Chapter VIII (4)

"The number of cases of death from typhoid fever coming under
the writer's observation, where the method of treatment pursued
has been similar to that briefly indicated above, have been very
few, a much smaller per cent. than in practice where alcohol has
been used as a 'cardiac stimulant.' I believe that the use of
alcohol in the treatment of typhoid fever is not only useless,
but absolutely harmful."

Dr. Kate Lindsay, of Battle Creek Sanitarium and Hospital, contributed an article upon Typhoid Fever to the _Bulletin of the A. M. T. A._ for January, 1896, from which a few notes are here taken:--

"The chief toxic centre is evidently the intestinal tract,
especially the termination of the ileum. The ulcerations,
necroses, perforations and hemorrhages are most frequently found
in the last twelve inches of the small intestine, and may extend
into the large intestine. The ulcerated surface and open vessels
increase the facility with which the poison finds entrance into
the circulation. The microbes, blood clots, necrosed tissue and
pus, furnish abundant supplies of toxic matter, which,
saturating the system, over-power and stop the activity of the
functions of all the organs of the body, causing degeneration of
tissues. Death is said to take place from heart, lung or brain
failure, but the failure involves every other organ as well.

"Regarding the intestinal tract as any other abscess at this
time, the physician should seek for methods of treatment or
remedies which will remove the morbid matters, and destroy, or
at least inhibit their action, thus decreasing the fever and
stimulating the circulation. Secondary toxic centres often
develop in the course of this disease, notably in the glands,
lungs and dependent organs, the hypostatic congestion resulting
from lying in one position, causing stasis of blood, death and
necrosis of tissue, both of the external and internal organs.
All vessels connected with the dying tissues carry toxins to
other parts of the body. Suppurating glands, and phlebitis of
the femoral veins are examples of this secondary infection, and
are accountable for the heart failure and collapse so often
fatal during the second, third and fourth weeks of typhoid
fever. * * * * *

"The old idea that in peristaltic action lay the great danger of
increase of the hemorrhage and perforation of the bowels, is
giving way to the more rational view that gaseous distention and
septic absorption, are what bring about fatal results from these
complications, and that the moderate peristalsis of the
intestinal walls lessens these dangers by closing the gaping
ends of the injured vessels, and expelling the septic matter and
foul gases. To meet these indications I have found lavage of the
bowels, even during hemorrhage, with water of 105 deg. to 110 deg. F. or
even hotter, given in moderate quantity of from one pint to
three, to give great relief by freeing the large intestines of
blood clots, fecal matter and other morbid matter. It also
increases peristaltic action in the small intestines, thus
favoring the expulsion of gas. The heat stimulates the
circulation in the peripheral vessels of the intestines, and
overcomes the tendency to blood stasis.

"In the cases cited, ice-bags, alternated with fomentations,
were used over the abdomen externally, and heat, or hot and
cold, to spine. The extremities were kept warm. From ten to
thirty minims of turpentine, in an ounce of gum acacia or starch
water, increased the efficiency of the enemata, and aided in
expelling the gas and checking hemorrhage.

"The tendency to hypostatic congestion and bed-sores, was
prevented by frequent change of position, and the use of hot and
cold to the spine by fomentations and compresses, or better
still, hot fine spraying, or the alternate hot and cold spray.
In one grave case, spraying was kept up for about twelve hours,
with only short intermissions. The heart was stimulated by heat
applied over it, whenever depression and collapse threatened,
and by hot and cold sponging of the spine."

Dr. Noble said some time ago in the _London Times_:--

"Although it is true that alcohol is an antipyretic, yet its
exhibition neither shortens nor modifies (favorably) the
diseases of which the fever is but a symptom. The paralysis of
the brain which is so frequent a cause of death in typhoid
fever, is more often brought about by alcohol than any other
cause, and more than one woman suffering from puerperal fever
has been done to death by the administration of this substance,
which, not being _convenienter naturae, is contra naturam_."

J. S. Cain, M. D., in an able paper, read at the Nashville Academy of Medicine, on "Rational Suggestions in the Treatment of Typhoid Fever," dissents from the practice, which still obtains largely in the medical profession, of administering alcoholic liquors, in the belief that they are "stimulants, conservators of force and even nutrients," and says:--

"After a careful and thoughtful study of this subject, I have
reluctantly, and against firm early convictions, been forced to
the conclusion that these theories with regard to the beneficial
effects of alcohol in disease are wholly fallacious. The only
rational conclusion at which I can arrive is that the agent is
ever, and under all circumstances, a depressor of temperature;
that it arrests the physiological interchange of carbonic acid
gas and oxygen in the tissues, as well as in the air vesicles of
the lungs; that it impedes the elimination of tissue waste, and
causes the accumulation of this refuse in the system; that it is
lethal anaesthetic in all quantities; that it is not stimulant in
the true sense, and never exerts that influence; and that it
supplies no element to the diseased and vitiated system
calculated to antagonize disease, repair waste, or invigorate
lowered vital forces, and therefore for these purposes is not
called for in the rational treatment of typhoid fever."

At the annual meeting of the American Medical Association held in Atlanta, Georgia, in 1896, Dr. G. B. Garber, of Dunkirk, Ind., read a paper upon "Alcohol in Typhoid Fever" from which a few points are here taken:--

"The fact that the mortality from typhoid fever seems to be
gradually lowering is no doubt due in great measure to the
non-use of alcohol in the treatment of the disease. Hardly a
week passes that some of our journals do not report a series of
cases treated without the aid of alcohol in any form. I used
alcohol in the treatment of the disease until two years ago,
when I became alarmed at the mortality; so I changed my plan,
and in 1894 I treated thirty-seven well marked cases of varying
degrees of intensity. I had two fatal cases, and in both of them
I had used alcohol. In 1895 I treated thirty cases of about the
same type, with no death. I only used alcohol in one of them,
and it caused me more trouble than any of the others. As this
case was in the family of a saloon-keeper, I could not control
the matter, as they would give it during my absence. On my
return I would find the face flushed, the temperature high, the
pulse rapid and the patient nervous. By close inquiry I would
find that some of the family had given 'just a little good
whisky' which had been in the house for twenty years.

"In closing, I wish to state that I am well convinced that in
the treatment of typhoid fever our patients will do better and
stand a greater chance of recovery, if we abstain entirely from
the use of alcohol in the treatment of the disease."

Prof. J. Burney Yeo, of London, in a paper read before the International Medical Congress held at Rome, Italy, said:--

"In order to maintain the intestinal antisepsis which forms an
essential part of this method of treatment, I insist on the
necessity of scrupulous attention and caution in feeding
patients suffering from enteric fever, great danger arising from
a failure to note the extremely limited digestive and absorptive
capacity exhibited by such patients.

"In conclusion, the use of alcoholic stimulants, and the common
employment of depressing antipyretic agents, must be condemned."

In a report of the treatment of typhoid fever by seventy-two physicians of Connecticut, thirty-eight declared that they did not use alcohol in any stage of this disease. The remainder used it sparingly in the last stages, and only two considered it valuable from the beginning of the disease.

In a discussion of typhoid fever by a medical society meeting in Rochester, N. Y., recently, sixty physicians being present, only three spoke in favor of using alcohol in this disease.

Hygienic physicians all insist upon a rigid fast as long as the high temperature continues, or until the patient is sufficiently hungry to eat a piece of plain, stale, graham bread, "dry upon the tongue." Dr. Charles E. Page of Boston says there would be very few relapses if this plan were carefully carried out. He contends that the whisky and milk diet, together with the not over-fresh air of the average sick room is enough to produce fever in a healthy person, hence is not likely to be conducive to recovery in one already infected with the disease.

In an article in the _Arena_ of September, 1892, Dr. Page says:--

"In my fever practice I have frequently observed the effect of
fasts of six, eight, ten and twelve days to be in the highest
degree productive of the health and comfort of patients, as, on
the other hand I have, during the past twenty years observed the
deplorable effects of the almost universal plan of constant
feeding. In some of the most distressing cases that have
happened to be thrown in my way, when all hope in the minds of
friends had been abandoned, I have found that withdrawal of
food, drugs and stimulants, and the substitution of simple,
fresh, soft water, has produced results that seemed almost
miraculous."

Fruit juices are now permitted by many physicians in fever, a few drops of lemon or orange juice, being a grateful addition to the water. Grape juice, unfermented, is highly recommended by some.

A young minister of great promise died recently of typhoid fever. His young wife, only one year married, is in settled melancholy, because she cannot understand why "God took her husband." Inquiry developed the fact that the physician in attendance was a believer in alcohol as a remedy, and used it in this case. In view of the better chances of recovery under non-alcoholic treatment shown by comparative death-rates, may it not be that the alcohol was responsible for the young man's death, instead of its being "God's will to take him?" The Author of all good has too frequently been held responsible for the errors of physicians, and the carelessness of nurses.

VOMITING:--"If the vomiting is due to undigested food, and the
sickness can be traced to excess, or to improper diet, draughts
of hot water should be taken in order to be rid of offending
matter in the stomach. After the stomach is empty bits of ice
may be sucked, or cold water sipped. A quarter of a Seidlitz
powder may be taken. A flannel, folded to four thicknesses,
dipped in hot water, and wrung dry in a towel, may be applied to
the pit of the stomach. Cover the flannel with a hot plate,
being careful to have the flannel large enough to prevent the
plate's burning the skin. Pin a dry towel over all, around the
body. This may be renewed every half-hour or hour, as required.
Sometimes a cold wet compress on the pit of the stomach, covered
with a dry towel is more efficacious, heat developing by
reaction. Fluid magnesia is often helpful."--DR. RIDGE.