1912 Journal of the American Medical Association  
sohlt ion, the strength in which it is usually dispensed. This should be given deep into a muscle whose wide network of vessels, Meltzer has shown, aborbs almost, as rapidly as a vein. Next, the abdomen should be massaged and pressure brought to bear on il, for the mechanical cll'cct is to squeeze the blood from the vessels along into the veins and toward the heart. Another effectual nay of stimulating tho splanchnic vessels is to give an enleroelvsis of hot, saline solution and hot black
more » ... . II should be hot. not lukewarm, should be at 110 to 115 F. The heal causes emit ruction of the splanchnic vessels and raises the column of blood in the vessels of Ihe genera] circulation and forwards their contents into the veins, while the coffee acts on the heart and vasomotor tenter if it is capable of responding. Another drug directed toward the vasomotor center is camphor 5 grains in 10 per cenl. solution in olive oil. or call'cin .'i to 5 grains hypodermically as a soluble doublt! salt, of call'cin and sodium salicylate or benzoato. Strychnin may be tried in doses of 1/20 grain hypodermically. bor tbe heart, more important (ban caffein or camphor is the intravenous use of slrophanthin. Digitalis in other preparations acting more slowly may be added lo sustain the circulation. Ifypodormoclysis or a saline infusion may be of value in these emergencies. One of the most, difficuH items in the treatment of endocarditis and myocarditis is the management of ( onvalesccnce. No patient should be allowed to get up until every symptom of.cardiac insufficiency has disappeared and he h freo from fever. Moreover, lie should nol be allowed up until some Bttidy has been made of his cardiac reserve. I cannot improve on Forchheimer's precautions, which J quote literally: I usually begin with a massage and resistance movements, applied in the mildest possible way al, drat and then gradually increased; the condition of the pulse as to regularity, rate and tension heing noted before and after manipulation. When the proper reaction takes place the passive exercises are increased in force and duration. . . . During the first week the patient has been allowed to sil, up in bed, lirst for a short time, then longer und longer, until only the normal change in pulse-rate is noted. After a week of treatment, sometimes sooner, sometimes later, the patient is allowed to leave his bed and sit up in a chair by the. side of the bed. The normal reliction of the pulse muy be determined here by ils frequency; if ¡in Increase of about 20 beats per inimité is produced, it must be looked on as an abnormal reaction. After he luis sat up in a chair, the time of sitting up being gradually Increased) he is allowed to walk; lirsl short disfnnees. then longer and longer, being finally permitted to lenve the room. Then he niny be permitted lo walk down stuirs, to go out for a drive and finally to walk up stairs. These rules are excellent and it is step by stop that the patient lias to be followed and observed. As the heart, regains strength, it needs exercise, but always iinder observation until il demonstrates its Improvement under the new test. Change of air and surroundings :nay help to hasten convalescence. fresh air, an abundance of good food and good cheer leave little for medicines. Tonics are usually superfluous under such circumstances and the red cells lake care of themselves, but if Ihe ideal cannot be attained, iron in the shape of Blaud's pills, 5 grains three times a day, with or without a little arsenic in the shape of arsenoiis acid 1/10 grain three times a day. which eau be combined with the iron, or as Fowler's solution li tn G minims three times a day.
doi:10.1001/jama.1912.04260020006002 fatcat:jwczuinvufffddpsyi2etulfam