« ForrigeFortsæt »
The patient continued to improve, and on February 22nd was discharged cured.
This case is the only one in which the tonsils and pharynx alone were involved.
This is the treatment pursued here, and with the above results. Oil of turpentine, as will be seen, is used almost altogether as a vapor, and is highly recommended; however, its use internally in drachm doses is advised by Dr. E. W. Kellogg, who reports most happy results from its use in this manner. He administered the oil in milk every one, two or four hours, as the case may be. In but one case were any unpleasant effects noticed, and that was in a patient four years old, in which 15 drachms had been administered in twenty-four hours, and which resulted in a temporary strangury. By giving the turpentine in milk it was retained in every case after it passed the epiglottis. This remedy is generally used in connection with oil eucalyptus and carbolic acid, in the proportions mentioned before, and as a vapor. Dr. C. Lewis, of London, advises that, in addition to this vapor, a sheet be spread over the patient so as to form a tent, and this vapor be kept under this tent constantly, and besides this that two cloths, about a foot square, be saturated in the mixture, one to be placed close to the face and the other on the pillow, near the head of the patient. In adults, or children over eight years old, one or two other cloths of the same size be soaked and hung about the cot. These must all be kept moist with the preparation and kept very close to the patient's face, but care must be taken that they do not touch it.
Dr. A. J. Rosenberry advises the use of a spray, as follows:
. Z vi. M. Sig.: To be used every hour.
Dr. Lloyd advises the use of a spray containing lime, sul. phur, eucalyptus and ext, pancreatin, which he says is very useful.
Dr. H. D. Taggart advises the use of chlorine water locally as a gargle. Gargles however, are very unsatisfactory, except when the tonsils and pharynx are involved, as it is almost impossible to reach any other parts of pharynx or larynx in an
adult, and in a child you cannot do anything with them. The use of peroxide of hydrogen as a spray in the proportion of one to four is recommended by W. F. Waugh in nasal diphtheria, however, Dr. J. M. Bigelow says that it should be foliowed immediately by a spray of bichloride of mercury 1-2000.
Dr. Alexander Fullton reports that the following treatment was successful in thirty-seven consecutive cases. This treatment consists in the application of a solution of nitrate of silver, forty grains to the ounce of rose water, applied by means of a throat brush, twice daily, to be followed immediately by a gargle of the following: R. Oil Eucalyptus...
3i. M. Sig: A pinch to be blown into throat every four hours.
Internally the following is administered, the dose varying according to the age of the patient.
R. Potassium Chlorate....
Tr. Ferri Chloride......
3 ii. zii.
3iii. ....gtts. iii,
The following is applied externally over the seat of the ton
R. Tr. Iodine......
zii. Oil Camphor.........
zi. M. Sig: Apply every four hours.
When there is a rise of temperature he gives small doses of antipyrine, and during convalescence puts the patient on mist. ferri. et. ammon acetatis and a light nutritious diet and champagne.
Dr. Jacques of Marseilles recommends, for a child seven or eight years old, after complete isolation in a room with very little furniture, two gargles. One, which is the most important
gms. 2. gms. 50. ...gms. 150.
consists of a solution of perchloride of iron; and the other one is a sol. of carbolic acid plus a solution of boric acid.
The perchloride of iron is prescribed as follows:
} M. Sig: A teaspoonful in one-fourth a glass of boiled water, the patient to take two or three mouthsful every two hours and to gargle as deeply as possible.
To relieve the astringency of this solution it is followed in a few moments by a three per cent. sol. of boric acid. The gargle of carbolic acid is as follows, and alternates with the former: R. Acid Carbolic......
After the administration of the food, which should, be after the gargles have been used, the mouth should be rinsed out, and especially if milk was the form of food given, for it is an excellent medium for the cultivation of the Klebs-Loeffler bacilli. Good nutritious food and stimulants are not to be forgotten, for these alone are sometimes worth more than all of our medicines. The food should be given regularly, and if it should happen that the patient cannot take it by ordinary means, enemata should be resorted to. When the throat becomes hot, dry and throbbing, liquid food should be given. It is at this stage that ice cream or frozen milk is beneficial. When threatened with paralysis of any kind you should immediately resort to the use of strychnine or nux vomica, and if accompanied by exhaustion the free use of alcoholic stimulants should be resorted to.
Another form of treatment is that known as the Brooklyn or Carbin method which consists in the use of calomel which is sublimed so that the patient can inhale the vapor. The quantity to be used at each sublimation should be from thirty to sixty grains, to be used every one, two or three hours. The whole quantity used on a case varying from one-half to several ounces.
Dr. S. Cohen, of New York says: "Mercury is, to-day, the one drug upon which most reliance is placed by the'entire medical profession in the treatment of diptheria, and from the various ways in which it is used with benefit, it probably exercises its good effects through the circulation; and further says that in his experience, the “hourly administration of .05 gms. of calomel has had, in many cases, the satisfactory results of softening and liquifying the diptheritic membrane, and in this way, avoiding the necessity of an operation.”
This article would not be complete without reference to Dr. A. Seibext's method of treating pharyngeal diphtheria by submucous injections of chlorine water. I copy the following from his report on this subject: “This treatment consist in injecting fresh chlorine water (U.S. P.) through the diptheritic pseudomembrane into the inflamed mucosa below. I now inject about fifteen drops into each spot, and according to the extension of the process as many as six or eight injections may be made at a sitting. Thirty-seven of the last fifty cases which have come to my knowledge bave occured in the practice of other physicians who were kind enough to report them to me; the remaining thirteen were treated by me. Of these fifty patients five were six to twelve months of age, thirteen were two to four years of age, fifteen were five to seven years of age, two were nine years of age, ten were ten to thirty years of age. The injections of chlo. rine water proved effectual in checking the diptheritic processes in forty-two cases; they showed but partial effect in four cases, and had no apparent effect in three cases. Complete recovery, (including disappearance of membranes), after injections occurred in one day in five cases; in two days in seventeen cases; in three to four days in three cases; in five to eight days in eleven cases; not reported in ten cases; died, four cases."
The syringe used for these injections consists of two tubes, two tips with finch point, two tips with inch points; syringe and bottle for chlorine water.
SANDER & Sons' Eucalypti Extract (Eucalyptol).—Apply to Dr. Sander, Dillon, Iowa, for gratis-supplied samples of Eucalyptol and reports of cures effected at the clinics of the Universities of Bonn and Griefswald. Meyer Bros.' Drug Co., St. Louis and Kansas City, Mo., Dallas, Texas, and New York, sole agents.
LEGAL REQUIREMENTS FOR THE PRACTICE OF MEDICINE IN THE UNITED STATES.—So many changes have been made in the legislation regulating the practice of medicine in this country during the past three years, that the Illinois State Board of Health will include, in its forthcoming Report on Medical Education, the text of all laws on this subject in force at the beginning of the present year in the several States and Territories of the United States, and in the provinces of the Dominion of Can. ada. From this forthcoming Report, through the courtesy of the Secretary of the Board, Dr. J. W. Scott, some data bave been gathered which will be of interest to the spring crop of new graduates, and to medical men generally.
Of the six New England States, Maine, Massachusetts, New Hampshire and Rhode Island have no legal requirements for the practice of medicine. . Connecticut has adapted a medical practice act which went into effect Oct. 1, 1893, and in Vermont the law requires the registry of a diploma indorsed by a Board of Medical Censors or a certificate of satisfactory examination by one of these Boards.
Exclusive of the four States first named, the other States and Territories may be roughly grouped into the following three classes :
In Alabama, Arkansas, Florida, Maryland, Minnesota, Mississippi, New Jersey, New York (act of May 9, 1893, North Carolina, North Dakota, Pennsylvania (after March 1, 1894), South Dakota, Texas, Utah, Virginia and Washington, the di. ploma confers no right to practice and has no legal value, except, in some cases, to give its possessor standing before an examining board. The right to practice in each of these sixteen States is determined by individual examination before boards of examiners created by law.
In California, Colorada, Connecticut (since October, 1893),