A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.
- Date:
- 1887
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![been used. Its effect is almost always a lowering of the temperature by several degrees centigrade, generally accompanied by sweating. Vomiting is sometimes observed after antipvrine, but unpleasant cerebral effects are rarely seen. It should, nevertheless, be considered that the effect of all internal antipyretics is limited to an influence upon the temperature, while the baths not only affect the fever, but have numerous other advantages (vide supra). If we had to choose whether to treat typhoid fever exclusively with baths or with quinine, and the like, we should certainly choose the baths. We do not by any means desire to banish the use of internal antipyretics from the treatment of typhoid, but only to make their employment more limited than has often been the case. We consider that they are actually indicated only where the fever is high and the employment of baths is for some reason impossible or contra-indicated, or where the fever remains con- tinuously high, despite bathing. In such cases it is often advantageous to com- bine the bath-treatment and the internal antipyretics, especially in the evening. If patients with a moderately high fever are made to take large doses of quinine and the like, without any satisfactory reason for it, we regard such treatment as at any rate useless and often really injudicious. This is, unfortunately, a com- mon practice, and frequently its only permanent result is a disordered stomach. [In spite of the German reports, the cold-bath treatment of typhoid and other fevers has never had any great following in this country, a conservatism which seems to have been wise in view of all the facts. A recent paper by Senator may here be cited. This observer, namely, compares the mortality statistics of the Ber- lin hospitals for ten years (1875-’84), and shows that the lowest typhoid rate—12 3 per cent.—was obtained in the Augusta hospital, which draws its material from the same class of the community as the others. In this hospital no methodical antipyretic treatment is carried out, while it was so done in the others. Senator thinks the special use of the cold bath is in cases with early stupor and profound nervous symptoms ; as an antipyretic he prefers quinine and antipyrine. The treatment he advocates coincides with that which is most in vogue in this country —a symptomatic and expectant treatment. Cool spongings with alcohol and water can be repeated several times during the day, and, in the hands of a skillful nurse, add greatly to the comfort of the patient, at the same time that they strengthen the nervous system and decidedly moderate the fever. Their use is highly to be recommended. Of the most modern internal antipyretics, the safest seems to be antipyrine. When well borne, as it is in the majority of cases, it promotes comfort and quiets the restlessness due to high fever. According to Beyer, it acts by increasing heat radiation, and neither weakens the heart, as do kairin, thallin, hydrochinon, and resorcin, nor does it damage the blood and the muscular tissues generally as do the two former of these remedies. Alcoholic stimulation is often required at some period in the course of the dis- ease, and the chief indication for its use is deficient heart-power, as shown by the pulse and the first sound at the apex. Large quantities of brandy, and the like, are seldom required, and the least toxic effect shows that the limit of toleration has been exceeded. Water or an acid drink should be given frequently by the nurse without wait- ing for the patient to ask for it, unless the mind is unusually clear.] Another important symptom which needs special treatment is intestinal haemorrhage. It has been already mentioned that if this occurs, the baths should cease at once. Further than this, the chief remedies are ice and opium. Flat ice-bags are laid upon the abdomen. They should not be too heavy, and should, if possible, be fastened to a hoop. Internally, the patient is given every two hours a powder of one half grain or one grain (gramme 0'03 to 0‘05) of opium, either](https://iiif.wellcomecollection.org/image/b21981565_0055.jp2/full/800%2C/0/default.jpg)
