White fish well boiled is, perhaps, the first solid meat which can be safely permitted, with tea or weak coffee, in which any plain biscuit may he soaked. Ord advised a return to solid food at an early date if the patient clamours for it. lie stated that lie had learned to give in to this strongly stated desire upon the part of the patient for solid food. The writer has not vet learned to do so. The intermittent attempts to estab lish authority for an early resort to solid food arise front an abuse of liquid feeding, and the fashion is taken up and advocated by the young physician till he meets with a case of perforation from this practice. By adding good nourishing scamps, arrowroot, fine sago, or cornflour, to the milk diet undue wasting is prevented, and the patient may safely be kept for 10 Or 1 2 days on this liquid regimen alter the subsidence of fever.
.acciiic Therapv.--Notwithstanding ceaseless activity in this method of treating typhoid fever, it is still impossible to pronounce very definitely in its favour, especially as there is still sharp differences of opinion about details. Some i-ec=onimend a Stock Vaccine with a dose of 200 to Soo million, others insist upon a sterilised autogenous vaccine. Some use living autogenous organisms, others sensitized vaccines. One physician recommends intravenous injections, whilst others rely upon the hypo dermic method; but all seem to agree in one point—if there is any benefit to he obtained, the vaccine treatment should be commenced early.
Captain D. Thomson's new method may solve the difficulty. He gets rid of the enclotoxin in the killed bacilli by washing with weak acids, so that very large doses of a culture capable of producing great quan tities of antibodies may be safely injected. Only future clinical experi ence can demonstrate the value of this departure in vaccine therapy.
Sermil from convalescent cases and from immunised animals has been tried, and many observers conclude that the best results are to be obtained from a combination of this with vaccines.
Urns; one seriously believes that the course of the disease can be cut short or its mortality sensibly diminished by the use of antiseptic drugs administered in the ordinary way. Whilst the com plications arising during the attack often afford clear indications for the employment of drugs, officious routine drugging roust be condemned.
Colloidal Gold in doses of i to 2 c.c. by the veins has been vaunted, but the set ere reaction is sometimes an alarming symptom, and the results are not convincing. If the physician is satisfied that he must employ some routine drug treatment to secure the confidence and maintain the hope of a nervous and apprehensive patient during the long siege of the fever, he may resort to the least objectionable of all the routine methods. This is what has been known as the Swedish treatment, and
consists in the administration of a mineral acid, as in the following simple combination: Acid. Hydrochlor. Dil. 5iij.
5j.
Aqua Destillata ad ciij. _11 isce.
Fiat mistura. Capial F5ss. ex j. mince quartis horis.
The above should not, however, be regarded as a mere placebo : the acid on coming into contact with the buccal and pharyngeal mucosa tends to stimulate the salivary and mucous gland secretion. thus the mouth moist and preventing the parched feeling and thirst. The glycerin prolongs the local effect by preventing drying, and the admission of the acid to the stomach acts as a restorative by supplying a constituent of the gastric secretion, which is always diminished in feverish states. This mixture does not interfere with the dietary unless when given immediately before or after a draught of milk.
Of the so-called antiseptic forms of treatment that of is the least objectionable. It is carried out by giving r oz. every 2 or 3 hours of a mixture made by adding i dr. pure Hydrochloric Acid to 3o grs. Potassium Chlorate in an empty 12-0Z. phial, and adding water gradually with brisk shaking to absorb all the free chlorine gas liberated. 2.4 to 36 grs. Quinine Sulphate with r oz. Syrup of Orange are finally added. This mixture. known as Euchlorine, probably exerts no antiseptic action save in the mouth or pharynx, and any good which it achieves is probably similar to that obtained by the simpler acid mixture; both combinations tend to cleanse the tongue and act locally as antipyretics by their sialagogue effect in keeping the mucosa moistened.
Calomel in large doses (to grs.) is a favourite antiseptic routine on the Continent when given at the commencement of the disease, and it is maintained that by resorting early to its use the disease may be cut short. Liebermeister gave 3 or 4 such doses during the first 24 hours, and satisfied himself that he was able in some instances to abort the disease. Beyond the thorough emptying of the entire intestinal tract, it is very doubtful if any good can possibly follow such a procedure, which, moreover, might cause a fatal issue if resorted to at a later stage of the disease. There are good reasons for believing that calomel is capable of exerting a decided antiseptic action on the bowel mucosa when given continually in small doses ( gr.) at very short intervals, but such treatment is inadmissible in a prolonged disease like typhoid fever, where salivation must certainly follow should the drug be pushed.