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Ergot, in drachm-doses every hour, has been highly recommended by some as a specific to control the hemorrhage. I doubt not that it might be of benefit in some cases; but still, in the light of present experience, I prefer the tincture of Rhus aromatica.
As soon as the function of secretion is re-established, the tongue-cleaning and pulse-softening, with moist skin, Quinia or Cinchonidia should be given in full doses every two or three hours, till the system is brought under its full influence. So far nothing has been said about the bowels. If they need moving, a powder of Rheum et Potassa compound and Leptandrin, ää., in doses of from four to six grains every four hours, may be given, assisted, if necessary, by enemas of tepid salt water. But if they should be too loose, a powder of trillin or geranin, bismuth subnitrate and diaphoretic powder, of each two grains, may be given from two to four hours apart, together with small enemas of starch and laudanum.
Convalesence will have to be managed with care. The diet must be of a bland and unstimulating character, consisting of rice-water, chicken-broth and fresh milk. If the patient craves acids, buttermilk, somewhat sharp, may be allowed in small quantities.
In the asthenic form sedatives will have to be used very sparingly, or not at all. Indeed, I very much question the propriety of their use. What we need is cardiac and nervetonics, and stimulants, used with judgment and discretion, together with counter-irritation and revulsives. To sustain the nervous and vascular systems we prescribe: R. Digitalis, spec. tr., gtts. x. to xx, Nucis vomicæ, spec. tr., gtts. x. to xx. Aquæ iv. Mx. S., teaspoonful every half-hour, or hour, until the circulation is improved. In the meantime, if there is drowsiness, Belladonna, gtts. x. to xx., must be added to the above, or to water, ziv., and alternated with the above in the same doses; or Ergot, in doses of half-drachm to one drachm every hour or two, may be exhibited instead. At the same time the hot mustard sponge-bath should be applied briskly to the whole surface, but especially to the spine as hot as can be borne, after which sinapisms to the extremities and spine may be applied if deemed necessary.
In extreme cases benefit has been derived from hypodermic injections of strychnia, grs. 1-40 to 1-60, and repeated every hour till reaction is established. We have never tried it, but should not hesitate to do so, as we are inclined to think favorably of it. The above measures should be energetically persevered in, until reaction is established, after which, should the circulation become excited, the proper sedative should be given.
As soon as the hemorrhage and icteric condition of the skin. make their appearance, the tinctures of Chionanthus and Rhus aromatica should be given in full doses, as before directed.
Much variety of opinion exists with regard to the use of quinia in this form of the disease; some contending that its use is positively injurious, whilst others regard it as being indispensable, and give it from the start. My opinion is, that it should be exhibited in moderately-free doses as soon secretion is re-established, as manifested by moist skin, a moist and cleaning tongue, and an open, regular, unexcited pulse. Given under these conditions its administration will result in benefit, in sustaining the nervous system and antagonising the morbid material in the blood.
If our conjecture of the cause of the disease is correctchronic malarial blood-poisoning-one would almost instinctively think of quinia; but it, like every other powerful agent, must be used at the right time and place, or it will do harm.
Should an indication for an antiseptic be present, in either form of the disease, it should be promptly met. The antiseptics, sulphate of soda, chlorate of potassa, Baptisia, hydrochloric, and sulphurous acids, and their indications are so well known by Eclectic practitioners that it is needless to point them out.
Other indications besides those mentioned may arise and require the use of agents not named. But the main features and treatment have been indicated, and is the result of observation and study, as well as information obtained from others. Convalescence will have to be managed with extreme care. The diet should be light and easily digested, consisting of fresh milk and corn-meal gruel, made thin, well cooked and
taken with the milk in small quantities at a time. Egg-nog, as a change, when the patient becomes tired of the gruel and milk, may be allowed; later on chicken or mutton-broth, or beef-tea, may be given.
The most scrupulous cleanliness should be enjoined. The alkaline sponge-bath should be used sufficiently often to keep the skin clean and determine to the surface; also the clothing should be changed every second or third day.
Case.-A Mr. B., who lived the larger part of last year in the cypress swamps, came to this place, and for several weeks had “chills." He appeared to be anæmic and somewhat cyannotic, and finally was taken down to his bed. It was a case of malarial hæmaturia. Two "regulars" first had charge of the case and gave large doses of ergot and calomel. They then abandoned the case. Dr. Cook, my associate, was next called, and the "regulars" said: "P. and C. now have a case that ‘weed-juice' wouldn't cure." But we put him through a regular course of pure specific Eclectic "weed-juice" and the patient came through all right. Regulars hors de combat and mum; but would like to know what that weed-juice was.
By S. W. INGRAHAM, M. D., Chicago, Ill.
Typhoid Pneumonia may be defined briefly as a tonic condition arising after the acute stage has passed, from some cause or agent that greatly depresses the vital powers, temporarily or permanently; and unless speedily arrested by appropriate treatment it is very certain to terminate unfavorably. It is not my present purpose to take very decided grounds upon the various theories of the cause of this disease. Many pathologists hold that bacteria are the sole cause of the toxic effect; others that decayed animal matter is the exciting cause in very many cases; while there are still others who adhere to the theory that abscess or gangrene contaminates the blood with poisonous matter, and that this is the true pathology of the disease.
I am unwilling to assail any of these theories, for the reason any one of the causes named might produce the effect necessary to cause the typhoid state. I am inclined to the theory that after congestion, inflammation and lancinating pain has passed, ulceration, abscess and eventually gangrene supervene, which poison and disintegrate the blood, so that the form which we call Typhoid ensues. We must not overlook one important fact, namely, that hepatisation exists in the parenchyma of the lungs, closing from one hundred thousand to one hundred million air-cells and cellular and inter-cellular passages, thus intercepting the carbonic acid in its exit from the lungs, poisoning the blood from want of proper decarbonisation, and rendering the system liable to the typhoid condition. It is also well to bear in mind that the lungs have lymphatics which begin on the surface and in the substance of the lungs and terminate in the bronchial glands, and that they in connection with the numerous capillaries, nerves, bloodvessels and parietes of the intercellular passages are hindered and hampered, so that they cannot perform their work of receiving and carrying oxygen for the decarbonisation of the blood, and that the system is thereby poisoned in such way and manner that typhoid will result therefrom.
One case of pneumonia has come under my observation in which both lungs were hepatised, and where well-defined symptoms of typhous fever were presented, and recovery ensued within a reasonable length of time through the heroic use of quinia, salicin and brandy combined. I will also call attention to another well-marked case under my observation, of abscess caused by a blow from a sledge-hammer in the hands of a blacksmith. It was in winter, and the patient evidently took cold from imprudence or exposure and congestion. Inflammation and abscess ensued in quick succession, terminating eventually in typhoid pneumonia.
I found filthiness of various kinds in his apartment, the ceilings of which were low and the rooms damp and cold. He was suffering from derangement of the brain and nervous. system, which involved nearly every function of his body. Abscess was well defined at a point between the fourth and fifth intercostal space. I introduced a trocar and canula with
out delay, but did not leave the canula remaining in the opening over ten seconds. He fainted on the instant, and I removed it at once. He had now great difficulty in breathing. I was soon rewarded, however, by seeing him cough up and expel great mouthfuls of bloody pus and hepatised matter resembling pieces of liver. A nourishing diet was ordered, and the patient left in the hands of a competent nurse for the night. Toward morning, however, he had a chill lasting for about three hours, followed by high fever, exalted temperature and great disturbance of the brain and nervous system. He exhibited all the evidences of blood-poisoning. I required him to be removed to a clean, airy apartment and administered powerful doses of quinia, salicin, Baptisia tinctoria, brandy, and milk with the most satisfactory results. He made a good recovery.
In the second house west of my residence on Washington boulevard, Chicago, lives Mr. B., whose wife had an abscess; following, I think, upon an attack of pneumonia. I was not in attendance upon her at the time, but was told by her sister that it had broke internally and that she coughed up nearly a quart of what their physician called purulent matter a few moments after. It is now several weeks since the abscess discharged its contents, yet she has not entirely recovered from the blood-poisoning.
SYMPTOMS OF TYPHOID PNEUMONIA.
There is a marked difference in the symptoms which will appear in two different persons, apparently affected with the same disorder under like circumstances of house, atmosphere, and other surroundings; and hence, it seems to me nearly or quite impossible to describe them with absolute exactness. Note the following: Dyspnoea well marked; veins about the neck becoming turgid; the countenance of a livid hue. If but one lung is involved, the patient will lie on the affected side; if both, he will lie upon his back, with his shoulders generally elevated, in order that respiration may be as easy as possible. The cough will generally be moist in this stage of the disease; and there will be a thick, rusty-colored sputum, tinged with