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TREATMENT OF DYSPNCEA—BED-SORES. 373
Bed-sores should be prevented by carefully watching the state of the skin of the back and sacrum, and by placing the patient on a water-bed, of which the half or three-quarter length sizes" are generally preferable to the full-length ones. When the skin, though red, is still unbroken, a wash of brandy-and-water, one part in four, has a fortifying effect, but if it is broken, collodion flexile may be applied with a view to form a protecting film, and thus afford the skin an opportunity of healing. This is, however, of little use if means be not taken to remove pressure from the part, which should be left free for dressings. A circular air-cushion will do the former, but at the Brompton Hospital it has been found that these soon get out of order, and cushions of down of similar shape have been substituted. Another method employed is to apply a piece of thick felt plaister or of the material known as ' rhinoceros hide,' perforated with a hole the size of the wound, and then to treat it with water dressing.
Some of the worst symptoms of the disease are those which indicate the different stages of ulceration of the larynx, pricking pain in the region, difficulty of swallowing owing to the swollen or ulcerated epiglottis, hoarseness, gradually amounting to aphonia and from time to time, convulsive dyspnoea. Here, some relief may be afforded by blistering the larynx externally and by inhalations of conium, carbolic acid, or iodine, internally ; and we have known great comfort being given by the use of the sulphurous acid in the form of spray, either alone or diluted with an equal amount of water.
Where the epiglottis is much swollen, temporary relief is afforded by scarifying it; and Dr. Marcet1 has had good
1 Clinical Sotes on Diseases of the Larynx, x. p. 95. Dr. Marcet's formula is:—
R, Iodi. gr. xx.
Potassii Iodidi gr. v.
results from applying a solution of iodine in olive oil, to the interior of the larynx with a brush.
Dr. Powell finds a linctus of morphia, chlorate of potash, glycerine, and syrup soothes the swollen epiglottis and renders swallowing more easy; and we have seen some good done by a combination of chlorate of potash, tannic acid, and glycerine applied to the upper part of the larynx with a brush ; but we must confess that hitherto no great progress has been made in the treatment of this very distressing group of symptoms of consumptive disease, and we trust that the efforts of practitioners will some day be more successful than they are at present.
DIETETIC AND HYGIENIC MEASURES.
By Dr. C. Theodore Williams.
Effects of good diet on Consumptive patients—Object of Diet—Importance of Meat—Exemption of Butchers from Consumption—Saw Meat: when useful—Blood drinking—Vegetables and Fruits—Objections to Pastry, Salads, Pickles—Cautions as to the use offatty and oily food—Bread and farinaceous articles—Liquid Nourishment—Stimulants—Mode of administration and uses— Varieties and Rules for their selection—Brandy and Rum best combined with Food—Cooling Brinks—Clothing—Best material for underclothing— Warm Wraps —Exercise: its Benefits—Active Exercise: its Object and Varieties—Rowing—Swinging—Gymnastics—Walking— Passive Exercise: its Varieties—Carriage—Sailing—Their effects—Riding —Its great Advantages—Habitation—Soil and Site—Locality and Shelter — Temperature—Ventilation and Drainage.
The dietetics of consumption form a very important item in the antiphthisical treatment, and the careful regulation of the food and drink, according to the capabilities of each patient, requires the greatest attention. At the same time it is evident that, though a sketch may be made of the system to be pursued, fixed rules cannot be laid down as to the variety or amount of food to be taken in all cases.
We know that on good diet alone, without any medicinal aid, consumptive patients have increased in strength and weight, and of this Dr. Risdon Bennett has published some striking examples.1 We have occasionally seen similar instances among the in-patients of the Brompton
'Medical Times and Gazette, 1869.
Hospital, and they demonstrate what effect good and plentiful fare may have on those unused to it; but great improvement, on generous diet alone, has not in our experience often occurred. Indeed, the ingestion and apparent assimilation of large quantities of food without increase, and with even decrease, of weight, has often struck us as a remarkable proof of the consuming nature of the disease.
The great object to be kept in view, as Dr. Pollock briefly expresses it, is ' to supply the largest amount of the most nutritious food which can be digested' But this is not-always an easy task in a complaint where the appetite is likely to fail and the stomach is prone to derangement.
Whenever it is possible, fresh meat plainly cooked and unalloyed with rich sauces, gravy, or stuffing, should be taken two, or even three times a day, and the diet varied occasionally by the introduction of poultry, fish and game, but a decided preponderance of butcher's meat, not overloaded with fat, should be retained. •
A striking proof of the importance of this point is furnished by the rarity of consumption among butchers ; and although the airy and open shops in which they live, and the amount of out-door exercise which they take, may contribute to their good health, their exemption from phthisis must be principally ascribed to the quantity of meat they consume, for, in addition to the cooked article taken at meals, they are in the habit of nibbling bits of raw meat while serving their customers,—a practice which explains the comparative frequency of entozoic disease in this trade. We may mention, by the way, that the use of raw meat in consumption has been much advocated in France and Germany ; and we have seen some good derived from its use, when the patients were hysterical girls who would not eat; but it is in the wasting diseases of childhood, that uncooked meat is most useful. When mixed up
with sugar, in the French method, it forms a palatable sweetmeat, much liked by children, though the absence of cooking renders them liable to worms from this source. Another practice, carried on in the South of France, and which we cannot regard as otherwise than disgusting, is to drink lamb's blood;1 and when at Hyeres we, ourselves, witnessed with a shudder, elegantly dressed French ladies repair daily to the slaughter-house and quaff the reeking draught, but with what result we never learnt.
Fresh vegetables, plainly dressed, and a small amount of ripe fruits, as, for instance, oranges, grapes,8 apples, and pears, are to be included in the dietary; but rich pastry, savoury dishes, salads, containing much vinegar, pickles of every kind, and the like, are to be carefully avoided, both as tending to upset digestion, and as interfering with the prolonged use of cod-liver oil. With regard to butter, cream, suet, and various other oily or greasy matters, we must bear in mind that the stomach and liver are already somewhat tried by the regular administration of cod-liver oil, one of the most easily assimilated members of this group, but still occasionally giving rise to symptoms of biliousness and gastric disturbance, and it is therefore highly important not to tax these organs further by the introduction of large quantities of fatty or oily material. Great moderation should be observed in the use of these articles, and, as has been mentioned in a former chapter, the quantity of milk should be limited. At the same time it must be remembered that there are individuals who can assimilate almost
1 Some years ago Dr. Marcet invented some biscuits, composed of the clot of sheep's or bullock's blood and chocolate, which seems to be a less objectionable mode of trying this form of nourishment, if it is to be tried at all.
2 The 'grape cure,' which is carried on by the lake of Geneva, and at Mersin in the Tyrol, is supposed to diminish the excess of fibrin in the blood of consumptive patients.