THE TREATMENT DURING THE ATTACK 



Severe hsemorrhages are of grave import, as is perforation. Sudden 

 death may occur at any stage of illness and during the convalescence, 

 but is, fortunately, very rare. 

 Treatment. — ^The treatment of enteric fever may be divided into : — 



A. The treatment during the attack. 



B. The treatment during the convalescence. 



A. The Treatment during the Attack,— This may be subdivided 

 into: — 



L Treatment of a simple uncomplicated case. 

 II. Treatment of special symptoms. 



I. The treatment of a Simple Uncomplicated Case may be 

 considered under the following headings: (i) General hygiene; 

 (2) nursing; (3) diet; (4) medicines. 



1. General Hygiene. — A well-ventilated, airy, and well-lighted 

 room should be chosen, and all superfluous furniture, hangings, 

 belongings, etc., removed, except such few things as may be de- 

 sirable to render the general appearance cheerful. Special atten- 

 tion should be paid to the bed, because the patient is to remain 

 in bed for about one month after reaching a permanently normal 

 temperature. The bed should not be too broad or too narrow, 

 and should have a wire-woven mattress, which is part of the bed. 

 Over this a soft horsehair mattress should be placed, and a reserve 

 mattress should be kept handy. Over the horsehair mattress 

 two folds of blankets should be placed, and then the sheet, and in 

 the middle third there should be the draw-sheet, with its water- 

 proof sheeting. The bed should be provided with an easily movable 

 mosquito-net . The whole room should be thoroughly cleansed once 

 a day by means of damp cloths dipped in Jeyes' fluid. All motions 

 and urine should be protected against flies, and, after being in- 

 spected by the physician, should be disinfected with Jeyes' fluid 

 or crude carbolic acid, which is allowed time to act before the con- 

 tents are thrown away. A separate set of feeding appliances should 

 be reserved for the patient, and these should be sterilized after 

 use. All fomites should be soaked in Jeyes' fluid or carbolic 

 lotion for some hours immediately after use and before being washed. 

 A large piece of ice is very useful to keep down the temperature 

 of the room in the tropics. 



2. Nursing. — The most important feature of the treatment. of 

 a case of enteric fever is the nursing. Two nurses, one for the day 

 and one for the night, are absolutely necessary, and their work 

 may be rendered easier, and the patient considerably benefited, 

 especially if he is over the average weight, by the use of a Skeflington 

 lifter, or, failing this, by some simple apparatus based upon the 

 plan of this ingenious lifter. The temperature should be recorded 

 every four hours, and as haemorrhage is so common in the tropics, 

 both nurses should be warned, and should be instructed to be on 

 the watch for the slightest suspicion of this symptom. Moreover, 



