Treating Enteric Fever With Sulphurous Acid (Acidum Sulphurosum)

While recognizing the difficulty of a true judgment about the effect of medicines in this fever on account of some uncertainty in its natural course and duration, and of the usual recoveries independently of any specific treatment, yet I must state my conviction that its course may be favorably influenced by the internal use of sulphurous acid, if commenced early enough. I know that many of the highest authorities have taught that the fever-poison having once been received must pass through certain changes before elimination, and that the best practice is mainly, - intelligent nursing; but careful observation of many enteric cases has led me to the conclusion that in some instances, under the influence of the administration of sulphurous acid or the sulphites, the attack has been shortened, and in others, high temperature and profuse diarrhoea have been relieved, coincidently with improvement in the general symptoms. In some advanced cases, with muttering delirium, sordes, and signs almost of dissolution, a favorable change has occurred shortly after commencing the acid treatment. Of thirty-six consecutive cases thus treated by Dr. Mackey, several illustrated these points, and none died. Special advantage from the acid is not claimed on the score only of the number recovered, for equal results have been recorded from other methods: the number is still too small to justify positive conclusions, but the impression made on my own mind as to the value of the acid is highly favorable.

It is true that sometimes unusual or persistent vomiting interferes with its administration, and the drachm or two-drachm doses recommended cannot always be given: 10 to 30 drops has been an average dose for an adult, when repeated every two to four hours, and when urgent bronchitis contra-indicates this remedy, for a time expectorants and diaphoretics must be substituted. Several years ago, Dr. Hamilton (Liverpool), treating his last eight cases of an epidemic of typhoid with sulphurous acid, "was struck by the mild form assumed, and apparent cutting short of the fever." They were typical cases at the commencement- five children, three adults - and the dose was from 1 to 3 dr.; they were generally better on the second day, and by the fifth day improvement had set in (Lancet, i., 1869, p. 45). Dr. George Wilks, of Ashford, refers to 171 cases of enteric fever treated by him with sulphurous acid, and all ending in recovery, some under very unpromising conditions; thus he instances a poverty-stricken child of four years, with violent vomiting, purging, tympanitis, and delirium, who could not have ordinary care and attention; a woman of seventy-three equally neglected; and a man of fifty-four apparently dying under ordinary treatment of astringents, etc., and yet rapidly recovering after commencement of the acid treatment (British Medical Journal, ii., 1870). The patients took from 2 to 20 drops with syrup and water every four hours for many days, until they showed ample evidence of the absorption and elimination of sulphur. Dr. Skinner reports twenty cases of enteric fever treated by sulpho-carbolate of soda (with one death).

Treating Enteric Fever With Antimony (Antimonium, Stibium)

Antimony has been commended in this fever, but the intestinal condition requires exceptional caution in its use; it does not of itself forbid the remedy, for diarrhoea and pain have often subsided under it (Trousseau), and when the lungs are implicated it may be especially useful.

M. Beriard records a case of fever with secondary pneumonia and delirium, rapidly passing into a hopeless comatose condition, which was relieved at once by free vomiting and purging from a large dose (nearly 6 gr.) of tartar emetic, and ultimately recovered (Bulletin de Therapeu-tique, 1873).

Treating Enteric Fever With Mercury (Hydrargyrum, Quicksilver)

We need not here refer to the older method of treating this fever by repeated purgative doses of calomel (v. Stille), a method not now advocated; but several eminent physicians abroad - Traube, Wunderlich, Liebermeister, and others - have recently recommended a "specific" treatment for the first nine days of this fever by calomel, giving 10 gr. in a single dose the first day, and 8 gr. (in divided doses) daily for three or four days afterward. They claim for these doses an antipyretic effect, and a power of lessening both the duration and the mortality of the disease (Medical Times, ii., 1876). I have not had experience of this treatment, nor, although foreign statistics show good results, has it made way in this country. An early moderate purgative dose is, however, often advisable, and Black has written to recommend one or two 5-gr. doses of calomel during the first week, as "antiseptic" (Lancet, i., 1875). Corrosive sublimate in minute quantities has also proved valuable in typhoid diarrhoea (British Medical Journal, i., 1874), and this is in accord with my experience, but with these exceptions mercury is not indicated in the treatment of this fever.