6
"
along the side of the glass without disturbing the liquid. Allow to stand a little if no shade appears at once.
Urine
Nitric Acid
Suppression of urine, partial or complete, occurred in a fairly large proportion of the cases, and the latter was always fatal.
Hiccough is fairly common, and often very troublesome. The cases which I saw varied very much in severity from those which were convalescent after 24-48 hours to fatal cases of collapse, hemorrhage, or suppression of urine. There are others which, with their complications, extend over a period of several weeks.
I was fortunate enough to see Dr. Thomas make several post-mortem examinations, and he also showed me patho- logical specimens in his laboratory which had been previously obtained.
In the post-mortem rooms jaundice was marked, and the viscera were tinged yellow in varying degrees. .
Fluid found in the peritoneum, pleuræ, and pericardium was also yellow.
The contents of the stomach varied from clear fluid with a few black flakes to distinct "coffee ground" vomit or very dark grumous material. The stomach walls were con- gested and showed hæmorrhagic spots. Ruga were markedly (It has been stated that the appearance of noticeable. the Ruge, like a bundle of Ascarides, is typical of the disease.) The kidneys were in all cases much congested and, in one instance, showed petechial hemorrhages under the capsule.
Hæmorrhages of this description were also seen under the visceral layers of the pleure and pericardium.
The liver always showed fatty changes but not always the typical "boxwood" instance of this was observed.
appearance, although one very good,
4. Treatment. From all the information I could obtain, I gathered that rest, as absolute as was possible, should, in this most exhausting disease, be given, in order to conserve the strength, and that, therefore, efficient nursing was one of the most important items.
A very great point is to get the patient as early as possible in the discase, the mortality being very much higher in those who have delayed seeking skilled advice. When seen early
the induction of sweating by means of a foot bath, with or without mustard, hot drinks, and blankets, &c., is often very useful and gives great relief; but, unless the case is seen then, this procedure is too exhausting and is associated with some dauger.
Drugs such as Phenacetin, Antipyrin, &c., are looked on as too depressing and are not used, but a dose of Pyramidon is sometimes given at this time.
An initial purge of Calomel (5 grains) and Rhubarb with a saline following, if necessary, is practically always adminis- tered, and the patient is placed on Soda or Magnesia, although the latter is by some said to give an alkaline mixture of rise to flatulence.
Alkaline enemata are given three or more times daily, the composition of which varies with the physician. Some order them containing 30 grammes of sulphate of soda to the litre, others only give 10 grammes to the litre and add a little bi-carbonate of soda, and, in some instances, only solution of bi-carbonate of soda is employed. They are given warm or cold, according to direction, but in the latter case give rise to a good deal of pain.
The objects aimed at in giving these enemata are :-
(1) Purgative, to assist in getting rid of the toxin and
keep the bowels clear.
(2) Stimulant and tonic, both general and local, to
kidneys.
(3) Antipyretic.
Enemata are not given with the object of being absorbed and thus supplying fluid to the circulation.
Theobromine is administered almost as a routine practice
to assist renal secretion, and always if any tendency to its diminution is noticed.
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