The therapeutics of diphtheria / by A. Jacobi.

  • Jacobi, A. (Abraham), 1830-1919.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: The therapeutics of diphtheria / by A. Jacobi. 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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    avoided ; the room kept airy, and rather dark, so as to encourage sleep if the patient be restless. In no disease, except, perhaps, in pneu- monia, have I seen more fatal results from sudden changes of posture, or from exertion. Unless absolute rest be enforced, neither physician nor nurse has done his or her duty. * The threatening feebleness of the heart yields a positive therapeu- tical indication. In no disease is the danger greater from the side of the heart, in no disease is the indication for sustaining and strengthen- ing the heart more positive from the very beginning. Digitalis, stro- phanthus, spartein, besides camphor, alcohol, and musk, must not be postponed until feebleness and collapse have set in. It is possible or probable that they will appear; and it is certain that a cardiac stimu- lant will do no harm. It is safe, and advisable to use them at an early date. That is particularly necessary Avhen antipyrin or antifebrin is given. A few grains of digitalis, in a palatable and digestible form, may, or must, be given daily. When a speedy effect is required, one or two doses of from two to four grains are not too large, and must be followed by smaller ones. When it is justly feared that the effect of digitalis may be too slow, I give, with or without the former, sulphate of spartein. An infant a year old will take one-tenth of a grain four times a day, as a matter of precaution, and every hour or every two hours in an emergency. Of at least the same importance as cardiac tonics are alcoholic stimulants. The advice to wait for positive symptoms of heart failure and collapse before the life-saving apparatus is employed, is bad. There are cases which get well without treatment, but we do not know before- hand which they will be. No alleged mild case is safe until it has recovered. When heart failure sets in—and often it will occur in apparently mild cases—our efforts are too often in vain. Thus alcoholic stimulants ought to be given early, and in large quantities, though amply diluted. There is no such thing as intoxication or danger from it, in septic diseases. A few ounces daily may suffice, but I have seen ten ounces daily of brandy or whiskey to save children who had done badly with three and four. Coffee is a good stimulant for the heart. Camphor may be em- ployed to great advantage for the same purpose. From five to twenty- five grains may be given daily, as camphor water, or in a mucilaginous emulsion, which is easily taken. It does not upset the stomach as ammonium carbonate is liable to do. It may be employed subcuta- neously when a rapid effect is aimed at, in five parts of oil, which is milder and more convenient than ether.