Results in 1019 cases treated by the cold-bath method in the medical clinic of Freiburg-in-Breslau. The mortality was 9.32 per cent.; but excluding cases which were moribund on admission, 7.9 per cent. Baths act not so much by lowering the temperature as by improving general nutrition, through the circulation and nervous system. Several factors influence the circulation; the peripheral vessels contract; the difference between the ar terial and venous blood-pressure, on which depends the rate of flow in the vessels, is accentuated, and the heart is stimulated mechanically; at the same time the respirations become deeper. Whether the bath treatment has any in fluence on the mortality from intestinal perforation is not known; but as to mor tality from haemorrhage it has almost cer tainly none. Apart from intestinal le sions, the greater number of deaths were due to pulmonary complications, though bronchial catarrh was certainly less com mon than in cases treated without baths. It was due to descending tracheo-bron ehitis from the inhalation of infected material from the upper air-passages. Baumler ( Dent. Archly f. klin. Med.; Brit. 'Med. Jour., June 14, 1900).
Treatment of Special Symptoms.—Pa tients suffering from a mild form of the disease without complications do not need any special medication, and care should always be taken that the stomach is not deranged by drugs unnecessarily given.
The headache in the first week is best relieved by phenacetin in from 3- to 5 grain doses. The smaller doses are often quite sufficient. Sodium bromide may be given alone or with aromatic spirit of ammonia. The application of the cold water coil or ice-bags to the head have often a good effect. A dose of calomel followed by a saline will sometimes re lieve a headache.
In the early stages sleeplessness is re lieved by the administration of trional or sulphonal. In the latter part of the disease opium is altogether the best remedy, and may be given in the form of Dover's powders. Opium has a tend ency to prevent elimination, and is, on that account, objectionable. The other nervous symptoms, coma vigil, subsultus, etc., do not often occur in those cases treated by cold bathing. In the adynamic condition, stimulants are especially neces sary, and should be given freely. Wilson recommends the administration of hypo dermics of ether in 10-minim doses, re peated once or twice at intervals of sev eral hours. IIe also speaks highly of Siberian musk in nervous depression. It may be given in pill form or in sup positories, 5 to 10 grains to the dose. Valerian and asafoetida are useful when the delirium is of an hysterical character.
Dryness and coating of the tongue and lips may be much relieved by first wash ing the mouth with a solution of boric acid, followed by the use of honey and borax, if there are any abrasions or ulcers. A very mild solution of potassium per manganate is sometimes used as a mouth wash. Vomiting may be relieved by the application of mustard over the epigas trium. Bismuth and oxalate of cerium, diluted hydrochloric acid, and cocaine hydrochlorates have been recommended. Aerated water, champagne, and brandy and ice have been given. Attention should be paid to the quantity and char acter of the food.
Tympanites, when moderate in degree, does not need any special treatment; when excessive the diet should be re duced in quantity, if necessary. Turpen tine stupes may be applied. Turpentine, salol, and betanaphthol, with salicylate of bismuth, may be given. The use of a rectal tube will give relief if the gas is in the large intestine.
If the meteorism is so great as to be really dangerous to life, rectal injections of a solution of sulphate of magnesia may be given. Puncture through the abdom inal wall is not advisable in any case.
Flushing of the colon advocated: from 1 to 3 quarts of cold water can be easily and safely passed into the colon, which will rapidly lower a high temperature. Tympanitic distension always disappears with the passing away of the water so injected. Buchman (Med. Record, Sept. 2S, 'SD).
Constipation is present in a certain proportion of cases, and, if they are of a mild type, it is probably not harmful. The bowels should be kept free by the administration of salines, castor-oil, or olive-oil: remedies which do not mate rially increase the peristaltic action of the bowels. If constipation exists in the second or third week, with evidence of severe typhoid poisoning, it is my opin ion that the administration of a saline is less dangerous than to allow this condi tion to continue. It must be stated that men of large experience—Wilson, for instance—advise against the administra tion of laxative drugs after the middle of the second week. IIe is also of the opin ion that large enemata, especially when given with are not free from 0..
danger.
Diarrhoea, unless excessive, does not require any special treatment. It is sometimes the result of local irritation from hard masses and irritating fluids, and a mild cathartic, by expelling these, will cause the diarrhoea to cease. If it still continues, the writer has found opium and acetate of lead the best reme dies.