The treatment of exophthalmic goitre : based on forty-five consecutive cases / by A.D. Rockwell.

  • Rockwell, A. D. (Alphonso David), 1840-1925.
Date:
1893
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Licence: Public Domain Mark

Credit: The treatment of exophthalmic goitre : based on forty-five consecutive cases / by A.D. Rockwell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    patient was first treated through a period of seven months to March 19th receiving some thirty-seven applications of electricity, improving gradually in every symptom. In July treatment was again .resumed and continued until she had received some tweiWy-five additional appli- cations. To this date the patient, who is under constant observation, retains all the benefit that she at first re- ceived. The pulse is 70 to 80, the eyes normal, and the thyroid enlargement gone. More perhaps than all else, she has been so relieved of the distressing headaches and nausea that it is only at long intervals that they occur, and with no great severity. Case XIV.—Mrs. J., aged thirty-four, was referred to me by Dr. George W. Harrison, of New York. She was in an extremely nervous condition, with a very decided enlargement of the thyroid, a pulse of 130, but no exoph- thalmus. She first observed some disturbance of the heart-action three years before, and a few months there- after she detected evidences of a swelling in the throat. This patient was treated every day for two weeks, when she was obliged to leave town, but in that brief period, contrary to my expectation, all the symptoms were very decidedly alleviated. After a thorough and prolonged seance of galvanization of the sympathetic, central gal- vanization and general faradization, the pulse invariably subsided some fifteen or twenty beats, only to rise some- what during the next few hours. It was every day no- ticeable, however, that the pulse beat with less violence and frequency, and when she left town it rarely rose above one hundred. The method of treatment adopted by me was carried out by her family physician, Dr. J. W. McLaughton, of Austin, Tex., and according to a communication from the patient, the pulse finally reduced to 80 and 85. THE USE OF ACONITE IN THE TREATMENT OF TETANUS. By L. L. von WEDEKIND, M.D., UNITED STATES NAVY. Having recently successfully treated a serious case of tetanus, using in conjunction with other drugs large doses of the tincture of aconite, and believing, from close obser- vation of the case and the behavior of the drug, that the patient’s recovery was due in large part to its beneficial action, I give for these reasons a summary of my notes of this case. The exciting cause of the trouble I believe to have been the tropical influence of eight degrees north, as- sisted by an ulcerated tooth; without this tropical influ- ence I imagine nothing peculiar would have occurred. We lay in the harbor of Corinto, Nicaragua, for nine days, sailing thence south. On June nth, at sea, one day out from Corinto, the patient, a hale and hearty man of about thirty years, reported at morning sick call, com- plaining of inability to move the jaws. He had for three days been suffering with a toothache, though an exami- nation of the affected part shows no swelling. The jaws firmly locked and the muscles of the face, neck, and back rigid. Much pain in the back and neck. Face anxious and eyes wide open and staring. Pulse, no; tempera- ture, 102.40 F. Owing to the locked jaws and tightly drawn lips, speech is very indistinct. Patient put to bed, and at 9, 11 a.m., i, 3. 5, and 7 p.m., or every two hours during the day, the following mixture was given : Tr. opii, H xv.; chloral hydrate, gr. xx.; potass, bromid., gr 1. This was mixed with water and administered through the spout of a feed-cup, while patient was in a reclining position. Whiskey and beef tea given whenever patient was thirsty. At 4 p.m of the first day, no effect of the medicine was noticed, not a wink of sleep, and pain still well marked. The temperature at 3 p.m. had reached 103.8° F., when iq v. of tinct. aconite was given and repeated at 4 and 5 p.m. At about 5 p.m. the patient dropped off asleep and slept until 7 p.m. After the administration of the aconite, a change was noticed : pain less, and a gentle moisture in general over the whole body, also a marked feeling of relief. The opium and chloral were now at work, and the rest and sleep gained from their action retarded the rapidly reducing strength. At 7 p.m. the temperature was 102.6° F., and the pa- tient was given a bath of equal parts of cold water and alcohol. Every four hours during the night the opium mixture was given, and the aconite every three hours. The action of this drug was noticed early, and though the dryness of the throat was exceedingly distressing, the general relief was so marked that the dose was only re- duced when the effect upon the general system was undoubted. At 9 a.m. of the second day the temperature had reached 104.20 F., with a pulse or 120. '1 he a< onite ad- ministered in about eighteen hours amounted to about thrte-quariers of a drachm, still its controlling influence upon the temperature seems to have been slight How- ever, without it, the temperature might have gone much higher. The opium mixture was given as on the first day. The pain in the neck and back, though less, is still very severe and sleep is almost impossible. Bath of cold water and alcohol frequently given; thirst very great and the mouth and throat dry. At 3 p.m. the tempera- ture, despite both external and internal treatment, reached 104.8° F. Tr. aconite iq v. every hour for three doses now given, this in addition to that regularly given dur- ing the day and night. At 7 p.m. of the second day the effect of the drug was such as to almost prostrate absolutely the patient, still, relief after the administration of the hourly doses was, as he expressed it, heaven to him.” Sensation almost gone, tingling marked, and the temperature 1° less. The asthenia, owing to the drug more than to the disease, though very marked, is not alarming. Opium mixture every three hours from 6 p.m. At midnight the pain of the muscles of the neck and back was such as to render sleep impossible. No aconite had been given since 6 p.m., and the effect of that previously administered had worn off. Patient was now given of chloral, 25 grains; bromide, 50 grains, tr. opii, iq, xxx., and 5 drops of aconite. At 3 and 7 a.m. the opium mixture of the first day was re- peated. Third day.—Passed a restless night; treatment same as on first day. At 4 p.m., temperature 103.6° F., and pulse, 130. No change in the rigidity of jaws, pain slightly less, though the agony in back and neck exceed- ingly marked and very prostrating. The opium mixture given every four hours, aconite iq v. every three hours, and its action very closely watched. Stimulation as necessary. Fourth and fifth day as above in general progress and treatment. On the evening of the fifth day, the jaw very minutely relaxed; the flat handle of a silver fork can enter between the teeth. Temperature, 10T F. ; patient sleeping better. On the sixth day the opium mixture every five hours, and aconite every four. On the seventh day, temperature, ioo° F. ; jaws some- what relaxed and movable through about half an inch. The ihuscles of the back and neck exquisitely tender. On the tenth day the jaws wholly relaxed and all medi- cation ceased. From the facts obtainable in reviewing the above case, the conclusions I reach are: That the temperature was controlled to some extent—very probably to a great one —by the aconite ; this balancing, the saving of strength thus obtained, as opposed to the loss occasioned by the drug. If of reflex action in incipiency, and continuous throughout the whole course, this disease should in great measure be controlled by aconite, judging by its known physiological action. I am almost positive of its ability, in this disease, to assist the action and consequent relief and benefit obtained by the exhibition of opium, chloral