A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck.
- Adolph Strümpell
- Date:
- 1901
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck. 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.
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![often see unpleasant effects from antipyrine (such as vomiting, profuse sweat- ing with defervescence, a chill when the temperature rises again, and some- times a measles-like eruption). The patient often feels better than before while under the influence of antipyrine, since the drug, as we have said, also acts favor- ably on the nervous symptoms (headache, restlessness). The dose of fifteen to thirty grains (grammes 1-2) can in severe cases be repeated several times a day, but, as a rule, we should not exceed eighty or ninety grains (grammes 5-6) in the twenty-four hours. One or two doses a day are usually all-sufficient. Lactophe- nine is also much recommended and even held as a specific in typhoid. In doses of seven to fifteen grains (gramme 0.5-1) it reduces the temperature considerably and usually causes a marked improvement in the general condition. A total of eighty or ninety grains (grammes 5-6) can be used in a day. Of the many other antipyretics which, of course, have often been tried in typhoid, we may first men- tion antifebrine (acetanilide), which in doses of four to seven grains (gramme 0.25-0.5) has a similar action to antipyrine (Cahn and Hepp), 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 aniline 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 phenacetine (fifteen grains, gramme 1, at a dose), salipyrine, etc., which have no special advantages. Qui- nine in doses of fifteen to thirty grains (grammes 1-2) and salicylate of soda in doses of seventy-five grains (grammes 5) are now little used as antipyretics, and properly, since their unpleasant action (vomiting, tinnitus, sweating, etc.) is much greater than that of the other drugs mentioned above. [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 itseK 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 occa- sional dose may be given. When used early in the course of the disease, anti- pyretics may seriously embarrass the diagnosis in doubtful cases. The method of Brand has been slowly working 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 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 suspended from a hoop. Internally, the patient is given every two hours fifteen or twenty drops of laudanum or 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, gr. ss., grm. 0.03; plumbi acetatis, gr. j, grm. 0.05; 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. In severe cases we may tiy injec- tions of ergotine or fluid extract of hydrastis, twenty drops three or four times. Liquor ferri chloridi (five to ten drops in water eveiy 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. The surgical treatment of peritonitis has rather more of a future and more success, but experi- ence of this is still scanty.](https://iiif.wellcomecollection.org/image/b21206296_0055.jp2/full/800%2C/0/default.jpg)
