Two moderately small beds, of precisely the same height from the floor, should be provided, so that, when drawn up exactly alongside each other, the patient can be shifted from the one to the other as safely as from one part of a large bed to the other. There is nothing so suitable as a firm straw palliasse, with a good hair mattress upon the top. A wire mattress instead of the straw palliasse is preferred by some as being cooler, but it lacks in firmness. The bed should be so placed—not in a corner—as to permit of the nurse and physician being able to walk all round it. Everything in the shape of hangings is to be forbidden. The bed-clothing must be light, and it is a good plan to replace the ordinary counterpane by a linen sheet, which can be frequently renewed. Mackintosh sheeting underneath is to lie regarded as a questionable adjuvant, but abundance of draw-sheets should be available.
The patient should he clad in a loose linen night-shirt, which must open down its entire length in front, sometimes a very thin woollen garment fashioned on the same principle may he substituted when there is con siderable perspiration.
As skilful nursing is of much more importance than drugging, the services of two experienced nurses, one for the day and the other for the night, are to be secured, when possible, and it should be insisted that they regularly keep up a written report or journal of the temperature, bowels, closes, nourishment, etc. In summarising the effects of different treat ments and in arriving at a conclusion about the advisability of altering any of the details of treatment in a case, it is essential for the physician to have a chart before him giving him a graphic or bird's-eye view of the variations in the temperature and number of evacuations passed daily.
The patient should be educated to the use of the bed-pan and the urinal from the start of his illness in order to secure the maximum of absolute rest in the horizontal position. If these utensils be first insisted
upon after the patient has entered upon his second or third week in bed, lie cannot use them to advantage owing to muscular weakness.
Cases where perforation, ha:morrhage and death have followed the exertion of the patient's getting up to the night-chair arc numerous.
It must, however, be acknowledged that the bed-pan is the weatest difficulty in the nursing of typhoid fever; some patients cannot tolerate its use, and in some cases the physician may feel himself compelled to select the lesser of two and permit the patient to be assisted to the night-chair. Straining on the bed-pan must he avoided by the prevention of constipation, and a small enema or a Glycerin suppository judiciously administered often settles the bed-pan difficulty.
Ewart points out the importance of keeping the patient as much as possible lying in a position of slight inclination towards the left side. This is effected by putting a bolster under the right side of the mattress, so as to prop the body forwards, or by raising the two right feet of the bed on blocks whilst the patient lies on his back. the object being to cause emptying of what he calls the cf.ecal pool— the retention of the liquid faces in the right iliac fossa, which he believes causes the toxic typhoid state. The entire body may be sponged daily in detachments, a little Permanganate solution being added to the tepid water.
A linen draw-sheet should be constantly worn, and scrupulous cleanli ness insisted upon. It is necessary, as already mentioned under prophy laxis, to have the motions disinfected by some antiseptic as Chlorinated Lime, Terebene, etc., as soon as they are passed. One of these may he placed in the bed-pan and urinal each time before being used. The soiled bed linen should be soaked in a bath of weak carbolic acid solution.