A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.

  • Strümpell, Adolf von, 1853-1925.
Date:
1887
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Licence: Public Domain Mark

Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.

    46/1008 (page 24)
    pure or combined with acetate of lead (opii, gr. \, grm. 003; plumbi acetatis, gr. j, grm. 0'05; sacchari albi, gr. j, grm. 0'05). The object of the opium is to check peristalsis, and thus promote the formation of a clot in the bleeding vessel. Liquor ferri chloridi (five to ten drops in water every hour) is often employed, but is of extremely doubtful value. The baths can not be resumed till there has been no bleedmg for at least three or four days—and then only cautiously. If peritonitis occurs, the treatment is much the same. Above all, opium must be used in still larger doses, but, unfortunately, as a rule, in vain. Per- haps surgical treatment is destined eventually to be useful, viz., incision, cleansing, and drainage of the peritoneum. Its results thus far are not very encouraging. If there is considerable diarrhoea, we can give mistura gummosa [P. Gr., gum arabic and sugar, each 15 parts; water, 170 parts], tannin, subnitrate of bismuth, or small doses of opium. Constipation at the beginning of the disease is over- come by calomel (vide supra). In later stages we always try enemata first, to produce an operation. If this does not succeed, then we must employ rhubarb or castor-oil. Great tympanites may be diminished by' laying cold wet cloths or ice-bags upon the belly. Considerable amounts of gas may often be removed by introducing a long rectal tube. As to puncturing the greatly inflated intestines, a method practiced by some physicians, we have no personal experience. If there are severe pulmonary symptoms, baths and pouring on cool water are, as we have said, the best remedies. Internally we may try liquor ammonii anisatus [P. G., olei anisi, 1 part; aquae destillatas, 24 parts; aquse ammoniae, 5 parts] and benzoic acid (grains ij to iij, gramme 0-l to 0-2, in powder). If the pulse be very rapid, we can put an ice-bag over the heart. If at the same time the pulse is small and weak, we give stimulants, of which the best is camphor (vide infra). Digitalis (one half grain of the leaves, gramme 0'03, two or three times daily) may also be employed if the pulse be rapid ; but it should be used with great caution. For nervous symptoms the baths and douching are the most effective reme- dies. The head is meanwhile covered by an ice-bag. If there be great excite- ment, as shown by excessive restlessness or delirium, small doses of morphine are often very useful. The conditions of collapse and cardiac failure, which sometimes appear rather suddenly, demand prompt and energetic treatment. Stimulants to be given in- ternally are some stronger kind of wine, camphor (two to five grains, gramme 0'10 to 030, in the form of a powder), musk (one half grain to one grain, gramme 0'03 to O'Oo at each dose), or Spiritus setheris [P. G., asther, one part; alcohol, three parts]. Subcutaneous injections act quicker and are much more conveni- ent. We may use either ether or camphor (one part camphor to four parts olive- oil, seven to fifteen minims, c. c. 0'5 to TO, every one to two hours). To start up respiration, the best means is to pour cold water on the back of the neck. Artifi- cial resphation also succeeds, in many cases, in reviving the breathing when it is about to stop. The numerous other complications and sequelae which may occur, but which can not all be mentioned here, should be treated on general principles. The prophylactic measures to avoid the spreading of the disease can be only briefly referred to. Of chief importance is careful disinfection of the excreta, which can be accomplished by pouring upon the stools a not too small amount of five-per-cent. carbolic solution. We should also take care that bed-pans, bed- clothes, linen, etc., are handled by other people as little as possible. If there seems reason to suspect that the disease arose from bad water, of course the source of such suspected water must be cut off.