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an essential part of pathology. The proper division of parties seems to me to be that given by Dr. Hughes in his paragraph on the a priori method, viz. with those who follow it in a broad, general, and more or less vague manner, and those who adapt it, not only to genera, but also to species and individuals, leaving out the a posteriori altogether as a mere abuse of the homoeopathic principle. It is only those persons in the second division who will ever obtain the full benefit of the homoeopathic law, and that only through the means of an accurate catalogue of the symptoms of a sufficiently large and sufficiently well-proved Materia Medica. With respect to the preference of Dr. Hughes for the plan of the Pathogenetic Cyclopcedia, it is not shared by Dr. Dudgeon himself, who is now occupied, in conjunction with Dr. Stokes, in supplementing it with an analysis after the manner of the Cypher Repertory,,]
THE TREATMENT OE TYPHOID EEVER BY COLD BATHS.
The cold-bath treatment of diseases attended by increased temperature has become such a recognised therapeutic method, and its results have been everywhere found to be so successful, that no system of medicine can afford to neglect this mode of treatment.
As representatives of progressive medicine, it is our duty to avail ourselves of every improvement in therapeutics, whencesoever it may come. As long as our treatment of diseases remains imperfect, so long shall we seek to diminish its imperfections by all the aids that accident or science may offer to us. The success of our treatment of typhoid and other febrile diseases attended by a great rise of temperature is not so absolute as to prevent us desiring some adjuvant to the merely medicinal treatment that may diminish still further the percentage of our fatal cases; and such an adjuvant is apparently offered to us in the now fashionable cold-bath treatment of fevers.
One of the earliest accounts of this treatment will be found in the Lancet of December 31st, 1870, where Dr. O. Fehrsen gives an account of the treatment of the feverstricken soldiers of the French and German armies in the Stadtkrankenhaus of Dresden.
A paper by Dr. C. Liebermeister, of Basel, in No. 31 of Volkmann's Sammlung klinischer Vortrage, gives us a detailed account of the treatment pursued in the Basel Hospital, and some historical account of the treatment, which we are happy to be able to lay before our readers en resume.
Until a very recent period it was generally supposed that fever was in some manner a wholesome effort of nature to throw off some morbid materies from the system. This opinion was held by the most illustrious names in medicine, as Asclepiades, Campanella, Van Helmont, Sydenham, Stahl, Boerhaave, &c.
Since it has been shown that the increased temperature in fever is owing to a more rapid combustion of material, and as in febrile diseases the appetite and digestive system are usually deficient, it is evident that the temperature can only be kept up by the consumption of the tissues of the body; hence the febrile process began to be looked upon as something the reverse of wholesome.
But it has now also been satisfactorily shown that the increase of temperature in the organism is accompanied by destruction of the organs themselves, and it has been found that when the temperature rises above a certain point, this destruction is complete and unmistakable, so that the integrity of the organs cannot be restored, and the patient must die. The destruction or disorganisation varies according to the organ. In all organs it is a real parenchymatous degeneration that accompanies this extreme temperature; the liver, heart, kidneys, brain, are each disorganised in their several manners.
This having been recognised as the inevitable effect of a certain elevation of temperature, it seemed desirable to check the tendency to elevated temperature in fever, and so prevent the disastrous effects that are owing to increased temperature alone.
It is well known that in the end of last century Dr. James Currie attained a remarkable degree of success in the treatment of exanthematic typhus and scarlet fever by means of cold water douches. But though his method was so successful, it found but few imitators, and was almost forgotten until the success of Priessnitz with his cold water cure brought Currie's method to remembrance. It is certain, however, that Priessnitz and his disciples did not commonly employ their method in cases of fever.
Ernst Brand, of Stettin, in 1861, wrote a book in which he vaunted the success of the cold water cure in typhus. But his recommendation fell dead on the ear of the profession.
It was not till the work of Bartels and Jurgensen, of Kiel, was pnblished in 1866, that attention was roused to the efficacy of the cold-bath treatment in lowering the temperature in fevers, and thereby obviating the ill-effects of the elevated temperature. These careful observers showed that cold baths could be given not only with impunity, but with immense advantage, as often as the elevated temperature rendered them necessary. They showed that the abstraction of heat from the patient should be carried out persistently day and night as often as the temperature as shown by the thermometer applied to the axilla reached or exceeded 39° C. It sometimes happened that as many as twelve baths had to be given in twenty-four hours, and that one patient had to get 200 baths in the course of his disease.
The results of this treatment were exhibited by the statistics of typhus abdominalis in the Kiel Hospital. From 1850 to 1861 there were treated 330 cases by the ordinary methods, of whom 51 died, showing a mortality of 15*4 per cent. Prom 1863 to 1866 there were 160 cases treated by the cold-bath system, of whom only 5 died = 3"1 per cent.
In Basel, where the abdominal typhus is extremely frequent and malignant, the success obtained in the hospital by the cold-bath treatment was equally striking.
Up to 1865 the treatment was the ordinary expectant treatment. In 1865, cold baths were employed to some extent, but as a rule only once, very seldom twice a day. But Dr. Liebermeister, having read Bartels and Jiirgensen's book in 1866, adopted the full cold-bath system administered by these gentlemen. The result is evident from the following table:
I. Ordinary treatment.
^* A paper by Dr. Behier, in the February number of the Practitioner, enables us to add to the statistics supplied by Dr. Liebermeister of the coldbath treatment of typhoid.
Brand treated in 1868, 171 cases, of whom 1 died.
1870-1, 89 „ 0 „
Elenard „ at Lyons, 12 „ 0 „
In the Leipzic hospital from 1851 to 1867, 1178 cases were treated by the old methods, of whom 213 died=18-1 per cent. From 1868 to 1872, 251 cases were treated by cold baths, with 18 deaths=7'2 per cent.
Mortality with treatment Mortality with treatment without baths. with baths.
Jiirgensen . . 15-4 per cent. 3'1 per cent.
Ziemssen and Immermann . 30'2 „ 7"5 „
Liebermeister and Hagenbach 26-2 „ 9'7 „
Kiegel . . • 20-0 „ 4-3 „
Stohr . . • 20-7 „ 6-6 „
This striking result of the cold-bath treatment of typhoid, whereby the mortality was reduced to nearly a fourth of what it had been under the ordinary expectant treatment, was confirmed by the experience of the hospitals of Munich, Erlangen, Wiirzburg, Nurnberg, Greifswald, Jena, Halle, &c, and there can be no doubt that it is a powerful remedial means that should not be neglected in the treatment of typhoid wherever it may occur.
But it is not only in typhoid that the cold-bath treatment is of use. It has been employed with success in typhoid pneumonia, in scarlatina, measles, the premonitory fever of variola, puerperal fever, pleurisy, meningitis cerebro-spinalis epidemica, &c.
The temperature of the water in the bath should be 20° C. or lower. The same water may be used for one patient repeatedly. The bath may stand in the patient's room ready for use, and he should remain in it for ten minutes at a time. The attendants should be instructed to take the temperature in the axilla every two hours, and whenever they find it 39° or upwards they should put the patient into the bath for ten minutes, then lift him out, wrap him up in a dry sheet, and let him rest for a time on the bed before putting on his night shirt.
Very weak patients should have the water rather warmer (24° C), and may remain in it a shorter time (seven or five minutes).
Such is the cold-bath treatment now so extensively employed, especially on the Continent, in the treatment of febrile diseases with a high temperature of the body. It promises to be a useful auxiliary to the best medicinal treatment of such diseases, and though like much of the medication of the so-called "rational" school, it is a mere treatment of a symptom, the increased temperature of the body, yet that should not prejudice us against it, for it is precisely this increase of temperature that constitutes the great danger in typhoid by the parenchymatous degeneration it is liable to produce. If by the use of cold baths we can effectually ward off this by no means insignificant peril, we shall afford to our specific remedies Baptisia, Rhus,