Krankheiten

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Vergleich: Siehe: Genus epidemicus + Nosoden

 

[Ruddock]

EPITOME OF TREATMENT-

1. Premonitory Diarrhoea: Rubiniís Camph. (Rubiniís Camphor consists of equal parts by weight of Camphor and Spirits of Wine, 60 degree O.P.).

2. Invasive stage: Rubiniís Camph., or Aconite (strong tincture in drop-doses).

3. Fully-developed Cholera: If Camph. be insufficient-Ars. Verb-a. Cupr-ac. Ip. Am-s.

4. Collapse. Ars. Acon. Carb-v.

5. Typhoid Conditions: Phos. Ars. Carb-v. Nit-ac. Cupr-ac.

6. Convalescence: China., Ph-ac.

7. Prophylactic: Camph. Cupr-ac.

 

GENERAL INDICATIONS.-Camphor, at frequent intervals, directly the first symptoms of Cholera-Diarrhoea, chilliness, and spasmodic pains in the abdomen-are noticed. It is often sufficient to cure the disease immediately in that stage. Should the disease have much advanced before the use of Camph. administer.

 

Acon.:[Dr. Hempel] first invasion of the disease, in restoring the pulse and rousing the vital reaction generally. The 1x, or strong tincture, should be given. Our own experience with Aconite during

an epidemic, when we prescribed it in several cases of Diarrhoea with great pain in the bowels, coldness of the body, and cadaverous appearance, fully confirms the foregoing statement.

As an illustration of the value of Aconite in Cholera, we mention the following facts from our own practice. Some years ago we prescribed, for a patient at a little distance, Acon. in a low dilution

for severe pain in the abdomen. The medicine produced such striking results in his own case, that, having a large portion to spare, he gave doses of it to his friends when they suffered in a similar manner. Finding the remedy so useful in relieving acute pain, he asked us to give him a supply of it to keep in readiness. At this time Cholera broke out in the village, and, although he did not know the name of the remedy, he gave it to as many as he found suffering from Cholera, taking the pain in the abdomen as the indication for its use. Death from Cholera occurred in the village, but in every instance patients who had Acon. quickly recovered.

Ars.: Cramps, Suppressed urine, and sudden extreme prostration, the last symptom being more marked than the profuseness of the discharges. A dose every thirty to sixty minutes.

Verat.: Excessive Vomiting and Diarrhoea, with Cramps.

Cupr-met.:Cramps, with vomiting and a cyanotic condition.

The remedies most suitable in COLLAPSE and in the TYPHOID CONDITION into which Cholera patients often pass, have already been indicated. For detailed symptoms, see the Materia Medica,

and the section on Enteric fever.

ACCESSORY MEANS.-Absolute rest in the recumbent posture, from the very commencement of the Diarrhoea. A hopeful and cheerful state of mind should be fostered; a presentiment of death being unfavourable.

The sick-room should be warm but well-ventilated; and the heat of the body maintained by friction, hot bottles, etc. Ice and iced water may be given freely; no food, much less stimulants; enemata of warm milk often repeated, though rejected, are beneficial. The return to ordinary diet should be slow. Evacuations, bedding and clothing should be disinfected. See Section on Nursing.

PREVENTIVE TREATMENT.-When Cholera is epidemic, Rubiniís Camphor should be taken once or twice a day, in doses of two or three drops on sugar. The simple diarrhoea which often precedes Malignant Cholera should be promptly met. Dr. J.H. Clarke says that if the person is much exposed to the disease one drop of Cupr-acet. 3x should be given night and morning in a little water. Camph., Ars. or Acon. may be prescribed according to the indications.

SANITARY AND HYGIENIC MEASURES.-The following excellent advice has been given, and should be adopted on the earliest indications of Cholera-

The house should be well aired, especially the sleeping apartments, which should be kept dry and clean.

All effluvia arising from decayed animal or vegetable substances ought to be got rid of; consequently, cesspools and dustholes should be cleaned out, and water-closets and drains made perfect.

All exposure to cold and wet should be avoided, and on no account should any one sit in damp clothes, particularly in damp shoes and stockings. Care should be taken to avoid chills or checking perspiration. Clothing must be sufficient to keep the body in a comfortable and even temperature.

Habits of personal cleanliness and regular exercise in the open air should be cultivated; also regularity in the periods of repose and refreshment; anxiety of mind and late hours should be avoided.

The diet should be wholesome, and adapted to each individual habit. Every one should, however, be more than ordinarily careful to abstain from any article of food (whether animal or vegetable) which may have disordered his digestion upon former occasions, no matter how nutritious and digestible to the generality, and to avoid all manner of excess in eating and drinking.

Not allowed: Raw vegetables, sour and unripe fruits, cucumber, salads, pickles, etc. should.

Wholesome varieties of ripe fruits, whether in their natural or cooked state, and vegetables plainly cooked, may be taken in moderation, by those with whom they agree.

 

Diphtheria.

DEFINITION.-A specific, contagious, and sometimes epidemic disease, dependent on the growth of a specific bacillus in the throat (Klebs-Loffler), and the poisoning of the system by its toxins,

in which there is exudation of lymph on the lining of the mouth, fauces, and upper parts, of the air passages, or, occasionally, on an abraded portion of the skin, attended with general prostration,

and sometimes remarkable nervous phenomena.

As just described, it is a general disease, manifesting local distinctive symptoms. It would be incorrect in theory, therefore, and might lead to grave errors in treatment, if the attention were concentrated on the local mischief, rather than in attempting to cope with the whole symptomatic depression.

SYMPTOMS.-Diphtheria is divisible into two classes, simple and malignant. In the simple variety, happily the most common, the symptoms are at first so mild as to excite little complaint beyond slight difficulty of swallowing, or pain in the throat, burning skin, pains in the limbs, etc., and is readily cured by one or more of the following remedies. Malignant Diphtheria is ushered in with severe fever, rigors, vomiting, or purging, sudden great prostration and restlessness, anxious countenance, etc., pointing to some over whelming disease, under which the system is labouring.

The skin is hot, the face flushed, the throat sore, and the mucous membrane bright-red; the tonsils are swollen, and grey or white patches of deposit appear on them, small at first, but gradually enlarging, so that one patch merges into another, forming a false membrane in the throat, rendering swallowing and even breathing difficult. In some cases, the false membrane has been detached,

and after extreme efforts ejected, presenting nearly an exact mould of the throat. The exudation of Diphtheria may be distinguished from a slough by its easily crumbling, by the facility with which

it can often be detached, and by the surface thus exposed being red, but not ulcerated. The false membrane looks like dirty wash-leather; and between it and the true membrane an offensive bloody discharge exudes, imparting to the patientís breath a most repulsive odour. The glands of the neck are always enlarged, sometimes pain is felt in the ear, and there is generally stiffness of the neck;

the inflammation is liable to extend rapidly, in consequence of the continuity of the lining membrane of the throat, with the mouth, nose, wind-pipe. and even the air tubes of the lungs. If the disease progress, the patient passes into a stupor, and the difficulty of swallowing or breathing increases, till the false membrane is forcibly ejected, or the patient dies from suffocation, the exudation blocking up the air-tubes; or, more frequently, he sinks from exhaustion, similar to that observed in Enteric fever.

DANGEROUS SYMPTOMS.- Increased foetor of the breath, a quick, feeble or very slow pulse; persistent Vomiting; drowsiness and Delirium; bleeding from the nose; extension of the disease to the lining of the nose; dyspnoea; suppressed or albuminous urine; increase temperature.

DIAGNOSIS.-The diagnosis of Diphtheria depends on the discovery of the bacillus and from all suspicious sore throats a swab should be sent for bacteriological examination. The disease which used to be called Croup, is an affection of the larynx, either due to diphtheria affecting that organ, or (Spasmodic Croup) to a spasm of the vocal cords dependent on other causes. The name croup should now be given up. Follicular Tonsillitis may be mistaken for Diphtheria. There is no true membrane in this disease, but as mild cases of Diphtheria can exist without much membrane formation, the bacteriological test is the satisfactory one.

CAUSES AND MODE OF PROPAGATION.-The specific poison of Diphtheria is now generally acknowledged to be a specific bacillus, called after the two men who had most to do with isolating and describing it, the Klebs-Loeffler bacillus. The severity of an attack depends largely on the resistance powers of the patient which may be diminished by unfavourable surroundings. Indeed, it can live in throats that give no sign of disease, and can thus be carried about by apparently healthy people till it gains access to a susceptible subject and causes obvious disease. It commonly occurs as an epidemic, and a solitary case may prove a focus for spreading the disease.

 

EPITOME OF TREATMENT-

1. Premonitory Diarrhoea.-Rubiniís Camph. ( Rubiniís Camphor consists of equal parts by weight of Camphor and Spirits of Wine, 60 degree O.P.).

2. Invasive stage.-Rubiniís Camph. or Acon. (strong tincture in drop-doses).

3. Fully-developed Cholera.-If Camph. be insufficient Ė Ars. Verb-a. Cupr-ac. Ip. Am-s.

4. Collapse.-Ars. Acon. Carb-v.

5. Typhoid Conditions.-Phos. Ars. Carb-v. Nit-ac. Cupr-ac.

6. Convalescence.-China., Ph-ac.

7. Prophylactic.-Camph., Cupr-ac.

 

GENERAL INDICATIONS.-Camphor, at frequent intervals, directly the first symptoms of Cholera-Diarrhoea, chilliness, and spasmodic pains in the abdomen-are noticed. It is often sufficient to cure the disease immediately in that stage. Should the disease have much advanced before the use of Camph. administer.

 

Acon.: [Dr. Hempel] Very useful, during the first invasion of the disease, in restoring the pulse and rousing the vital reaction generally. The 1x, or strong tincture, should be given. Our own experience with Acon. during an epidemic, when we prescribed it in several cases of Diarrhoea with great pain in the bowels, coldness of the body, and cadaverous appearance, fully confirms the foregoing statement. As an illustration of the value of Aconite in Cholera, we mention the following facts from our own practice. Some years ago we prescribed, for a patient at a little distance, Aconite in a low dilution for severe pain in the abdomen. The medicine produced such striking results in his own case, that, having a large portion to spare, he gave doses of it to his friends when they suffered in a similar manner. Finding the remedy so useful in relieving acute pain, he asked us to give him a supply of it to keep in readiness. At this time Cholera broke out in the village, and, although he did not know the name of the remedy, he gave it to as many as he found suffering from Cholera, taking the pain in the abdomen as the indication for its use. Death from Cholera occurred in the village, but in every instance patients who had Aconite quickly recovered.

Ars.: Cramps, Suppressed urine, and sudden extreme prostration, the last symptom being more marked than the profuseness of the discharges. A dose every thirty to sixty minutes.

Verat.: Excessive Vomiting and Diarrhoea, with Cramps.

Cupr-met.: Cramps, with vomiting and a cyanotic condition.

The remedies most suitable in COLLAPSE and in the TYPHOID CONDITION into which Cholera patients often pass, have already been indicated. For detailed symptoms, see the Materia Medica, and the section on Enteric fever.

ACCESSORY MEANS.-Absolute rest in the recumbent posture, from the very commencement of the Diarrhoea. A hopeful and cheerful state of mind should be fostered; a presentiment of death being unfavourable.

The sick-room should be warm but well-ventilated; and the heat of the body maintained by friction, hot bottles, etc. Ice and iced water may be given freely; no food, much less stimulants; enemata

of warm milk often repeated, though rejected, are beneficial. The return to ordinary diet should be slow. Evacuations, bedding and clothing should be disinfected. See Section on Nursing.

PREVENTIVE TREATMENT.-When Cholera is epidemic, Rubiniís Camphor should be taken once or twice a day, in doses of two or three drops on sugar. The simple diarrhoea which often precedes Malignant Cholera should be promptly met. Dr. J.H. Clarke says that if the person is much exposed to the disease one drop of Cuprum Acet. 3x should be given night and morning in a little water. Camph. Ars. Acon. may be prescribed according to the indications.

SANITARY AND HYGIENIC MEASURES.-The following excellent advice has been given, and should be adopted on the earliest indications of Cholera-

The house should be well aired, especially the sleeping apartments, which should be kept dry and clean.

All effluvia arising from decayed animal or vegetable substances ought to be got rid of; consequently, cesspools and dustholes should be cleaned out, and water-closets and drains made perfect.

All exposure to cold and wet should be avoided, and on no account should any one sit in damp clothes, particularly in damp shoes and stockings. Care should be taken to avoid chills or checking perspiration. Clothing must be sufficient to keep the body in a comfortable and even temperature.

Habits of personal cleanliness and regular exercise in the open air should be cultivated; also regularity in the periods of repose and refreshment; anxiety of mind and late hours should be avoided.

The diet should be wholesome, and adapted to each individual habit. Every one should, however, be more than ordinarily careful to abstain from any article of food (whether animal or vegetable) which may have disordered his digestion upon former occasions, no matter how nutritious and digestible to the generality, and to avoid all manner of excess in eating and drinking.

Raw vegetables, sour and unripe fruits, cucumber, salads, pickles, etc. should not be allowed.

Wholesome varieties of ripe fruits, whether in their natural or cooked state, and vegetables plainly cooked, may be taken in moderation, by those with whom they agree.

 

DANGEROUS SYMPTOMS.- Increased foetor of the breath, a quick, feeble or very slow pulse; persistent Vomiting; drowsiness and Delirium; bleeding from the nose; extension of the disease to the lining of the nose; dyspnoea; suppressed or albuminous urine; increase temperature.

DIAGNOSIS.-The diagnosis of Diphtheria depends on the discovery of the bacillus and from all suspicious sore throats a swab should be sent for bacteriological examination. The disease which used to be called Croup, is an affection of the larynx, either due to diphtheria affecting that organ, or (Spasmodic Croup) to a spasm of the vocal cords dependent on other causes. The name croup should now be given up. Follicular Tonsillitis may be mistaken for Diphtheria. There is no true membrane in this disease, but as mild cases of Diphtheria can exist without much membrane formation, the bacteriological test is the satisfactory one.

CAUSES AND MODE OF PROPAGATION.-The specific poison of Diphtheria is now generally acknowledged to be a specific bacillus, called after the two men who had most to do with isolating and describing it, the Klebs-Loeffler bacillus. The severity of an attack depends largely on the resistance powers of the patient which may be diminished by unfavourable surroundings. Indeed, it can live in throats that give no sign of disease, and can thus be carried about by apparently healthy people till it gains access to a susceptible subject and causes obvious disease. It commonly occurs as an epidemic, and a solitary case may prove a focus for spreading the disease.

 

 

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