TYPHUS FEVER.
Prophylaxis.—The prevention of typhus, especially in time of war, siege, famine, and overcrowding from any cause, particularly when accom panied by destitution, is of vital importance. Except in the case of smallpox, there is no other disease so actively contagious, hence the most effective prophylactic agent is free and abundant supplies of fresh air maintained night and day by thorough ventilation. Rigid isolation of all patients suffering from the affection should be carried out if possible before the appearance of the eruption. Convalescent patients should not be permitted to mix with the healthy for at least 3 weeks, and this may be accepted as the quarantine period. As the disease is carried by articles of clothing, bedding, etc., these should he thoroughly disinfected or burned, and the sick-room sterilised by fumigation.
Experience in the late war has proved that the disease can he trans mitted by lice, and hence the great importance of personal cleanliness and the destruction of these parasites. but the writer is morally certain. from experience in more than one epidemic, that typhus may spread from the diseased to the healthy where these parasites are entirely absent. as seen sometimes in hospital cases where there was no possibility of the:pres ence of lice, fleas or bugs. Garlic is stated to have prophylactic powers.
Vaccine Prophylaxis.—Though the identity of the causal organism has not yet been demonstrated beyond a doubt. in the Balkan outbreaks during the late war a vaccine prepared from the suspected bacillus—B. tv-phi exanthematicis—was employed, apparently with very satisfactory results.
The selection of the sick-room is a matter of considerable importance the details mentioned on p. 987 should be attended to. but a freer supply of air is necessary than in the treatment of typhoid patients. The room should be cut off from the remaining parts of the house, and it is well that it should be in an upper storey with no sleeping-room above it. 3,00o cubic feet of air should be available. This will be obtainable in a room 15 feet square, with a ceiling of 13 feet, for it must be remembered that at least two pairs of lungs will be continually drawing upon this air space. since the patient must never be left alone by his nurse for a moment.
and when the delirium is active two attendants will be requisite. When an air space is thus provided of t,000 to 1,5oo cubic feet for each individual, the writer has rarely seen the disease to spread, though he has had con siderable experience in more than one small epidemic. The patient should be sent to bed at the earliest moment.
The administration of food should be carried out as in the treatment of typhoid fever; though there are not the same urgent necessities for a purely liquid nourishment, owing to the absence of bowel ulceration, nevertheless the great advantages of a liquid dietary are so well recognised that every detail applying to typhoid fever in this respect holds here equally well. More beef tea and chicken or other soup can be given. as there is not the same danger of exciting diarrhoea, and it is a good plan to give milk and beef tea alternately in most cases where the patient takes to this method.
The indications for Alcohol are the same as in typhoid fever, but 64 stimulants as a rule should not he given during the first week, unless when I the patient has been daily accustomed to the use of alcohol in some form or other. Speaking generally, the writer would say that, in his experience, there is more need of alcohol and more good to be expected from it in typhus than in typhoid fever. All old patients require it, but children very seldom do. The dose may reach 15 or even 20 oz. whiskey in the twenty-four hours. The keynote to the use of alcohol, antipyretics, and baths lies in this one consideration—that the siege, though a severe one, will be almost certain to last only fourteen days, and the entire effort and the one thought of the physician should be to fight the disease, not with the view of exterminating it, but to try by a purely expectant method to keep the patient alive till the expiration of that time. In some cases within sight of the goal, life may be sustained upon stimulants when all else fails, but it must ever he remembered that life can be sustained upon stimulants for a very short time only; alcohol as a routine agent must not he recommended in every case, and when employed its action will require close watching.