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I>r4»mher. 1952 southern hfedicine & surgery 531 most patients can be discharged to their homes where acti\ity is gradually increased. The decompensated patient takes a "low-sodium" diet of less than 1 gram a day, increased after the first weelc or two. Weigh to determine if taking too much salt. In severe and stubborn edema cases rice diet for the period of convalescence. Make certain that an acute sodium de-nciency does not develop, as this may be far more dan-egrous than a mild degree of congestive failure. All the water he desires, daily fluid intake three liters or better; due to their sodium content not more than J/ glass of fruit juice per day. In most instances a maintenance dose of digitalis right through convalescence. Ammonium chloride is an effective diuretic and probably should be used a great deal more than it is—I Gm. enteric-coated 4 i. d. frequently will keep the patient at ''dry weight." In many instances give it one week out of each month, in others steadily over long time. Xanthine diuretics promote active diuresis in most instances without injury to the kidney—10 grains of theocin t.i.d. In stubborn cases mercurials orally, parenterally, or in combination. Give some poly-vitamin preparation, most important H complex. Surround the patient with an air of cheerfulness at all times. Occupation modifications. Keep the patient contented and busy within the limits of his capacity. II Convalescence from Coronary Occlusion one might consider starts when patient is out of bed. Softening is greatest fifth day after the arterial closure, from then on the repair process goes on rapidly and after the first week the acute phase is over. Levine in a series of 81 patients who had suffered acute myocardial infarction, had the majority sitting in a chair within the first two days. They were lifted or helped into a wheelchair and pains were taken to avoid any pressure in the popliteal spaces. He urged the patient to remain out of bed as much of the day as possible without causing discomfort. This amounted to one or two hours the first day, and at the end of one week the patient was in the chair the greater portion of the day. Neither high temperature, severe pain, friction rub, diastolic gallop rhythm, heart block, arrhythmias in general, nor need for oxypn was considered a contraindication to sitting in a chair. The patient fed himself and was permitted a bedside commode or toilet privileges. The patients were permitted to walk a few steps at the end of the third week and usually were out of the hospital in four weeks. Anticoagulant therapy was used in all but nine cases. The end results in this series compared favorably with treatment by the more conventional methods. Untii the role of cholesterol metabolism is determined It would be well to avoid egg yolk, butter, cream, and cheese. Restrict the caloric intake in the obe.se, no need to restrict salt. If dicumarol has been started during the acute stage it should be continued until ambulatorv; in certain cases for months or years. Some one of the vasodilators is indicated routinely and should be continued for an indefinite period. Tobacco is a powerful vasoconstrictor and is contra-indicated unless interdiction might do more harm than good. One ordinary cocktail or drink of whiskey twice daily may be taken particularly in those persons who have been >n the habit of using alcohol. Walking is the best exercise, enough to suit the individual, nothing strenuous. By using restraint and common sense most men may resume marital relations in the third month. In some instances a gradual return to the former job, possdily with certain modifications is feasible; in others alterations in the working conditions, in some a complete change in the type of work may have to be effected. Rarely should a patient give up work altogether. Encourage; cite cases of such patients who have lived many years and led active and useful lives. A n'r.-w man.\r.emrnt of Hypertenston Ir n wii,i. only hold out.^ Patient admitted to the hospital after several months of saft-frce diet at home, b. p. up to 236/150. He was shortly started on hexamcthonium chloride, "C,;,'' and hydrazino-phalazine (apresoline) orally. Dosage of each increased slowly, at the end of 10 days, C,3 .^75 mgm. and apresolinc 75 mgm, at 5:00 a. m. to 9:00 p. m.. were maintaining normal readings most of the time .\presolinc was then maintained at 75 mgm. 5 times a day, and C,. was varied according to the systolic reading, at the time of the dose as: 150, 500 mgm. C^.; 130-150 mgm.; UO-130 250 mgm.; 100-110 125 mgm. If below 100 omit dose of C,;. The h. p. readings and dosages were by nurses for two days, while the patient was taught to take his own b. p. As soon as he was taking reliable readings his medicine was placed at the bedside and record keeping started by patient, he began to regulate his own dosage. After several days of checking his b. p. readings and shifting his dosage for optimum I>. p. he was discharced. b. p. level at 110-l,?5/S2-94. This patient had been on a home salt-free diet for some months, and upon admission was placed on a hospital salt-free diet. On the sixth day of therapy he had the usual malai.<;c and lethan/y of a return to normotension. At this Lime weather t. of 100° to 106"" F. was the rule. The malaise, etc.. continued, he began typical salt-depletion syndrome, which responded dramatically to NaCl given orally. Two weeks after discharge b. p. and dosage record showed maintaining b. p. 120/80 to 135/92; dosage of drugs apresolinc 375 mgm., and an average of 1875 mgm. C,; per 24 hrs. I. j. E. Duke. M.7').. nirniitiffliam. in .If. Mn/. .-issn. Jla. Lnr,\h Injections of penirilun in Local Infections a. Batimfianlncr, :M.n.. Clcvclniul. in Ohio Med. Jl., Sept.) Penicillin by IV injection in abscesses, carbuncles, and cellulitis may not penetrate the peripheral barrier to reach the scat of the infection. Among the conditions treated by local injections have been carbuncles, human bites, and localized scalp infections. Terhnique: Inject 10 to 20 c.c. of sterile 1% novocaine sfil. irto ;i vial containing 100,000 or 200.000 units of penicillin. af.'ilate the vial until all the penicillin is in solution, use :it once (prepare fresh for each treatment). Treatments given daily at fir.st and then e.o.d. until the infection is controlled. Streptomycin may be used in like manner in combination with penicillin, or separately if indicated. The sol. is drawn into a 10 c.c. glass syringe to which is attached a IJ/ or 2 in., 21 gauge needle; injected around, under, and into the infected area using 10 to 20 c.c. of sol. noo.noo to 200.000 units of penicillin) at carh treatment. The results obtained were impressive and prompt. Hcal-inir and re.solution occurred with a minimum of disturbance. These treatments rnn be given at home or at the office. The points to be emphasized are that in this treatment the antibiotic is placed in the infected area in sufficient concentration to be effective; and it is painle!5s.
Object Description
Rating | |
Fixed Title * | NCHH-22: Southern Medicine and Surgery [1921-1953] |
Document Title | Southern Medicine and Surgery [1921-1953] |
Subject Topical Other | Medicine -- North Carolina -- Periodicals. |
Publisher | Charlotte, N.C. : Charlotte Medical Press, 1921-1953. |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1952 |
Identifier | NCHH-22-114 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 114 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-22/nchh-22-114.pdf |
Document Sort | all; group-e; nchh-22 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-22-114 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-22 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb2542543 |
Revision History | keep |
Description
Fixed Title * | Page 307 |
Document Title | Southern Medicine and Surgery [1921-1953] |
Subject Topical Other | Medicine -- North Carolina -- Periodicals. |
Publisher | Charlotte, N.C. : Charlotte Medical Press, 1921-1953. |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1952 |
Identifier | NCHH-22-114-0535 |
Form General | Periodicals |
Page Type | all; report/review |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | southernmed1141952char_0535.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 114 |
Issue Number | 12 |
Page Number | 307 |
Health Discipline | Medicine |
Full Text | I>r4»mher. 1952 southern hfedicine & surgery 531 most patients can be discharged to their homes where acti\ity is gradually increased. The decompensated patient takes a "low-sodium" diet of less than 1 gram a day, increased after the first weelc or two. Weigh to determine if taking too much salt. In severe and stubborn edema cases rice diet for the period of convalescence. Make certain that an acute sodium de-nciency does not develop, as this may be far more dan-egrous than a mild degree of congestive failure. All the water he desires, daily fluid intake three liters or better; due to their sodium content not more than J/ glass of fruit juice per day. In most instances a maintenance dose of digitalis right through convalescence. Ammonium chloride is an effective diuretic and probably should be used a great deal more than it is—I Gm. enteric-coated 4 i. d. frequently will keep the patient at ''dry weight." In many instances give it one week out of each month, in others steadily over long time. Xanthine diuretics promote active diuresis in most instances without injury to the kidney—10 grains of theocin t.i.d. In stubborn cases mercurials orally, parenterally, or in combination. Give some poly-vitamin preparation, most important H complex. Surround the patient with an air of cheerfulness at all times. Occupation modifications. Keep the patient contented and busy within the limits of his capacity. II Convalescence from Coronary Occlusion one might consider starts when patient is out of bed. Softening is greatest fifth day after the arterial closure, from then on the repair process goes on rapidly and after the first week the acute phase is over. Levine in a series of 81 patients who had suffered acute myocardial infarction, had the majority sitting in a chair within the first two days. They were lifted or helped into a wheelchair and pains were taken to avoid any pressure in the popliteal spaces. He urged the patient to remain out of bed as much of the day as possible without causing discomfort. This amounted to one or two hours the first day, and at the end of one week the patient was in the chair the greater portion of the day. Neither high temperature, severe pain, friction rub, diastolic gallop rhythm, heart block, arrhythmias in general, nor need for oxypn was considered a contraindication to sitting in a chair. The patient fed himself and was permitted a bedside commode or toilet privileges. The patients were permitted to walk a few steps at the end of the third week and usually were out of the hospital in four weeks. Anticoagulant therapy was used in all but nine cases. The end results in this series compared favorably with treatment by the more conventional methods. Untii the role of cholesterol metabolism is determined It would be well to avoid egg yolk, butter, cream, and cheese. Restrict the caloric intake in the obe.se, no need to restrict salt. If dicumarol has been started during the acute stage it should be continued until ambulatorv; in certain cases for months or years. Some one of the vasodilators is indicated routinely and should be continued for an indefinite period. Tobacco is a powerful vasoconstrictor and is contra-indicated unless interdiction might do more harm than good. One ordinary cocktail or drink of whiskey twice daily may be taken particularly in those persons who have been >n the habit of using alcohol. Walking is the best exercise, enough to suit the individual, nothing strenuous. By using restraint and common sense most men may resume marital relations in the third month. In some instances a gradual return to the former job, possdily with certain modifications is feasible; in others alterations in the working conditions, in some a complete change in the type of work may have to be effected. Rarely should a patient give up work altogether. Encourage; cite cases of such patients who have lived many years and led active and useful lives. A n'r.-w man.\r.emrnt of Hypertenston Ir n wii,i. only hold out.^ Patient admitted to the hospital after several months of saft-frce diet at home, b. p. up to 236/150. He was shortly started on hexamcthonium chloride, "C,;,'' and hydrazino-phalazine (apresoline) orally. Dosage of each increased slowly, at the end of 10 days, C,3 .^75 mgm. and apresolinc 75 mgm, at 5:00 a. m. to 9:00 p. m.. were maintaining normal readings most of the time .\presolinc was then maintained at 75 mgm. 5 times a day, and C,. was varied according to the systolic reading, at the time of the dose as: 150, 500 mgm. C^.; 130-150 mgm.; UO-130 250 mgm.; 100-110 125 mgm. If below 100 omit dose of C,;. The h. p. readings and dosages were by nurses for two days, while the patient was taught to take his own b. p. As soon as he was taking reliable readings his medicine was placed at the bedside and record keeping started by patient, he began to regulate his own dosage. After several days of checking his b. p. readings and shifting his dosage for optimum I>. p. he was discharced. b. p. level at 110-l,?5/S2-94. This patient had been on a home salt-free diet for some months, and upon admission was placed on a hospital salt-free diet. On the sixth day of therapy he had the usual malai.<;c and lethan/y of a return to normotension. At this Lime weather t. of 100° to 106"" F. was the rule. The malaise, etc.. continued, he began typical salt-depletion syndrome, which responded dramatically to NaCl given orally. Two weeks after discharge b. p. and dosage record showed maintaining b. p. 120/80 to 135/92; dosage of drugs apresolinc 375 mgm., and an average of 1875 mgm. C,; per 24 hrs. I. j. E. Duke. M.7').. nirniitiffliam. in .If. Mn/. .-issn. Jla. Lnr,\h Injections of penirilun in Local Infections a. Batimfianlncr, :M.n.. Clcvclniul. in Ohio Med. Jl., Sept.) Penicillin by IV injection in abscesses, carbuncles, and cellulitis may not penetrate the peripheral barrier to reach the scat of the infection. Among the conditions treated by local injections have been carbuncles, human bites, and localized scalp infections. Terhnique: Inject 10 to 20 c.c. of sterile 1% novocaine sfil. irto ;i vial containing 100,000 or 200.000 units of penicillin. af.'ilate the vial until all the penicillin is in solution, use :it once (prepare fresh for each treatment). Treatments given daily at fir.st and then e.o.d. until the infection is controlled. Streptomycin may be used in like manner in combination with penicillin, or separately if indicated. The sol. is drawn into a 10 c.c. glass syringe to which is attached a IJ/ or 2 in., 21 gauge needle; injected around, under, and into the infected area using 10 to 20 c.c. of sol. noo.noo to 200.000 units of penicillin) at carh treatment. The results obtained were impressive and prompt. Hcal-inir and re.solution occurred with a minimum of disturbance. These treatments rnn be given at home or at the office. The points to be emphasized are that in this treatment the antibiotic is placed in the infected area in sufficient concentration to be effective; and it is painle!5s. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-22/nchh-22-114.pdf |
Document Sort | all; group-e; nchh-22 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-22-114 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-22 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb2542543 |
Revision History | keep |
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