222 DISEASES DUE TO BACTERIA 



In paratyphoid fever A and B the aggkitination test and cultural 

 characteristics have to be relied on. 



One must not forget that typhoid and another disease may co-exist. 

 The mortality in the tropics is about 20-25 per cent. 



TREATMENT. 



(i) General management. 



Patient to be put on a wire-woven mattress with a soft horsehair 

 mattress placed upon it, two blankets, then the sheet with a draw sheet, 

 and its waterproof covering in the centre. 



A mosquito net must be provided. 



The room must be large, as empty as possible, and well ventilated. 



All motions and urine and fomites sterilized at once in carbolic. 



A day and a night nurse well skilled and vaccinated are essential. 



The patient to be sponged all over twice daily with tepid water. 



Gently rub irritated parts with rectified spirits, and then dust with 

 boric or starch powder. 



Mouthwash necessary. Bed pan and urine bottle to be used all the 

 time. 



(2) Diet. 



No solid food is the safest rule. 



Milk, beef-tea, chicken broth, albumin water from white of eggs. 

 Plasmon, barley water, malted milk, whey, junket and weak tea. 

 Water ad lib., neither hot nor cold. 



(3) Drugs. 



The less the better as a rule. Simple enema for constipation. 

 Urotropine gr. x t.d.s. in second week to disinfect urinary tract. 



(4) Serotherapy. 



Chantemesse's anti-typhoid serum has good results. 



The Wright-Leishman's vaccine from forty-eight hours culture, irr 

 three doses 500 millions of bacilli, ten days later 1,000 million, ten days 

 later another 1,000 million. This is used as a prophylactic. 



Leishman had 19,000 cases under observation in India with the 

 following results : — 



9,000 were inoculated. Case incidence, 5*3 per cent. Case 

 mortality, 9 per cent. 



10,000 were not inoculated. Case incidence, 30*4 per cent. Case 

 mortality, 17 per cent. 



The immunity lasts about one year. If the whole Indian army was 

 inoculated, 1,000 cases of enteric fever and 200 deaths would be avoided 

 each year. 



Mixed vaccines can be obtained for the three stains. 



