A system of practical medicine. By American authors. Vol. 3

by Unknown

Jaminet, regarding the affection as wholly the result of exhaustion, relies entirely upon stimulants and concentrated nourishment, ignoring the aid of anodynes altogether. It is difficult to see the reason for this, even admitting to the fullest extent his theory of the disease, for nothing can be more exhausting than the intolerable pain which characterizes this affection, and nothing could act more promptly as a restorative than an efficient anodyne.

Starting from the theory already given as to the mode in which the disease is produced, the writer was led to the idea that benefit would be derived from the use of an agent that would induce contraction of the capillaries, and thus correct the want of tone which was considered to lie at the foundation of the difficulty. For this purpose ergot was employed, with the belief that it would be useful, first, by contracting the vessels of the brain and spinal cord and relieving their congested state; and, secondly, by restoring tone to the superficial vessels, and thus imparting vigor to the circulation.

An extended trial warrants him in saying that the results justified the theory. In his hands, though not always successful, ergot was certainly very useful in a considerable number of cases. He has seen very severe pain completely relieved within half an hour after the administration of a drachm of the fluid extract. In other instances unsteadiness of the limbs, which seemed about to usher in paralysis, yielded promptly to one or two doses. A teaspoonful of the fluid extract may be given, and the dose repeated in half or three-quarters of an hour, unless the pain is relieved.

Frictions, with or without stimulating liniments, are very generally resorted to, and seem sometimes to give momentary relief, but it appears to be rather by occupying the attention of the patient than by any action occasioned in the part. In some instances, when the pain is confined to a particular locality, having the part immersed in hot water will afford temporary relief. But the use of the general hot bath is not advised, as it is unsafe to increase the already existing relaxation of the vessels. In several of Jaminet's cases paralysis came on while in the hot bath. In two of the writer's cases cold was applied to the spine, with apparent benefit in each.

Epigastric pain is almost always relieved at once by the use of an alcoholic stimulant with ginger, as employed by Jaminet.

Vomiting is best treated with sinapisms to the epigastrium and swallowing small bits of ice.

When paralysis occurs it is to be treated on general principles. Cups or leeches, with douches and frictions to the spine, may be useful; and, if the case be protracted, the use of strychnine may be called for. Electricity may be of service in preserving the nutrition of the muscles. The bladder will almost certainly be involved, requiring the constant use of the catheter.

The cerebral symptoms which occasionally occur are, with the exception of coma, so transient in their nature as to call for no special treatment. Coma, when it takes place, is to be managed according to the circumstances of the case, as when proceeding from other causes. If accompanied by a full, strong pulse, venesection may be expedient.

There remains to be considered a plan of treatment originally suggested by Pol, and carried out to some extent by Foley—viz. returning the patient at once into the compressed air. Foley says, as the result of his experience, "A true specific is returning to the caisson, through which means all such accidents (pains, vertigo, etc.) speedily disappear. It is to be resorted to unhesitatingly in all threatening cases, and the pressure should be admitted rapidly." But the means of access to the caisson are usually such that it would be difficult to remove a patient into it, even if he could be comfortably cared for while there or if his presence would not interfere with the work. It would therefore be desirable to have facilities for employing compressed air at some point above ground which would be easily accessible.

Of course the secondary effects which arise in protracted cases would not be capable of direct relief by simply reproducing the physical conditions existing in the caisson. The most that might be hoped for in such cases would be that the pressure might result in giving a new impulse to the circulation in the congested part, and thus favor resolution.