TYPHOID FEVER. 651 



misunderstood, I may give this warning before urgently advising the 

 abstraction of heat in treating either exanthematic or abdominal ty- 

 phus ; because, so far as I know, the hydrotherapeutic treatment of 

 typhoid fever was first introduced and carefully observed in my clinic. 

 Until within a few years, when the bodily temperature had risen to a 

 dangerous height, and there was occasion to lower it, I have had the 

 patients wrapped in cold, wet sheets, and the proceeding repeated at 

 intervals of ten to twenty minutes, until the desired end was attained. 

 After satisfying myself that the patients were unnecessarily annoyed 

 by the repeated transportation from one bed to another, which was 

 unavoidable in this operation, I have used cold baths in its place, and 

 they are much more convenient. I found that they had the same effect, 

 and were better borne by the patient than was the repeated envelop- 

 ment of the body in wet sheets. But I could not hide from myself 

 that, immediately after the bath even, there was occasional exhaustion 

 along with the retardation of the pulse, sinking of the temperature, 

 and clearing of the intellect. This exhaustion usually passed off 

 quickly, and the disease finally terminated in recovery ; but, along with 

 such cases, others occurred where the exhaustion continued longer after 

 the baths, and where early death made me doubt if I had actually 

 benefited the patient, or if, while removing one danger, I had not in- 

 duced another. Perhaps this anxiety was overstrained, but, after the 

 careful observations made at my clinic by Liebermeister and Tmmer- 

 mann as to the amount of heat passing from the patient into the 

 water, the possibility of this danger cannot be denied. It is true we 

 reduce the temperature of the body by cold sheets and cold baths, but 

 we at the same time increase the production of heat. If this were 

 not so, the patient would be cooled much more. I think it would be 

 proper to compare the action of an energetic abstraction of heat to 

 that of excessive exercise ; then it will be asked if it be advisable to 

 subject an already exhausted patient to this action. The question, is 

 it not possible, by hydrotherapeutic means, to reduce the temperature 

 of the body without exhausting the patients by an excessive increase 

 of the production of heat ? which I consider a very important one, has 

 been solved by Obernier and especially by Ziemssen. I consider the dis- 

 covery, that a far less energetic and less sudden abstraction of heat than 

 was accomplished by the methods formerly employed by myself and 

 others will reduce the temperature of a typhoid patient two degrees 

 or more, is a very important advance in the therapeusis of the disease 

 I have not observed the above-mentioned state of exhaustion, which 

 formerly alarmed me, since I have ceased to wrap patients in cold, wet 

 sheets, or place them in cold baths, but have employed the following 

 plan, recommended and tried by Ziemssen : As often as his tempera- 



