ENTERIC TYPHOID FEVER AT THE AUCKLAND HOSPITAL.

New Zealand Herald, Volume XXV, Issue 9022, 7 April 1888, Page 3

ENTERIC TYPHOID FEVER AT THE AUCKLAND HOSPITAL.

TO THE EDITOR. Sib,—With regard to the "cold water cure," and all the rubbish that is being written about it at present by irresponsible and ignorant persons, it will be as well to clear the public mind of a few erroneous impressions. Now, to begin with, the " cold-water cure" was not at any time carried out as a routine practice at the Hospital, nor has it ever yet been practised there in its entirety. Your correspondents do not even seem to know what is meant by the cold-water treatment, which really consists of lifting the patient bodily into a bath of such a temperature as will not cause shock, and gradually lowering the temperature by adding cold water, which proceeding brings down the fever, but must do repeated when it rises again to an unsafe height. This treatment in experienced hands and selected cases never does harm, and frequently gives excellent results, but is clumsy and difficult to adopt either in hospital or private practice.

What was done during 1885-86 specially alluded to, was precisely the same as in the year before, namely, in addition to such treatment as was indicated, when the patient became very feverish, he was either sponged from head to foot, or a series of wet compresses placed upon him, which proceedings in my experience, when carefully and intelligently carried out, are produotive of nothing but good. Now, this is what is styled by St. Leger the "coldwater treatment," and to it is attributed the high death rate for a certain period in 1885-86.

" St. Leger," who is one of the latest additions to the honorary staff, only having joined thie year, cannot therefore speak but from hearsay, the value of which evidence is as a rule doubtful, to say the least. I have been one of the honorary staff for the last four years, and state distinctly that the high death rate for the period complained of was not in any way due to the " cold water" or any other special kind of treatment ; and I indignantly deny the imputation of your correspondent "Layman" that it might be due to " using the Hospital as a theatre of experiment" or to the weakness of young practitioners succumbing to the " fasolnation of practising every new fad that enthusiasts advocate in the Lancet."

The true cause was this, and if blame attaches in any quarter kindly fix it on the right one:—ln 1885-86 the population of Auckland had greatly increased. Typhoid fever of a severe type was very prevalent, and had to be treated if in hospital in the general wards of the main building, there being at that time no new fever wards, aa now, the result Of which was that both the fever Mid the other patients did badly from overcrowding of the wards and want of space and quiet—the moat fatal conditions under which a fever patient can suffer. When the typhoid commenced again in the autumn, 1886-87, the patients had again to be treated in the general and so alarming was the outlook that the prompt action taken by the honorary staff

resulted in the building of the present fever wards, and the removal of the fever cases to them; those brought from the crowded general wards showing immediate improvement, and those subsequently admitted recovering better —the death rate showing a wonderful decrease —the treatment remaining exactly the same as before the patients were removed. "St. Leger" implies that in 1885-86 the treatment was exclusively what he terms "cold water." There is not a germ of truth in this; aad I say with absolute certainty that there was more cold water used by very many gallons during the autumn of 1884-5, when the mortality was 20 per cent., one-half of that in 1885-86, when it) was 40 per cent, for a time, the true reason of which mortality I have stated. Dr. E. G. Leger Erson has admitted to me his identity with " St. Leger," and I think he should have hesitated before prejudicing in the eyes of the public an institution so indiepeneible and deservedly popular as the Hospital. Dr. Erson did not ask for information from the members of the staff and others who could have given him reliable data, but stated to me that he had been told so-and-so by some of the nurses, that Dr. Bell had given him misleading statistics, &c, &c. Now, if " Layman," "Cold Water-Cure," and others did not "itch to interfere in matters which they do not understand," and if such persons would mind their own business, allowing the medical men who do understand them to look after such matters, it would be best for all concerned. Finally, it is wisest and in better taste for medical men to keep out of the public press as much as possible, but when one uke Dr. Erson feels that he must relieve his feelings in print, let me beg of him before committing himself to become possessed of reliable information and to state facts.—l am, &c, J. Caenegie Macmullek, L.R., C.5.1., &c, Honorary Staff, Auckland Hospital. TO THE EDITOB. Sib, —Well may the Hospital staff exclaim, "Save us from our friends." "St. Leger," in his determination to overthrow "Cold-water Cure," has allowed his zeal to outrun his discretion. It has been ascertained that his chief informant with regard to the results of the cold-water treatment of typhoid fever in the Hospital during the period of the high death rate was a nurse, who at that time was not on the Hospital staff. She happened to be nursing a case of typhoid fever outside for a doctor, who remarked in an off-hand way that the cases in.the Hospital were doing badly, one in every two dying. Those who know best what the treatment was at that time deny that the cold-water treatment was used alone, and as a matter of fact, according to the Hospital register, the death rate from typhoid fever during 1886 was less than 30 per cent., instead of 40 per cent., as stated. Now it must be remembered that at that? period we nad no new fever wards, and all cases had to be treated in the general wards, mixed up with all the other cases commonly found there. During the epidemic tha accommodation was quite insufficient—the wards were all overcrowded, and in every way circumstances were against the patiente. Last year, during a similar state, of affaire, the new fever wards were built in a great hurry, and from the time of their being opened till the end of the typhoid season, in August, of twenty-four cases treated there only one died. This fact speaks for itself, and is further supported by the results this year so far—for of seventy-five cases admitted nine only have died. J

With regard to the patients sent to us, it must again be remembered that they are often brought from long distances— sometimes landed from vessels arriving in the harbour. In such cases the patient has always been ill for some time, and is sent) to the Hospital at the time when removal and travelling are most dangerous. Several have been admitted in a moribund condition even, and then these deaths send up our death rate, and it is afterwards quoted as an index of something disgraceful in the treatment of the patients.—l am, &c., P. A. LtNDSAT, M.8., CM., April 6, 1888. House Surgeon.