The albuminuria as a rule demands no special treatment.
If heart-weakness is threatening, stimulants are to be used imme diately: caffeine sodium benzoate, 0.01 to 0.1 Gm. (to 2 gr.) two or three times a day: camphor benzoate, 0.015 to 0.0.5 Gin. (i to 1 gr.) every hour or two; digalen three times a day, four to eight drops, finally camphor and ether injections. If necessary, oxygen inhalations must be used_ Nursing and time must accomplish the rest, and the physician should see the patient two or three times a day. Later as a tonic, a cinchona preparation.
The danger of sudden heart failure, even in mild cases, lasts aS long as the patients are or the pulse is arrhythmic, and rest in or on the bed should therefore be observed until these symptoms are over come. Following malignant diphtheria, all the patients should stay in bed for two or three weeks after the pharynx has cleared. Later, they should be out a great deal in the fresh air to overcome the anaemia, which persists in a slight degree for a long time. Iron and arsenic or iron waters may he administered.
Isolated paralyses recover by themselves in a few weeks. For obstinate multiple pareses, massage, passive and active gymnastics, and faradization are to be used; the French authors (Comby) praise the favorable action of large repeated doses of antitoxin. For laryngeal. paralysis strychnine is to be given by mouth 0.001 Gm. to 0.003 Gm. to gr.] once or twice daily, or hypodermically, 0.001 Gm. two or three times a week (Henoch, Heubner). Garage may be necessary. If paralysis of the diaphragm comes on, the phrenic nerve may be stimulated by the constant current, with the cathode between the trachea and the sternomastoid, the anode on the nape (Heubner, Escherich), with artificial respiration and inhalations of oxygen.
Great value is to be attached to careful cleansing of the mouth and teeth, the latter being cleaned with a mild disinfectant three times a day after each meal, the mouth being rinsed freely. For the hourly gargling,. 0.1 per cent. to 0.3 per cent. hydrogen dioxide, a weak phenol solution (one dessertspoonful of a 5 per cent. solution to a quarter-litre of water),. or diluted odol (containing salol), or lemon-water. if the children are small or somnolent, the mouth should lie frequently washed for them,.
or lemon-water given for drinking. If the children are intelligent and willing, the throats may be sprayed once or twice a day with one of these. solutions. The earlier pernicious practices of swabbing, forcible detach ment of the membrane and painting of the pharynx with strong disin fecting solutions are to be condemned. They are superfluous when the antitoxin is used and are dangerous in malignant eases.
A Priessnitz bandage may be applied to the neck and once or twice. a day a bandage wrung out of warm oil to protect, the skin.
Cleansing the nasal cavities is necessary and important in all cases of diphtheria. This may be done with the solutions already mentioned,.
having them lukewarm, and pouring them in from a teaspoon or nasal douche. The head must be so held that the fluid will flow horizontally backwards and not upwards into the accessory sinuses.
Injections or irrigations with force are to be avoided, as infectious matter may be carried into the Eustachian tube.
Treatment of Nasal Diphtheria.—In nasal diphtheria irrigations are to he alternated with insufflations of menthol, 0.5 Gm. tS gr.), sodium sozoiodate 1.0 to 2.0 Gin. (15-30 gr.), powdered sugar 20.0 Gm. (5 dr.). The eroded areas on the nose and upper lip are to be pro tected with an ointment. If the obstruction of the nostrils is so great that drinking is impossible one or two drops of a 1 per cent. cocaine solution may be instilled into the nostrils. For subsequent use a weaker solution is to be recommended,—cocaine hydrochlorate, 0.5 Gm. tS gr.), boric acid 4.0 Gm. (1 dr.). water 200.0 c.c. (4 oz., 2 dr.) in order to reduce the swelling of the mucous membrane quickly.
Treatment of Diphtheritic Otitis.—On account of the constant danger of the spread of a nasopharyngeal diphtheria to the tube and middle ear, the ears must be examined daily and if redness of the drum membrane is found, a warm solution of thymol, 0.1: 50.0, or phenol glycerin, 1: 10, should be dropped in the canal. The latter acts more surely but renders difficult the judgment on the inflammation because a little clouding occurs. Paracentesis has the usual indications. If there follows a purulent discharge, a 1 per cent. to 2 per cent. solu tion of hydrogen dioxide should be dropped in hourly.