Typhoid fever is an acute infectious disease, excited by the _typhoid
bacillus_. It is most prevalent in the autumn, although it occurs at
all seasons. The disease is not directly contagious, and can only be
acquired by taking the special bacillus into the alimentary canal. This
is usually accomplished through the medium of polluted water, milk
contaminated with infected water, raw vegetables (celery, lettuce,
water-cress) which have grown in infected soil, or raw shell-fish
(oysters) taken from the beds of polluted streams. Occasionally
physicians and nurses are infected directly in handling the patient or
his clothing which has become soiled with his discharges.
The bacilli are contained in nearly all the secretions of the patients,
especially in the stools and urine.
While the bacilli are widely distributed through tissues, the only
characteristic lesions of the disease are in the glands of the
intestines (Peyer’s patches), which in the first few days become red
and swollen, about the beginning of the second week soft and pale, and
in the third week ulcerated. If the patient survive, cicatrization
usually begins in the fourth week.
Death may result from exhaustion, the result of the systemic poisoning,
from perforation of the bowel by an ulcer, from intestinal hemorrhage,
the result of erosion of a blood-vessel, or from some complication,
like pneumonia.
=Symptoms.=—The _initial symptoms_, which may last a week or two
before there is any fever, are headache, weakness, loss of appetite,
nose-bleed, and perhaps slight diarrhea.
The _fever_ rises gradually, reaching its maximum (104°-105° F.) in
about a week; it remains stationary for one, two, or three weeks,
and then falls, reaching the normal in another week, thus making
the febrile period of the disease of four or five weeks’ duration.
Throughout its course the evening temperature is apt to be two or three
degrees higher than the morning temperature.
The abdominal symptoms consist of distention of the abdomen
(tympanitis), pain and tenderness in the right iliac region, and often
diarrhea.
Between the seventh and ninth days a rash usually appears on the
abdomen, consisting of small rose-red spots. These come out in crops
and disappear on pressure.
The _pulse_ becomes rapid and feeble, and the heart sounds become weak
and dull.
The _respiratory symptoms_ include cough, hurried breathing, and slight
expectoration.
_Nervous symptoms_ are not always marked. In severe cases there may be
delirium, stupor, twitching of the muscles, picking at the bed-clothes,
and coma.
The _face_ is dull and listless. The _tongue_ is coated and tremulous.
In severe cases it becomes dry, brown, and fissured, and sordes tend to
collect upon the teeth.
Relapses are common. In some cases they are due to the too early use of
solid food, to excitement, or to overexertion.
When typhoid fever is prevalent, the most reliable _preventive
measures_ consist in thorough boiling of all water and milk used for
drinking purposes and the avoidance of uncooked vegetables, oysters,
and shell-fish.
=Management.=—Unless otherwise directed take _temperature_,
_respiration_, and _pulse_ every three hours, in mouth or axilla, as
desired. If for any reason a change is made in taking temperature,
it should be noted on the chart. Note the effect of _sponging_ or of
_bathing_ upon temperature and pulse. Note the character of pulse, and
effect, if any, which stimulants have had upon it. Note the amount of
_cough_, and the character and quantity of the _expectoration_; also
any pain that may occur in the chest.
Note the amount of _flatulence_ and the number and character of the
_stools_; especially be on the lookout for blood or undigested food in
the discharges.
Note carefully any _abdominal pain_, any _increase in the distention_,
as these symptoms, with or without a rather abrupt _fall in
temperature_, _chills_, and _pinched features_, are suggestive of
perforation.
=Treatment for Hemorrhage.=—Stop all orders immediately, including
diet. Elevate the foot of the bed. Give morphin sulphate, gr. ¼ (gm.
0.015), hypodermically, and apply an ice coil or iced compresses to the
abdomen until the physician arrives.
Note the occurrence of _vomiting_ and the character of vomit.
Be on the lookout for retention of _urine_, which is quite common. Note
the amount of urine passed in a day and any abnormalities connected
with its appearance.
Note the condition of the _skin_ and _tongue_.
Note the amount of _sleep_, its character, whether quiet or restless
and whether or not there have been delirium, stupor, or twitching of
the muscles.
Note the exact amount and character of _nourishment_ taken, and the
time it was given; also the amount, time of administration, and effect
of _medicines_ and _stimulants_.
Cleanse the mouth and teeth frequently with some antiseptic wash, such
as listerine, 1 part; water, 3 parts.
Bed-sores can nearly always be prevented by keeping the patient and
bedding perfectly clean, the skin absolutely dry, and the bed-linen
smooth. Changes of position are also important. Parts subjected to
pressure and soiling should be washed at least twice daily with soap
and water, thoroughly dried, gently rubbed with alcohol, and then
dusted with a powder like the following:
Boric acid, 1 part;
Starch, 1 “
Zinc oxid, 1 “
If the skin be reddened and tender it may be painted with collodion and
then dusted. When the part cannot be kept dry, it should be smeared
with zinc ointment and powdered. In very prolonged cases it usually
becomes necessary to use water- or air-pillows or water- or air-beds.
To _disinfect the feces and urine_, use a solution of chlorinated soda
(Labarraque’s solution). Cover the urine and feces with the solution
and leave the contents stand for an hour. Cleanse pan thoroughly and
pour into it the Labarraque solution.