PRINCIPLES

OF

TREATMENT

MEDICAL

BY

GEORGE

CHEEVER
Assistant

SHATTUCK,

General

FOURTH

to the Massachusetts

Physician

Hospital

REVISED

EDITION

BOSTON:
W.

M.

LEONAED,
1918

Publisher

M.D.

^^
-'^-

COPYRIGHT

BY

W.

M.

LEONARD

1918

TO

WILLIAM

HENRY

SMITH,

TEACHER

MEDICINE

IN

AND

FRIEND

TO

MANY

M.D.

CONTENTS

INDEX.

AND

PAGE

Preface

12

CHAPTER

CARDIAC

Principles
Methods

I.

INSUFFICIENCY.

of Treatment

of

13

Treatment:

(a)

Rest

(6)

Depletion

"

13

.'

13

(c) Stimulation

17
"

(d) Diet

(e)

19

Regulation

Valvular

Disease

I.

Valvular

of

19

Disease

19

Diagnosis

and

Treatment

Life

of

"

Classification
Pathology

Mode

of

for:

21

"

Congenital

Obsolete

and

Valve

Infectious

Lesions
II.

23

Infectious

Active

III.

Syphilitic

IV.

Degenerative

Hypertension
Acute

with

Pulmonary

Pulmonary

Circulatory
Cardiac

Valve

Cardiac
Edema

Disorders

in

25

Lesions

25

Insufficiency

27

Hypertension

with

without

23

Lesions

Valve

Edema

Pectoris

the

Infectious

29

Diseases

Classification

"

31

"Vasomotor

Relaxation,
:

27

Hypertension

Disorders

Vascular

Angina

Lesions

Paresis"

33

"

37

"

37

Diagnosis
4

5
PAGE

SyphiliticAngina

"

Treatment

in

General

39

Treatment

of

Attack

39

Degenerative Angina
Embolic

Treatment

41

Treatment

Angina:

Neurotic

41

Treatment

Angina:

41

CHAPTER

II.

NEPHRITIS.
Classification

43

Differentiation

Renal

Acute

Acute

of

Irritation:

Nephritis :
Principles

45

Treatment

Treatment
Treatment:

of

49
"

Sweating

49

Purgation

51

Diet

51

Liquids

53

Nutrition

53

Medication

53

Prophylaxis

53

Chronic

Nephritis :

Principles

Methods

55

Nephritis

57

Degeneration:

Congestion:

Passive

Methods

57
57

"

of

Treatment

ACUTE

59

of

of

Orders

III.

INFECTIOUS

DISEASES.

Treatment

63

Typhoid
Principles

Treatment

Treatment

CHAPTER

Principles

55

Treatment

Arteriosclerotic

"

Treatment

of
of

Syphilitic

Routine

47

"

of

Methods

Uremia

Types

Treatment

Fever.
65
65

6
PAGE

Methods

Treatment:

of

"

Prophylaxis

67

Dilution

Elimination

and

Conservation

Toxins

of

67

Strength

of

69

Diet

69

Medication

71

Observation

71

Convalescence

73

"

Nursing

73

Symptomatic
Fever

Treatment:

"

Toxemia

and

Circulatory

75

Weakness

77

DlARRHCEA

79

Constipation

79

Distention

79

Vomiting

79

Headache

81

Complications,

Treatment

of:

"

Hemorrhage

81

Perforation

81

Rheumatic
Principles

ACUTE

Treatment

of

Methods

Fever.
83

Treatment

of

INFECTIONS

83

MOST
By

Edwin

COMMON

H.

Scarlet

Prophylaxis

Place,

IN

CHILDHOOD.

M.D.

Fever.

"

Immunity
.

87

Asepsis

87

Isolation

87

Quarantine

89

Disinfection

89

Treatment

Toxemia
General
Local

91

Sepsis
Sepsis

91
93

7
PAGE

97

Nephritis

99

Coiviplications

Cardiac

99

Fever

Measles.
101

Prophylaxis
Treatment
Acute

"

101

Toxemia

103

Infections

Membrane

Mucous

Pertussis.
Prophylaxis

105

Treatment

105
Varicella.
109

Prophylaxis

109

Treatment

"

Diphtheria.
Prophylaxis:

"

Ill

Immunity
Asepsis

111
"

Isolation

Ill

Quarantine

113

Treatment:

"

Toxemia

113

Obstruction
Local

to

Breathing

113

Treatment

Complications:

113

"

Cardiac

115

Paralysis

115

Chronic
Serum

Obstruction

of

Larynx

Disease

117

Carriers

119

PULMONARY
Lobar

Principles
Methods
Stimulation
Delirium:

117

Treatment

of
of

Treatment
of

Heart

Treatment

INFECTIONS.
Pneumonia.
123
123
125
127

8
PAGE

Broncho-pneumonia
Bronchitis,Acute

Bronchitis, Chronic
Bronchiectasis

127
Treatment
:

129

Treatment

131

Treatment

131-133

PULMONARY
By

Course

of

TUBERCULOSIS.

John

B.

Hawes

2nd, M.D.

Disease

the

Complications

135

Sequell^

and

135

Diagnosis

135

Prophylaxis

137

Treatment
Sanatorium
Home

General

in

137

Treatment

139

Treatment

139

Climate

139

Tuberculin

141

Heliotherapy

141

Drugs

143

Miscellaneous

143

ACUTE

INFLAMMATION

OF

RESPIRATORY

THE

UPPER

TRACT.

Etiology

145

Complications

and

Sequell^e

145

Diagnosis

145

Prophylaxis

145

Treatment
Acute

Applicable

Pharyngitis:

CoRYZA

General

in

Treatment

Tonsillitis:

Acute
Acute

149
Treatment

149

Laryngitis:

Treatment

151

Tracheitis:

Treatment

151

CHAPTER
GASTRIC

Indications

for

Principles

Diet

149

Treatment

Acute

Methods

147

of
of

AND
Medical

Treatment

Treatment

DUODENAL
Treatment

IV.
ULCER.

153
153

153

153, 161

9
PAGE

Treatment

Complications,

of:

"

Hemorrhage

157

Perforation

159
159

Obstruction

Pyloric

Severe

Persistent

Symptoms
Acute

159

Indigestion.
163

Diagnosis
Principles

163

Treatment

of

Methods

163

Simple Diarrhoea.
167

Diagnosis

Principles
Methods

167

Treatment

of

169

Treatment

of

Medication

169

Constipation.
Classification
Principles
Methods

171

"

Constipation

Spasmodic
Atonic

171

Treatment

of

173

Constipation

175

Constipation

Obstructive

175

Various

175

CHAPTER

V.

Foreword

179

Abbreviations

181
.

SYNOPSIS

Important Drugs
1. Salvarsan

4. Diphtheria

DRUGS.

:
and

Neosalvarsan

2. Mercury
3. Iodide

OF

183-189
189

of

Potash

Antitoxin

193
195

5. Morphine

195

6. Digitalis

199

10
PAGE

7.

Nitroglycerin

8.

Theobromine

9.

Magnesium

and

Nitrites

201
203

Sulphate

and

Other

Purgatives.

205
.

10.

Quinine

207

11.

Salicylate

207

12.

Hexamethylenamine

209

Valuable

and

Drugs

Non-medicinal

Preparations:
213

13.

Blaud's

14.

Trional

213

15.

Bromide

213

16.

Phenacetin

213

17.

Dover's

18.

Codeine

19.

Sodium

20.

Bismuth

215

21.

Calomel

215

22.

Castor

23.

Cascara

24.

Vaccine

Virus

217

25.

Typhoid

Vaccine

219

26.

Tuberculin

27.

Normal

28.

Alcoholic

29.

"Russian

30.

Agar-Agar

Drugs

Valuable

List

Drugs
List

Tables

Pill

215

Powder

215
215

Bicarbonate

217

Oil

217

219
Salt

Solution

219
219

Beverages

221

Oil"

221

for

Occasional

Use:
225

op:

in Common

Use:
227

of:

of

."

Weights

and

Measures

229

PREFACE.

This

work

of

Most

Smith

H.

William

these

which

and

pupils
Brevity

is

of

in

use

their

Harvard

the

this

but

brevity,

to

have

the

the

be

supposed

Hospital

set

of

or

that

the

of

any

forth

that

or

of

medicine,

the

kindliness

their

patients.

to

the

of

appreciation

deep

writer's
book

this

purpose,

synopsis

prepared

was

primarily

School.

EDITION.

SECOND

first, completeness

has

been

added

and

many

material

new

reliance
but

chiefly, from
is

in

as

Dr.

has

been

sacrificed

changes

made.

been

More

It

in

Medical

TO

edition,

his

The

incomplete.

practice.

Shattuck,

of

here

tried

revision.

express

to

C.

The

been

private

F.

thing

teachers

essential

to

every

humanity

PREFACE

In

to

his

to

being

necessarily

for

here

owes

to

is not

require

not

wishes
he

It

staff

the

have

in

or

Prof.

concisely

and

pathology.
that

those

by

taught

fully

will

writer

The

Hospital

School.

advance

further

General

on

known

on

from

others

subscribe

men

based

been
or

Medical

Harvard

debt

have

them

clearly

offer

to

selected

are

Massachusetts

the

attempt

an

treatment

described

methods

to

of

principles

sound

at

represents

criticism
of

the

information

recent

literature.

pleasure
of
the

before

than

friends

been

has

and,

Massachusetts

salvarsan

about

acknowledge

to

notably,
General

placed

the
that

assistance
of

Mr.

on

personal

perience,
ex-

derived,

was

and

helpful
macist
Phar-

Godsoe,

Hospital.
G.

C.

S.

TO

PREFACE

This

book

has

the

and
"

ready

it

publish

to

Dr.

2nd,
known

and

on

in

Place

Doctor

text

of

the

the

ment
Treatit

gave

an

the

was

it

first,

emphasize

been

peared,
ap-

Medical

to

has

more

has

been

principles.

changed

their

and
sections

ciples
"Prin-

to

the

able

in

Dr.

John

fields

is

his

in

text

favorably

so

C.

S.

them

for

for

the

prevented

has

France

revised

have

Hawes

by

Hawes

EDITION

absence
of

by

B.

G.

FOURTH

edition

infections

acute

by

this

unnecessary.

revision

written

of

respective

continued

Doctor

be

to

tuberculosis

TO

careful

fortune

some

comment

Shattuck's
than

more

book

on

PREFACE

Doctor

from

edition

that

book.

and

good

rare

work

render

to

the

material

whose

as

the

methods

of

piece

Place

H.

men

of

of

ground

because,

of

first

Treatment."

new

Edwin

title

the

Synopsis
the

on

scope

name

Medical

count

the

the

the

of

name,

subordinate

to

Accordingly

of

since

"A

criticized

change

to

desire

my

original

idea

inadequate

EDITION.

considerably

grown

been

has

THIRD

minor
and

corrections.
added

the

to

edition.

previous
W.

M.

L.

CHAPTER

INSUFFICIENCY.

CARDIAC
GENERAL

PRINCIPLES

A.

Rest.

B.

Depletion.

C.

Stimulation.

D.

Suitable

E.

Regulation

The

of

Mode

OF

to

be

regulated

underlying
suit

to

needs, and

individual

meet

the

whatever

same

however,

must,

symptoms,

Life.

of

the

much

are

Treatment

severity

TREATMENT.

OF

Diet.

principles

cause.

I.

for

the

ties
varie-

of disease.
An

diagnosis

exact

insufficiency and
diagnosis

is

treatment

for

be

may

be

not

may

for

METHODS

OF

2.

Minimum

3.

Relieve

position

discomfort

morphine

Obtain

Purgation.
according
edema

exhaustion

Magnesium

planning

Rest.
in

and

B.

When

for

and

prognosis

in

accuracy

bed

chair.

or

exertion.

discomfort

1.

first, but

severe

TREATMENT.

A.
Semirecumbent

of

presence

future.

the

1.

the

at

necessary

important

very

in

diflScult

is

to

If

sleep.

there

is

much

is indicated.

subcutaneously
Depletion.
catharsis

watery

more

or

less

profuse

of edema.

amount

absent

secure

or

slight avoid

excessive

purgation

result.

sulphate

(p. 201)

is useful

as

purgative.
.

13

lest

15

of

Limitation

2.

should

exceed

not

twenty-four

in

to

suffer

ice

or

minimum.

from

follow

the

Theobromine

prescribed.

should

Calomel
salivation

be

not

right

kidneys

if the

has

is contraindicated
anemia.

some

the

side

of the

inner

the

made

be

in the
The

knife.

latter

the

evidence
edema

Apply
then

would

them

be

oozing
coiurages

6.

is

of

and

gorgement
en-

venous

ment
engorge-

withdrawn.

be

marked

by

or

be

can

by

vein

stopped

weakness

incising

tourniquet

be

may

prominent.
the

Venesection

with
with

vein

The

incision

the

point of

pad

on

around

put

and

or

should

sharp

bandage.

as

substitute

undesirable

be

will

or

for

when

generally relieve

venesection

symptoms

when

less

are

painful engorgement

liver.

of the

allow

veins

Useful

Leeching

severe.

there

is unnecessary.

Leeching.

5.

long axis of

vein

pected
ex-

theophylline

or

marked

may

elbow.

bleeding

the

Suturing

more

emaciation

the

render

to

arm

be

be

may

occasionally when
with

should

cases.

generally withdrawn

is

liquids with

liver.

by

Blood

cases

nephritis because

theocine

in

ventricle

even

or

by

severely damaged.

not

are

patient

Apocynum,

and

pint of blood

of

mild

its substitutes

or

stasis; e.g., dyspnoea, cyanosis, pulmonary

of neck-veins

relieved

diuretics

extreme,

or

Indicated

of the

be

may

limitation

and

theobromine

than

Venesection.

4.

the

given

result.

better

pint

patient should

digitalis. In

of

use

(p. 199)

provided

may

act

may

well

act

to

persistent

is

edema

When

It

One

suffice.

digitalismay

without

or

The

thirst.

insufficiency,rest, purgation

of

hours.

twenty-four

by gargling.

should

Diuresis

the

near

liquids,including liquid foods,

in

pints

is

sucking cracked
3.

three

hours

allowed

be

not

Total

Liquids.

dozen

remain

to

covered
from
the

leeches

the

with

bites.

leech

Tapping.

until

to

over

the

they drop

right hypochondriimi
off.

The

large, moist, absorbent

A

bite.

Necessary

cavity seriously embarrasses

drop of milk
Salt
when
the

causes

fluid in the
heart

or

should

dressing

placed
him

abdomen

to

on

and

the

to

favor

skin

let go.

chest

or

respiration.

abdominal

en-

17

Stimulation.

C.

ordinarily

twenty-four
needed

forty-eight

to

initial dose

an

effects

When

be

When

quicker

in from

apparent

results

are

injected into

be

(or 2 c.c.)may

are

given by

should

hours.

min.

of 30

bad.

digitalis

gluteal muscle.

the

When
be
to

dosage

in sufl"cient

mouth

its action

of

digitalisno

pushing
probably

is

preparation

the

apparent

after

If

well.

acts

(other drugs
*

good tincture

preferred occasionally). A

be

may

stimulant

cardiac

best

the

Digitalis (p. 195) is

effects

prompt

used.

given by mouth

When

intravenously.

used

quickly when
strophanthin

it should

in from

effects

show

in

act

can

twelve

from

For

hour.

to

It

acts

more

insufficiency

urgent

very

is

It

intravenously.

used

be

may

(p. 197)

digipuratum

cularly
Digipuratum-solution injected intramus-

hours.

twenty-four
may

desirable

are

dangerous

(p. 197).
sodio-salicylateis believed

Caffeine
used

in

should

with

conjunction
be

(or 0.06

0.2

to

Black

coffee

caffeine

or

this purpose

the

repeated doses
be

citrate may

restlessness

Slight exacerbations
by

in

diuresis

of from

when

caffeine
3

1 to

grs.

gm.).

cause

may

digitalis. For

subcut.

used

promote

to

of

or

tried

feine
Caf-

by mouth.

insomnia.

dyspnoea

distress

or

can

be

often

lieved
re-

quicldy diffusible stimulant, e.g.,

By mouth:
(a) Spiritus ammonite
(6) Whiskey
Subcutaneously

or

{d) Cocaine
act

Many

Should

from

to

in oil: f 3 grs. (or 0.2

hydrochloride: from

0.016
very

prefer powdered
be

brandy:

1 drach.
1

oz.

(or

(or 15

to

c.c).
30

c.c).

(c) Camphor

to

aromaticus:

gm.).

It is said

to

well.

leaves

specially prepared

in

pill-form,

for subcut.

use.

gm.).
|
be

to

cularly.
Inject intramus-

i gr.

dangerous

(or 0.008
but

may

19

Insufficiency with
seems

under

act

to

pain requires morphine

these

circumstances

which

favor

recuperation.

under

these

circumstances

to

prompt

ensure

It

cardiac

psychic relief

and

be used

morphine should

The

(p. 191).

efficient

an

as

brings also physical comfort

It

stimulant.

much

subcut.

effect.

Diet.

D.

effort,particularlyif there is
Spare the patient unnecessary
much
dyspnoea, by ordering food which is easy to swallow and
which requires no chewing.
By frequent small feedings and by avoiding gas-producing
foods

seek

to

Emaciated
as

is

distention.

ment
nourishconcentrated
patientsshould take as much
practicable in order to strengthen the heart muscle

by improved nutrition.
Fat or plethoricindividuals

may

benefit

prevent relapse during and

by fasting.
of Life.

of Mode

Regulation

E.
To

from

embarrassment

prevent cardiac

convalescence,

after

the

mode

wisely regulated; and intelligent

patient and physician is essential to this
cooperation between
tell the patient something
to
It is generally necessary
end.

of life of the

about
induce

his

patient

condition

be

must

and

to

him

warn

to

fatigue and exertions which

much

avoid

activities which
much

cause

dyspncea.

in dealing with
be exercised
an
Judgment and caution must
apprehensive patient lest danger be exaggerated in his mind, and
After a sufficient period of complete rest the patient
harm
result.
should be encouraged to take regular exercise within the limits
in order
to
of tolerance
strengthen the heart by promoting

hypertrophy.
Exercise
close

and

should

work

Congenital

2.

Infectious

3.

Syphilitic

VALVULAR

OF

(Most
.

very

gradually under

Most

I
Degenerative

discovered

in

early

commonly discovered in youth.

in middle
discovered
commonly

life.

Most
.

DISEASE.

childhood.

(Most
.

commonly

4.

resumed

supervision.
CLASSIFICATION

1.

be

commonly

discovered

in old age.

21

NOTES

ON

Congenital lesions.

1
.

mistaken

It is seldom

with

confused

be

2.

for

with

Infectious

lesions

(a) Active

stage.

of bacteria

the

on

AND

other

DIAGNOSIS.

stenosis is the most

Pulmonic

anomalies

combined

often

are

PATHOLOGY

of lesion but

types

which

common.

have

similar

easily

may

signs and

which

it.
:

Inflammation

due

of valves

to

presence

valve.

(6) Obsolete

deformed

Valves

stage.

and

scarred

as

result of inflammation.

(c)

Recurrent

Reinfection

stage.

with

inflammation

site

at

of old lesion.

Lesions
and

found

are

mitral valve

at the

commonly

at the

or

aortic

mitral

ally
Occasionvalves, seldom at the aortic valve alone.
the
mitral, aortic and tricuspid valves are all diseased.
Stenosis develops frequently.
Obsolete
lesions if well compensated may
give no symptoms.
attention
cardiac
They first attract
by diminished
efiiciency
or
by failure of compensation.
In

active

the

general infection with

extends

and

aorta

The

The

are

of

those

failure of

compensation.
cending
generally begins in the assubsequently to the aortic valve.

without

or

Syphiliticlesions.

3.

stage the symptoms

recurrent

or

lesion

earliest
of

murmur

may

be slightdilatation
of the
arch and the
signs may
of aortic regurgiaortic roughening. Later, that
tation
relative mitral regurgitationmay
and, finally,
appear

develop.
A

lesion of the

syphilis as
coexist

its

aortic valve
Aneurism

cause.

part of the

as

Evidence

of

only,

same

in

or

adult, suggests

young

coronary

endarteritis

may

process.

old

syphilissupports the diagnosis.

in syphilis,the signs point to
4. Degenerative
lesions.
As
of syphilisis lacking.
lesion at the aortic valve but evidence
a
The
background is one of senilityand general arteriosclerosis to
an

which

sclerosis of the

There

may

be

dilatation

degeneration,perhaps
Note.
followed

"

aorta

All
in time

the

and

of the

also

of the
arch

and

aortic valve
evidence

is incidental.
of

myocardial

angina pectoris.

types of lesion

enumerated

by cardiac insufficiency.

above

may

be

23

FOR

TREATMENT

Obsolete

Congenital and

TYPES

Treat

according

They

must

be

Infectious

II. Active
A
.

2.

Minimum

3.

Dilution

4.

Elimination

5.

Maintenance

6.

Stimulation

chief

the

As

for acute

in

general

be

may

or

recurrent.

toxemia, exhaustion, cardiac

from

are

acute, subacute

tation
dila-

embolism.
of

preexisting rheumatic
fever, chorea
diagnosis of active endocarditis.

recent
a

(a) Good

and

toxins

threatens

intake

to

and

if there

or

very

by attention
possible,spare

whenever

Have

is

nursing

comfort

promote

dilute

liquids.

be

(c) Feedings should

favor

to

embolism

is to

order

output recorded.

or

or

The

feed

ance.
annoy-

abundance

If cardiac

tation
dila-

be restricted.
liquidsmust
frequent, the food nutritious,and the
is edema

avoided

be

to

are

exertion

elimination

Liquids and

regulated by digestive power.

because
preferablein severe
cases

(d) Stimulants

important.
details,should

him

amount
are

infections

p.r.n.

infection

patient and,

of

of Valves.

of nutrition.

Methods,

(h) To

of symptoms.

cause

of toxins.

dangers

should

nurse

to

if present.
insufficiency

tonsillitis strengthens
B.

regard

of toxins.

history

with

exertion.

The

"

or

above.

in bed.

Rest

The

and

nature

Lesions

for cardiac

1.

Note.

individual

for the

Principles of Treatment.

(p. 23) and

of Valves.

general principlesgiven

modified

severity, duration,

DISEASE.

Lesions

Infectious

the

to

VALVULAR

OF

feared

be

easy

to

soft

swallow.

unless
and

solids

clearlynecessary
stimulation
might

cause
befavor

it.

(e) Tachycardia

placed
C.

over

the

be

reduced

by

an

ice-bag

praecordia.
To

Convalescence.

patient in bed

sometimes

may

and

as

minimize

quiet

as

danger of relapse keep the

after
possiblefor weeks or months

25

pulse and

the

depends
against strain, and

in

if

eliminate

sinuses,teeth, tonsils,or genito-urinary

(6) Diseased
suitable

and

tonsils,as

is

It

opportunity.

rule, should

lesions

dangerous

and

Therefore, guard

anemia,

or

provement
im-

possible

of the

extent

malnutrition

treat

Permanent

of

patient.

promote hypertrophy of the heart.

for
D. Prophylaxis,
(a) Search
infection

degree

and

the

of

power

to normal.

The

location

the

on

recuperative

the

on

remains.

nearly always

damage

returned

have

temperature

be

removed

to

remove

present,

to

all

of

foci

tract.
at

the

them

first
when

acutely inflamed.
the

(c) Warn
attend

promptly

strain, and

patient against

exposure

ailments,

if

to

even

physical exertion

any

and

insist

slight, and

he

that

avoid

mental

produces dyspnoea

which

or

fatigue.
III.

Syphilitic Lesions
well

as

Little

of

general

as

improvement

diagnosis be made

cation
require antisyphiliticmedi-

Valves

be

can

unless

the

irreparable damage

has

expected, however,

extensive

before

insufficiency.

for cardiac

measures

and

occurred.
IV.

principles with
(a) When

the

Thin

is

heart

high,

should

They

nitrites

little

treated

on

eral
gen-

follows:
be

may

of

value

to

pressure

temporarily.

nutrition

to

or

strengthen

purgation unless

no

is considerable.

(c) Regulation of life is of the

after convalescence.

(d) Many
more

less

or

lives.

The

his medicine
muscle

may,

form

dosage

Several

be
or

patients' cooperation
for

small

sufficient.
to

of treatment.

doses
Warn

give it up

perhaps, be

the

on
so

his

or

individual
per

the
own

changed

week

be secured.

must

digitalisand

take

long periods

for

during and

importance

utmost

patients should

frequently
best

may

The

these

of

only by trial.

any

as

by lowering

undergo

be

may

modifications

certain

of the

Valves

patients require the maximum

heart.

edema

of

blood-pressure

lighten the work

(6)

Lesions

Degenerative

for the
can

be

taken

patient

not

rest

regular
be

responsibility.
that

it cannot

their

determined

at
to

of

salts

tervals
in-

without

The

heart

respond

to

27

WITH

HYPERTENSION
and

Etiology

is

is

in

commonest

also in arteriosclerosis.

seen

ventricular

left

and

INSUFFICIENCY.

Hypertension

Symptoms.

nephritisand

chronic

CARDIAC

The

hypertension
develop gradually.
gradually as to be

hypertrophy

often
increase
of insufficiency
so
Symptoms
The
of the
condition
disregarded by the patient for months.
the signs would
critical than
to
seem
patient is generally more
in these
is common
Acute
indicate.
cases.
pulmonary edema
of

Many

show

them

toxemia

of

signs

attributable

deficient

to

renal elimination.
Methods

for cardiac

insufficiency(p. 13).
of the heart by lowering blood-pressure
the work
Reduce
sequence.
temporarily unless the urinary output falls in con1.

Treatment.
2.

nitroglycerin(p. 197), lower bloodtemporarily and often promote diuresis also.

pressm-e
and
measures
(6) Purgation, diuresis,venesection
tending
to improve the circulation seem
to relieve toxemia
or
(a) Vaso-dilators,

if not

to favor

(c) Fasting

for

several
is

to

days

benefit

surest

be

marked

or

may

must

reduction

cause

day

of the

one

e.g.,

means

avoided

of pressure

restriction

in

of

tension.
hyper-

food

for

It
plethoric individuals.
of lowering pressure.
ciation
Ema-

because

it increases

cardiac

weakness.

{d) Relief

followed

by

toxemia

When

3.

psychic strain, e.g., business

from

(a) Purgation

of

(c)

Hot-air
If toxemic

ACUTE
Notes.

it

reduce

by:

diuresis.

food, and
or

hot

of

soaks

proteid in particular.
if cardiac

symptoms

permit.

been

symptoms

PULMONARY

EDEMA

IN

HYPERTENSION.

and
in hypercommonly
characteristically
tension.
attack
and
not
generally follows exertion
may

Occurs

"

The

The

be

persist after improvement in the

in origin and
circulation they are
probably uremic
should
be treated accordingly (p. 59).

4.

have

baths

may

fall in pressure.

is present

or

(6) Restriction

cares,

preceded by

onset

is sudden

marked
and

symptoms

alarming.

of cardiac

insufficiency.

29

The

and

dyspnoea, cyanosis,wheezing, cough,

be prsecordial
may
pinkish, frothy expectoration. There
symptoms

are

severe

pain.
Mild

Treatment.

off

pass

may

require energetic and

attacks

Severe

attacks

after

little rest.

treatment

prompt

as

follows:

upright without effort.

Give
morphine sulphate, gr. J (or 0.016 gm.) atropine
to 0.001
gm.) and
sulphate, gr. xk to io (or 0.00065
to 0.001
gm.)
nitroglycerin,gr. t^ to ^ (or 0.00065

Prop the patient up

subcutaneously

he

so

at

sit

can

once.

Unless

4.

The

following drugs

be of service.

may

nitrite: 5

Amyl

By inhalation:

(or 0.3 c.c).

m.

aromaticus:

Spiritus ammonise

Spiritus setheris compositus:

By mouth:

(or

5.

Do

not

15

Rest
to

7.
8.

appear

specialtreatment.

drach.

are

"Hoffmann's

to

oz.

gr.

(or

0.016

gm.);

dangerous.
:

for

is advisable

without

cardiac

few

days

to

allow the heart

insufficiency

When

of doubtful

anodyne."

severe

seldom

from

any

acute

it should

avoid

to

be

to

treated

blood-pressure being normal

value and may
perhaps do harm.
the

It

cause.

enough

re-

edema

Pulmonary

Hypertension.

stenosis,but

except, that
nitrites

(or

passed.

Edema

in mitral

drach.

itself.

recover

in

dangerous (p. 197).

transport the patient until immediate

to

attempt

in bed

be needed.
purgation, etc, may
Digitalis,
Subsequent regulation of life is essential

Pulmonary

common

hydrochloride: I

said to be

has

(or

c.c).

30

to

Strophanthin

danger
6.

brandy: from

or

Cocaine

Intravenouslv:

drach.

c.c).

Whiskey

Subcutaneously:

c.c).

may

nitroglycerin
be required.

improvement begins promptly, the

should be repeated, and venesection
may

3.

as

is

require
in hypertens
or
low,

31

edema

Pulmonary

be

it may
For

origin.

acute, but

very

treatment

see

''Pneumonia,"

71, 75, and

in infectious

also

occurs

CIRCULATORY

33; also

p.
p.

is not

diseases.

In

monia
pneu-

necessarily of cardiac

"Typhoid

Fever,"

pp.

125.

DISORDERS

IN

THE

TIOUS
INFEC-

DISEASES.
Note.

and
be

in

Common

"

in

The

septic states.

attributed

to

of the

one

infections, particularly in

acute

monia
pneu-

circulatory disturbances

following

causes

or

to

may

combination

of them.
A.

CAUSES.

1.

Faulty innervation

2.

Cloudy swelling of myocardium due to toxemia.

Ill-nourished
myocardium
secondary to emaciation

3.

of the

due

heart

toxemia.

to

or

anemia.
4.

Infection

5.

Lesions

of the

obstructing
of the

6.

Vascular

Dilute, eliminate

2.

Minimize

3.

Prevent

4.

Strive

5.

Emaciated

them
6.

as

well
a

food

toxemia.

to

GENERAL.

IN

neutralize

toxins.

exertion.

maintain

distension.
nutrition.
of

patients, capable
and

indirectlyas

precisediagnosis or

as

which

act

to

seem

times
some-

for

stimulant.

often

must

taking little food,

alcohol

of

large doses

on

stimulants

Cardiac

lack of

due

or

abdominal
to

the

TREATMENT

1.

pericardium.

or

bolism
pulmonary circulation, e.g., empulmonary artery or of^its
large branches.

relaxation

B.

do

valves, myocardium

be

last

tried

hope.

empirically
They

often

from

fail to

do good.
C.

TREATMENT
I.

1.

tried.

Cardiac

Faulty Innervation.

bag, etc., may

2.

IN

be

Disorders.

Alcohol, digitalis,
strychnine

tried but

Cloudy Swelling.

PARTICULAR.

are

not

likelyto

Digitahs, caffeine

avail
or

or

ice-

much.

camphor

may

be

33

Ill-nourished

3.

patient. Alcohol

the

and

stimulants

Infection.

Cardiac

4.

demands

Myocardium
Treat

improved nutrition
perhaps help.

may

active

for

as

of

infectious

carditis,
endo-

p. 23.
5.

Obstruction

6.

Pulmonary

used

may

be attributable

Notes.

be tried.

Venesection

Relaxation

relaxation

The

"

action of toxins

on

nerves

*'

dilatation.

Vasomotor

is believed

Paresis."

be

to

blood-vessels.

or

the

The

be

may

the

watching

gradual

It

still of

heart-sounds

low

peripheral pressure

the

heart's

are

action

rapid.

or

that

development,

the

result

and

of

the

occasionally

occurs

in

pneumonia.
although its cause

and

the

It

be

can

pulse becomes

good quality. Later,

becomes

and

more

weak
as

of blood

return

meager

observed, by

to

rapid,

more

the

of

Promote

Treatment.

of

heart,

the

perhaps irregular. Finally, the extremities

face pale and the pulse imperceptible.

Principles

while

result

and

cold, the
heart

the

same.

onset

fainter

do good if the

may

infections,particularlyin typhoid
condition
is analogous to surgicalshock

is not

sounds
become

to

the

by hypodermoclysis is

idly
rap-

of

return

blood

by:
(a) FiUing

vessels,or by

the

(6) Constriction
Methods:

and

It may

bad.
time.

Salt

1.

absorbed

of vessels.
solution

life

save

pint, heated
It may

be

repeated

dilatation

When

the

frequent

may

need

be

in from

the

patient'scondition

in

doses

unless

an

hour

or

of salt solution
excretion

for salt solution

be

kept

can

be

be

be

utes.
min-

is very
used

later if needed.

given intravenously

administering it should

five to fifteen

blood-temperature^ should

to

lead to cardiac

well

when

even

of

Salt solution

used

generally acts

administration

of

strophanthin

or

severe

The

stimulants

directlyto cardiac

Vascular

II.

Cardiac

subcutaneously.

edema

in

Lung.

Edema

{dangerous,p. 197)

As

rule

nothing can be done.

occasionallyyieldspromptly to atropine,

in the

at

The

in this way

may

rapid.
in very

critical

anticipated the

in readiness.

ditions.
con-

means

35

2.

Direct

transfusion

3.

Adrenalin

chloride

results

with

milder

and

Caffeine

cutaneously,

tried

if

it

could

be

is

is

It

effect.

vaso-constrictor

powerful

very

difficult

to

but

satisfactory

get

it.

has

Pituitrin

its

in

transient

very

be

might

delay.

without

done

blood

of

less

effect

an

It

transient.

sodio-salicylate,
but

is

not

verv^

like

blood-pressure

on

be

may

gr.

(or

effective

tried
0.2

as

but

safely.

gm.),
a

adrenalin,

may

be

vaso-constrictor.

tried

sub-

37

ANGINA
Pain

Definition.

occlusion, of
is

Spasm

heart
is

there
be

may

or

or

be

may

Syphilitic:

2.

Degenerative

to the

of

3.

Embolic:

4.

Neurotic:

to

degenerative

confined

other

to

"neurotic

angina," in

common.

Occlusion

rather

exhaustion

ficient
of de-

or

myocardium.

in

of

Angina

men

of

arteriosclerotic:
in endocarditis

seen

be

may

threatened

common
or

or

spasm,

embolic.

Etiological Classification
1.

to

syphilitic or

aorta, and

lesion, is

indicative

blood-supply

with
lesions

the

to

known

no

thrombotic

Angina

attributable

artery.

coronary

vessel-wall,but

parts of the
which

distress

or

generally associated

in the

change

PECTORIS.

early middle
in old

common

intracardiac

or

in young

common

Pectoris.

age.
men.

thrombosis,

women.

DIAGNOSIS.
An

history of

accurate

of the
for the

pain and

disease

the

is of the

suggests angina.

the

Angina

mode

of onset, duration

discovery of

adequate

an

greatest importance.
in

young

ation
radi-

background

Pain

middle-aged

or

and

exertion

on

suggests

man

syphilis.
A

complete physical examination

Angina

in

Painless

woman

young

angina, otherwise

I.

nothing important.

suggests psychic trauma.

typical, is

SYPHILITIC

seen

rarely.

ANGINA.

Syphilitic changes in the

Patholbgy.
coronary

show

may

their

arteries, diminishing

aorta, aortic

circulation

are

valves

or

generally

demonstrable.

Etiology.
middle

late

manifestation

of

syphilis; commonest

life.

Prognosis.

The

prognosis is

very

uncertain.

in

39

A.

Treatment

1.

Antisyphiliticmeasures.*

2.

Regulation

in

of life to reduce

is of the

General.

demands

the heart

on

importance.
to bring on
(a) Avoid
anj^thing known
angina
individual,e.g., exercise after meals.

it^canmeet

utmost

(6) Avoid

physical and mental

(c) Avoid

distention

Food

(d)

what

to

and

of the

(e) Tobacco

and

(/) Bowels

should

alcohol
be

and

be taken

bowels.

in moderation.

in great moderation

kept

the

strain.

stomach

liquids should

in

all.

if at

free.

Cardiac

if present, requiresappropriate treatment

insuflSciency,
on
general principles.
the number
4. Small
doses of digitalisoften help to reduce
the
of attacks
usual signs of cardiac insufficiencywhen
even
3.

absent.

are

barium

chloride,grs.
At

5.

Theobromine

relieved

ro

the first

sodio-sahcylate, grs.
be tried for the
t.i.d.,
may

of

the

attack

an
sign
(p. 197) or amyl nitrite,
repeat

and

quiet for

remain

time

after

An

expected attack can sometimes

of nitroglycerin. The
drug must
effort. Nitroglycerin should

the

mouth

but

not

purpose.
take

glycerin
nitro-

if not

minutes

few

the attack

has

passed.

be

prevented by timely use

out
be always accessible with-

be

chewed

and

absorbed

in

kerchief.
amyl nitrite taken by inhaling it from a handIt is important to provide pearls which
break
easily
spontaneously if amyl nitrite is to be used.
and

B.

same

patient should
it in

t.i.d.,or

called

to

cutaneously

or

of

Treatment

treat

an

attack

amyl nitrite

or

Anginal

Attacks.

angina use nitroglycerinsubboth

immediately. Repeat the

of

glycerin
If nitropatient is not relieved.
effect in repeated doses amyl nitrite may
gives no
haps
perrelieve.
If the
and
obstinate
pain is luiusually severe
be injected.
morphine may
Do not attempt to transport the patient and do not allow him
for a time
after the symptoms
the slightestexertion
to make
attack.
have passed. Rest in bed is advisable after a severe
be avoided.
That
is known
to bring on
which
attack must
an
in

dose

"

few

It is doubtful

cardiac

disease.

minutes

whether

if the

Salvarsan

should

be

used

in the

presence

of

severe

41

II.

Pathology.

of

part

at

occur

may

take

there

is any

digitalisand

salts

individual

the

be

must

doses

in small

be

life to

cardiac
for

be

often

eration,
degenstrable
demon-

sudden

but

possible

death

The

dose

required for

carefully by trial.
iodide

potassium
number

the

patient should

insufficiency the

determined

limit

may

strain.

avoid

long periods.

Digitalis,theobromine,

3.

myocardial

arteriosclerosis.

life may

Regulate

1.

When

2.

chronic

time.

any

Treatment.

of

and

myocarditis, will

widespread

Years

Prognosis.

fibrous

without

or

ANGINA.

sclerosis

Coronary

with
as

DEGENERATIVE

of

or

attacks

barium

chloride

even

prevent

or

them.
If

4.

old

an

protiodide
The

5.

be

syphilis

of mercury

moderate

in

the

for

treatment

suspected

iodide

give potassium

and

doses.
is the

attack

in

as

same

syphilitic

angina.
EMBOLIC

III.

Vaso-dilators

in

usually required
of

onset

likely

are

Etiology.
fear

or

It is seen,

complete

emotional

suddenly

come

may

at

cure

when

to

and

changes recognized.
in

excess

is not

to

associated

often

be

tea, coffee, or
with

debility.

women.

young

and

expected

tobacco,

the

chance

of

is excellent.
the

Remove

hygienic

means

attack

shock

Death

1.

these

ANGINA.

exclusively, in neurotic

almost

General

but

due

Commonly

Treatment.

The

NEUROTIC

characteristic

No

Prognosis.

By

(Death

is

Morphine

symptoms.)

Pathology.

2.

give little relief.

to

large doses.

IV.

to

ANGINA.

can

generally
severe,

possible.

when

measures.

recurrence

is

cause

too

it should

be

brief
be

prevented.
and

mild

treated

to

like

require

ment,
treat-

organic angina.

CHAPTER

II.

NEPHRITIS.
CLASSIFICATION.

1.

Acute

Renal

2.

Acute

Nephritis.

3.

Chronic

4.

Syphilitic Nephritis.

5.

Arteriosclerotic

6.

Passive

Congestion.

ON

require different
renal
be

to

appear

allied

degree,

instead

of

from

vascular

either
Besides

the
the

process

intermediate

amyloid

rare

differs

the

which

from

former
two

may
or

degeneration

be

mation.
inflam-

mainly
in

that

slowly.

an

inflammation

degeneration

secondary

combined.

often

are

essentially different

being primarily

being
are

it may
is

renal

nephritis

acute

degeneration

bridged

are

nephritis

acute

from

nephritis

diseases

of

types

though

latter

them

infectious

three

it progresses,

nephritis,

disease,

these

chronic

and

between

acute

nephritis

chronic

and

gaps

the
of

irritation

nephritis

and

arteriosclerotic

kidney

important

more

clinically and

recognized

The

cases

recovering

chronic

of the

diseases.

most

and

Although

be

the

only

separate

can

forms

Toxic
in

to

irritation, acute

for

responsible

CLASSIFICATION.

treatment.

intermediate

by

aims

nephritis which

Acute

Conditions.

Degeneration.

classification
of

types

Allied

Nephritis.

NOTES

This

Irritation.

such

In

to

binations
com-

predominate.
mixed

forms

and

of

variety

nephritis there
of

forms

are

difficult

the
to

classify.
*

The

nephritis

recent

work

is caused

of

by

H.

the

Cabot

and

Crabtree

viridans*

streptococcus

43

seems

to

show

that

glomerular

45

less

by

in the

profound changes

insufficiency and

renal

It is

cause.

distinguished from

is

Irritation

Renal

Acute

prompt

Nephritis * is common
generally traceable to an acute

in acute

and

tonsillitis

follow

may

and

the

of

It is

youth.

disease,is

infectious

of

symptoms

fevers.

childhood

in

of

after removal

recovery

Acute

nephritis

acute

absence

urine,

frequently symptomatic

after scarlet fever

NEPHRITIS.

OF

TYPES

OF

RECOGNITION

found

often

result from

or

an

in

severity and
nephritis differs much
poison. Acute
show
Severe
cases
consequently in signs and symptoms.
may
and
anuria or marked
perhaps uremia.
oliguriawith anasarca
is loaded
with blood, albumen, casts
in these cases
urine
The

irritant

smaller

contains

conditions

of mild

that

fat,and

and

Blood-pressure

amount.

the

moderately elevated,

be

may

in

elements

same

weeks, left ventricular

persists for some
develop.
hypertrophy may
Chronic
ritis,
Nephritis. The etiology is like that of acute nephcases
arising from chronic
as
rule, but there are some
a
disease

if the

and

toxemias.

stages.

1.

Early.

2.

Subacute.

^^^^^^^

Phases.

Chronic,

3.
The

of the

course

twenty

disease

from

run

may

Any

more.

or

years

,.

Exacerbation.

0.
.

^,

"

stage

be

may

few

without

less to

or

years

symptoms.

nephritis,
acute
be mistaken
and exacerbations
nephritis. Left
may
ventricular
hypertrophy and hypertension develop gradually
and there is a progressivefall in the specificgravity of the urine
The

early stage

be

may

indistinguishablefrom

acute

for

associated
The

with

an

in the

increase

late stage shows

left ventricular

marked

200 mm.
blood-pressure generally over
of very
low gravity,containing little or

sediment.

parenchyma has been

shrinkage has followed so
in size.
The
chief dangers
The

sublimate
the

acute

is of

glomeriilar

hypertrophy,

of mercury
albumen

no

and
and

urine

a
a

scanty

of
glomeruli and much
tissue,and
replaced by connective
diminished
that the kidneys are much
of

this stage many

At

the

of urine.

amount

type

tubiilar
and

the

by

variety,

is caused

from

are

nephritis produced
the

whereas

by

the

uremia

irritant
that

or

poisons such

of

streptococcus.

the

acute

cardiac

from

as

corrosive

infections

is of

47

of
insujEciency secondary to hypertension. In the absence
arteriosclerosis a provisionaldiagnosis of chronic nephritis may
of hypertension and
of cardiac
often be made
by the evidence
Cases

of

chronic

nephritis complicated with arteriosclero

to
liable
are
apoplexy.
SyphiliticNephritis is generally regarded as an unusual form
of acute nephritis. It occurs, according to Osier,most
commonly
of the prisix months
in the secondary stage of syphiliswithin
mary
resembles
it
lesion and
glomerular nephritis. Gumma
but it is probable that some
of the kidney is rarely seen
instances
of syphiliticorigin. Signs of an
of renal arteriosclerosis are

hypertrophy.

syphilisin the

active

the

that

prove

two

Arteriosclerotic

be

may

part of

chieflyin

manifested

destruction
sclerosis of the

arteries

and irregularityor
The

of

and

casts.

Hypertension

in the

well marked
The

the

of

the

those

Local

parts.

greatest dangers

from

are

and

albumen
of

that

chronic

hemorrhage.
Typical uremia
there
but
degenerative cases
the
with
nephritis combined

occurs

is

inflammatory
nonon

some

nephritis.

hypertrophy are
renal degeneration.

cardiac

it

shrinkage

left ventricular
later stages of

or

results.

considerable

show

occurs

in

kidney dependent

of the surface

it resembles

Later

There

kidney.

parts

roughness

and

kidney is most common

widespread arteriosclerosis

supplying

urine, at first,
may

blood

not

of the

Degeneration
be

nephritissuggest but do

related.

are

It may

old age.

of

presence

generally

cerebral
or
insufficiency
rarely if at all in pure

often

more

or

less

chronic

Chronic
degenerative lesions.
be important etiologicaUy.
lead-poisoning,gout or syphilismay
Passive
Congestion is secondary to congestion in the venous
circulation.
diac
Therefore, it is commonly
symptomatic of carinsufficiency. The urine is high colored, scanty and of a

high gravity. Albumen

and

number.

clears

congestion

uremic
of the
mask

may

found, varying

are

in amount

and

symptoms,

the

urine

congestion.
an

nephritis,especially

acute

active stage of endocarditis.

ACUTE

Treatment.

the

casts

no

are

rapidly after removal

Passive
in the

There

and

The

RENAL

IRRITATION.

signs of irritation

free administration

of

water.

The

can

be
water

much

reduced

dilutes

the

by
irri-

49

and

tating substance
other

No

is needed.

direct treatment
Make

Caution.

that

sure

nephritisis not developing.

NEPHRITIS,

ACUTE
PRINCIPLES

Reduce

A.

by stimulating diuresis.

excretion

promotes

OF

the demands

TREATMENT.

the

on

kidney by;

in bed.

1.

Rest

2.

Elimination

\ ,,{

channels.

other

bv

\.-^

^s

i (6) Sweatmg.
3.

Suitable

4.

Limitation

C.

Avoid

D.

Drugs

liquidsin suitable

of

cases.

nutrition.

Maintain

diet.

exposure

to

should

be

cold

to

or

used

sudden

cooKng.
indicated; never

when

only

by

routine.
METHODS

TREATMENT.
in bed

1.

Hot-air

2.

Hot

tub-bath.

3.

Hot

wet

4.

Electric

lightbath.

5.

Turkish

or

Sweating.*

Hot-air

OF

baths

are

best

bath

or

chair.

pack.
Russian

given

bath.
bed.

in

If the

baths

cause

be used daily for an hour

or
profuse sweating they may
more.
If sweating does not begin promptly a drink, hot or cold, may
start
be administered
it, or pilocarpine may
subcutaneously.
and
edema
Pilocarpine may
cause
pulmonary
is, therefore,
contraindicated
the

or

when

the

patient unconscious.

Some

first respond well to subsequent

If

the

baths

must

unconscious

an

cannot

weak, the lungs congested,

patients who

Uttle at

sweat

baths.

be

induced,
patient develops cardiac

sweating

if the

or

is

heart

if the

pulse becomes
during
symptoms

be

given up.
They should
consideration
patient without

not

be

weak,
a

ordered

followed

bath
for

by close

observation.

Hospitals provide apparatus

"

The

value

of sweating

for the

is in dispute.

hot-air

bath.

In

private

51

it

houses

can

the

arch

sheet,

bed,
or

bottomed

under

around

taken

be

Obtain

Purgation.

which

for the

hole

must

from

elimination

not

table

kerosene

chair

the

and

to

rubber

provide

to

sit in

lamp.

small

as

lamp

clothing,may

stands

the

heat

kitchen

the

stovepipe and
patient, without

the

strong wire

barrel-hoops or

of

wrapped

leaving no
Care

oilcloth

an

chair

then

are

improvised with

elbow

an

heat;

the

be

cane-

Blankets

patient together,

to escape.
the

to set

blankets

watery

catharsis

of toxic

material

to

fire.

on

reduce

and

edema

to

by the intestinal tract.

tional
Magnesium
sulphate, or compound
jalap powder with addipotassium bitartrate,or elaterium are good for this purpose

increase

(p. 201).
In

absence

the

lest the

of

edema, purgation should

be

not

excessive,

patient'snutrition suffer.

ritate
Proteids, meat
broths, spices, acids and alcohol irthe kidney and are to be avoided
during the acute stage.
Milk
is an exception to the rule against proteid because
perience
exshows
that it is not injurious. A diet exclusively of

Diet.

becomes

milk

needed

quantities are
tend

may

Salt

to

if

monotonous

increase
not

seems

to

to

long continued

maintain

nutrition

and
that

such

large

the

fluid part

When,

however,

edema.*
be

harmful

as

rule.

*'

salt-free" diet
persistsin spite of other treatment, a
be tried,i.e.,
salt is not to be added
to food either before or
may
after cooking. This
change is followed occasionally by rapid
advisable
If deemed
the phosdisappearance of the edema.
phatef in milk can be precipitatedby adding 5 grs. (or 0.3 gm.)
edema

of calcium

pint of milk.
Diet
List
butter, sugar, junket,
(incomplete). Milk, cream,
ice cream,
bread, toast, cereals,rice, potato, macaroni, sago,
tapioca,spinach, lettuce,sweet raw fruits or stewed fruits.
In convalescence
of danger
enlarge diet cautiously on account
of relapse. When
returning to proteid foods allow eggs first,
then

carbonate

fish and

Three

per

lastlymeat, red

quarts

of

milk

furnish,

or

about

white.

2000

calories

which

is scant

for

an

adult.

t One

liter of milk

Sommerfeld,

"Handb.

contains

3.80

gm.

d. Milchkunde,"

of phosphate
p. 271.

and

1.79

gm.

of chlorides;

53

is

there

when

should

is

very

small

emaciated

and

by
feeble,

To

Exposure.
and

ture

do

in

harm

For

avoid

iron

and

acts
If

Prophylaxis.
of

entrance

suitable
Uremia.

the

or

time

and

days.

enough

should
For

such

temperar

blankets.

calomel,

as

ous
danger-

are

mineral

alkaline

also
it

tried,

be

may
et

treatment

may

of

seat

advised.
see

be

stage.
or

F.)

Basham's
which

tains
con-

diuretic.
that

appears

PiU,
N.

able,
valu-

perhaps,

early

Blaud's

be

may

may,

the

acetatis

mild

original
be

e.g.,

ammonii

as

it

during

cases

severe

waters

but

convalescence,
in

and

useless

are

apocynum

nephritis.
or

ferri

(Liquor
iron

lowed
fol-

food

equable

at

room

lie between

or

diuretics,

acute

in

them

anemia,

Mixture

flannel

wear

diuretics

salhie

to

receive

day

several

for

state

patients

for

fasting

on

the

well-nourished

should

person

and

strength,

food

chill, keep

theocine

particularly
wiser

of

depends

nephritis.

of

Theobromine,

Mild

anemic

prescribed

by

benefit

quantities

Irritating
forms

aU

perhaps

be

to

It

elimination.

their

Strong,

may

prevent

patient

let

Medication.
in

liquid

more

body-weight.

maintain

to

ice

excreted.

freely

physical

patient.

nephritis

severe

food

the

nephritis,
the

of

nutrition

having

Cracked

suffers,

when

favors

of

quantity

the

of

severity

and

substances

The

Nutrition.

of

strictly

fully execreted.

enough.

patient

diuretic

excellent

an

irritating

dilutes

be

the

limited

being

not

are

may

if

but,

be

allowed.

be

Water

the

thirst,

for

used

be

may

they

hours

twenty-four

in

pint

One

when

or

anasarca

should

foods,

liquid

including

Liquids,

p.

59.

the

tonsils

disease

their

were

the
removal

point
at

55

CHRONIC

NEPHRITIS.

PRINCIPLES

nourishment

Adequate

1.

chronic

and

demands

because

the

disease

is

expected.

the

on

TREATMENT.

is essential

to be

not

cure

Limit

2.

OF

kidney and

guard against uremia

by (a) diet, (6) elimination.

Guard

3.

and

against cardiac

Avoid

4.

insufl"ciencyby avoiding physical

strain.

mental

to

exposure

cold.

METHODS.
Methods

they
and

must

the

Avoid

the

are

nephritis,but
of the patient

chronic.

as

be

must

severe,

treated

Nutrition

then

as

acute

becomes

important problem.

Exacerbations

nutrition

is

diet should
Latent

treated

are

important than

more

be

more

(a)

Meats.

(6)

Meat

in acute

early,subacute,

To

favor

nephritis except that

nephritisand therefore

acute

liberal.

more

phase

Restrict

like

or

less the

chronic

or

following:
{d) Alcohol.

broths.

(e) Acids,
(/) Salt.

(c) Spices.
2.

acute

restrictions.

Stage, when

Early

more

1.

for

as

appHed with regard to the condition

stage and severity of the disease.

nephritis until recognized

a

general

be

unnecessary

The

in

same

elimination

of

toxic

material

the

following may

be advised:

(a)

saline cathartic

Bowels

(")

Hot

second, third, or

every

fourth

day.

be

kept free.
tub-baths, Russian,
must

Turkish

or

baths

twice

weekly,
(c) Alkaline
3.

Uremia.

4.

Cardiac

treatment.

For

mineral
treatment

waters

see

with
p.

59.

Insufficiency demands
It results

commonly

meals.

from

recognition and
hypertension, p. 27.

prompt

67

NEPHRITIS.

SYPHILITIC

severity and

to the

according
2.

Iodide

and

5.

Watch

urine

under

for

principles advised

Apply

1.

and

omit

When

treatment.

be

diagnosis is

the

there
As
generally improves promptly.
signs mistakes of diagnosis easilyoccur.

RENAL

used

in small

irritation increases

if renal

mercury

nephritis

case.

should

salvarsan

ARTERIOSCLEROTIC

chronic

or

of the

symptoms

or

mercury

acute

the

correct

are

urine

characteristic

no

DEGENERATION.

TREATMENT.

Search

1.

and

for

if it is believed

Such

causes

of arteriosclerosis.

cause

are,

still to
e.g.,

(a)

(c) syphilis; (d) prolonged

2.

Nutrition

must

3.

Limit

demands

the

be

be

operative

If such

be found

can

it

appropriately.
lead-poisoning; (6) gout;

chronic

treat

worry.

maintained.
on

the

kidney by moderate

restriction

of:

(d) Alcohol.

(a) Meats.
Meat

(6)

(e) Acids.

broths.

(c) Spices.
4.

Avoid

strain
to
guard
physical and mental
insufl"ciency;(") cerebral hemorrhage.

cardiac
5.

Cardiac

reference

to

when
insuflBciency,
present, should
its probable cause, e.g.:

(a) Degenerative valve

lesion,p.

6.

heart

Mild

toxemia

may

with

41.

p. 27.

clear up

under

cardiac

treatment

if the

is at fault.

Alkaline
Methods

diuretics may
advised

be of

for uremia

PASSIVE
The

be treated

25.

(6) Degenerative myocardial lesion,p.

(c) Hypertension,

against (a)

treatment

use.

may

CONGESTION

is that

of the

be used

OF

cause

THE

if toxemia

KIDNEY.

of the stasis.

be

severe.

59

UREMIA.
Note.
in

of

exacerbations

in

so

in

nephritis and

acute

severe

of unknown

intoxication

is an

Uremia

"

nature,

nephritis, and

chronic

subacute

the

common

ticularly
par-

of

chronic

be

mental

stage

nephritis.
Symptoms

in

much

vary

There

degree.

may

loss of appetite, nausea

or
or
coma,
sluggishness,drowsiness
ium,
twitchings or convulsions, headache, delirvomiting, muscular
of vision,transient ocular paralysis,paresis of
disturbance
urine is usually
the extremities
or
paroxysmal dyspnoea. The
scanty or suppressed. Retinitis and Cheyne-Stokes respiration

The

common.

are

onset

and

relativelyacute

or

Edema

severe.

of

Methods
uremia

mild

For

Diet

2.

Eliminative

as

with

slightsigns,

be present

may

or

absent.

Treatment.

for mild

1.

gradual, and

be

may

nephritis.

acute

measures.

(a) Purgation.
(5) Sweating.*
is little or

if there

Water

(c)

edema.

no

{d) Saline diuretics.

Severe

for

uremia

acute

severe

be much

Water

edema.

restricted

in

nephritis. Vomiting

prevent feeding for

2.

is any

insufficiency.

should

Diet

1.

is essential if there

stimulation

Cardiac

3.

If water

quality as

unconsciousness

or

may

time.

should

quantity and

be

administered
be

cannot

taken

freelyunless there be much

by mouth

it

can

be

used

as

salt-solution

by:
(1) Hj^odermoclysis.
(2) Intravenously.
(3) By rectum, (a) Enema.

(6)Seepage.
*

Sweating

generally does

is said

good in

to
some

do

harm
way

in
not

some

yet

cases.

understood.

believe, however,

that

it

61

Magnesium

Purgation.

3.

201)

used.

be

may

and

ball

placed

rubbed

on

the

obtain

to

is

and
of

do

with

of

back

unless

be

be

tend

may

counteracted

scious
uncon-

into

swallowed.
if

employed,

catharsis, but

watery

(p.

butter, made

it wiU

tongue,

should

purgatives

especially for

Little

the

purgation

harm,

other

or

is useful

up

profuse

excessive

thus

may

oil

purgatives

and

prompt

edema,

no

of

doses

Repeated

Croton

If

patients.

sulphate,

needed,

when

there

toxins,

to

concentrate

bv

free administration

water.

Sweating

4.

daily if they
for

is

from

at

the

vein

at

hand,

by

solution

patient.

elbow

or

by

baths
should

They

cardiac

incision,

should

be

may

if

or,

be

not

be

consciousness.
un-

or

withdrawn

suitable

dered
or-

not

insufficiency

blood

of

more

used

be

may

Pilocarpine

edema,

pint

apparatus

aspiration.

divided

is

Opinion

sweating.

pulmonary

Venesection.

5.

be

unconscious

an

Hot-air

good.

profuse

cause

if there

used

do

to

seems

after

the

to

as

bleeding.

need

value

or

Ordinarily,

of

injectiug salt

do

patients

weU

without

it.

be

in

tried
7.

the

is followed

The

The

Morphine

diuretics,

"Basham's

about

peel

sat.
40

can

of

toxins.

diuresis

in

water

may

vaso-dilators

other

or

patients having

is transient.

given subcutaneously
e.g.

hot

"Cream

of
be

may

for

when

use

Pot.

water,"*

tartar

of

convulsions.

the

citrate,

severe

toms
symp-

are

required

when

there

is

cardiac

any

ciency,
insuffi-

13.

sol.

grs.

be

nitroglycerin

by pronounced

mixture,"

stimulants
p.

elimination

of

subsided.

have

Heart

of

effect

be

may

large quantities

promoting

use

frequently

hypertension.

or

of

hope

Drugs.

Saline

with

irrigations

Colon

6.

in
used

of

Pot.

pint,
for

bitartrate,
or

to

flavoring.

gm.

the
in

strength
500

c.c.

of

which

of water.

is

1 in

Lemon

201,
juice

equal
or

lemon

to

III

CHAPTER

2.

Rest

Ingestion

To

conserve

To

reduce

l::

in bed

TREATMENT.

OF

PRINCIPLES

1.

DISEASES.

INFECTIOUS

ACUTE

of much

strength.
metabolic

waste.

a.

To

dilute

b.

To

favor

toxins.

water

favor

To

{a.
To

6.

Good

digestion.
absorption

prevent

toxic

6.

elimination.

their

of

substances.

cleanliness.

a.

To

secure

6.

To

conserve

strength.

c.

To

promote

comfort.

d.

To

afford

nursing
information

accurate

to

physician.

5.

6.

Diet

Meals

should

be

should

facilitate

To

e.

a.

Easy

b.

Easily

c.

Nutritious

d.

Palatable

treatment.

swallow.

to

digestible.

"

but

and

Frequent

b.

Commensurate

to

The

8.

Infection

9.

Symptoms

the

sick-room
of

circumstances

small

to

favor

tion.
diges-

be
in

digestive
7.

bulky.

varied.

and

a.

not

should
others
should
of

be

well

must

be

be

treated

the

case.

63

quantity

with

power.

ventilated.

prevented.
as

they

arise

with

regard

65

TYPHOID
Notes.

of

ulceration
in the

colon

the

small
is

and

rare

bacilli enter

Typhoid
and

is characterized

Typhoid

"

FEVER.

pathologicallyby peculiar
Ulceration
is less frequent

intestines.
in the

rectum.

the

blood,

the

the

organs,

secretions,

excretions.

the

|g|Thedisease

is

self-limited,
lasting from, two weeks to three
and
common
Relapses are
complications frequent.

months.

is often

Toxemia

severe.

CAUSES

COMMON
1.

Toxemia.

2.

Exhaustion.

3.

Severe

OF

DEATH.

complications.
(a) Perforative
peritonitis.
(6) Repeated hemorrhages.
OF

TREATMENT

infection

of others.

PRINCIPLES

A.

Prevent

B.

Dilute

C.

Conserve

D.

Diet

toxins

and

favor

strength of

should

their

the

suited

be

FOR

TYPHOID.

elimination.

patient.

to

the

individual

as

well

the

to

as

disease.
E.

Drugs
the

to reduce
F.

are

to be

only and

reasons

not

fever.

Observe

the

patient'scondition

promptly when
G.

prescribed for definite

closelyand

modify

ment
treat-

indicated.

nursing available and if possible have

day-nurse and a night-nurse.
H. Treat
and
complications with due regard
symptoms
other

Have

best

the

circumstances

of the

ROUTINE

case.

ORDERS

1.

Enteric

2.

Dr.

3.

Baths

4.

Suds

5.

Spray throat and wash

Hexamethylenamine,

6.

TO

NURSE.

precautions.

Shattuck's
as
enema

enteric diet.

directed
every

every
other

four

day
mouth

5 grs.

(Prof. F. C. Shattuck.)

hours, 2?.r.n.
or

'p.r.n.

and

eyes

every

(or 0.3 gm.) t.i.d.

four

hours.

to

67

Record

7.

temperature, pulse and respirationevery

daily excretion

the

of

urine, and

the

OF

METHODS
A.

of food

amount

ingested.
Specific directions for diet and baths
due regard for the circumstances
of each
be required,
may

should

hours,

and

be

FOR

water

given

Frequent

case.

TREATMENT

four

with

fication
modi-

TYPHOID.

Prophylaxis.
I.

Prophylactic inoculation

into intimate

should

with

contact

required for
patient (p. 215).

the

be

those

ing
com-

II. "Enteric
1.

precautions."
Isolation of the patient is desirable.

2.

Flies must

3.

Those

excluded.

be

who

touch

patient should

the

wash

their hands

promptly.
4.

5.

Eating utensils should

be

patient and washed

and

Sheets

other

and

should

linen

be

for at least haK

6.

The

best

Kaiser.

reserved

kept apart.

when
in

soaked

5 per

cent

the

room
sick-

carboHc

acid

boiled.

hour, or
of dealing

*'It consists

from

removed

an

method

exclusivelyfor the

with

fseces

is that

of

of

adding enough hot water

to cover
the stool in the receptacle and then adding
of quicklime (calcium
about
I of the entire bulk
oxide), covering the receptacle and allowing it to
stand

for two

Urine

7.

Bath

water

but
8.

B.

1.

hours
of

The

by

urine

taken

H.

and

to

treated

bring

of the

Elimination

urinary output
free

administration

can

be

obtained

similarlyby adding enough

it to

be boiled

may

this is not

Cleanliness

Dilution

be

can

quicklime

hours."

boil.

after

where

while

worth

Bui.

practicable,
plumbing is good.

of Toxins.

should

be

kept

of water.

but

it is

Mass.

State

above
much

60

oz.

favor
about

Board

in

24

larger quantity

question whether

not
large quantities may
includingliquidfoods,should total

Monthly

when

is essential.

attendant

in very

Linenthal:

using

water

hemorrhage.
three

of Health,

quids,
Li-

quarts daily.
Jan., 1914.

69

kept clear. If they do not move

be
employed as often as necessary.
freelysuds enemata
may
Cathartics are to be avoided as a rule during the ulcerative stage
excessive peristalsis
favor hemorrhage or perforbecause
ation.
may
bowels

The

2.

of the
Very important because
of typhoid.
duration
feed the patient, turn
him
should
allow
over,

Conservation

C.

1.
him

average

The

nurse

Strength.

for himself

nothing

do

to

maximum

The

2.

of

long

be

should

and

should

make

of nutrition

should

be

him

comfortable.

maintained

quent
by fre-

feedings.
Visitors should

3.

be excluded

entirelyas

rule.

Diet.

D.

principle in choosing

Shattuck's

Dr.

by him
rather

"Feed

follows:

as

than

of

name

Easily digestible.
Non-irritatingto intestine.

5.

Quantity
Adapted

6.

Palatable

hours

or

digestive power

to

articles of diet

as

bulky.

not

commensurate

the

to

be

take

can

even

but

and

should

patient

stated

2.

Meals

been

surfaces."

Nutritious

4.

the

reference

1.

3.

diet has

disease,avoiding such

might irritate ulcerated

Requirements

with

every

digestivepower.

to

patient'scondition.

varied.

frequent,
little at

least

at

time

in

once

he should

four

hours.

be fed every

If
two

hour.

following foods
and any
others that conform
to the requirements stated above:
liquidfoods,strained cereals,custard,blancmange, junket,simple
Diet

List.

ice cream,

milk, soft

soaked

The

has

loss of

cream

can

be added

c.c.

in 120
may

enteric

toast

diet may

without

oysters without

eggs,

Coleman
cream,

An

include

the

the

crust, bread

or

crackers

in

heel,finelyminced chicken,etc.
shown
that, by the free use of milk-sugar and of
sometimes
be prevented.
weight in typhoid may
be added

can

to

the

milk

or

to

other

foods.

liquids,in the proportion of | oz. in

c.c.) of liquid. Coleman's
diet, if used
death.
perhaps cause
to

Milk-sugar
4

oz.

(or 15

nately,
indiscrimi-

71

Departure

from

routine

diet

be

may

required for various

e.g.

reasons,
1.

Patient

2.

Vomiting.

3.

Persistent

4.

Severe

Advantages

weak

too

to swallow

solid food.

diarrhoea,often due to milk.

distension,often due to milk.

of

liberal

diet.

1.

Weight and strength are

2.

Toxemia

3.

Distension

4.

Convalescence

5.

Patients

better

maintained.

is less.
is

uncommon.

is shorter.

suffer less.

(p. 205) should be prescribed

by routine as a urinary antiseptic. It may,
rarely,
hematuria
then
It should
be
or
cause
painful micturition.
for a few days and resumed
omitted
in smaller dosage.
Other drugs may
be ordered occasionallyfor specialsymptoms
E.

as

Medication.

Hexamethylenamine

required.
Antipyretics should

prescribed to reduce fever, but

be used for headache, in the early stages of typhoid.
they may
the circulation is
Being depressants they are dangerous when
not

be

impaired.
F.

Observation.
I. Examine

the

patient once

or

more

daily during the febrile

stage.
Look

for:

2.

Signs of circulatoryweakness.
Pulmonary hypostasis.

3.

Bed

4.

Changes in the condition

1.

sores.

(a) Distension

of the abdomen.

of abdomen.

(6) Spasm.
(c) Tenderness.
{d) Distension

of bladder

from

retention.

73

Keep track of:

II.

1.

Urinary excretion.

2.

Nourishment.

3.

Account

for

is the

duty

They
pulse or temperature.
be the first sign of hemorrhage or perforation.
may
Keep sterile salt-solution ready for use by hypodermoclysis or intravenously in case of need.

4.

III.

It

times

at

G.

he

and

occur,

may

when

Massage
H.

the

emergencies

is

In

hemorrhage

his assistant

or

perforation

or

should

supervise

be

accessible

arise.

may

convalescence

evacuation

free

of

the

important.
hasten

may

physician carefully to

period when

himself

Convalescence.
bowels

of

the

during

treatment

in

changes

of

return

strength.

Nursing.
nurse's

The

general duties

to

are

do

her

to

utmost

spare

the

patient exertion,discomfort and mental unrest; to report to the

physician at his visit all changes in the condition of the patient;
to be prepared to answer
questions as to the effect of treatment
of alarming sympprescribed; and to notify the physician at once
toms
or
signs suggesting severe
hemorrhage or perforation.
She

should

pulse

rate

know
and

the

possiblesignificanceof sudden
and

temperature

should

look

for

changes

blood

in

in every

f cecal

dejection. To prevent accident she should, as far as possible,

when
he is not
avoid leaving the patient alone even
ently
appardelirious.

The

following complications can

experienced nurse:

generally be prevented by

an

"

1.

1.

Bed

2.

Corneal

3.

Middle-ear

4.

Parotitis.

To

sores.

ulceration.

prevent bed

infection.

sores:

5.

Boils.

6.

Cracked

7.

Tender

8.

Hypostatic congestion.

lips.
toes.

"

(a) Keep sheets smooth, clean and dry.

(6) After soiling,clean the skin promptly, dry it,rub
zinc oxide ointment, and powder with starch.

in

75

the

(c) Change
(d) Do

patient'spositionoccasionally.
allow
on
prolonged pressure
bony

not

(e) If

red

keep
paint
To

2.

spot
pressure

the

spot with

prevent corneal

the eyes

that

off

picricacid, 1
with

keep
2

pressure

pads and

or

cent.

per

clean

cornea

cent

per

been

rings

part by

ulceration

four hours

every

has

there

where

appears

nences.
promi-

ing
by bathsolution

watery

of boric acid.
Boils in crops

3.

If

boil appears

4.

Cracked

5.

Middle-ear
of

care

must

care

taken

to

use

avoid

of

dirty sponges.
fection.
spreading the in-

be

mouth.

The

throat

sprayed every
Dobell's solution,or

the

be

the

to

prevented by the use of cold cream.

infection or parotitismay
result from
improper

lipscan

the

with

necessary,

generallydue

are

one

mouth

four hours
"alkaline
or

two

be

should

cleaned

and

the

non-irritatingantiseptic.
antiseptic"will serve, diluted,if
with

parts of water

avoid

to

irritation of

dryness of the tongue from

mouth
breathing can be prevented by the use of vaseline.
6. Hypostatic congestion of the bases of the lungs is due in
position. It can be combated,
part to protracted lying in one
membranes.

mucous

Excessive

if not

prevented, by rollingthe patient on one side and supporting

of a pillow.
him in this positionfor an hour or more
by means
The patient should then be rolled onto the other side for another
should
be practiced at
period of time, and these manceuvres
least

once

daily.

SYMPTOMATIC

TREATMENT
Fever

and

TYPHOID.

FOR

Toxemia.

Hydrotherapy generally acts well.

Benefits expected from it are:
1.

Fall of temperature

2.

Fall

in

rate

with

of from
increase

1 to
of

degrees.

force

and

volume

of the

pulse.
3.

Deeper

4.

Better

5.

Diminution

breathing and

diminution

sleep.
of

symptoms

of toxemia.

of

pulmonary

hypo-

77

Rules

should

and

warmer

be ordered

children

For

2.

of baths

use

Baths

1.

be

for

for definite indications

for thin

and

shorter

and

feeble

for the

than

only.

patients,baths

robust

should

adult.

physician should supervise the first bath and prescribe

subsequent baths with regard to the effect of the first one,
the bath should be stopped.
4. If the pulse gets weaker
5. Much
cyanosis or shivering after the bath indicates that
used.
too cold,or too long, or that not enough friction was
it was
3.

The

6.

Stimulants

is suited

the

to

Baths

7.

and

case

Routine

bath

give bath

every

order.
four

of

G.

"M.

water

Typhoid

chest, limbs, and

of the

Sponge baths
mixture

solution

of
in

that

For

they greatly excite

rise of

temperature.

of 103.5

degrees rectal

half

every

degree

of bath-water

temperature

Bath."

be

often

With

of temperature

5".

at

sheet, supported
patient. Dash

in bed

of

vigorously in turn, with

rub

minutes

20

well

act

the

not

and

the

the

abdomen.

less if

or

and

the

duration

ordered.

so

hands,

The

preferred in

are

equal parts of alcohol

water

rubber

tub

make

back, but

should

bath

cause

if

temperatm-e*

rolls of blanket

him, and

over

omitted

or

at 85".

hours

bath

bathing :
H.

edges by

For

after

or

given.

sleep,or

103.5" lower

above
Methods

well

with

before

required

modified

be

must

patient,interfere

the

at

seldom

are

cent

per

required temperature

cases.

many

boric
be

can

used

acid
for

bathing.
CIRCULATORY
I.

Cardiac

which

are

Temperatures
mouth

than

higher
t Chap.

than

the

in

typhoid

I, p. 31, 33.

conditions

another, e.g.,

are

lesions.

or

pericarditis.

control.

best

temperatures,
mouth

one

by various

lack of nourishment.

Preexistingcardiac
Cloudy swelling.
Fresh
endo-, myoDeranged nervous

reliable
"

from

2.

5.

caused

distinguishfrom

Exhaustion

4.

difficult to

be

may

1.

3.

weakness

WEAKNESS.

temperature.

taken

by rectum

"the rectal

because

temperature

these
averages

are

m"re

about

79

generallydevelop gradually so that there is plenty

Symptoms
of time to prescribe.
regular
irStimulants
should be ordered if the pulse becomes
weak
or
or

their

use

above

goes

120.

Digitalis,caffeine or other drugs may

Emaciated
or
septicpatientstaking
alcohol.
as

It

sometimes

seems

well

act

may

not

or

all,and

at

be tentative.

often

must

They

to

act

be

tried.

little food
as

do well

may

food, and

on

indirectly

stimulant.

II.

(p. 33) is suggested when

relaxation

Vascular

the

pulse is

in

The
condition
can
proportion to the heart sounds.
of development
has been
generally be recognized if its mode
noticed (p. 33).
It may
The best remedy is a saline infusion.
a rapid faU
cause
in the pulse rate and a marked
improvement in the pulse. It
weak

may

be necessary

may

not

be

infusion

repeat the

to

after

hours

some

it

or

required again.
DIARRHCEA.

Severe

diarrhoeas

Examine

1.

food.

stools

If so,

Curds

from

omit

milk

Tincture

2.

determine

to

that

may

of

dangerous and

are

kind

if

they contain

food

of

be checked.

must

or

undigested
the

reduce

amount.

be found.

opium

Paregoric generally acts well.

or

CONSTIPATION.

Constipation is
Calomel
oil

Fl. Ex.

frequent

cause

of

fever

in

convalescence-

Sagrada, Castor-oil or "Russian

(p. 217) may be given at this stage. Neglect of the bowels
result in foecal impaction.

"

may

or

of Cascara

DISTENSION.
1.

If stools show

2.

Turpentine stupes*

3.

Rectal

tube

curds

may

reduce
may

or

omit

milk.

give relief and

can

be used

p.r.n.

be tried.
VOMITING.

Reduction

modification

or

least.
of

of

diet is advisable

Swallowing small pieces of cracked

shaved
ice with brandy may
relieve.

See

textbook

on

nursing.

ice,or

for
a

time

at

teaspoonful

81

HEADACHE.

relieved

If not

fr. 5 to

acetin

by

10

Ifgr.(or 0.065

an

grs.

gm.),

or

ice-cap placed on the forehead, phen(or 0.3 to 0.6 gm.), with caffeine citrate
be prescribed.
other analgesic may
some

COMPLICATIONS
HEMORRHAGE

I.

TYPHOID.

OF

THE

FROM

BOWEL.

sign of small hemorrhage is blood in the stool.

be a rapid fall in temperaFirst sign of large hemorrhage may
ture
and a rise in the pulse rate.
Treatment.
1. Omit
nourishment, water, and baths.
ice by mouth
for 24".
2. Give nothing but cracked
3. Give morphine subcutaneously
repeat dose in 15 minutes
First

Signs.

"

half

or

and

hour

an

repeat

slower.

respirationbecomes

the

below

minute.

10 per

again

When

half-hour

at

Do

let the

not

it has reached

15

until

intervals

respirationfall
less

or

give

phine
mor-

dosage, if at aU, lest poisoning result.

and to keep
The object of using morphine is to stop peristalsis
the patient quiet until the hemorrhage has ceased.
4. If the patient be exsanguinated raise the foot of the bed to
in small

death

prevent

from

is imminent

syncope

danger, because

but

do

increase

prolong the hemorrhage.

The
best circulatorystimulants
infusion
5.
not
6.

in

or

For

direct transfusion

smaU

hemorrhages
be required.
Patients

who

are

very

stimulate

not

of

there

imless

blood-pressure

for this condition

are

may

saline

of blood.

narcotization

weak

or

with

emaciated

morphine
should

may

be

fed

spite of hemorrhage.

H.

Surgical. Early

Treatment.
are

has

PERFORATION.

essential
been

to

success.

watched

diagnosis and
When

the

prompt

condition

closely before the

of perforation the
diagnosis will
symptoms
is extremely rare.
recovery

of the

appearance
be

ation
oper-

easier.

domen
ab-

of the

taneous
Spon-

83

FEVER.

RHEUMATIC
The

typical, is characterized
by a
i
nflammation
articular
and
with
peri-articular
pyrexia
migratory
untreated
the inflammation
and leucocytosis. When
generally
and
six weeks.
endocarditis
lasts about
Relapses are common
is frequent. Pericarditis or myocarditis is seen
occasionally.
Note.

"

is

There

infectious

disease, when

believe

to

reason

arthritis.

that

Perhaps

rheumatic
of

most

is

fever

the

cases

are

of

form

due

to

specificorganism.
OF

PRINCIPLES

TREATMENT.

in bed.

1.

Rest

2.

Relieve

3.

Dilute

4.

Prescribe

5.

Prevent

6.

Watch

pain.
and

eliminate

toxins.

large quantitiesof salicylateand

of alkali.

recurrence.

for cardiac

complications.
METHODS.

1.

Relieve

bandages
be

rubbed

useful

to

or

and
pain by protecting the joints with cotton
by splints. For psychic effect oil of gaultheriamay

on

the

relieve

permit gives

much

by other
salicylatehas had
Dilution

skin before

pain and

relief.
means

time

to

tub

bath

pain be

when

pain and
and

severe

free administration

of water.

not

of toxins
Three

can

quarts

be

as

3.

Food

should

be

trolled
con-

the

by

the

should

be

promoted

or

more

ingested in twenty-four hours unless the heart be weak.

complications may
require limitation of liquids.
bowels

fever

act.

elimination

The

be

may

hypodermically until

morphine

and

2.

hot
If the

use

Fomentations

bandaging.

Cathartics

kept clear.

Cardiac

be

may

scribed
pre-

needed.
should

because

be

nutritious
is often

and

as

abundant

as

can

be

gested
di-

rapid and anemia may

develop.
4. Medication.
Sodium
other
salicylate (p. 203) or some
should
be prescribed in large dosage. The
salicylcompound
quantity should be proportional to the degree of pain and acuteof the inflammation.
For severe
10 grs. (or 0.65 gm.)
ness
cases
be ordered
hour
until the patient is relieved or toxic.
may
every
wasting

85

irritation of the

avoid

To

seem

to diminish

of soda

more

soda

Enough

less

cause

When
be

be

should

taken

to

dose

every

render

the

urine

given

bicarbonate

salicylates. Twenty

with

ordered

of sodium

be

of

grains

salicylate.

alkaline.

tried.

be

may

be

may

should

to
good substitute for sodium salicylateand seems
Aspirin,* or oil of gaultheria,
gastric disturbance.

is

SaUcin

toxic effects of

the

dose

every

Large doses

full glass of water.

with

or

stomach

have

symptoms

be

It should

reduced.

been

relieved

continued

patient is apparently well.

When
salicylatesact well, in

the

for

dose

of the

month

or

more

to

forty-eight

drug

can

after

the

hours,

fall of

temperature

from

twenty-four

occurs,

and

with

it there

comes

rehef from
jointswelling and marked
pain.
of salicylatepoisoning are nausea
The
or
common
symptoms
and occasionallyerythema or delirium.
vomiting, tinnitus,headache
the drug must
be omitted
When
these occur
until they
diminution

of

subside.

then

It may

in smaller

resumed

be

dosage

or

in different

form.

Early
patient

recurrence

in

subsided
30

of arthritis is

Recurrence

5.

bed

grs.

convalescence.
Late

week

Exercise
and

recurrence

avoided

by keeping the
after the inflammation
has entirely

by continuing the use

(or 2 to 3 gm.) daily,for

and

to 40

generally be

can

for

early or late.

common

should
future

of

sodium

one

be resumed
cardiac

month

salicylate,fr.
or

after

more

gradually.

disease

can

often

be

vented
pre-

by eliminating all foci of suppuration. Inflammation

of the tonsils or
genital tract, sinus infection and pyorrhoea
should
be
for.
alveolaris
looked
reveal
Tonsillectomy may
deep suppuration not demonstrable
externally. Tonsillectomy f
should

insisted

for future
likelysource
infection.
Pyorrhoea can be benefited by rubbing the gums daily
with a solution of potassium permanganate
and by rinsing or
sponging the mouth
frequently with hydrogen peroxide (p. 187).
be
6. Cardiac
latent or
latory
Circusevere.
complications may
weakness
require limitation of liquids.
may
The
patient should remain flat in bed for weeks or months
after the disappearance of all signs of active
cardiac infection,
*

be

Incompatible

t Dangerous

with

while

on

if the

alkalis,
the

tonsils

tonsils

are

(N.N.R.)
are

acutely inflamed.

87

avoid

should

and

to

give

itself to the
is

There

tend

the

exertion

heart

hypertrophy

to

after
there-

adjust

to

or

changes.
ward

to

believe

to

reason

ACUTE

in

taken
salicylates

that

large quantity

off endocarditis.

further information

For

time

ample

months

for several

of all kinds

endocarditis,see Chapter I,page

on

INFECTIONS

IN

COMMON

MOST

21.

CHILDHOOD.
By

Edwin

H.

SCARLET
I.

A.
1.

Prophylaxis.

much

Increases

Natural.

considerable

during

1st year

and

of age

after 8 years

and

lowest

marked

from

2 to

of age.

6 years

of

FEVER.

Immunity.

after 21 years,

2.

M.D.

Place,

by Gabritschusky by

Claimed

Active.

streptococci obtained
at

intervals

be used.

may

B.

Asepsis.

C.

Isolation

from

scarlet

of 4

days,

of doses

Value

very

See under
"

of

great

fever

of vaccines

means

Three

cases.

of from

one

to

ten

jections,
inlions
mil-

doubtful.

diphtheria (p. 111).

value

and

be

should

early as possible.
neighborhood or
as

in family or
Finding of missed cases
school often
possible by investigationat the time of the first
These should be searched for in each recognized
recognized case.
of sore
of contacts
for evidence
case
throat, sore
by examination
endocarditis,
discharging ears, glands, nephritis,arthritis,
nose,
desquamation. The finding of these signs does not necessarily

show

that

carried

on

patient
for

four

has
weeks

had

scarlet

and

fever.

until there

Isolation
are

no

should

abnormal

be
charges.
dis-

Technique. Technique of isolation is that of surgicalasepsis

instead of a
reversed, i.e.,to keep infection in a small zone
Air currents
small area
infection.
free from
play no practical
part in spreading the disease.
Avoid
utensils from
a
or
infecting clothing of attendants
careless touching of patients or putting infected hand or
Wear
things into pockets, etc.
gowns.
1.

89

"TWash

hands

Do

thoroughly

handle

not

face

or

of infection.
leaving zone
uninfected
objects until hands
on

Be careful of door knobs.

thoroughly cleansed.
Boil dishes,utensils,etc.,as they leave patient. Do
infected dishes,etc.,in an uninfected
zone.
put down
are

d Boil

clothes

soak

or

in 5 per

them

phenol solution

cent

similar

Be careful not
germicidal solution.
surroundings in removing these objects from
or

not

to infect
the

fected
in-

zone.
e

discharges from nose, throat,

sick room.
Use
being spread about
etc., from
towel or cloth and
deposit at once
piece"of paper,

Use

to

care

tags or

paper

/ Do

prevent

stethoscope, books,
infected
g

objects

thermometer,

as

be

to

etc.,

money,

without

zone

taken

from

disinfection.

proper

released
fected
infrom
patient when
while of questionableimportance,
still
zone,
The
mouth
should
be
done.
be
must
thoroughly
cleansed and antisepticsprays
be used in the nose,
may

cleansing

Thorough

of

"

although value
released

Quarantine.
places or come

new

social

or

Care

be

should

study
who

taken

E.

of the

are

Patients

entirelysubsided.
should
Exposed persons
in contact

assembly, etc., until

infection.

or

is uncertain.

until all signs'

of inflammation
have

to

in

pencils,

"

D.

soft

burn.
infected

allow

not

ear,

to

see

with
2

that

pupils is made

to

mucous

children

not

is unnecessary

eliminate

be

not
branes
mem-

be allowed

after the

they have

Closing of school

of

not

other

weeks

should

to go

in school

as

last exposure.
mild

and

looked
over-

provided
those

who

ful
care-

are

ill

carriers.

Disinfection

"

of doubtful

value

as

general

of

measure

Proper cleanliness and asepsis about

patient obviates
this necessity. In well-lightedand
aired rooms,
objects that
of
might have been infected have usually ceased to be a source
danger by the time the patient has ceased to harbor the organisms
control.

and

to
and

water

sublimate
gas.

can

be

released.

Disinfection

can

be

done

by

posure
ex-

by thorough cleansing and washing with soap

and germicidal solutions such
as
phenol or corrosive
dehyde
to formalor
by thorough and prolonged exposure

sun,

91

II.

The

Treatment.

great dangers of scarlet

fever

nephritis and toxaemia.

greatest factor in mortality.
A

Toxaemia,

Serum

1.
.

should

of

treatment

ment,
sepsis,cardiac involvethese
sepsis is by far the
are

Of

"

Convalescent

treatment.

patient'sblood

50

to

100

be used

intravenously preferably. Testing for syphilis

should
be done
before
and bacterial contamination
using serum;
this treatment
of limited applicationbut has some
value.
The
whole
blood
of patient either citrated or
injected as soon
as
drawn
be used for intra-muscular
injections.
may
obtained
from
horses.
Moser's
Antistreptococcus serum
strains of strepobtained
by injectinghorses with many
tococci
serum,
scarlet fever patients, may
cultivated
from
be used in
CO.

least 200

doses

of at

often

disappointing.
Free

2.

patientsdo

fluid

It is of little value

cc.

in

some

cases

1^ litres daily according

intake.

to

age.

and

If

subor
freelyit may be given by rectum
cutaneously or in very toxic cases
intravenously as salt solution.
3. Eliminative
Mild catharsis.
treatment.
Daily warm
bath,
not

take fluid

etc.

Rest

4.

B.

in bed.

General

Sepsis,

of:

treatment

"

Prevention.

1.
a

Guarding portals of entry.

(1) Local cleansing of mouth, gums,
teeth, etc., with
swab
cotton
applicator 2 or 3 times daily. Saline
solution,soda bicarb, solution,borax solution or a
of these with 10 or 20 per cent glycerine
combination
or other mild
cleansingsolution may be used such as
DobelFs.

(2)

Protection

of

AlboHne

membranes

mucous

trauma,

etc.

petroleum oils are of value

following cleansing of mouth, especiallyin mouth
membrane
inbreathers,and where there is mucous
fecton.

and

from

similar

Carious

etc., should

be

teeth, old roots,

seen

tartar

deposits,

to.

(3) Antiseptics. Phenol, eucalyptus, argyrol, silver

iodine,etc., are

of doubtful

value.

Their

trate,
niuse

93

chemical

cause

may

injuriesto

membrane.

mucous

used, careful consideration should be given to the

of harm
amount
they do to tissue as well as to
The
bacteria.
least injuriousto tissue are
usually
If

best.

well

as

infection

Nasal

infection.

Nasal

(4)

as

and

sinus

accessory

nasal

vault

disease

may

fection
in-

be

danger but are difficult to treat effectually.

ing
SyringMechanicalcleansing by swabs is allowable.
is liable to cause
injury, or spread infection.

sources

of

Patient

may

clear the

applicationof ointment
and

mild

by blowing, if old enough

nose

medicated

and

antisepticaction

is of value.

blisters,etc., of the skin should

in "allcases.
treated asepticallyand antiseptically

(5) Bums,

wounds,

possible in the
has been
suggested and,
early

In

General

b
2.

very

limited

in

stage

done

favorable

course

adenoids
of

practice,seems

number

been

tonsillectomyhas
fever

acute

as

beneficial.

tonsils and

of

Removal

(6) Tonsilectomy.

in

of

cases

early stage
has

oils for protection

be

as

infection
to

be

in which
of scarlet

followed.

Hygiene.

Treatment.

Same

as

in

Rest

prevention.

bed, free fluids,

fort
sleep and com-

Secure
sunshine, fresh air,outdoor treatment.
of discomfort
available.
by alleviatingcause
by any means
Sleep and rest should not be sacrificed to the use of antiseptics,
foods.
etc. -Supply energy
Sugar is of
by easily assimilated

great value.
C.

Local
1.

of :
Sepsis, treatment
ness
CleanliThroat.
Antiseptics of questionable value.
is principle. Swabbing
and
soothing treatment
local lesions carefullywith one-half strength hydrogen
peroxide, 20 per cent argyrol,iodine preparation, 5 to
"

50

per

cent

silver

nitrate,or

to

per

cent

chromic

Hot
used may
be of benefit.
selectively
irrigationsoften help. Coughing and struggling when
irrigationsare given contraindicate their use.
Nose.
Cleansing of nose
by the patient blowing is
better and safer than
irrigations.Sprays are of little

acid solutions

2.

value

but

may

be used.

95

Instillations of 15 per

iodine,gr. i,in

gr. V, and

of calomel

Insufflations
Otitis

3.

argyrol,or camphor, gr, v, menthol,

be tried.
alboline,1 oz. may
powder twice daily are often of value.

cent

Media.

Prevention.

nasal

enoids,
irrigation,palpation of nasal vault for adcoughing, forcible washing of throat, Trendelenberg's
position,etc.
obstruction
of nose
from
acute
(2) Prevent
swelling
by oily
above.
in oily
instillations or sprays
Adrenalin
1 to 8000
as
sometimes
help. Ten
preparations (adrenalin inhalant) may
Avoid

(1)

"

of

drops
and

15

per

allowed

to

holding head

argyrol

cent

side

that

to

into

down

run

instilled into

be

may

the

while

in

fossa

of

nostril

the

Rosenmiiller

by

supine position for

the

20

minutes.

Note.

Previous

"

abnormalities
well

large turbinates,etc., as
in

important factors

are

(2)

Free

often

as

of

asepsis

local

at

causing otitis.

100

at

The

to

dry

with

drum

but

boric

110

(5)

acid

instead

of

alcohol

in

as

saline

or

To

canal.

solution.

questionable value.

Watch

for symptoms

irrigations

frequent

this may

Silver salts and

ing
spong-

wick

narrow

instillations of 5 per

or

of

are

boric

It consists of

keeping

the
closelyfilling

cent

per

and

sterile cotton

used

be

may

powder insufflations

15

it

degrees Fahrenheit.

discharge is thin.

not

with

hours

to

treatment

especiallywhen
out

nasal

necessary.

solution

(4)

and

nose

(3) Irrigations ev.

cent

other

to

the

added

be

boric acid

tics
antisep-

of mastoiditis.

Mastoiditis.

Prevention.

Treatment.

(1) Prompt
as

attempts

as

noids,
ade-

as

pharynx as above.
if bulging. Repeat
drainage by cutting drum

Treatment

4.

vault, such

Treatment.

(1)

in

of nasal

often

as

drainage

necessary.

Applications of

ice to

(2) Operation
or

and

Watch

promptly

of middle

treat

otitis media.

by paracentesis. Repeat
2 hours
hot.
Copious irrigations
every
ear

"

the

mastoid

is indicated

[iftemperature

process.

if tenderness

remains

up

persists,if cedema
for

more

than

creases
in-

days.

97

desirable

be

Operation

may

Continued

discharge alone

Cervical

5.

of

signs.

these

indication.

an

Adenitis.

and

(1 ) Throat

removal

disease

of the

mouth

further

results,but

attention
cleanliness,

of tonsils and

(2) Removal

(3) Treatment

teeth,gums,

etc
.

adenoids.

Even

tonsils has

given highly favorable

of the

experience

in

acute

an

stage

is desirable.

of the

of diseases

to

and

nose

sinuses.

accessory

Treatment.

applications the

(1) Ice
Resolution

without

(3) Chemical
value

but

if

incisingtoo

in lines

6.

nose

poultices.

needed.

as

methyl

as

salicylate,iodine

(Crede)

doubtful

of very

are

pet-

early, allowing

to become

pus

of

Burrowing

promptly.

Incision

of

of the

cleavage

results obtained

Best

occurs.

skin

is

pus

should

be

short

the

and

If it

rare.

as

avoid

to

locaHzed

by

as

occurs

possible

scar.

Pyaemia.

Incisions
7.

suppuration

subside.

to

very

with

occurs

and

poultices afterward.

days;

be used.

(4) Incision

incise

often

of colloidal silver

may

induration

first few

applications

ointment

rogen,

pus

throat, mouth

Treat

(2)

and

be

may

absence

Prevention.

not

in the

even

and

drainage

lesions

as

develop.

Arthritis.

(Scarlatinal arthritis

(a) Simple.
limited

to

bandages

a
or

few

Rest.

days.

periarthritis.) Self-

and

Immobilization

splints. Applications

of

by

cotton

batting

methyl salicylatedressings,

etc.

(6) Septic. Incision

Thorough
tight has
dam
8.
such
9.

and

has

Phlebitis
as

early

prolonged washing

given

drains

as

best

the
not

been

result.
so

diagnosis has

as

Incision

favorable.

(rare). Elevation

cavity and

of

out

only

Thrombosis
after

for

10.

Empyema.

11.

Peritonitis

12.

Local

sewing

followed

by

circulation.
be

Local

up

rubber

has

heat

used.

(rare). Elevation, local heat,

line of demarkation

made.

Immobilization.

poultices. Citric acid internallymay

Arterial

been

tation
ampu-

formed.

Drainage by operation.
(rare). Operation required.

infections

may

then

be

benefited

by

autogenous

99

D.

Nephritis.
Prevention.

I.

Attempt

reduce

to

toxaemia

of

acute

stage.

See

under

toxaemia.
h

Kidney

rest.

Rest

in bed

(1)

(2) Avoid
the

excessive

loss of heat

fluid intake

Free

(3)

for at least three

in the

weeks
and

absence

all

in all

cases.

chillingof

of oedema

skin.

fits
probabl}^bene-

kidney.

and
fat.
protein, chiefly carbohydrate
rich
in piu-in.
Avoid
foods
extractives,nucleo-proteids and
to two
Cream
and
pints, cereals,especiallywheat,
milk, one
sweet
potatoes, tapioca, sugar,
rice,baked
fruits,bread, green
In
the
acute
vegetables, except asparagus.
stage patient may
be used
at this time
refuse everything but fluids.
Sugar may

(4)

Diet.

Low

freelj'.
(5) Daily

hot

(6) Salt intake

be

may

bath.
may

be reduced

but value

is uncertain.

Alkalis

given.
See

1.

Treatment.

2.

Uraemia.

E.

Cardiac

Endocarditis.

Nephritis,page

See page

49.

59.

complications.

Prevention.

promptly treat local infection as alveolar

abscess,otitis media, septic joints, diseased tonsils,
sinus
focal infections,
disease and other
accessory
which
be responsiblefor infection.
may
exertion
(2) Prevent
during the period likely to be
attended
by cardiac complications.
(1) Avoid

and

(3) Reduce
6

Toxaemia.

Treatment.

(1)

be

complete as possible,prolonged until

2 to 6 mos.
lesion has entirely healed
Cardiac

Rest

to

as

"

stimulants

are

does

contraindicated

because

cardiac

sufficie
in-

develop early. An
ice-bag,
aconite, or bryonia may
perhaps give the heart
relative rest by quieting its action.
be kept
(2) Salicylates. Danger of kidney injury must
in mind.

not

101

2.

Pericarditis.

Morphine
need

to

be

The
be

may

upright

same

necessary

also

endocarditis.

as

for this

because
reason.

of

pain. Posture

Fluid

may

may

require

piration.
as-

will

requireoperation and drainage.

F. Fever.
Usually self-limited,not prolonged. Alcohol rubs,
cold baths, may
be used
for a stimulant
cold sponges,
effect.
Friction of the skin is usually advisable while using cold treatment.
butter may
Friction alone using cocoa
also reduce temperature,
Pus

stimulate

vaso-motors

and

add

to

comfort.

MEASLES.

Prophylaxis.
Practicallynone.
Immunity.
Naturally except during 1st
of life especially1st 6 mos.
Immunity from one attack
year
great and almost always complete.
very
B. Asepsis. Particularly difficult in general life because
of
droplet infection. The most casual contact will allow the disease
Avoid
the region of persons
who
to be contracted.
sneeze.
Keep hands clean and avoid touching mouth or nose with infected
hands
or infected
objects.
of littlegeneralvalue because of the contagiousC. Isolation
ness
the
of the disease, and
of contagiousness
appearance
usually several days before the disease is recognized. Isolation to
be of any value should be secured early in the catarrhal stage,
until the acute
continued
and
catarrhal
stage has subsided,
to fifteen days.
that is,from
There
carriers.
seven
no
are
be isolated so that droplet infection
Technique. Patient must
not
be carried to others,otherwise
technique same
as
may
for scarlet fever except of much
less importance.
Persons
D. Quarantine. The one effective means
of control.
until
exposed should be kept from contact with non-immunes
I.

A.

"

three

weeks

from

the

stopped in schools

last exposure.
inspection and

The

disease

cannot

be

requires closing of the

schools if it is desired to check
the epidemic. Closing of the
schools to be of value requiresprevention of continued
contact
of the families of a community.
Measles
E. Disinfection
of practicallyno
general value.
contagion dies with extreme
rapidity and probably invariably
within 24 hours after leaving body under
ordinary conditions.
Surroundings of patients who have recovered have ceased to be
"

infectious.

by

103

II.

chief

of

Treatment.

cause

death

is

secondary infection of mucous

of which
is of greatest importance.
membranes
pneumonia
brane
memTreatment, therefore,should be directed against mucous
infection,especiallyof the lungs,
The

toxaemia.

A.

Acute

1.

Free

2.

Cathartics

fluid intake.
be used

must

carefullyto avoid causingdiarrhoea.

3. Stimulation.
a

Tepid baths

Friction

to

cool

or

skin, as

butter

cocoa

rubs, etc.

infections.

membrane

B.

Mucous

1.

Bronchopneumonia.
a

sponging.

Prevention.

(1) General
and

resistance.
food

easy

Fresh
to

air,sunshine, rest

digest

and

to

absorb

in

bed,
help to

resistance.

maintain

cleanliness,prevention of
nasal and laryngealobstruction,soothing oilysprays
do good.
may
of other
infections
(3) Avoidance
as
colds, diphtheria,

(2)

Local

resistance.

Mouth

etc.

See

h Treatment.

pneumonia,

page

121.

Acute

2.
a

laryngitis.
is the
Expectorants of which water
hydriodic acid, etc.
ipecac,syrup
with
Steam
inhalations
compound
and

most

essential,syrup

tincture

of

benzoin

menthol, followed

by oily sprays.
if obstruction
and requires it.
Intubation
c
occurs
in all cases
d Antitoxin
unless diphtheria has been excluded
by examination
the

of the

larynx and

taking cultures from

larynx.

3.

Tracheitis.

4.

Otitis

5.

Rhinitis.

Same

Media.

as

laryngitis.

See scarlet

fever.

Soothing applications,oily sprays.

b Atropine, camphor, etc.,as in rhinitis tablets.

6.

Stomatitis.
a

Mouth

cleanliness.

105

foul
use
once
are
peroxide if teeth and gums
twice daily.
or
Chromic
acid solution,2 to 4 per cent: apply with swab
c
once
daily.
of carious roots, bad teeth,etc.
d Removal
b

Hydrogen

Careful

"

Mouth
of any kind.
antisepticsolution with cotton swab

avoidance
mild

Iodine

of trauma

preparations and

silver nitrate may

have

value

liness,
clean-

cators.
appliin

tain
cer-

selected conditions.
7. Noma.
a

Careful

Preventions.
of

mouth

the

teeth

attention

to

membranes

mucous

prevents stomatitis.

Avoid

by
promptly

trauma

all ulcers
manipulations. Treat
with peroxide and apply chromic
acid solution.
b Treatment.
to
Escharotic
destroy completely the inthe
fected
actual
cautery is the best, with
area;
or

chloroform
8.

anaesthesia.

Conjunctivitis.
Boric

acid solution wash

b White

vaseline for lids.

three times

daily.

Avoid

injuringcornea.

Entero-colitis.

9.
a

Prevention.
other
or

food

Avoid

is free from

sterilized.

b Treatment.
doses

every

overfeeding; be

Avoid

contamination
unwise

that

sure
or

catharsis.

is

milk

and

pasteurized

Avoid

fluid,cereal diet,bismuth
four hours.
Beta-naphthol may

tion.
starva-

in drachm

Force

be tried.

PERTUSSIS.
I.

Prophylaxis.
A. Immunity.
1. Natural.
becomes
Extremely low in earlylife,

five years and considerable in adult life.

2. Active
immunity is claimed by means

greater after

of vaccine.

is uncertain.
B.

Asepsis. Similar

to that

of

measles, p. 101.
C. Isolation.
Similar to that of measles, p. 101.
D. Quarantine. Similar to that of measles, p. 101.
E. Disinfection.
Similar to that of measles, p. 101.

Value

107

Treatment.

II.

A.

Vaccines

trial.

Vaccines

bacillus
million
B.

containing

should

be

used

used

be

may

of doubtful

stillremain

value, but
of the

strains

many

dosage of from

"

at intervals

of from

million

100
two

worthy of
Bordet-Gengou
are

five

to

to

1000

days.

Hygienic.

sunshine.
Fresh
air and
general resistance.
of prostrationor fever.
Rest, varying with the amount
2. Diet.
Easily digested foods such as cereals,milk, bread
and butter,rice,simple puddings, chicken,scraped beef,zwiebach,
1.

Building

up

in

vomiting occurs, meals should be frequent and small

If a meal
and given.if possible after the paroxysm.
amount
be repeated. High protein foods
vomited, it should at once

are

inadvisable

the

If

etc.

because

of the

longer stay
vomiting.

danger of loss from

Bitter

3.

tonics,iron, etc.,
might upset digestion.

which
C.

Local

sprays
to

albolene

as

and

throat

nose,

essential.

albolene

or

larynx

Inhalations

sometimes

with

may

of steam

useful to stop the

the expense

dust, irritant

Avoid

resistance.

given. Avoid

be

may

stomach

in the

be

Free

used.

with

but

Oily
antiseptics
etc.

or

water

and

menthol

paroxysm,

medicines

gases,

sedatives

other

must

once

or

twice

E.

Paroxysms

1.

Fresh

2.

of

air

min.

ev.

hour^ and

and

appears
may

then

severe

sleep and
a
day, or
of Belladonna,

increasing

continuing

in the

be used

for

dose

in

of 2 to

day.

of

cough.
day and night is,probably, the

most

efficient

diminishing cough.

Psychic

suggestion and
3.

Avoid

4.

Pressure

around

at

of

beginning with 1 to 3
until the physiological effect
Chloral
slightlysmaller doses.

means

are

used

be

not

is

intake

creosote

general hygienic treatment.

D. Sedatives
demanded
should be used only when
the patient or interferes with
cough which exhausts
nourishment.
Antipyrin 1 to 4 grs. three times
be tried,or Tincture
Quinine Sulph. 2 to 5 grs. may

5 grs.

and

is

treatment

avoid

"

calm

the

patient by psychic

fear of

psychic upsets and

loud

noises.

all irritants.
on

the abdomen.

the

epigastrium

or

the

use

of

tight bands

109

Spraying the larynx, with sedative solution such as menthol

of steam
with benzoin
followed
by menthol,
by inhalations

5.
or

of limited

etc.,are

value.

Sedative

above.

drugs: see
Complications.
Bronchopneumonia.

6.
F.
1.

A.

Prevention.
sunshine

air and

(1) Fresh

the

throughout

disease,

Rest.

(2)

(3) Keep
(5) Avoid
such
Stomatitis.

3.

Otitis

4.

Cerebral

dust, etc.
See Measles,
See

hemorrhages
severe

103.

page

Scarlet Fever, page

paroxysms

Vomiting. Prevention
The
danger is malnutrition.

93.

be

guarded against by attempting

of cough.
depends on control of cough. The

may

5.

small

colds,irritants,

acute

as

as

Media.

to control

by wise feeding,

fatigue from paroxysms.

other
infections,such

(4) Avoid

2.

nutrition

up

effects

meals, and by taking

minimized

be

quent
by frepromptly after vomiting.

can

food

VARICELLA.
I.

Prophylaxis.

six months
Considerable
under
and increased
Immunity.
in adult life.
distinctlyafter five years, and is rather marked
in practice,the disease is so
B. Asepsis.
Difficult to carry
on
contagious. Principlesare similar to scarlet fever and diphtheria.
A.

C. Isolation
continued

until

be

should

"

insisted

on

complete healing of

early

as

lesions

the

as

or

possible and
until they are

entirelydry.
I.
D.

Technique, same
Quarantine.

contact

with

others

E.

Disinfection.

II.

Treatment.

as

It is

for scarlet

important

for three

weeks

See Scarlet
The

toxaemia

fever
to

diphtheria,p.

keep exposed

after

Fever,
of

and

the

p.

the

infection

of the

89.

varicella

skin lesions with

from

persons

last exposure.

Nephritis rarelyfollows the disease.

is from

87.

other

is of
The

portance.
slight imchief

organisms

danger
such

as

streptococcus, diphtheria bacillus,etc.

A.

Toxaemia.

fluids,during

the

Cold

sponging, ice

acute

stage of fever.

caps,

rest

in

bed,

force

Ill

lesions.

Local

ginning.
asepsis is essential from the beDaily baths with soap and water preferablyby shower,
drying the skin with clean towels and anointing with boric acid,
oil are
of value.
vaselin or camphorated
Underclothes, night
clothes and sheets should be kept scrupulouslyclean and changed
be advisable
weak
to use
chlorinated
daily. At times it may
baths.
Chlorinated
soda is especiallybeneficial for small areas
of secondary skin infection and may
be followed by application
B.

of ammoniated

Careful

mercurial

C. Mouth

ointment.

lesions.

mouth

which

D.

Corneal

in the
lesions occur
Occasionally manj^
require very careful asepsisand cleansing.
Treatment
of
occur.
conjunctivallesions may

may
or

these lesions should

be very

and

prompt

active to avoid

blindness.

DIPHTHERIA.
I.

Prophylaxis.

A.

Immunity.

This

be

5V of
by Schick's test.
the minimum
lethal dose of diphtheria toxin freshly diluted is
A positivereaction at the
injectedintracutaneously into arm.
end
of 48 hours shows
a
or
red, infiltrated area of 1 cm.
more
in size,the central part of which
later becomes
pigmented and
finallydesquamates. The whole duration of the lesion is one
weeks.

can

tested

Persons

no
having a positive reaction have
antitoxic immunity, although they may
have
other immunity.
Those
showing no reaction at the end of 48 hours are immune.
The
immunity usually persists indefinitely.False reactions
cause
usually occur
an
early and subside quickly. They may
in
be secured
error
reading results. Control may
by:
or

more

(1) Heat

toxin

75" C. for ^ hour

to

(2) Repeat and give dose

blood and test
(3) Draw
1.
For

Passive.

1000

immediate

2.
85 per

is

Toxin
of the L

injected

at

and
+

3.

Remove
Treat

Local.

Secure

bad

teeth

diseased
or

gums

chemical

or

to

three

of

weeks

mixed
week

one

lasts months

local conditions

roots, diseased
and

mucous

injuriesto

strength.

the

subcutaneously.

or

mixtures

of toxin

that

good

before.

as

of antitoxin,

antitoxin

intervals

immunity slowly appears

for antitoxic

one

dose

use

of antitoxin.

units

2000

need; lasts

Active.
cent

to

and

more.

with

for three
or

of

membranes

70

to

unit of antitoxin

one

doses.

An

years.

membrane.

mucous

tonsils and

mucous

used.

are

adenoids, etc.
and

membranes.

avoid

chanical
me-

113

Asepsis.
putting fingers,pencils,pins, etc., in

B.

Avoid

1.
to

the

the

mouth

or

nose.

the

Wash

hands

carefullybefore eating.
not
3. Do
use
common
towel, etc.
drinking cup or common
4. Avoid
kissingon lips.
5. Avoid
region of people who cough, sneeze
or
spit.
milk
6. Avoid
handled
or
produced under poor conditions,
and avoid public dining rooms
or by ill persons,
poorly managed.
is of
Isolation
C. Isolation.
great value.
Prompt
nition
recogthis effective.
is required to make
Missed
also
cases
be
found
must
by epidemological studies, and
culturing
2.

Isolation

suspects.

bacilli have

be

should
been

continued

absent

until

shown

as

virulent

theria
diph-

cultures

by

for

at

least three

days.
Technique of isolation. See under Scarlet Fever, p. 87.
tures
Quarantine. Quarantine is of little practicalvalue as culand if found to be negative,
be taken in exposed persons,
may

1.
D.

quarantine need not be continued.

places of assembly is unnecessary,
to

discover

thus

carriers

those

who

II.
The

chief

diphtheria toxin

acting on

cases

other

or

be taken
who

those

among

in

finding

disease.

Treatment.

death

of

causes

should

measures

is of great value

test

the

susceptibleto

are

but

clinical

as

Schick's

together.

come

weU

as

Closing of schools

the

in

diphtheria
centers

nervous

are
or

the
upon

result
the

of

heart

of mechanical
and to a less extent
lation
stranguperipheral nerves
and pneumonia, as in the lar5nigealcases.
The essential,
and meof diphtheria toxaemia
chanical
is,therefore,prompt treatment
or

obstruction
A.

For

1.

Antitoxin.
a

to

breathing.

Toxaemia.

As

early as possible,first day best.

Dose, varying with severity of disease
administration.
or

2.
page

General
63.

more

for very

eliminative

2000
severe
measures.

for

very

cases.

mild
See

to

and

mode

of

100,000 units

antitoxin,page 191.
See principlesof treatment,

115

B.

obstruction

of

breathing.
as
early as possible.
for obstruction
Intubation
at larynx.
of
muscles
(a) Indications.
Stridor,use of accessory
Relief should
restlessness,dyspnoea.
secured before cyanosis and exhaustion
occur.
For

"1. Antitoxin
2.

3.

4.

piration,
res-

be

Tracheotomy,
(a)

If intubation

(6)

For

fails.

obstruction

above

below

or

the

larynx.

Bronchoscopy.
For

(o)

membranous

obstruction

low

slightvalue

or

in

down

trachea

or

bronchi.
C. Local
1.

acid

Of

treatment.

importance.
Saline solution,boric

Cleansing irrigationsfor the throat.

solution,

Dobell's

or

solution

be

may

and

cleansing and
as

warm

membranes
soothing mucous
patient can tolerate it. Do

used

as

copiously for
should

exhaust

not

be

the

used

patient

by excessive attention.
2. Bacteriocidal
therapy has faUed.
3. Soothing applications for mechanical
cous
protection of muThe
nose
membranes, such as alboline and oily sprays.
in this way
be
treated
or
by instillations. Irrigations
may
should
D.

not

be used

patient should
cardiac

or

all

In

Rest.

in the

nose.

cases

in

be

kept in bed for

complications may

nerve

toxaemia

which

is marked

three

to

six

occur

as

late

Sunshine, fresh air,freedom

the

weeks, because
as

this.

from

dust, etc.
F. Diet.
diet
of fluid. Balanced
amounts
easily
Large
special
requirements. No
digestibleand suflBcient for energy
E.

Hygiene.

dietic indications

and
except digestibility

III.

1,

Cardiac.
a

Treatment

Occurs

Prevention.

of

water

content.

Complications.

chieflyin the firstthree weeks

Solely by early antitoxin

of the disease.
in

sufficient

amount.

6 Treatment.

(1) Horizontal
to

position.

Do

not

allow

the head

or

body

be raised.

(2) Nothing by mouth

if

nausea

or

vomiting is present.

117

(3) Nutrient

and

enemata

salt solution

by

rectum

as

thirst.

required by
(4) Morphine subcutaneously

in small

doses

for sedative

effect.
of doubtful

(5) Stimulation

to five ev.

grains one
The

essential

of

rest

and

distm'bance

is

Note.

degree
If the

"

cardiac

the

on

recovery

strain

function

cylate
sali-

the

secure

the

on

highest

heart.

than

one

The

week.

is

kept to a minimum
Myocardial weakness

occur.

may

late in disease and

occur

of

sodium

hours,subcutaneously.

is to

treatment

avoidance

Caffeine

self-limited,
rarely lasting more

demand

period,

this

of

value.

require careful

but

rest

for
may

it is of small

portance
im-

compared to the early acute cardiac deficiency.

Diphtheretic Paralysis.
of antitoxin
(a) Prevention.
Solelj^by early administration

2.

in sufficient amounts.

(6)

Treatment.

circulation

(1) Improve

locallyby

passive motion.
(2) Improve general condition.
food, iron and tonics.

electricity

massage,

and

(3) Antitoxin
3.

Otitis Media.

4.

Pneumonia.

5.

Chronic

is of

value

no

See under
See under

after the

air, sunshine,

paralysisappears.

Scarlet

Fever, page 93.

Pneumonia, page 121.

chronic

"tubes";

Fresh

obstruction

of

larynx

after

tubation.
in-

Prevention.

(1) Avoid

in

trauma

(2) Correct

operation.

size tubes

(3) Shortest

avoid

undue

duration

of

to

reasonable

pressure.

wearing

tube.

h Treatment.

(1) Tracheotomy

to

if obstruction

(2)

After

Cervical

7.

Serum
a

laryngeal irritation or injury

persistsfour weeks without ment,
improve-

healing of larynx mechanical

of tubes
6.

avoid

or

Adenitis.

dilatation

by

means

dilators.
See under

Scarlet

Fever,

p.

95.

Disease.

Urticaria.
and

Local

and

general sedatives,and

free fluid intake.

Adrenalin

1 to

mild
1000

artics
cathsolu-

119

tion, minims,

10

subcut.

15

to

Repeat in

minutes

20

if necessary.
b

Angio-neurotic edema.

Treatment

and

unnecessary

effective.
in-

No
effective.
treatment
Eythema multiforme.
d Enlargement of lymph-nodes.
Apply ice.
e J
Arthralgia. Immobilize, gaultheriadressings,salicylates.
jection
local cellulitis at point of ina
phenomenon,
/ J^Arthus'
c

of antitoxin.
g

Poultices.
for

apply

Vomiting. Stop everything by mouth

Anaphylactic shock.

time.

(1) Prevention.
(a) Skin

Scratch

test.

Local

skin

reaction

of

and

urticarial

type

little
in

serum.

to

15

susceptibility.This case should

be given serum
only when
absolutely essential
and under specialprecautions.
shows

minutes

(6) If sensitized

horse

to

bovine

serum

serum

be

may

used,but sensitization to this should also be tested.

be tried.
desensitization may
(c) If patient is sensitized,
(1) Small doses startingwith j^^ cc. to xoVo cc,
and

increase

the dose

carefullyat about

hour

intervals.

(d) Paralyze mechanism

(1) Atropine
before

in

bronchiole spasm.
shock, i.e.,
full dose subcutaneously, 1 half hour
of

serum.

in

(2) Adrenalin

fuU

dose

at

the

same

time

as

allow

of

serum.

(2)

Treatment.
treatment

Usually death
being used,

(a) Atropine, full

is too

rapid

to

doses.

(6) Adrenalin, full

doses.

(c) Oxygen.
(d)

Heat.
IV.

1.

Remove

mucous

Enlarged tonsils and

Carriers.

abnormalities, if possible.
sinus
adenoids, foreign bodies, accessory
membrane

disease,carious teeth, etc.

2. Chemical
applicationshave

been

of very

doubtful

value

"

121

nitrate,

silver

well

staphylococcus

definite
4.

proved
5.

as

acetic

argyrol,

acid,

chromic

acid,

iodine,

used.

"Overriding,"

3.

the

been

have

etc.,

as

by

spraying

and

bacillus

with

other

bulgaricus

bacteria,
has

not

such

proved

as

of

value.

kaolin

Powdered
its
Vaccine

applications

at

short

intervals

value.
treatment

is

still

of

questionable

value.

has

not

PULMONARY

INFECTIONS.

LOBAR
Notes.

An

"

the

pulse and
Mortality

infectious

acute

caused

commonly

most

PNEUMONIA.

I(a)

multiple
The

etiology,
rate

of

toxemia.

of

disturbance.

Circulatory

I (6) Asphyxia,

less often

f (a) Empyema.
\ (6) Pericarditis.

to

Complications.

2.

to

of

pneumococcus.

indices

are

due

commonly

Toxemia

1.

the

by

respiration

disease

1(c) Endocarditis.

PRINCIPLES

1.

Secure

2.

Eliminate

3.

Watch

4.

Stimulate

5.

Prescribe

6.

Take

7.

Diet

8.

Recognize

fresh

nursing and

good

and

TREATMENT.

OF

dilute

air.

toxins.

circulation.

drugs only

precaution
suitable

to

to

required.

when

promptly

definite

for

reasons.

accident.

prevent

case.

complications

promptly.

METHODS.

Eliminate

1.

unless

the

toxins

heart

urinary output

air

the

old

and

is,perhaps,

diminishes
3.
of

to

the

Note

pulse

at

that

feeble
the

best
and

outlines
every

requiring
and
the
is

treatment

dyspnoea
the

weak,

see

Out-of-door

2.

but

be

by

are

keep

likely

likely

promotes
sounds

visit.
123

to

in

ingestion of water,

bowels

the
is

water

stimulant

and

copious

clear.

Watch

being excreted.

to

benefit

do

better

robust

patients,

indoors.

Fresh

Sometimes

pneumonia.

it

comfort.
of

the

heart

and

the

quality

125

Stimulation

4.

(6) if it

poor,

is indicated

becomes

if the

(a)

quality

(c) if

irregularor

the

of the

rate

pulse be

above

go

120.

Irregularityearly in the illness is less apt to herald danger

than that developing late.
5. Morphine is indicated to relieve pleuriticpain when
a
tight
fails
is
do
to
swathe
so.
important to conserve
Sleep
very
the strength of the

be used

patient and morphine may

early stages of pneumonia.

to

obtain

it,especiallyin the
bronchial
secretion is
Morphine is contraindicated whenever
it checks expectoration, and if morphine is to
profuse, because
in the

used

be

Diet

6.

later stages caution

should

is necessary.

of food

consist

that

requires no

chewing and

that is

easilyswallowed; i.e.,liquidsand soft solids.

should
be gauged by the digestivepower
The
of the
amount
of the disease is so short that
individual,but the usual course
nutrition

is seldom

Avoid

7.

Besides
true

important.

renal irritants and

gas-producing foods.

complications above-mentioned

the

look

When

9.

(or 30

is very

temperature

baths

sponge

be used

may

Tympanites

reduce

to

require

may

high and
the

the

heart

doing well,

fever.
An

treatment.

of

enema

glycerinundiluted generally acts well.

be relieved to some
10. Dyspnoea with
cyanosis can
by inhalation of oxygen
passed through absolute alcohol.

oz.

c.c.)of

STIMULATION

the third
be

may

nephritis.

8.

On

for

out

fourth

or

ordered

t.i.d.

OF

day,
It

10

may,

m.

extent

HEART.

(or

0.6

c.c.)of

perhaps, ward

Tr.

digitalis

off sudden

tation
dila-

of the heart.
For

be
sodio-salicylate
may
be
time
used
the same
digitaliscan
for subsequent effect,or digipuratum solution
given by mouth
(p. 197) can be injectedinstead of caffeine.
For

irregularityor weakness
subcutaneously, and at

acute

cardiac

dilatation

tried

according to circumstances
Subcutaneously :
1.
2.

caffeine

the

following remedies

for subcut.

use.

be

Digipuratum-solution.
Camphor in oil: 3 grs. (or 0.2 gm.).
prepared

may

It should

be

specially

127

sodio-salicylate:3

Caffeine

3.

Intravenously Digipuratum-solution
be

The

given.

cause

wakefulness.

or
irritability

may

It may

(or 0.2 gm.).

grs.

latter is

Strophanthin

or

(p. 197)

dangerous.

By mouth:
1.

Brandy,

2.

Aromatic

fr.

form

reflex

ice-bag

an

vascular

with

abdomen

the

to

Salt

beneficial.

be

delirium

used

subcut.

with

exhaustion.

No

If

of

cold

in

good by causing

subpectorally
results

improvement

her

or

ameliorated

travenou
in-

or

follow

the

place lest

be

the

of service

5,

sec.

for

patient jump

for delirium

be

slight, may
even

dangerous.

moment

some

the

from

one

window.

shoxild be left about.

kind

of any

weapon

room

(see

by morphine

by hyoscine hydrobromate*

when

even

leaves

nurse

take

razor

solution

internally may

Delirium,

the

should

do

may

sometimes

or

Alcohol

Caution.
When

large dose

TREATMENT.

be

may

123), by hypnotics,

p.

much

caffeine.

DELIRIUM:

Active

to

application

momentary

contraction.

may

it up

The

relaxation.

of

with

cyanosis

gm.) given subcutaneously.

(or 0.001

gr-

is

there

(or 6 c.c).

yields occasionally

edema

pulmonary

atropine gV

the

1 drach.

if

good

c.c).

30

to

right ventricle.

of the

Vascular

(or 15

oz.

do

may

engorgement

of

to

spiritsof ammonia,

Venesection

Acute

BRONCHO-PNEUMONIA.
Treatment
that

is
the

essentiallythe

disease

when

this

is often
is the

case,

for

as

generally runs

Nutrition, therefore,is
Bronchitis

same
a

lobar

milder, but

pneumonia

longer, coinse.

important.

more

associated

with

expectorants

broncho-pneumonia,
may

be

of

service

convalescence.

Scopolamine

is

chemically

cept
ex-

the

same

as

hyoscine.

(U.S.D.)

and

during

129

BRONCHITIS.
ETIOLOGY.

follows infections of the upper

commonly
respiratorytract and especiallyinfections by the pneumococcus
bacillus.
influenza
It occurs
fectious
inor
symptomatically in some
diseases,e.g., typhoid and measles.
Chronic
bronchitis is often associated,in old or middle-aged
with
slight cardiac insufficiencyor with emphysema.
persons,
bronchitis

Acute

Rarely, gout is

factor.

DIAGNOSIS.
Acute

chronic

by tuberculosis
is imperative. Many
cases
and, therefore,sputum examination
of bronchiectasis
following influenza are wrongly diagnosed as
bronchitis or as phthisis.
or

bronchitis

ACUTE
1.

keep

BRONCHITIS

When

there

warm

and

2.

If there

3.

Bronchial

If the

secretion
not

the

symptoms

patient should

by staying indoors.

may

be

advisable

must

be

expectorated, but unproductive

to fatigue the patient or
to

be

from

comes

it; if

sufl"ce to check

may

of

cough

TREATMENT.

change of temperature

fever,bed

cough should
prevent sleep.

constitutional

are

avoid

is

be simulated

may

allowed

or

necessary.

laryngeal irritation (p. 151), lozenges

halation
infrom the larjmx or trachea, steam

(p. 151) TdOif be

cough codeine sulphate \

serviceable.

If necessary

relief

for

gm.) or heroine hydrochloride*

be prescribed for use
in the
gm.) may
gr- (or 0.005
T2
afternoon
at night. Morning
to
or
cough is generally needed
clear the lungs. It can
be promoted by a hot drink.
4. Substernal
distress or pain, see tracheitis,p. 151.
5. Expectorants are
contraindicated
during the acute stage of
bronchitis

They

because
be

may

expectoration
*

The

'Heroin"

they irritate

used

name

the

inflamed

during convalescence,

is often

hydrochloride
is

(or 0.016

gr.

tenacious

of the

diacetic

bearing U. S.

t.

mucous

at

which

and

difficult to raise.

ester

of morphine

(N.N.R.).

membrane.

(U.S.D.)

time

not

the

official.

131

6.

Several

weeks

generallyrequired for complete

are

feels well

the

patient
his occupation. Smoking

but

when

CHRONIC
1.

2.

in the

as

are

SquillPill

Compound

may

The

expectorant.

an

bathing should
be

should

recovery,,

to

be

resume

resumed

avoided

long

as

TREATMENT.*

of fr. 5 to 10 grs.

is

stimulants

allowed

generally beneficial,particularlypotassium
0.3
0.6
to
(or
gm.), t.i.d.
sign of cardiac insufficiency,approany
priate
For
indicated.
slight insufficiencythe

are

dose

there

When

exposure

be

may

BRONCHITIS:

Expectorants
iodide

cold

and

cautiously and unnecessary

as
expectoration persists.

he

well both

act

dose

usual

as

stimulant

heart

is from

to

and

pillsdaily.

ment
treatfreshly prepared. Systematic cardiac
be required.
may
climate
3. An
comfort,
equable and warm
promote
may
especiallyfor elderlypersons.
be suspected treat
of bronchiectasis
the
4. If the
presence

should

They

case

as

5.

of bronchiectasis.

one

exacerbations

Acute

much

be

is acute

as

indicate

chronic

of

bronchitis, but

bronchitis

be

may

treated

generally
developed, and

symptoms

severe

has
pneumonia
should be regulated accordingly (p. 121),
treatment
6. Codeine
sulphate or heroine hydrochloride should not be
used consecutivelyover
of the danger of
long periods on account
that

forming
7.

bronchitis
Exclude

hardly

Much

"

to

of

habit.

The

Note.

form

some

be

of overfed

gout

as

patients is often benefited

factor.

improvement

may

in chronic

expected

pletion.
by de-

be

for but

hoped

cure

is

bronchitis.

BRONCHIECTASIS.

chronic,lastingfor thirty years, more

be subjected to recurring attacks
less. The
of
or
patient may
broncho-pneumonia, or of hemoptysis. Many
patients have
asthma.
condition
is often
or
f The
diagnosed
emphysema
Note.

"

There

The

"

disease

is increasing

bronchitis, in

the

reason

great

tuberciolosis,bronchiectasis,
t Empyema,

is

believe

to

majority
or

of

slight cardiac

abscess, arthralgia,

or

that

instances,

of

cases
are

in

supposed

chronic

reality pulmonary

insufficiency.

pneumothorax

occur

in

rare

instances.

133

wrongly

bronchitis

as

The

influenza.

to

abundant

contains

lobe

one

influenza

bacilli.

influenza

disseminated

or

raised

cases

will

at

bacilli

examinations

Repeated

organisms.
the

be

can

Many

cavities

other

strate
demon-

to

be

may

both

throughout

various

as

be necessary

may

The

purulent,

coughing, and

by

well

as

traceable

are

typically, is abundant,

sputum,

greenish, nummular,
often

tuberculosis.

or

in

localized
Nutrition

lungs.

is

show
generally good. As the physical examination
only a
may
rest
the history, the character,
few
rdles,the diagnosis must
on

and

the

of the

amount

sputum.

TREATMENT.

yet devised

method

No

Efforts

possible from

be

at

such

gm.)

the

patient

facilitated

or

viscid

expectorants

come

material

odor

to

In

emetic

An

of

Sputum

fr. 5 to
used

as

if the

the
This

coffee

or

(or 0.3

10 grs.

in

day.

tea

water,

in the

to

secretion

be

0.65
too

these

be

must

be

not

expectoration.

and

secretion

simulate

may

made

from

relief

gives
the

foul

condition

bronchial

history and

asthma.

sputum.

by clearing the lungs.

are

better

in

relieve

but

cannot

patients
may

cavities

retained

cyanosis

climate

free

sputum.

of

can

check

they

give immediate

uniformly mild
5.

far

as

rising

on

later in the

of hot

be

may

to the

diagnosis

will

Most

4.

iodide

instances

dyspnoea and

differential

drink

because

and

extreme

its

with

patient

cavities

twice

or

decomposes

then
breath

the

the

readily.

up

sedatives

The

3.

by taking

other

Avoid

2.

once

Potassium

his

drain

to

times.

to

cure.

relieving

to

morning, and, if necessary,

can

hope of

unpleasant symptoms.

Teach

1.

directed

be

must

offers

swallowed

because

weather.

warm
cure.

diarrhoea

may

result.

Foul-smelling sputum

6.

The
of

odor

be

can

Eucal5^tol
7.

chance

When

on

the

of relief

means

ameliorated
a

lump

disease

by the

of sugar
is locaUzed

by surgical means

inefficient
use

several
in
may

one

be

drainage of cavities.

of 3 min.
times
lobe

(or

0.2

c.c.)

daily.
of the

considered.

lung the

135

PULMONARY

TUBERCULOSIS.

By

2nd, M.D.

Hawes,

John

Consumption, Phthisis,Tuberculosis of the lungs.

tubercle
Etiology. The
bacillus,discovered by Robert Koch
be
in 1882.
mentioned
an
Among
predisposing factors may
constitution or predispositionto the disease;
inherited weakened
overwork, or bad conditions of work, such as the dangerous
cohol,
altrades; poverty and poor living conditions; bad habits
etc.; certain acute diseases,such as measles and whooping
cough, etc.; or in fact,anything which may lower the resistance
of the body to infection.
Synonyms.

"

"

COURSE

two

either

to

seven

years.

overwhelming
run
resistance,it may
weeks.
months, or even
is not

the disease

chronic

In

certain

rapid

In

confined

These

semi-active
are

as

years,

time

the disease is in

object of treatment
as possible.

of

long

condition

is to make

and

Tuberculosis

short

these

in

chronic

usual

periods of

the

great lack
end
the

form

two

or

few

least,
of

more.

the disease,

of

to

seven

during which

semi-arrest.
arrest

of

it may

cases

type

at

years

duration

of arrest,or

as

The

permanent

SEQUELS.

AND

elsewhere

the

of from

course

or

COMPLICATIONS
1.

The

exceptions,however.
above
a
mentioned, runs
intermissions

twenty

or

the

with

toward

certain

for fifteen

form

or

lungs but takes

in

there is

where

cases,

ending fatallyin

cases,

the

general septicaemia. Likewise,

last in

acute

course,

such
to

disease,usually lasting

of infection

amount

an

DISEASE.

THE

is

tuberculosis

Pulmonary
from

OF

body, especiallythe

throat

genito-urinarytract.

2.

Hemorrhage.

3.

Cardiac

tubercle

Weakness,

due

to

the

toxins

generated by the

bacillus.
DIAGNOSIS.
for extensive

signs in the lungs, nor for a positive

before making the diagnosis and institutingtreatment.
sputum
Pay specialattention to constitutional signs and symptoms, such
as
evening fever and rapid pulse, subnormal
temperature and
Remember
rapid pulse,loss of weight, strength and energy, etc.
Do

not

wait

137

in

that

instances

most

tuberculosis

pulmonary
wet
are
pleurisies,
and

of

also

than

sense

"absence

that

and

that

tuberculous.

common

proof is

from

hemorrhage

the

mouth

means

pleurisies,
especially-

most

the thermometer
on
Depend more
the stethoscope and remember

on

proof of absence."

not

PROPHYLAXIS.

Destruction

1.

all sputum.

of

See

that

the

patient

uses

be
flasks,or cloth or paper
napkins which can
of sputum.
burned, according to the amount
2. See that the patient is trained
to place his hand
handkerchief
or

sputum

cups,

in front of his mouth

coughing

on

Separate the children to

of infection,
all sources
whether
3.

4.

Mechanical
and

papering

premises in
them
5.

which

adults
soap,

"

best

is the

an
or

sneezing.
extent
as possiblefrom
other

children.

ing
water, scrubbing, repaint-

treating the
consimiptive has lived, in order

of

means

rooms

to

or

make

safe.

Observance

living,as
the

cleanliness

great

as

or

to

average

of

the

ordinary rules of hygiene and right

work, sleep,play, food and drink, is the best plan for
who

person

wishes

TREATMENT

Treatment

and

be

GENERAL.

IN

active

this disease.

aggressive. It should begin

made
the diagnosis;in certain cases,
as
soon
as the physician has
fit to tell the patient definitely
this may
be before he has seen
that he has consumption.
In the vast
majority of instances,
it is far better to talk frankly and plainly to the patient. If the
diagnosis is certain,teU the patient; if you are in doubt, and
of the symptoms,
merely suspect that tuberculosis is the cause
explain the situation frankly and clearlyto the patient and to
his relatives

should

avoid

to

friends.

In

and

no

other

way

can

secured.
Methods

of treatment

include

the

following:

1.

Sanatorium

2.

Home

3.

Climatic

4.

Tuberculin.

5.

Heliotherapy, or sunlighttreatment.
Drugs.

6.

treatment.

treatment.

treatment.

cooperation

be

139

SANATORIUM

TREATMENT,

time or other during the period

Every consumptive, at some
in which he is trying to regain his health,should spend some
time
to spend in this
The length of time necessary
at a sanatorium.
be short or long, according to the intelligenceand
way
may
of the patient and the nature
of his disease.
finances
In selecting
the following
consider
sanatorium, the physician should
a
points:
(a) Cost per week.
(6) Accessibility.

(c) Climate

and

altitude.
and

dispositionof
time patient expects to

(d) Temperament
of

(e) Length

HOME

This
been

is

at

usually

of successful
1.

and
2.
3.
4.
5.

similar

treatment

detailed

sending

him

the
the

benefit

tials
essen-

are:

the

patient by physician

TREATMENT.

distance, in order to
certain climate, the physician should

patient
of

considerable

followingpoints:

The

2.

Will the

of

cost

transportation and

the

cost

of board

after

rival.
ar-

patient be happy so far from home?

Has
the patient funds enough to remain
at least one
year?
See that the patient is placed immediately under high-grade

medical

him

The

nurse.

1.

5.

institution.

patient has

cooperation between
patient and physician.
Provision
for outdoor
sleeping.
Prolonged rest.
Finances
sufficient to insure proper
food and nursing.

consider

4.

the

Close

Before

3.

after

supervision of

CLIMATIC

give

at the sanatorium,

remain

and

before
some

or

home

and

Adequate

patient.

TREATMENT.

necessary

sanatorium

the

In
to

advice.
case

go

on

the

patient has had

account

of the

hemorrhages, will it be safe for

altitude?

141

Do

6.

the

favorable

Remember

7.

that
in

of his disease
him

for

with

if

climate,

they

certain

friends

this form

with

other
In

of

signs

the

treatment

at

the

of the

patient through

hoping

be

never

make

to

careful

the

had

has

patient

is under

unless

given
well

leave

absolute

stated

tuberculin

be

may

careful

with

in his

1914,
It is

has

is the

to

is

should
made

unless

the

should

it be

the

to

general practitioner may

of

pulmonary

article

on

work

this

disease.

of

fully

Leysin,

of this method.

subject

and

under

himself

of RoUier

to

well

sunlight used

powerful agent

disease

make

Air in Relation

that

good particularly in pulmonary

the

advocate

foremost

remember

TREATMENT.

physician should

subject by reading

excellent

important

lier's method

The

forms

Essay "Atmospheric

an

thereby

explained

are_

put

of tuberculin

use

times, nor

SUNLIGHT

tried in certain

Switzerland, who

the

all

possibledangers

OR

his

with

attempted

the

to

This

be
at

obtained

advisable

one.

of

alone.

supervision.

familiar

its

above, however,

HELIOTHERAPY

This

not

supervision

the facts and

As

patient.

should

have

physician has

the

or

course

treatment,

experience

some

It

therapeutically.

who

permanent

more

and

pulse

tuberculin.

through

tuberculin

of

In active

use

is sometimes

disease,it

arrest

been

elsewhere

or

to

wrong

have

attempted, however, unless

study and

live

to

fever, increased

absolutely

course

tuberculosis.

is any

patients who

sanatorium

arrest

apparent

an

impossible

home

take
general practitioner to under-

pulmonary

there

it is

toxemia

of certain

case

in

where

cases

or

be

may

return

to

arrest

apparent

safety.

for the

of treatment

progressive

or

progressive

TREATMENT.

it is inadvisable

rule

how

matter

or

an

climate, it

climate,

TUBERCULIN

advanced

patient gets

favorable

other

and

his relatives

As

friends,no

in the

are

if the

even

live in any

to

from

away

disease.

of the

stages

patients far

send

not

may

do

dale,
Hins-

Tuberculosis,"
worth

reading.

according
harm

as

to

Rol-

well

as

143

TREATMENT

in

Drugs,
merely

the

symptoms
be

must

tract

certain

In

of

treatment

tuberculosis,

the

disease

be

irritating cough

must

from

mild

these,

tonic

checked.

testinal
in-

tives
laxasive,
Excesbe

occasionally
stimulate

to

drugs

no

The

vegetable

or

must

used

are

itself.

saline

clear, hence,

instances,

Aside

indicated.

is

pulmonary

Diarrhoea

and

unproductive
allayed.

kept

DRUGS.

never

"

needed.

often

are

of

treatment

treat

to

BY

appetite
in

needed

are

the

tuberculosis.

pulmonary

MISCELLANEOUS.

patient

given

patient

has

the

patient's

upon

the

extent
"

Standards

childbearing

As
less

degree

exceptions
advice

is
to

dangers
methods

this
to

apphes

that
of

lie before

avoiding

and
them

such

his

of

while
It

wife
under

dangers.

not

every

such

effect

subjects

the

physician's
case

familiar
necessary.
To
are

many

physician's
duty,

understand

circumstances

of

cerning
con-

marry.

There

addition

is the
in

the

thoroughly

man.

in

and

physician.

every

patients when

tuberculous

than

Health

and

should

women

disregarded.

husband

to

be

to

more

"Diagnostic

important

duty

far

the

Massachusetts,

marriage,
are

situation

to

The

Community

perusal

women,

this, however,

that

and
and

tuberculous

generally

see

study

let

perseverance

lungs.

the

that

states

should

Framingham,

physician's

exact

rule

of

use

he

depends

and

the

in

tuberculous
it is the

general

in

tuberculosis

of

explain the

to

the

careful

the

on

which
and

for

He

courage

disease

the

disease.
outcome

should

physician

when

favorable

the

assuming

this

not

Demonstration

worth

is

inteUigence,

of

question

The

has

that

prepared

Tuberculosis
well

or

clearly

know

upon

are

he

responsibility that

the

realize

tuberculosis

diagnosis of pulmonary

the

In

ever,
howthe

and

the

145

ACUTE

INFLAMMATION
RESPIRATORY

Etiology: infectious

staphylococcus,

in

bacteria

predisposing factors lowered

to cold are
important.
Course

of

instances.

pneumococcus,

be

may

causative.

physical resistance

Inflammation

Disease.

The

coccus
bacillus,diphtheria bacillus,micro-

other

or

UPPER

TRACT.

most

influenza

catarrhalis

THE

OF

and

Among
exposure

generally begins

in

the

usually extends within a few days

membrane
to the nasal mucous
(coryza) and often to the tonsils
of
or
(tonsillitis)
larynx (laryngitis).The severity and extent
the inflammation
depends chieflyon the kind and virulence of
the infectingorganism and on
the resistance of the patient.
nasopharynx

(pharyngitis)

It

Complications and

Sequelae.

1.

Bronchitis.

8.

Bronchiectasis.

2.

Otitis media.

9.

3.

Peritonsillar

10.

Septicaemia.
Meningitis.

4.

Lobar

11.

Peritonitis.

12.

Inflammation

abscess.
broncho-

or

pneumonia.
5.

Arthritis.

antrum,

6.

Endocarditis.

moidal

7.

Glomerulo-nephritis.

sinuses.

Diagnosis. Exclude
and
diphtheria. The
be

can

take

if the
to

made

whooping-cough,
diagnosis

by culture

only.

in every

culture

another

the

fever, measles

diphtheria, in
the

Therefore

the

frontal, ethor
sphenoidal

scarlet

of inflammation

case

report be negative but

take

of

of

some

cases,

plan is to
the throat
and,

safest
of

signs suggestive of diphtheria

culture.

PROPHYLAXIS.
If there

1.

due

is

reasonable

diphtheria or
provisionally.
to

2.

If

antitoxin
on

the

the

to

one

of

clinical evidence

(p. 195)
culture; or

to
even

the
if

are
probability that the symptoms
the exanthemata
isolate the patient

points to
patient without

diphtheria administer

waiting for the report

the first culture be negative.

147

Prophylactic inoculation
3.

Patients

Good

risk of

coughing

on

ventilation

of

of the

respiratory tracts

should

sneezing.

or

occupied by

rooms

APPLICABLE

patient in

the

Keep

uniform
2.

diphtheria

to

the

patient reduces

contagion.

TREATMENT

1.

exposed

on.

having infections

mouth

the

cover

4.

insisted

be

should

all persons

of

IN

but

warm,

GENERAL.

well-ventilated

at

room

temperature.

Promote

and

rest

sleep,using sedatives

hypnotics when

or

needed.
3.
have

Move

bowels,

been

Allay unproductive

5.

Avoid
Cleanse

or

carthartic

or

unless

they

irritatingcough by lozenge or sedative.

or

local irritation

of

means

without

by tobacco

membrane

mucous

by
with

enema

acting freely.

4.

6.

salt

septicus alkalinus

frequently,

and

non-irritatinggargle.

sodium

or

concentrated

or

bicarbonate
be

(N.F.) may

used

in

liquor.

flammati
in-

soothe
Warm

water,

it,or Liquor anti-

diluted

with

parts of

water.

warm

7.

caffeine

citrate

(p. 203),
fever, malaise
8.

fr. 5 to

Antip5n:etics,
e.g., phenacetin

gm.), with
be

outset, by

at

Food

Abortive

alleviate

may

be

readily digestibleand
This

Treatment,

only, and

seldom

gm.),

discomfort

(or 0.3 to 0.65

grs.
or

salicylpreparations

especially if there

pain.

or

should

(or 0.065

1 gr.

10

can

then.

even

easy

to

be effective in the

following

The

measures

swallow.

early stages
be

may

tried.
1.

Cleansing, non-irritatinggargle.

2.

Hot

bath

3.

Hot

drink

4.

Early

5.

Catharsis

6.

The

bathing

to

before
on

retiring,or

retiringto produce sweating.

bed, and

by calomel

patient should
on

the

hypnotic unless sleep comes

or

quickly.

saline.

dress

in

following morning.

warm

room

and

avoid

cold

149

METHODS

OF

PHARYNGITIS.

ACUTE
1.

Cleansing gargle

2.

Oil spray

3.

Check

four

every

hours.

gargle to protect and

after

soothe

cough with lozenges (p. 151) when

codeine

use

TREATMENT.

brane.
mem-

mucous

wise
possible. Other-

heroin.

or

CORYZA.
as free
Keep the nose
Irrigationof the nose
much
relief,but some

lead

may

oil spray

An

If the

cause

severe

Atropine

can

may

dose

from

it in

of

2.

Whereas

fr. 4

sinus

nasal

gm.)

0.00032

hours

to

is viscid

gives
this practice
middle

or

quantity
of

s.o.s.

throat, increases

be

can

phate
atropine sulAtropine is
Excessive

tenacious.

or

ear.

passages.

its

watery,

(or

the

be used
min.

in the

form

(or 0.6

discomfort, and

to

of Tr.
2

of belladonna

leaves;

c.c).

TONSILLITIS.

ACUTE
Take

and

that

often

poisoning.

10 to 30

1.

free the

to

gi"-

270

drjness

causes

solution

frontal

the

secretion

when

contraindicated

of

profuse

by using
repeating

alkaline

an

physicians believe

used

be

secretion

and

dosage

be

may

diminished

with

inflammation

to

secretion.

possiblefrom

as

culture.
the

constitutional

symptoms

are

apt

to

be

severe

The

generallyadvisable to keep the patient in bed.

Prescribe
foiu" hours.
cleansing gargle to be used every
be painted daily with argyrol,tfr. 10 to 20 per
tonsils may

cent

in watery

it is
3.

solution.

4.

An

oil-spray,*used

5.

An

ice-bag coUar

after

gargling,may

may

help

easy

to

much

to

give

relief.

some

relieve

pain

in

the

throat.
The

6.

diet must

be

swallow.

Cold

drinks

may

be

grateful.
*

The

Menthol
liqiiidum will serve.
be added
(or 0.3 c.c.) or both can
per oz.

Petrolatum

5 min.

De

t U.

Vilbiss
S. t.

atomizer

is good.

5 grs.

(or 0.3 gra.)

(or 30 c.c.) of liqmd

or

Eucalyptol
petrolatum.

151

Occasional

7.

of

doses

phenacetin

beneficial for

be

or

of

fever,malaise

salicylpreparation
or
pain.

(p. 203) may

sometimes.
8. Opiates or hypnotics are indicated
acts
well in some
9. Salicylate(p. 203) in large doses
cases
of tonsillitis having slight articular
due
symptoms
probably
streptococcus infection.

to

and

at first visit the

Note

10.

the presence

and

kidneys

the

or

of

absence

discharging

before

heart

or

size,positionand

Watch

murmurs.

of the

for any

patient, determine

the

heart,
change

whether

the

suffered.

have

LARYNGITIS.

ACUTE

intubation
Scarification,

1.

sounds

or

tracheotomy

even

be

may

quired
re-

for edema.

should
be

be

used

every

inhaled

from

the

the

To

water.

used

to

sensitive

medicated, ordinarily gives

or

few
mouth

water

tincture

compound
be

plain

Steam,

2.

of

throats

the

be

benzoin.

desired.

as

added
A

and

steam

oil may

The

steam

It
can

pitcher containing boiling

together

steam

steam

or

from

or

may

oil and

spray

hours

relief.

drach.

(or

atomizer

is still better.
act

better

c.c.) of

which

can

For

very

without

other

5 grs. (or 0.3 gm.), or Eucaljrptol 5

ingredients,but Menthol
be added
min.
oz.
(or 0.3 c.c), or both can
(or 30 c.c.)of
per
Liquid petrolatum.
Excessive
It can
is harmful.
dryness of the air of the room
to escape
be mitigated by allowing steam
constantly from kettle
or

chafing dish.
be checked
and talking minimized.
3. Cough must
4. Smoking is especiallyharmful
as
a rule.
ACUTE
Treatment

inhalation

or

upper

chest

or

steam

distress.
Mustard
help to relieve substernal
if resultingpigmentation would
be avoided
contraindicate
''Gomenol
3 to 6 hours
jujubes"! taken every
may

should
its

suflQce.
laryngitismay
mustard
poultice* for the
for

as

flaxseed

TRACHEITIS.

use.

may

relieve.
*

See

textbook

preparation

on

nursing.
of Oleum

cajuputi (U. S.).

CHAPTER

IV,

AND

GASTRIC

DUODENAL
MEDICAL

FOR

INDICATIONS

ULCER.
TREATMENT.

ulcers.

1.

Recent

2.

Chronic

3.

Chronic

with

ulcers

mild

which

ulcers

symptoms.

have

had

not

satisfactory medical

treatment.

Ulcers

4.

for which

surgical

is too

treatment

dangerous

has

or

refused.

been

As

5.

under

prognosis

The

medical

OF

PRINCIPLES

principles and

The

ulcer

the

is better

treatment

the

more

ulcer.

the

recent

operation.

for

preparation

is in the

methods

stomach

Prolonged

rest

2.

Avoidance

of food

3.

Reduction

of

4.

Good

essentially the

are

in the

or

for the

1.

TREATMENT.

duodenum.

patient and

mechanically

gastric secretion

whether

same

for the

tract.

chemically irritating.

or

to

digestive

the

minimum.

of teeth.

care

METHODS.

and

A.

Rest

B.

Diet

for

should

if

be

of

ever,

be
very

much

chiefly of soft carbohydrates,

be

starvation

by

irritable.

value

Nutritive

because

of starvation

be

rectum.

fats,milk,

frequent.

begun

Diuring the period

given daily by

is essential.

more

should

may

stomach

or

consist

Feeding

eggs.

Treatment
the

month

they
three

Cracked

for

several

enemata
are

not

days, if
eeldom,

are

well

absorbed.

pints of salt solution

ice may

be

sucked

should
to

allay

thirst.

Begin
p.

165)

feeding
.

with

Later, bread,

small
or

quantities of

crackers
153

and

milk

milk, milk

(see Vomiting,
toast, strained

155

cereals with

simple

added

be

can

later

rice,custard,blancmange, junket,
or
potato with cream
butter,
dropped egg, purees, soft fruits,
the
dietary until the patient is

baked

or

soft boiled

or

raw

sugar,

mashed

ice cream,

eggnog,

etc.,

and

cream

or

to

taking ample nourishment.

nutritive

value

increased by adding
liquidscan be much
of milk, fr. | to 1 oz. in 4 oz.
to them
(or fr. 15 to 30
sugar
be added
in 120 c.c.) of liquid. Cream
to milk, and
may
gm.
should
be used freely.
butter
vegetables, condiments, acids,
Irritatingfoods, e.g., coarse
be avoided.
and particularlyalcohol must
Hot
drinks and meat
broths, as a rule,should not be taken.
to be avoided,
Proteid foods, in the opinion of the writer,are
The

of

"

as

rule,except

C.

in the

Modification

emaciated, or
harmful, and
after

the

of

of milk

diet

is

feeble

and

it may

be
has

hemorrhage
of food

amount

form

anemic.
wise

eggs.

required
For

for

them

patients that
starvation

to

are

be

may

begin feeding by mouth

stopped, and quickly to increase
to

ingested in order

nutrition.

or

soon

the

proved
healing by impatient with the

accelerate

The

experience of the
of his digestionrequires consideration.
peculiarities
In marked
contrast
to those
expressed above are the views
held by some
diet consistingchiefly
a
physicians who advocate
of proteid. Their
of proteid is to neutralize the
aim by means
acid

secretion
with

some

the
is

Lenhartz

Reduction

by

diet low

administration

the

times
E.
1.

these, and

diet schedule
of

Frequent feedings are

mended
recom-

object.

of

one

formed.

as

same

His

cases.

D.

fast

as

his method

follows,p.

gastric secretion*
in
of

may

may

be

preferred for

157.

be favored

by

tion,
starva-

of salt and by
proteid,by the avoidance
I to 1 tablespoonful of olive oil several

daily.
Medication

Sodium

t should

bicarbonate

be

prescribed freelyfor relief

-pain or distress in the dose of fr. | to 1 teaspoonful, or more

A hot water
if required,in a glass of water.
relieve.
bag may
should
subnitrate
2. After
feeding has been begun bismuth
of

Small

doses

t Magnesium

of atropine
oxide

are

recommended

is preferred by

some

by

some

physicians.

physicians,

157

daily in teaspoonful doses before meals with

the hope of benefit by coating the ulcer mechanically. Bismuth
is not
It is important that the drug
constipating in this dose.
should be pure.*
bowels
should be kept free by enema
tics.
cathar3. The
or by mild
Milk
of magnesia acts well as a mild
cathartic and also as
given

an

antacid.
D.

times

three

be

Convalescence

General

1.

bowels

hygienic

attention

including

measmres

the

to

important.

are

should

Work

2.

resumed

be

and

gradually

than
physical,should
psychical more
3. Rest, lying down, for from
|

be

fatigue,

avoided.
1 hour

to

much

after

meals

is of

great benefit.
Food

4.

middle

should

afternoon

of the

in the

taken

be

and

at

middle

morning, the
addition to regular

of
in

bedtime

the

meals.
The

5.

the

strictlythe diet and

more

greater the

dietary than

to

of

chance

success

undernourish

the

but

regimen

be

can

it is better

to

favors

should

as

to

Hemorrhages,

When

when

small,require no

hemorrhage

severe

be

followed

year.

TREATMENT.

COMPLICATIONS:
A.

enlarge the

good nutrition

patient because

heahng of the ulcer. The treatment

strictlyas practicablefor from six months

followed

specialtreatment.

lie
patient should
be given subcutaneously
the

occurs

possibleand morphine should

in dosage suflicient to bring the patient well under
its influence
and
medication
is not
to
inhibit peristalsis(p. 81). Further
likelyto do good.
An
be placed over
the stomach.
ice-bag may
Stimulation
of the cu'culation by salt solution,by transfusion
of blood, or by drugs should be withheld
unless demanded
by
as

still as

immediate

danger,

because

raising

the

blood-pressure

may

prolong the hemorrhage.

If syncope
raise

'

the

be

feared

foot of the

after

hemorrhage

bed.

Squibb's is good for this

purpose.

it may

be

advisable

to

159

is

Operation

seldom

hemorrhages

most

has

patient

for

from

the

dangerous.
after

operation

the

hasten

to

when

resulting

anemia.
to

or

recovery

the

prepare

operation.

Perforation

be

may

peritonitis,

general

is

indication

advised

be

because

operation

an

because

hemorrhage
and

sufl"ciently

may

subsequent
B.

is

recovered

Transfusion
for

exsanguinated

hemorrhage
has

patient

during

spontaneously,

stop

become

Repeated

indicated

acute

abscess,

to

subacute.

or

adhesions

to

or

It

lead

may

causing

to

persistent,

symptoms.

severe

The
should

and

perforations

acute

receive

those

surgical

prompt

with

abscess

formation

Early

treatment.

diagnosis

is

important.

very

C.

obstruction

Incomplete

with
and

temporarily
bed,

Under
and

such

dilatation

gastric

and
the

treatment

the

at

dilated

often

be

by

rest

periods

soft

operation.

can

long

for

breakfast,

inflammation

acute

requires

severe,

sometimes

before

daily

lavage

liquids.

when

obstruction,

Pyloric

diet

with

stomach

pylorus

lieved
re-

in

limited

tract
con-

may

subside.

may

'

This
should

is
be

D.
treatment

adds

it

Persistent
demand

for

to

severe

that

the

operation.

obstruction

pyloric

imperative

greatly

for

preparation

early

urged
make

symptoms

patient

excellent

an

the

Operation
because

weakened

when
of

condition

risk.

symptoms

operation

which
be

do

seriously

not

yield
considered.

to

medical

the

161

.ii

11

"+h"
cu

o
o

163

ACUTE
Pathology

intestines

of the

1.

Etiology:
2.

of

the

membrane

mucous

of the

stomach,

of both.

or

Ingestion

of

food

unwholesome

either

in

itself

individual.

for the

or

with hypersemia, and possibly

Probably irritation,

inflammation

with

INDIGESTION.

Excess

of food.

Excess

of alcohol

other

beverage.
Diagnosis of indigestionis made by history and by exclusion.
the
Do
not
overlook
cause
following diseases which
may
vomiting:
3.

or

OF

PRINCIPLES
and

1.

Rest

2.

Removal

3.

Rest

TREATMENT.

warmth

for

of

of symptoms.

cause

patient.

for

digestivetract.
Symptomatic treatment.

4.

METHODS.
Methods

and

Rest

chosen

with

and

The

Warmth.

be

warmly

may

be

covered

useful

for

pain. Rest and

recuperation.
2.

regard

to

the

severity

cause,

of symptoms.

nature

be

must

cold

warmth

of

Removal

or

Cause.

remain

extremities
diminish

If the

or

in

lie down

bed.

for

and

should

Hot-water

abdominal

bags

distress

metabolic

waste

distress is

gastric,and

and

has

not

or

promote
if the

be induced
freelyemptied, emesis may
of a
water
or
administering quantities of warm
by means
water.
spoonful of mustard-powder mixed in a cup of warm
stomach

been

should

patient should

by
tea-

165

If symptoms
unless

evacuated
saline

of service

be

be

given

be

retained.

at

calomel

or

if the
time

any

intestine

the

profuse diarrhoea

cathartic,

may

Both

for

and

by

retain

can

efTect

prompt

emesis

cleared

has

followed

stomach

bowel

the

catharsis

it

be

thoroughly.
cathartic,

saline

it.

or

should

An

enema

may

if cathartics

cannot

are

for

necessary

some

cases.

severe

for

Rest

3.

do
Plain

Digestive

best without

water

food

mineral

or

Tract.

Well-nourished

kind

of any

water

be

may

patients

for from

allowed

12

24

to

in small

erally
gen-

hours.

quantities

intervals.

short

at

from

come

beginning

When

tea, chicken

to

feed
milk

broth, hot

two

hours.

The

and

in

more

kind

it is wise
or

nourishment

to

orange

should

liquids,such
juice,a few ounces,
use

be

increased

in

as

beef
every

amount

less

rapidly according to the physician's

of the
estimate
patient's digestive capacity. Hunger and a
clean tongue generally indicate that considerable
quantities of
be assimilated;whereas
coated
food can
a
tongue and disgust
for food

or

the

mean

reverse.

Symptomatic Treatment.
(a) Nausea
generallyyields to

6.

Emesis

is advisable

for

some

rest

abstinence

and

from

food.

cases.

the stomach
usually stops spontaneously when
If it does not
has been emptied.
yield to rest and abstinence
from
food it may
be checked
sometimes
by a teaspoonful of
shaved
ice with brandy, by a drop of Tr. of iodine in a teaspoonful
of water, by I gr. (or 0.016
gm.) of cocaine hydrochloride

(6) Vomiting

gm.) of
from
the mouth,
morphine sulphate absorbed
by other drugs,
should
be withheld
or
by gastric lavage. Food
entirely for
from
after vomiting has
Water
ceased.
about
3 to 12 hours
be allowed
should
small amounts
during this period in very
dissolved

in

if at all.

Cracked

teaspoonful of, water, by |

ice may

be

sucked

gr.

(or 0.008

for thirst.

days, salt
in the form
be administered
of enemata,
solution must
by rectal
is
or
by hypodermoclysis. Three
pints in 24 hours
seepage
These
and
rectal feeding are
enough.
measures
rarely
very
When

needed

gastric disturbance

in acute

lasts

over

period

of

gastritis.

be
resumed
cautiously, using milk diluted
Feeding
with mineral-water, lime-water, or carbonated
water; or orange
should

167

in

broth

juice,or

of nourishment

half hour.

teaspoonfuls every

should

increased

be

and

the

The

quantity

intervals

between

feedings lengthened gradually.

(c) Diarrhoea should not be checked until all old faecal matter
has been
discharged. If the diarrhoea persistsin a mild form
doses of about 15 grs. (or 1 gm.) of bismuth
subnitrate may
a few
suffice to stop it. When
diarrhoea is severe
quired.
opiates are often reA
of
be prescribed after
paregoric may
teaspoonful
be required subcutaneeach loose movement.
Morphine may
below.
see
ously. For other medicaments
be checked, when
(d) Colic can
slight,by the application
and by rest and abstinence
of heat to the abdomen
from food.
Paregoric or other preparations of opium or morphine may
in full
be used
for severe
pain but they are contraindicated
dosage until the intestinal tract has been cleared, and also
conditions

when

be ruled

which

require surgicalinterference

may

cannot

out.

DIARRHOEA.

SIMPLE

DIAGNOSIS.

"Do

not

overlook

the

following diseases

which

may

cause

diarrhoea.

3.

Dysentery, bacillaryor amoebic.

Other infectious diseases,e.g., typhoid.
Nephritis with colitis.

4.

Carcinoma

5.

Faecal

6.

Rectal

7.

Mucous

8.

Reflex

1.
2.

9.
10.

of lower

bowel.

impaction with intermittent

diseases with

diarrhoea.

tenesmus.

colitis.

exophthalmic
diarrhoea,e.g., due to chill,
goitre,or perhaps to anxiety.
Habitual
in eating and insufficient exercise.
excess
Irritatingingesta or imperfectly digested food.
or

nervous

PRINCIPLES
Suit

methods

(a) Remove
(") By means

to

OF

TREATMENT.

severity,duration

and

persistence of

usually imperfectly digested food.

irritant,
of

suitable

diet avoid

further

irritation.

toms:
symp-

169

(c) Limit
(d)
is

peristalsis.
there is toxemia, dilution and

When

ehmination

of toxins

important.
METHODS.

A.

To

prescribe"a

evacuated

this result

that

Unless

bowel

which

will

purge

has

obtained

been

been

has

thoroughly

quickly and
proceeding to

act

before

tain
ascer-

other

of medication.

kinds
A

Irritant.

Remove

be used.
If these are
vomited
an
oil,may
do
induce
to
be advisable
emesis
good. It may
Calomel
generally acts well (p. 211).
Diet should
due;
be non-irritating;should leave little resi-

saline,or

enema

may

(p. 159).
B.

The

castor

and, preferably,should be digested high up.

well digested as a rule.
are
Eggs, broths and lean meats
be preferred occasionStarches
ally.
containing little cellulose may
Fats, fruits and
Liquids should
C.

To

be

(6) Restriction
be

may

of

the

state

(c) Warmth,
avoidance

general are

Meals

should

time.

of nutrition

and

be

duration

of short

entirelyfor

hot

avoided.

cold.

not

ingesta.

be

to

bed.
small

food

and

and

quent.
fre-

liquids

pends
length of time deof the patient.

The

tolerance

externally and internally,i.e.,a

hot-water
a
changes of temperature,

of

and

and

conditions

severe

forbidden

on

bland

in

peristalsis, (a) Rest, preferably in

limit

In

vegetables

coarse

warm

bag

room,
on

domen
ab-

drinks.
MEDICATION.

(a) Astringents.
1.3

to

gm.)

Acidum

nalbin

(6)

2 to

every

tannicum

may

Bismuth

be

subnitrate,fr.

(U. S.), boiled

green

diarrhoeam

Camphor
and

Tannic
*

U.

S. t.

(N. F.).

Mixture,"
1

acid

(or 0.65

tea, red wine,

or

Tan-

tried.

Sedatives.

Diarrohcea

grs.

8 hours.

best, e.g.
Opiates are
(U. S.) "Paregoric," or Tr. opii deodorati
contra

10 to 20

gr.

and

(or

2 grs.

as

"Cholera

others,

0.065

or

gm.), Opium

(or 0.13 gm.).

t Not

"C.

official.

opii camphorata
(U. S.), or Misturse
mixture," "Squibb's

Tr.

O. T.

gr.

"

containpill f ing
(or 0.016 gm.),

171

CONSTIPATION.

Constipation is a symptom
functional, some
organic. The
cause

in the

causes

or

of every

should

Hence,
of prime importance.

CLASSIFICATION

I.

diseases, some

many

treatment

individual
is

case

in

seen

case.

per

the

standing
clear under-

CONSTIPATION.

OF

Spasmodic Form : 90
coUtis.
(a) Mucous

combat

cent

of all

cases.

(6) Neurasthenia.

(c) Lead poisoning.

(d) Intra-abdominal
(e) Fissure
II. Atonic

pelvic inflammation.

anus.

Form.

Muscular

ni.

of

or

weakness

1.

Fevers.

2.

Anaemia.

3.

Cachexia.

4.

Senile

or

general debilitydue

to :

debility.

Obstructive

Form.

(a) Stricture.
(6) Adhesions.

(c) Pressure

from

tumor

or

pregnancy.

(d) Ptosis with kink.

(e) Acute obstruction.
IV.

Less

varieties of

common

constipation are

excluded

from

lack of space.
and ptosis or kink can
stricture,adhesions
but
be made
bismuth
without
satisfactorily
x-rays,
is often misleading.
evidence

Diagnosis

of

A.
and

The

bad

essential

Clear

including the
C. Soothe

the

as

to correct

intestinal

constipationare neurasthenia
the
it is imperative to encourage

of chronic

hygiene. Therefore

patient as well
B.

causes

x-ray

TREATMENT.

OF

PRINCIPLES

dom
sel-

his habits.
tract

thoroughly and

keep it clear,

rectum.
or

stimulate

the bowel

by suitable diet

as

required.

173

E.

cathartics

Use

irritation of the
F.

Prescribe

G.

Enjoin

sparingly

bowel

liquid

avoid

undue

in definite

quantity.
and
prescribefalse teeth

of food

mastication

proper

all,and

at

them.

by

sufficient

not

or

if needed.
H.

/, Exercise

abdominal

or

help sedentary

may

persons.

SPASMODIC

FOR

METHODS

Colitis.

Mucous

regularityin defecation.
unless
contraindicated,
massage,

patient about

Instruct

Non-irritating diet composed

1.

carbohydrate with a moderate

assimilable proteid. Avoid
tea, coffee amd

CONSTIPATION.

amount

foods

rich

chiefly of
of fat and
little easily
a
in cellulose,
acids,spices,

alcoholic beverages.
foods

is not

complete, and should

The
be followed
not
too
experience of the
closelyin all cases.
Fresh
be valuable.
milk, cream,
butter,sugar, rice,
patient may
of wheat, white
macaroni, sago, tapioca,strained oatmeal, cream
bread
or
toast, potato, baked, boiled or mashed, junket, custard,
The

followinglist

blanc-mange,

of suitable

boiled, poached, scrambled

eggs,

shirred,finely

or

lamb, boiled tongue, or tender steak if it can

the patient.
starve
Do
be well chewed.
not
be kept clear by injectionsof oil in the evening
2. Bowels
must
to be retained
during the night, and by cleansing enemata, preferably
salt solution,every
of warm
normal
morning.
minced

chicken

or

Cathartics

3.

than

be

are

When

4.

the

relaxed.
and

stimulate

perhaps
used

and

stools

normal

begin

irritated

an

massage

217,

p.

flamed
in-

or

do

may

Agar-agar,

or

to

mixed

to

appear

patient

more

act

well

normal

can

drop

rich

in

diet

the
the

regimen

can

tirely
injections en-

cellulose

and

fruit

to

defecation.

irrigationswith

tried in very

have

"

to

non-irritating.

return

be

abdominal

Oil

Finally, the

Colonic

5.

"Russian

good.

and

together

and

membrane

mucous

harm

particularlyinjurious

are

obstinate

advised

never

or

them

without
cases.

appendicostomy
I have

not

seen

may

them

for colitis secondary to chronic

constipation.
Lead

Poisoning
with

with

morphine

or

Antispasmodic
required.

Constipation.

atropine is

cation
medi-

175

Intra-abdominal
Anus

removal
METHODS

mild

Treatment

be

constipation,being transient, may

laxatives

of

the
mands
de-

CONSTIPATION.

ATONIC

FOR

Post-febrile
with

Fissure

or

constipation by reflex spasm.

of the cause
by appropriate means.

cause

may

Inflammation

Pelvic

or

treated

for convenience.

Constipation in Anaemia, Cachexia, or Senile Debility. The

should
be considered, especially in ampatient's convenience
bulatory
or

cases,

Nux

vomica

may

when

the

be

service,and

of

chance

mild

is small.

cure

laxatives,glycerine

stances.
according to circumFaecal impaction should be guarded against and watery
catharsis must
be avoided.
do good and mechanical
Massage may

suppositories,or

support

enemata

be

of ultimate

may

aid defecation

may

advised

when

the abdominal

wall is weak.

late
help to stimudiet,rich in cellulose,
fruits,and sugar, may
peristalsis.Graham
bread, oatmeal, cracked wheat, green
stewed
raw
or
vegetables, beets, carrots, turnips, tomatoes,
A

for those

fruits and
who

can

jams are particularlyto be recommended

digest them.

METHODS

OF

TREATMENT

FOR

OBSTRUCTIVE

CONSTIPATION.

ation
Operation will generally be required. Palliof "Russian
Oil
injecby mouth, or by rectal tions

(a) Stricture.

by

"

means

be beneficial.
by cleansing enemata
may
The
palliativemeasures
just mentioned
may
do
be
or
good. Operation may
massage
may

of oil followed

(6) Adhesions.
sujQ"ce.

Exercise

advisable.
Palliate

(c) Pressure.
(d) Ptosis.

or

suitable

operate according
abdominal

to

supporter

circumstances.
relieve.

may

Other

exercise or massage
and
palliativemeasures
help.
may
offers
little hope of relief,
as
Operation
a rule.
(e) Acute Obstruction.
Prompt operation is imperative.
METHODS

USEFUL

IN

KINDS

VARIOUS

OF

CONSTIPATION.
I.
"

or

Massage
Cannon-ball

16-lb.

"shot"

daily may

be very

Massage."

(made

for

beneficial.

heavy ball is

athletics) and

necessary.

covered

with

12-

leather

177

lying
'

cloth

strong

or

his

on

abdomen

II.

before

reflex

be

itself

after

regained

From

to

(6) Cleansing
Sod.

bicarb,
used

be

can

of

enemata

of

or

salt

This

reflex

Olive

120

colon

the

for

rectum

As

result

sometimes

can

linseed

or

retained

(4.0 gm.)

of the

be

the

the

to

at

night.

addition

of

pint (500 c.c.)

is to

membrane

mucous

used

the

through

with

water

by

ofl is suitable.

c.c.) should

180

to

be

drach.

the

injections at night, followed

warm

irritation

when

lost.

oil should

the

of the

course

("dyschezia ")"

morning.

(or fr.

oz.

injection and

each

be

of oil

the

patient,

repeatedly around

the

completely

course

enemata

the

toilet.

the

may

in

daily

long-continued constipation

defecation

to

cleansing

In

(a)

shot

along

to

twice

or

roll the

caecum

going

empty

never

the

the

Enemata.

may

Once

serve.

back, should

from

minutes

15

will

be

avoided.

(c) Cold

hot

water,

water,

salt solution

potent than

or

(4

oz.

and

water

III.

c.c);

30

to

aa

(or

oz.

Laxatives

diet, abundant

liquid (6

hygienic habits.
(a)
min.

15

min.
of

Fl.

to

the

(or
30

0.6

bowels

with

When

the

Senna
the

number

be

reduced

Oil

mechanically and
"

The

abdominal

or

do

to

dose

medicine

is

eat

been

have

of prunes

(c) Russian

the

Instruct

bag), and

bowels

can

in

or

be

muscles

of

only

or

of fr. 10

regularity

When
Cascara

be

can

longer required.

no

to

dozen

stew

(enclose leaves

once
a

of 10

or

time

the

twice

of

amount

taken.

are

daily.
Later,

reduced.

(p. 217)

irritate the
shoTild

for

doses

single dose

leaves

prunes

prunes

Agar-agar
not

10

regular

until
can

in

patient

tablespoonfuls of Senna

two

able
suit-

daily) and

water

used

be

can

established

Senna.

to

required.

c.c.) at bed-time.

to

drach.

suits all persons.

sagrada

been

and

cheese-cloth

0.6

if

used

fr.

sulph., glycerine,

Mag.

glasses of

laxative

one

more

are

only in conjunction with

to

drop by drop until

(b) Prunes

in

(or
has

be

c.c), after meals,

to

min.

diminished

prunes

No

of Cascara

Ext.

used

be

should

water

glycerine

of

sol. of

Sat.

c.c.) can

60

and

water.

warm

of

or

suds

soap

consisting

(d) .Strong enemata,

1

or

be

relaxed

may

be

tried.

They

act

intestines.
while

the

ball

is being

rolled.

V.

CHAPTER

DRUGS.
FOREWORD.
He
better

who

masters

than

he

Before

the

who

of

use

tries many

few

good drugs will succeed

at random.

prescribing a drug,

indications

let the

for its

be

use

clear.
Prescribe

expedient.
drugs singly when
whether
Ascertain
an
idiosyncrasy to the
to the patient.
prescribe is known
When

drug has

toxic effect.
If neither

been

Increase

dose

given,

If toxic effects occur,

later in smaller

dosage

omit

the

try

or

one

the

either

results,change

wish

you

for its good

watch

until the

drug

the other

or

preparation

drug for

time

for

or

to

its

is apparent.
the

or

and

drug.
it

resume

substitute.

EXPLANATION.
The

purpose

of the

drugs and
for the

Much

average

useful

Dispensatory."

adult

It

follows

is to

preparation of each
The
and

may

information

believed

to

dosage recommended
require modification

is contained

this book.

describes

indicate

in the

the
be

portant
imthe

is suitable
for the

"United

dividual.
in-

States

drugs of the principal pharmacopoeias

the preparations of the "National
Formulary," and
unojfficial preparations. "New
edies"
Remand
Non-official
about
gives information
proprietary drugs. The
many

writer's information
from

the

generally useful.

most

many

list which

about

It is

the

patents and

trademarks

published yearly by

Association.
179

the

was

American

derived
Medical

181

ABBREVIATIONS.

U.

United

S.

States

British

Br.
N.

F.

U.

S.

N.

N.

U.

S,

R.

D.

and

Rev.

Pharmacopoeia.

National

p.

8th

Pharmacopoeia,

Formulary.
t.

New
United

United
and

States
Nonofficial

States

patent

and

Remedies,

Dispensatory,

trademark.
1914.

19th

Ed.

183

SYNOPSIS
I.

DRUGS.

OF
SALVARSAN.*

Kills certain

pathogenic organisms in the livingbody.

toxic
to have
irritate the kidneys or liver but seems
no

Action.
It may

effect per

for other

se

organs.

Excretion

Elimination.

rapid, chiefly in urine

and

faeces.

of the drug is
normally, most
eliminated
the first day and nearly all within three or four
on
injection.
days after an intravenous
diminution
effects.
of
1. Signs of renal irritation or
Toxic
the

When

excretory

act

organs

kidney function.
2.

Jaundice,

3.

Erythemia.

4.

Hyperemia

and

i.e.,"Herxheimer

swelling at the site

reaction."

To

this

of

syphilitic,
lesions;
probably belong

group

arising within three days of

dangerous symptoms
them
ing,
be mentioned
the injection. Among
headache, vomitmay
of the

many

convulsions
and coma.
earache, syncope,
5. Fever
developing gradually after a day
from rapid destruction
of spirochaetse.
Accidents

or

which

errors

may

or

two

symptoms

severe

cause

result

may

or

death:
of the distilled
"water-error," i.e., contamination
water
(used for solution) with bacteria living or dead; or with
the
chemical
Symptoms
impurities from
distillingapparatus.
to
perature,
often attributed
water-error
are
rigor, rapid rise in temThe

1.

2.
3.

gastro-entericdisturbances, etc.f
used in the solution.
Impurity of NaCl or of NaOH
of the Salvarsan
be followed
-Oxidation
by signs of
may
ritis,
poisoning, gastro-entericdisturbance, peripheral neuparaplegia,etc.

arsenical

Accidental

4.

The

U.

pulmonary

S. p.

Salvarsan.

t There
error"

in technic

Errors

and
*

is 10 times

former

5.

are

of

use

and

They
are

due

t.

to

other

instead

toxic than

of

alkaline

an

solution.

the latter.
result in

of injection; may

bosis
throm-

venous

embolism.

extremely
who

acid

more

Diarsenol

are

those

an

believe
causes,

extensively used

is being
similar
that
e.g.,

if not

the

identical

symptoms

overdosage.

as

substitute

for

in action.

attributed

to

the

"water-

185

Use

7.

Lack

8.

Excessive

of

of after-care

effect of various

Neurorecurrence.
of

recurrence

cases.

syphilis,not

other

after

of

various

used

wisely and with the best technic.

Salvarsan

weeks

or

is not

relative rather

are

mentioned.
months

and

syphilis,relapsingfever,yaws,

and

Contraindications

diseases.

stances,
existingcircum-

effect of salvarsan.

an

cases

patient.

under

factors above

It appears

Suitable

Indications.

of Salvarsan

of the

dosage for the individual

early repetitionof dose.

Combined

10.

is

preparation, or

too

or

9.

in unsuitable

of Salvarsan

6.

than

dangerous

absolute.

when

The

use

4.

particularlydangerous when the patient has;

Aneurism, coronary
sclerosis,
myocarditis, evidence of angina
lesions of the circulatorysystem.
pectoris,or other severe
In non-syphiliticnephritis.
adrenal glands.
In diseases of the liver,pancreas,
or
When
there is advanced
degeneration of the nervous
tem.
sys-

5.

Profound

1.

2.
3.

is

anemia,

cachexia

pronounced

or

due

not

to

syphilis.
Severe

6.

from

lesions,or

pulmonary

marked

physical weakness

cause.

any

is advisable

Caution

when

there

are:

lesions of the central nervous

S3T)hilitic
system, or when
is indicated
their presence
by changes in the spinal fluid or
suggested by slightsymptoms.
2. In the secondary stage of syphilis.
3. When
the patient is alcoholic.
4. Shortly after fatigue or exertion.
of any
be pre5. When
excess
kind, work, or travel,cannot
vented
for a time after the injection.
1.

6.

In

old

age,

or

Administration.

receptacle with
with

suffice.
is used
has

An

to

the

there

at

the

the

lower

flow.

bottom,

When

left the

is taken

to

consisting of
rubber

tube

glass

provided

clamp and a needle will

General
Hospital salt solution
end,

prevent the entrance

nearly all the salt solution

is poured in.
Salt solution

receptaclethe Salvarsan
is poured in again to clear the needle
Care

arteriosclerosis.

apparatus

at the

Massachusetts

establish

is advanced

infusion

opening

an

glass window
At

when

before

it is withdrawn.

of air into the vein.

About

187

is allowed

five minutes

vein, and

the

for the

of flow

rate

is

of the Salvarsan

passage

regulated by the height

into the
of the

ceptacle.
re-

operation requires strict asepsisat every step.

Dose.
in syphilis,Ehrlich
Speaking of the use of Salvarsan
"The
dose depends entirelyon
the type and stage of the
says:
disease."
Ordinarily,fr. 0.1 to 0.6 gm.* is u^ed at intervals of
from 5 to 10 days. In rare
instances smaller or larger doses may
This

be tried.
When

with
begin treatment
series of very
small doses at long intervals,or an
a
energetic
The
of large doses
of Mercury.
combined
of Salvarsan
course
use
Caution.

and
Note.

of

danger is

Alternate

"

at the

Mercury
for

feared

time

same

is believed

Salvarsan

of

courses

to be recommended

be

to

and

to be unsafe.

of

Mercury

are

syphilis.

NEOSALVARSAN.

Like

Action.

that

of

Salvarsan

but

powerful

less

in

equal

dosage.
Toxic

Similar

Effects.

to

of Salvarsan

those

but

milder

with

equal dosage.
Indications.
to prepare,

be

It may

toxic effects

when

or

preferred to Salvarsan

Contraindications.

As

because

easier

feared.

are

for Salvarsan.

with
air
contact
immediately, because
rapid decomposition. Do not mix the drug until everything

Administration.
causes

is

Use

prepared and the needle

Dose.

0.9

of arsenic

as

Preparation

of

gm.

0.6 gm.
of

already in
contains

Neosalvarsan

the

vein.

the

quantity

same

Salvarsan.

Alkaline

Solution

of

Salvarsan

for

Intravenous

Use.

Printed
with

the

instructions

for

preparing the solution

are

provided

drug.
Technic

of the

General

Massachusetts

Hospital.

Everything used for preparing the solution is sterilized

beforehand, and is handled under strictlyasepticprecautions.
1.

more

The

full dose

frequently

now

of 0.6
at

gm.

the

is being
Mass.

Gen.

used

less frequently, and

Hosp.

smaller

doses

189

2.

solution

The

is mixed

in

bottle which

8-oz.

an

should

have

The
bottle
is graduated for 100 and
200
c.c.
glass stopper.
Similar ungraduated bottles should be used for dispensing.
3. The
drug is dissolved in the mixing bottle by hard shaking

with

about

50

of 0.6

c.c.

Solution

water.

salt solution

cent

per

takes

instead

without

place rapidly

of distilled

the

aid

of

c.c.

of

beads.
4.

To

normal
until
c.c;

dose

NaOH

of 0.6

of Salvarsan

gm.

solution

is added

and

solution

is filtered back

the

of

sterile gauze,
for

ready

which

is held

neck
in

added

then

with

again shaken
make

to

200

the

of

the

place by

bottle

pin.

is covered

sertion
in-

with

drug is

The

the

then

use.

Salvarsan

kept cool

the

is

solution;
dispensing bottle,and after

into the

stopper,

mixture

the

dear.
Salt solution is
'perfectly
the dispensing bottle is rinsed

dissolved

thus

until

List

within

decompose

may

needed, and should

of

Things

1.

Burette

2.

Flask

of

3.

Glass

funnel

4.

One

0.6% NaCl
and

to

hours.

It should

be

warmed

only

Preparing

little.

Solution.

NaOH

containing normal

c.c,

be

tion,
solu-

solution.

filter paper.
and

graduated

few

then

for

Required

graduated

plain

one

8-oz.

bottle

having glass

stoppers.
5.

Basin
a

6.

of

file

antiseptic containing also the

and a pin.

Sterile sheet

and

Mercury."

(a) Hydrargyri salicylas.* "Neutral

chloridum

mercuric

corrosivum

salicylate."

(U. S.).

sublimate," "Bichloride of mercury."

(c) Unguentum
hydrargyrif (U. S.). "Mercurial
Not

official in U.

It is used

t Conts.
"Blue

at

the

about

ointment,"

S.

There

50%

of

is also
General

Massachusetts

conts.

varsan,
Sal-

HYDRARGYRUM.
''

of

sponges.

2.

(6) Hydrargyri

ampule

Mercury

about

33%

by

basic

"Corrosive

ointment."
(Merck).

salicylate of mercury

Hospital.
weight.

of Mercury.

Ung.

Hydrarg.

DU.

(U.S.),

191

iodidum

{d) Hydrargyri

yellow iodide

flavum

(U.

"Protiodide

S.)-

or

of

Mercury."
of the above
Action
preparations is essentiallythe same:
local irritant,
and antiseptic.
anti-syphilitic,
Elimination.
and
Chiefly by intestines
kidneys; also
is slow.

Excretion

saliva.
Toxic

in

Acute

Effects:

Poisoning: stomatitis,salivation,renal

diarrhoea,abdominal
irritation,
pain and gastricdisturbance.
Chronic Poisoning: cachexia,anemia, etc.
of a
choice
Indications:
mercurial
Syphilis. The
tion
preparathe
and
of
the
on
depends
severity
stage
disease, the
of the
condition
under
which
patient, and the circumstances
is to be carried out.

the treatment
mentioned

has

of the four

Each

preparations

Contraindications.

advantages lacking in the others.

Nephritis unless luetic,cachexia, anemia.

Administration

Dose.

above

and

(o) Hydrargyri salicylas:nearly insoluble;single dose

to 15 min.

(or 0.6

to

in

c.c.)of
in

10 per

from

cent

emulsion

fr. 10

of the

drug

the
Petrolatum; repeat
days. Inject
Use a platinum needle 1-1in. long.
glutealmuscle.
corrosivum:
(6) Hydrargyri chloridum
soluble;single dose
fr. 7 to

drug in
in 1

or

min.

15
a

(or 0.5

10 per

cent

days.

to

c.c.)of

into

10

to

1 per

solution

cent

watery solution of Sodium

of the

chloride;repeat

Inject into the glutealmuscle.

Use

platinum

needle.

hydrargyri: administer

(c) Unguentum
fr. i to

1 drach.

(or 2

Dose
by inunction.
on
Efiiciencydepends much

gm.).
thoroughness of application.
(d) Hydrarg5rri iodidum
flavum;
mouth.

Dose:

dose

Caution.

by half and
When

gr. t. i. d.

gradually until the

reduce

to

in

gm.) and

upward,

signs of mtolerance

appear.

(or

first

administer

0.013

piUs

by

ing
increasThen

continue.

mercurials

are

given, the

mouth

must

be

Teeth
should
be
kept scrupulously clean to avoid stomatitis.
If there
brushed
and throat gargled after every
is pyormeal.
rhoea
be
scrubbed
with
castile
alveolaris,the gums
may
soap
swabbed
of
1
cent
with
solution
Potassium
or
a
daily
per
manganate,
perapplied with cotton stick; also rinse or spray mouth
with
of
Hydrogen
giving the Protiodide
peroxide. When
iodide also, give the ProPotassium
or
Mercury and Sodium

193

tiodide

c.

a.

and

iodide

the Potassium

Biniode

of

p.c.

to

prevent formation

When

using large doses of anymercurial, the bowels should be kept clear,and the food should
nutritious and ample in quantity.
be readilydigestible,
The
reader
is advised
not
Note.
to use
Mercury in large
doses or by injectionunless familiar with the details of its administrat
of

the

Mercury.

"

dosage and
in

account

indications.

Forchheimer's

Gottheil

gives

"Therapeusis

of

an

cellent
ex-

Internal

Diseases,"

POTASSII

3.

'*

(U. S.)

lODIDUM.
Iodide

of

Potash."

Properties. White, crystalline,

very soluble in
Action.
1. Causes
disappearance of gummata;

water.

but

lesion

disappears while iodides are being taken is not necessarily

syphilitic.
in respiratorytract.*
2. Increased
fluidityof mucus
3. Seems
to increase
thyroid activity.
Elimination.
Rapid, chieflyin urine as salts,partly in saliva.*
which

Toxic

Effects

Acute

Acne, erythema, and

other

serious

skin

of respiratory organs,
gastric distmrbances,
lesions, catarrh
anemia.
delirium,etc. Chronic : loss of weight, nervousness,
1. Late
Indications.
stages of syphilis.
with sticky expectoration.
2. Bronchitis
3. Empirically in arteriosclerosis,
asthma, lead poisoning,

simple goitre,and

other

many

Contraindications.

conditions.
acute
inflammation
irritation,
be
It may
"hyperthyroidism."

renal

Acute

respiratory tract, and

in phthisis.
harmful
Administration.
1. For
syphilis,fr. 10 to 20 grs. (or 0.6
For
1.3 gm.) t. i. d. p. c. in milk.
syphilisof central nervous

of

the

system,
One

hundred

The

sat.

2.

As

dose

sol. in water

expectorant

t. i. d. p.

3.

rapidly until benefit or iodism

grains (or 6.5 gm.) t. i. d. is large enough

increase

For

Bastedo.

c.

is convenient:

give

fr. 5

1 min.
to

10

grs.

well diluted.

empirical action

use

small

doses.

1 gr.

(or

0.3

or

to

to

results.

dosage.

0.065

gm.

0.6

gm.)

195

Substitutes.

Mercury,
As

syphilis: other

For

preparations of

Iodine,

Salvarsan.

or

chloride.

Ammonium

expectorant:

DIPHTHERIA

4.

ANTITOXIN.*

in

Curative

diphtheria.
Absorption.
slowly from the subcutaneous
tissues,the process
lastingfor several days.
Toxic
Effects.
Urticaria,erythema, joint-pains,etc.
Indications.
Clinical diphtheria; and
for those
exposed
Action.

It

absorbed

is

to

diphtheria.
Contraindications.

from

It

asthma.

horse

absolute.

Never

is doubtful

Dangerous in sufferers
whether
a
single dose of

sufficient to
produces sensitization in humans
cause
anaphylactic shock on administering a second dose.
Administration.
By injection into the loose subcutaneous
tissues of the abdominal
wall or below the angle of the scapula.
Intravenous
injectionsare best for severe
cases.
The
Dose.
dose should be gauged according to the severity
duration
of illness,
of symptoms,
and extent
and location of the
antitoxin

ever

membrane.*

Large
or
nasopharynx is
diphtheria.

doses

are

much

indicated

when

5.

MORPHINE
"

Properties.
Action.

stimuli.

Relieves

3.

Slows

4.

Diminishes

can

be

or

''

Morphia."
in about

sixteen

parts

in alcohol.

Diminishes

sensibilityto lastingimpressions and

pain.
respu-ationand

Manufactured

charge.

"

For

(U. S.)

SULPHAS.

Morphine

100,000 units.

(SoUmann.)

2.

It

1.

to

soluble
White, crystalline,

less soluble

water;

larynx,trachea,
especially in virulent

involved, and

Therapeutic dose for adults, fr. 5000

immunization, fr. 1000 to 2000 units.

the

obtained

heart-action.

(Bastedo.)

metabolism.
by
from

Departments
the

State

of Health
Board

and

of Health

by
in

pharmaceutical
Massachusetts

firms.
free

of

197

5.

Diminishes

6.

In

acute

7.

In

colic

Toxic

in the

it may

intestinal spasm

or

Elimination.
oxidized

peristalsis;
therefore,constipating.
cardiac dilatation gives relief.

1.

Somnolence

4.

5.

Retention

6.

During

7.

Death

3.

2.

Discomfort

3.

Acute

is

become

may

shallow

regular
ir-

and

is

nausea

common.

depression of respiratorycenter.

conditions

Acute

Severe

drug

from

results from

1.

Some

of urine.

recovery

Indications.

cathartic.

stupor.

or

slow and
Respiration very
(Cushny).
Pupillary contraction.
Flushing or cyanosis of face.

2.

as

gastro-intestinaltract.

Chiefly by
body.

Efifects.

act

with,

"

pain.
preventing sleep.
cardiac insufficiency.

Internal

pulmonary, intestinal)
hemorrhage (gastric,
5. Persistent vomiting.
In chronic
Contraindications.*
1. Danger of forming habit.
4.

recurring non-fatal diseases,and in conditions which can be

relieved by milder means,
use
morphine with caution if at aU.
or

When

2.

bronchial

secretion

is profuse,morphine may

prevent

expectoration: see pneumonia, p. 123.

3. Idiosyncrasy: causes
excitement, vomiting, depression.
For
conditions
Administration.
give subcutaneurgent
ously in the dose of fr. | to | gr. (or 0.008 to 0.032 gm.), with
without
to
or
atropine sulphate,fr. ^wo to jio gr. (or 0.00032
necessary

0.00052

in tablet,
generally given by mouth
a mixture.
Morphine can be absorbed
from the mouth
and will then act more
quickly than if swallowed.
the gastric
Atropine given with morphine tends to diminish
disturbance
which
follow.
Atropine produces toxic sympmay
toms
if repeated often.

gm.). Morphine
in watery solution,or in

Codman

believes

that

gastric dilatation; and

is "much

or

bowels."
is any

morphine
Bastedo

some

cases

"It

should

uremic

as

of pneumonia,"
be

tendency,"

employed
and

after
says

depression of respiration,

breathing and
there

is

in

abdominal

it should

in edema
or

in

"

not

of the
acute

operations
be

used

may

when

duce
inthere

limgs, Cheyne-Stokes

dilatation

of the stomach

cautiously in nephritis, especially if

"infancy

and

old age."

199

Opium in pill,as tincture,or in suppository.

1. Pilulse opii (U. S.): conts.
opium 1 gr. (or 0.065 gm.)
(
morphine | gr. or 0.008 gm.).
2. Tinctura
(or
opii deodorati (U. S.). Dose fr. 5 to 15 m.
Substitutes.

0.3 to
3.

c.c).

Tinctura

for adult

fr. 1 to 4 dr.

4.

Codeinse

5.

Heroine

(U. S.)

opii camphorata
(or 4

to

16

Dose

"Paregoric."

"

c.c).

sulphas (U. S.). | to | gr. (or 0.008 to 0.032 gm.).

hydrochloride, the diacetic ester of morphine, not

dose tV gr. (0.006 gm.).

official;
6. Hyoscinse hydrobromidum
(U, S.). Dose fr. xi^ to j^o gr.
to 0.00065
with
(or 0.00033
gm.) subcutaneously. Combined
act better than
either.
morphine it may

6.

TINCTURA
*'

Action.

Tincture

Increases

1.

DIGITALIS.
of

force

(U. S.)

Digitalis."*

of cardiac

systole.

Lengthens diastole and slows heart action.

is low.
3. Raises blood-pressure if pressure
there is dropsy.
4. Promotes
diuresis when
Absorption slow; therefore 24 hours or more
2.

result.
Toxic

Action

cumulative

be

may

because

is

required for

excretion

is slow.

Effects.

Tachycardia or bradycardia with irregularity,

heart-block, pulsus alternans, fall of blood-pressure, oliguria,
vomiting, headache.
Indications.

insufficiencyin

or
general, with
without
valvular
disease.
Almost
useless in circulatoryweakness
resultingfrom vascular dilatation or from depletion.
Tachycardia, per se, does not call for digitaUs.

Myocardial

Contraindications.
be

dangerous,
When

When

e.g., cerebral

heart-block

Administration.

blood-pressure would

hemorrhage.

is developing
Prescribe

of

increase

use

with

digitalis
cautiouslyif at all.

water

p.

c.

Ordinary dose: fr. 5 to 20 m. t. i. d. (or 0.32 to 1.3 c.c). If

be required. Tincture
preparation is weak, higher dosage may
should
be assayed physiologically.
*

their

Davis

Parke,

The

others

each

may

are,

be

"

Co.

and

Burroughs,

physiologically.

tinctures

I have

Welcome
used

probably, equally reliable.

preferred.

the

"

Co.

former

Powdered

and
and

leaves

Squibb
found

assay

it good.

in pills of 1 gr.

201

quick action is required, fr. 20 to 30 min. (or 1.3 to

be injectedintramuscularly. It is a local irritant.
CO.) may
To prevent cumulative
effect,keep bowels free.
Dose
fr. 1 to 4 tablets
Substitutes.
1. "Digipuratum." *
When

in

Each
twenty-four hours.
gm.) of digipuratum and is

(or

c.c.) of

the

about

action is like that

of the

tincture

quickly and digestivedisturbance

is

1|

(or

grs.

0.097

in

equal

strength to 15 m.
theradigitalis.Its peutic

of

tincture

active

most

contains

tablet

the effect

but

This

rare.

comes

drug

more

should

act

in fr. 12 to 24 hours.
"

"

in
obtained
be
can
Digipuratum-solution
vials, each
containing 1^ grs. (or 0.097 gm.) of the drug, and this dose, or
half of it,can
then
effect can
be injectedintramuscularly. The
The
be expected in about half an hour.
same
preparation acts
when
used
in about
10 minutes
intravenously. The injection
be given very
should
slowly. Single doses of fr. f to 1| grs.
(or 0.05 to 0.097 gm.) can be used intravenously.
2. Strophanthinum
heart is like digion
(U. S.).t Action
talis
but effects are
sudden
and profound.
Death
result
may
if the patient has taken
preparation of the digitalisgroup
any

within
thin

one

On

week.

should

be

should
5 minutes.

intravenously, and

used
be

given

Dose

very

fr. 0.0005

"

slowly over
to

0.001

"

Glonoin,"

strophan-

avoid

shock

period of

not

to

the

jection
in-

less than

gm.

NITROGLYCERIN,

7.

Action.

of local irritant action

account

Trinitrin."

Lowers

sels.
blood-pressure by dilating peripheral veswithin
Acts
few minutes; effect lasts about
a
" hour.
In the presence
of hypertension diuresis may
result.
Toxic
Effect.
of fulness in head, throbbing
Flushing, sense
of urinary output.
Reduction
headache, faintness.
Indications.
Angina pectoris.

Cardiac

embarrassment

)
,

TT

U. S. p. and

good

are

and

"

for digipuratum

t Boehringer's

drug

in

expensive.

t.; very

less expensive.
which

is good.

when

Csesar

due

"

to

Loretz

Digifoline (Ciba) is
is very

difficult to

It is marketed

high

pressure.

powdered
now

digitalisleaves

being tried

stitute
sub-

obtain.

in vials containing 0.001

solution.

t Official only in the form

as

of Spiritus glycerilisnitratis

(U. S.).

gm.

of the

203

Contraindications.

Low

Tablet

Administration.
tablet

should

blood-pressure.
For quick absorption the
triturate.*

be

and

chewed

Ordinary dose, j^u

(or 0.00065

gr.

unless toxic symptoms

For

gm.)

some

is better.

1.

3 to 5 min.

gm.)

quently
fre-

Amylis

nitris

(or 0.18

to 0.3

c.c).

may

gm.),

or

very

"

Break

pearl and inhale

Pearls
2.

repeated

^V gr, (or 0.0013

be required.
(U. S.). "Amyl nitrite."

(or 0.00032

gr.

rapidly. Effect very transient.

May act when nitroglycerinfails.
Put up in "pearls
containing 3 or 5 min.

Acts

be

may

result.

Larger doses

Substitutes.
Dose

2^7

cases

swallowed.

not

break

t should

Action

0.3

c.c).

handkerchief.

from

easilybut

Sodii nitris (U. S.).

(0.2 or

spontaneously.

not

"Sodium

nitrite."

but lasts longer.

nitroglycerin,
Best prescribedin watery solution.
Dose, 2 grs. (or 0.13 gm.).
like

8.

"THEOBROMINE

Properties.
turn

brown

on

SALICYLATE."

SODIUM

White

pwd.
to

exposure

sol. in

v.

unpleasant,

taste

water,

air.

Action.

Diuretic; slightlyirritatingto the kidneys. Effect

is produced in from
twelve to forty-eighthours; lasts for from
two
to three days.
Toxic

Effect.

Indications.

Vomiting.

dropsy. (Uselessor nearly so in pure renal

act well in angina pectoris,
dropsy.) Small doses sometimes
p. 39.
Acute
Contraindications.
nephritis.
In capsules or in a cachet
Administration.
p. c.
Dose, 15 grs. (or 1 gm.) 4 i. d. If no result after 48 hours,
double dose.
than 3
Never
prescribeit in these doses for more
days at a time.
Substitutes.

hemp."
milder.
Dose,
*

Tablets

t Allen

Germany

1. Fluidextractum
Action

diuretic

fr. 5

to

lose strength
"

t A double
in

Cardiac

Hanbury's

in

are

15

m.

time.

(N.N.R.).

(or

0.3

test

them

to
take

Effects

c.c).
" tablet

oc-

yourself.

good.

salt of theobromme-sodium

remedy.

To

and

dian
apocyni (U. S.) or "Canalike that
of digitalisbut

"Diuretin"

and
is the

sodium
"trade

salicylate. It is official
name"

of

similar

prietary
pro-

205

Better
prescribed as a fresh infusion
casionally dangerous.
(Wheatley) corresponding dose, fr, 5 to 10 min. (or 0.3 to 0.6 c.c).
fr. 3 to 6 grs. (or 0.2 to 0.4 gm.)
2. Theophylline.* Dose
in capsule.
t. i. d. in powder with water
or
be used in the dose of
3. If kidneys are
sound, Calomel
may
for from twenty-four to fortyfour hours
3 grs. (or 0.2 gm.) every
longer. To reduce danger of salivation take
eight hours or even

precautions described
9.

under

Hydrargyrum.

MAGNESII

SULPHAS.
Salts"

''Salts," ''Epsom

(U. S.)
"Bitter

or

Properties. Colorless,crystalline,
very

Salts."

soluble in water, taste

bitter.
Action.

Hydrogogue

in dilute

purge

in concentrated

solution,cathartic

solution.

Toxic

Gastric

Effects.

solution

concentrated

irritation and

it may

be

If

vomiting.

absorbed

and

then

may

in

given
cause

poisoning characterized
by oliguria,hematuria, slow
weakness
and
respiration,paralysis of the intestines,extreme
urine in poisoning shows
t The
a
collapse.
high specific
very
the
of
to
excretion
the
the
gravity owing
drug by
kidney. These
severe

effects

are

rare.

Dropsy

Indications.

Contraindications.

uremic

or

states.

Weakness,

emaciation, vomiting,

struation,
men-

pregnancy.

Administration.

and

the stomach

water.

to

Small

1.

pelletof butter.

unconscious

(or

oz.

doses

15

of

cup

before

to 30

with

black

breakfast

coffee
when

or

gm.) followed

much

Croton

1 to

If

the

water

Pot.

3.

Elaterium

4.

"Ten-ten," calomel
Not

oil,fr.
placed on

official.

(Br.) i

Under

the

gr.

(or 0.016

and

by half

be

can

name

Jr. A.M.A.,

Dec.

10, 1910.

of

(or 0.06

back

jm.)

jalap,aa

(N.N.R.).
t Boos:

3 min.

of the

patient it will be swallowed.

bitartrate and Comp. jalap,pwd.

2.

1 hour

used

for

catharsis.

Substitutes.
in

taken

in

is empty.
From

Dose.

mild

easily taken

effective when

most

glass of

Most

"Theocin"

aa

tongue

drach.

c.c.)

to 0.2

of

an

(or 4 gm.).

in tablet.

grs.

10

(or 0.65 gm.).

it bears

U.

S. p.

and

t.

207

SULPHAS.

QUININE

10.

"

"

(U. S.)

Quinine."
in

Properties. White, cryst., slightlysol.

taste

water,

very

bitter.

Specific for malaria, antipyretic; readily absorbed,

in urine.
and rapidly eliminated
Action.

Effects.

Toxic

occasionallyrenal

Tinnitus, headache, vomiting, erythema;

irritation,
amblyopia, or cardiac depression.

Malaria.

Indications.

Contraindications.

Idiosyncrasy but patients are

in believingthey cannot
take quinine.
mistaken
Administration.
In capsule p. c.
Dose, fr. 5 to
0.32 to 0.65 gm.) from
2 to 4 i. d.
Larger doses
Substitute.
10 grs.

(or 0.5

1.
to

Quininse hydrochloridum

10

grs.

may

be

(XJ. S.)*

in water

gm.) daily,dissolved

0.65

frequently

and

fr.

(or
quired.
re-

to

given in-.

(Manson).
tramuscularly, or 30 grs. (or 2 gm.) in enema
2. Craig recommends
for pernicious malaria intramuscular
jections
inof Quinine bihydrochloridef grs. 7| (or 0.5 gm.) dis. in
water, 15 min.

(or 1 c.c.)and repeated

Quinine and

3.

recommended

as

local anaesthetic

hydrochloride f is

urea

been

every

in recent
and

be

obtained

if necessary.

soluble

more

It is much

years.

can

4 hours

used

and

has

in surgery

in sterile solution

in.

vials.

II.

SODII

Properties. A white

SALICYLAS.

powd. sol.

in

(U. S.)
water,

taste

sweetish

and

saline.
Action.

curative

Analgesic, antipyretic, and

effect

in

nitrogen elimination

some

in the

forms

Soluble

t Not

in 35

official.

parts

water,

and

rheumatism.

It

It

has

increases

cholagogue and
It is readily absorbed
diuretic.
and is eliminated
by the kidney.
Toxic
Effects.
Tinnitus, headache, vomiting, erythema,
delirium and gastro-enteric disturbance.
It is slightlyirritating
to the kidneys and
unless given with alkali may
uria.
albumincause
drowsiness
cause
Very large doses may
or
coma.
*

urine

of

diaphoretic.
acts

as

209

Rheumatic

Indications.

in

Useless

and

fever

various
in

gonorrhoeal and

the

forms
some

of

matism."
''rheu-

other

types

of arthritis.
Acute

Contraindication.
In

Administration.

of

used

be

the

unless

water

nephritisor idiosyncrasy.
tablet or capsule followed by a full glass
be

heart

prescribe

also

sodium

enough

alkaline

medicine

must

resumed

in

such

arthritis

the

bicarbonate

doses

may

10 grs.

bowels

they
in

dosage or
of pepsin, may

fr. 5 to

promote

may

until

smaller

smaller
"

omitted

be

essence

as

see

that

large doses

If

are

to

render

to

kept free.
For
rheumatic
Dose.
fever, 10 grs. (or 0.65 gm.) of sodium
salicylateevery hour until the patient is relieved of pain; then
4 hours until convalescence
has been
10 gr. (or 0.65 gm.) every
established; then fr. 20 to 30 grs. (or 1.3 to 2 gm.) daily for a
the
to prevent relapse. If toxic effects occur
month
or
more
urine

the

and

insufl"cient.

be

off.

pass

to

It

different

form.

helpful.

For

sufficient.

be

(or 0.3

be

0.65

In

then

can

vehicle,

mild

cases

of

matism
"rheu-

chronic

gm.) taken

be

fr. 2 to 4 i. d.

comfort.

Substitute.

1.

Salicinum.

(U. S.)

Action

and

like

uses

dium
so-

and causes
less gastric disturbance.
salicylatebut weaker
2
Oleum
Should
OH of wintergreen
gaultherise (U.S.)
be given in milk, or in capsule. Dose, fr. 15 to 30 min. (or 1
"

to 2

c.c).

acid.
Aspirin:* Acetylsalicylic
their carbonates
alkalies,
for sodium
saUcylate,

as

''

and

ture,
Incompatible with heat, moisbicarbonates

HEXAMETHYLENAMINA.

12.

Dose

(N.N.R.)

(U. S.)t

Properties, Crystalline,readily sol. in water.

Excretion.
Chiefly in the urine in the form of ammonia
formaldehyde or unchanged.
Action.

When

formaldehyde J is set free it acts as

the drug is excreted
unchanged,

antiseptic. When
happens, it is inefl"cient.
*

U.

"

S. p. and

t May

only

in

an

urinary

as

often

acid urine.

t.

Urotropine,"
to

It acts

and

"Formin,"

Hexamethylenamina.

give Fehling's

and

"Aminoform"

(N.N.R.)
reaction.

(Bastedo.)

are

proprietary

names

plied
ap-

211

and

bacilluria

in

pain

irritation

the

and

and
of

region

Especially

Indications.

or

Renal

Effects.

Toxic

the

useful
It

cystitis.

turition
mic-

painful

bladder.

in

fever

typhoid

well

act

may

hematuria,

in

other

to

prevent
of

cases

cystitis

pyelitis.
Acute

Contraindication.
Administration.

grs.

(or

the

urine

dose

change

of

to

is
10

its

capsule

In

0.3

grs.

0.6

(0.65

reaction,

Hexamethylenamine

gm.)

alkaline

nephritis.

i.

t.

or

with

neutral,

gm.)
but

d.

or

or

this
because

more

drug
they

tablet.

acid
if

should

are

Dose

full

glass

sodium
needed

from
of

be

be

When
in

prescribed

administered

incompatible

10

to

water.

phosphate
can

not

(Bastedo).

the
to

with

213

VALUABLE

DRUGS.

Pilulae ferri carbonatis.

13.

"Blaud's

(U.S.)

Pill."

rubifacient,slightlyconstipating,turns stools black.

Used
especiallyin chlorosis and secondary anemias.
Dose:
pillsof 5 grs. each (or 0.3 gm.); fr. 1 to 2 f. i. d., p. c.
1. Ferrum
reductum.
Substit.
(U. S.) Dose, 1 to 3 grs.
(0.065 to 0.20 gm.) 3 or 4 i. d. in pillor powd.
2. Liquor ferri et
ammonii
acetatis.
(U. S.) "Basham's
Action:

mixture."

Dose,

(or 4 c.c).

Sulphonethylmethanum.

14.

hypnotic, sol.

Action:
Toxic

Effect

Used

for

in 195

water,

and

mental

somnolence

mouth.

Larger doses
in

Prescribed

powder by

be used
mouth

soluble

more

and

(0.3

to

in alcohol.

physical depression.
delirium.

for alcoholic
1

gm.) in powd. by

for delirium.

with

water

(U. S. pat.)

"Veronal."

Substit.

or

Dose,

in sol. by rectum.
as

for trional

in

tab.

or

{a)
{h)

15.

may

"Trional."

(U.S.)

wakefulness, sometimes
for sleep,fr. 5 to 15 grs.

Dose:

powd.

1 dr.

Sodii

Potassii

Mild

Action:

bromidum.

bromide."
(U.S.) "Sodium
mide."
bro(U. S.) "Potassium

bromidum.

sedative, lessens

reflex

excitability.Slightly

to the stomach.
irritating

Vomiting, acne, coryza, somnolence.

for nervousness,
wakefulness, epilepsy,and

Toxic

Effect

Used

alcoholic

to

ward

off

delirium.

Usually fr. 5 to 15 grs. (or 0.3 to 1 gm.) t. i. d., or a

singledose at night for sleep.
Much
albe required for epilepsy and for coholic
larger doses may
Dose

patients.
Prescribed
or,

in

watery solution

occasionally,by
16.
Action
Toxic
Used

by mouth

well diluted

(U. S.)

"Phenacetin."*

and

p. c,

rectum.

Acetphenetidinum.

analgesic,antipyretic,mild diaphoretic,and sedative.

Effect : circulatorydepression.
especiallyfor migraine and occasionallyfor other painful
:

conditions.

Bayer's is the best.

215

fr. 5 to

Dose:
small

dose

Prescribe

(or 0.3

grs.

in tab.

gm.)

to

if
repeated in an hour or more
with caffein citrate,1 gr. (or 0.065 gm.).

ipecacuanhae

opii.

et

powder.

or

be

may

Pulvis

17.

15

necessary.

"Dover's

(U. S.)

Powder."
mild

pyretic
opiate: hypnotic, sedative, diaphoretic, antiand analgesic; slightlyconstipating.
is irritable vomiting may
Toxic
Effect:
When
stomach
result.
Used
generally in single dose in the evening for malaise or
infections
such
in acute
insomnia
the
as
"grippe," tonsillitis,
or
Action:

exanthemata.
Dose

fr. 10

15

to

Codeinae

18.

grs.

(or 0.6

to

sulphas.*

gm.) in pwd. by mouth.

"Codeine."

(U. S.)

Used

Slightlyconstipating.
opiate and sedative.
Effect : vomiting, generally on
followingday.
to allay unproductive cough.

Dose

Action

mild

Toxic

fr.

| to ^ gr. (or 0.008

Sodii bicarbonas.f

19.

to 0.032

in

gm.)

tablet,by mouth.
"Saleratus."

"Soda."

(U.S.)

antacid.

Action:

gastricdisturbance,not poisonous.
in acid poisoning;
for "hyperacidity," in acidosis,and
Used
in acute
urine alkaline; and with salicylate
rheumatism.
to render
fr. ^ to 1 dr. (or 2 to 4 gm.) 3 to 4 i. d. with
Dose
water
:
by
be required in acidosis.
mouth.
Larger doses may
Toxic

Effect:

subnitras.

Bismuthi

20.

Action

"Bismuth."
with

H2S

diarrhoea,"hyperacidity," peptic ulcer, and

for

astringent and

mild

(U. S.)

intestine to form
Toxic

Effect

Used

for

antacid.

Combines

in

black, insoluble sulphide.

with therapeutic dose.
none
a

testinal
in-

fermentation.
for

Dose:

after

each

loose

of 1 dr. (or 4 gm.)

distress.

Prescribed

Mild

Action:
Diuretic.

a.

c.

powd. by

purgative and

(or

grs.

For
coat

to

mouth

0.65

hydrochloride

t Magnesii
a

pure

oxidum

may

be

ulcer

with

preparation:

e.g.,

and

(U. S.)

preferred.
Squibb's.

R.

gm.)

C.

to

peated
re-

doses

relieve

water.

supposed intestinal

(U. S.) is preferred by Dr.

1.3

peptic ulcer J

the

mite.

to

Antisyphilitic.

Heroine

% Use

in

20

movement.

used

are

to

Hydrargyri chloridum

21.

fr. 10

diarrhoea

Cabot.

"Calomel."

antiseptic.

217

Toxic
Use

and

Dose

(or 0.006
mild

renal

Effects:

1.

gm.)

irritation,
stomatitis,etc. (p. 187).

15

every

saline cathartic

mild

as

for 8

m.

1 hour

either in the

purge,

after

doses

10

or

the

and

dose

of t"^gr.

followed

by

last

dose, or fr. 1 to 3 grs.

singledose at night and the

gm.) can be taken in

saline on the followingmorning.
4 hours
2. As a diuretic: 3 grs. (or 0.2 gm.) every
for fr. 24 to
48 hours
until diuresis begins. When
or
using this dose the
scribe
usual precautions againstpoisoning must
be taken
(p.187). Pre(or 0.065

to 0.2

in tablet.
3.

is

to salicylateof
preferred by many
of syphilisby injection.

Calomel

the treatment

ricini.

Oleum

22.

"Castor

(U.S.)

for

mercury

oil."

purgative; acts in fr. 2 to 6 hours; after effect

constipating. Do not prescribe it during menstruation
or
nancy.
pregmild

Action:

Toxic
Dose

Effect

not

fr.

to

poisonous but
ozs.

or

brandy helps to disguisethe

Fluidextractum

23.
ext. of

Toxic

Taste

purshianae. (U.S.)

(or 0.6

m.

"Fl.

bitter.

very

to

c.c.)at bed-time

is used

of cow-pox

virus should

The

is

juice or

with

water.

virus.

living virus

cow-pox

c.c). Lemon

irritation of bowel.

Vaccine

small pox.

60

taste.

rhamni

laxative.

fr. 10 to 30

24.
The

mild

Effect

Dose

to

sagrada."

cascara

Action

(15

more

be vomited.

may

be

as

fresh,and

prophylactic against

a
a

"take

"

lesion of

or

required to confer immunity.

Admin.

Clean

1.

if used, must

skin

with

soap

and

water.

Antiseptics,

they kill the virus.

2. When
without
dry, scarify skin very superficially
causing
will serve.
bleeding. A needle or any sharp instrument
3. Apply virus.
After it has dried completelycover
the spot
with a sterile pad and secure
it with adhesive
plaster.
4.

be washed

When

bathed
time.

the

off lest

inoculation

"has

with

antisepticsand
Secondary infection

taken"

dressed
and

the

lesion

asepticallyfrom
much
pain can

should
time
thus

be
to

be

avoided.
Note.

"

Virus

everywhere and

is

prepared

is distributed

by

health

free to

departments
physicians.

nearly

219

Typhoid

25-

killed

vaccine.

culture

of

typhoid

bacilli

standardized

by

count.

against typhoid (p. 65).

prophylactic inoculation
of a
at intervals
given subcut.
general, three doses are
or ten
days as follows: 500 million,1,000 million,and 1,000

Used

for

In

week

million.
The

reaction

is seldom

interval

The

There

severe.

between

be

may

injections should

fever

be

not

and

laise.
ma-

longer

than

lest

anaphylaxis result.
is strongly recommended
Inoculation
for persons
who
travel,
for nurses,
be exposed
physicians,soldiers and others who may
to typhoid infection.
and
Note.
Prepared by health departments
pharmaceutical
10

days

"

firms.

26.

Tuberculin.
for

Used

and

diagnostic tests

of tuberculosis.

detailed

For

for treatment

information

in suitable

cases

"Early Pulmonary
Treatment," by John

see

Tuberculosis; Diagnosis, Prognosis, and

B. Hawes
" Co.)
(Wm. Wood
2nd, M.D.
There
a

several

are

glycerineextract
*'

27.

kinds

of tuberculin.

of tubercle

Normal

bacilli.

Koch's

It is still used

by hypodermoclysis, intravenously, or
circumstances
and object in view.
depending upon
solution

common

extensively.

salt solution."

Used

The

is

old tuberculin

consists

of 0.6 per

by

rectum,

cent

of sodium

other

formulae

ride
chlo-

in distilled water.

Solutions
contain

are

calcium

prepared also according

and potassium chloride

to

in

addition

which
sodium

to

chloride.
When

prescribingspecify formula

28.
A.

Alcoholic

beverages.

(a) Spiritusfrumenti.

(U. S.) "Whiskey."

(") Spiritusvini Gallici.

Uses
1.

desired.

"Brandy."

(U. S.)

Quickly diffusible stimulant:

to

oz.

(or 4

to

30

dose

c.c).

1 drach.

by mouth, fr.

Dose

subcut.

30

min.

2c.c.).

Distributed

free in Massachusetts

by

the

State

Board

of Health.

(or

221

To

2.

appetite; best

promote

with

taken

meals

and

well

diluted.
As

3.

in

food

malnutrition

in sujQScient
in selected

Dose

fr, 1 to

at intervals

repeated

(or

oz.

foods

other

is

Alcohol

typhoid

septic infection.

30

or

c.c.) diluted

60

to

of fr. 2 to 6 hours.

especiallyuseful
with

and

water

doses

Larger

sorbed
ab-

not

are

quantity.

of

cases

when

are

times
some-

beneficial.
If odor

remains

is often

Champagne
when

the

breath

on

borne

Beer, ale, porter,

improve appetite and

but

"Russian

Oil

between
Oil

"

is

to

more

taste, but
Substitutes

the

Oil"

Kquid
Pharmacopoeia,

British

is

ordinarilythe

usually has

case

with

yellowish color and

Oil"

of

ence
differ-

"Russian

Petroleum.

is colorless and

"Russian

liquidpetrolatum.
an

ant
unpleas-

tasteless.

should

similar

general
of high specificgravity.
have

tasteless,and
and
sometimes
less efficient,

seem

are

liquid petrolatum because

refined than

characteristics,should

Lighter oils

of

American

for

weight.

"Russian

and

the former

of

meals

OIL.'V

Russian

latter

The

increase

promote

(U. S.) and

is not

prescribed with

be

may

definition

the
"

malt

or

liquidum

paraiEns under

better

^'RUSSIAN

29.
Petrolatum

lengthen interval.
than
whiskey or brandy
or

is irritable.

stomach

B.
to

dose

reduce

be

escape

through

thefanus
involuntarily.
Action:

lubricant

which

through the intestine.

less apt to disturb
Used

with

forms

from

Dose

after

undigested

and

olive oil it is not

food, and

is

constipation,alone

or

in

conjunction

of treatment.

1 to 3
a

unabsorbed

digestion.

chieflyin chronic

other

hours

the

Unlike

passes

tablespoonfulstwice daily; preferably several

meal.

30.

AGAR-AGAR.

Action:

is not

Agar-agar swells tremendously by absorbing water,

in the intestinal tract.
digested, and does not ferment

Therefore,
bowel.

it stimulates

peristalsisand

helps

to

sweep

out

the

223

Used

other
Dose

in

forms

chronic
of

from

water.

in

generally

conjunction

with

treatment.

Administration

agar

constipation,

to

can

Agar-agar

be

tablespoonful

Powdered
mixed
wafers

once

can

agar

and

with

are

more

or

be
washed
attractive

twice
eaten

daily.
on

down
but

cereal.
with

expensive.

ulated
Granmilk

or

225

VALUABLE

DRUGS

extract.*

Thyroid

1.

"

S.)

(U.

arsenitis.

potassii

Liquor

2.

USE.

OCCASIONAL

FOR

Fowler's

solution."
3.

Pilocarpinae

4.

Apomorphinae

5.

Vinum

6.

Quininae

7.

Hyoscinae

(U.

tiglii.

(o.

Elaterium.

ri.

Adrenalin

Atropinae

(U.

sulphas.

(U.

14.

Strophanthinum.

15.

Apocynum.

(U.

16.

Theophylline,

"

17.

Emetine

U.

Boehringer's

"

Not

t.

official.

to

1,000.

S.)

S.)
S.)t

S.)
201.

p.

hydrochloride.!

official.
S.

oil."

(U.

hydrochloridum.

3.

F.)

Croton

solution,!

chloride

Cocainae

Not

"

(the

(Br.)

2.

S.)

(U.
(N.

S.)

(chemically

S.)

hydrobromidum
sodio-salicylas.

Oleum

9.

(U.

hydrobromidum

Caffeinae

S.)

(U.

hydrobromidum.

S.)

S.)

(U.

seminis.

Scopolaminae
8.

(U.

hydrochloridum.

colchici

S.)

(U.

hydrochloridum.

Welcome

Burrough's,
Parke,
is

Davis

good.

"

Co.

"

Co.'s

extract

is

good.

same.

227

DRUGS
Ferrum

2.

Liquor
Heroine

4.

Spiritus

ammoniae

bitartras.

6.

Potassii

citras.

7.

Pilula

8.

Liquor

scillae

11.

Strychninas

12.

Tinctura

13.

Syrupus

nucis

(N.

F.)

"

Do-

(U. S.)
(U. S.)

vomicae.

(U. S.)

hypophosphitum.
of

hypophosphites."

hypophosphitum

Compound

17.

Glycerinum.

18.

Tinctura

iodi.

19.

Tinctura

belladonnas

20.

Pilulae

of

"

(U. S.)

Senna

(U. S.)

oflttcial.

(U. S.)

compositae.

aloini, strychninae,
"A.

(U. S.)

foliorum.

Cathartic

Compound

F.)

leaves."

(U. S.)

catharticae

Pilulae

hypophosphites."

Magnesia.f

Senna.

Milk

compositus.
of

syrup

16.

Not

F.)

(U. S.)

Phillips'

(N.

compositus.

sulphas.

Syrupus

(N.

(Br.)

alkalinus.

boratis

15.

21.

tartar."

S.)

(U.

citrata.

Syrup

"

of

solution."

Caffeina

''

Cream

antiseptic."

sodii

10.

14.

(U. S.)
"

S.)

composita.

Alkaline

"

(U.

antisepticus

bell's

S.)

195.

p.

aromaticus.

Potassii

Liquor

(U.

acetatis.

mixture."

5.

9.

ammonii

et

hydrochloride,*

3.

USE.

(U.S.)

ferri

Basham's

''

COMMON

reductum.

1.

"

IN

S.

andB.

t Proprietary.

Pills."
et

belladonnae.

Pills."

(U. S.)

229

AND

WEIGHTS

MEASURES.

METRIC

(kg.)

kilogram

density,

4"

i.e., at

kg.

C.

and

1000

litre

SYSTEM.

of

760

mm.

0.1

gm.

decigram

centigram

(eg.).

milligram

(mg.).

gm.

gram.

(dg.).

APOTHECARIES'

grain

drachm

ounce

pound

minim

fl.

drachm

fl.

ounce

fl.

"

12

or

dr.

or

or

(0)

of

water

16

or

"

or

"

weighs

or

or

455.6

(or

dr.

480

approx.

grs.

or

grs.

480

c.c.

30

gm.

gm.

gm.

MEASURE.

approx.

60

approx.

approx.

WINE

c.c.

dr.)

or

grs.

375

approx.

0.062

(drach.
(oz.)

480

OR

m.

WEIGHT.

60

APOTHECARIES'

oz.

or

TROY

gm.

drach.)

or

(lb.)

(min.)

pint

0.065

(dr.

S.

OR

gr.

(oz.)

U.

or

maximum

(gm,).

0.001

at

grams.

gm.

gm.

water

pressure.

1.0

0.01

distilled

m,

m.

or

or

drop

approx.
approx.

wat^r).

of
4
30

c.c.

c.c.

Volume

Companion

to

of Medical
Shattuck's Principles

MANUAL

Pradical

LEWIS

all the

The

volume."

respectively with

Fluids
as

the

"

into

Fluids

Sputxun

Gram

and

are

colored, illustrate

the

text

is

"

have
as

printed

There

postpaid

Eight

the

for

many

waiting
New

"

for

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ONE

toneal
Peri-

Topics,

Spirochseta PalHda,
of

Gram

of Diseases

Plates, Four

such

Medical

DOLLAR

which

pages.

physicians
just

of

provide for notes,

To

alternate

be

"

absent.

or

Text.

upon

must

been
this."

and

negative organisms, and

Figures

Eleven

Feces

Pirquet test. Tables

von

dealing

Miscellaneous

Stain, the stain

the

Pleural

"

and

Preface.

The

"

small

Chapters,

Blood

that

practical

Author's

The

"

that

together in

Eight

Leucocytosis is present

in which

Price

the

Urine

The

test,

positive and

From

Spinal

"

Gram

Schick

the

The

Contents

Gastric

"

put

long time

tests

be

is divided

work

for

laboratory
could

M.D.

HILL,

Author

the

to

needs

man

compact

such

WEBB

worth-while

medical
and

seemed

has

OF

LaboratoryDiagnosis

By

"It

Treatment

who
book

Journal.

AND

HALF

THE

MEDICAL

The

BOOK

THE

OF

YEAR

(Starvation

Allen

Treatment

of
THIRD

Diabetes

EDITION

By LEWIS

W.

M.D.

HILL,

and

RENA
Dietitian

S.

ECKMAN

the Massachusetts

at

General

Hospital

This Book
Presents
been

is

easily directed

easily followed
Which

is used

by

which

Diabetes

has

successful.

proved

Which

for

Treatment

by

and

thousands

by

Physicians

and

as

Patients.

recommended

without

reserve

Physicians.

of

the Dodor

It Gives
Full

Description of Treatment.

Typical Case
Complete

Histories

Daily
Fat,
Diet

Tj^ical

of Adults

Diet

Lists, with

and

List

Number
for

of

First

Children.

and

hydrate,
Protein, CarboCalories

Fifteen

stated.
after

Days

Starvation.

Recipes
Table

CLEAR,

Price

W.

of Food

as

LEONARD

well

as

Safety

of Diabetics.

Values.

COMPREHENSIVE,

Postpaid

M.

Comfort

for

ONE

DOLLAR

.*.

COMPLETE
AND

Publisher

BOOK

QUARTER

.-.

BOSTON