-This is a disease which arises mainly from defective drainage. It is rarely contagious from person like infectious fevers generally, the typhoid bacillus being found in the discharge from the bowels. This is of an exceeding subtle nature, so that an infinitesimal quantity of the discharges from a typhoid patient, if it finds it way into a well or a stream that is used for drinking purposes or for washing vessels used for articles of food, will be sufficient to infect those who drink of the water or eat of the food. Milk often becomes a carrier of the contagion, contaminated water being used to dilute the milk or wash the vessels used for carrying it. It is the risk of this that renders it necessary to boil or sterilise all milk before it is drunk when typhoid fever is about and especially to have the milk sterilised that is given to the patients from the disease, or otherwise they may be taking the very thing that has given them the fever.
The discharges from typhoid patients should be carefully disinfected, and no water should ever be used for drinking or washing purposes that is taken from a well that has a privy or cesspool in its neighbourhood.
When the person has absorbed the poison of typhoid he does not become ill at once. He may be a little out of health, and not know what is the matter with him, but he is not stricken down with the illness until ten days or three weeks afterwards. Then he becomes feverish, loses all strength, has pains and aches all over him, and becomes delirious at night. With this there is pain in the body, diarrhoea, the stools being like pea-soup. The diarrhoea is the most characteristic feature of the disease, and is due to inflammation leading to ulceration of certain glands in the mucous membrane of the bowels. This may go on to perforation of the bowels, the ulcer eating quite through, when the contents of the bowels escape into the cavity of the body, causing inflammation (peritonitis) and death. These ulcers often become the seat of bleeding which may be excessive and cause death by exhaustion. In some cases there is no diarrhoea, but the opposite, constipation; and these are rather more favourable than the others. Typhoid has a characteristic eruption, consisting of small red spots, like fleabites (without the central point), which come and go. There are seldom more than half a dozen out at a time. They are found on the body, chest, and front of the wrists. The temperature in typhoid is peculiar. In the earlier stage it goes up two degree at night, and falls one degree the following morning, and throughout it has this up-and-down character.
The fever lasts twenty-one days, the most dangerous day being the fourteenth. It is a disease which is much subject to relapse, and sometimes the patient goes from one relapse to another, the fever thus lasting for months.
General Treatment.-The chief indication in the treatment of typhoid fever is to maintain the strength. The long duration of the illness puts a drain on a patient’s strength that must be met. At the same time the bowels are in such a condition that only the most unirritating form of nourishment can be borne. The least solid food, if it passes the stomach undigested, may cause such irritation of the inflamed or ulcerated surface of the bowels that perforation may take place in consequence. Light food is admissible; and of such milk in some form, when it is tolerated, is the best. It should always be sterilised, for the reasons stated above, and may be diluted with soda-water or lime- water. After milk comes thick water-gruel, and, for a drink, barley-water. If there is sickness, soda-water may be given. If there is no diarrhoea, or only a little, strong beef-, mutton-, or chicken-tea may be given, either liquid or in jelly. They must be made strong, and in the case of chicken-tea the whole bird must be cut up and bones pounded, and then well boiled or, better still, steamed into a jelly. Nourishment should be given regularly, at two hours’ interval; if the patient takes a fair amount, a breakfast-cupful at a time will be sufficient of milk or gruel, and a teacupful of beef-tea. When the patient is thirsty he may have as much barley-water as he likes. When milk disagrees, Koumiss should be given instead, or else Benger’s Peptonised Food, which is, like Koumiss, partly digested already.
Of course an airy, well-ventilated room is a necessity. The patient should be sponged with hot vinegar and water (one part to six) night and morning. He must never be allowed to rise from bed for any purpose, a bed-pan being used to take away everything. The nurse must be on the watch for bed-sores, and on the first signs of redness she must bathe the part with spirit. The motions, &c., should be at once carefully disinfected. Medicines.-(Only a few of the most useful can be indicated here. Of course when there is a physician within reach he must be consulted. Medicines must be given every hour till the symptoms abate, and then at less frequent intervals.)
-Dull, heavy appearance; delirium, in which the patient imagines he is in separate parts, and can not get himself together; diarrhoea with offensive stools.
-Great prostration, thirst, restlessness, anxious delirium.
-Low fever, rheumatic pains in head and body, worse from from movement.
-If there is blood in the motions, and the blood is bright.
-Bleeding from the nose, and blood in the stools, the blood being dark.