The non-surgical treatment of exophthalmic goitre / by Solomon Solis Cohen.

  • Solis-Cohen, Solomon, 1857-1948.
Date:
1912
Catalogue details

Licence: In copyright

Credit: The non-surgical treatment of exophthalmic goitre / by Solomon Solis Cohen. 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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    Symptomatic Measures. In addition to the general treatment of rest, fresh air and dieting, hot and cold applications, intestinal antisepsis, and the administration of organic extracts, there are various measures, medicinal and physiological, that may be useful in controlling or mitigating symptoms. Since these are familiar to most, they may be mentioned briefly. For the nervous erethism, especially if there is a tendency to insomnia, strontium bromide in doses of from 2 to 4 grams (30 to 60 grains) twice or thrice daily, according to circumstances, may be given. Hyoscine hydrobromide, or, better, scopolamine hydrobromide, ^ milligram grain) or less, once or twice daily, is helpful. The treatment suggested by Forchheimer, namely, neutral quinine hydrobromide, 5 grains or more thrice daily, is also of considerable service in controlling the cardiac and nervous symptoms. I have sometimes observed even better results when ergot and picrotoxin are associated with the quinine salt, than when it is given alone. When there is considerable tendency to erythema, purpura, urticaria, and similar angioneurotic phenomena, these same drugs (neutral quinine hydrobromide, ergot, and picrotoxin) are also useful, and may be given singly or in conjunction, according to the effect in the particular case. Hydrated calcium chloride, calcium lactophosphate, calcium glycero- phosphate, or calcium lactate may serve to control pruritus, and sometimes to mitigate urticaria. Digitalis and strophanthus, the latter especially, are useful in regulating cardiac action, the indica- tions being familiar. When other measures have not proved sufficient to quiet the heart—especially when the patient is first put to bed, and, later, when modified activity is first resumed—small doses of strophanthus may be used continuously. Better than any drug, however, during rest, and also in the rest periods that punctuate activity, is the application of a precordial coil through which ice-water is allowed to run. The ice-bag is a con- venient, but less effective and somewhat clumsy, substitute. In some instances the ice-bag or coil may be more effectively applied to the cervical or cervicodorsal (thoracic) spine; or the precordial and spinal applications may be coincident or alternating. Another drug useful in many cases, sometimes alone and some- times in association with digitalis or strophanthus, is cactus. This is talking heresy; but I have records, including blood pressure measurements and tracings, showing the effect of a good cactus preparation in reducing abnormal pulse frequency, correcting arrhythmia and elevating blood pressure, especially in cases of Graves’ syndrome and allied conditions. It is not often that aconite or veratrum viride becomes indicated in Graves’ disorder, when rest and hydrotherapeutic measures have been instituted. In exceptional cases the familiar indications for these drugs may be presented. I have no experience with the use of atropine in this