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Gastric Intermittent.

This classification is peculiarly appropriate to those cases where there is great gastro-intestinal disturbance, although medical writers do not generally accord it a distinct place. There are two conditions that are met sufficiently often to merit a consideration.

Irritative Form.—The gastro-intestinal irritation is shown by the contracted and pointed tongue, reddened at tip and edges, slightly coated in center and by a bad taste in the mouth, with nausea and frequent vomiting. There is tenderness in the epigastric region; there is also great irritation of the nervous system, face flushed, eyes bright and contracted, intense headache, and sometimes delirium. The skin is hot, dry, and constricted, the urine is scanty and high colored; there is constipation, sometimes followed by diarrhea. The chill is usually short and the febrile reaction quite high; the intermission is not so perfect as in the simple form.

Atonic Form.—The second condition is where there is atony and torpor. The chill is prolonged, although reaction is not so high; the tongue is broad, pale, and flabby and more or less coated with a dirty-yellowish, pasty, mucoid coating. There is a sense of weight and oppression in the epigastrium. The appetite is impaired; there is more or less nausea, but rarely vomiting. The 'skin is yellow, doughy, and inelastic, and inclined to be cool. The bowels are constipated, the stools being clay colored; the urine is but slightly decreased in quantity, but pale, frothy, and of low specific gravity. The patient is dull and listless, with a dull headache; the extremities are inclined to be cold. Either one of these forms is easily recognized.

The treatment will consist in correcting the condition of the stomach and bowels, bringing the fever back to the simple form, when antiperiodics will be used as already indicated. To overcome the irritation, use counter-irritants over the stomach, either a sinapism or the cold pack. Internally, give the small dose of ipecac or subnitrate of bismuth in mint water.

Ipecac. 5 drops.
Water 4 ounces. M.
Sig. Teaspoonful every twenty or thirty minutes.

Or,

Subnitrate of Bismuth 1 drachm.
Water 4 ounces. M.

Or,

Aconite 5 drops.
Rhus Tox 10 drops.
Water 4 ounces. M.
Sig. Teaspoonful every hour.

Where there is great torpor and atony, this must be corrected or our antiperiodics will not be absorbed.

Sodium Sulphite.—For the moist, pasty, dirty tongue give sulphite of soda, in twenty-grain doses, every three hours. If the tongue is broad and flabby, but clean,—

Nux Vomica 5 drops.
Water 4 ounces. M.
Sig. Teaspoonful every hour.

Podophyllin and Leptandrin.—For the torpor of the liver,—

Podophyllin. and Leptandrin 1 drachm each.
Water 4 ounces. M.
Sig. A teaspoonful every two hours.

If the tissues are full and there is puffiness under the eyes, with thick tongue and doughy skin,—

Potassium Acetate 1/2 ounce.
Water 4 ounces. M.
Sig. A teaspoonful every three or four hours, the patient drinking freely of water with each dose.

Belladonna.—Where the tongue is clean, but thick, with dull pains in the head, pupils dilated, pulse small,—

Belladonna 10 drops.
Water 4 ounces. M.
Sig. A teaspoonful every four hours. Then use quinia.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.



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