In fulfilling the second indication, in addition to judicious and efficient bath ing, packing, or sponging with cool water sufficient to moderate the high fever, heat, and promote natural metab olism and excretion, these effects may be further promoted by giving 1 or 2 grains of calomel every two hours until the bowels are moved by it, which will generally be within the first twenty-four hours, and during the same time a mixt ure of equal parts of liquor amnion. acetatis and spt. of nitrous ether may be given between the closes of the calomel. This may be continued after the opera tion of the calomel with the addition to each dose of 2 or 3 minims of the tinct ure of aconite-root so long as the skin remains hot and dry and the pulse firm under pressure. If the small doses of calomel fail to move the bowels within the first twenty-four hours they may be aided by a full rectal enema of warm water holding in solution 2 drachms of chloride of sodium (common salt), which will generally be followed by free evacu ations of both faces and urine.
If the patient passes beyond the first week without excessive delirium or pro found stupor, with a temperature not above 104° F. and a pulse not above 120 per minute, little else is required besides a faithful continuance of the hygienic measures already indicated, with the aid of mild diaphoretics and an occasional enema of warm water and salt when needed, and the patient will pass the crisis near the end of the second week in safety. But if at any time after the first five days of the attack the pulse be comes softer and more frequent, with less force and steadiness of cardiac sys tole, less depth of inspiration with less resonance over the lower and posterior parts of the lungs, and increasing stupor or muttering delirium, the aconite and diaphoretic mixtures should give place to efficient doses of strychnine in solu tion with nitric or nitromuriatic acid every four hours, and half-way between 10 grains of hyposulphite of sodium and 5 minims of tincture of belladonna in solution in mint-water. There is, prob ably, no other remedy known to the pro fession that is more reliable for main taining the sensibility and action of the respiratory, cardiac, and vasomotor nerve-centres and ganglia than strych nine given in solution with a mineral acid, especially in the advanced stages of typhus and typhoid fevers. And I
know of no more efficient antiseptic or antidote for the toxremic agents pervad ing the blood and tissues of such pa tients than efficient doses of the hypo sulphite of sodium.
If, as occasionally happens, the bowels become too loose, the hyposulphite should immediately give place to an emulsion of oil of turpentine and oil of wintergreen, to each close of which from 5 to 10 minims of tincture of opium may be added. On the other hand, eases are sometimes met with presenting an anxious expression of countenance. very frequent pulse, and continued insomnia or sleeplessness, in which a powder corn posed of Dover's powder, 10 grains; pul verized gum camphor, 2 grains; and calomel, 1 V., grains, given in the even ing, will produce several hours of natural sleep followed by decided improvement in the condition of the patient. When the stage of convalescence is reached, no other treatment is required except to in sist on the continuance of rest, good air, and easily digestible food, until a fair degree of nutrition and strength has been regained.
UREMIA.—Urmia is the term which is applied to a group of nervous symptoms supposed to be produced by the retention in the blood of excrementitious sub stances normally excreted by the kidneys, or when there is interference with the secretion or the discharge of the urine. It is met with in Bright's and other dis ease of the kidneys (cancer, tubercle, suppuration, etc.), and in cases of anuria, obstructive or non-obstructive, in preg nancy and in parturition.
Symptoms.—All the nervous functions may be involved in urwmia. The prin cipal cerebral and mental derangements are drowsiness, stupor, coma, and delir ium. The most common disorders of the sensory functions are pain, especially in the head, sometimes very persistent and intense; dimness of sight, or actual blind ness of one or both eyes, sometimes at tended by albuminuric retinitis or in some cases without retinal lesion; tin nitus aurium, and sometimes deafness. Among the disorders of the motor func tions, the most important arc involuntary muscular twitchings or general convul sions; the tendency to vomiting; and not infrequently extreme dyspnwa. By close observation we distinguish two forms of uraemia: the arnle and the chronic.