2. The antiseptic method is based upon the fact that germs and toxins exist in the intestinal canal which may be taken up into the system and produce some of the serious muscular and nervous symptoms. In the later stages of typhoid fever the bacilli are found in large bers in the bowel-contents, and it is prob able that in some cases there may be a mixed infection and the colon bacilli may become more virulent than under ordinary circumstances. The antiseptics which have been the most generally used are bismuth, salicylates, betanaphthol, sulphurous acid; chlorine, as recom mended by Yeo; salol, boric acid, and turpentine.
Guaiacol carbonate (Med. and Surg.
Bull.; Dorn. Med. Jour., '97) is abso lutely non-poisonous, 90 grains having been given without causing any symp toms of intoxication. Putrefactive proc esses alone render it absorbable, and it appears to be more thoroughly absorbed when given in small doses. It has no direct influence on the temperature.
Attention is called to the efficacy of chlorine in the treatment of typhoid fever. After four years of observation, the conclusions presented in a former paper are reiterated: 1. That in the treatment of typhoid fever chlorine can be safely administered until complete disinfection of the alimentary canal is obtained. 2. Under its use the tongue becomes cleaner, the appetite and diges tion better, the fever lower, and the stools devoid of odor save that due to chlorine. 3. The general strength, in tellectual processes, and nervous condi tions improve. 4. The disease is short ened in duration and the patient usually proceeds to a rapid and complete re covery. Wilcox (Med. News, Feb. 11, '99).
Many eminent authorities, Osler and Wilson among others, look upon intes tinal antiseptics as useless.
Wilson states that intestinal antisep tics, in so far as new pathogenic organ isms are concerned, are directed against germs which do not exist in the bowel prior to the breaking through of the in testinal lymph-vessels, and are, therefore, largely inoperative. This may be quite true, but in the latter stages it would seem rational to render aseptic, if sible, the fluids which are in constant contact with the ulcerated surfaces and which contain both germs and toxins. If remedies can be given which do not affect the patient and which change the character of the passages from an smelling liquid to one which has little or no odor, the effect cannot be other than beneficial.
3. The eliminative treatment, which is usually combined with the antiseptics just described, has been advocated by Bouchard in France and by many on this continent.
Eliminative treatment used in 20 pa tients without a death. Treatment be
gun by giving the patient a ea psule containing calomel, grain; guaiacol carbonate, 2 grains; podophyllin. grain to grain—every two hours for twenty-four to forty-eight hours, accord ing to the condition of the bowels, and continued until four or five intestinal evacuations occur for two successive days. The calomel is then stopped, and 7, grain of menthol added to the guaia col and podophyllin. Small doses of salts or Hunyadi water are given if there is a tendency to constipation. Dccinormal salt solution is given per rectum when the skin and kidneys fail to act properly. T. Virgil Hubbard (Med. News, July 21, 1900).
Thistle, of Toronto, introduced some five or six years ago a form in which purgatives were more freely used than had been previously advocated, at least in late years.
In a more recent paper Thistle makes the statement that the adoption of the eliminative plan of treatment lowers the mortality of typhoid fever to a remark able degree. It also lessens the severity of the symptoms and the duration of the fever.
Statistics of the Toronto General Hos pital are given showing the number treated for four years from 1893-97 to have been 563, with a mortality of 6.57 per cent. The mortality for eight years including these four is over 10 per cent. During the four years a large number were treated on the elimination plan, some on the expectant plan, and perhaps a fifth by cold baths. Thistle has had so far under his observation 51 cases, with 1 death from pneumonia. He has collected 190 cases treated by physicians in the Province of Ontario, with 4 deaths: 2 from Itmorrhage, 1 from pneumonia, and in 1 the cause was not known.
A series of therapeutic experiments were made to determine the value of calomel in typhoid fever. In 71 cases calomel was given in a dose of 4 V, grains thrice daily, while, for the pur pose of comparison, quinine was given in the same doses in 40 other cases. The patients in the first group continued to take the calomel till their evening tem perature became normal; this result was obtained after a total amount of the drug varying from 2 to 5 drachms had been taken. Stomatitis never occurred, nor was diarrhoea aggravated. The dis ease in all these patients was mild in type, and often aborted. The fever abated more quickly, and the mortality (2.82 per cent.) was less than in the cases treated with quinine. No patient who was put on the calomel treatment, within the first week of the illness, died. Although calomel is not a specific, it is a most useful remedy in typhoid fever. Andrievsky (Sem. Mad., Dec. 28, '98).