Vegetable and mineral astringents of all kinds are to be condemned; they are not only useless, but positively injurious, as they upset digestion and may cause vomiting. Oil of Turpentine is still administered by many physicians, but it never reaches the bleeding-point except in such a state of dilution as to be useless as a haemostatic. Ergotin and its derivatives Ernutin, Cornutine, Ergotoxine, Sclerotinic Acid, etc.—are advocated, but the rise of blood-pressure which follows the administration of these sub stances, either by the mouth or hypodermically, may more than counter balance any haemostatic action which they exercise on the eroded vascular walls. For the same reason alcohol should be suspended or given only in such amount as will help to keep the patient alive till the dangerous period is tided over. Strychnine hypodermically may be substituted for it if the heart has been flagging.
Gelatin possesses undeniable haemostatic powers when injected hypoder mically; 3o grs. dissolved in normal saline solution may be injected every hour in severe hemorrhage, provided the gelatin is thoroughly I sterilised. Tubes of sterilised gelatin solution are obtainable for addition to boiled water or normal saline, and the solution may he injected up to the strength of 2 to so per cent. In the former case the contents of the tube is dissolved in 5 oz. water, and in the latter it oz. water is employed.
Gelatin is, however, of considerable value when administered by the mouth and in the form of a cold, slightly sweetened jelly; it should be given every 5 to so minutes in tablespoonful (loses in every case as soon as any blood appears in the motions.
this is moderate in severity it always responds to the cold pack, sponging or bathing. The severe head pain which ushers in the grave cerebral type of typhoid fever at the onset must he met by the agents mentioned under I /elirium. Cold affusion, Leiter's Tubes or the ice-cap will be indicated, with smart counter-irritation of the nape of the neck. Leeching of the temples may he necessary. Antipyrine (io grs.) combined with 5 grs. Citrate of Caffeine may he tried every 4 to 6 hours. Quinine always aggravates the condition. If in the very early stage, io grs. Calomel may be administered, and sometimes relief may be obtained at this stage of the disease by plunging the legs into a hot mustard hath.
Heart prolonged continuous fever tends to cause serious myocardial degeneration, hut even before there is time for this the action of the toxins on the heart may become marked. Digitalis, so valuable in other forms of cardiac weakness, must he regarded as powerless in the condition under consideration, and the same remark applies to Strophan thus. Whether it is owing to the high temperature or to the poisonous
action of the toxins, the entire group of cardiac tonics has been tried in vain, some of them having been administered in enormous doses without effect.
The only drug to be relied upon is Strychnine, and this appears to have practically no action on the cardiac muscle or nerve apparatus, unless when given hypodermically in doses of at least to gr.
Alcohol acts as a cardiac stimulant, and, as already pointed out on a previous page, its administration in continued fever is maintained to be the best method of preventing cardiac failure and of aiding the weakened ? cntricle to do its work once it has been crippled in the general toxaemia.
There cannot be a doubt that the lessened mortality following hydro therapeutic measures is mainly due to the cardiac tonic action of cold-water treatment by packs, baths or sponging. It is much more rational to attempt to prevent the serious poisoning of the cardiac muscle by an early resort to the use of agents which reduce the temperature, promote elimina tion of toxic products, and strengthen the ventricular contractions, than to wait till the toxemia has already occurred and commence pouring in alcoholic stimulants.
has already been dealt with in detailing the bath treatment. The only way to save life is to abandon all hope of reducing the temperature by means of drugs, and to resort immediately to the cold bath, cold pack, or cold affusion. The speediest, most convenient, and most reliable method of dealing with very high temperature is by a combination of the pack and affusion, which can he carried out in a few minutes without disturbing the patient's horizontal position. By placing him in a sheet wrung out of tepid water on a straw palliasse or wire mat tress, tepid gradually changed to cold water should be liberally poured over the sheet and allowed to flow into a receptacle by the foot of the bed till the rectal temperature falls to about ioo°.
Insomnia.—The treatment of the sleeplessness occurring in typhoid fever may be relieved by any of the hypnotics mentioned in the article on Insomnia, but as this condition is due to the poisoned blood circulating through the brain, which influences the thermic and higher centres, the free resort to cold sponging or the pack is more rational than the administration of narcotics. Often the patient falls asleep in the pack or soon after coming out of it.