COMPLICATIONS.
The treatment of the various complications occurring during an attack typhoid fever is to he conducted upon the generally received principles of therapeutics, modified, however, by the presence of the primary zymotic condition. For convenience these may be briefly referred to in their alphabetical order regardless of their frequency or importance.
Bedsores.—Upon p. 76 the treatment of this condition will be found in detail. Bedsores should never be seen in typhoid fever patients where skilful and conscientious nursing has been carried out; on rare occasions their occurrence may he pardonable where a perforation prohibits the slightest change of posture of the patient's body. Frequent changes of soft linen or cotton draw sheets, which should never be permitted to rease, are of vital necessity. The use of mackintosh sheeting is answer able for much mischief; when such is employed it should not be placed in contact with the patient's skin. Tioggs has pointed out that the frequent baths and packs render the skin more liable to abrasions, and he urges the necessity of adding Alum to the water in every case.
Constipation.—This must be avoided for two reasons—the hard faces may seriously irritate the ulcers when these are lower down than usual in the colon, but a very much more serious objection to constipation is the difficulty which the patient experiences in the bearing-down efforts at defecation. During the increased abdominal pressure the floor of a deep ulcer may give way and cause perforation; this is more likely to occur on the bed-pan than on the night-chair. The cast-iron rule of some physicians that under no circumstances whatever is the patient to be allowed out of bed to use the night-chair is certainly the cause of some deaths from perforation, especially when constipation is present.
The only safe drug is castor Oil, and a small dose every day or every second day should he given in obstinate cases. The writer's dose is t fluid dr. given in two soft gelatin capsules. Pure Paraffin in tot oz. doses often acts very satisfactorily. A large soap and water enema is preferred
by some, whilst others employ the routine of a Glycerin suppository. Any or all of these methods may be employed in a given case and at the same time. Thus, should the oil fail to act, a suppository should be inserted, and if this does not start the bowel the nurse should be ready to ad minister a soapy injection whilst the patient is placed on the bed-pan. Goodall administers the soap by the mouth, since his favourite mixture is an emulsion of olive oil (to oz.) with liquor potassx (1 oz.), which is really a strong solution of soft soap, but the writer has no experience of how the stomach tolerates this compound, which is recommended in -oz. doses 3 or 4 times a day to keep the motions soft.
The plan of administering calomel and saline purgatives for the con stipation sometimes occurring during the third week of the fever is a dangerous practice.
Cystitis and Retention of Urine.—The former, if due to the presence of the typhoid bacillus, should be met by to-gr. doses of Urotropine thrice daily. When the result of other infection, it is always caused by the use of an uncleansed catheter which has been passed to relieve a temporary retention, in which case the urotropine should also be administered. Washing out of the bladder is never necessary when rigid sterilisation of the instrument has been employed.
A note of warning is here necessary to the Young practitioner as regards the diagnosis of retention in typhoid. and the writer regrets to say that he has witnessed the overlooking of this grave condition in more than one instance by experienced practitioners, with disastrous result.
In no other affection is the dribbling overflow of a distended bladder so liable to be mistaken for incontinence of urine, as the tympanites often prevents the palpation of the distended organ even when this rises as high as the umbilicus. If the attendant is in doubt he should invariably resort to the catheter, and he will never regret using the instrument.