TREATMENT 31 



existing shortage. Water was given freely, and liquids and soft 

 solids were provided according to appetite and digestion. In 

 some unconscious patients water and liquid nourishment were 

 given by esophageal tube. Mouths were swabbed at least five 

 times a day with boric acid and glycerin solution, and in case of 

 marked dryness petrolatum or boric acid ointment was applied. 



Cool water sponge baths were given for temperatures of 103 

 or over as taken for the four-hourly chart, and in our opinion 

 were of distinct value as in typhoid. Enemas were given every 

 second day as needed for constipation, since although there is 

 no theoretical objection to cathartics by mouth in typhus 

 fever, practically they seemed to have little effect. Watch was 

 kept for necessity for catheterization. 



Digitalis or strychnia was given in most cases for possible 

 supportive effect, and in collapse camphor or caffein, none with 

 any manifest advantage. We were unable to use strophanthin 

 as recommended by Danielopolu (1919, p. 327). For milder 

 delirium or insomnia veronal or chloral were prescribed freely, 

 especially as the Division was visited each evening, and for 

 severe and exhausting delirium hyoscine hypodermically 

 proved of service where the condition demanded it. Codein was 

 much depended on to diminish tiresome cough, and contrary to 

 some teachings we found morphia hypodermically to be of dis- 

 tinct service in delaying exhaustion from the frequent com- 

 bination of cough, restlessness, insomnia, delirium, and general 

 discomfort. Gangrene over points of pressure was combated 

 by efforts to distribute pressure by pads; in one case threatened 

 gangrene over a large area was aborted. Parotitis was treated 

 by icebags, but all cases except one later required surgical 

 incision. Other complications not peculiar to typhus were 

 treated as is usual in other diseases. Some of the more impor- 

 tant clinical observations made upon these 181 cases are pre- 

 sented in tabular form, Table III. 



