A text-book of medicine : for students and practitioners / by Adolf Strümpell.
- Date:
- 1893
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell. 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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![small doses of tballin (two thirds to one grain, gramme 0'04,0-OG) eveiy hour would have a favorable influence upon the course of the disease, although this has been asserted. The newest antipyretic of all is phenacetine, which was recommended by Kast and Hinsberg. Its dose is about fifteen grains (gramme 1). After all, it should be borne in mind that the only benefit from the internal antipyretics consists in the lowering of the temperature, while baths not only abate the fever, but possess numerous other advantages, as has been already shown. If we had to choose whether to treat typhoid fever exclusively with baths or with antipyrine, 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 impos- sible or contra-indicated, or where the fever remains continuously high, despite bathing. In such cases it is often advantageous to combine 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 common practice, and frequently its only permanent result is a disordered stomach. [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. Phenacetine seems to have proved itself less depressing to the heart than its predecessors. The antipyretic dose usual in this country is five grains. A strong protest should be entered against the routine or frequent use of any of these internal antipyretics. If the temperature seems, in itself, to cause restlessness and discomfort, an oc- casional dose may be given. When used early in the course of the disease, anti- pyi'etics may seriously embarrass the diagnosis in doubtful cases. The method of Brand has been slowly worldng its way in America of late years, and perhaps would have spread more widely and rapidly were it not that we have long been in the habit of frequently sponging our typhoid patients with alcohol and water.] Another important symptom which needs special treatment is intestinal heemorrhage. 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 suspended from 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 pure or combined with acetate of lead (opii, gi-. ss., grm. 003; plumbi ace- tatis, gr. 3, grm. 005; sacchari albi, gr. j, grm. 0-05). The object of the opium is to check peristalsis, and thus promote the formation of a clot in the bleeding vessel. Liquor ferri chloridi (five to ten drops in water every hour) is often employed, but is of extremely doubtful value. The baths can not be resumed till there has been no bleeding for at least three or four days—and then only cautiously. If peritonitis occurs, the treatment is much the same. Above all, opium must be used in still larger doses, but, unfortunately, as a rule, in vain. Per- haps sui'gical treatment is destined eventually to be useful, viz., incision, cleansing, and drainage of the peritoneum. Its results thus far are not very encouraging. If there is considerable diarrhoea, we can give mistura gummosa [P. G., gum arable and sugar, each 15 parts ; water, 170 parts], tannin, subnitrate of bismuth, or small doses of opium. Constipation at the beginning of the disease is over- come by calomel (vide supra). In later stages wo always try enemata first, to](https://iiif.wellcomecollection.org/image/b21981553_0053.jp2/full/800%2C/0/default.jpg)
