Obrázky stránek
PDF
ePub

present in the initiatory stage, usually appearing after the acute symptoms have subsided and recovery of these serious conditions progress as recuperation takes place.

The above list of diseases readily indicates what effects the toxemia has upon the system. Stomach disorders are sometimes sources of anxiety, as stomatitis, gastritis and enteritis, also nervous vomiting, probably due to disturbance of center located in medulla oblongata. Some cases may present one of the varieties of nephritis, produced by irritation of the kidney cells, from elimination of excretory products, but this condition is sometimes present in other infectious diseases.

The after effects or sequelæ are of short duration, but this must not be accepted as a fundamental rule. It is now observed by the profession that the majority of our cases pursue a favorable course. It must not be overlooked that influenza occasionally rekindles a dormant inactivity of some unforeseen organic disease, which comes forth with renewed vigor and hastens our patients to their untimely demise. Then again, this disease is frequently engrafted on other acute or chronic ailments, which is not at all encouraging and necessitates a guarded prognosis.

It goes without contradiction that when the intercurrent conditions are pronounced, our mortality per cent. will be greatly increased. A clear conscience is a source of much comfort, as we fully realize that the diminished vitality and extreme prostration upon an already impaired constitution is more than any human being could withstand.

Cases are observed in which there is a perceptible lack of energy. with undue readiness to fatigue and loss of appetite, consequently diminished weight and anemia follow.

There is no other disease in which the sequelæ are so pronounced. except diphtheria. These conditions have been studied very scientifically during the past twelve years. Previous to that time our knowledge is meager.

Functional derangements of the nervous system are not unusual, and are due to direct effects of toxemia. Mental derangements are sometimes observed, such as melancholia, delirium, hypochondriacal

Mental

states, with occasional delusions and suicidal tendencies. dullness and dementia are usually confined to senile cases. Types of melancholia are more prolonged; the other varieties are transient. Hysteria is aggravated, and states of trance or cataleptic stage may occur, and this condition generally follows the febrile stage. The presence of epileptic convulsions have been reported in some cases during the acute stage and recurred after a long period of quiescence.

The brachial plexus, intercostal and sciatic nerves often take on a neuritis, the multiple variety being unusual. A predisposition to a gouty diathesis is a forerunner of rheumatism, which is fibrous. in character. This inflammation may become severe about articular surfaces and involve them, thereby simulating the articular variety, and might result in rheumatoid arthritis. Cerebral meningitis may develop. The cranial nerves are seldom affected, however, optic neuritis, irregular cardiac action and vomiting without nausea are examples of this type. Otitis media and abscess formation are to be apprehended and are trying conditions.

The diagnosis of influenza is not always possible, and no doubt many of us have felt the want of increased knowledge and experience. Those who are expert in microscopy can make examinations to clear up the mist, but the general practitioner has to depend on previous observation, judgment and recognized reference books to aid him in his diagnosis. If an epidemic is prevalent the problem is not so difficult. The above remarks have reference to masked types. An important point to bear in mind is the extreme prostration and depression of spirits is out of proportion to what is observed in other diseases affecting similar structures. We must differentiate by excluding acute follicular tonsilitis, acute muscular rheumatism or myositis, intermittent, malarial, typhoid, dengue and cerebro-spinal fevers; also measles in children before the eruption appears.

Uncomplicated cases run a favorable course, the death rate being practically nil. If serious complications occur, the mortality per cent. is increased and the prognosis must be guarded. It is well to remember that existing functional or organic diseases, also consti

tution and age, figure prominently in the death rate. The proper management and treatment of influenza is simple and better understood than the symptomatology. It should be our aim to use supportive measures and stimulate the secretions and excretions. Instructions should be given about clothing and the necessity of being warmly clad; also that unnecessary exposure is not beneficial and favors relapse and complications. A preliminary cathartic is always necessary, and the best to be selected is either a saline or mercurial. I prefer for this geographical area fractional doses of calomel. It acts as an indirect cholagogue, intestinal antiseptic, diuretic and gastric sedative. There are many agents that can be used with satisfaction in different combinations and to suit the condition of the patient and the intensity of the attack. I seldom administer more than any of the following three in one prescription, as phenacetine, acetanilid, salicin, sodium benzoate, sodium. salicylate, Dover's powders, philocarpine, salol and quinine sulphate. Stimulating agents are usually indicated and can be alternated with any of the above combinations. I generally prescribe strychnine and spirituous frumentum with some palatable vehicle. It is necessary to use expectorants if a severe bronchitis exists, and the ammonia preparations are the best if gastric irritability is not present. The application of cold compresses externally to the throat, and using chipped ice internally, produces a soothing effect for the pain and discomfort caused by the existing tonsilitis and pharyngitis. There is no objection to antiseptic gargles, and they are exceptionally valuable from a physiological standpoint. In regard to the dietary, it is best to administer easily assimilating food, especially of fluid consistency. In addition, it is important to keep the intestines in a soluble condition. Insist on quietude and relative rest, but it is not always possible to have our patients carry out this instruction, as many of them will insist on remaining up and attending to business matters-so-called "walking cases." During the period of recuperation, give an invigorating tonic suitable to the individual case, and advise the importance of unnecessary exposure and overexertion, which are frequent causes of a relapse. All complications and sequelæ of a serious nature require

important consideration, especially when the influenza, per se, is of minor importance. When the diagnosis of these conditions are made, it is always best to manage same as if it was the true disease. I consider it feasible to pursue this plan along with the basis of treatment now accepted in the ordinary type of la grippe. The laity are perfectly satisfied with the outcome of "grip," either for better or worse, and the profession is not so readily criticised as they realize that a severe attack is often fatal, especially when serious complications exist.

THE MANAGEMENT AND TREATMENT OF TYPHOID,

OR ENTERIC, FEVER.

S. T. TURNER, M. D.,

EL PASO, TEXAS.

An acute, infectious fever, due to the implantation and proliferation of the typhoid bacillus of Eberth. Believing that this part of the subject would be more interesting to you than the whole, I decided to omit from my paper the etiology, pathological anatomy, symptomatology, diagnosis, etc., referring you to your works on the practice of medicine for information on these parts of the subject. The patient should be put to bed at the earliest possible moment, strict quietude enjoined, placed under the care of a competent nurse, and all visitors prohibited. The room should be large, well lighted and ventilated, with a sunny exposure. All openings should be screened, to prevent the entrance and exit of house-flies, common carriers of this disease. The personal and bed linen should be changed daily and placed in a one-twentieth carbolic solution, until it can be boiled for at least half an hour. Nurses should be taught the importance of cleanliness in caring for typhoid patients, and shown that even their own health depends upon it. A fresh solution of chloride of lime (six ounces to the gallon of water) or an eight per cent. solution of formaldehyde gas, which is equally as effective, but more expensive, should be kept constantly at hand, and in the bed-pan and all vessels for receiving sputum, material vomited, urine, and discharges from the bowels, and more of the disinfectant poured over these secretions and excretions, and let stand for an hour, until the specific organisms have been killed; then emptied into the sewer, or, if in the country, poured on sawdust and burnt, or, in the case of large camps, the discharges should be emptied into a trench not less than four feet deep and covered. with the milk of lime. After a discharge from the bowels the patient's buttocks should be washed with a solution of bichloride of

« PředchozíPokračovat »