- ducing loss of appetite, nausea, pain in the stomach and intestines, diarrhoea, and bloody stools ; or they may be cerebral, evidenced by headache and exhaustion, sleeplessness, giddiness, and fainting; indeed even coma and collapse may be produced. In spite of these untoward accidents, Lewin has never had a fatal case ; the injections must be stopped when poisoning sets in. Tonics and stimulants are useful in relieving the nervous symptoms, while opium is indicated for the diarrhoea. After symptoms, such as weakness, tremor, etc., were never observed. Among 26,000 syphilitic patients in the Royal Charite of Berlin, no death occurred from laryngeal stenosis. Local treatment, as already stated, is of secondary importance, but may, when associated with general remedies, hasten a cure. In syphi- litic catarrh the application of a solution of nitrate of silver, by means of a brush, or better still, a solution cf iodine in iodide of potassium and glycerine may be employed (iodine *2, iodide of potassium 2, glycerine * The dose of iodide here recommended may, with advantage, be increased (Translator)