Typhoid fever is a continuous fever, caused by an infectious poison, supposed to be due to a micro-organism, known as typhoid bacillus. The fever usually lasts about a month.

How Acquired

It is believed that drinking impure water is the most usual source of typhoid fever, although epidemics have been traced to food, such as infected oysters and milk. The length of time required for its incubation is not very definite, but is supposed to require two or three weeks to develop; sometimes longer. The first symptoms are languor, slight headache, pain in the limbs, muscular weakness, and a general feeling of indifference and malaise. These sensations are likely to increase with the disease until the fever becomes quite manifest. It must be remembered that many other ailments begin with similar symptoms so that it is difficult to determine with certainty when typhoid fever exists, until the more pronounced symptoms, peculiar to typhoid appear. The most important of these perhaps are (1) temperature. In typhoid it rises with remarkable regularity from day to day, and is from one to two degrees higher in the evening than in the morning. (2) Pale red spots. Generally at the beginning of the second week, a number of small pale red spots called roseolae appear on the skin, especially on the chest and abdomen. There is also sensitiveness in right illiac region. The fever is now well established and all the premonitory symptoms will have disappeared.

The face of the patient will be flushed and will likely have a bright patch on the cheeks. Sometimes there is constipation but usually diarrhoea.

Effects Of The Disease

The typhoid bacillus attacks Peyer's patches and soli-tary follicles in the lower end of the ileum, just above the illeo-coecal valve - the entrance into the large intestines.

About the end of the second week ulcerations are formed, where the bacilli are supposed to multiply and their poison taken up by the blood. The drowsiness and delirium characteristic of typhoid is the result of bacterial poison.

From this brief explanation it will be readily understood why typhoid is such a serious malady. In severe cases the mucous membrane erodes to such an extent, as to ulcerate and cause haemorrhage. This is not necessarily fatal, but is often so.

The ulcers sometimes perforate the intestines and recovery in such cases is very rare, indeed.

Besides the direct danger from haemorrhage, patients die from exhaustion, and complications of other diseases, especially pneumonia, caused by the poisoned condition of the blood.

In feeding typhoid cases the following facts must be borne in mind:

(1) The patient's strength must be maintained.

(2) The introduction of insoluble food, which may cause perforation, is strictly prohibited.

(3) Food, which, owing to the diseased condition of the patient, cannot be digested, will probably cause fermentation and undue distention of the bowels, and haemorrhage.

The matter of diet in typhoid fever is so important as to deserve extended notice. Most typhoid patients die of exhaustion or perforation of the bowels, which emphasizes the importance of using great care in feeding. Milk may disagree with patients and resort must be had to other foods. Where there is nausea and foul stomach, lavage is often practiced with great benefit.

Cereal gruels, cooked four hours or more and strained, are often well tolerated, especially if malt extract be added (made by steeping commercial malt in cold water for twelve hours). Fruit juices will make the various foods more palatable, and give variety. The beaten white of eggs in water, malted gruels, fruit juices and milk, buttermilk, koumys, about cover typhoid dietaries, except the prepared foods, which are often prescribed.

The lower bowel may be evacuated, if there be constipation, by using an enema of tepid water, to the amount of one to two pints, which should be injected high up in the rectum.

In convalescence, no solid food can be given for at least ten days or two weeks after the fever has ceased. Ignorant but well meaning people have caused the death of many, by suggesting that this or that will not hurt the patient. They do not know that a little solid food or gaseous fermentation may cause perforation of the bowels, and cause the death of the patient. To prevent imprudence in diet, convalescents should be constantly watched, and no food or fruit should be left in their rooms. Pain and distention of the bowels call for immediate medical attention.