By the administration of Urotropine, Lactate of Sodium, Lactic Acid Bacilli, Citrate or Bicarbonate of Potassium, etc., the amount of organisms in the urine and aces has been lessened for a time, but it must he re cognised that all our present known agents are futile for the permanent sterilisation of the typhoid carrier. Such individuals cannot be com pulsorily segregated, but they should be prohibited from pursuing any occupation which involves the handling of food supplies purchased by the public„ and the doctrine of the most rigid cleanliness should be instilled into them. With the conscientious carrying out of such precautions as just mentioned, the typhoid carriers' constant menace to public health may be greatly minimised.
Vaccine Prophylaxis or .:Intityphoid _Inoculation has demonstrated its remarkable efficiency during the late war. The fact is now so firmly established that the necessity of quoting statistics is no longer needed. In the British Army. at an early stage of the war. the incidence of the disease was found to be 14 times greater, and the deaths 42 times more frequent, amongst the uninoculated than amongst the inoculated. There is ground for hoping that by improved methods this relative immunity may be made absolute; the inoculations as at present practised confer more or less immunity for several years, but they are not protective till after the lapse of a few Weeks from the first injection. This method of protection against typhoid should he carried out in every individual who is going to take up residence or to travel in regions Nx here the disease is endemic.
The usual dose is i,000 million killed bacilli. followed in a week by double this dose. The first injection is liable to be followed by i con siderable amount of reaction: in one case the writer witnessed a rise of temperature to almost to-s`, but such a result is very rare. The second dose, though much greater, is usually followed by little or no disturbance. Obviously the individual should be confined to bed for i to 2 should the reaction be marked.
Castellani maintains that more satisfactory immunising results are obtainable by using attenuated living cultures, and that a mixed method is the best routine. This he carries out by injecting c.c. of dead culture prepared by Wright's method, which is followed up by a i c.c. live attenu ated culture after the lapse of a week. The live culture is prepared by
inoculating broth-tubes with a 48 hours' old culture of a typhoid strain, which has been kept alive in the laboratory for 3 years till it has lost its virulence. Many authorities now recommend a Triple Vaccine of typhoid, paratyphoid A and paratyphoid B ; this was often necessary during the war.
As soon as the diagnosis has been made of typhoid fever, the patient should be at once sent to bed if he has not already been laid up by the malaise, headache, etc. There is no single factor in the management of the disease of such vital importance as the stage at which the patient is compelled to take absolute rest. Recovery is expedited and the mortality of the disease considerably reduced in those patients who take to bed as soon as the first symptoms of the disease show themselves. It is a grave mistake to wait for a positive \Vidal reaction. as this may not show itself till after the end of the first week.
The selection of the sick-room should be seen to by the physician, and it should be quiet, well ventilated. large. and airy. with abundance of light, which can be easily cut off when desired. Where a large room can be obtained it should he selected, even in winter, and by a few screens placed around, but at a distance from the bed, an agreeable aspect of comfort can be easily produced. A fire, even in summer, is usually desirable for heating milk, etc.: moreover, it aids in ventilation and in the maintenance of an equable temperature. The less furniture the better, and carpets should be removed, their place being taken by a few thin rugs; all unnecessary articles and ornaments should he taken away.
The plan of haying two rooms, one for the night and one for the day, is theoretically a good one, hut in practice a dangerous one, owing to the serious consequences which may arise from moving the patient about.
It may, however, he adopted in those cases where two good rooms open directly into each other, the patient and his bed being carried (not rolled) from the one to the other. upstair room is preferable (this is most desirably in typhus), and if it opens by French windows on to a balcony and has a well-flushed water-closet on the same level, everything that can be desired is thus secured. The temperature of the room should be kept at about 6o' F.