The medical treatment of typhoid fever / by James Stewart.

  • Stewart, James, 1847-1906.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The medical treatment of typhoid fever / by James Stewart. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    G The marked stimidating effect of the cold on the peripheral nervous system, and reflexly on the nerve centres, is undoubtedly a powerful means in preventing the supervention of a low typhoidal state, which is so common a fealui'e of severe cases treated on the expectant plan. Kohin has shown that the processes of oxidation are decidedly reduced tluring the course of this disease. He has further pointed out that the jold bath increases oxidation, there being a distinct increase in the exchange of gases and in the whole process. He considers that the beneficial effects of cold bathing are due to this increase of oxidation, whereby the toxic products of the tissue destruction are reduced to less harmless excretory bodies. Whether the leucoeytosis observed after bathing has any influence, has not yet been determined. Tlfii: TitBATMENT QF liNTBSTlNAL HAEMORRHAGE. Intestinal haemorrhage is, next to perforation, the most common alarming symptom in typhoid fever. In our eighteen fatal cases it was the cause of death in three instances (l.G per cent.) We had in all 13 cases of haemorrhage in the 408 cases (3.18 per cent.) It is not infre- quent to meet with concealed haemorrhage. This occurred in a good many cases. A sudden fall in temperature should always be looked upon as srispicious of the occurrence of a haemorrhage, even if no blood appears externally, if there is no other likely cause for the sudden lowering of the temperature, the condition should be treated as one of haemorrhage. Haemorrhage in typhoid fever is frequent enough to constitute it a symptom, rather than a complication. No doubt one frequently sees cases where a slight haemorrhage appears to be beneficial, convalescence setting in apparently soon after its appearance, still it is always wise to take a serious view of even a trifling haemorrhage and to place tiie patient at once under such measures as are suitable. In a few cases, haemorrhage from the bowels appears to be a simple oozing from the blood vessels. In cases of profound toxic poisoning, t;.‘c blood breaks down and finds its way out of the vessels without any special lesion of continuity of the vessel walls. Even severe losses of blood ]uay not be attended by fall of temperature, as much as 80 ounces in tliree days having been lost without affecting the temperature. In dealing with haemorrhage it is important to lessen the amount of nourishment given by the stomach, or wholly stop feeding except by iiie rectum. The foot of the bed should be elevated and a Letter’s metallic coil applied to the abdomen. There is no remedy to be com- l)ared with opium. It should be given in doses sufficient to cause either slight drowsiness or contraction of the pupils. It is often a difficult point to decide how far it is advisable to push opium in these cases. The reaction following the effect of large doses, given for some days.