Typhoid Fever

Typhoid Fever (ENTERIC FEVER), a malady characterised by a condition of inflammation affecting the lymphoid glands of the intestines, and accompanied by a state of continuous fever, and usually by the development of a characteristic rash. The disease is widely distributed throughout the globe, and has probably prevailed from early times, but it is only within recent years that it has been distinguished from typhus fever, the distinction between these two maladies being finally established by Sir William Jenner about the middle of the present century. The incubation period of enteric fever is of somewhat variable duration, but usually covers about a fortnight. The early symptoms are rise of temperature, headache, vomiting, and diarrhoea, with pain and tenderness on the right side and lower part of the abdomen. The tongue becomes coated with fur, and tends to get dry; and there may be delirium, especially at nighttime. At the beginning of the second week from the commencement of symptoms the rash appears; it consists of slightly elevated rose-coloured spots which disappear on pressure, and which are mainly developed on the abdomen, chest, and back. These spots come out in successive crops, each of which lasts for a few days; in some instances the rash is very scanty, and it may be altogether absent. As the disease progresses the abdomen becomes swollen, and pain and tenderness in the right lower abdomen are more marked, the edge of the spleen can usually be felt just beneath the ribs on the left side, diarrhoea is generally present, and the stools tend to assume what is known as the pea-soup character. In some instances recovery now gradually ensues; in others what is known as the typhoid condition becomes developed, the fever remaining high, the pulse rapid and feeble, and a condition of prostration accompanied with drowsiness and delirium supervening. The lips are now often covered with sordes, and blood sometimes appears in the stools. Recovery may still take place, but in the more severe cases the patient passes into a condition of coma and dies. Even in favourable instances recovery from the disease is a tedious process, and relapses are liable to occur. In most attacks of enteric fever the lungs are to some extent affected by bronchitis; sometimes this condition severely aggravates the malady, and actual pneumonia may be developed. Bleeding from the bowel is a symptom which is not infrequent during the third and fourth weeks of the disease; it is commonly associated with the process of ulceration which is in progress in the intestine, and the loss of blood may in some cases be so great as to cause death. When the wall of the intestine becomes completely eaten through, by ulceration, perforation is said to occur, and peritonitis results. This complication is almost invariably fatal, and is usually made evident by the sudden onset of intense pain in the abdomen, with vomiting and collapse. Numerous sequelae of the disease have been observed: bed-sores are apt to form, thrombosis of the veins may be developed, and ulceration of the larynx sometimes occurs. The mortality among persons attacked is usually about 15 or 16 per cent.

The condition of the intestines in typhoid fever is the most characteristic lesion in that malady. The masses of lymphoid tissue in the lower part of the small intestine are particularly involved. The solitary glands and the agminated glands (Peyer's patches) become swollen and then (usually after the lapse of nine or ten days) commence to undergo ulceration. Sloughs are formed, and these sloughs become separated, usually during the third week of the illness; after this the ulcer, in the absence of an unfavourable issue, gradually heals. In association with the intestinal mischief the lymphatic glands of the mesentery become enlarged, and the spleen is almost always considerably swollen and congested.

The treatment of the malady consists in enforcing absolute rest in bed and administering a suitable diet, from which all forms of solid food must be carefully excluded. In severe cases stimulants are generally necessary, and drugs are sometimes administered with the special object of reducing the fever. Lung complications, haemorrhage, etc., requite, of course, the adoption of special measures. Perhaps in no disease is the patient more dependent upon skilled nursing than in typhoid fever. The disease usually occurs in children and young adults, and is rare at later ages. It is especially prevalent in the autumn, and is least common in Spring. Dr. William Budd first directed attention to the fact that cases of the disease were traceable to the consumption of polluted water, and this mode of origin of enteric fever has been abundantly confirmed by subsequent researches. Typhoid fever has also been caused by contaminated milk and cream. In some instances it has been attributed to the effluvia from drains and sewers to which typhoid stools have obtained access. The disease does not appear to be conveyed from person to person, as is the case with scarlet-fever and small-pox, and those who are brought in contact with typhoid fever patients incur little risk of contracting the malady provided they adopt ordinary precautions as to cleanliness.

The numerous outbreaks of the disease which have been traced in recent years to the contamination of public water-supplies, and the great reduction of typhoid mortality in this country which has followed upon the adoption of improvements designed to prevent faecal contamination of drinking-water, sufficiently indicate the most important source of the disease, and the direction in which the safety of the individual can be further assured. A particular organism to which attention was first directed in 1880 by Eberth, and which has been since attentively studied by Gaffky and others, is almost invariably met with in the spleen, Peyer's glands, and mesenteric glands of typhoid patients, and is usually considered to be the cause of typhoid fever.