Glycerini Purifioati Aqucv Chloroformi ad 5iv. Misce.
Fiat. mist. Capiat 3j. ter in die ex aqua post cib.
Should improvement he very slow; the Arsenic may be pushed till griping and indigestion, or signs of irritation of the conjunctiva or nasal mucous membrane, show themselves.
The new organic Arsenic compounds—Arsamin, Atoxyl or Soamin; Cacodylates; Arrhenal or New Cacodyle, have been vaunted, but the physician will be wise who refuses to employ these compounds in full doses, since optic atrophy and other forms of peripheral neuritis may supervene without warning. All that arsenic can accomplish may be more safely obtained by gradually increasing the dose of the official liquor, but where the stomach cannot be made to retain this preparation Cacodylate of Soda may be given hypodermically in moderate doses. Several cures have been reported where Salvarsan had been injected.
Poynton and Paine discovered the illicrococcus rlieumaticus in the brain cortex of choreic subjects; since then Salicylate of has been exten sively tried, but the results have been unsatisfactory save in those where the disease has made its appearance during an attack of acute rheumatism. In mild cases it may be used as a routine, since it is very desirable to have a non-toxic agent which may be freely prescribed in the extern departments of hospitals for children whose mild symptoms do not warrant detention in the wards, and there is always in prescribing con centrated arsenical mixtures for the children of the poor the danger of a large overdose being swallowed by mistake. Aspirin has, however, given better results than the salicylates, and may he dispensed in powder form with sugar.
In acute chorea complicating rheumatic fever, arsenic should only be commenced after the febrile disturbances have been subdued by free doses of the salicylate. In all cases of very severe chorea where the movements are such as seriously to interfere with feeding and sleep, their violence must he alleviated by agents which have a quicker influence over the disease than that possessed by arsenic. The best routine under such cir
cumstances is a combination of Bromides with Chloral Hydrate, r gr. of Chloral for each year of the child's life (up to 8 years old) may be given every 4 hours with a grs. bromide till drowsiness supervenes, the child being kept at rest in a carefully padded cot and nursed by a skilled atten dant, who should administer small quantities of concentrated liquid nutri ment at short intervals during the waking hours, and who should specially guard against the possibility of bedsores. Harley's remedy consisted in such cases of the administration of large doses of Hemlock Juice till the physiological action of the drug became apparent; thus Ringer has pushed the drug in the case of a child till 7 drs. were given every hour. The hot pack is very valuable and often induces sleep. Several authorities recom mend that in intractable cases the Chloral should be pushed till deep sleep is induced, and Bastian has carried this treatment so far as to keep the patient asleep for several weeks except at half-hour intervals for feed ing. Lichtschein has given 120 grs. daily to a girl of 12 years for 3 weeks, keeping up a continuous state of somnolency.
Bacelli extols Monobromide of Camphor; he commenced with 5 grs. ter die, increasing to double the amount when necessary, and this drug he employed as a routine method in milder cases.
In these gravely acute cases chloral hydrate may be combined with other drugs, and the following combination may be given to a six-year-old child: H. Chloral Ilydratis gr. cl.
Sodii Bromidi 5iv.
Succi Conii Aqure et Syrupi ad gvj. Jlisce. Fiat mistura. Capt. 3ij. quartis horis.
Morphine should seldom be resorted to. but excellent results are some times obtained by the hypodermic use of Hyoscine Hvdrobromide in doses ofsuo gr. in grave cases. In a few cases Cannabis Indica has given rest; more frequently it is useless.
Chloroform or Ether inhalation is indicated when the movements do not cease during natural sleep or that induced by hypnotics.