THE TREATMENT OF CONVALESCENCE 



1403 



to gradually increase and modify the dietary. The patient should 

 not be allowed to sit up or to get out of bed until the temperature has 

 remained normal for about four weeks. In the meanwhile the 

 urotropine treatment should be carried out, and, if possible, a 

 bacteriological examination of the urine and faeces should be made 

 six weeks after the permanent return to a normal temperature. 



II. The Treatment of the Sequels. — The phlebitis has been 

 mentioned, and as it is followed by oedema will require a bandage 

 or elastic stocking. Post-typhoidal neuritis requires massage and 

 electricity. Nervous sequelae are not very uncommon, giving rise 

 to a temporary form of mental weakness, or to types resembling 

 disseminated sclerosis, myelitis, etc. 



III. The Treatment of the Acute Carrier.— If a patient has 

 become an acute carrier, he should be treated by antityphoid vac- 

 cination, as already described, and urotropine should also be ad- 

 ministered, for this drug, in addition to its action on the kidney, 

 is excreted during twenty-four hours by the liver cells and by those 



/ of the gall-bladder. A dose of 15 grains per diem is said to be 

 sufficient to destroy the B. iyphostis in a gall-bladder in ten days, 

 but the complete cure of carriers is very difficult, even having 

 recourse to surgical measures. 



Prophylaxis. — The essential features in the prophylaxis of enteric 

 fever are a pure water-supply, a good system of drainage, and 

 sewage and dust disposal, a pure food and milk supply, the destruc- 

 tion and prevention of fly-breeding grounds. 



Another essential feature is the watering of the streets with anti- 

 septic solutions when there is much dust, and lastly, and by no 

 means least, the search for, discovery, isolation when possible, and 

 treatment of the typhoid carriers. 



Vaccination. — At the present time Cast ellani's triple vaccination 

 (typhoid, para A and para B) has come into general use. The triple 

 vaccine can be prepared according to various methods: broth cul- 

 tures killed by heat, carbolic salt solution emulsions, oily emulsions, 

 sensitized vaccines, etc. In a general way, it may be stated that, 

 whatever the method of preparation, the results are satisfactory. 

 We generally use a vaccine consisting of an emulsion of typhoid, 

 para A and para B bacilli in normal salt solution, to which J per 

 cent, carbolic acid has been added. The details of preparation may 

 be found in various papers by one of us. Each cubic centimetre con- 

 tains typhoid 500 millions, para A 250 millions, para B 250 millions. 

 Half a cubic centimetre is inoculated the first time and i cubic centi- 

 metre a week later. Certain authorities recommend a double dose, 

 I c.c. the first time and 2 c.c. the second. The triple vaccine gives a 

 certain amount of immunity for the three varieties of enteric — viz., 

 typhoid, para B, and para A ; the immunity for typhoid and para B 

 seems to be more marked than that for para A. 



The inoculation of the triple vaccine gives rise to a local and 

 general reaction, which is not more marked than after the old 

 typhoid monovaccine; some infiltration and pain at the point of 



