Henry Baird Favill, AB, MD, LL.D., 1860-1916, a ... - University Library

MEDICINE AND PUBLIC HEALTH 141
to only a very limited degree curative, though abundantly
palliative. The average duration has not been materially
affected by any so-called plan.
This does not warrant inactivity in the premises.
Skillful
use of the means at hand is imperative. It is incumbent
upon one to know their various relations, and then to
adopt as a guiding principle Trousseau's rule: "No case
should be treated by predetermined routine."
Right in the face of this sage advice, and while accepting
it fully, I venture to outline a routine, which I would apply
to a typic case. Inasmuch as one may never see a typic
case, the stultification may not be so great.
1. Empty the bowels thoroughly, preferably with a
sharp mercurial.
2. Administer salicylate of soda to its full analgesic
effect; if it is not well borne by the stomach, its equivalent,
oil of wintergreen. If it is contra-indicated by cerebral conditions,
use antipyrin, or the coal-tar preparation best
adapted. If these are contra-indicated, by condition of the
heart or nervous system, use opium. At all events control
pain.
3. As the pain is controlled by such means, aided by
local measures, particularly heat and immobilization, gradually
draw away the salicylate element and saturate the system
with alkali, continued until the active process seems
controlled.
4. Finally, while giving alkali, or after it, administer
iron, providing the conditions of bowels and liver permit.
5. At all times, and incessantly, strive to promote
intestinal hygiene, by mercurial, cholagogue, or saline, with
the conviction that upon the processes here represented the
disease, its duration, and complications largely depend.
Impatience with the tediousness of the course, leading
to ill-considered and premature activity, must be avoided.
The most discouraging behavior will swing around into
satisfactory convalescence, often in the briefest period.