Chemical antipyretics have been proved to he of no real service, and the value of the cold or tepid bath is not yet quite established in the same way as in typhoid as a routine element in the treatment. The use of the bath is beyond doubt of the greatest value when the temperature is high; hut the writer thinks that its routine employment should not be commenced till the temperature reaches at least 03°. Quinine may he used at the same time in some cases with advantage. Cold sponging of the body and limbs should be made a matter of routine in all cases. The writer can speak of its comforts and its benefits from his own personal experience.
If some form of drugging must be carried out, the least objectionable routine would be the administration of 15 mins. Dilute Hydrochloric Acid well diluted with a large volume of water.
Serum has been tried with apparent success by Nicolle and Blaizot, who injected 10-20 c.c. of the serum of horses immunised by injections of the spleen of experimentally infected guinea-pigs.
Delirium, headache, and sleeplessness may be met by Ice to the head and counter-irritation to the nape of the neck. Active delirium calls for most alert nursing; the typhus patient is often treacherous, and should never be left unwatched; owing to his delusions and hallucinations he will often attempt to assault his attendants or jump through a window. Some authorities blister the scalp in such cases. Musk (io-gr. doses) with Oil of Cajuput (5 mins.) the writer has used with advantage when the nervous symptoms and prostration have been alarming. As an hypnotic, Chloral was much used in conjunction with large doses of Bromides; ' but it should never he given on account of the weakened heart which is ai element of typhus. Opium cannot be borne when the headache and delirium are marked, unless when given, as advised by Graves, along with moderate doses of Tartar Emetic; but in the early stage of the disease a 3o-min. dose of Liquor Morphia is safe and more certain than any of the numerous new hypnotic drugs. Often in the insomnia of typhus the speediest hypnotic will be the cold pack.
As in typhoid fever, coma must be promptly met by cold affusion if the temperature is high, or by rectal injections of strong coffee, or by coffee by the mouth if the stupor is not complete. In deep stupor Murchison laid stress upon the necessity of counter-irritation over the loins, either by cupping-glasses or by sinapisms covered by mackintosh, and he blistered the scalp by strong Ammonia in some cases. The wi iter would
recommend the warm pack under such circumstances, and the general treatment for acute urfemia mentioned upon p. 91, if albumin is found in the urine and the temperature be only moderately elevated.
Hyperpyrexia should be promptly met by the cold pack combined with free affusion of cold water by pouring it over the enveloping sheet used in the pack.
On account of the blurred mental condition of the patient his bladder must be carefully watched, and the soft rubber catheter passed as often as needed. Food must be, for the same reason, regularly forced upon him, and his position changed from time to time as he lies in bed to avoid hypostatic congestion.
Heart Failure cannot be anticipated by digitalis, the only reliable drug being Strychnine given in doses of gr. hypodermically.
Pneumonia must be met by free stimulation, counter-irritation, and the internal administration of Ammonia in full doses. If the " typhoid state be present ammonia should not be given; then full doses of Turpentine, with a little Ether and Cajuput, are admissible. The Glycerin of Borax should be applied to the tongue and mouth frequently, and bits of ice and small but frequent draughts of iced water may be given all through the disease. The patient often fails to ask for water, but the nurse should see that he gets it as regularly as his nourishment and stimulants. Free elimination is of vital moment, and water is too often withheld.
Rapid convalescence begins as soon as the crisis has been safely passed, but owing to the change in the cardiac muscle he must be carefully pre vented from suddenly assuming the erect posture or getting out of bed to the night-chair. Stimulants should be lessened after the first 24 hours of apyrexia, and in three or four days almost stopped. By that time the appetite has improved, and semi-solids, as farinaceous foods, fish, chicken, oysters, etc., may be given inside a week from the fall in the fever heat. Sometimes the appetite becomes ravenous, and due care should be exercised in the amount of food permitted. The following tonic is useful during convalescence: Quinince Sit/ph. ass.
Acid. Nit.-Hyd. Dil. 3iv. Tr. Calltntlue Tr. Quassice ana ay.
Inf. Aurantii ad 5viij. .11isce.
Fiat inistura. Capiat cochleare magnum ex cyatho vinario ante ethos ter in die.