- Typhoid fever is generally preceded by several days of languor, low spirits, and indisposition to exertion. There is also, usually, some pain in the back and head, loss of appetite, and drowsiness, though not rest. The disease shows itself by a chill. During the first week there is increased heat of the surface, frequent pulse, furred tongue, restlessness and sleeplessness, headache and pain in the back; sometimes diarrhea and swelling of the belly, and sometimes nausea and vomiting. The second week is often distinguished by small, rose-colored spots on the belly, and a crop of little watery pimples on the neck and chest, having the appearance of minute drops of sweat; the tongue is dry and black, or red and sore; the teeth are foul; there may be delirium and dullness of hearing; and the symptoms every way are more serious than during the first week. Occasionally the bowels are at this period perforated or ate through by ulceration, and the patient suddenly sinks. If the disease proceeds unfavorably into the third week, there is low, muttering delirium, great exhaustion, sliding down of the patient toward the foot of the bed, twitching of the muscles, bleeding from the bowels, and red or purple spots upon the skin. If, on the other hand, the patient improves, the countenance brightens up, the pulse moderates, the tongue cleans, and the discharges look healthy. Give the patient good air, and frequent spongings with water, cold or tepid, as most agreeable. Keep the bowels in order, and be more afraid of diarrhea than cost-iveness. Diarrhea should be restrained by injection of cold water. For costiveness, give mild injections, made slightly loosening by castor oil or common molasses. To keep down the fever and produce perspiration, give tincture of veratrum viride, ten drops every hour. If the bowels are swelled, relieve them by hot fomentation of hops and vinegar. If the pain in the head is very severe and constant, let the hair be cut short and the head bathed frequently with cold water. Give light nourishment, such as milk etc.; and if the debility is great, broth will be needed. Cleanse the mouth with very weak tea - old hyson. If the fever runs a low course, and the patient is very weak, quinine may be given from the beginning. Constant care and good nursing are very important.
Typhus fever is distinguished from typhoid by there being no marked disease of the bowels in typhus. The patient must be placed in a large, well-ventilated room, where drafts may be avoided; he should have his bed so situated that the light from a window will not fall upon his face, as this is annoying; all curtains, carpets, and bed-hangings should be at once removed; the bed should not be too soft, and a mackintosh or india-rubber sheet should be placed under the patient. He should not be allowed to exert himself in any way, as it is absolutely necessary that he husband all his strength. The greatest cleanliness must be observed, and all excreta removed at once, and carbolic acid or chloride of lime should be mixed with them; soiled linen should be put into a tub containing some carbolic acid. Bed-sores are very liable to form on the back, and so the nurse must always be on the lookout and try to prevent them by smoothing the sheets, drying the patient, and rubbing brandy and balsam of Peru over the part; better still to have a water cushion or water bed. The skin may be sponged down with tepid water, one part being sponged at a time, so as to prevent any undue chill of the surface from exposure; this relieves the patient and partly counteracts that disagreeable smell which the skin gives off in typhus cases. None but the nurse and doctor should see the patient; all noises must be stopped, and perfect quiet enjoined; at night there may be a small light in the room, but so placed as not to disturb the patient. Milk must be the chief article of diet, and is best given cold; an egg or two may be beaten up in it, and three or four pints of milk may be given in the twenty-four hours; this must be done at regular intervals of two hours, in equal quantities, special care being taken that it is given at night and in the early morning, when prostration is greatest. Beef-tea and broths, jellies, extract of beef, custards, etc., may be given if the patient can take them and wants them. For drinks in the early stage, lemonade, cold tea, or soda-water may be given, but do not let him have too much effervescent drinks; in bad cases the nurse will have plenty to do to get the milk down. Stimulants are very useful, but the quantity must vary with each case, and be left to the doctor's judgment. Brandy is the best stimulant, and may be given with iced milk; too much must not be given at first, as it causes oppression and inability to take nutrient food; but afterwards, in the stage of great prostration, its proper and careful administration may save the patient's life.