The diagnostics and treatment of tropical diseasesStitt, E. R. (Edward Rhodes)
Science
The diagnostics and treatment of tropical diseases
Stitt, E. R. (Edward Rhodes)
Tropical medicine
At any rate when a case is seen early it would seem advisable
to give about 2 grains of calomel in divided doses of ¼ grain
every half hour and then follow it up with saline treatment. Most
authorities recommend a preliminary dose of castor oil. During
the first day or two enemata of normal saline, boric acid or 1½%
sodium bicarbonate solution in 2 pint amounts would seem indicated
as assisting the salines in the elimination of toxic material.
After that time the tenesmus and rectal irritation make the use of
the rectal tube too trying to the patient. I have used the Murphy
protoclysis method with a certain degree of success, but this
procedure cannot be kept up long. Hot fomentations to the belly
relieve the griping pains.
The saline treatment is highly recommended by Buchanan who gives
60 grains of sodium sulphate every two or three hours until the
dysenteric character of the stool disappears.
Bahr in the Fiji islands treated 53 consecutive cases, of which
41% had marked constitutional symptoms, with a mortality of 13.2%.
He gave 1 dram of sodium sulphate every hour for the first day and
subsequently the same dose every four hours.
In a second series of 106 cases, of which 42% had marked
constitutional symptoms, he treated 34 with salines plus the
administration of capsules of cyllin. The remaining 72 cases
received in addition to this treatment injections of a polyvalent
serum obtained from the Lister Institute. The mortality in this
series was 1.8%. He notes that 5 of the cases in this second series
were of the severest type as evidenced by the gangrenous stools
and toxic condition and yet not one of these five serum-treated
cases died. He notes that the stools of those who received serum
injections became normal in five days for an average while for
those treated with saline alone the average period was eight days.
Bahr strongly recommends the combined treatment of salines and
serum. In very severe cases Bahr used 50 to 70 cc. of the serum but
ordinarily 20 cc. for adults and 10 cc. or less for children.
Willmore and Savage think one obtains the best results by injecting
from 80 to 120 cc. of a polyvalent serum into the subcutaneous
tissues of the flank or abdomen or intravenously. They think that
anaphylaxis is less liable to follow a massive initial dose of serum.
In the use of serum Shiga recommends a dose of 10 cc. for a mild
case or two injections of 10 cc. at intervals of ten hours for
cases of medium severity, while in very toxic cases he uses 60 cc.
in 3 daily doses of 20 cc. each. It is important to use serum early
as it has little or no effect if used after the 7th day (Klein).
The best known sera are those of Shiga, Dopter and that prepared by
the Lister Institute.
Public-domain text, read in full here on John Shaqi.
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