If there is any tendency to constipa tion, or any failure of daily action of the bowel, calomel, alkaline laxatives, glyc erin suppositories, or enemata should be employed according to circumstances. It is usually well to begin treatment with the administration of calomel in divided doses.
General medication is useful. At the outset in the aged and in feeble children strychnine should be given in doses of about/ 140 grain to '/210 grain, repeated at intervals of from one to six hours, ac cording to age and effect. It is not well to make a profound impression with the drug, or the patient's recuperative force will be exhausted. A gentle and con tinuous support to the vital powers is the object aimed at. For emergencies strych nine may be given hypodermically in doses to suit the occasion. Should car diac debility become alarming, strych nine should be supplemented by cam phor, which in children usually acts effi ciently when given as spirit of camphor by the mouth, in appropriate dosage: from 1 to 10 drops; to an infant, drop in hot water. To an adult, camphor should be given hypodermically, dis solved in sterilized olive-oil, 1 to 10; one, two, or three syringefuls of 20 to 30 min ims each may be given, as needed. Hyp odermic injections of ether are sometimes useful. To children alternate hot and cold douches may be applied. The am monium preparations are useful in nearly all cases. The aromatic spirit of am monia, ammonium carbonate, ammonium chloride, or ammonium salicylate may be chosen. A good formula for an adult consists of:— 4 Ammonium chloride, 10 grains.
Ammonium carbonate, 5 grains.
Fluid extract of coca, 1 flui drachm.
Spirit of nitrous ether, 20 minims. "Essence of pepsin," 1 fluidrachm. Water, or Solution of ammonium acetate, suf ficient to make fluidounce.
Dose: Tablespoonful CA fluidounce) every two, three, or four hours.
The coca in this formula, while it is useful as a heart-tonic and diuretic, is used primarily merely to disguise the ammonium taste, and the pepsin prep aration helps the stomach to bear the medicine. If pleurisy exists, ammonium salicylate may be added to this mixture. Another useful method of giving ammo nium carbonate is to dissolve 5 or 10 grains in a dessertspoonful of liquor am monii acetatis, and put this dose with 15 drops of glycerin and a drachm or two of sherry-wine in a wineglassful of cracked ice. The whole can be swallowed
at a gulp, and will often be retained with out disturbance of the stomach, when the drug cannot otherwise be given.
Opium need not be given except there be urgent indication to relieve pain or quiet excessive unproductive cough. It should then be used with circumspection. Codeine is usually the best preparation, but, if preferred, the deodorized tincture of opium or the camphorated tincture of opium may be added to the aromatic spirit of ammonia or other ammonium preparation employed. With children, paregoric is usually the best form in which to give opium.
In cases of continued weakness of the heart, not sufficiently urgent to call for the hypodermic use of camphor, tincture of digitalis or Merck's German digitalin may be used in such doses as will produce the effect desired. In tuberculous cases, especially those with high fever, digitalis may be employed in fairly large doses, as urged by Beddoes, and this use of it some times seems to be followed by the hap piest results. From 20 to 30 drops of a good tincture may be given to an adult from three to six times a day, until the pulse is reduced to 60 beats per minute; after which sufficient is given, the stom ach permitting, to keep the pulse-rate in the neighborhood of 70.
Out of 150 cases of broncho-pneumonia treated by rectal injections of creasote, 125 recovered and only 25 died. If the enemata should not be retained, a few drops of laudanum may be added. The simplest and most practical means of ad ministering the creasote is in milk; the amount of creasote for a child under a year is from 2 to 5 drops night and morning; for an adult, from 30 to 40 and even 50 drops in each enema. The quantity of milk should not exceed an ordinary glassful. The enema should be given warm; if it is evacuated immedi ately or within a short time, it is neces sary to give a second one. If no move ment has been produced for a day, the intestine should be emptied with an enema of warm water and glycerin. Schou11 (Jour. des Prat., June 12, '97).