INTESTINAL ILEMORRIIAGE. — When symptoms of haemorrhage appear, the patient should be kept quiet; the foot of the bed may be raised to prevent fainting, and blood which is passed through the bowels should be removed with as little disturbance as possible. All stimulants should be forbidden. Nerv ousness on the part of the patient will excite the heart and thus tend to increase the hemorrhage. An ice-bag may be placed on the right iliac fossa. Opium is the best internal remedy, for, while it lessens the peristaltic action of the bow els, it also quiets the patients. Turpen tine is thought by some to be especially valuable. Intestinal antiseptics, by re ducing tympanites, are of use in haem orrhage. Normal salt solutions in amounts of from 4 to G ounces, may be injected into the subcutaneous areolar tissue. Transfusion of blood is a diffi cult operation, and in the writer's experi ence has not been of much value.
The food should be given in small quantities and stimulants avoided. The bowels should be kept quiet for six or eight days. According to Lauder Brun ton, lime-water given during the course of the disease may prevent intestinal hemorrhage.
PERFORATION.—This very grave lesion has not been so far treated with much success. A low septic peritonitis usually follows, which is quickly fatal. The usual treatment is complete rest and the administration of opium or morphine hypodermically. Ice may be given for the dryness or the throat, and all food should, for a time, be withdrawn. If an early diagnosis is made, surgical inter ference is indicated. This procedure is warranted by the success which has so far attended early operative measures. (See STOMACH AND INTESTINES, SUR GERY OF, this volume.) The early diagnosis of perforation has, in one or two cases, been confirmed by making a blood-count and finding a great increase in the leucocytes. Unfortu nately, rupture may take place without increased leucocytosis, and the latter condition may arise from other local in flammations when there is no perforation.
The operation should be performed as early as possible after the symptoms of shock have passed away. Keen states that the second twelve hours after the accident have been shown by statistics to be the most favorable time. The fol lowing statistics, taken from Keen's "Sur gical Complications and Seguehe of Ty phoid Fever," show the danger of delay in this operation:— Keen states that if the operation is not done within about twenty-four hours after the accident there is practically no hope of recovery.
Appendicitis may occur as an acci dental complication of typhoid fever. and as such bears no other relation to the typhoidal infection. It may appear during the course of typhoid fever and be caused by conditions engendered by both local and general infection by the bacillus of Eberth.
Patients are sometimes met with who a re suddenly ta ken ill with symptoms unmistakably appendicular in character, but which gradually subside and are merged into a typical typhoid, which then runs its usual course.
While the occurrence of an appendi citis in the course of typhoid fever may be accidental or causal, yet it is the third condition mentioned which is most puzzling to the physician, and demands a great deal of care to prevent him from falling into the error of advising an operation upon an appendix situated near, and irritated by, specific lesions in and about the head of the colon. C. J. Aldrich (Cleveland Med. Gaz., Jan., 1901).
The mortality of enteric fever is from 7 to 14 per cent. Of the fatal cases, 50 per cent. of the deaths are due to asthenia, 25 per cent. to perforation, and 25 per cent. to haemorrhage and other accidents. Of the deaths which are due to perforation, by means of early operation after an early diagnosis, between 30 and 40 per cent. may be saved. Ont of 11 cases operated upon in the Johns Hopkins Hospital since January 1, 1900, 5 recovered. Osier (Lancet, Feb. 9, 1901).