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The General Treatment of Sumption

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THE GENERAL TREATMENT OF SUMPTION.

For a disease of so much variety of symptom and complication and emergency, it is impossible to lay down anything but the most general lines on which to proceed.

General Rules. — The consumptive should live a methodical, regular life.

The diet should be generous, rather than restricted, should contain abundance of milk, eggs, bread, and butter, as well as meats, vege tables, and fruits. The meals should be sepa rated by 4 or 5 hour intervals.

The bowels must be kept regular, for which a rhubarb pill or tabloid will suffice.

Clothing should be regulated by the weather, flannel or woollen always being next the skin. Care should be taken that the feet are well pro tected by stout boots when the patient is able to move about. Women should abandon corsets and all tight clothing that restricts the play of the chest, and should never wear low dresses.

Bathing of the skin should be regularly at tended to; sponging the whole body down with tepid water and following with a good rub being daily performed. Bathing in the open is to be avoided.

Occupation. — As far as possible fatigue should be avoided. Consideration should be given to the character of the occupation, spe cially as regards its freedom from dust, and the ventilation and openness to sunlight of the place where it is carried on.

Exercise in the open air is desirable, if possible, but it must be regulated by its effects on cough and temperature. No violent exercise should be engaged in, and nothing involving strain or holding the breath. Cycling must be prohibited.

The home of the consumptive should be selected, as far as circumstances permit, in as open a district as possible, on elevated ground with a porous soil. The larger the rooms the better, so situated as to be daily flooded with light. The patient's room should be warm, as far as possible kept between 54° and 60°, but well ventilated by windows constantly open, the bed being so placed that it is not between window and door, or window and fire, and therefore not in a draught, but yet perfectly open to the fresh air.

Climate.—In general the country is to be preferred to the town, inland to be preferred to the sea-coast, and a high level to be preferred to a low. But the high level should be open, not surrounded by hills, open moorland, for instance. A sea voyage of some duration is an exceedingly good aid to recovery in some cases of consumption. In selecting a climate for either a temporary or a lengthened stay, the things to take into account are the amount of sunshine, the dryness of the air, the free dom of the air from dust, the absence of great oscillations of temperature. Patients in early stages of consumption, who are able, and propose to go away for a prolonged period, should, in selecting a climate, consider whether the place they select might, if it suited them, be a place in which they could subsequently settle. Davos, for instance, among the Alps,

may be very beneficial, but the descent from there is apt to be followed by a return of the disease. On the other hand, Denver, in Colo rado, and many places in California afford plenty of opportunities for settling down in business if the place agrees.

Special acute cases must be treated in bed, though, if the house and situation permit it, the bed may be outside, pro tected from wind and rain, the patient being thoroughly well covered up, head and neck as well as body, and the feet kept warm by a hot bottle. In such cases also the diet must be liquid, milk and soups, solids being gradually added as improvement takes place. The patient should not be permitted out of bed so long as fever exists to any noticeable amount.

Fever is best treated without drugs by tepid sponging of arms and legs, or the whole body, repeated as often as necessary, the water being at a temperature of 75°, and from time to time lowered till water at 60' is used if the patient bears it.

Cough.—The treatment of cough will de pend on its character; the irritable, dry cough being relieved by inhalations of steam, medi cated with compound tincture of benzoin (a tea-spoonful to an inhalation) with euca lyptol, menthol, creasote, camphor, &c. Some form of opium may be necessary, but it should be avoided if at all possible. A codeia pastille should first be tried, or some one of the numer ous pastilles now obtainable from druggists.

Sweating.—Sponging with vinegar in the water should first be tried, a tea-cupful of vinegar to a pint of water. If that fails, a pill of to I grain extract of belladonna, or a,. grain of its active principle—atropine—may be tried.

Diarrhoea may be due to the irritating character of the bowel contents, if it is not dependent on ulceration already present. In either case the bowel will be soothed by each morning securing that it is swept clean of such matters. For this 1 tea-spoonful of castor oil, with or without 5 drops of laudanum, may be effectual for a long time, provided the diet is carefully regulated. If this does not suffice, the usual remedies for diarrhoea (p. 242), be ginning with bismuth, may be tried.

Pain iu the chest may require poultices, blisters, or sedative drugs, but which of these will depend on the condition of the patient.

Bleeding.—The treatment is noted on p. 370. The hypodermic injection of grain of atropine, with or without a small dose, ith grain, morphia, acts with great rapidity, and often with remarkable success.