— 
Asiatic Society of Bengal. ciil 
on * The Management of Typhoid Cases with a Note on the 
Causation of Hemorrhage in the Enteric Fevers.”’ 
Colonel Barnardo based his evidence upon a total of some 
30,414 cases seen during the war in South Africa, during civil 
medical practice in India, and in the Great War on cases 
passing through Bombay. He first insisted that typhoid fever 
was a disease to be diagnosed by the cliniciam rather than by 
the pathologist and quoted Garrow’s criteria for the diagnosis 
of the enteric fevers. The French Army statistics during the 
war showed the value of anti-enteric inoculation. Besredka 
had advised discontinuance of this inoculation, with the result 
that in the next 12 months the French Army had about 
73,009 cases of enteric as against about 4,000 in the British 
Army in France, of approximately equal size, but protected by 
inoculation. He considered typhoid to be a bacillemia, but 
sometimes the typhoid bacilli were eliminated and a secondary 
invasion of the blood stream with streptococci resulted. 
Clinically with the onset of hemorrhage went a transitory 
fall in blood pressure, great acceleration in the pulse rate. 
great increase in blood pressure and often polyuria. Here if 
blood cultures were taken what was found was not so frequent- 
ly the B. typhosus, but streptococci or staphylococci. The 
ordinary practitioner treated typhoid along a line of expectant 
therapy, in other words drift, whereas it was one of the most 
easily controlled of diseases. A red line should be drawn across 
the temperature chart at 102. 5°F. and the temperature 
should not be allowed to exceed this. by hot not cold sponging, 
baths, ete. The mucin of the intestine being the chief defen- 
sive mechanism of the gut, judicious administration of calcium 
salts was useful; but they must not be pushed so far as to 
favour thrombosis. Iron perchloride was the sheet anchor of 
treatment, given in big doses. Proteids should be eliminated. 
from the diet and for threatened heart failure intravenous 
Strophanthin. In the last 340 cases treated at the Medical 
College Hospital on these lines the mortality had oe pee 
given cultures of septic cocci from the blood. Typhoid was 
a very amenable disease to treat, if one only knew the right 
lines upon which to proceed. ; ; 
Solonel Barnardo’s paper led to a vigorous discussion. Dr. 
Bose considered the cocci isolated from the blood to be 
potamia, as he had seen some of them. Most of them were 
not true typhoid at all but paratyphoid A, a disease amenable 
