ON ENTERIC FEVER.
symptoms
By Surgeon W. E.
Saunders, ( Continued from page 159.)
a.m.d.
In the
following
remarks I
and obviate the the
VII.? Treatment.
to counteract
patient
to recovery. where there are
found
uncomplicated
for
adopting
practice,
and the
reasons
each.
indication, of course, is, if specific poison which destroy
The first and chief
possible, gives rise know of
to to no
therefore be
the
As yet, however, we for this disease ; so we must
the disease.
specific content
to
the
relieve the
distressing
distressing symptoms.
to
complications by placing
death
circumstances Now
favourable shall
occur
useful in
tendency
under
compare the different forms of treatment that have been most
the local
cases
most
sometimes
very prominent or These arc simple and no
cases, and
require
the least
possi-
ble treatment ; we merely have to sustain the powers of the patient by appropriate food, and
mitigate
the force of the blow which
powerless
to
ward
off,
we
are
and nature will then be
able to reassert herself and restore the sufferer to
health.
This form
of treatment has been
THE INDIAN MEDICAL GAZETTE,
206
termed the expectant treatment, and does very well in mild cases ; we must not adopt it in all however.
cases
Dr. Lionel Beale says : " We must remember that mere passive expectancy in the treatment of disease
the denial of
means
the
knowledge,
ignoring of broad facts of observation and experiment, a contempt for the lessons taught by experience, and a disbelief in all that has been handed down to us by those who have observed and laboured and thought before we lived.
predominance of certain symptoms must be varied in different
while in fevers
widely
cases
the treatment
of the same
different in their
feve^
causes
it may be identical. I mention this because various attempts arc constantly made to introduce a certain treatment for all cases of the diswould have
ease ; some
us
cases, others say there is
pentine,
and
enough
in
so
The
on.
digitalis in all nothing equal to turdrugs are valuable
certain cases, but
nise the fact that medicines
special
use
conditions ;
to
we
have to recog-
only required distressing diarrhoea, pain,
are
relieve
Remember the natural termination of enteric
for
fever may be. death as well as recovery ; we must therefore be careful not to thwart the
symptoms, such as excessive sleeplessness, and delirium, which if unchecked hasten exhaustion and prevent recovery.?(Murchison). In every case we. must combat dangerous symptoms as they arise. Some would give no medicine internally at all in an uncomplicated case, but I think something may always be given with advantage. I have generally used the following,
natural modes of recovery, or favour the natural ' modes of death in our endeavours to cure.' "
As there the
seems to
hypothesis
be
belief in
increasing
an
that enteric fever is due to
local lesion of the intestinal
a
which has
glands,
been set up by the introduction into the alimentary canal of low living organisms, we must
adapt
our treatment to
such
substances
growth
and
as
destroy
this
value in more
practice, and popular hereafter.
vitality
will
employ
arrest
the
of the disease of great doubt become
proved
no
The class embraces such remedies
acid, cially
and
known to
are
the
view,
germs. This class of remedies has
as
salicylic
quinine, carbolic and mineral acids, espediluted sulphuric acid; borax and benzoic
hyposulphites which seem phenomena very rapidly, but unfortunately their continued use brings on a cachexia. Of late the eucalyptus oil has been recommended as being a better disinfectant than carbolic acid, besides being a useful stimulant. Iodine is also a very useful drug, and may acid ;
and
sulphites
to combat abdominal
be used in certain
cases.
General principles of treatment. The less
we
better, but of we can
do
a
interfere with
course we must
great deal if
we
case
the
something, judiciously
and
mild
a
do
act
and
without what may be termed meddlesome interIt must not be treatment
which is almost the
imagined
that each fever lias
of its own, but
according
to the
same as
what Murchison
mixture of
gave, viz., Sulphate of quinine gr. ii., Acid sulph. dil. vel. arom. 7^. x., with some syrup of oranges and lemons in water,
frequently
a
every 3 hours. To this in m6st cases, I added Tr.
Belladonnae
or
Digitalis
in 7![.
v.
doses.
I have
found belladonna very useful, more especially if there is any tendency to constipation. It seems to
opium in quieting the peristaltic action without altogether checking.it; and is most useful for children, where intussusception is It gives the greatnot an uncommon affection. est amount of rest'to the ulcers without locking up the discharges. Digitalis is most useful for urinary complications, but I shall enter into this more fully directly. Salicylic acid has been much employed of late, but there are many and great objections to its It certainly reduces the pyrexia, but Muruse. chison found it caused delirium, albuminuria, and sometimes almost total suppression of urine. It has since been suggested that the dose used was too large, but it is certain that the drug is not act better than
tolerated
ference.
a
[August, 18S3.
enteric
in
cases as
it is in rheumatic
fever, and should, when used, always be given the form of
a
soda salt.
Relapses
are not
in
pre-
1883.]
August,
SAUNDERS ON
ENTERIC FEVER.
vented, and the tendency to epistaxis is increased ! by its use. The maximum quantity used should not exceed 4 not to
tion
give
on
drachms
daily, owing to the depressing acwhen given in sufficient quanti-
the heart
to have any effect on the temperature. Subchloride of mercury and iodine are both powerful antiseptics, the latter may be used as a
ty
medicine:?Iodine grs. ?i; of this 5 Tl^. in
vi,
water
a
Potass. Iodid. gr. xii, glassful of water
wine
every 3 hours may be given for some time. In enteric fever it is necessary to bear in mind that we have to deal with a lesion of the assimi-
lating organs,' chiefly directed
therefore
our
attention
to the diet ; and
we
must be
must
take
that the
patient only gets the simplest easily digested food, especially during the 2nd week, when the sloughs begin to separate. In the first place we must enforce physical rest by keeping the patient religiously in bed ; the bedpan should always be used, and the patient should care
and
most
not
allowed up for this purpose after the malady is recognised.
be
nature of the It is most
important kept in a state
tines be
tendency lessened
to
quiescence, will be
The diarrhoea if
and the
greatly
not exces-
by medicine, for it is pathological doctrine be
not be checked
alike wrong whichever the correct one. is
of
excessive diarrhoea
thereby.
sive, should
that the inflamed intes-
as
more
intestinal
"
undoubtedly milk ; but even given in too great quantity,
this must not be and should be ad-
ministered in small and stated
quantities, and at regular intervals ; should milk not be easily tolerated, soda water may be mixed with it to render it less rich, and.it would be best to give it while in a state of effervescence, with a small lump of ice added, if there be any irritability of the stomach. at once
rejected
In hot weather,
curdled,
or
if the milk is
it would be well to add
little lime water.
a
Avoid
bread, beef-tea, and the like, but a well whisked egg may be given once or twice a day. Tea and coffee also may be given in the early part of the day, unless the state of the nervous system contra-indicates its
use.
Dr. Parkes found that coffee increased the elimination of
urea
that it lessens tion.
in
fevers,
and there is
no
doubt
both drowsiness and prostrajellies must be rigidly
Animal broths and
excluded from the diet.
The nutrition of the
body must be maintained by appropriate food,? rice, milk, rusks and hot milk, blanc. mange, custard or even junket, rennetted milk, afford sufficient variety for milk diet. Dr. Parkes has shewn that there are theoretical objections to a purely nitrogenous diet in fever. It is doubtful if the disintegrating nitrogenous tissues can be fed, and in
the affected
generally believed, glands are throwing off some poison to be got rid of, why try and retain it to be again absorbed in the intestine as formerly recommended ? But if on the other hand, as is most probable, the discharge sets up a secondary ulceration by inoculation of those glands not involved in the first instance, what could be worse than to check the expulsion of that which leads to a prolongation of the disease, and increases the danger to the patient ? Lock up the bowels and keep them so," was most dangerous advice. The next most important point is to obtain physiological rest, as far as possible, by giving nothing that contains any indigestible matter?we must avoid giving any thing that cannot be digested and disposed of in the upper part of the intesIf,
The most suitable diet of all is
tinal canal.
but it is better
it at all
207
that
the albuminous food must
case
got rid
of
organs.
Milk is therefore
tea
article of diet in all fevers.
as an
Recovery attention
by
already
overtasked
be
glandular
preferable
to
beef-
from enteric fever is
to
fresh air and are as a
the
dependent on the smallest details ; simple diet wine rather than the use of drugs,
rule indicated.
Look well after the
bladder,
and
use
the cathe-
when necessary with the greatest care, as all the membranes arc in a most tender state?" use ter
a
gum elastic catheter with all and delicacy."? (Sir W. Gull).
soft
care
Give tea
mucilaginous drinks,
(infusion),
possible
rice water, linseed
and should the scorbutic taint be
present, lemonade made from fresh lemons, lime juce Cases
or
should be taken. should not be treated under
canvas
THE INDIAN MEDICAL GAZETTE.
2oS
when it
be avoided,
they do not get on changeable. Give plenty of fresh air however, and encourage the free use of diluents, to help in the elimination of the exaggerated metamorphosis in so
can
as
well if the weather is at all
the blood and tissues. in
In adults all fevers
grave proportion muscle and fat.?(Murchison). to
Success in 'treatment
the
are
of
development
depends
on
a
careful
attention to details ; and it may be said to resolve itself into and consist of simple measures and
Such then
diet.
simple
are
the
general
indications for treatment, but it will be^necessary to
modify
them
according
to
the stage of the
disease ; there is no doubt that the severity and danger of an outbreak of enteric fever may be
greatly diminished by appropriate treatment, the complications may be lessened, and even the duration of an attack considerably shortened. If early in the fever there is flushed face and headache, a high temperature and thickly coated tongue, calomel may be given with advantage in doses of 3 grs. More than this is bad.?(Parkes,
Wood). If the stools
are neither large nor very liquid, and don't exceed 3 or 4 in the 24 hours, it may even be repeated with advantage after a day or
two, but not oftener.
Calomel in doses of
from 1?3 grs. is recommended by some, even twice daily, associated with ipecac, when the stomach is not irritable.
following :?Blue pill grs. xii, Ipecac, gr. ii, Opium gr. ii, mixed and divided into 12 pills, and gives one of these every one Wood
uses
the
He says it modifies the temperachecks the ture, peristaltic action, and acts as a sedative. or
two hours.
Calomel is contra-indicated if the diarrhoea is
great,
or
if there be
bowels with
early
there is ansemia,
severe
colicky pains
in
and violent meteorism, or
hemorrhagic
the
01*
if
diathesis.?
(Aitken). It increases the evacuations after
its
during
but
the
12
hours
administration, purging. If the patient lies on his back with oppressed breathing, tumid abdomen, and projecting, but troublesome
never
sets up
[August, 1883.
without marked tenderness, and the bowels have not acted for 12 hours, or even if the stools be fre-
only a little faecal matter and wind time; in such cases great relief is obpassed tained by giving a draught of Castor Oil gii, with 01. Terebinthinae gi or gii. A warm enema is also good, but th^ draught is -better, unless contraindicated by suspicions of peritonitis?(Dr. J. Little, Dublin). A cold compress or a turpentine stupe is the best local application. Ipecacuanha in small doses, ]/x gr. to % gr. every 2 hours is useful, especially if there be any bronchial irritation, and this is most often present Dover's powder given in small doses at frequent quent
and
each
intervals is also very useful in some cases. Constipation, should it exist, must be overcome small doses of castor
by by
some
other
oil,
as
such
laxative,
noted
above, phosphate
as
or
of
soda. Looseness should not be checked unless the
stools
frequent or copious as to injuriously affect the strength of the patient. It may be stated generally, that so long as there are not more than 3 stools a day, astringents should be withheld. The diarrhoea is not entirely due to the actual bowel lesion, but is in part due to the irritation caused by the foetid discharges which it tends to carry off. It is therefore salutary so long as it is not severe enough to sap the patient's strength. If laxatives must be given, only those that are so
?
the upper part of the canal should be administered. Phosphate of soda is the best
act
on
?
it acts very gently, has very little taste, and is It may be readily taken not at all irritating. dissolved in a little warm milk or gruel, gss to
gii
for
a
dose, once or
even
twice
daily
as
required*
If the tongue be very red and dry, chlorate of potash will be found the best remedy. Sleep may be induced
by
a
draught
of Bromide of
Potassium gr. xv?xx and Chloral ?xv in peppermint water.
Hyd.
gr.
x.
Turpentine has been strongly recommended by some, and may be thus given Oil of 1 urpentine H[xv, Lucca oil TILxxv made up with mucilage. It is said to reduce the number of the stools, and lessen the
tympanitis,
and also
August, 1883.]
NEVE ON THE RADICAL CURE OF HERNIA.
wasting of the tissues, thereby obviating the necessity of giving stimulants.* It certainly reduces the tympanitis, and should be given when required for that ; but it is apt to prevent the
disorder the stomach, and there is also danger of its
causing strangury.
Tonics and stimulants
are
required
about the
week. Alcohol is the usual stimulant
3rd
ed, but
opium
doses.
full,
is also
nor
employ-
useful stimulant in small
a
It may be given when the pulse is not strong, and when cerebral symptoms do
not exist.
In
the latter
stages Tr. Digitalis may be doses every 4, 6, or 8 hours.
in n^v to It is known to be
ment, and induces bonate of ammonia is
subdues
sleep,
promotes
objectionable,
acting beneficially nervous
when
excite-
gentle perspiration.
Car-
useful after many diseases, it may irritate the bowels
so
as
and increase the diarrhoea. When the
is slow and feeble, and the
pulse
skin cool, the tongue and teeth encrusted with dark sordes, at an advanced stage of the fever, then stimulants
are
when the skin is
obviously necessary. frequent, and
pulse is feeble, yet hot, stimulants are
even
then
But the
known
to be of service ; but it is necessary to administer them with
great caution, and
to
watch the
and
effects
constantly closely. They are doing good if they lessen the pulse and increase its fulness and strength, if the skin becomes cool and moist, and if the delirium is subdued 01* moif refreshing sleep be
derated, and especially procured. The diet is
importance as in particularly in cases
of the utmost
the earlier part of the disease,
of the scorbutic type. In addition to lemonade, the juice of sweet fruits, or the very soft
fruits, or the pure jelly of ripe fruits, may be given, but fruit in its crude state is to be strictly withheld. A teaspoonful of lemon juice and water is
pulp
of
often necessary to moisten the mouth before giving food.
During
convalescence the
is necessary *
as
to diet and
Dr. P. L,
utmost
aperients.
O'Neile?Practitioner, 1S77.
caution
As
regards
diet.
Liebig's
Extractum Carnis
very valuable nutriment during the early part of convalescence. No solid food should be is
a
allowed until the
morning temperature has been normal for I week; and then commence gradually, giving a little bread at first, then fish or fowl, but no meat should be given until the evening temperature has been normal for a like period ; even then the food should be as free as
possible from Malt or on
given it
1.
209
liquor
an
excrementitious matters. should
not
be taken before
empty stomach, for it
food,
is liable to dis-
agree. 2. Do not interfere much with the but if necessary
use
castor
oil
or
bowels; simple ene-
mata
only. give the treatment for special and complications and sequelae, and I shall given all the treatment of the disease. (To be concluded.) I will
grave have
symptoms
By Surgeon W. E.
Saunders, ( Continued from page 159.)
a.m.d.
In the
following
remarks I
and obviate the the
VII.? Treatment.
to counteract
patient
to recovery. where there are
found
uncomplicated
for
adopting
practice,
and the
reasons
each.
indication, of course, is, if specific poison which destroy
The first and chief
possible, gives rise know of
to to no
therefore be
the
As yet, however, we for this disease ; so we must
the disease.
specific content
to
the
relieve the
distressing
distressing symptoms.
to
complications by placing
death
circumstances Now
favourable shall
occur
useful in
tendency
under
compare the different forms of treatment that have been most
the local
cases
most
sometimes
very prominent or These arc simple and no
cases, and
require
the least
possi-
ble treatment ; we merely have to sustain the powers of the patient by appropriate food, and
mitigate
the force of the blow which
powerless
to
ward
off,
we
are
and nature will then be
able to reassert herself and restore the sufferer to
health.
This form
of treatment has been
THE INDIAN MEDICAL GAZETTE,
206
termed the expectant treatment, and does very well in mild cases ; we must not adopt it in all however.
cases
Dr. Lionel Beale says : " We must remember that mere passive expectancy in the treatment of disease
the denial of
means
the
knowledge,
ignoring of broad facts of observation and experiment, a contempt for the lessons taught by experience, and a disbelief in all that has been handed down to us by those who have observed and laboured and thought before we lived.
predominance of certain symptoms must be varied in different
while in fevers
widely
cases
the treatment
of the same
different in their
feve^
causes
it may be identical. I mention this because various attempts arc constantly made to introduce a certain treatment for all cases of the diswould have
ease ; some
us
cases, others say there is
pentine,
and
enough
in
so
The
on.
digitalis in all nothing equal to turdrugs are valuable
certain cases, but
nise the fact that medicines
special
use
conditions ;
to
we
have to recog-
only required distressing diarrhoea, pain,
are
relieve
Remember the natural termination of enteric
for
fever may be. death as well as recovery ; we must therefore be careful not to thwart the
symptoms, such as excessive sleeplessness, and delirium, which if unchecked hasten exhaustion and prevent recovery.?(Murchison). In every case we. must combat dangerous symptoms as they arise. Some would give no medicine internally at all in an uncomplicated case, but I think something may always be given with advantage. I have generally used the following,
natural modes of recovery, or favour the natural ' modes of death in our endeavours to cure.' "
As there the
seems to
hypothesis
be
belief in
increasing
an
that enteric fever is due to
local lesion of the intestinal
a
which has
glands,
been set up by the introduction into the alimentary canal of low living organisms, we must
adapt
our treatment to
such
substances
growth
and
as
destroy
this
value in more
practice, and popular hereafter.
vitality
will
employ
arrest
the
of the disease of great doubt become
proved
no
The class embraces such remedies
acid, cially
and
known to
are
the
view,
germs. This class of remedies has
as
salicylic
quinine, carbolic and mineral acids, espediluted sulphuric acid; borax and benzoic
hyposulphites which seem phenomena very rapidly, but unfortunately their continued use brings on a cachexia. Of late the eucalyptus oil has been recommended as being a better disinfectant than carbolic acid, besides being a useful stimulant. Iodine is also a very useful drug, and may acid ;
and
sulphites
to combat abdominal
be used in certain
cases.
General principles of treatment. The less
we
better, but of we can
do
a
interfere with
course we must
great deal if
we
case
the
something, judiciously
and
mild
a
do
act
and
without what may be termed meddlesome interIt must not be treatment
which is almost the
imagined
that each fever lias
of its own, but
according
to the
same as
what Murchison
mixture of
gave, viz., Sulphate of quinine gr. ii., Acid sulph. dil. vel. arom. 7^. x., with some syrup of oranges and lemons in water,
frequently
a
every 3 hours. To this in m6st cases, I added Tr.
Belladonnae
or
Digitalis
in 7![.
v.
doses.
I have
found belladonna very useful, more especially if there is any tendency to constipation. It seems to
opium in quieting the peristaltic action without altogether checking.it; and is most useful for children, where intussusception is It gives the greatnot an uncommon affection. est amount of rest'to the ulcers without locking up the discharges. Digitalis is most useful for urinary complications, but I shall enter into this more fully directly. Salicylic acid has been much employed of late, but there are many and great objections to its It certainly reduces the pyrexia, but Muruse. chison found it caused delirium, albuminuria, and sometimes almost total suppression of urine. It has since been suggested that the dose used was too large, but it is certain that the drug is not act better than
tolerated
ference.
a
[August, 18S3.
enteric
in
cases as
it is in rheumatic
fever, and should, when used, always be given the form of
a
soda salt.
Relapses
are not
in
pre-
1883.]
August,
SAUNDERS ON
ENTERIC FEVER.
vented, and the tendency to epistaxis is increased ! by its use. The maximum quantity used should not exceed 4 not to
tion
give
on
drachms
daily, owing to the depressing acwhen given in sufficient quanti-
the heart
to have any effect on the temperature. Subchloride of mercury and iodine are both powerful antiseptics, the latter may be used as a
ty
medicine:?Iodine grs. ?i; of this 5 Tl^. in
vi,
water
a
Potass. Iodid. gr. xii, glassful of water
wine
every 3 hours may be given for some time. In enteric fever it is necessary to bear in mind that we have to deal with a lesion of the assimi-
lating organs,' chiefly directed
therefore
our
attention
to the diet ; and
we
must be
must
take
that the
patient only gets the simplest easily digested food, especially during the 2nd week, when the sloughs begin to separate. In the first place we must enforce physical rest by keeping the patient religiously in bed ; the bedpan should always be used, and the patient should care
and
most
not
allowed up for this purpose after the malady is recognised.
be
nature of the It is most
important kept in a state
tines be
tendency lessened
to
quiescence, will be
The diarrhoea if
and the
greatly
not exces-
by medicine, for it is pathological doctrine be
not be checked
alike wrong whichever the correct one. is
of
excessive diarrhoea
thereby.
sive, should
that the inflamed intes-
as
more
intestinal
"
undoubtedly milk ; but even given in too great quantity,
this must not be and should be ad-
ministered in small and stated
quantities, and at regular intervals ; should milk not be easily tolerated, soda water may be mixed with it to render it less rich, and.it would be best to give it while in a state of effervescence, with a small lump of ice added, if there be any irritability of the stomach. at once
rejected
In hot weather,
curdled,
or
if the milk is
it would be well to add
little lime water.
a
Avoid
bread, beef-tea, and the like, but a well whisked egg may be given once or twice a day. Tea and coffee also may be given in the early part of the day, unless the state of the nervous system contra-indicates its
use.
Dr. Parkes found that coffee increased the elimination of
urea
that it lessens tion.
in
fevers,
and there is
no
doubt
both drowsiness and prostrajellies must be rigidly
Animal broths and
excluded from the diet.
The nutrition of the
body must be maintained by appropriate food,? rice, milk, rusks and hot milk, blanc. mange, custard or even junket, rennetted milk, afford sufficient variety for milk diet. Dr. Parkes has shewn that there are theoretical objections to a purely nitrogenous diet in fever. It is doubtful if the disintegrating nitrogenous tissues can be fed, and in
the affected
generally believed, glands are throwing off some poison to be got rid of, why try and retain it to be again absorbed in the intestine as formerly recommended ? But if on the other hand, as is most probable, the discharge sets up a secondary ulceration by inoculation of those glands not involved in the first instance, what could be worse than to check the expulsion of that which leads to a prolongation of the disease, and increases the danger to the patient ? Lock up the bowels and keep them so," was most dangerous advice. The next most important point is to obtain physiological rest, as far as possible, by giving nothing that contains any indigestible matter?we must avoid giving any thing that cannot be digested and disposed of in the upper part of the intesIf,
The most suitable diet of all is
tinal canal.
but it is better
it at all
207
that
the albuminous food must
case
got rid
of
organs.
Milk is therefore
tea
article of diet in all fevers.
as an
Recovery attention
by
already
overtasked
be
glandular
preferable
to
beef-
from enteric fever is
to
fresh air and are as a
the
dependent on the smallest details ; simple diet wine rather than the use of drugs,
rule indicated.
Look well after the
bladder,
and
use
the cathe-
when necessary with the greatest care, as all the membranes arc in a most tender state?" use ter
a
gum elastic catheter with all and delicacy."? (Sir W. Gull).
soft
care
Give tea
mucilaginous drinks,
(infusion),
possible
rice water, linseed
and should the scorbutic taint be
present, lemonade made from fresh lemons, lime juce Cases
or
should be taken. should not be treated under
canvas
THE INDIAN MEDICAL GAZETTE.
2oS
when it
be avoided,
they do not get on changeable. Give plenty of fresh air however, and encourage the free use of diluents, to help in the elimination of the exaggerated metamorphosis in so
can
as
well if the weather is at all
the blood and tissues. in
In adults all fevers
grave proportion muscle and fat.?(Murchison). to
Success in 'treatment
the
are
of
development
depends
on
a
careful
attention to details ; and it may be said to resolve itself into and consist of simple measures and
Such then
diet.
simple
are
the
general
indications for treatment, but it will be^necessary to
modify
them
according
to
the stage of the
disease ; there is no doubt that the severity and danger of an outbreak of enteric fever may be
greatly diminished by appropriate treatment, the complications may be lessened, and even the duration of an attack considerably shortened. If early in the fever there is flushed face and headache, a high temperature and thickly coated tongue, calomel may be given with advantage in doses of 3 grs. More than this is bad.?(Parkes,
Wood). If the stools
are neither large nor very liquid, and don't exceed 3 or 4 in the 24 hours, it may even be repeated with advantage after a day or
two, but not oftener.
Calomel in doses of
from 1?3 grs. is recommended by some, even twice daily, associated with ipecac, when the stomach is not irritable.
following :?Blue pill grs. xii, Ipecac, gr. ii, Opium gr. ii, mixed and divided into 12 pills, and gives one of these every one Wood
uses
the
He says it modifies the temperachecks the ture, peristaltic action, and acts as a sedative. or
two hours.
Calomel is contra-indicated if the diarrhoea is
great,
or
if there be
bowels with
early
there is ansemia,
severe
colicky pains
in
and violent meteorism, or
hemorrhagic
the
01*
if
diathesis.?
(Aitken). It increases the evacuations after
its
during
but
the
12
hours
administration, purging. If the patient lies on his back with oppressed breathing, tumid abdomen, and projecting, but troublesome
never
sets up
[August, 1883.
without marked tenderness, and the bowels have not acted for 12 hours, or even if the stools be fre-
only a little faecal matter and wind time; in such cases great relief is obpassed tained by giving a draught of Castor Oil gii, with 01. Terebinthinae gi or gii. A warm enema is also good, but th^ draught is -better, unless contraindicated by suspicions of peritonitis?(Dr. J. Little, Dublin). A cold compress or a turpentine stupe is the best local application. Ipecacuanha in small doses, ]/x gr. to % gr. every 2 hours is useful, especially if there be any bronchial irritation, and this is most often present Dover's powder given in small doses at frequent quent
and
each
intervals is also very useful in some cases. Constipation, should it exist, must be overcome small doses of castor
by by
some
other
oil,
as
such
laxative,
noted
above, phosphate
as
or
of
soda. Looseness should not be checked unless the
stools
frequent or copious as to injuriously affect the strength of the patient. It may be stated generally, that so long as there are not more than 3 stools a day, astringents should be withheld. The diarrhoea is not entirely due to the actual bowel lesion, but is in part due to the irritation caused by the foetid discharges which it tends to carry off. It is therefore salutary so long as it is not severe enough to sap the patient's strength. If laxatives must be given, only those that are so
?
the upper part of the canal should be administered. Phosphate of soda is the best
act
on
?
it acts very gently, has very little taste, and is It may be readily taken not at all irritating. dissolved in a little warm milk or gruel, gss to
gii
for
a
dose, once or
even
twice
daily
as
required*
If the tongue be very red and dry, chlorate of potash will be found the best remedy. Sleep may be induced
by
a
draught
of Bromide of
Potassium gr. xv?xx and Chloral ?xv in peppermint water.
Hyd.
gr.
x.
Turpentine has been strongly recommended by some, and may be thus given Oil of 1 urpentine H[xv, Lucca oil TILxxv made up with mucilage. It is said to reduce the number of the stools, and lessen the
tympanitis,
and also
August, 1883.]
NEVE ON THE RADICAL CURE OF HERNIA.
wasting of the tissues, thereby obviating the necessity of giving stimulants.* It certainly reduces the tympanitis, and should be given when required for that ; but it is apt to prevent the
disorder the stomach, and there is also danger of its
causing strangury.
Tonics and stimulants
are
required
about the
week. Alcohol is the usual stimulant
3rd
ed, but
opium
doses.
full,
is also
nor
employ-
useful stimulant in small
a
It may be given when the pulse is not strong, and when cerebral symptoms do
not exist.
In
the latter
stages Tr. Digitalis may be doses every 4, 6, or 8 hours.
in n^v to It is known to be
ment, and induces bonate of ammonia is
subdues
sleep,
promotes
objectionable,
acting beneficially nervous
when
excite-
gentle perspiration.
Car-
useful after many diseases, it may irritate the bowels
so
as
and increase the diarrhoea. When the
is slow and feeble, and the
pulse
skin cool, the tongue and teeth encrusted with dark sordes, at an advanced stage of the fever, then stimulants
are
when the skin is
obviously necessary. frequent, and
pulse is feeble, yet hot, stimulants are
even
then
But the
known
to be of service ; but it is necessary to administer them with
great caution, and
to
watch the
and
effects
constantly closely. They are doing good if they lessen the pulse and increase its fulness and strength, if the skin becomes cool and moist, and if the delirium is subdued 01* moif refreshing sleep be
derated, and especially procured. The diet is
importance as in particularly in cases
of the utmost
the earlier part of the disease,
of the scorbutic type. In addition to lemonade, the juice of sweet fruits, or the very soft
fruits, or the pure jelly of ripe fruits, may be given, but fruit in its crude state is to be strictly withheld. A teaspoonful of lemon juice and water is
pulp
of
often necessary to moisten the mouth before giving food.
During
convalescence the
is necessary *
as
to diet and
Dr. P. L,
utmost
aperients.
O'Neile?Practitioner, 1S77.
caution
As
regards
diet.
Liebig's
Extractum Carnis
very valuable nutriment during the early part of convalescence. No solid food should be is
a
allowed until the
morning temperature has been normal for I week; and then commence gradually, giving a little bread at first, then fish or fowl, but no meat should be given until the evening temperature has been normal for a like period ; even then the food should be as free as
possible from Malt or on
given it
1.
209
liquor
an
excrementitious matters. should
not
be taken before
empty stomach, for it
food,
is liable to dis-
agree. 2. Do not interfere much with the but if necessary
use
castor
oil
or
bowels; simple ene-
mata
only. give the treatment for special and complications and sequelae, and I shall given all the treatment of the disease. (To be concluded.) I will
grave have
