To prevent the spread of typhoid the following precautions are observed. The stools and urine of patients are thoroughly disinfected by im mersion in strong solutions of corrosive sub limate, carbolic acid, or chlorinated lime. In districts having a defective drainage system the dejecta may finally be disposed of by mixing with sawdust and burning or burying in trenches after saturation with chloride of Ihne. Bed pans, rec tal thermometers, syringes, tubes, and all other utensils coming in contact with the patient's dis charges are disinfected by boiling and immersion in antiseptic solutions. Bedclothes and linen are similarly disinfected. During epidemics drinking water and milk should he boiled and raw vege tables such as lettuce and celery avoided.
Careful nursing and regulated diet are of first importance in the treatment. The patient is strictly confined to bed from the beginning of the disease until the temperature has been normal for at least a week. A liquid diet has been found best throughout the course of the attack. The best food is milk, to which may be added lime water vichy: or it may be peptonized. Broths, con sonna., albumen water, or beef juice are giv en where milk disagree. or to vary the diet. The patient is urged to take plenty of cool water, and the juice of an orange or lemon may he _riven at intervals. Food is taken about every three hours during the day, and once or twice at night if there is great exhaustion.
Control of the lex er is the most important ele ment in the direct treatment of typhoid, and this is best accomplished means of cold water, by sponging, the met pack, and bathing. ;sponging
is valuable when a full bath cannot be given and for children and delicate persons. The cold pack consists in wrapping the patient in a sheet wrung out of water at 00 or 65° and sprinkling ad water over the body with an ordinary watering pot or similar device. The full bath, or 'cold tubbing.' was introduced by Brand of (;ermany, and this treatment is now almost universally followed in hospitals. By its use the fever is re duced, sleep is obtained, all the symptoms are rendered less intense, and the mortality greatly lowered. In giving the Brand bath the entire body except the head is immersed in water, be ginning at a temperature of 70 ', which is grad ually lowered by adding pieces of ice. The bath lasts 15 or 20 minutes and is given whenever the fever rises above F., or on an average of once in three hours. Vigorous rubbing of the trunk (with the exception of the abdomen) and extremities in order to prevent chilling and to increase the stimulating effect of the bath is kept up while the patient is immersed. After tubbing the patient is wrapped in blankets and hot-water bottles put to the feet. This pro cedure is usually followed by a refreshing sleep. The drug treatment of typhoid is symptomatic. Bathing renders febrifuges unnecessary. Antipy rine and phenacetin are sometimes given, but they tend to depress the heart. Intestinal anti septics, such as turpentine, salol, and carbolic acid, render the stools less offensive and prevent the production of gas. Return to solid food must be gradual on account of the danger of perfora tion through intestinal ulcers.