Typhoid fever : the empty-bowel treatment (traitement à vide) / by William Ewart, M.D.Cantab., F.R.C.P., senior physician to St. George's Hospital and to the Belgrave Hospital for Children; joint lecturer in medicine at St. George's Hospital.

  • Ewart, William, 1848-1929
Date:
1905
Catalogue details

Licence: In copyright

Credit: Typhoid fever : the empty-bowel treatment (traitement à vide) / by William Ewart, M.D.Cantab., F.R.C.P., senior physician to St. George's Hospital and to the Belgrave Hospital for Children; joint lecturer in medicine at St. George's Hospital. Source: Wellcome Collection.

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    regarded as a genuine expression of the syphilitic process, and hospital gangrene as a normal development in pathology —views which are no longer held. Possibly some similar change of opinion may be in store for us in connexion with the typhoid ulcer. Indeed, we are already aware that the lesion does not in all cases proceed to the stage of ulceration. I may then, for the practical purposes of this lecture, venture upon assumptions, and state it as my opinion that the classical description in question is a picture, not of that which constitutes the essence of the typhoid lesion pure and simple, but of that which it should never be allowed to become, and that the “ foul ” typhoid ulcer is a preventable condition, the product of bad forms of infection combined with worse sanitation. The Line of Treatment.—As the clinical aggregate includes every degree of severity, and every variety of type, the adop¬ tion of any one uniform method seems almost impracticable : yet thoroughness of treatment is always essential, if not for the safety of the patient, at any rate for our own; and the early stage is the only season for success. Our need, then, is a practical treatment, so effectual as to safeguard the bad cases, and so harmless as to be suitable even for the mildest ones. That to be described to you is my best attempt in that direction, but one much open to improvement. Most of the suggestions upon which it is based are free from the reproach of being novel or heterodox, since they are variously stamped with such good names as Jenner, Brunton, Bouchard, Gee, and others. The chief novelty is their practical combi¬ nation in the service of simple and straightforward principles, for well-defined purposes of action. To put before you at once the heart of the matter: The two generally approved aims in the treatment of typhoid are also our aims, namely, to (i) feed the patient, and (2) starve the disease. The first, largely represented under the heading of “ diet,” should also include any indirect help towards nutri¬ tion and “general support.” The second will include all measures tending to check the morbid process, and among them a special endeavour to apply the neglected principle, “local treatment for the local disease.” How this may be attempted will need some further explanation; but a general idea will at once be suggested by the following headings: The Empty Bowel Treatment. (“Traitement a Vide.”) RETROSPECTIVE REMARKS. The French name is already identified with the method, thanks to my having recently enjoyed in France the privilege of explaining the latter to confreres who are perhaps more often called upon than we now are to treat typhoid. Both names are used, not in metaphor, but in their plain practical sense, “no faeces.” Inasmuch as this method is a develop¬ ment of previous ones, it is opportune to preface it with a brief retrospect, particularly in connexion with diet, medica¬ tion, and other therapeutic measures.