Conditions of Disease.
Eclectic Treatment of Disease.
The successful treatment of disease is the final objective point of every student of medicine. It has been the sentiment of conspicuous members of the profession that, after all the research of the past, we know nothing about the curing of disease. Doubt and indecision have prevailed for centuries. But out of all the study, research and observation, especially of the past half century, positive advancement has been made. From the mass of theory, facts have been determined, truths have been developed, and exact and correct principles have been enunciated, until now we feel that we can prevent, and cure disease.
A principle, now of almost general acceptance, is that of the selective action of each remedy, upon exact disease manifestations, through its influence upon special structures, parts or organs. Conversely, by carefully studying fach disease in its totality, by dissecting and analyzing it, we find exact conditions, upon each of which some remedy will act directly.
It is necessary to consider all of the phenomena of a given disease under a given head, but in the treatment of that disease we must consider every element or factor of the disease present in each given case separately, with special reference to the specific selective action of that single remedy which experience has taught us will correct that symptom or group of symptoms. Certain of these conditions, elements or factors of disease occur as pathological entities, exhibited either by one symptom only, or by a group of nearly invariable symptoms. These may be found to occur during the progress of many diseases, and whenever occurring exercise an important influence upon the condition as a whole. We have found these conditions amenable to specific treatment, which exercises the same influence upon them, whatever the disease may be in which they are found.
Among the conditions which we have to consider in the treatment of any disease, are congestion, elevated and subnormal temperatures, hyperemia and anemia, local or general, and especially of the brain or nerve centers; pain, nervous irritation, direct or reflex; the condition of the secretions, the condition of the tongue, the condition of the gastro-intestinal tract, excessive or deficient acidity, and sleeplessness.
I will present, very briefly, some suggestions which are applicable in the treatment of these conditions, whenever they may be found.
Congestion:—This is undoubtedly the initial, the primary pathological condition in acute inflammation. It may be caused by micro-organisms, by cold or by injury. This condition is considered in the treatment of the various diseases, as there are characteristic underlying symptoms when congestion attacks distinct organs primarily which must be considered. When the congestion threatens the brain, or the meninges the patient is dull, listless, indifferent, drowsy, the eyes are dull, the pupils dilated, and insensitive to light, the skin is cool, usually moist, and in extreme cases the extremities are cold. There may or may not be chilliness, but the general temperature is usually high, always so after the condition is well established. We have no remedy in the materia medica which is more specific in its influence than belladonna is to acute congestion, and less positively, to congestion of more gradual development. Whether congestion be present independently of other acute inflammation, or whether congestion or inflammation be diagnosed in any other organ at the same time, this agent is of much service.
Belladonna is contra-indicated in acute cerebral hyperemia and in nervous excitement from other causes. It is a profound active physiological stimulant to the capillary circulation. Heat is a most important measure in the treatment of congestion. Intense, persistent heat is the most direct, the most rational antagonist to congestion known. It is always of service and can do no harm.
Subnormal Temperature occurs as an accompaniment of certain conditions, usually in the crisis, or after the abatement of the active symptoms. When so occurring the usual treatment directed to the restoration of the patient under those circumstances, will be found sufficient. But every practitioner meets with patients who are very ill, suffering from symptoms which cannot be named as belonging to any common disease. The temperature he finds to be sub-normal, depressed probably by some influence which acts directly upon the central nervous system, but which cannot be positively determined.
Strychnin is the remedy usually depended upon to elevate the temperature under these circumstances. Good results are obtained from this remedy, or from nux vomica, ignatia, xanthoxylum and capsicum. However, I have obtained better results from the use of from two to five or even ten minim doses of cactus every hour, than from any of the above named remedies. It acts directly as a stimulant upon the heat centers and upon the nervous mechanism which controls the heart and circulatory apparatus. Avena sativa is also of service in these cases. Myrica is recommended when sub-normal temperature is induced by chronic malarial conditions.
Cerebral Hyperemia:—The condition of the nervous system is of first importance in the treatment of nearly all diseases. Acute cerebral hyperemia is of not uncommon occurrence. It usually appears with increased temperature and causes headache, sleeplessness, vertigo or convulsions, and often delirium. It is especially common in childhood, but may occur at any age. The symptoms are a flushed face, with hot skin, bright eyes, with contracted pupils, restlessness, or ceaseless activity, and general nervous excitation.
These symptoms are the specific indications for gelsemium, which should be given in sufficiently full dosage, and must be discontinued when the symptoms are relieved. Other remedies are the bromids and ergot. The latter is especially valuable. With children ergot should be given in small and frequently repeated doses. With adults, especially in strong, active males, it should be given in full doses for its immediate effect. Cimicifuga and passiflora are of service also. When the condition is present during the stage of enfeeblement of a protracted fever, rhus toxicodendron is indicated. In extreme excitement, where convulsions are threatened, the bromids should be given either alone, or in conjunction with chloral or hyoscyamus. They are serviceable when there is extreme gastric acidity with nervous excitation.
Cerebral Anemia is occasionally present. This is shown by pallor, by general feebleness and inactivity, by absence of fever usually, and by certain forms of delirium, with vertigo, faintness, nausea and general depression. This condition must be met with stimulants. The specific emergency remedy is nitroglycerine, or amyl nitrite, for extreme acute cases. These determine the blood to the brain directly. Strychnin, digitalis, capsicum, avena sativa, xanthoxylum, or brief but sufficient alcoholic stimulation are indicated in given cases. Camphor or the ammonium compounds will assist in overcoming the condition until the circulation is equalized. In depleted circulation from acute loss of blood, nothing takes the place of the physiological salt solution. This supplies the deficiency temporarily, establishing a normal condition of the circulatory apparatus by restoring the quantity of the blood fluids. Where death seems imminent this should be administered by hypodermoclysis. Often it will be sufficient to introduce it as hot as can be borne into the rectum through a long rectal tube.
Pain is depressing in its effect. It prevents the action of specific remedies and advances the processes of disease. In most cases we have specific remedies for specific pain. In others we have much yet to learn in the control of pain. Stomach pains are often controlled by local measures: By artificial digestives, when induced by indigestible food, and by hydrochloric acid, when that agent is deficient in the gastric juice, by sodium bicarbonate when due to excess of acid. When caused by pyloric spasm, lobelia or gelsemium will relieve it, as they will when due to neuralgia. Dioscorea will control the pain when bilious colic is present.
There are a number of remedies which act specifically upon pain within the abdomen. The pain of peritonitis is controlled by heat and bryonia, if begun at once, as is the pain of appendicitis. Dioscorea is of service in various forms of colic, besides bilious colic; it will relieve pain from the passage of gall stones, and is of much service in spasmodic conditions within the abdomen. It is also of service in spasmodic and neuralgic dysmenorrhea. Pain of any kind in the pelvic organs is relieved by cannabis indica, especially pain and irritation in the bladder and urethra. Other remedies for pain in the urinary apparatus are thuja, kava kava, hydrangea, gelsemium, cimicifuga, benzoic acid in proper combination and chimaphila.
Pain in the pleura is first controlled by a sharp mustard plaster, and then by bryonia or asclepias. The pain of pneumonia is influenced by the same remedies and by the application of libradol. Much more could be said of specific measures for pain, but the remedies themselves must be carefully and thoroughly studied, separately, with reference to their specific pain-relieving properties. The general remedy for pain is opium and morphin. We give them in the absence of specific agents, but in the smallest possible dosage. In severe traumatism or in any surgical emergency or in a severe burn, a full hypodermic of morphin is demanded, but this agent must be avoided or prescribed cautiously when it covers up or conceals the evidences of progressive pathologic processes in any disease, and especially in appendicitis and pneumonia.
If we could not control pain in the inflammation of serous or synovial membranes with bryonia, and other directly indicated measures, we should use small, frequently repeated doses only of the deodorized tincture of opium, or morphin, until the influence was seen, and then either give the doses farther apart, or abandon this anodyne and depend upon the specific remedy, which may then be effectual.
I have mentioned farther on in this work a method of combining morphin with a bromid and a mild stimulant, which gives excellent results in many cases where mild pain or general distress, or discomfort are present and demand treatment.
Headache and head pains are controlled by removing the cause and meeting direct indications. There are gelsemium and bryonia headaches, and also those which are cured by rhus, by ergot, by nitroglycerin and the bromides. Supra-orbital pain clue to disordered conditions within the post nasal passages is controlled by bryonia and sodium salicylate, but head pains must be studied with reference to their causes in every case. A remedy, especially a depressant, given simply because it will relieve the pain, with no consideration of its actual influence, is unsafe treatment indeed.
Severe muscular aching and deep soreness are conditions which exist with nearly all acute fevers. They should be relieved, as they are often the source of annoyance and nervous irritation. Muscular aching is controlled by cimicifuga in small frequent doses; arnica and hamamelis administered in the same manner, will control soreness and pain, especially that depending upon violent muscular action or upon injury. Arnica stimulates the nervous system to a satisfactory degree at the same time if enfeeblement, depression or prostration be present.
Acute Nervous Irritation and excitability may be induced either by hyperemia or anemia. If induced by hyperemia, as just described, it is usually a condition of exaltation of nervous action, and is best relieved by the sedatives mentioned. When the condition is extreme they must be used to their full influence, often to the exercise of a conspicuous depressing action. This, however, must be avoided when the depression will produce an actual weakness of the heart's action, or will result in any condition which must itself be subsequently overcome by treatment.
If the irritation be induced by anemia it is a condition of depression. Other conditions also may result in exhaustion or in depression of the nerve force, causing irritation and excitability. When a condition of this kind is present, sedatives and depressing remedies must be positively avoided, but the irritability must be relieved by measures calculated to elevate the nerve force, and overcome the depression. This is directly accomplished by properly selected stimulants, by forced nutrition and perhaps by the use of heat. Usually the correctly adjusted stimulant will exercise its influence more satisfactorily if given in small doses frequently repeated. The use of the stimulating alkaloids in this manner is proving of great service. Occasionally a so-called stimulating sedative carefully selected may be administered with excellent advantage.
Reflex Irritation is a condition altogether too large and too important to be fully considered at this time, but it is one of quite common occurrence and one frequently overlooked in the treatment of disease. It causes high temperature at times, erratic and otherwise unaccountable, and nervous irritation. Profound convulsions may result from it, or it may induce severe local spasm. It irritates the action of the heart in various ways, resulting in palpitation, excitable action, irregularity or intermittency, with dyspnea, vertigo, nausea, and depression. It interferes with the action of the stomach, inducing persistent vomiting, complete loss of appetite, and indigestion, or extreme pain. It induces various forms of diarrhea, which may be severely bilious in character, or the movements may be large and watery. A long train of reflex symptoms, which may be general in character, may result from intestinal irritation, and are usually ascribed to worms, although more commonly undigested food in a state of decomposition or toxins from imperfect digestion may be the cause.
In the treatment of reflex irritation the cause should be determined and immediately removed. When the cause cannot be readily determined, however, the intestinal canal must be evacuated without irritation. Other emunctories as well as the orifices of the body must receive attention. There is no doubt that orificial irritation is a common cause of reflex irritability, in chronic or sub-acute cases. A general condition of much importance, which is often induced by reflex irritation, and the cause entirely overlooked, is neurasthenia, which may be acute in character, but is usually sub-acute or chronic in its development.
When the reflex irritation is unaccompanied with depression, and the cause cannot be determined, a nerve sedative properly selected will usually relieve it. Irritability of the heart yields to gelsemium, cimicifuga and the bromids. Irritability of the stomach is often very difficult to control. Its treatment in full will be given under its proper heading, as will irritation of other organs. In reflex nervous irritation in young girls, from menstrual or ovarian causes, I have found damiana in large doses an excellent remedy. I have found santonin almost specific in the relief of reflex irritation, when the cause is unknown. I was led to the use of the remedy by its effect in a case of intestinal irritation, which I supposed was caused by worms. It relieved the irritation admirably, but I made the discovery that no worms were present. I was forced then to attribute the influence to nerve sedative properties in the agent, which had not been previously ascribed to it. I then used it in reflex, coughs, and reflex irritation of the heart, and other reflex irritations and invariably with success. I advise that it be used freely, but with caution. If a frequently repeated dose of one grain does not produce satisfactory results, the dose may be increased in selected cases, to its maximum, looking always for renal or intestinal irritation, or for a profound depressing effect.
Secretion:—The condition of the secretions must be considered in every case. Elimination seldom receives sufficient attention in any disease. With the suppression of the secretions there is always a demand for increased elimination. The evidences of suppressed secretion are dry skin, dry mouth and tongue, deficient renal action and constipation. These, however, are not all of the evidences, and these are sometimes misleading. There may be perspiration and yet the solids carried off through the skin may not be properly secreted. The action of the kidneys may be such that the solids are not eliminated while the patient is passing considerable water. On the other hand, elimination may occur quite readily from the intestinal glands and yet deficient peristalsis interfere materially with proper evacuation of the bowels. Or retention of urine may occur from spasm of the sphincter or from urethral spasm. In these cases reabsorption results in autoinfection.
Our best general stimulant to the secretions in acute sthenic cases, is jaborandi or pilocarpine. These may be given in repeated small doses, but where patients who have previously been in excellent health and are vigorous and active, are attacked with profound congestion at the onset of an acute disease, a single full dose may accomplish all that is necessary. This remedy usually influences the skin first. In some of my cases it has produced extreme salivation, to be followed by a mild action upon the skin and free action upon the intestinal tract and upon the kidneys. It usually stimulates the action of the mucous glands uniformly throughout the whole body. Jaborandi can thus be given during the sthenic stage of protracted fevers. It overcomes dryness of the mouth, and of the skin, prevents constipation and stimulates the action of the kidneys. It is usually best given in doses of from two to five drops every two hours. Elimination at the onset of acute disease, has long been promptly and satisfactorily re-established by the use of hot foot baths, hot diaphoretic drinks and induced perspiration. A most satisfactory course in acute high temperature is to envelop the patient in a wet sheet, adjusting the temperature of the sheet to the condition of the patient. If the patient be vigorous and the fever high, the water may be quite cool; in feeble patients it should be but little below the temperature of the body, and in cases suffering from depression it should be above the body temperature at 100 F. to 110 F. This should be wrapped with a warm flannel blanket until reaction and free perspiration occur. We have a long list of remedies which can be selected for their influence upon the skin, or upon the other secreting organs. We do not advocate the use of irritating cathartics. Many cases demand a free laxative and thorough evacuation of the bowels, but this must be accomplished always without irritation. The best stimulant to renal deficiencies is persistent heat, which may be applied dry or moist. Moist heat is preferable, and in cases where from sepsis, acute cold or other cause, immediate suppression of urine occurs, heat must be used externally, in conjunction with an intestinal flush, as hot as can be borne. If possible the lower bowel should be filled with hot water and this should be retained.
When secretions are excessive, these must be restrained. This is best done by the use of belladonna, stramonium, and astringent remedies, which may be applied in accordance with the indications existing. Excessive mucus secretion is difficult to restrain at times. An extreme outpour of mucus whether from the bronchial tubes, from the stomach or from the intestinal canal, may be controlled often better with turpentine, than with other remedies. This may be given in doses of from two to five drops, on sugar slowly dissolved in the saliva within the mouth and the saliva swallowed.
Turpentine will meet certain indications of deficient secretion most satisfactorily, paradoxical though this statement may seem. It is given in typhoid conditions, with or without tympanites, when the mucous membranes are dry and dark red, the tongue dark red, thin and pointed, and coated with a brown or black coat, with sordes on the teeth. It may be given in the form of an emulsion if so preferred.
The Tongue:—The condition of the tongue has been referred to in part, but there is much more that should be said of it as presenting strong indications for treatment in acute febrile and inflammatory disease. All of these conditions cannot, however, be presented here. In addition to what has been said there is a condition most common during malarial fevers in which the tongue is broad, thick and pale, and is coated with a thick coat which is dirty or yellowish white, at first, but inclines to brown as it persists. This coat may finally become smooth on the top, like porcelain, apparently encrusted and very brown. With this there is no appetite, rather a disgust for food; there is lassitude, disinclination to effort, decreasing strength, mental dulness, and finally delirium. This condition demands an emetic. We do not advise emetics as often as formerly, but this is one of the cases in which a thorough preliminary emetic will change at once the entire condition. As an emetic we may use ipecac or lobelia or apomorphin, or eupatorium if masked malarial symptoms are pronounced. Baptisia is demanded in protracted fevers when the tongue is coated brown, and inclined to be dry, with an inclination to sordes on the teeth. Twenty drops of specific baptisia should be added to four ounces of water, and with the indicated fever remedy this should be given in dram doses every hour or two. This agent is demanded by dusky discoloration of the tongue, by a tongue covered with a moist, pasty coat, with foul breath, or by a sleek, dark red, raw-looking tongue, with inactivity of the stomach. It may be given advantageously with other agents which have similar indications. Rhus toxicodendron and certain acids meet these indications at certain times also, as determined by a thorough study of these remedies. In all cases a thorough study of the remedy is fully as important as the study of the disease.
Hyperacidity:—I am convinced that many prescribes fail at times in obtaining results from any measures, which might be obtained by very simple remedies, if excessive acidity of the stomach and intestinal tract be first neutralized. It is well known that frequent severe attacks of pain which are attributed to extreme causes, such as biliary calculi, or hydatids of the liver, or to chronic ulceration or even to malignant disease, are controlled and the condition disappears under the use of half dram doses of the sodium bicarbonate alone. I have been frequently called to treat severe and intractable neuralgias where chill and fever were present, or to administer relief for toothache, and have known of the teeth having been extracted for the pain, where the condition was entirely relieved by a few full doses of a well selected alkaline remedy. A simple, reliable saline laxative is often of great service.
The specific indications for alkaline treatment—the evidences of hyperacidity—are a broad, thick tongue, free salivary secretions, and pale mucous membranes. The tongue is usually coated with a uniform, moist, white coat. There is a lack of appetite and poor digestion. The sodium or magnesium compounds administered in acute disease with these indications, are of incalculable service. They sometimes relieve the other conditions so positively that but little specific treatment is needed. Prof. Scudder was a strong advocate of the use of the sodium sulphite when there was excessive hyperacidity, with lack of tone and decomposition of food. He gave as his indication for this remedy, pallor of the tissues of the tongue, which was broad and coated with a thick white, yellowish white, or dirty fur, and always moist. It prevents gastro-intestinal fermentation, and is specific for the vomiting of frothy and yeasty matter. When these conditions are present it reduces the temperature, relieves nervous excitement and greatly improves the appropriation of other remedies, and encourages the digestion and assimilation of food.
Our Neutralizing Cordial, the compound syrup of rhubarb and potassium, is a very important remedy for hyperacidity, and now generally used for this condition by the profession. It tends to correct all abnormal gastric and intestinal conditions that have been induced by, or act as causative factors to the hyperacidity. Magnesium sulphate in small doses is an excellent remedy, and magnesium citrate and calcined magnesia are of much value.
Deficient Acidity:—The demand for acids in the system, when it exists, is another very important condition. It comprehends the group of symptoms that are described as typhoid, but may vary from a simple dark red appearance of mucous membranes, to an extreme typhoid condition with sordes, with entire absence of the salivary secretion. The tongue, which is quite dry, is long and thin, with thin edges and a pointed tip. Ultimately a dirty coat forms in the center of the tongue, which quickly becomes light brown, then dark brown, and finally, if there is extreme high temperature and great depression, the coat may become black. If begun early, acids properly administered in any acute condition will often prevent the development of this train of symptoms. If omitted at first, they must be administered in larger doses and more frequently. They may be given in water as a beverage, and sweetened.
Hydrochloric acid is the acid most frequently selected, nitrohydrochloric acid was advised by our older writers, when with the evidences of a deficiency of acids, there was marked torpor of the liver or other perverted liver action, without obstruction to the flow of the bile. Nitric acid is indicated when the mucous membranes are violet, carmine, or of a clear red color, the mucous membrane appearing as if it were transparent, the red color showing through it, distinctly. Sulphuric or sulphurous acid is of service when the tongue is dry and deep red at the tip and edges, and when the brown coat increases in color to black from the edges to the center. It is also of service when the tongue is sleek and dry, the^ papillae generally diminished. Phosphoric acid is of much service where, with the above appearance of the mucous membranes, there is excessive prostration or any great degree of nervous debility.
There is a condition in which hydrochloric acid alone is deficient in the fluids of the stomach. This results in impairment of the digestion and is more common in sub-acute and chronic cases than in acute cases. The evidences of this are extreme gastric atonicity, anorexia, a moist tongue, with elongated papillae, which are red at the base, but are tipped with a white coating through which the pinkish redness of the base can be readily seen. This appearance is uniform over the entire surface of the tongue. The judicious administration of hydrochloric acid will usually correct this condition.
Insomnia:—Sleeplessness depends upon many factors and should have much more thorough consideration than I can give it here. It occurs independently of any well defined disease, or it occurs as a most troublesome factor during the course of severe acute disease, preventing rest or restoration, and interfering with the normal action of every function of the body. It prevents the proper action of remedies administered for important conditions, results in cerebral irritation, and in severe cases it may cause or increase delirium. Independently of disease, it occurs as a result of bad habits of working, thinking, eating or sleeping. It results from temporary cerebral hyperemia, or from cerebral anemia.
In sthenic cases with cerebral hyperemia, the patient should eat sparingly at the evening meal and nothing afterward before retiring; should spend the evening quietly and restfully at home, and should sleep in a cool room with the head properly elevated, and with the least bed clothes possible. He should take no stimulants of any form after noon, and should avoid them in toto if the condition is persistent. If the condition induces cerebral excitement, he should have a constitutional treatment, calculated to unload the system of urea and uric acid and which will promote normal excretion, and when everything is favorable he may for three nights consecutively take a cerebral sedative, selected with a view to relieving the brain of excess of blood. This should be taken in a full dose the first night, and in decreasing doses on three following nights. Gelsemium in five minim doses, or sodium bromid in ten or fifteen minim doses, with ten drops of ergot will often be all sufficient. The medicine should be omitted for a period of three or four nights, when, if the sleeplessness continues, this course may be repeated. No patient should know what he is taking for insomnia, nor be allowed to procure it for himself. Chloral should be used only in extreme cases, and then only on the prescription of the physician. I avoid other synthetic remedies entirely, because of the habits soon induced and because of their deleterious influence on the blood and upon the digestion and assimilation of food. Cold applications to the head are beneficial with these patients. One suffering habitually from cerebral hyperemia should, in riding in a sleeping car, always sleep with his head toward the engine.
In cerebral anemia with any degree of debility or exhaustion, the patient should have a full but easily digested meal at six o'clock p. m. and upon retiring he should drink from half of a pint to a pint of hot water, or he may drink instead, in sips, slowly, a glass of hot milk, and eat a few graham crackers or salted crackers, or drink a bowl of hot beef tea with crackers. He should sleep with the head low, and perhaps the lower extremities a little high. It is best to sleep without a pillow, or in extreme cases the foot of the bed may be elevated two or three inches. The bed should be comfortable and warm, with sufficient coverings. One suffering from cerebral anemia should sleep, when riding in a sleeping car, with the feet toward the engine. An unusually refreshing sleep may result.
Sleeping remedies in anemia must not be sedative to a pronounced degree, but should be slightly stimulating, and administered with care. The monobromated camphor, or in some cases the ammonium bromid, are indicated, or minute doses of nitroglycerine repeated two or three times.
When patients are persistently wakeful, the habit of excluding everything disturbing from the thoughts can be readily acquired. They should force themselves to think of but one thing, and that, something of no importance whatever. The simple expedient of breathing through the nose and imagining that the breath is seen and watched, until it disappears, is good. I have kept my thoughts fixed upon what I dreamed before I awoke, of upon a foolish dream of the past, with best results. I am soon dreaming again. Other similar courses are all based upon the necessity of composing the mind to calm and rest. In acute disease the exciting conditions must be considered and attended to.
Medicine is justifiable, but it must be specifically administered. Gelsemium, passiflora, hyoscyamus, scutellaria, valerian, conium and cannabis indica are all mild soporifics. Hyoscyamus is excellent in small doses frequently repeated, for two hours before the bed time, for infants and those advanced in years, or those especially feeble. If given to strong adults, the dose must be full and large, and to obtain its best action it must meet its own indications.
Passiflora in full or large doses will prove satisfactory more often than any one of the remedies named. In a high degree of nervous irritation or nervous excitability, where gelsemium fails, the bromides or small doses of chloral may be used, given in a menstruum acceptable to the stomach. Hydrobromic acid will often prove a useful remedy.
None of these remedies is successful when severe pain induces wakefulness. Here small doses of opium or morphin may be used, or Jamaica dogwood, if specific measures to control the pain are not available or successful. I give opiates in small doses frequently repeated until the result is obtained, and desist at the earliest possible moment. In severe acute pain a hypodermic of morphin will be demanded. In giving morphin for pain and to produce quiet and rest, especially after a surgical operation or after confinement, I have had most happy results from the use of the following formula and have yet to witness the least unpleasant result, even after severe operations, where vomiting is severe: Morphin, one grain; hyoscyamus, ten minims; sodium bromid, from one to three drams according to the amount of nervous excitability; tincture of capsicum, ten minims, in syrup of tolu, simple syrup or water, two ounces. Of this a teaspoonful is given every ten, fifteen or twenty minutes until from three to five doses are given. This will soon produce tranquillity and relief from pain. Vomiting usually ceases and sleep quickly follows. In mild cases, two doses are sufficient. And once relief is obtained a dose given three or four times within twenty-four hours will preserve the condition of relief perfectly.
Fever:—During any disease the maintenance of a normal temperature is of the utmost importance. Where the disease factors have produced either sub-normal or hyper-normal variation, this must be corrected. I lay it down as a principle that must not be violated, that elevated temperature should always be treated as such, and must receive first attention. However simple an elevated temperature, it should never be neglected.
I am aware that even the best of our antipyretics fail at times to control pyrexia; and because of this, to justify the failure of the physician I think, a theory has become popular that fever is a conservative and essential condition—is nature's effort to rid itself of the causes which underly the condition. This is a most erroneous opinion. Fever is as much the result of the chemical forces at work, from the antagonism of the causes of the disease to healthy tissue and fluids, as heat is the result of the chemical processes involved in the fire which would reduce my house to ashes, and I would no more be justified in neglecting the one than the other.
This is practically true in the fevers of childhood. In many cases temperature is the result of simple causes, which may persist or may not; but persistence of elevated temperature rapidly induces other pathological ills which are more serious, such as acute hyperaemia of an organ or part, and which may soon be followed by the usual consecutive processes of a developing acute inflammation.
The positive treatment of the initial fever immediately, stays the further development of the pathological processes, often, and in many cases wards off nerve irritation, with its train of symptoms, or prolonged inflammation, with its dire results. Further, where we have evidence of initial development of these processes the factors that underlie their development are often retarded and checked by the positive control of the temperature. This position can be defended by unanswerable arguments.
Of simple fevers not specifically diagnosed, Dr. William Pasteur says:
"Simple fevers are very common in childhood, and their early recognition is of great practical importance. They may be roughly grouped under the following heads:
"1. Abortive or incomplete forms of the specific continued fevers,—typhus, typhoid and relapsing fever. Cases of irregular type may occur at any time, but are more frequent during the epidemic prevalence of these diseases.
"2. Cases of scarlet fever, modified variola, and, more rarely, measles and erysipelas, in which the eruption is either absent or unnoticed.
"3. In rare instances, anomalous forms of intermittent fever.
"4. Fevers due to the effects of some localized inflammation, in which the local signs are transient, ill developed, or beyond the reach of observation. Cases of this kind occur in connection with lymphadenitis, tonsillitis, and acute catarrhal affections of the alimentary and respiratory mucous membranes.
"5. The whole group of fevers which are caused by disorders of digestion, attended by the absorption of toxic substances.
"6. Fevers depending on some disturbance or exhaustion of the nervous system as a consequence of exposure to heat, or of some peripheral nerve irritation. Also those depending on mental disturbances and those of reflex origin, the cause of which is obscure or indeterminate."
With some neurotic, excitable or hysterical women, a high temperature will sometimes result from anger, extreme nervous excitement, or from anxiety when some other disease is present. I have found patients, when convalescing, to develop a high temperature for a few hours after entertaining company in the sick room. I have found nervous women, after a satisfactory confinement, develop a temperature with every visitor that was admitted; or to have an increase of temperature upon hearing startling news, or upon being disappointed. I have known the high temperature in these cases to persist until local inflammation was induced. Such inflammation is often erroneously attributed to sepsis. But sepsis may be absent, in which case the inflammation will be the direct result of the influence of the high temperature. This condition must be treated with quiet, rest and remedies calculated to soothe the nervous irritability. It will be found that there is some exhaustion or prostration present, and a carefully selected stimulating sedative will be needed. The causes of irritation, as has been stated, must be arbitrarily excluded, and the digestion and appropriation of food, and the selection of foods, must have careful attention.
Fevers in which there is a regular and marked morning remission with the evening exacerbation occurring at about the same time each day,—one rise and one fall only in each twenty-four hours,—are favorable and readily amenable to treatment. When the temperature continues to increase after midnight, with no abatement in the early morning or with irregular rise and fall during the day, or where the temperature remains stationary at a point above 102.5° or 103° F., the conditions are not so favorable,—are more intractable, and less responsive to the measures used.
The following specific statements concerning the medical treatment of fevers, refer only to the above mentioned, and other erratic and unusual manifestations of fever. The medical treatment of fevers of regularly and definitely known types, is considered fully elsewhere, each under its proper title. The general suggestions here made are applicable to all fevers.
Treatment:—A high temperature in a positively asthenic patient must be treated entirely different from the ordinary fevers. In asthenic fevers, aconite in quite small and frequent doses, bryonia or rhus toxicodendron will be found indicated. This latter remedy is indicated when the tongue and mucous membranes are dry and red, when there is cerebral irritation, or when with the exhaustion there is flushed face and bright eyes. With the intestinal irritation there is usually tympanites.
When there is a general asthenic condition with fever, accompanied with irritability and feebleness of the heart's action, cactus will reduce the fever and soothe the irritability of the heart.
Where the fever is induced by reflex irritability, it has been immediately controlled by santonin in one-grain doses every hour or two, when all other measures had persistently failed. Echinacea will be found of great value in fevers caused by pyemia or septicemia. It will antagonize the toxins and exercise a sedative influence at the same time.
In the treatment of persistent fevers the first attention should be paid to the stomach. Incorrect feeding and overeating are common faults, and disorders of the stomach and bowels are of very frequent occurrence. If the evidences of excessive acidity are present, with resulting fermentation and presence of gas, the syrup of rhubarb and potassium,—the neutralizing cordial of the older physicians,— is a most rational compound and meets the indications in a very great majority of the cases. In children especially, a dose of this will remove the cause of many cases of sudden fever and acute gastric or intestinal pain, and with the removal of the cause the symptoms of the disorder will disappear. The use of lime water is too frequently advised with infants. While a most serviceable remedy, no inorganic chemical agent of a character so positively opposed to the presence of the essential free hydrochloric acid of the gastric juice, should be advised ad libitum, as this is so commonly advised by many physicians.
Physics and active laxatives should be made use of only when indicated. The old tradition that a physic is needed every time any disorder threatens is erroneous in the extreme, and is frequently the cause of the sudden and rapid development of severe phases of the disease, or of a positive increase in the disease phenomena, without being so recognized.
Flushing the intestinal canal with a large volume of hot water can do no harm, and is often of immense value. This may be repeated until the fluid returns clear. If the patient is aged or one previously enfeebled by chronic disease, or one suffering from a chronic disease of the heart, the physiological salt solution may be used hot, instead of hot water, and as much as possible should be retained in the bowels.
In introducing a large quantity of the fluid, the patient should lie on the left side with the hips elevated, and a small compress may be held flat over the anus when it is desired that the fluid be retained.
The use of a mild saline laxative is often of great service. The specific indications are a broad, thick tongue, coated white, with a yellowish tinge to the coat in the center of the tongue, the mucous membrane being pale.
I cannot conceive of a more foolish procedure than persistence in the use of physics when the mouth and tongue are dry, the mucous membranes a deep red, the tongue pointed, thin and narrow, with red tip and edges,—positive evidence of the lack of secretion, and of a deficiency of the acid elements, or of an excess of alkaline constituents. If a laxative is used at all it should be acid or neutral in chemical reaction, or given in conjunction with free acid drinks; never alkaline under these circumstances.
The use of a hot footbath at the onset of a fever is a domestic measure of scientific importance and value, and should seldom be omitted. Where the chill was markedly severe at the onset of the fever, a hot bath may be given first. The patient should be taken from the bath, wrapped in warm blankets, the feet immersed in a deep vessel containing water pungently hot, to which is added a table-spoonful of mustard to each gallon. Pleasant hot drinks may be administered also. When, after twenty or thirty minutes, the patient is placed in bed, the blankets should be slowly removed, the perspiration being continued for an hour or two, according to the previous condition of the patient. This course is often much more effective than medicine, in breaking up colds and warding off the results of a chill, and the accompanying fever.
It is often important that at the sudden onset of fevers the patient be deprived of food entirely for several hours. The obsolete practice of administering an emetic was often of great value, but unless the stomach be greatly overloaded, rest, with perhaps a mild digestive if there is distress in the stomach, will often be sufficient. Subsequently small quantities only of simple foods should be taken.
In simple sponging, the face, trunk and limbs are sponged for from ten to twenty minutes with water,—cold or tepid, or even hot, as the patient may express a preference. In markedly sthenic cases, water as cold as fifty degrees may be used; but in children cold water readily produces shock, and a temperature of sixty-five to eighty degrees is preferable and more efficacious. When cerebral hyperemia seems to threaten, by flushed face, hot head and bright eyes with contracted pupils, cold compresses to the head are essential. They should be frequently changed. The wet sheet pack, fully described elsewhere, is of excellent service in aborting simple fevers.
