A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.
- Date:
- 1887
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![containing Peruvian balsam, 1-B0.* If tbe bed-sore be extensive, dusting with iodoform is very efficient treatment. We should be particularly careful not to let the skin be undermined. If this has already occurred, we must be prompt in the use of the knife or drainage-tube. We can not recommend too strongly that the mouth should be kept clean. In a light case the patient can see to this himself, but otherwise the mouth and tongue must be frequently cleansed with a linen cloth wet in cold water or a solu- tion of borax (1 to 30). Perhaps we need hardly repeat the reason for this exces- sive cleanliness. It lies in the causative relation between stomatitis and inflam- mation of the parotid gland, and of the middle ear. If the tongue and lips be dry, they may be touched with glycerine. The diet must be at once liquid and nourishing. Milk is excellent, and should always be ordered, hut will, unfortunately, be taken by very few patients continu- ously. It is often better borne if coffee or a little brandy be added to it. Cocoa made with milk may also be given for a change. In severe cases Nestle’s food (Kindermehl) has been often employed by us with benefit. Broth and soup, thick- ened with sago or rice, are also good. They may be made more nourishing by adding an egg to them. If the patient is very anxious to have more solid food, as often happens, we need not hesitate to give him a roll or rusk (Zwieback) that has been softened by soaking. If a patient becomes exceedingly enfeebled, we should give him fine shavings of raw beef, regardless of the fever. A little dilute hydrochloric acid might be given with the meat. Beef-tea would be still better than the raw meat, and is to be strongly recommended. The various prep- arations of meat which are now made (meat-solution, meat-peptones, etc.) may he sometimes useful. Where the fever takes a sluggish course, we must often begin to give stronger nourishment before the fever has ended. The best drink is cold water, which the patient would often not think of using unless we offered it to him. Lemonade and similar preparations generally become distasteful in time. Drinks containing carbonic dioxide are to be avoided, because they increase the meteorism. Cold tea with milk is good. In all severer cases we should give some good strong wine, such as port, Malaga, or Hungarian wine. If the patient desires beer, we need not hesitate to give it in moderate amount. During conval- escence we should be very careful about diet, since errors often have disagreeable consequences. We must wait till there has been no fever at all for seven to ten days before we allow a solid, animal diet, and return by degrees to common sorts of food. [The chief indication of beginning convalescence is the absence of febrile move- ment. It is not customary with us to wait so long as the author advises before allowing the patient to take solid food. Simple articles of food simply cooked should be selected, and the change from liquid to solid food should be made cau- tiously ; hut beef-steak and the like can be safely given in very many cases from the beginning of convalescence. There is little or no reason to think that proper solid food has any influence on the occurrence of relapses, though an error in diet may cause a temporary recrudescence of the fever.] The general and dietetic treatment which we have thus far discussed is very important. Outside of this, it is our opinion that there is only one method of treatment to be chiefly considered—at least under the present limitations of our therapeutic ability. This method consists in the persistent use of cool baths, as first practiced by Brand in Stettin. We do not indeed believe that the indications for this method of treatment are exactly what its original promoter held them to * The unguentum balsami peruviani is made by mixing one part of balsam very exactly with thirty parts of the glycerite of starch (B. P.). It is not officinal in Germany.—Trans.](https://iiif.wellcomecollection.org/image/b21981565_0052.jp2/full/800%2C/0/default.jpg)
