A review of the statistics of the vari ous hospitals of Paris. omitting that un der the direction of Dr. Chantenesse, showed that the combined mortality from typhoid fever wa> 19.3 per cent. While there were naturally variations, the low est recorded mortality in any hospital exceeded 12 per cent. In the hospital in Dr. Chantemesse's charge, where serum therapy was adhered to in every case, there were but 7 deaths out of 1S6 pa tients—a mortality of 3.7 per cent. Other treatment employed was practically the same in all the hospitals. Three out of the 7 deaths were due to perforation. 1 to purulent peritonitis, and l to intes tinal hemorrhage. All these patients came under treatment late in the disease. thantemesse has noted no complications in patients Coining under treatment earls'. So necessary does he consider immediate serum-injections that he gives them even before the diagnosis is cer tain, for 2 cubic centimetres can do no harm. So far in Paris 350 patients have received this serum-treatment, with but 17 deaths—a mortality of 4.7 per cent. At Toulon, out of 151 patients treated, 1:3 died. Adding this, the mortality was 0 per cent. The German army statistics, always held up as a model in France, give a mortality of 0.5 per cent. in ty phoid fever. Chantemesse explains the effect of this serum in that it is not only both anti-infectious and antitoxic, but, above all, it excites phagocytosis. Thus it is almost specific in typhoid fever. Be sides, he calls attention to the necessity of isolating typhoid-fever patients for the protection of other patients. This lie
considers an important means of prophy laxis. Editorial (Phila. Sled. Jour., Jan.
24, 1903).
Convalescence. — Patients should not be allowed to get out of bed until they are sufficiently strong to make the change with safety. I have always allowed pa tients to sit up and to move about in bed, two or three days previous to their sitting in a chair. The dressing of patients often produces more fatigue than sitting up, and a dressing gown only should be allowed at first. In some the strength returns very slowly, and a recrudescence, with slight elevation of temperature last ing two or three days, is not unusual. Strychnine, iron, and arsenic are indi cated in cases of anaemia and cardiac asthenia.
It is not necessary to cut the hair short in typhoid fever, but when the system of cold bathing is adopted it is venient to do so. Peripheral neuritis, producing paraplegia, is treated by tonics, local massage, and the use of galvanic and faradic currents. Typhoid spine, which has been alluded to, is best treated by supporting measures and the local use of the thermocautery.
Thrombosis of the veins of the leg is often a troublesome sequel of typhoid fever. The patient should remain in bed until the local pain and swelling have disappeared. Iodine may be applied over the affected veins. In many cases careful bandaging is necessary after the patient gets up.