Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    144/976 (page 124)
    Whenever the symptoms assume an acute or sub-acute form, the patient ought at once to be placed in bed, and ipecacuanha should be given as recommended in the acute stage, in doses suited to the condition of the patient, and the violence of the symptoms. Gentlemen who have done duty in the clinical wards at Netley have often seen me use this remedy under such circumstances with the happiest effect. I recommend the use of a water-belt over the abdomen for some hours daily. This acts as a fomentation, and the steady, uniform pressure it maintains seems to favour the absorption of the fibrine effused between the intestinal coats. If there be much uneasiness about the fundament, a water compress over the anus often affords more relief than opiate enemeta. The cold hip-bath should be used daily for a few minutes. I have seen this most serviceable. The greatest attention should be paid to diet. The proper nutrition of the patient is often the most difficult part of the treatment. In those cases where atrophy of the small intestine is much advanced, with perhaps fatty or amyloid degenera- tion of the liver, or both, it is almost, if not quite, impossible, and the patient dies starved. If the state of the gums point to a scor- butic taint, the diet must be regulated on the principles already laid down under that head. In extreme cases milk must be our chief resource, sometimes with a little lime-water, or beat up with egg, and good sherry or brandy; a teaspoonful of curapoa added is often highly relished. Rice-flour, sago, arrowroot, or stale bread may be added, and changed so as to suit the capricious appetite. When solid food can be taken without suffering, it should be given ; tender mutton should be broiled “quickly and not too much,” and eaten with bread and butter. -These rules are quite as applicable to the acute stage, where food, while the acute symptoms last, should be simple and farinaceous, and the return to solid food should be gradual. With regard to medicine, where astringents are indicated, they should clearly be of such a kind as do not tend to lower the already sufficiently low state of the patient. Acetate of lead, sulphate of copper, and suchlike remedies, I use with a sparing hand, and only under the pressure of necessity. My favourite remedy, par- ticularly in men returning from tropical regions, anaemic from loss of blood and the depraving influence of malaria, is the solution of the pernitrate of iron, which I use at Xetley very freely, and often with the happiest effect. Under this remedy the whole system often rallies wonderfully, the condition of the blood improves, colour returns to the blanched cheek, the stools become more natural and less frequent, the appetite improves, and digestion is more perfectly performed. The citrate of iron and quinine may after a time be substituted. When astringents of a more direct kind are necessary, the decoction of logwood with lime-water, catechu, gallic acid, and suchlike may be used Pain must be allayed by opiate enemeta, gentle douches to the anus are often most soothing, and the use of liniments containing chloroform, often allay irritation. In Conclusion.—It will not fail to be remarked that I have not only