There are many exceptions to the usual course of the disease just described. Of most importance are the dreaded occurrences which may appear at the acute stage of the disease. These retard convalescence, and are sometimes fatal. There are two chief dangers : intestinal hremorrhages and perfora tion, These usually occur in the third week, and result from intestinal ulcers caused by the typhoid bacilli. The patient may recover from the hxmor rhages, but perforation is generally fatal. In many cases the patient suffers a relapse at the end of the disease, which is generally caused by some error in diet, and this relapse is, at times, more severe than the original attack.
In the treatment of typhoid, great progress has been made during the last decades. Medical treatment has been almost totally discarded, as it has proved fruitless. On the other hand, splendid results have been attained from treatment directed toward sensible nourishment, appropriate use of water, etc. On the appearance of the first symptoms of the disease, the patient must go to bed, and must remain in bed until after the final dis appeara ice of fever. As long as there is any fever, the nourishment must be very scanty and entirely fluid. During the first week only milk, tea, lemonade, and wine should be given. In the second week broths and cocoa may be added, and in the third week paps. Solid food may not be given
until after recovery. The patient's appetite may have to be restrained so as to avoid indiscretions in diet. After the healing of the ulcers the patient generally recovers very rapidly, the nourishment is thoroughly digested, and in a few weeks the loss in weight has been regained.
The cold baths introduced by Dr. Brandt, of Stettin, have been of great benefit in the treatment of typhoid. They reduce the high fever, and clear the brain. Two or four baths are given daily, according to the patient's condition. The bath should last ten minutes, and the patient must be carefully lifted in and out. The baths, as well as the general treatment of typhoid, should be given under the supervision of experienced nurses ; otherwise serious results may arise. Care must also be taken that the patient does not get bed-sores during his prolonged stay in bed. The treatment of any accidental occurrences must be entirely according to medical advice, which in such a severe disease is necessary throughout.
In order to prevent contagion, the rules given in the article on DISINFECTION must be conscientiously followed. They should be observed until three weeks have elapsed after the disappearance of the fever.