Delirinm.—This is often in proportion to the intensity of the fever, but it may be an indication of a grave general toxaemia when the pyrexia, is moderate. The best routine is cold sponging, cold packs or tepid baths. In the fierce delirium which sometimes characterises the onset of fulminat ing cases the ice-cap to the shaved scalp is clearly indicated, and this appliance may be employed for the relief of delirium occurring in the third week. Cold allusion is a powerful agent, and may be resorted to when the fever is high. A sinapism to the nucha and large doses of Bromides may be advantageously employed. Alcohol must be used with great caution in such cases. Any possible source of the delirium should be sought for; thus it may be the result of a distended bladder or of pneumonia.
Oiarrhwa.—This troublesome symptom should only give the physician much anxiety when the motions become very frequent, foul and watery. When but 3 or 4 fluid motions are passed during the 24 hours the diarrhoea may be let alone. The evacuations should, however, always be inspected carefully with the view of detecting the undigested casein of the milk; should this he present it will he visible in the form of small curds, and is a clear indication for the peptonisation of the milk and a reduction in its amount.
Soups, beef tea and farinaceous foods should be stopped; the only starchy food which is admissible is a good brand of Arrowroot, made thin with peptonised milk or whey. Pure Gelatin may be advantageously administered as a jelly in doses every hour.
The old practice of drenching the patient with vegetable astringents like tannin, catechu, kind and rhatanv, and pouring in solutions of lead, copper sulphate, alum, etc., upset gastric digestion, and often aggravate the condition. Calcium Salts are less objectionable, and mild diarrhoea may be controlled by a free dilution of the peptonised milk by Lime Water. Sometimes Chalk Mixture with Bismuth Carbonate is an efficient astringent.
As the main element in the production of the diarrhoea is exalted peristaltic action, Morphia or Opium is the most reliable agent when given in small and frequently repeated doses, but it is a mistake to paralyse and lock up the bowel, which like a stagnant cesspool may remain full of poisonous toxic products, the absorption of which increases the dangerous toxemia. The ideal' treatment should be to restrict the over-active peristalsis by small doses of Opium, and to reduce the source of the primary irritation by combining with the narcotic an intestinal antiseptic as Calomel in I-gr. doses, Creosote, Carbolic Acid (2 mins.), Salicylate of Bismuth
(2o grs.), Beta-naphthol (I o grs.); or the Euchlorine mixture may be tried. In obstinate cases the writer has found the following combination very efficacious: . Tannalhin gr. x.
31orphice Hydrochlor. gr.
Bismuthi Carb. gr. xx. Misce.
Fiat pulvis. Mille xii. Signa.—" One powder to be given three or four times a day wrapped up in moistened wafer paper." Where there is much tenesmus, the opium may be given in the form of Laudanum (3o mins.) by the bowel with 3 or 4 oz. thin starch.
When the above measures fail irrigation of the colon may be tried ; a large enema of very hot water ° ) is employed by Geissler. Teissler recommends cold water, and Shuell passes up a soft rubber tube to the sigmoid, and irrigates the entire colon from a reservoir containing sterilised warm water. These measures are, however, attended with some degree of danger during the ulceration of the colon in the third week of the disease.
from the bowel may prove fatal, and should always demand prompt attention, especially as a small external haemor rhage may be accompanied or followed by a large outpour of blood into the small intestine or upper part of the colon. The most absolute rest to the body is imperative, and where there is any difficulty in the use of the bed-pan this should he discarded and the patient permitted to pass his motions into oakum or cotton-wool packed loosely about the anus. Cold should be applied to the abdomen by covering the skin with a double ply of lint containing small pieces of ice between its folds. In severe cases a hypodermic of Morphia (1 to gr.) should be given without delay, in order to paralyse peristalsis. Adrenalin is not to be relied upon. as it may he absorbed by the stomach. and by increasing the blood-pressure may cause increase of the bleeding.
Chloride or Lactate of Calcium is the only hiemostatic of any value; it not only increases rapidly the coagulability of the blood, thereby favour ing clotting at the site of the haemorrhage, and sealing up the mouth of the eroded bloodvessel, but it acts as a tonic to the heart without:markedly increasing blood-pressure. The chloride should be given in zo-gr. doses every two hours in solution in chloroform water. i dr. may be injected into the rectum, and in desperate cases life may be saved by dissolving the drug in 4o oz. Normal Saline solution, and injecting this quantity hypodermically into the loose cellular tissue in different parts of the body.