The mortality of the operation has been considerably reduced by resorting to the Fowler-Murphy after-treatment. The patient being placed in bed and supported by pillows in the upright sitting posture, warm normal saline solution is permitted to flow guttatim into the rectum from a reservoir through a rubber catheter, by which means up to i gallon of the solution may be administered during the 24 hours for several days.
complication must be dealt with on generally ac cepted therapeutic principles. Its presence in typhoid fever should be accepted as a clear indication fur pushing hydropathic measures com bined with the free administration of Alcohol, and at a later stage Strychnine hypodermically should be administered every S hours in doses of at least gr.
Spinal Complications.--'` Typhoid spine " is the name given to a chronic complication which is rather of the nature of a sequela. The pain in the spine and back muscles may remain severe for many months, and the rigidity and tenderness of the vertebral column may be associated with cord symptoms. The only treatment for this tedious condition is pro longed rest in bed followed at a later stage by gentle massage and exec tricity. The same remarks apply to those forms of both multiple and solitary, which often manifest themselves in the convalescing stage of the disease.
plugging of the veins of the lower extremity caused by phlebitis is a serious complication, unless when treated by prolonged rest, owing to the danger of the detachment of the clot, which may cause sudden death in the convalescent period. Friction should never be employed, but a thin layer of absorbent wool being placed round the limb, this may be covered in by thin mackintosh sheeting, and a many-tailed bandage applied with moderate pressure from the toes to the groin. By raising the foot of the bed for , to 6 inches the circula tion in the limb is materially assisted. When the pain is severe over the inflamed vein, any local anodyne application as the Liniment of Belladonna may be painted on the skin or an ice-poultice may be applied.
In order to diminish the tendency towards clotting Lemon Juice may be administered to decalcify the blood, or the Citrate of Potash may be prescribed as an effervescing mixture.
is this troublesome or prominent unless food has been too earnestly pressed beyond the digestive capacity of the patient, and it may be well to remember that some individuals can never take milk in health. By diluting the milk after peptonisation with Potash or Soda Water, the vomiting is often arrested. The writer has found the artificially prepared Koumiss to act most satisfactorily when milk and even soups could not be tolerated.
Champagne is a favourite remedy, hut it frequently sets up fermentative changes in the stomach, which aggravate matters. A tablespoonful of old Brandy in a large wineglassful of iced Apollinaris Water is better. Small pieces of ice may be swallowed at intervals, a sinapism to the pit of the stomach and a minute perle of Morphia gr.) may he given every
4. to 6 hours. When the vomiting is continuous, food by the mouth must be stopped for 12 hours, during which rectal feeding should be employed. On the return to mouth alimentation the best plan is to commence with small doses of cold strained whey made by adding one wineglassful of Sherry to a pint of boiling milk.
Re/apses of typhoid fever arc to he treated like the primary attack, and if the patient has been permitted to indulge in solid food, to leave his bed or to relax any of the precautions already insisted upon, his liberty must be immediately restricted, and he should commence the treatment lc novo.
To prevent relapses, the patient should never he permitted to sit up or leave his bed for at least LI days after the morning and evening temperatures have returned to the normal.
The following quotation from the late Dr. l;ristowe is still worth perusal: " Let me state briefly the treatment to which I should like to be subjected if ever, unfortunately, I should become affected with enteric fever. I should like to be placed in a cool, well-ventilated room and covered lightly with bed-clothes, and to have a skilful and attentive nurse to look after me; to be fed solely with cold milk, unless vomiting should demand the addition to the milk of medicine calculated to allay vomiting. If diar rhoea became troublesome, or if ever there was much pain or tenderness in the ctecal rings and in the bowels, I should like to he treated, not with laxatives, but with Opium, given either by the mouth or by the rectum. If constipation were present, I should, excepting in the first week, like to have enemata only employed for its relief. In the event of intestinal haemorrhage coming on, I should like to have ice to suck or ice-cold fluids to drink, cold compresses to the belly, and cold injections into the bowels; and, though I am sceptical as to their efficacy, I should still choose to have astringents, and more especially Lead, given to me at short intervals. If perforation should take place, let me have large and repeated doses of Opium. Stimulants I should prefer to do without early in the disease; later, however, and during convalescence, I should like to have them in moderation, As to the cold baths, I would rather not have them, but I would nevertheless leave it to my physician to exercise his discretion in the matter. I would leave it also for him to decide, according to circumstances, whether alcohol should he administered to me in large quantities. I would prefer not to be treated at a temperance hospital." The quarantine period in typhoid fever is usually stated as three weeks. Owing to the danger of dissemination of the disease by bacilli passed in the urine long after convalescence, the greatest care should be exercised as regards infection from this source as well as from the feces.