Stimulants seem to have little effect on the disease, but may he given in doses of half a glass of champagne or a tablespoonful of brandy or whiskey every 4 hours if the patient's appetite seems to be improved or if the administration of the dose is followed by refreshing sleep.
If pain is a marked symptom a hypodermic of Morphine (1 gr.) may be given, but should be discontinued as soon as possible. A prolonged hot vaginal douche (Ito° to I r4° F.) of saline solution should be given night and morning to induce temporary congestion of the pelvic organs and pro mote the flow of lochia. For the same purpose Citric Acid (3o grs. in solution every 4 hours) may be given, or the patient may be encouraged to take lemon juice or drink home-made lemonade. She may drink as much plain water or other bland fluids as she likes, as the fluid assists in washing the toxins out of the circulation. If the bowels are confined, an aperient should be given. Often diarrhcea sets in, and should not be hastily checked, as it is probably due to irritation of the intestines by poisonous substances excreted into them. If it is causing much irritation or exhaustion, an attempt may be made to check it by a large enema of normal saline solution, or, that failing, by a starch and opium enema. Distension is common. It may be relieved by hot stupes to the abdomen and by soap-and-water enemata with a drachm of Turpentine in each. Insomnia may be met by the administration of Sulphonal (2o to 3o grs.) or Paraldehyde (5j. in Aquae Chlorof. The patient should be sponged if the temperature rises above F. The onset of rigors should be met by external warmth and the administration of hot brandy or whiskey.
The general medicinal measures recommended are Quinine, either alone or combined with Ergot. The Quinine seems to have a certain amount of influence on the fever, and the Ergot tends to produce involution of the uterus, hut care should be taken that the drugs do not do harm by interfering with the patient's appetite. If they do, it is wiser to stop the administration. When the pulse is over t2o, the following mixture may he given : Tr. Digitalis 5ij.
Tr. Nucis 'Fem. 5iiss. Nit. 5iv. Chlorof.
Aqua? ad ;:;viij.
Fiat mist ura. ass. paths koris ex aqua.
If the temperature is above to2° F., Aspirin may be given in 5-gr. doses every 4 hours, but it should be remembered that the profuse perspiration induced by Spt. /Ether. Nit. and Aspirin may cause some collapse, and the practitioner should be on his guard to stop the drug on the first warning.
Again, measures may be taken to supplement or to stimulate the natural mechanism by which the body protects itself against infection. One of these measures is the injection of antistreptococcie serum, which presumably contains anti-bodies capable of neutralising a certain quantity of the toxins produced by the streptococcus, the organism causing the vast majority of severe and fatal cases of septicemia. Whether these bodies are present in an amount too small to have any effect or whether the appropriate bodies are not present at all, the fact remains that the adminis tration of antistreptococcic serum is disappointing. If does not cure, as diphtheria antitoxin, for instance, cures diphtheria, and there is even a difference of opinion as to whether it has any effect at all on the infection. I think that I have seen good done by injecting 20 c.c. of the serum under the skin of the abdominal wall, and repeating the injection at an interval of at least 24 hours. The effect seems most marked, as one would expect, in mild cases and near the beginning of the illness. In bad cases it is practically useless. Attempts have been made to improve the condition by the use of vaccines, but the administration of these must be left to a specialist, as the possibilities of doing irreparable damage by injecting during a negative phase of infection render the most skilled supervision absolutely necessary. It is unlikely that the treatment will ever be of value in fulminant cases. It appears more likely to be of service when the infection is subacute, subject to exacerbations with intervals of com parative freedom from symptoms, or establishes itself as a lingering inflammatory condition.