TYPHOID FEVER. 647 



TREATMENT. Prophylaxis requires that, in large cities, where 

 typhoid fever is endemic, there should be sanitary police rules to pre- 

 vent the soil from becoming soaked with putrid decomposing materials. 

 Of late, many attempts have been made, by drainage in cities, to re- 

 move the moisture of the soil, which greatly favors the decomposition 

 of animal substances, and, consequently, the occurrence of typhus and 

 cholera germs. Should the drainage succeed, and should it decrease 

 the number of typhus and cholera cases, as the drying up of swamps 

 sometimes does that of intermittent fever, the still youthful science of 

 hygiene would boast of a brilliant triumph. Some physicians still 

 doubt the contagiousness of abdominal typhus, or, at least, consider it 

 as not proved. But such views must not be brought to the bedside 

 of the patient ; here the fact, that the non-contagiousness has not 

 been proved, must make us act as if its contagiousness had been de- 

 monstrated. The sick should be isolated from the well, and only 

 those attendants required in caring for the patients should be allowed 

 in his vicinity. It is just as important that all healthy persons, who 

 can be spared, should be removed from the locality where the infection 

 of one or more persons has occurred. I have learned of one very sor- 

 rowful instance in Rheinland during the past few years, where, ap- 

 parently, from the neglect of this precaution, almost all the members 

 of one family, one after another, died of abdominal typhus. Lastly 

 we must take care that the dejections of patients be not thrown into 

 privies used by other persons. We know no prophylactic remedies 

 that protect from infection by typhoid. 



When abdominal typhus has once begun, we may, under some cir- 

 cumstances, attempt to cut short its course. It is now generally recog- 

 nized that this cannot be done by emetics or venesection, which, for a 

 time, were recommended for this purpose ; in fact, these measures al- 

 most always have an injurious influence on the course of the disease. 

 Only when there is undigested food in the stomach, should we give a 

 dose of ipecac. ; in all other cases we mi^st remain immovable to the 

 senseless and often annoying requests of the laity for the administra- 

 tion of an emetic. The case is very different with a few large doses 

 of calomel. After the accurate observations of Wunderlich, we can 

 scarcely doubt that by this remedy we may, in some few cases, cut 

 short the disease (according to Wunderlich, one or two five-grain 

 doses are enough), and that in the great majority of cases where this 

 remedy is given during the first week, and before the occurrence of 

 much diarrhoea, the course of the disease is rendered milder and shorter. 

 The experience of Pfeufer's clinic, as well as my own, perfectly agrees 

 with W'Mnderlicli's. We shall not attempt to say whether the calo- 

 mel has a favorable influence on the typhous intestinal disease, by op- 

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