ere is, however, a species of endurance, which may prove unable
to endure the sustained and active force of these applications. In such
cases milder applications and more frequent changes are recommended.
Packs, interchanged with baths, clysters or enemas which subdue fever,
alternated with ablutions, and similar methods.

Extremely stout and nervous patients must be treated with the greatest
caution.

As typhus cases gradually develop, care must be exercised to prevent too
violent treatment in case of serious complications. In fact the
physician must not be guided by fixed rules, but must be able to
individualize with prompt discretion.

During the severest stage the diet must be absolutely a fever diet,
prescribed in Form II, while patients suffering from lighter attacks,
and convalescents, may be permitted the milder fever diet, given in Form
III.

_Mental Condition._ Great care and observation is necessary with regard
to the patient's mental state. The observance of a quiet demeanour on
the part of everyone about the sick room should help to keep the patient
quiet and undisturbed and may serve to preserve his consciousness.

I have treated very severe cases of typhus, with extremely high fever,
during which, however, consciousness remained. Inexorable strictness in
this respect is often resented and misunderstood by those surrounding
the patient until they realize the far-reaching importance of the orders
by comparison with other cases.

Cold ablutions on the affected parts, air and water cushions, must be
employed early enough to avert any danger of bed-sores.

This strict treatment of the patient--physically and mentally, will in
most cases be sufficient to render his condition endurable; otherwise
the struggle against the irritation of complications becomes intense,
rendering it imperative, in the first degree, that the brain symptoms
should be carefully watched.

Cold compresses on the head must be used in case such symptoms appear,
but absolute undisturbed rest will conduce more than anything else to
their infrequent occurrence.

Collapse must be contended against with light stimulating food (light
bouillon of veal or chicken with a little condensed substance). Wine
with alcohol might endanger the life of the patient. If the collapse is
protracted, constituting a menace to life, the addition of cold water to
the lukewarm bath and similar procedure may be tried, but only by a
skilled expert.

Diarrh