Medical reprints with original essays : home, foreign, and colonial, illustrated.
- Date:
- 1897
Licence: Public Domain Mark
Credit: Medical reprints with original essays : home, foreign, and colonial, illustrated. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![malarial enteritis. They blamed the water, the food, the cooking utensils—everything but the true cause, the malarial poison. There was no question, for the water and food were excellent, and the disease attacked us first off the coast of Senegambia. Moreover other ships passing through the same belt experienced a similar epidemic. I have no doubt that malarial germs floating in the atmosphere were inhaled into the alimentary canal and set up inflammatory changes, result- ing in this form of enteritis. Once taken in they found suitable material for their development in the weak and unhealthy organs of some of the passengers, and extended the range of attack upon the others long after the malarial belt was passed, by virtue of generated epidemic powers. The symptoms were very similar. Digestive disturbances were present early, and in most cases there was tenderness on pressure over the epigastric region, bilious vomiting, pointed tongue, red at tip and edges, hut covered elsewhere with a yellow dirty fur. There was headache with purging and tenesmus, and sometimes stabbing pain in the anus, as if from spasmodic contraction of the 1 Hemorrhoidal veins. The stools were dark, more or less natural at first, becoming watery with blood corpuscles, shed epithelial cells, triple phosphates and particles of undigested food. The evacuations were as many as forty per day, but small in quantity. The straining was very severe, and lent to the face a peculiar anxious expression. The temperature was always above normal; it was periodic in type, but in some cases presented considerable irregularity. It never rose above 104° F., generally keeping a low level and inclining upwards to the crisis. The urine was scanty and high coloured, and in a few cases contained albumen. The kidneys were tender to deep pressure, and evidently in a state of congestion. Rigors heralded the enteric symptoms, and always appeared again if the bowel took on increased inflam- matory action. Sweating was seldom well marked In one case, however, where there was little or no fever it was a prominent symptom, coinciding always with an improvement in the enteritis. Collapse often occurred at the crisis, and had to be care- fully guarded against; shock, too, appeared early in one or two cases, but these were in old people or those suffering from chronic diseases. In some epidemics the symptoms vary in prominence, but always heralding an attack and persisting long after it is the digestive disturbance. It is this which delays recovery, and which if not assisted will either destroy the patient, or lay the seeds of an atonic dyspepsia lasting for years if not for life. In treating the enteritis I aimed at producing an antiseptic effect upon the length of the bowel, at the same time endeavouring to control the excessive peristaltic action. I found that I best could obtain this result by the following: IJ. Liq. hydrarg. perchloridi .. .. .. til xv Tinct. opii .. .. .. .. .. itl v Fiat haust. M. Sig.—Every two hours till the purging was stopped. This it generally did within the first twelve or twenty-four hours. I never found this preparation rejected. The first two doses were sufficient to check the vomiting in most cases; if it continued equal parts of Bismuth Carb. and Bicarb. Soda was effectual. Complete rest was ordered; no food was permitted, except soda water and milk in small quantities frequently, and if collapse was feared champagne. In most cases the question of nourishment must be faced early. The gastric mucous membrane improves so slowly that if the exhaustion is great we must find a suitable method to introduce nourishment or lose our patient. The best preparation in my opinion after a long experience with various drugs is at first one which will digest and soothe. The following is what I prescribe: II Bismuth carb. .. .. .. .. .. gr. xv Bicarb, soda .. .. .. .. .. gr. x Lactopeptine .. .. .. .. .. gr. x Fiat pulv. M. Sig.—To be taken every four hours. Custard puddings, chicken jelly and soup to be given in small quantities. Two days after this treatment has begun, cold chicken, game, pounded meat, fish or any light nourish- ment may be tried, discontinuing the soda and bismuth, and giving the Lactopeptine during the meal in weak whisky and water. At the same time it is well to act more directly upon the blood and nervous tissues. This may be done by ordering a. mixture to contain iron with a mineral acid com- bined with strychnine or arsenic. Change of climate will complete the cure. This is, however, not always necessary, and a constitution built up in the pernicious influences which threatened to destroy it gains in the process, as it were, powers to resist fresh invasion. ABSTRACT OF A PAPER ON THE USE AND ABUSE OF ERGOT IN OBSTETRICS.1 By T. More Madden, M.D., F.R.C.S.E., M.A.O., Honoris Causa, Royal University of Ireland, Obstetric Physician and Gynaecologist, Mater Misericordia Hospital, Dublin. [Reprinted, by permission of the Author, from the New Orleans Medical Journal.] The reaction against the former abuse of ergot in obstetrics has apparently been now carried to an extreme and undue ' extent, and has led to its desuetude in many instances '. wherein this ecbolic might be most advantageously employed. •' The writer therefore submits some observations with regard to the circumstances under which loug clinical experience has convinced him that ergot, or its preparations, may and should be given in midwifery practice, and the methods of its j administration, together with a summary of the results to mother and child in one hundred and fifty of the instances in which, in his practice, this drug was thus resorted to. Circumstances under which Ergot may be employed in 1 Midwifery Practice.—Judging from the recent literature of •) this subject, it may not be superfluous to premise that to j use ergot or any of its preparations safely and effectively during parturition the presentation should, as a rule, be cranial ; that there should be no disproportion between the foetus and the maternal parts, nor any obstacle to deliverance in the genital tract; that the os uteri, if not previously fully dilated, should at least be sufficiently dilatable to allow speedy delivery by the forceps whenever that may become neces- 5 sary; and that a preparation of ergot should be selected and a dose given calculated to produce the required ecbolic effect. Under such conditions ergot may be given with utility when required either before, during, or after the second stage . of labour, viz.firstly, in some instances (a) of delay from inertia of the uterus before the full dilatation of a dilatable os, and in which there is any evident danger to either mother or child from protraction of labour ; secondly, it may be ■ administered during the second stage (b) in nearly every case' of long delay from inertia wherein the presentation is natural and the delivery not otherwise impeded, or in which (c) there is then either reason to apprehend the probability of subse- quent haemorrhage, or any such complication as may call for its use ; thirdly, during the last stage of labour this ecbolic may be employed (d) to hasten the expulsion of the placenta when delayed by inertia, or (e) for the arrest of haemorrhage;! fourthly, after labour ergot may be resorted to either immedi-j ately (/) to prevent or check flooding, or subsequently (g) to produce such tonic or permanent contraction as will effec- tually seal up the uterine vessels, and so lessen the liability to subsequent septic invasion, or (h) to effect the expulsion of clots and so arrest after-pains; fifthly, and lastly (i), to stimulate such contraction as may quicken or secure the; process of involution after parturition. Method of employing Ergot.—In such cases this ecbolic, if given at all—and whether ergot, ergotine, ergole, or any other of its preparations be selected—should be employed not in the repeated small and utterly insufficient quantities that have been recommended by some modern writers, but should be administered only once during labour, and then in such a bold, full, and effective dosage as may be likely to excite speedy and permanent or tonic uterine contractibility. With this view, in my own practice I therefore generally use the fresh liquid extract of ergot of the Pharmacopoeia, of which I commonly give a couple of drachms, or some cases three drachms, by the mouth, together with a drachm by deep : hypodermic injection in the gluteal region at the same time. Abstract of 150 Obstetric Cases in which Ergot was f employed.—In 70 of these cases the patients were primiparse ; in 80 they were multiparse In 148 instances the result was favourable to the mother. In 95 of the cases referred to the drug was given before the birth of the child—viz., in 15 for delay from inertia in the first stage of labour, the os being previously dilatable and the head presenting ; and in 80 either . for delay similarly occasioned in the second stage, or else then | for the prevention of lisemorrhage, or for other complications. •. In 92 of these instances the children were delivered alive, either by uterine action or by the forceps. Of the 95 cases in which ergot was given before the birth of the child, in 86 the placenta was normally expelled, and in 9 its removal had to be assisted for morbid adhesions or other causes, one r>nly~ of which was a case of hour-glass contraction. In 55 cases 1 the ergot was given after the birth of the child—viz., in 25^/ during the third stage to hasten expulsion of placenta or to ' prevent haemorrhage; and in 30 after delivery, for the arresu 1 Read before Obstetric Section Royal Academy of Medicine, Ireland, April 24th, 1S97. / .;9](https://iiif.wellcomecollection.org/image/b2247464x_0008.jp2/full/800%2C/0/default.jpg)
