hand, a rubber, or a mitten made of lint. ' The strength used depends on the feel ings of the patient, and special attention should be paid to the hands and feet. The rubbing should be continued during the whole time of the bath. A cloth rung out in ice-water is placed on the patient's head before he is put into the bath-tub and should be frequently changed. If pronounced nervous symp toms or high fever are present ice-water is sponged freely over the head whenever the cloth is changed. The bed is pre pared before the end of the bath as fol lows: Over the lower sheet a mackintosh is spread, and on this is put a linen sheet. At the end of the bath the patient is lifted back into bed, a dry sheet is held over the bath and beneath it the wet one is pulled to one side cf the patient. He is lifted up as before, held to drip for an instant, and lifted into bed. The sheet is tucked around him, as is also the one that was previously put on the mackin tosh sheet. Generally a blanket is put over these; some patients like two blank ets. The patient is left in the wet sheets ten minutes, after which he is rubbed dry, the sheets and mackintosh are re moVed, and the night-dress and bed clothes are replaced. The temperature is taken one-half hour later. This is • called the after-bath temperature, and is recorded. Nourishment is never given in the bath, but usually immediately afterward. Alcohol is not given as a routine practice with the baths. Many cases—in fact, the majority—go through without any. It is frequently ordered only with the baths, and then it may be given either before or after. If alcohol is being regularly administered,—say, every three hours,—it is generally given at bath-time.
The patient is removed at once from the bath if any of the following condi tions appear: Extreme distress, dysp non, cyanosis, vomiting, or convulsions. There is no routine method; every case has a special order as to bath-time, etc.
A description of the method of giving the baths at the Toronto General Hos pital has been kindly furnished me by Mr. Tanner. The details are the same as those already given in almost every par ticular, except that the water which is at 85 when the patient is placed in the bath is cooled down to 70 by means of ice.
This method of treatment should be commenced as early as possible when the temperature reaches 102.5°. The num ber of baths given depends on the tem perature of the patients. When the baths are given before the fifth day, the mor tality is very light, and J. C. Wilson, who has had a very large experience in this method of treatment, found that, in a series of 132 consecutive cases treated before the fifth day, the mortality was about 3.4 per cent.; in those between the fifth and tenth day, 7.7 per cent.; and in those after the tenth day, 22 per cent. In the latter eases the mortality would, under any circumstances, be high, be cause the early treatment would probably have been injudicious, and the removal from one place to another is always dan gerous iu advanced cases. Wilson gives the baths when intercurrent diseases, such as bronchitis and pneumonia, me present. Menstruation and pregnancy
do not contra-indicate the use of baths. The mortality in 524 cases under Wilson in the German Hospital up to January, 1896, treated by cold bathing was 7.25 per cent. In the Johns Hopkins Hos pital 652 cases were treated under Osler's directions up to January 1, 189S, accord ing to Brandt's system, with a mortality of 7.1 per cent. Perforation and hem orrhage are not increased by bathing, but there is a greater number of relapses.
The benefits arising from cold baths are due to the reduction of temperature, the improved condition of the nervous system, and the more rapid elimination of toxins by the urine.
Résumé of 1211 cases of typhoid pub lished, in all of which cold baths were used from the beginning. There were 12 deaths: that is, about I per cent. From these 12 fatal eases 2 should be elimi nated, in 1 of them the treatment hav ing been suspended upon the sixteenth day on account of arthritis, and the other terminating fatally from some un known cause. Paul Cheron (L'Union Med., May 24, 'SS).
[The mortality of typhoid cases in Chickamauga Park, treated according to the Brandt system, was 6.25 per cent. (Phila. Med. Jour., Sept., '95). J. E. GRAHAM.] A good deal depends upon the time when the treatment is begun. Of 32 cases treated before the fifth day there was a loss of but 1, or 3.4 per cent.; of 75 treated before the tenth day there was a loss of 6, or 7.7 per cent.; IS cases receiving the treatment after the tenth day, there was a loss of 4, or 22 per cent. James T. Whittaker (N. Y. Med. Jour., Jan. 14, '99).
Death from perforation and hemor rhage is more frequent under the Brandt than under other methods of treatment. Relapses, however, are not more frequent under the Brandt treatment. Of 408 per sonal cases relapses occurred in about S per cent. Heemorrhage was the cause of death in three. Stewart (Montreal Med. Jour., Feb., '99).
Statistics of 1904 cases treated by the Brand method, or the same somewhat modified. Conclusions: The treatment does not avert or diminish the frequency of hemorrhage, but the frequency of per foration is reduced. It diminishes the danger of complications, especially those relating to the circulatory and respira tory tracts. The treatment is attended by albuminuria in a large percentage of cases. Purgatives are administered early in the attack, calomel being used in frac tional or large doses, sometimes followed by a saline. Drugs are used as each case requires, but only about 10 cent. of the cases require any medication what ever, except the early purgatives. In stead of having patients lifted into the tub beside the bed, those who can do so are encouraged to help themselves. Then a stationary tub is placed at the end of the ward and the patients, with assist ance, walked every three hours to the bath and back to the bed. This proced ure was found to exert a very favorable influence upon the course and symptoms of the attack. The mortality was 7.5 per cent. J. C. Wilson and J. L. Sal inger (Phila. Med. Jour., Mar. 3, 1900).