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ium salicylate in divided doses brought this down to 1000 within 24 hours. A day later he was out on the street. Several similar cases followed at intervals, with the same result, so that I saw them but two or three times. Often patients with prodromic symptoms of fever would call at my office, and after prescribing I would lose sight of them and not learn the result. Probably this was not uniformly good, and it is within the bounds of possibility that not all of them needed medical advice. I saw some others where the same opportunity for abortive treatment presented, but without the same happy result, although a mild run of short duration was secured in all. Others, seen perhaps after a week of fever, ran the usual course with a medium temperature, with general symptoms of extreme mildness, and with uniform recovery. Two only reached the danger line, passing perilously beyond, but they also got well. Several of these cases were complicated with pneumonia. To them I gave the remedy with ammonia in excess, as I also did to the grave cases already mentioned. Some of them received a small Dover's powder two or three times a day, but there was far less frequent need of it than there usually seems to be. Of all of them, and of others occurring subsequently, only the two seemed unresponsive to the treatment. Most of them answered surprisingly, and all of them satisfactorily. The effect upon temperature was very uniform. Not seldom this was found as high as 105° at the beginning, but whether high or moderate at this stage, it nearly always came down promptly to 100°, to reach normal within a day or two more, in cases recovering at this point, and varying from 1000 to 1020 in cases reaching the third week.
A case of puerperal septicæmia occurred about this time, developing pelvic cellutitis and pneumonia. The latter seemed to involve one entire lung and the base of the other. The temperature when those complications arose was 1060. The patient's pulse was feeble and irregular, her face livid. The prognosis was grave enough; a drachm of the salicylate of ammonia given through the night reduced the temperature to 101°, and it never rose but one degree higher. The patient's recovery was rapid and complete; excepting digitalis the salicylate was the only remedy given, opium being contraindicated by the deficient and labored respiration.
The next case of the same nature, without the pneumonitis, did not fare as well. Her temperature was 10472°, but it fell off three degrees within twelve hours. Twelve hours later it remained the same. The patient looked and felt so comfortable and well that I told her that I would wait to hear from her before calling again. Two days later I was sent for to find her as bad as ever. She had felt so well that she thought it unnecessary to renew her medicine after it was all taken. I directed an immediate return to it, but it did not avail. She grew rapidly worse and died a few days later. I have never felt wholly blameless for this death, although recovery might have been impossible at best.
Something like a dozen cases have come under my care since, including those, a majority, following early abortions. In nearly all, cellulitis was present; in some peritonitis and in a few inflammation of the lung or pleura. With one exception they all recovered promptly, and this one after a dangerous run of more than two weeks. In all of them a prompt reduction of temperature followed the administration of the salicylate, with or without the help of opium, and nearly always without the use of the hot or the antiseptic injection:
In ordinary attacks of pelvic cellulitis, arising often from indeterminate causes, all of the salicylates have pioved of value, and are probably unsurpassed by other remedies.
A case of gangrene of the lung following entire hepatization of one side came to my care in the second week. I employed quinine with the ammonium salicylate, but several times tried the effect of suspending one and then the other of the remedies. The quinine was not missed, but high temperature and hectic ensued when the salicylate was omitted for even a few hours. Whisky was also given for prudential reasons, as the patient had been a hard drinker. He recovered completely and is still, after nearly two years, in excellent health.
In a case of pulmonary gangrene attending tuberculosis the sali cylate proved far superior to all other agents, but, of course, could not avail to save life. Death by asthenia was evidently deferred for many weeks, the patient's comfort being promoted unmistakably.
In the septicæmic state of the last stage of tuberculosis it has often mitigated the fever and other distressing symptoms where quinine failed or could not be borne. It has even served to lessen the cough, or at least to promote the action of other agents addressed to that symptom.
Its favorable effect in the pneumonitis complicating other affections, led me to employ it in idiopathic pneumonia, as its indication was also clear from the well known benefit of both the chloride and the carbonate. In all these cases a varying excess of ammonia was given. They all terminated in recovery after the usual course, characterized, however, by unusual mildness. It is not to be forgotten that pneumonia is a self-limited disease, with a tendency to spontaneous recovery. Nevertheless, recovery does not always occur, and sudden death from embolism is an event of sufficient frequency, even among cases of a mild character and with a hopeful prognosis. Bearing in mind the possibility of this accident in all cases we may turn with favor to any agent that promises to guard against it more effectually than those hitherto employed, and this, it seems to me, the ammonium salicylate does; with me it has largely superseded all others except opium.
Since beginning this paper last week I have been afforded the opportunity of employing it in the high temperature of cerebral meningitis. I used it because two recent cases of the same age ended fatally under the customary treatment. This one, a child four years old, had been ill a day, with intense headache, delirium, and almost constant vomiting. Her temperature when I first saw her was 1030 Three grains of the salicylate every hour and a half or two hours, and the ice-cap at the head, reduced this four degrees by the next morning. The vomiting was greatly lessened, but delirium was more pronounced and constant. The pupils were contracted and sensitive, and the urine was discharged voluntarily. The temperature rose one degree during the next day, then fell to normal, when it seemed that convalescence was assured. But this hope was illusive. On the sixth day the temperature rose suddenly to 103%, 9. The ice-cap which had been kept off for two days, and the salicylate, which had been practically abandoned, were restored, with the eftect of reducing the temperature to 101 and 102, between which points it still on the eighth day-vacillates, while there is absence of delirium and a general condition which affords a very favorable prognosis.
A case in which I gave the salicylate through an initial error in diagnosis will serve to point out one of its probable dangers. It was that of a man about thirty-five years old, who was taken with chills and high fever, severe headache and uncontrollable vomiting. It seemed to be a commencing remittent. He lived a long distance in the country and as it was late at night I gave such remedies as I had with me and prescribed the salicylate of ammonia for the next day. The next evening I found him in a semi-coma, with urine suppressed, and all symptoms of the gravest omen. Then I elicited from his wife a history of Bright's disease of some two years' duration, and discovered, when too late, that this was an acute exacerbation. It is presumable that the case might have ended fatally under any treatment, but I am inclined to think that the action of the agent employed was unfavorable, and now I should never give it when there were undoubted renal lesions, either acute or chronic, and should watch its effect with solicitude where there was a tendency to anuria from any cause.
In concluding this report I desire to say that I have not attempted to present to this society a panacea for the various affections it enumerates. Probably this will never be discovered. But I fully believe that the results already obtained will justify further investigations upon a much larger scale. My own cases have been far too few to establish definitively the superiority of the salicylate of ammonia, in the line of treatment to which it has been addressed. The clinical material afforded by a country practice during so short a period is necessarily too limited. Still, it does not seem too much to say that the following conclusions may be provisionally accepted:
The salicylate of ammonium is to be ranked among the most efficient of the antipyretics.
As an antipyretic in all fevers characterized by extreme adynamia it ranks among the safest, owing to its ammonium base.
It is stimulant as well as antipyretic, and this of itself fulfils indications otherwise only met by a combination of remedies.
It is an agent of wide germicidal powers, being promptly efficient in affections of great etiological and pathological differences, each confessedly arising from its own proper specific infecting microorganism.
As a remedial agent in typhoid and remittent fevers it is unsurpassed, aborting them at the outset, under favorable conditions, and greatly mitigating their severity and danger under circumstances less favorable.
It is entitled to confidence in the treatment of pulmonary inflammations, either idiopathic or septic, and probably eliminates the dangerous factor, embolism, with greater certainty than any other prime curative agent.
It is the most efficient known remedy in puerperal septicæmia and probably also in most septic inflammations of non-puerperal origin.
It is worthy of a trial in non-tubercular cerebral meningitis, as it gives some promise of relief in an affection which has hitherto resisted, if not resented all modes of medical treatment.