Vol. 60, 1909 - University of North Carolina at Chapel Hill

XXII THF CHARLOTTE MEDIOAL JOURNAL
An Interesting Point in the Treatment voluntaryevacuationsof feces and urine con- i
of Typboid Fever.
tinned. On January 18 at noon A-S-phen i
By Henry C. F. Kellner, M. D., Philadelphia, Pa., (more generally known as thermol) in five- '
Visiting Physician to the Roosevelt Hospital.
g^^j,, doses every hour was added to the i
One of the greatest problems that has treatment. Examination of the urine show- i
confronted the medical profession in recent ed enormous numbers of typhoid bacilli S
years is the discovery and proving of an present. i
antithermic and antiseptic agent which will From the time of beginning the adminis- j
act in typhoid fever with comparative quick- tration of A-S-phen the temperature never •
ness without at the same time unduly de- rose above 101.3 degrees, the respiration i
jjressing the heart action or lowering the gaii ed in depth and fell to 24 per minute, i
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vitality of the organism. It would seem
the duty of all the members of the profession
to make accurate observations, and,
from time to time, reports upon remedies
and the pulse became fuller and stronger, i
alihough counting at 100. The general 5
symptoms abated, and the patient slept ;
quietly, with very little restlessness. On
presented for their approval, in order to
secure legitimate conclusion as to the merits
of these drugs and compounds, with a view
January 21 the temperature fell to 99, the i
pulse to 94, and the respirations to 20. A ;
specimen of urine sent to the laboratory
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to establishing their degree of value, and showed a marked decrease in the number !
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thus, whenever possible, adding to the arma- of typhoid bacilli.
ment of the physician. The temperature diminished daily but i
In a number of cases of typhoid fever gradually, a few tenths degree marking the (
occurring recently in my charge at the improvement in the averages for each day. ]
Roosevelt Hospital of Philadelphia, I have With corresponding favoring changes in i
been interested to note the results from the pulse and respirations, normal conditions
use of a certain agent which seemed of un- were established on February 2. At this
usual qualifications, and which I herewith
report for comparison and investigation,
The following typical cases give the salient
time bacteriologic examination of the urine
showed the typhoid bacillus present in very i
small numbers. February 10, reports showed i
features observed in administration:
Case 1.— F'ritz M— , aged 26, a Russian
practical elimination of the typhoid bacillus
from the urine, and on February 12 the pai
tailor, was admitted to the hospital January tient was discharged as cured. 1
12, 1909, with a temperature of 104 degrees. Case II.—Ethel P— , aged
22, a seam-
pulse 100, respirations 24. His tongue was stress, was admitted to the hospital January
badly coated, and the characteristic rose 13, 1909, with a temperature of 105 degrees,
spots of typhoid fever were present on the pulse 104, respirations 24. She complained
abdomen. He was given ^ sponge bath of of great malaise, and showed all the classic
iced water, and the ice cap was ordered to symptoms of typhoid fever, which were conhis
head. His diet was restricted to milk firmed by a positive Widal reaction and the
and iced water, and a routine pepsin-hydro- determination of the presence of the bacillus
chloric acid mixture was prescribed in tea- in the urine. She was placed upon a milk
spoonful doses everj' three hours. diet, and a pepsin-h^'drochloric acid mix-
There was the usual reduction of tern- ture reinforced by one-thirtieth grain of
perature following the sponge bath, but it strychnia sulphate every three hours, was
rose again to 104 degrees by noon of the ordered, with a teaspoonful or whisky. She
following day, the patient lying semicon- was given a hot cleansing bath, and four |
scious and restless. There was a marked hours later was sponged with iced water,
loss of sphincter control, the feces and urine She made considerable complaint of pain
passing involuntarily. The Widal test was in the abdomen, and some tympanites were
positive. To quiet the exhausting restless- present. The bowels were ordered irrigated
ness and the cephalic symptoms complained with iced water at intervals of four hours,
of, the patient was given a capsule of caf- The first irrigations relumed clear, but
feine citrate two grains and phenacetin five later a yellowish tinge of the water was obgrains,
early in the afternoon, the dose be- served. Under this treatment the temperaing
repeated at nine in the evening. Re- ture ranged from 102 to 105 degrees, with
peated spongings with iced water brought full rapid pulse registering 110 and respirathe
temperature down to 101 degrees dur- tions at 24. On the day of her admission a
ing the next twenty-four hours. This treat- capsule of quinine sulphate two grains,
ment was continued with the substitution phenacetin three grains, and salol three
of one-thirtieth grain of strychnia sulphate grains, was ordered every four hours,
for the plienacetin-calTeine capsule. On January 16 capsules of A-S phen, five^
From this time until January IS the tern- grain doses every two hours, were ordered
perature was from 101 to 103, pulse from 95 substituted for the quinine-salol-phenacetin
to 108, respiration 36, shallow. The in- combination. From this time the average
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