« ForrigeFortsæt »
streaks of blood resembling liver in its consistence, which will sink to the bottom of a vessel and adhere to its sides and bottom. The bowels are usually constipated; the mind confused, fretful and restless; there is an anxious expression of countenance; the urine is scant in quantity and generally of a reddish color; there exists imperfect sight in some and dullness of hearing in others; and in some cases both of these phenomena. Among other noticeable symptoms are stupor, picking of the bed-clothes, insensibility; the countenance shows an expression of gloom; the tongue becomes coated and clammy, or dark and dry; the stomach is irritable, the pulse feeble and slow; the temperature is often 106° to 109° (F.); the skin is covered with a cold, clammy sweat; the countenance becomes cadaverous, and unless the patient is speedily relieved death is very certain.
Diagnosis. The very high temperature that prevails in this disease is an important diagnostic symptom. The skin is hot and dry; the urine is scanty and high-colored; the pulse obstructed, weak and irregular. By inspection of the chest we may discover that the side affected does not expand during inspiration in the same manner as the one on the opposite side. We may prove this by palpation, or placing both hands flat on corresponding parts of both lungs and noticing the diffent motions of the two sides during respiration. By percussion over the inflamed lobe a dull sound is produced, caused by increased density. In order to fully appreciate this dullness the percussion should be made in both lobes. If a portion of the lobe is hepatised, there will be a dull, flat sound. Auscultation will reveal a loud "muco-crepitant rattle." "But as the lung continues to break down, and a cavity is formed, amphoric breathing and gurgling takes the place of other sounds." Finally, the former history of the case, together with the usual tests properly made, will be sufficient for a proper diagnosis of true typhoid pneumonia.
Prognosis. The prognosis in typhoid pneumonia is not generally very unfavorable, especially if but one lobe is involved, and there has been no great derangement of the solids. and fluids of the body. When, however, a virus has been gen
erated, disintegrating the blood, then we must look upon the case with apprehension, especially where both lungs are involved, and there are other complications, such as frequently
Treatment. The disease being of a passive character its treatment will require sound judgment and the exercise of good common sense. As I have already remarked we have to contend with a very high temperature (106° to 109° Fahrenheit), and a slow, sluggish circulation, with the vitality greatly depressed. In order to support the sinking powers of the body, and to neutralise the blood-poison, which is often a very difficult matter, we should give wine-whey, carbonate of ammonia, camphor, or champagne wine. Doses of quinia, sufficiently large, should be administered. In toxic diseases much larger doses are required, as all physicians well know; and the physician in charge of such patient should be equal to the emergency. My plan of treatment has been to give a large dose of quinia, salicin and brandy at bed-time, and supporting treatment through the day. This will tend to enable reaction to be permanently set up and established before another dose is given. I believe that medical men generally agree that large doses of quinia act as an antiseptic, and become much more valuable as such when combined with brandy, salicin and other well-known stimulants, I would not overlook the value of such remedies, as phenol (kreosote) Baptisia tinctoria, iodide of potassium, salicylate of soda, and other reputed antiseptics. They have all had their advocates, and I doubt not have been of good service to many practitioners in the treatment of this terrible malady; but no remedy has served me so well as full doses of quinia, associated with brandy, and in some cases salicin.
THE ABUSE OF OPIATES.
BY HENY WOHLGEMUTH, Springfield, Illinois.
I do not stand alone in expressing my conviction that the use and abuse of opiates is a question that will soon require more than ordinary attention on the part of our profession. I would more especially mention the sulphate of morphia, since it is prescribed and used not only by physicians, but by many others without the advice of a physician. The notion that opium and morphia constitute an all-healing remedy, which many physicians seem to have adopted, is as foolish as it is pernicious. It seems to me impossible for any intelligent physician to regard the growing tendencies towards the indiscriminate use of these opiates otherwise than with alarm.
I think it will be admitted by all impartial persons that it is wrong for medical men especially, to prescribe and deal out drugs, the effects of which are known to be pernicious in many cases, without carefully considering the particular case in hand. The case may often times seem complicated, demanding the utmost care and the highest exercise of judgment on the part of the practitioner for the proper treatment. Constitutions are differently affected by the use of opiates. Some are irritable and nervous, others are torpid and sluggish. In some the vital powers are naturally weak, in others there is a superabundance of latent force and strength of constitution, which if only brought into exercise has largely to do with the process of change from a condition of disorder and weakness, to that of vigorous health and strength.
It is in view of this fact and other kindred topics, that we are as medical men, from all parts of the country assembled in annual meeting to present and discuss matters appertaining to health, happiness and life. This is a duty we owe to ourselves, to the profession whose representatives we are, and to humanity at large. We come here to interchange ideas, to state facts observed in our experience, so that it may be for others to profit by them. So doing, we add our personal contribution to the sum of human knowledge. In pursuance of
the duty assigned me how far I shall succeed in doing justice to the subject under consideration I leave for others to decide.
I regard as a true medicine that agent which acts in harmony with the laws of nature, not interfering with life, but assisting in the eradication of disease, and in helping to restore to health and vigor, by removing the obstructions and probable causes of disorder, and thus making possible the healing or curative process.
True science in the practice of medicine does not consist in the administration of a drug merely, but it is the all-important faculty of knowing how and when to act. In the successful pursuit of this science, we must always recognise the relationship we hold to the laws of nature, for we are well aware that the actual healing process lies with nature herself. Without that assistance we shall always fail. But we do know that it is within the power of the physician to assist or prompt nature in those mysterious processes of recuperation and recovery, which unaided, she might be unable herself to accomplish. Herein lies the true technic of our profession. To do this, it becomes every physician to acquaint himself with nature's laws and requirements to the fullest possible extent.
This being true, we enquire whether physicians, when called to the bed-side of the sick, are justified in resorting to the unrestrained use of morphia, or other opiates, merely to relieve pain regardless of the ulterior consequences. It is doubtless. true that the physician is oftentimes regarded as a wonderfully successful practitioner, because he removes or allays pain so quickly. Granting that he does that, as in modern practice is too often the case, where to gain a great reputation upon a small basis of actual skill, the morphinite is ready with his pop-gun hypodermic syringe, to inject his favorite drug under the skin. A wonderful machine is this syringe under certain circumstances, it is true; but it is not to be handled as though it would answer for the cure of all the ills that human flesh is heir to. I would be the last person to raise my voice against its proper use, when circumstances and the condition of the patient demand it at our hands. I would administer morphia hypodermically or by the mouth, for the relief of
pain, or for the procurement of rest, and thus come to the relief of nature, struggling, as it were under the burden of a heavy weight, by the removal of which recovery becomes possible.
Indeed, I will further say without fear or successful contradiction, that there is no drug or medicine in the whole catalogue of the Materia Medica more useful to relieve pain, or for many ailments, than opium and morphia. Rob the Materia Medica of these drugs and you would strike the vital blow to the successful practice of medicine, and disarm the profession of one of its greatest instrumentalities.
While all this is true and we admit the value of morphia as a remedy the administration of which oftentimes is necessary, and without which we might be deemed cruel, nevertheless how many times have medical men, especially those of long experience, witnessed in many instances the most unfortunate results. How many a life has been made miserable, and how many a sufferer becomes an object of pity for life. Yea, how many lives have been sacrificed under its indiscriminate use.
I venture to say that in many instances physicians are responsible. Many when summoned do not hesitate to bring forth their hypodermic syringe, inject morphia, no matter what the nature of the complaint may be, whether colic, sick stomach, lumbago, sciatic rheumatism, pain in the head, a fall, a bruise, or a cut of some trivial nature; when a mustardplaster, the application of hot or cold water cloths, or the administration of effervescent magnesia, soda or salicylic acid would answer every purpose. It seems to be thought by many wiseacres that it is more impressive or fashionable at least to make display of their little pop-gun, and in goes the morphia. Perchance it affords relief at least of pain, but the unwary patient does not know all that is it to follow.
In many cases, the general excitement indeed is calmed, pain is diminished; a disinclination to muscular exertion is produced, and the force of external impressions on the senses diminished. The patient becomes indifferent and imagines himself better. Sleep and stupor follow, but on awakening