In private practice, we should isolate the patient and carefully dis infect the stools, urine, and cxpectorations. This is done best and cheapest by a copious addition of slaked lime to the stools and urine and of a solution of sublimate or a concentrated solution of lysol to the sputa; by subjecting the underclothing and bed clothes to the action of live steam; by keeping the attending nurses away from other patients; by scrupulous cleansing of the hands, etc.
Before dealing with the still necessary symptomatic treatment, I shall briefly review the results of specific therapy. Pfeiffer and Rolle availed themselves of an active immunization method, injecting agar cultures of the typhoid bacillus which had been floated by a solution of common salt and killed by heating. A similar procedure employed by Wright with British soldiers in India is said to have been attended with success. The general harmlessness of this immunizing method, as con firmed on various sides, justifies its trial in severe and widespread typhoid epidemics.
Chantemesse proposed a serum treatment. For this purpose lie uses serum from horses immunized by gradually increased injections of a typhoid toxin that he prepared. In patients thus treated he had a mortality of 6 per cent. and it seemed that the process of the disease was milder and shorter. Josias, among 50 cases treated with this serum, recorded only two deaths, and with early injections he produced an abor tive course and never experienced any unpleasant after effects. For my own part, I have not yet tested this treatment.
Jez prepares a sort of pulp from the bone marrow, spleen, thymus, brain, and spinal marrow of rabbits highly immunized against typhoid; crushing the pulp in a mortar, and adding a mixture of alcohol, common salt, and water, stirring up the mass, placing it into an ice chest for 24 hours, and finally filtering. The rather clear, reddish yellow filtrate is administered by mouth. In its use, Jez noticed a rapid fall of the tem perature and speedy improvement of the symptoms. Results communi cated from other sources, however, are contradictory. I used it only once, as prepared in Tavel's laboratory in Berne (Switzerland). The case was a girl eight years old suffering from severe typhoid fever. Two of her younger sisters had the disease but with symptoms less intense. The treatment did not shorten the morbid process, nor influence the temperature curve nor even prevent a relapse. Still, I am not inclined to pronounce judgment on the strength of a single case.
As to symptomatic treatment, not much must be expected. I am :•ure from a rather wide experience in Prague in the treatment of typhoid cases that none of the many antipyretic nor antiseptic methods either in my own practice or in that of others presented anything to convince me of its efficiency. Some of these modes of treatment are disagreeable to the patient, and some distinctly dangerous and for such reasons a wise restriction of their use cannot be too strongly recommended.
- The hope of sharply checking the process by energetic primary intestinal disinfection gave rise to the calomel treatment. Apart from the fact that the object in view cannot be attained by any remedy and that for the most part we see the cases at a stage when the blood circu lation has already been colonized by the bacilli, the above method is not without certain dangers, as it irritates the bowel and is apt to provoke stomatitis and ulceration of the gums. For the benefit of the patients, it is better not to use it. Whoever wants to use any of the "intestinal antiseptics," as salol, benzonaphthol, etc., will at least not cause any harm. They are administered in the form of a powder or emulsion in daily doses of 0.5-2 Gm. (74-30 gr.), according to age.
In profuse diarrhceas astringents are indicated. Among these are subnitrate of bismuth, tannalbin, tannigen, fortoin, enterorose, bismu tose, ichthalbin, in doses of 0.1-0.25 Gm. (11-4 gr.), with or without addition of opium, a knife-pointful of these powders three to four times daily. The ordinary typhoid diarrhoea with 2 to 4 evacuations a day is best when unchecked. The strenuous may try to remove a part of the infectious material by the high injections as recommended by Marfan.
Against the fever the whole arsenal of the antipyretic method used to be, and is by many still called into requisition, not for the benefit of the children, hut as statistics show at times to their harm, as in collapse from cold baths, or after large closes of antipyretics, and rarely to their joy, as can be inferred from the excitement caused by any of the hydro pathic measures in these poor little sufferers. It is my firm conviction gained in the course of many years from the unprejudiced observation of numerous eases, that the progress of abdominal typhoid in childhood is neither shorter, nor milder, nor more pleasant for the children, if the temperature, according to one or another method, is artificially reduced.