Fluids, especially cold water, should be given freely to produce a free diuresis, and thus rid the system of poison.
The temperature should be taken at least night and morning and recorded in a chart. The use of a chart is of much importance, because the attending phy sician frequently gains a much better idea of the case by examination of the chart than by looking over a list of tem peratures.
After the subsidence of the fever the sponging should be continued, and fol lowed by gentle massage. During con valescence the patient should be taken out on a stretcher and allowed to spend many hours in the open air.
—The power~ of digestion are much diminished, and it is not only use less, but harmful, to give food which will pass through into the intestine without undergoing the normal changes in the stomach, and may act as a direct irritant on the mucous membrane and at the same time undergo fermentation and decom position, thus increasing the gas in the intestine and producing poisons which may be taken into the circulation. For this reason even liquid nourishment should be given in limited quantity. Milk is altogether the best food, and should form the principal diet of typhoid patients. Lime-water, barley-water, and rice-water are sometimes added to pre vent dense curdling in the stomach. Peptonized milk, koumiss, or matzoon may be given. From 3 to 5 pints of milk may be given daily. Clear soups, jellies, broths, and eggs—raw or soft boiled— may also be given. In occasional cases milk is not tolerated by patients, and other forms of nourishment may be sub stituted for it. Want of tolerance is often a fancy of the patient, and, when milk is perseveringly given, dislike to it ceases. Patients are, however, met with now and again with whom milk does not agree. For such, soups, jellies, barley water, rice-water, freslr eggs, chicken broth, mutton-broth, and coffee with much milk may be given.
The digestive functions seem less af fected when the temperature is not high, and in mild cases many of these simple foods can be given without danger. Coffee or chocolate with a large propor tion of milk is recommended by some in the early part of the day.
During twelve years, from 1886 to 1897, 3S0 cases of typhoid fever came under the writer's personal care. Of those from 1886 to 1893. 235 patients were treated under a milk diet, with a mortality of 10 per cent., and from 1893 to 1897, 147 cases were treated under a much more extended diet with a mor tality of 8.1 per cent. In the latter series water was used more efficiently, but the extension of the diet did not prove injurious. "My plea is simply for ' treating the patient rather than the dis ease, for feeding him with reference to his digestive power, rather than solely or mainly with reference to his fever." The following typhoid diet given: 1. Milk, hot or cold, with or without salt, diluted with lime-water, soda-water, Apollinaris, Vichy; peptogenic and pcp tonized milk; cream and water (i.e., less albumin) ; milk with white of egg; slip , buttermilk; koumiss; matzoon; milk whey; milk with tea; coffee; cocoa. 2. Soups: beef, veal, chicken, tomato, po tato, oyster, mutton, pea, bean, squash; carefully strained and thickened with rice (powdered), arrowroot, flour, milk or cream, egg, and barley. 3. Horlick's food, Mellin's food, malted milk, carni peptone, bovinine, and somatose. 4. Beef-juice. 5. Gruels: strained cornmeal, crackers, flour, barley-water, toast-water, albumin, and water with lemon-juice. 6. Ice-cream. 7. Eggs, soft-boiled or raw; eggnog. S. Finely-minced lean beef; scraped beef. The soft part of raw oysters. Soft crackers with milk or broth. Soft puddings without raisins. Soft toast without crust. wine-jelly, apple-sauce, and macaroni. T. C. Shattuck (Jour. Amer. Med. Assoc., July 11, '97).
Coffee, tea, thin gruel. eggnog, clear soups, koumiss, and soft-boiled eggs are among the articles of food which should be permitted patients, even at the height of the disease. The urine of patients subjected to cold baths is greatly in creased in toxicity, the kidneys being stimulated by the nervous system. Tox iemia is less common in these patients. Intestinal antiseptics may be added to the bath treatment. F. G. Finlay (Mon treal Med. Jour., vol. xxviii, No. 2, p. 96, '99).