Lukewarm baths are the most agreeable remedy for temperature, and the local and general symptoms of the disease. Whenever the tem perature exceeds 39° C. (102° F.) a bath two or three times daily is given; in cases of infants at 27° R. (93° F.); in older children as low as 25° R. (89° F.). Duration 6-15 minutes. In addition, cold spongIng of the entire body followed by dry friction is often advantageous. With this treatment, one can get along in mild CaSCS. Besides the baths, or in the first instance cold chest comprews are very popular, and are of decided value in prolonged temperature over 39° C. (102° F.). Regarding cold and warm compresses and baths and their contraindications see bron chopneumonia, page 360. hi cases of very high temperature and rest lessness the complete pack (10-15 minutes) is often of benefit, as is also the ice-cap to the head. This is also to be employed when cerebral symptoms are present.
In typhoid co»ditions, cold irrigations during the warm bath fol lowed by rubbing are advisable. According to the advice of Jurgensen, cold aud rapid spongings are of advantage whenever the arteries are flabby and not well distended. He also recommends them in attacks of weakness occurring about the time of the crisis. If the cold compresses cause prolonged coldness of the slzin and cyanosis, they had better be discontinued. In these instances, a bath of short duration at about 30-32° R. (100-104° F.) is indicated.
With the onset of the crisis, all compresses and baths are to be dis continued. If after the fall of the temperature, resolution is delayed, an attempt may be made to hasten it by means of warm chest compresses.
Antipyretics may usually be dispensed with, as they often act injur iously on the heart. They are to be especially avoided immediately before the crisis. In cases of excessively high temperature, over 41° C. (106° F.), great restlessness, and cerebral symptoms, they are occasion ally of transitory value. (Phenacetin 0.1-0.3 Gm. (li-5 gr.) in the even ing, or quinine by enema). Even under other conditions, internal med ication may often be dispensed with. Whoever cannot desist therefrom may give an acid mixture, dilute hydrochloric acid 1-2:100 (al, 15-30 to 3i oz.). The irritating cough and the pain in the side often require the administration of codeine or morphine (added to the acid mixture), in older children also given hypoclermatically in cases of severe initial pains (3 milligrams at 5 years, 5 milligrams at 10 years of age). During the febrile stage the indication for the administration of expectorants is usually absent. After the crisis they may have some claim for consid
eration (lig. amnion. anisat. (P. G.) whenever the secretion is abundant, ipecac in a dry- catarrhal condition). Evacuation of the bow:els is hastened by sugar water, fruit juices, apple sauce, and if necessary by daily enemata. III cases of obstinate constipation robust patients are to be given a laxative. Whenever cerebral symptoms are present, large doses of calomel are indicated. Otitis media with severe symptoms may require a paracentesis of the tympanic membrane.
From the beginning, the cardiac strength is to be preserved by avoid ance of all unnecessary exertion on sitting up, going to stool, and in the bath; and a reserve fund should be established by a good nutritious diet.
In weak subjects it is advisable to administer mild stimulants such as bouillon, beef-tea, tea, and cotTee, from the beginning, at least as soon as cardiac and systemic weakness becomes manifest; and also after each bath. These stimulants are sufficient in the majority of cases. However, as soon as the pulse becomes very- frequent, small, and the artery poorly distended, together with cyanosis and dyspnam, the admin istration of strong stimulants should not be delayed. Alcohol had better be avoided except in cases of unexpected collapse. In cases of weakness of the heart's action some preparation of digitalis is of service, i.e., infusion of digitalis 0.15-0.ti Gm. (II-12 gr.) according to the age, to be given in the course of two days; or, caffein. sod. benzoic in aqueous solu tion 0.05-0.3 Gni. (I-41 gr.) pro die. It is often advisable to give digi talis first, and afterwards if it is not sufficient, caffeine. In severe cases, caffeine is also given subcutaneously with advantage; as is also camphor (spirit camphorate, 1-1 syringeful several times daily). The heart de mands careful supervision shortly before and after the crisis. In cases of severe cyanosis and dyspnuiti with threatening pulmonary, (edema, venesection acts apparently beneficially, provided the heart's action is still good (Baginsky, Gregor).
During the first few days after the crisis rest in bed is imperative, and should be maintained until all symptoms of consolidation have disappeared.
During the period of convalescence, the anaimia and weakness make the adniinistration of quinine, iron, and malt preparations desirable. Later, for complete recovery and strengthening of the system, a pro longed stay in the country is advisable.