readily reducing the temperature, it may be done by the external application of cold, or by
of
administration of
internal
quinine, digitalis, &c.,
or
such
by
remedies
as
combination of
a
these methods. The
of withdrawal of heat
principle
in-
was
troduced by Dr. Currie of Liverpool some time towards the end of last century, and has since
England and Germany extensively employed wet sheet packing, as well as the mortality has been consider-
been worked out
particularly,
of
means
by
the cold bath
ably
fully
where it
:
in
was
reduced whenever
adopted.
The most useful method is the cold bath ; but in
cases
where this is
wet sheet
tepid sponging,
tepid contra-indicated, packing, and Roberts' or
cooling pad (which is fully described in theMedical Times and Gazette of 16th Dec., 1871) are useful. The latter should be applied over the abdomen and not the spine, as some have used it. I have found it of the greatest use, and I should think it would prove most acceptable in private practice, where it is difficult sometimes to get the patient to take the baths
through
fear.
When the temperature is very excessive the cold bath should be resorted to, but there is an to the
objection inasmuch followed
again this
for
as
by
a
a
as
a
rule,
shock at first which is
the temperature time after. Tepid baths
reaction,
some
reason
of the cold bath
use
there is
rising are
for
the best.
If the temperature rises to
104? F. about 4 r.M., tepid bath. One method is as follows (Ziemssen's). Bring the bath to the bedside of the patient and see that the
it would be well to order
ON ENTERIC FEVER. ^
By Surgeon W. E.
( Continued
Saunders, from page 2 op.)
a.m.d.
Complications. rises above to reduce
it,
the
est
dangers
temperature
F. it is necessary to take steps for in all febrile attacks the increas-
103?
ed blood-heat becomes in itself to life.
Now there
one are
water used is io? F. lower than the
temperature
of the
him
patient,
then after
placing
bath, and when the first sensations have
VII.? Treatment?continued.
Hyperpyrexia.?Whenever
a
of the greatmany ways
in the
passed off, reduce the temperature gradually to about 8o?, leave him in the bath 20? 30 minutes, and then take him out and dry quickly, putting him He will generally fall into to bed in a blanket. a quiet and refreshing sleep. Sometimes there is a tendency to syncope, but this is easily remedied by 1 oz. of brandy, or by ammonia, which should always be at hand. No one can realize the soothing, effect of the
September, 1883.]
tepid
SAUNDERS ON ENTERIC FEVER.
bath who has not taken F.
at
one
with his tem-
however, the temperature is regained in two hours in slight attacks not for 12 hours. It is well to give some medicine internally to check the production of heat, lest the abstraction of heat be followed by increased production as in
105? personally experienced this, and can testify to the benefit of tepid baths ; I could not, however, endure that cooling process, but prefer taking a bath at 8o? F. at first, and the next bath some\yhat cooler, but do not care for one cooler than 90? F., as the after effect is not so good.
perature
01* so.
I have
The number of baths necessary must of
health. Quinine in
course
by the individual case, by means of a careful and frequent use of the thermometer. At first they may be required every two hours, or even every hour, but as they act by reducing the temperature for a longer period, fewer will be required ; sometimes 3 a day are sufficient from the beginning. One bath may be given daily height
as
after the first
2 01*
This form of treatment is contra-indicated if there is
haemorrhage from the bowel or any symp torn of peritonitis indicating a chance of perforation, also if the eruption is very abundant, or of a deep red colour (scorbutic). Do not adopt it or
as
the bath
bath,
so
it is found in
in
frequent
Head
people.
and up to
doses,
20 or
24
applications is
a
very
symptom, and is often every distress-
common
ing.
cold
complications.?Headache
It must be treated
by
cold
applications,
and the head should be shaved if very bad. Sinapisms to the nape of the neck and calves of the
legs,
or
with it there
either young, -children or elderly Cold enemata have been recommended
than
salicylic dangers attending the
the
and small
if it alarms the patient. It is not suited
to
practice.
efficacious
the 24 hours ; and oz. in should be used in addition.
be necessary. Delirium is
or
cause
Alcohol is also said to be of the greatest use in some cases of hyperpyrexia. It must be given
other
haemorrhage
it will
Quinine is more acid, and free from use of that drug.
3. It is most useful in the early of the disease, especially if continued sleepstage lessness and delirium be present.
cause,
well
ous, and
the baths discontinued, unless improvement in the symptoms
if the heart is weak from
often
congestion give quinine ; for if given just before or be acting about the time
quinine
that the temperature would be again rising; thus the combined effect should be advantage-
may be reduced, it is not always followed by good results ; alarming depression may folloiv instead of sleep, so the pulse must be closely some
doses of
after the
ture
there is
or
Large
cases
and
an
of lungs, brain, &c. Now it is best to
The cold bath is not suited to all ages or stages of the disease, for although the tempera-
watched,
(say 5ss) will, within
up the effect, and is most useful at the crisis, or when the temperature is rising instead of falling.
about 4 P.M. or when the of the evening paroxysm is attained.
moderate
doses
large
two, cause a fall to the extent of 3 or 4 degrees of temperature, and to a less degree of the pulse ; but it must be repeated to keep hour
be decided
in
243
blistering
of the
scalp
may
even
very common complication, and is often a strong tendency to
a
The
suicide.
patient must therefore never be day or night. I remember several Kemperdich of Berlin, who appears to have us^d instances where patients have seized the opporthem successfully in his enteric fever cases. tunity afforded by the attendant falling asleep, The application of cold diminishes or leaving his post, though it be for a short time externally metamorphosis, and leads to the non-elimination only ; on one occasion the patient jumped from of the products, to which many of the dangers a balcony about 20 feet high, and was killed, of fever are due. while the attendant was getting him some drink The bath
degrees
degrees
reduces the
at once, but the
sometime
temperature
temperature
afterwards;
in
by
2
falls 5
severe
Dr
or or
3 6
cases,
left alone
he asked for. The
though
greatest the
vigilance
patient
is
may appear
necessary
even
quite rational,
THE INDIAN
244
MEDICAL GAZETTE.
The heart and circulation.?Failure
is due to brain
Delirium
(reflex) irritation, and is not the result of the poison acting on the There is one brain by circulating through it. for this, and that is alcohol, great remedy which acts by allaying irritation and soothing the nervous system, especially in reflex irritations.
[September, 1883.
heart's action is
likely
to
may be
one
in
occur
of the
complications
enteric fever:
to the
equal
of the
a
most
weak heart
ordinary requirements
of
health, but breaks down under the extra work thrown upon it in fevers. Its vigour may sometimes be restored by the administration of small
alcohol when necessary, and stop obtained?(Gull). Of the
quantities of easily digested food. Two or three teaspoonfuls of milk every two hours night and
variable and very small amount is excreted as alcohol, but the larger portion, at least in the case of most organisms, is
day will often suffice, but we must resort to alcohol, wine, &c., if the food does not act, and give small doses of digitalis. In all fevers and extensive general inflam-
Only give
it when the resultis alcohol taken
only
a
changed in the system, actually taken up by the living matter, appropriated and converted into other substances.?(Dr. L. Beale.) Alcohol should be so given in repeated doses, so as to keep the effect up, and the pulse Have a reason for giving it must be our guide. for and one continuing its use, for each case must be taken on its merits : one patient will be influenced by a small quantity, whereas 4 times that quantity may be required for another person. The weight should be a guide to a certain extent.
Two
ounces
every hour
may be necescritical over the
cases sary to tide certain a bottle of brandy or period,
not an uncommon amount
whiskey
a
day
sometimes for
in health to consume; why should it be as enormous in disease ?
is
regarded
complications.?Bronchial irritation is a very large percentage of cases, but generally subsides when the severity of the fever is lessened by appropriate treatment.?Ipecac, will be found very useful, but if there is much consolidation of the lung, there is nothing equal to hot fomentations with a slight sprinkling of turpentine, frequently applied until the symptoms lessen, on spongio-piline. Stagnation of blood in the pulmonary capillaries impeding the aeration of the blood is to be. met by stimulants such as alcohol, ammonia and ethers. Digitalis by strengthening the heart's action, and turpentine which seems to have also
stimulating the capillary circulation,
useful
under
Avoid the
use
lessen the
contracting
certain
of drugs like tartar
circumstances.
emetic,
power of the heart.
or
less failure of the
cessation of the capillary circulation over a considerable part of the body, for it is to this the failure of the force of the heart is
mainly
due.
Abdominal complications.?Excessive diarrhoea. Diarrhoea is excessive if there be 4 or 5 large stools daily. After the first fortnight the sloughs
begin
to
separate, but it is difficult
fix
to
the
date, and the irritating secretions and putrid discharges often give rise to a troublesome diarrhoea. If the diarrhoea must be restrained of lead, dil.
use
acetate
Ferri
pernit. or sulphuric acid, Liq. without or with opium. Liq. astringent Ferri pernit. is very good, possibly owing to its
other
present in
are
more
capillary circulation ; we have to try and prevent stagnation of the blood in the small vessels, and
men
Chest
the effect of
mations there is
which
corrective action
on
the foetid alkaline contents
One of the most convenient
of the bowel.
remedies to check excessive diarrhoea is the
pill
by Dr. Hudson, viz. bismuth gr. 3, gr. t. d. I have opium yi gr., carbolic acid found great benefit from its use. If pills cannot recommended
be
taken,
a
bismuth mixture
somewhat similar very
good,
but
to the
we
pills. must give
might
be
given
Chalk mixture is it
sufficiently
fre-
and remember it has to pass through feet of intestine before it can act on the many part desired. If the stomach is irritable, an enema
quently
of starch and
opium (n[
will be found
useful.?(Gull.)
xx
of
tinct.)
at
night
Constipation.?The typhoid symptoms are not due in every case to the absorption of pus or putrid discharges from the local bowel lesion,
SAUNDERS ON ENTERIC FEVER.
September, 1883.]
frequently occur, and is a good reason for not allowing the bowels to become confined. Constipation exists in some of the worst-
but such does
cases, and should never be allowed to continue
long. The French is not
a
safe
practice
one
if the action of the bowels is
;
deemed advisable
&c.,
previously
as
It is in
cases
of giving saline laxatives
give enemata,
or
castor
oil,
recommended.
description that I consiso useful, no doubt partly power of diminishing reflex
of this
der belladonna is from its remarkable
irritability. It moreover calms down excited respiration, augments renal secretion, and allays irregular spasm of the non-striated muscular fibre, which prevents cicatrization of the ulcers
245
Hemorrhage.?Now hemorrhage may be of little or no importance, or it may be of serious import, according as it occurs early or late in the disease. If it occurs about the 8th or ioth day, it may not only be innocuous, but positively beneficial?(Trousseau). This hemorrhage will cure itself most likely if the patient is kept in a horizontal posture, with the administration perhaps of gr. of opium by the mouth or rectum if necessary, to quiet the intestines.?(Gull). Ice or cold compress may be also applied to the abdomen. Should the
hemorrhage
occur
about the
week of the disease, it is due to the
3rd giving
way of some of the larger and deeper seated vessels of the muscular coats, which become
local sedative,
involved in the ulcerative process. This form occurring when the p#atient is already much
power over the vaso-motor The extract should be used in severe
exhausted, is generally more copious, and is always an evil omen if not directly fatal.* The
preference to the tincture. Mcteorism,?Meteorism, or accumulation of air in the large intestine, is often very painful and distressing to the patient. It may be relieved by the passage of a long stomach-pump tube up the anus, or even by puncture of the bowel by a fine trocar and canula,
treatment recommended above should be carried
by keeping
their bases
on
the
stimulant to the circulation and with
It is
move. a
a
wonderful
a
system. in
cases
in bad cases,
Journals cations
some
as
recommended
time since.
relieve,?mustard
may
in the Medical
At first local
appli-
poultices,
or
turpentine stupes followed by hot fomentations ; or when these cease to give relief, cold compresses may lessen the tension and the
in the It
and
intestines, in
was
a
case
so
diminish the
of this
gurgling suffering".
kind that I
found
Roberts' as
pad of great service. Vomiting. ?When the stomach is involved, it often is in severe attacks, there is trouble-
some
such
ice,
vomiting with or without hiccough. In effervescing draughts, champagne,
cases
creasote
poultices
or
carbolic acid,
with
mustard
out, but it will be necessary or
tannic
or some
other
gallic
to
give
in addition
acetate of lead,
acid, powerful astringent. or
turpentine The treat-
prompt if the amount passed be and this would be indicated by a sudden
ment must be
large,
fall in the temperature, pallor of the skin, and failing pulse. Do not wait for the blood to appear in the
stools, give an astringent at once. Ergotinc injected subcutaneously is the best; hour if necessary, give 5 grs. and repeat it in also place an ice bag over the iliac region. Oil of turpentine is another valuable remedy, but it is more useful in cases where general oozing from the mucous surfaces takes place, the scorbutic variety. It was originally as in recommended by Dr. Graves, and was highly spoken of by Murchison. It may be given in all cases where the tongue is dry and beefy, which always seems to accompany an increase of
tympanitis
and ulceration of the ileum.
Dr. Wood also in
to the
such
oil of
epigastrium, must be tried. There are many other complications, such as jaundice, peritonitis, &c.', but space will not admit of my entering on all here, I must
doses of 5 to 20 minims every hour in emulsion of gum-arabic, loaf sugar and water, yolk of eggs and honey or mucil-
confine my remarks
age.
ment.
to
special forms
of treat-
cases
gives
turpentine in
or
two
*
Dr.
Macjagan. February Lancet, 8, 1S73.
-J
THE INDIAN MEDICAL GAZETTE.
246
An amelioration in symptoms may be observed in 24 hours or more, the tongue becoming moist and the abdomen less distended. The
use
of the Oil of
diminished gradually. used in
teaspoonful
should be
Acetate of lead
acet. lead
solution; )i
acetic acid and 6
Turpentine
dissolved
is best in
gi
distilled water added ; a of this every half hour. It is not
advisable to
give
oz.
more
than
20
altogether. Epistaxis often occurs about the 3rd week of the disease, and should be checked by injections of vinegar Ice must be
sucked at
grs.
intervals.
and cold water, and cold compresses should also be used. If this is not sufficient, gallic
acid, &c., internally, and even plugging of the posterior nares may be necessary to stop this troublesome complication. Renal complications.?The excretion of urea Warm baths, diluent drinks, must be kept up. small doses of alkaline carbonates, or nitrate or bicarbonate of potash will often suffice?(Parkes). Digitalis, in the form of infusion, is very useful in severe forms of enteric fever, in the second week during the violence of the fever (Wunderlich). Large.doses without interruption must be given until the full effect is produced. The infusion should be made with Pulv. Digitalis ; grains xv to xx in 8 or 10 ozs. of boiling distilled water may be consumed in 24 hours by adults. The temperature will be reduced 2? or 30 Fah. in the evening by it. Repeat this treatment for one week, unless the pulse should be rapidly decreased, when its Test daily use must at once be discontinued. for albumen.
( To
be
concluded,.)
[September, 1883.
of
administration of
internal
quinine, digitalis, &c.,
or
such
by
remedies
as
combination of
a
these methods. The
of withdrawal of heat
principle
in-
was
troduced by Dr. Currie of Liverpool some time towards the end of last century, and has since
England and Germany extensively employed wet sheet packing, as well as the mortality has been consider-
been worked out
particularly,
of
means
by
the cold bath
ably
fully
where it
:
in
was
reduced whenever
adopted.
The most useful method is the cold bath ; but in
cases
where this is
wet sheet
tepid sponging,
tepid contra-indicated, packing, and Roberts' or
cooling pad (which is fully described in theMedical Times and Gazette of 16th Dec., 1871) are useful. The latter should be applied over the abdomen and not the spine, as some have used it. I have found it of the greatest use, and I should think it would prove most acceptable in private practice, where it is difficult sometimes to get the patient to take the baths
through
fear.
When the temperature is very excessive the cold bath should be resorted to, but there is an to the
objection inasmuch followed
again this
for
as
by
a
a
as
a
rule,
shock at first which is
the temperature time after. Tepid baths
reaction,
some
reason
of the cold bath
use
there is
rising are
for
the best.
If the temperature rises to
104? F. about 4 r.M., tepid bath. One method is as follows (Ziemssen's). Bring the bath to the bedside of the patient and see that the
it would be well to order
ON ENTERIC FEVER. ^
By Surgeon W. E.
( Continued
Saunders, from page 2 op.)
a.m.d.
Complications. rises above to reduce
it,
the
est
dangers
temperature
F. it is necessary to take steps for in all febrile attacks the increas-
103?
ed blood-heat becomes in itself to life.
Now there
one are
water used is io? F. lower than the
temperature
of the
him
patient,
then after
placing
bath, and when the first sensations have
VII.? Treatment?continued.
Hyperpyrexia.?Whenever
a
of the greatmany ways
in the
passed off, reduce the temperature gradually to about 8o?, leave him in the bath 20? 30 minutes, and then take him out and dry quickly, putting him He will generally fall into to bed in a blanket. a quiet and refreshing sleep. Sometimes there is a tendency to syncope, but this is easily remedied by 1 oz. of brandy, or by ammonia, which should always be at hand. No one can realize the soothing, effect of the
September, 1883.]
tepid
SAUNDERS ON ENTERIC FEVER.
bath who has not taken F.
at
one
with his tem-
however, the temperature is regained in two hours in slight attacks not for 12 hours. It is well to give some medicine internally to check the production of heat, lest the abstraction of heat be followed by increased production as in
105? personally experienced this, and can testify to the benefit of tepid baths ; I could not, however, endure that cooling process, but prefer taking a bath at 8o? F. at first, and the next bath some\yhat cooler, but do not care for one cooler than 90? F., as the after effect is not so good.
perature
01* so.
I have
The number of baths necessary must of
health. Quinine in
course
by the individual case, by means of a careful and frequent use of the thermometer. At first they may be required every two hours, or even every hour, but as they act by reducing the temperature for a longer period, fewer will be required ; sometimes 3 a day are sufficient from the beginning. One bath may be given daily height
as
after the first
2 01*
This form of treatment is contra-indicated if there is
haemorrhage from the bowel or any symp torn of peritonitis indicating a chance of perforation, also if the eruption is very abundant, or of a deep red colour (scorbutic). Do not adopt it or
as
the bath
bath,
so
it is found in
in
frequent
Head
people.
and up to
doses,
20 or
24
applications is
a
very
symptom, and is often every distress-
common
ing.
cold
complications.?Headache
It must be treated
by
cold
applications,
and the head should be shaved if very bad. Sinapisms to the nape of the neck and calves of the
legs,
or
with it there
either young, -children or elderly Cold enemata have been recommended
than
salicylic dangers attending the
the
and small
if it alarms the patient. It is not suited
to
practice.
efficacious
the 24 hours ; and oz. in should be used in addition.
be necessary. Delirium is
or
cause
Alcohol is also said to be of the greatest use in some cases of hyperpyrexia. It must be given
other
haemorrhage
it will
Quinine is more acid, and free from use of that drug.
3. It is most useful in the early of the disease, especially if continued sleepstage lessness and delirium be present.
cause,
well
ous, and
the baths discontinued, unless improvement in the symptoms
if the heart is weak from
often
congestion give quinine ; for if given just before or be acting about the time
quinine
that the temperature would be again rising; thus the combined effect should be advantage-
may be reduced, it is not always followed by good results ; alarming depression may folloiv instead of sleep, so the pulse must be closely some
doses of
after the
ture
there is
or
Large
cases
and
an
of lungs, brain, &c. Now it is best to
The cold bath is not suited to all ages or stages of the disease, for although the tempera-
watched,
(say 5ss) will, within
up the effect, and is most useful at the crisis, or when the temperature is rising instead of falling.
about 4 P.M. or when the of the evening paroxysm is attained.
moderate
doses
large
two, cause a fall to the extent of 3 or 4 degrees of temperature, and to a less degree of the pulse ; but it must be repeated to keep hour
be decided
in
243
blistering
of the
scalp
may
even
very common complication, and is often a strong tendency to
a
The
suicide.
patient must therefore never be day or night. I remember several Kemperdich of Berlin, who appears to have us^d instances where patients have seized the opporthem successfully in his enteric fever cases. tunity afforded by the attendant falling asleep, The application of cold diminishes or leaving his post, though it be for a short time externally metamorphosis, and leads to the non-elimination only ; on one occasion the patient jumped from of the products, to which many of the dangers a balcony about 20 feet high, and was killed, of fever are due. while the attendant was getting him some drink The bath
degrees
degrees
reduces the
at once, but the
sometime
temperature
temperature
afterwards;
in
by
2
falls 5
severe
Dr
or or
3 6
cases,
left alone
he asked for. The
though
greatest the
vigilance
patient
is
may appear
necessary
even
quite rational,
THE INDIAN
244
MEDICAL GAZETTE.
The heart and circulation.?Failure
is due to brain
Delirium
(reflex) irritation, and is not the result of the poison acting on the There is one brain by circulating through it. for this, and that is alcohol, great remedy which acts by allaying irritation and soothing the nervous system, especially in reflex irritations.
[September, 1883.
heart's action is
likely
to
may be
one
in
occur
of the
complications
enteric fever:
to the
equal
of the
a
most
weak heart
ordinary requirements
of
health, but breaks down under the extra work thrown upon it in fevers. Its vigour may sometimes be restored by the administration of small
alcohol when necessary, and stop obtained?(Gull). Of the
quantities of easily digested food. Two or three teaspoonfuls of milk every two hours night and
variable and very small amount is excreted as alcohol, but the larger portion, at least in the case of most organisms, is
day will often suffice, but we must resort to alcohol, wine, &c., if the food does not act, and give small doses of digitalis. In all fevers and extensive general inflam-
Only give
it when the resultis alcohol taken
only
a
changed in the system, actually taken up by the living matter, appropriated and converted into other substances.?(Dr. L. Beale.) Alcohol should be so given in repeated doses, so as to keep the effect up, and the pulse Have a reason for giving it must be our guide. for and one continuing its use, for each case must be taken on its merits : one patient will be influenced by a small quantity, whereas 4 times that quantity may be required for another person. The weight should be a guide to a certain extent.
Two
ounces
every hour
may be necescritical over the
cases sary to tide certain a bottle of brandy or period,
not an uncommon amount
whiskey
a
day
sometimes for
in health to consume; why should it be as enormous in disease ?
is
regarded
complications.?Bronchial irritation is a very large percentage of cases, but generally subsides when the severity of the fever is lessened by appropriate treatment.?Ipecac, will be found very useful, but if there is much consolidation of the lung, there is nothing equal to hot fomentations with a slight sprinkling of turpentine, frequently applied until the symptoms lessen, on spongio-piline. Stagnation of blood in the pulmonary capillaries impeding the aeration of the blood is to be. met by stimulants such as alcohol, ammonia and ethers. Digitalis by strengthening the heart's action, and turpentine which seems to have also
stimulating the capillary circulation,
useful
under
Avoid the
use
lessen the
contracting
certain
of drugs like tartar
circumstances.
emetic,
power of the heart.
or
less failure of the
cessation of the capillary circulation over a considerable part of the body, for it is to this the failure of the force of the heart is
mainly
due.
Abdominal complications.?Excessive diarrhoea. Diarrhoea is excessive if there be 4 or 5 large stools daily. After the first fortnight the sloughs
begin
to
separate, but it is difficult
fix
to
the
date, and the irritating secretions and putrid discharges often give rise to a troublesome diarrhoea. If the diarrhoea must be restrained of lead, dil.
use
acetate
Ferri
pernit. or sulphuric acid, Liq. without or with opium. Liq. astringent Ferri pernit. is very good, possibly owing to its
other
present in
are
more
capillary circulation ; we have to try and prevent stagnation of the blood in the small vessels, and
men
Chest
the effect of
mations there is
which
corrective action
on
the foetid alkaline contents
One of the most convenient
of the bowel.
remedies to check excessive diarrhoea is the
pill
by Dr. Hudson, viz. bismuth gr. 3, gr. t. d. I have opium yi gr., carbolic acid found great benefit from its use. If pills cannot recommended
be
taken,
a
bismuth mixture
somewhat similar very
good,
but
to the
we
pills. must give
might
be
given
Chalk mixture is it
sufficiently
fre-
and remember it has to pass through feet of intestine before it can act on the many part desired. If the stomach is irritable, an enema
quently
of starch and
opium (n[
will be found
useful.?(Gull.)
xx
of
tinct.)
at
night
Constipation.?The typhoid symptoms are not due in every case to the absorption of pus or putrid discharges from the local bowel lesion,
SAUNDERS ON ENTERIC FEVER.
September, 1883.]
frequently occur, and is a good reason for not allowing the bowels to become confined. Constipation exists in some of the worst-
but such does
cases, and should never be allowed to continue
long. The French is not
a
safe
practice
one
if the action of the bowels is
;
deemed advisable
&c.,
previously
as
It is in
cases
of giving saline laxatives
give enemata,
or
castor
oil,
recommended.
description that I consiso useful, no doubt partly power of diminishing reflex
of this
der belladonna is from its remarkable
irritability. It moreover calms down excited respiration, augments renal secretion, and allays irregular spasm of the non-striated muscular fibre, which prevents cicatrization of the ulcers
245
Hemorrhage.?Now hemorrhage may be of little or no importance, or it may be of serious import, according as it occurs early or late in the disease. If it occurs about the 8th or ioth day, it may not only be innocuous, but positively beneficial?(Trousseau). This hemorrhage will cure itself most likely if the patient is kept in a horizontal posture, with the administration perhaps of gr. of opium by the mouth or rectum if necessary, to quiet the intestines.?(Gull). Ice or cold compress may be also applied to the abdomen. Should the
hemorrhage
occur
about the
week of the disease, it is due to the
3rd giving
way of some of the larger and deeper seated vessels of the muscular coats, which become
local sedative,
involved in the ulcerative process. This form occurring when the p#atient is already much
power over the vaso-motor The extract should be used in severe
exhausted, is generally more copious, and is always an evil omen if not directly fatal.* The
preference to the tincture. Mcteorism,?Meteorism, or accumulation of air in the large intestine, is often very painful and distressing to the patient. It may be relieved by the passage of a long stomach-pump tube up the anus, or even by puncture of the bowel by a fine trocar and canula,
treatment recommended above should be carried
by keeping
their bases
on
the
stimulant to the circulation and with
It is
move. a
a
wonderful
a
system. in
cases
in bad cases,
Journals cations
some
as
recommended
time since.
relieve,?mustard
may
in the Medical
At first local
appli-
poultices,
or
turpentine stupes followed by hot fomentations ; or when these cease to give relief, cold compresses may lessen the tension and the
in the It
and
intestines, in
was
a
case
so
diminish the
of this
gurgling suffering".
kind that I
found
Roberts' as
pad of great service. Vomiting. ?When the stomach is involved, it often is in severe attacks, there is trouble-
some
such
ice,
vomiting with or without hiccough. In effervescing draughts, champagne,
cases
creasote
poultices
or
carbolic acid,
with
mustard
out, but it will be necessary or
tannic
or some
other
gallic
to
give
in addition
acetate of lead,
acid, powerful astringent. or
turpentine The treat-
prompt if the amount passed be and this would be indicated by a sudden
ment must be
large,
fall in the temperature, pallor of the skin, and failing pulse. Do not wait for the blood to appear in the
stools, give an astringent at once. Ergotinc injected subcutaneously is the best; hour if necessary, give 5 grs. and repeat it in also place an ice bag over the iliac region. Oil of turpentine is another valuable remedy, but it is more useful in cases where general oozing from the mucous surfaces takes place, the scorbutic variety. It was originally as in recommended by Dr. Graves, and was highly spoken of by Murchison. It may be given in all cases where the tongue is dry and beefy, which always seems to accompany an increase of
tympanitis
and ulceration of the ileum.
Dr. Wood also in
to the
such
oil of
epigastrium, must be tried. There are many other complications, such as jaundice, peritonitis, &c.', but space will not admit of my entering on all here, I must
doses of 5 to 20 minims every hour in emulsion of gum-arabic, loaf sugar and water, yolk of eggs and honey or mucil-
confine my remarks
age.
ment.
to
special forms
of treat-
cases
gives
turpentine in
or
two
*
Dr.
Macjagan. February Lancet, 8, 1S73.
-J
THE INDIAN MEDICAL GAZETTE.
246
An amelioration in symptoms may be observed in 24 hours or more, the tongue becoming moist and the abdomen less distended. The
use
of the Oil of
diminished gradually. used in
teaspoonful
should be
Acetate of lead
acet. lead
solution; )i
acetic acid and 6
Turpentine
dissolved
is best in
gi
distilled water added ; a of this every half hour. It is not
advisable to
give
oz.
more
than
20
altogether. Epistaxis often occurs about the 3rd week of the disease, and should be checked by injections of vinegar Ice must be
sucked at
grs.
intervals.
and cold water, and cold compresses should also be used. If this is not sufficient, gallic
acid, &c., internally, and even plugging of the posterior nares may be necessary to stop this troublesome complication. Renal complications.?The excretion of urea Warm baths, diluent drinks, must be kept up. small doses of alkaline carbonates, or nitrate or bicarbonate of potash will often suffice?(Parkes). Digitalis, in the form of infusion, is very useful in severe forms of enteric fever, in the second week during the violence of the fever (Wunderlich). Large.doses without interruption must be given until the full effect is produced. The infusion should be made with Pulv. Digitalis ; grains xv to xx in 8 or 10 ozs. of boiling distilled water may be consumed in 24 hours by adults. The temperature will be reduced 2? or 30 Fah. in the evening by it. Repeat this treatment for one week, unless the pulse should be rapidly decreased, when its Test daily use must at once be discontinued. for albumen.
( To
be
concluded,.)
[September, 1883.
