The Symptoms of Typhoid Fever

Lassitude; irregular chills, sometimes followed by perspiration; frequently headache; confusion of mind; irritability of disposition; no appetite; nausea or vomiting; nosebleed; pain in back and limbs; looseness of the bowels; as the disease advances, countenance becomes dull and stupid; cheeks, hands, and arms red, or of a dusky hue; wakefulness; more or less delirium in severe cases; patient talks in his sleep, tries to get out of bed, picks at the bedclothes, etc.; jerking movement of the tendons at the wrist; tongue coated whitish, yellowish, or brownish, usually smooth and glassy, or dry and hard-tremulous; a brownish accumulation on teeth and lips; bleeding of lungs; bowels distended with gas; tenderness low down on the right side; gurgling on pressure; hemorrhage from the anus or bowels, or both; a few slightly elevated rose-colored spots on the abdomen; fever less in the morning; increased in the evening; pulse ninety to one hundred and twenty.

This is a general febrile disease, attended by local affection of the glands of the small intestines. For several days preceding the attack, the patient feels weak, debilitated, and a general indisposition. What is termed the forming period of the disease lasts about four days. The severity of the attack is indicated by the temperature. When the thermometer shows a temperature of 100 or 107, the case may be considered a very grave one. The severity of the disease itself is often greatly increased by complications, the most serious of which are pneumonia, inflammation of the parotid glands as in mumps, peritonitis, hemorrhage. The duration of the disease is generally from two to four weeks. The popular belief in critical days does not seem to have a very solid foundation. In some cases, the brain symptoms do not disappear with the occurrence of convalescence. In occasional instances, the illusions or delusions incident to the delirious stage of the disease continue for a short time after all other symptoms have disappeared. Recovery from this condition generally takes place, however, in from one to three weeks. In a case of this kind which occurred in our practice a few years ago, the patient was subject to marked religious delusions, which disappeared, however, in a very short time, as his strength returned. Cases frequently occur in which the symptoms of disease are not sufficiently severe to confine the patient to bed. These are termed "walking cases" of typhoid. As a general rule, patients gain flesh very rapidly after recovery begins, often acquiring a greater weight than at any previous time.

The Causes of Typhoid Fever

Typhoid fever is, by many physicians, supposed to be produced by a specific germ, which is communicated chiefly by means of the bowel discharges. It is believed that when the discharges are mingled with other human excreta, as in privy vaults, sewers, etc., the germs will affect the whole mass. Others believe that the germs may originate outside of the body, under certain conditions. This theory does not necessitate belief in spontaneous generation, as it is held that germs which, under ordinary circumstances, may not give rise to disease, or, under certain other peculiar circumstances, may give rise to other diseases, may, under circumstances not fully understood, but the existence of which is entirely passible, give rise to the disease known as typhoid fever. These germs, however they may originate, are generally received into the system by means of drinking-water. Wells and cisterns often become contaminated by means illustrated and described on plates XV and XVI. Milk has also been known to be a carrier of typhoid-fever germs, becoming infected through the use of water containing germs either in diluting the milk, or in washing the milk cans or other vessels in which it was placed. It has also been claimed that milk may be contaminated through the drinking of infected water by cows. Recently an epidemic of typhoid fever in which a large number of persons were affected by the disease, occurred in Germany, the cause of which was traced to the use of soup made from the flesh of a calf which, as was afterward proven, had died of typhoid fever.

It is thought by some that the inhalation of sewer gas, and of the foul odors from neglected privies, cesspools, etc., may occasion typhoid fever; but it is probable that, in these cases, the disease is somewhat different in character, although allied to this affection. Fever originating in this way has been termed cesspool fever.