The ColdPack, though mentioned last of the hydrutherapeutic methods, is really the best of all when the portable bath and well-equipped fever hospital with its ample nursing staff are not admissible. Even when these are available the cold pack should he substituted for the bath if the local abdominal signs suggest the probability of perforation, as it can be carried out with the minimum of change of posture. A sheet wrung out of water at 75° is made to envelop the patient's body and limbs by turning him gently over on it and loosely covering him by its fold as he lies between blankets for about half an hour till the pyrexia falls to about roo`. The effect can be prolonged by keeping the sheet moist with cold water from time to time by sprinkling. In very high temperatures and in hyper pyrexia this method may easily be changed to that of Cold Affitsion by discarding the upper blanket and pouring a liberal supply of cold water over the sheet; this may be caught by any large receptacle under the bed, which should be raised at its head and protected by mackintosh sheeting. The cold pack in routine practice may he repeated every 3 or 4 hours as in Brand's bath treatment.
The mortality of typhoid fever by the routine treatment with hydro pathic agents has been reduced so considerably that this method must be regarded as placed upon a most secure and unassailable basis. Statistics when available for large numbers of cases show an all-round reduction to about one-third the mortality obtainable by the ordinary expectant plan of treatment—viz., from a death-rate of about 20 to about 7 per cent.
Stimulating Treatnient—Alcohol.—One of the chief dangers in the progress and termination of the disease being the tendency towards heart failure, the employment of large doses of alcohol has constituted itself a part of the routine since the time of Graves and Stokes. There cannot be a doubt that this practice has been pushed so far that gross abuse has resulted. Just at present we are threatened with the swing of the pendulum in the opposite direction, some authorities maintaining that alcohol should never be employed in the treatment of this disease. It will therefore he necessary to look fairly in the face the question of giving or withholding alcoholic stimulants in fever.
There are certain general principles which will meet with almost universal acceptance, whilst some disputed points will be considered later on. The majority of cases do not require any stimulants at any stage of their progress. The routine practice of administering stimulants in fevers is growing gradually less and less, if indeed it has not entirely vanished. Seldom if ever are they 'indicated in the early stages of the
disease unless in the case of those addicted to their habitual or daily consumption. A patient who appears to have the indications for alcohol during the first week of his attack will, in all probability, be beyond the influence of remedial agents. The writer does not hesitate to give alcohol when indicated in the way to be presently mentioned, and when he gives it it is with no sparing hand, but he is decidedly opposed to it as a routine treatment.
Statistics, if impartially considered, would seem to prove that the routine use of alcohol and the rigid exclusion of alcohol all round bring the mortality to about the same level—a result which has been explained by assuming that the drug is either useless or at least not injurious, since if it does not lower it does not raise the death-rate, but a serious fallacy underlies such a conclusion. The explanation of the uniformity of the two classes of statistics will be found on reflection to he due to the fact that the physician who employs alcohol in every case will cause the death of some patients. while he who withholds it in all cases will also raise the mortality of the disease.
It is the duty of the physician, therefore, to weigh every case upon its own merits, and only to arrive at a decision after examining the indications for and against, just in the same way as if opium or calomel or antipyrine were being discussed for administration to meet certain clear indications.
The debatable question of giving alcohol as a food need hardly be discussed here, though there can scarcely he a doubt that a considerable portion of it is burned or used up in the body just as other foods are. A small percentage of cases may be improved, and the patient's chances of recovery increased by giving small doses of alcohol along with the milk food where there is good reason to believe that the digestive powers are weak, and where close observation proves in the case before the physician that the addition of a teaspoonful of good whiskey or brandy actually does assist the digestion of other nourishment when given along with each close of it or immediately afterwards.
There are various indications which are relied upon as calling for alcohol in severe cases. These are mainly symptoms of cardiac failure, and those who place their faith in alcohol in such cases do so because, amongst other actions which it possesses, they believe alcohol to be the best cardiac stimulant, though it is idle to affirm that the drug can possess any cardiac tonic powers.