Volume 1
A text-book of medicine for students and practitioners / by Adolf v. Strümpell.
- Adolph Strümpell
- Date:
- 1911
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf v. Strümpell. Source: Wellcome Collection.
60/874 page 32
![at night. With severe headache, nervous restlessness, etc., this remedy is especially indicated; but we regard it as at least useless and often improper to give a patient with moderate fever large doses of an antipyretic without any sufficient reason, as unfortunately is often the case in practice; the only perma¬ nent result is to make the patient feel worse and upset his stomach. [In America, the use of antipyretics in typhoid and other acute infectious fevers is exceptional. They may occasion collapse, particularly if given just as a lysis or crisis is about to begin.] In regard to the different antipyretics so frequently brought forward and recommended of late, we are of the opinion that antipyrin is most to he rec¬ ommended. It was introduced by L. Knorr and first recommended by Filehne. In doses of 15 to 30 gr. (gm. 1 to 2), best given in wafers, it usually reduces the temperature considerably, although we may find that the height and the obstinacy of the fever are not identical terms. We do not often see unpleas¬ ant effects from antipyrin (such as vomiting, profuse sweating with deferves¬ cence, a chill when the temperature rises again, and sometimes a measles¬ like eruption). The patient often feels better than before while under the influence of antipyrin, since the drug, as we have said, also acts favorably on the nervous symptoms (headache, restlessness). The dose of 15 to 30 gr. (gm. 1 to 2) can in severe cases be repeated several times a day, but, as a rule, we should not exceed 80 or 90 gr. (gm. 5 to 6) in the twenty-four hours. One or two doses a day are usually all-sufficient. Lactophenin is also much recommended and even held as a specific in typhoid. In doses of 7 to 15 gr. (gm. 0.5 to 1) it reduces the temperature considerably and usually causes a marked improvement in the general condition. A total of 80 or 90 gr. (gm. 5 to 6) can be used in a day. Of the many other antipyretics which, of course, have often been tried in typhoid, we may first mention antifebrin (acetanilid), which in doses of 4 to 7 gr. (gm. 0.25 to 0.5) has a similar action to antipyrin (Cahn and Ilepp), and it should be used in practice among the poor because it is much cheaper. If we avoid too large doses we seldom see unpleasant results. The appearance of a pale cyanotic hue of the skin is the only disturbing feature; this, as in anilin poisoning, is probably due to a change in the coloring matter of the blood, and therefore warns us to be cautious. Other new antipyretics are phenacetin (15 gr., gm. 1, at a dose), pyramidon (4 to 7.5 gr., gm. 0.25 to 0.5), salipyrin, etc., which have, however, no special advantages. Of the older antipyretics, quinin (in doses of 15 to 22.5 gr., gm. 1.0 to 1.5) is to be specially mentioned; indeed, it has recently been claimed that quinin has a favorable effect on the course of the disease. Another important symptom which needs special treatment is intestinal hemorrhage. 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, cold-water coils, are laid upon the abdomen. The ice bags should not be too heavy, and should, if possible, be suspended from a hoop. Inter¬ nally, the patient is given every two hours 15 or 20 drops of laudanum or a powder of 0.5 gr. or 1 gr. (gm. 0.03 to 0.05) of opium, either pure or combined with acetate of lead (opii, gr. ss., gm. 0.03; plumb! acetatis, gr. j, gm. 0.05; sacchari albi, gr. j, gm. 0.05). The object of the opium is to check peristalsis, and thus promote the formation of a clot in the bleeding vessel. [Morphin](https://iiif.wellcomecollection.org/image/b3136276x_0001_0060.jp2/full/800%2C/0/default.jpg)
