REPORT OF A FIFTH SERIES OF CASES OF 
ENTERIC OR TYPHOID FEVER TREATED 
BY SYSTEMATIC COLD BATHING IN 
THE GERMAN HOSPITAL, 
PHILADELPHIA. 
BY 
JAMES C. WILSON, M.D., 
PHYSICIAN TO THE HOSPITAL, AND PROFESSOR OF THE PRACTICE OF MEDICINE 
IN JEFFERSON MEDICAL COLLEGE. 
FROM 
THE MEDICAL NEWS, 
November 25,1893. [Reprinted from The Medical News, November 25, 1893.] 
REPORT OF A FIFTH SERIES OF CASES OF 
ENTERIC OR TYPHOID FEVER TREATED 
BY SYSTEMATIC COLD BATHING IN 
THE GERMAN HOSPITAL, 
PHILADELPHIA. 
By JAMES C. WILSON, M.D., 
PHYSICIAN TO THE HOSPITAL, AND PROFESSOR OF THE PRACTICE OF 
MEDICINE IN JEFFERSON MEDICAL COLLEGE. 
From the introduction of the treatment of enteric 
fever by systematic cold bathing according to the 
method of Brand, in the German Hospital, February, 
1890, until June 1, 1892, 226 cases were treated, of 
which number twelve terminated fatally, giving a 
death-rate of 5.3 per cent. The hospital statistics 
relating to the subject were published in detail in 
this journal last year.1 
During the year terminating June 1, 1893, 74 
additional cases have been treated by this method, 
bringing the total number up to 300. 
The following table, compiled from the records 
of the hospital by Dr. Hand, resident physician, 
shows in detail the date of admission, the sex, age, 
the day of the disease as nearly as could be ascer- 
tained upon which the patient entered the hospital, 
the highest recorded temperature, the first day of 
the attack upon which the temperature fell to 
normal, the number of days in the house, and the 
number of baths administered in each case : 
1 Medical News, November 26, 1892. 4 
Cases of Enteric Fever Treated by Systematic 
Cold Bathing. 
Series No. 5. June 1, 1892, to June 1, 1893. 
No. 
Admitted. 
Sex. 
Age. 
Day 
of 
dis- 
ease. 
Max. 
temp. 
First 
day 
normal 
temp. 
Days 
in 
house. 
No. 
of 
baths. 
I 
May 2=; 
F. 
25 
IO 
105.8 
38 
6l 
I5I1 
2 
June 3 
M. 
15 
8 
104.8 
22 
39 
331 
3 
7 
F. 
19 
IO 
105.8 
30 
60 
94 
4 
9 
F. 
l6 
l6 
8 
5 
21 
M. 
22 
8 
104.4 
15 
30 
31 
6 
22 
F. 
29 
34 
28 
7 
July 14 
M. 
36 
IO 
105 
l6 
69* 
8 
15 
M. 
26 
5 
105.6 
23 
42 
67 
9 
24 
M. 
36 
6 
104.8 
is 
40 
43 
IO 
29 
M. 
24 
12 
104.2 
18 
28 
23 
II 
29 
F. 
21 
4 
104.4 
17 
49 
1094 
12 
Aug. 3 
M. 
38 
7 
104.2 
15 
40 
34s 
13 
4 
F. 
3° 
3 
104.6 
17 
48 
53 
14 
II 
F. 
21 
14 
103.4 
31 
63 
53s 
15 
12 
M. 
18 
3 
104.4 
IO 
3i 
47 
l6 
12 
M. 
25 
4 
104.2 
18 
43 
667 
17 
l6 
M. 
46 
104 
29 
3i 
18 
18 
M. 
l6 
6 
104.2 
18 
42 
12s 
19 
18 
F. 
18 
12 
102.4 
18 
37 
7 
20 
25 
M. 
33 
8 
104 
l6 
24 
29 
21 
« 3° 
M. 
32 
6 
103 
13 
3i 
8 
22 
Sept. 1 
M. 
22 
102.2 
19 
2 
23 
I 
M. 
31 
7 
103.6 
22 
29 
17 
24 
I 
M. 
26 
h 
105.2 
28 
29 
59® 
25 
4 
M. 
28 
5 
104 
12 
21 
20 
26 
4 
F. 
66 
30 
104.4 
47 
51 
24 
27 
7 
M. 
18 
4 
104.6 
12 
40 
31 
28 
l6 
M. 
19 
34 
69 
29 
21 
F. 
3i 
7 
104.4 
l6 
33 
25 
3° 
23 
F. 
27 
4 
104.8 
15 
29 
37 
31 
23 
M. 
3° 
104.6 
34 
32 
32 
26 
F. 
19 
IO 
105.4 
l6 
23 
9710 
33 
Oct. 8 
M. 
32 
4 
105.6 
19 
34 
6l 
34 
IO 
M. 
23 
104.6 
23 
31 
35 
12 
M. 
28 
103.4 
19 
3 
36 
l6 
F. 
24 
7 
104.2 
14 
5° 
19H 
37 
3i 
M. 
17 
104 
29 
2 
38 
Nov. 2 
M. 
23 
106.2 
42 
17 
1 One relapse. * Repeated hemorrhages. 
3 Death. 4 One relapse. 
5 One relapse. 6 One relapse. 
7 Vide post-mortem note. 8 Repeated hemorrhages. 
9 One hemorrhage. 10 Relapse and death. 
11 One relapse. 5 
No. 
Admitted. 
Sex. 
Age. 
Day 
of 
dis- 
ease. 
Max. 
temp. 
First 
day 
normal 
temp. 
Days 
in 
house. 
No., 
of 
baths. 
39 
4 
M. 
23 
104 
29 
3 
40 
4 
M. 
22 
104.6 
29 
14 
4i 
6 
M. 
23 
105 4 
21 
41 
42 
13 
M. 
19 
IO4 2 
22 
12 
43 
17 
M. 
*9 
IO4.2 
3° 
64 
44 
Dec. 15 
M. 
27 
... 
104.6 
31 
82 
45 
l6 
M. 
46 
103.4 
28 
22 
46 
19 
M. 
21 
106 
40 
1951 
47 
3i 
F. 
19 
4 
104.4 
II 
26 
242 
48 
Jan. 3 
F. 
17 
5 
104.8 
23 
37 
21 
49 
Feb. 18 
M. 
20 
7 
!05 
12 
34s 
50 
20 
M. 
23 
9 
102.2 
15 
21 
3 
51 
23 
M. 
49 
102.6 
35 
7 
52 
23 
M. 
19 
7 
104 
15 
32 
48 
53 
24 
M. 
15 
6 
106.2 
17 
1134 
54 
25 
M. 
24 
7 
104 
17 
42 
67s 
55 
Mar. 3 
M. 
30 
105 
39 
20* 
56 
3 
F. 
22 
5 
104 
45 
82 
147 
57 
12 
F. 
18 
4 
103.4 
14 
69 
I27 
58 
28 
M. 
26 
* 7 
106.4 
20 
123s 
59 
29 
F. 
19 
4 
1044 
l6 
38 
47 
60 
April 3 
F. 
28 
8 
105.8 
29 
77 
105 
6l 
5 
M. 
26 
3 
104.4 
21 
37 
103 
62 
12 
M. 
.24 
8 
104.8 
8 
459 
63 
22 
M. 
42 
8 
105.2 
26 
43 
60 
64 
23 
F. 
29 
12 
103.2 
18 
70 
4>° 
65 
May s 
F. 
27 
6 
104 
14 
29 
l6 
66 
9 
F. 
18 
2 
105 
19 
4i 
20 
67 
IO 
F. 
29 
5 
104.6 
20 
35 
38 
68 
12 
M. 
20 
8 
105 
16 
27 
36 
69 
13 
M. 
18 
12 
105.8 
20 
9511 
70 
15 
M. 
21 
8 
104.6 
18 
70 
76*2 
7i 
20 
F. 
20 
2 
105.4 
l6 
37 
S3 
72 
29 
M. 
18 
IO 
103.8 
22 
20 
28 
73 
29 
F. 
25 
3 
105 
20 
89 
75 
74 
30 
F. 
20 
3 
104.8 
19 
49 
25 
Total number of cases, 74; deaths, 8 5 mortality, 
10.8 per cent. Relapses, 10—13.5 per cent. 
1 Relapse and death. 2 One relapse. 
3 Repeated hemorrhages, pneumonia, and death. 
4 Meningitis and death. 5 One relapse. 
6 One hemorrhage. 
7 Lobar pneumonia on the twenty-first day. 
8 Death. 9 Hemorrhages and death. 
10 Remained for treatment for organic nervous disease. 
11 Hemorrhages and death. 12 One relapse. 6 
The patients were chiefly adolescents and young 
adults. Children are not received into these wards, 
as there is in connection with the hospital a chil- 
dren’s infirmary; 58 cases (78 per cent.) were under 
30 years of age. 
From 15 
to 
20 
years 
. 20 
“ 20 
tl 
25 
6S 
. 21 
“ 25 
it 
30 
“ 
• 17 
“ 3° 
35 
. 8 
“ 35 
40 
it 
• 3 
“ 40 
45 
t( 
. 1 
“ 45 
“ 
50 
“ 
• 3 
66 
years . 
. 1 
Total 
• 74 
Baths : Average number, 44; smallest, 2 ; largest, 
195. Average number of days in the hospital ot 
the non-fatal cases, 33. 
Notes on the fatal cases : 
No. 7.—G. H., male, thirty-six years of age, was 
admitted on the tenth day of the disease, having 
had hemorrhages before admission ; he lived sixteen 
days in the hospital. 
No. 32.—M. L., female, nineteen years of age, was 
admitted on the tenth day of the disease; normal 
temperature on the sixteenth; relapse on the nine- 
teenth ; death on the thirty-third. 
No. 46.—A. K., male, twenty-one years of age, 
admitted in a very weak condition; about the 
second week of the disease, pulse 172, temperature 
1060 ; improved with the baths, and temperature came 
down to normal; after a week, relapse began; 
emaciation extreme; death at the end of the second 
week of the relapse. 
No. 49.—J. K., male, twenty years of age, admit- 
ted on the seventh day of the disease ; hemorrhages 
on the ninth day; pneumonia on the fourteenth 
day ; death on the nineteenth day. 
No. 53.—G. S., male, fifteen years of age, admit- 
ted on the sixth day of the disease ; in the morning 
remissions during the first week the temperature was 
but twice down to 103.50 ; highest temperature 7 
io6.2° ; developed meningitis and died on the 
twenty-second day. 
No. 58.—B. S., male, twenty-six years of age, 
admitted on the seventh day of the disease and had 
great mental depression from the outset; died on 
the twenty-seventh day. 
No. 62.—J. C., male, twenty-four years of age, a 
“ walking case,” admitted on the eleventh day of 
the disease, with spots ; hemorrhages on the four- 
teenth and fifteenth days ; passing by the bowel one 
hundred and seven ounces of material consisting 
largely of blood; death on the fifteenth day. 
No 69.—W. C., male, colored, eighteen years of 
age, admitted on the twelfth day of the disease; 
hemorrhages on the twenty-fifth and twenty-sixth 
days of the disease ; death on the thirty-first. 
The total number of cases treated by this method 
to June 1, 1893, 1S 3°° i total deaths, 20—giving a 
death-rate of 6.6 per cent. In the entire series of 
300 cases relapses occurred in 29 instances; more 
than one relapse in two cases. 
The following statistics, though based on a rela- 
tively small number of cases, support the generally 
accepted statement of Brand that the influence of 
the treatment upon the mortality is proportionately 
favorable as it is instituted early in the course of the 
attack. 
In Series No. 5, 20 cases were admitted on or 
before the fifth day of the disease ; of these, none 
died. Forty-two cases were admitted prior to the 
tenth day; of these, 4 died, giving a mortality 
of 9.5 per cent. Twelve cases were admitted after 
the tenth day; of these, 3 died, giving a mor- 
tality of 25 per cent. The day of the disease upon 
which the patient was admitted to the hospital was 
not noted in 20 cases. 
In Series No. 4,1 12 cases were admitted on or 
before the fifth day; of these, 1 died fifteen days 
later of a complicating meningitis. Thirty-six cases 
1 The Medical News, November 26, 1892. 8 
were admitted before the tenth day; of these, 2 died, 
giving a mortality of 5.5 percent. Six were ad- 
mitted after the tenth day, with 1 death, giving a 
mortality of 16 per cent. The day of admission 
was not noted in 24 cases. 
Taking Series 4 and 5 together, we note that of 
32 cases admitted not later than the fifth day 1, 
or about 3 per cent., terminated fatally. In 78 
cases admitted prior to the tenth day, the death- 
rate was 7.7 per cent., and in 18 cases admitted after 
the tenth day the death-rate was 22 per cent. * 
The dictum of Brand, that none of the cases in 
which the treatment is instituted prior to the fifth 
day are likely to terminate fatally, is well known. 
The fatal case in the fourth series, a boy aged 
thirteen, was admitted on the third day. The cause 
of death in this case, however, was meningitis oc- 
curring as an early complication. 
In civil practice, except in local epidemics, the 
positive diagnosis of enteric fever can rarely be 
made as early as the fifth day. In hospital practice 
only a small portion of the enteric fever cases are 
received before the fifth day. In the service of the 
German Hospital patients are subjected to the bath- 
treatment if, upon admission, the diagnosis of enteric 
fever is probable or becomes so by exclusion. This 
practice has led to very few errors in diagnosis. 
It is understood that in by far the greatest number 
of instances the date of the beginning of the fever 
can only be approximately determined ; only ex- 
ceptionally does the disease begin with an abruptness 
that fixes definitely the day or hour of its onset. 
The general rule in taking the cases has been to date 
the beginning of the attack from the day on which 
the patient regarded himself as having fever or on 
which he was obliged to give up his occupation. 
The appearance of the eruption and enlargement of 
the spleen, which usually may be noted on the 
seventh or eighth day, rarely as early as the sixth 9 
and seldom so late as the tenth, are clinical events 
which aid in fixing the date of onset. 
Ephraim, of Breslau, in a recent communication 
on “ The Significance of the Statistical Method in 
Medicine,”1 says: “The statistics of the cold-water 
treatment of enteric fever are untrustworthy because 
this disease shows the widest variations in its prog- 
nosis, and because for this reason an enormous 
number of observations are necessary to establish 
the value of a method of treatment.” 
The treatment of enteric fever by systematic 
cold bathing according to the method of Brand now 
rests upon statistics that fulfil the second require- 
ment of this criticism. The number of reported 
cases is enormous. They are the results of work 
done by different observers in all parts of the world, 
and many of the collections of cases, as those of 
Brand himself, those of the military physicians at 
Lyons, those of Hare of Australia, are sufficiently 
large in themselves to establish the value of this 
method of treatment. 
To these we may now add the statistics of the 
German Hospital in Philadelphia, which are based 
upon the observation of a sufficient number of cases 
and extend over a period of time sufficiently ex- 
tended to eliminate in part at least the errors arising 
from the variations in the prognosis of individual 
cases and in the intensity of epidemics in different 
years. 
Certainly the literature of internal medicine shows 
no aggregate of statistics in regard to the treatment 
of any other disease that has reached such propor- 
tions and in which the treatment has been carried 
out with the same rigid adherence to rule. 
A remarkable and instructive fact is this, that the 
statistics from various quarters and from relatively 
large and small collections of cases show a mortality 
1 Sammlung klinischer Vortrage, Volkmann, No. 70, 1893. 10 
percentage that is as a rule nearly constant, so that we 
may now regard it as demonstrated that the death-rate 
of enteric fever under the treatment of Brand, insti- 
tuted early in the attack and rigorously carried out, 
does not range beyond 6 or 7 per cent., while the 
general statistics show a mortality under various 
other forms of treatment, most of which are essen- 
tially expectant-symptomatic, ranging from 15 to 25 
per cent., and exceptionally, far higher. 
It seems hardly necessary to dwell upon the 
importance of this difference in death-rate. What 
argument in favor of the treatment by systematic 
cold bathing can be more urgent or more conclu- 
sive ? From eight to fifteen or more lives saved in 
every hundred cases, and this in the endemic fever 
of our historic period—an infection from the effects 
of which no large community is ever free—which is 
kept alive and fostered by the methods of living in 
civilized countries in this age ! The from eight to 
fifteen lives lost in every hundred by adherence to 
obsolete and traditional methods are, as a rule, 
picked lives. They are taken from the best— 
adolescents, young adults, the very flower and hope 
in every community. This is not the place to 
speak of the emotional effects of this sacrifice of 
life to routine. It is, however, proper to suggest 
the economic aspect of the matter, the appalling 
waste of young life that could so easily be saved. 
We in the Western world are in the habit of speak- 
ing somewhat scornfully of Oriental apathy. Enteric 
fever and tuberculosis, the endemic scourges of our 
civilization, are in theory at least preventable dis- 
eases. Enteric fever is a disease in which, as has 
been demonstrated, the death-rate can be lowered 
from between 15 and 25 per cent., to 6 or 7 per 
cent., by the abandonment of traditional methods 
of treatment and the adoption of a different plan. 
Yet the older methods prevail. 
Redmond, in a paper read before the British Medi- cal Association in August, 1893,1 makes the following 
remarkable statement: 
“ With the exception, however, of a paper by Dr. 
Sidney Coupland, in the Lancet for 1884, so far as 
I am aware, no attempt has been made through the 
medium of the medical journals to popularize the 
principle and remove that prejudice the undoubted 
existence of which, both in the professional as well 
as the public mind, constitutes the chief obstacle to 
the more general adoption of a line of treatment 
the practical evidence in favor of which can no 
longer be doubted by, I venture to affirm, any 
rational man.” 
The writer of the foregoing paragraph has over- 
looked much that would interest him in the medical 
journals of the last five years. Not to speak of the 
German and French reports upon the subject, he 
will find that many attempts have been made in the 
United States to break down the barriers that are 
in the way of the general use of the Brand treat- 
ment. Are the writings of Baruch, Sihler, Peabody, 
Thompson, Wilkins, and others on this side of the 
Atlantic, who have reported cases and detailed the 
method, wholly unknown to him ? Is our work in 
the German Hospital in Philadelphia since the be- 
ginning of 1890, the subject of repeated articles in 
the journals, no effort to “ popularize the principle ” 
and remove prejudice? We have now reported 300 
cases ; Redmond’s paper is based upon four obser- 
vations. 
11 
1 Therapeutic Gazette, September 15, 1893.