The great question, however, is how to pre vent the fever running too high. Each case must be judged on its merits, but the modern view is that, if it runs up to 103', something must be done to prevent it going higher. This may he done by the use of cold water in one or other of several ways—time various ways described on p. 510. The cold pack is more efficacious than cold sponging, and the full cold bath is much advocated in Germany and in America, where it is called the Brand bath. The bath is brought to the bedside, the patient is lowered into it naked, is kept in 10 to 15 minutes, during which time every part of the body, except the lower port of the abdomen, is gently rubbed successively. The temperature of the water varies, according to the case, from 90° to 65° Fahr. The detailed directions for treatment of fever laid down on p. 507 and the succeeding pages are applicable to typhoid.
For weeks after the disappearance of the fever great care is necessary. Even in mild cases the person should on no account be allowed to sit up till a week after complete disappearance of fever, as shown by thermo meter (p. 38). Even weeks after apparent recovery, improper exercise or improper food may lead to serious mischief in the bowel. All hard food should therefore be avoided for weeks after recovery.
Typhoid fever may be connnunicated by the discharges from the patient, long after the patient's recovery, because the organism con tinues to inhabit the bowel. Such persons are called typhoid carriers.
Care must be taken to disinfect the dis charges in the manner described on p. 516. All linen must be disinfected. In the country special pains must be taken that the discharges do not find their way into wells or burns from which a water-supply is taken. In this way contagion is spread.
Inoculation against typhoid fever is now prac tised, and should be submitted to by anyone going to live where the disease is common. It consists in the injection under the skin of an anti-typhoid vaccine. Two doses are given, the second ten days after the first.
There are two varieties of fever, strongly resembling typhoid, and only of recent years distinguishable from it by special tests, called Paratyphoid A and Paratyphoid B. The ino
culation used should be a vaccine for all three.
(Dengue—Three-day Fever Break-bone Fever).--This is an infections fever, not known in Great Britain, but occurring in India, Burmah, Egypt, Persia, North and South America, and the West Indies. It attacks per sons of both sexes and of all ages.
Symptoms.—Time fever presents symptoms resembling rheumatic fever, scarlet fever, and ague. It often begins suddenly with severe pain in some joint, specially a finger-joint. The pain jumps from one joint to another, soon attacking many. There are high fever with shivering's, loss of appetite, great weari ness, sickness, and pain in the head and eye balls. The rash comes out on the third day, and is like that of scarlet fever, the face being red and puffy, the throat red and sore, the eyes red, and a general redness being over the body. It is usually accompanied by itching. The pulse is frequent, breathing is quick, and the tongue is covered with a white coating out of which red points project. On the fifth or sixth day the rash passes otl, and the fever falls, and comparative health is restored. This lasts, however, only for from two to four days, when the fever returns, and a second rash resembling measles or nettle-rash (p. 420) appears. The second attack lasts two or three days and gradually passes off; much of the scarf-skin often separating. Though the fever passes oli; the pain and swelling of the joints, especially of the smaller ones, remain, and may continue to afflict the patient for weeks. Fur ther, more than a second relapse may occur, making recovery slow and doubtful. In ordi nary cases, however, eight days is the average length of the disease. In time course of the fever delirium, in children convulsions, may occur.
Treatment.—Gentle movement of the bowels should be regularly obtained, but there should be no purging. The ammonia and ether mixture (see p. 511) should be given in tea-spoonful doses every two or three hours. The addition of tincture of belladonna is recom mended, and two or three doses of from 5 to 10 drops may be given at intervals of an hour, the mixture being afterwards given alone.