Imagini ale paginilor
PDF
ePub
[ocr errors][ocr errors]

23

THE MEDICAL WORLD.

But little opportunity is afforded for pathologic study since the disease so seldom proves fatal.

General Symptomatology of Mumps.

There is at first fever from 101 to 104

Jaundice.

51

Jaundice or icterus is a pigmentation of the tissues and the secretions with the coloring matter of the bile, and may be due to either obstruction in the flow of

degrees, accompanied by a feeling of bile, or from a disintegration of the blood

general malaise. Patients complain to a greater or less degree of pain in the parotid region and of an inability to open the mouth freely. There appears a certain swelling of the parts, giving a very characteristic appearance. The swelling is observed below and in front of the ear, is pyriform in shape, and has a doughy feel. There is considerable edema of the surrounding parts, and the features may be distorted beyond recognition. The saliva may be increast or diminisht. There is great impairment of the hearing, owing to swelling of the eustachian tube.

Often during the course of the attack, the inflammation suddenly subsides in the face and as suddenly appears in the testicle in the male or the ovary or the breast in

the female.

Treatment of Mumps.

The initial point in the treatment is rest in bed. The fever may be controlled by mild febrifuges, and the bowels should be kept open. Locally lead water and laudanum, or some rubefacient liniment may be employed, one containing tincture of aconite root, tincture of iodin, and chloroform being generally productive of ease. If there seems to be a suppurative tendency or if an induration persists after the subsidence of the inflammation, potassium iodid will give excellent results.

When the disease extends to the genitalia the swollen parts should be elevated and covered with lint soaked with lead water and laudanum. If there is not a ready yielding to this treatment, use an ointment of mercury, belladonna and ichthyol.

When suppuration occurs, operative measures must be taken, the same as would be done with any abscess, no matter what the location Bile dost,

المسلمين

[ocr errors]

or a destruction of the liver substance.

In the first instance, the obstruction of the bile which leads to its accumulation and reabsorption may be due (a) to congenital or acquired stricture of the bileduct; (b) catarrh of the bile-ducts or of the duodenal mucous membrane around. the opening of the ductus choledochus; (c) foreign bodies, as gall-stones or parasites, in the ducts; (d) tumor of the liver or the adjacent viscera compressing the ducts, or fecal accumulations, a pregnant uterus, or displaced organs acting as obstructive agents; e) lowered blood-pressure in the vessels of the liver, causing increased tension in the bile-ducts, such as in the icterus following depressing emotions.

The

characteristic symptom is, of

course, the yellow discoloration of the skin and mucous membranes. This is generally first noticed in the conjunctiva. The stools are of a peculiar light, clayey tinge, while the urine becomes dark, sometimes frothy and resembling porter in appearance. There is seldom fever, more often a subnormal temperature. There is complaint of an itching sensation in the skin, and there is always mental depression. Urticaria is a common complication, while in grave cases ecchymoses appear subcutaneously.

In the form due to hematogenous processes, the staining of the skin is not so intense and the stools contain bile. In this form, however, grave cerebral symptoms sometimes develop. It is seen in pernicious anemia, but more commonly results from the introduction of some toxic element in the blood, especially in poisoning by phosphorus, snake-poison, etc., and more particularly in paludal dis

eases as yellow fever, relapsing fever, and sodium bicarbonate and calomel, are indimalaria.

There is headache and giddiness with nausea, constipation, sometimes diarrhea, because the food ferments from the absence of bile and acts as an irritant to the mucous membrane of the bowels, thus causing loose and frequent actions in spite of diminisht peristalsis from the absence of the bile. The pulse is generally very slow and sometimes intermittent, altho in some of the graver forms where there is great prostration, the pulse becomes rapid and feeble.

Treatment of Icteroid Conditions.

It must be remembered in treating jaundice that it is merely a symptom and not a disease, and that a large proportion of cases are due to either catarrhal inflammation of the biliary passages or to gallstones. Sometimes neoplasms, particularly in persons past middle life, cause closure of the ducts by pressure. The indications to be met are the removal of the cause, the opening of the biliary passages, and the relief of the symptoms.

Diet is necessarily of great importance, both because of the effect of food upon the disorder and because of the effect of the bile upon the food. Fat, sweets, starches, and highly-seasoned dishes must be interdicted. Buttermilk, lemonade, fresh fruit, green vegetables and lean meat, with bread, preferably toast, in small quantities, would make a good bill of fare. Skimmed milk also is especially useful, as it increases the action of the kidneys. Alkaline drinks are far preferable to acid wines and lemonade, which are so usually directed, this, because they render the bile more liquid and quite probably increase the amount formed. The use of pure water in abundance is also an excellent thing, as it increases the flow of bile and tends to force the obstructing plug out of the bile-duct.

In the same line of reasoning, drugs that increase the flow of bile and render it less thick, such as sodium phosphate,

cated. Sometimes, in cases of chronic jaundice, the use of hydrochloric acid has produced excellent results. Ammonium chlorid is productive of much good in cases of the catarrhal type, and bismuth and magnesia are well spoken of when there is nausea, while cerium oxalate in combination with bismuth and cocain, will produce almost immediate relief in this condition. Constipation is best treated with the salines and calomel. Diarrhea, as a complication, is best met with bismuth, salicylate or beta-naphthol. Acetanilid will relieve the persistent and distressing headache, and sponging with a solution of sodium carbonate will often relieve the itching.

When occurring in the new-born (icterus neonatorum), little or no treatment is required, beyond calomel, in very minute doses, in combination with soda. Where the malignant form occurs, it is due to either septic poisoning or to congenital occlusion of the biliary passages, and here treatment is useless.

Treatment of Epidemic Influenza or La Grippe.

There are many cases of grip so mild that a physician is not called in, little or no treatment being called for, or, at least, given. The patient keeps up and about his business, resisting the depressing effects of the disease as well as he can, and struggles along, sometimes with real suffering, always with discomfort.

It is a physician's duty, wherever practicable, to denounce such course, since the chief danger of the disease lies in its devitalizing power, predisposing to the sequele which so often prove fatal, and thus appear in health-reports as the cause of death, no mention being made of the original factor, the influenza. These complications and sequelæ are as apt, if not more apt to appear after apparently slight cases as after the severe ones; more apt, because in the slighter attacks the patient more generally exposes himself unneces

sarily, inviting ill results. The development of a fatal dysentery or pneumonia can too often be traced directly to the patient's efforts to "fight it off" and not give up to what he mistakenly deems an indisposition of trifling import.

The above may seem to be a broad statement, but it can be verified by a close study of the health-statistics in the years, in which epidemics of influenza prevail. Although the percentage of deaths given as due to grip itself may not appear large, it will be seen that the entire death rate is very materially increased, and that particularly large numbers die from catarrhal diseases.

The first step in treatment, therefor, must be to enjoin abstinence from work, and the staying indoors. It may not always be necessary to see that the patient keeps his bed, but even this procedure can do no harm, while the reverse may result in some ill effect. The house must be kept warm but not close, and careful attention must be paid to diet and the regulating of the bowels and the excretory functions.

When the case is taken early, this may be all that is necessary, and if, after a few days, all febrile movement has subsided, the patient may be allowed to go out cautiously, avoiding exposure to inclement weather.

Unless the case is of this mildest type, the patient should always be confined to bed, the same hygienic measures being taken as has been advised in fevers of the typhoid type (MEDICAL WORLD, Vol. XVI., page 418, col. 2). The only exception. noted may be that of the use of the bedpan, which need not be enjoined save in cases of the most severe type, altho in all cases acts of defecation and micturition must be performed within the room.

Unless there is extreme prostration, stimulants are contraindicated, their use being of distinct disadvantage. If there appears need of bracing the patient, this should be done, save in very exceptional cases, by small doses of strychnia.

[ocr errors]

portance to ply the patient freely with all the nourishing food he can eat, but this is not always a good procedure, since it sometimes causes grave digestive disturbances, which in turn give rise to serious complications. Unless the case requires strong supportive measures, it is best to restrict the diet to a liquid one, milk, meat, broths, etc., as it is important to not overburden and possibly derange the digestive organs. Often much discomfort, if no results more serious, arise from the excessive zeal with which attendants provide nourishment. Generally a very mild diet will favor the well-being of the patient and will render defervescence more prompt.

In all the states usually developed in this disorder, milk is the preferable food, the amount given varying from one to two quarts during the twenty-four hours, according to the severity of the attack, the age of the patient, etc. The milk may be assisted by the addition of the white of egg. Solid food should be interdicted, at least, at the height of the disease. Often nausea is a prominent symptom, and when this occurs, tact must be shown in regulating the diet, both as to quality and quantity.

Specific qualities have been ascribed to a number of drugs in this disease, but thus far, claims made have not been fully substantiated. The affection has such protean forms that what might be most efficacious in one case, would possibly prove without avail in another.

Salipyrin, the salicylate of antipyrin, is highly spoken of by a number of recent writers, and statistics seem to prove that it is very efficacious in typical cases without serious complications. It should be given in large doses and at frequent intervals.

The headache and backache, which are so annoying, can be relieved by the administration of doses of from three to five drops of benzol, the effect being very quickly obtained. The treatment should

It seems generally thought of great im- be continued for three or four days, with a

strictly milk diet, and the patient carefully kept from exposure during this time. A chief claim for this drug is that, under the treatment outlined, no sequelae will develop, a most important point, since the chief danger of grip is not the disease itself, but its complications.

Potassium bicarbonate is highly praised, and it is said that if given on the first appearance of chilliness it will completely prevent the disease from developing. Given at any stage, it is claimed that it will destroy the power of the infection generally within four to six hours, always in less than twenty-four hours. The strength is conserved, and convalescence is short and without sequelae.

The chief battle, however, has been waged over the use of the coal-tar derivatives. As is well known, these powerful drugs have a distinctly depressing effect upon cardiac action and also impoverish the blood. It seems probable that in longcontinued fevers, such as typhoid or malaria, these objections are excellent, but they are not sustained in influenza, the course of which normally is from three to nine days. Unless there is very profound nervous and general depression, or an idiosyncrasy against the drugs, they are of great service, often producing marked beneficial effects. These are not so much in the line of shortening attacks, as in diminishing the suffering and increasing comfort. This is markedly noticeable in cases where supra-orbital pain and constriction, headache, backache and muscular soreness, with a considerable degree of fever, are present.

In such conditions many writers say that five to eight grains of phenacetin, given in capsule every hour, will soon produce markt amelioration; and a feeling of wellbeing will follow, with refreshing sleep. If antipyrin is preferred, this is best given in watery solution in a dosage of about fifteen grains. Acetanilid may also be given in the form of tablet or inclosed in capsule. The drugs last named should be given to the extent of three, possibly four, doses, at in

tervals of at least two hours, possibly better three, but, after the first dose, the fever and suffering will never be so intense, and the attack will seem to be abbreviated. Profuse sweating will often be noticed, sometimes accompanied by depression. In such event the dose must not be repeated. Of the trio of drugs, acetanilid seems the least desirable, this because of cyanosis so frequently following its use.

Should the temperature rise unduly after the first dose, it should be repeated until the symptoms yield. It must be borne in mind, however, that in the presence of complications such as pneumonia, gastro-enteritis, etc., the use of these drugs is not only undesirable, but might prove distinctly disadvantageous.

A peculiar point in treatment is that combinations of drugs are of little service in this disease. It seems far better to select the remedies indicated in the various stages and give them singly, changing to others as new conditions arise.

Many pin their faith to quinin, giving it in full doses, even to the point of cinchonization, seeing some resemblance between epidemic influenza and the malarial diseases. It is certainly a valuable agent, but it is not so prompt as the coal-tar group On the other hand, it is not so depressing, and has tonic qualities as well as antifebrile. It is preferably given, when used, in a slightly acid solution in a dosage of say 10 grains every third hour until relief or until three doses have been given. After this the daily dose should be about 10 or 12 grains, divided to suit the ideas of the attendant physician. The discomfort that quinin does not relieve may often be controlled by the use of opium.

Hydrotherapy is quite valuable and obviates the use of much drug medication. Cold water applications give good results where there is much headache, and sponging the body with tepid or cold water will relieve the pyrexia. The liability to catarrhal and inflammatory conditions would seem a contraindication to the full cold bath. Stimulants should always be given

to patients who are of advanced age or debilitated constitution, but it would be well to restrain their use to such conditions merely.

To combat insomnia, give chloral in about 20-grain doses, not more than twice at an interval of about two hours. If there is much cardiac depression small doses of strychnia should be given. Other complications, such as pneumonia, bronchitis, etc., should be treated as when occurring singly, bearing in mind when choosing remedies the depression and prostration of the influenza.

In convalescence the utmost care should be taken to guard against relapse. Stomachic tonics, such as nux vomica and gentian should be given to stimulate the appetite, and iron, strychnia, etc., will be useful to overcome persistent depression, mental and physical.

Great care should be taken thruout to avoid unduly exciting or crossing the patient in order to avoid developing the occasional mental complications. Efforts should be made to amuse and entertain in any way possible that will not fatigue the patient. Reading should be discouraged, but if desired some person could be employed to read something light to him.

The heart must be carefully watcht, and anything that would produce a sudden strain upon it must be guarded against. If the patient develops a tendency to be easily fatigued, he must not be exhorted to efforts to overcome this, but should rather be encouraged to take things easy until recovery is assured and complete. Better be over careful than not sufficiently so.

A peculiar complication of the epidemic of influenza now prevailing in Philadelphia is the fact that violent urticaria, generally of the bullous type, occurs in about one-tenth of the cases. This is also associated with constipation, and is sometimes relieved with the appearance of catarrhal symptoms in the bowels. Cases of appendicitis are also reported as consequent upon a number of cases of

[merged small][merged small][merged small][ocr errors][ocr errors][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small]

These are quotations in twenty-fiveounce lots. A duty of 25 per cent. is to be calculated, but that will not account for the exorbitant excess charged to American consumers above the prices charged the consumers of other countries. This injustice is made possible by our patent laws. If foreign manufacturers persist in taking advantage of our laws to overcharge us, we should change our patent laws, and make them similar to the patent laws of Germany. It is right to protect an inventor against infringement, but he should not be protected in such monstrous overcharging as is illustrated above, which are some of the most extreme cases of such overcharging.

Mental Capacity in Will Making.

Johnson (Canadian Journal of Medicine and Surgery), says that a medical man should never consent to make a will for a patient, and he should remember that if he signs his name as a witness, he not merely acknowledges that the testator did sign the will, but that he was in a fit and proper condition to do so. If a medical man is asked to decide whether a dying person is or is not in a fit state of mind to make a will, it is as a rule only necessary to ascertain whether the sick person can clearly and rationally answer a few questions put to him or can repeat unaided the provisions of the will he wishes to make. In the case of feeble-minded persons, a private interview should be insisted on, when the patient may disclose the existence of any undue influence. He discusses the wills of insane persons as well as wills of persons incapacitated by drunk. enness, delirium, the stupor induced by narcotics, and similar conditions.

« ÎnapoiContinuă »