3. Cleanliness.- The body and bed-linen, including the blankets, should be frequently changed, and all matters discharged from the patient immediately removed. All excreta should be most carefully and thoroughly disinfected and the greatest care must be used over all bed linen, etc., that may have come in contact with discharges from the patient. The mouth should be frequently wiped out with a soft, wet towel, to remove the sordes which gather there in severe forms of fever. The water may contain a little of Perfumed Carbolic Acid. The patient’s body should be sponged over as completely as possible at suitable intervals with tepid or cold water, as may be most agreeable to his feelings, and quickly dried with a soft towel. The sponging may be done piece by piece, to avoid fatigue. Carbolic Acid may be added to the water. three or four drops of the pure acid to a quart of water. Sponging the whole surface of the body with cold or tepid water should never be omitted in fever; it reduces the excessive heat, soothes the uneasy sensations, and is indispensable in maintaining that cleanliness which is so desirable in the sick-room. Water thus applied acts as a tonic, giving tone to the relaxed capillaries, in which the morbid action goes on. Frequent washing of parts pressed on with soap and water also tends to prevent bed-sores by keeping the skin in a healthy condition. Sponging afterwards with undiluted spirit such as whisky still further strengthens the skin. If bed-sores have formed, they should be dressed with Hypericum Oil and protected by Arnica, or Calendula-plaster.
4. Hydropathic Applications.-In addition to the sponging and washing and just recommended, we have found the abdominal wet- compress of great utility. See p. 91. It tends to diminish excessive Diarrhoea, seems to check the spread of ulceration of the ileum, and so to obviate perforation. Should lung- complications arise, the compress should be applied to the chest as well as the abdomen. During the early course of the fever, the wet-pack, described, pp. 92, 93 is an invaluable application, and tends to give a mild character to the disease. Treatment by frequent cool baths in which the patient is immersed, has been used.
5. Beverages.-At the commencement of the fever, pure water, toast-and-water, barley-water, lemonade, or soda water, is nearly all that is necessary. Cold water is an agent of supreme importance; it lowers the excessive temperature, and proves a valuable adjunct to the medicines prescribed.
6. Diet and Stimulants.-In a disease which lasts three or four weeks, or sometimes five or six, in which the waste of tissue is great, and when common food cannot be taken, it is point of high importance to supply the patient with appropriate nourishment otherwise he may sink before the disease has completed its course. The following are points requiring attention. Patients are often unable to swallow or relish nourishment in consequence of the dry and shrivelled state of the tongue, when it will be found necessary to soften the mucous lining by putting a little lemon-juice and water, or other acceptable fluid, into the mouth a few minutes before food is taken. All the ailments given should combine both food and drink in a fluid or semi-fluid form, until recovery has fully set in. The digestive functions being more or less completely suspended, the nourishment given must be only such as requires the simplest processes for its assimilation. The following are examples of this form of nutriment-Milk (a most important article in the treatment of fever patients), iced milk, thin arrowroot, with milk; wine-whey, prepared by adding half a pint of good sherry to one pint of boiling milk, and straining after coagulation; blancmange of isinglass or ground rice (not gelatine); yolk-of-egg, beaten up with a little brandy, wine, tea, cocoa, or milk; beef tea and meat broth (a little thickened with well-cooked old rice, vermicelli, isinglass, or a few crumbs of bread); and in some cases alcoholic drinks. The addition of two or three grains of pepsine to each cupful of milk or broth facilitates its digestion. Fruits are generally inadmissible.
A little good wine with an equal quantity of water may be given every hour or two, according to the requirements of individual cases. Effervescent wines must be avoided. But the effects of the wine or brandy should be carefully watched by the medical attendant and only given in proportion to the demands of the system, the bulk and force of the pulse being the main guides. Except in small quantities, stimulants are not required by children, not by persons who can take a sufficient quantity of other kinds of nourishment, nor early in the disease. On the other hand, aged persons, and patients greatly prostrated, or with cold extremities, and livid surface, often require alcoholic stimulants. Under any circumstances, if stimulants aggravate existing symptoms, their employment should be modified or altogether discontinued.
Further, nourishment should be given with strict regularity; in extreme and long-continued cases of prostration, both day and night.
7. Watching Patients.-Fever patients should be attended and watched day and night. Their urgent and incessant wants require this, and their safety demands it. Instances have occurred of patients, in the delirium which so frequently attends severe fever, getting out of bed, and even out of the window, during the absence of the nurse, and losing their lives from injuries thus sustained.
8. Moderation in Convalescence.-Food should only be allowed in great moderation, and never to the capacity of the appetite, till the tongue is quite clean and moist, and the temperature, pulse, and skin have become natural. In Enteric fever, and in other conditions in which the bowels have been inflamed, this caution is especially necessary during convalescence. Solid food should not be given till the temperature of the patient in the morning and evening has remained, at least for two days, at about the natural point 98-99 degree F. The tongue may be moist and clean, and the appetite vigorous, but the Enteric ulcer yet unhealed. If the thermometer shows an evening temperature of about 101 degree F. with a morning temperature one or two degrees lower, solid meat might be sufficient to induce fresh irritation of the unhealed ulcer, fatal Haemorrhage, or perforation. Not until the evening temperature has remained, for at least two successive days or more, below 99 degree F., can we be certain that the ulcers have healed, and that solid food may be allowed without risk. We have known solid meat given too early bring back the most severe features of the disease. If stimulants have been given, they should be gradually withdrawn as the quantity of nutritious food is increased. Even when convalescence has some what advanced, moderation should still be exercised, as the appetite is often excessively craving.
9. Change of Air.- The salutary influence of change of climate or scene to persons who have suffered from a serious attack of fever can scarcely be over-estimated; and if the place and climate be intelligently chosen, the happiest results may be anticipated. After recovery, from a serious attack of fever, the whole man becomes changed, and there seems to be a renewal of youth. Nothing gives such a beneficial direction to this change, or renders it so perfect, as a temporary removal to a suitable climate and locality. We fully endorse Dr. Aitken’s statement-No man can be considered as fit for work for three or four months after an attack of severe Enteric fever.
10. Precautionary Measures. To check the contagion-(I) All discharges from fever patients should be received on their issue from the body into vessels containing a concentrated solution of Chloride of Zinc, or other efficient disinfectant, Jeyes’ Fluid, or Perchloride of Mercury. (2) All tainted bed or body linen should immediately on its removal be placed in water strongly impregnated with the same agent. (3) The water-closet should be flooded several times a day with a strong solution of chloride of zinc; and some chloride of lime should also be placed there, to serve as a source of chlorine in the gaseous form. (4) So long as fever lasts, the water-closets should only be used as receptacles for the discharges from the sick, and disinfected as directed above.
Prevention of Enteric fever.-Architects and builders should provide for the ventilation of every house-sewer, by a pipe running up sufficiently high, so as to prevent injury to the occupants of the upper stories. Where the waste-pipe communicates with the drains, sewer-emanations are absorbed by the water in the cistern, and foul air admitted into the dwelling.
The ventilation of sewers thus becomes a matter of great importance, for, on account of the lightness of sewage gas, hurtful results have been shown to arise where sewers and drains are merely trapped, if provision has not been made for its escape at the highest outside elevation. At Croydon, at the Orphan Asylum at Beddington, and again at Eastbourne, numerous cases of Enteric fever occurred from the absence of proper sewer- ventilation. In some of these cases the sewer and house-drains have been found in good order, and properly trapped; the water, also, was pure; the source of mischief being in the absence of outside ventilation for the house-drains. It cannot be too forcibly impressed upon architects and builders that sewerage- traps are useless when the gas has reached a certain pressure, for it will force them. But with proper outside ventilation the communicating house drains can never store in them as much sewer- gas as will suffice to force a properly made trap.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."