Lavage of the stomach has been tried, but is rarely successful. Cocaine, 
chloroform, tincture of peppermint are advised by many, but nothing 
succeeds like absolute rest, and the doctor must see that it is enforced, 
as continued vomiting invariably brings on black vomit and wears out 
the strength of the patient. 
Hiccoughs. 
Are apt to be troublesome. In the early stages a little fresh, iced 
champagne fully charged with gas works wonders. In the later 
stages the hiccoughs are signs of ammonaemia. 
Black vomit. 
The treatment for ordinary vomiting should be tried. Iron has 
not proved of much value nor has ergot. Adrenalin by the mouth 
has appeared to be ol benefit. All fluids should be stopped so that 
the adrenalin can have time to act in an undiluted state. Gi\e 20 to 
40 drops in a teaspoonful of water. Have plenty of bowls to catch 
the vomit, and if possible do not let the patient see it. Many patients 
will not notice the colour or will believe it to be bile. Do not confound 
haemorrhages from the gums or posterior nares with black vomit. 
The recumbent patient may swallow the blood and later on vomit 
this is apt to occur in the first day and will create a wrong prognosis. 
Bowels. 
The ordinary enemata are sufficient to keep the bowels open. 
Diarrhoea is liable to occur in the haemorrhagic stage, eithei 10 
blood in the stomach or bleeding from the congested duodenum, 
evacuations are tarry and intensely foetid. Large clysters given ve y 
slowly should be administered. 
Delirium. 
For mild or intermittent delirium, apply an ice-bag or P^ ov 
head, and enjoin absolute quiet in the patient s room. ot 
of service. Use as little restraint as possible. In vio ent e 1 » 
maniacal patients may have to be tied down. con 
hopeless. Bromides and chloral have been recommended. 
