In typhoid fever, as in all other febrile diseases, it is important to watch the temperature and regulate it. If, for instance, with a tempera ture of 105°, we find restlessness and excitement with wakefulness, the child should be sponged over the whole body with tepid or cold water. This lessens fever, calms irritability, and induces sleep. More than tepid or cold sponging is seldom necessary. If, however, the temperature be not appreciably lowered by the sponging or rise again immediately, the child may be placed gently in a bath containing water at 70°, and be kept immersed for ten, fifteen, or twenty minutes. It is well to continue the bath until distinct shivering has been produced. The child must be then. removed, wiped dry, and returned to his bed. A stimulant may be given at this time if thought desirable. The cool bath should not be used unless there is a real necessity for it. Children can bear a continued high tem perature better than older persons ; and if there is a daily remission, as occurs in most cases, mere sponging will do all that is required.
Delirium is scarcely sufficiently violent in children to require treat ment—at any rate in ordinary cases, and headache is seldom a trouble some symptom. If it should be so, it is usually relieved by cold applica tions. Sleeplessness may be generally relieved by the tepid sponging above referred to. If necessary, a draught containing bromide of potas sium in combination with chloral may be given.
Diarrhcea may sometimes require remedies. In every case where the stools are too frequent and watery we should examine them for curd of milk. If this be present, the amount of milk taken at one time must be reduced. We should also take care that the child does not drink fluid in excess, and if necessary his drink must be given to him in smaller quan tities. When drugs are required to arrest the purging, chalk and catechu should be given if the motions are frothy. If they are strongly alkaline, dilute sulphuric acid is most useful. In the later period, when there is ulceration of the bowel, bismuth in large closes is indicated. Hremorrhage
from the bowels is a comparatively rare symptom in the child and seldom requires treatment by drugs. If necessary, however, gallic acid and dilute, sulphuric acid may be administered with small closes of opium. In such a case the child should on no account be allowed to raise himself from the recumbent posture even to relieve the bladder or the bowels. It is well also to give him his food in small quantities and in a concentrated form. Strong beef-essence, well iced, and good meat jelly should be em ployed ; and but little milk should be allowed, for fear of irritating the intestine with lumps of curd.
If perforation and peritonitis occur, opium should be given in small doses, but frequently, so as to produce some of the early physiological effects of the drug, such as drowsiness and tendency to contraction of pupils. In my experience opium is in such cases of small value unless pushed to this extent. The belly should be also smeared with an oint ment composed of equal parts of extract of belladonna and glycerine, and be kept covered with hot linseed meal poultices frequently renewed. The food in these cases also must be concentrated and given frequently in small quantities. Brandy and egg will be required to sustain the strength.
During the period of convalescence careful feeding is still necessary, for errors in diet at this time are a frequent cause of relapse in the fever. I have always made it a rule to allow no solid food until ten days have passed after the final fall of temperature. But even then the usual diet of health should be only slowly returned to.
In order to prevent relapses Immerman recommends, in addition to the utmost vigilance with regard to diet, the daily administration of sali cylate of soda in full doses; beginning directly the fever subsides, and continuing the use of the drug for ten or twelve days. The after anzemia, and weakness must be combated by iron and good food. Change of air to a dry bracing place or to the seaside is very useful.