The Woodbridge treatment is similar to that of Thistle, the object being to render the contents of the bowel asep tic by free elimination. Whatever may be the theory upon which the eliminative treatment is founded, the writer, from personal observation, is satisfied on two points: 1. That, in a number of cases, the temperature falls to normal or nearly so within twenty-four hours after free purgation is induced.
2. That cases at the end of the second or in the third week, when the patients are in a low toxTmic condition,—as shown by the dry, cracked tongue; sordes; low, muttering delirium; and meteorism,—have experienced decided and favorable change within twenty four hours after free purgation. The writer is quite aware that such practice may possibly tend to the onset of haem orrhage, but he considers the danger from the latter to be less than from the poisoned condition of the system.
Hydrotherapy.—The cold-bath treat ment, as it is carried out in well-ap pointed hospitals, is probably the best form of treatment known, and if all pa tients could be treated in this way there would be little use of adopting any of the other known methods.
The remarkably-small mortality of three out of ninety-nine cases treated in the Johns Hopkins Hospital is an evi dence of this. Every practitioner of ex perience knows, however, that many cases in private practice cannot be treated with cold baths. It is often impossible to in duce patients to go to a hospital, and it is therefore necessary to treat them at home, even if the surroundings are un favorable. Then, again, in country dis tricts this method is, in many cases, quite impossible. When an epidemic spreads over a large section the procurement of baths, nurses, etc., would be quite an impossibility. Some other method of treatment must, therefore, be devised, and the antiseptic method with moderate elimination has so far been the best.
It is, no doubt, true that the cold-bath treatment might be adopted in many pri vate houses where it is not now used if the attending physician were more firm in its advocacy and had more faith in the great benefit of this mode of treatment.
[Dr. W. H. Thomson (Med. News, '97) gives the following treatment adopted in the Roosevelt Hospital. If a patient is admitted before the end of the second week of the fever, 5 grains of calomel and 35 grains of compound jalap-powder are administered on three successive nights. The calomel treatment is dis
continued after the eighteenth day of the disease on account of the liability to haemorrhage. Ten grains of saccharated pepsin with 10 grains of carbonate of bismuth are given every three hours to prevent tympanites and diarrhma. If the latter persists, a double dose of bis muth is given. Whenever the tongue begins to be dry at the tip, 15 drops of oil of turpentine are given in emul sion every six hours. Moderate doses of strychnine and caffeine are sometimes given for cardiac debility, but never digi talis.
The cold bath is resorted to as soon as the temperature reaches 103°. The patient is actively rubbed in the bath and is taken out when the temperature falls to 101°. J. E. GRAHAM.] The cold-bath treatment of fever was employed by Curry, an English ship-sur geon, in the latter part of the last ury, and it was first systematically intro duced for the treatment of typhoid fever by Brandt, in 1861. I first saw the cold bath treatment used in 1870, when it was adopted in the German army. This method is constantly growing in favor.
It should not, however, be used for old and feeble persons or for those who have weak hearts or for excessively nervous individuals who struggle each time they are put into the bath. Baths are contra indicated if peritonitis or hmmorrhage is present. The following description of the method adopted in the Johns Hop kins Hospital has been kindly given to me by Dr. T. McCrae, who has had re cently more immediate charge of the typhoid cases:— The baths are given every three hours while the temperature is 102° or 102 or over. The interval is measured from the time the patient is put into the tub.
The patient remains in the bath twenty minutes. The temperature of the first two or three baths is SO° or S5° and in a robust adult the subsequent baths are given at 0°. But in cases where that temperature is not well borne or when the patient is delicate or perhaps ad vanced in the disease before admission, the temperature may remain at 80° or S5°. There is no lowering of the perature by ice. The patient is placed in the bath and no further attention is paid to the temperature of the water. A bath with reduction of temperature—say, from 95 to 80—is rarely given, and only in special eases. The temperature of the bath for children is generally SO, and they are left in from ten to fifteen min utes.