Chapter 13 - Diseases of the General System and Miscellaneous Diseases
Introduction to Diseases of the General System and Miscellaneous Diseases
Blood Aneamia
Typhoid Fever
Prevention of Typhoid
Bilious Remittent Fever
Congestive Fever
Fever and Ague
Yellow Fever
Purple Disease
Bubonic Plague

13.8 Typhoid Fever

Typhoid Fever.

OF the different kinds of fever, this is one of the most common and widely prevalent. The name typhoid is from two Greek words which mean like typhus, or similar to typhus. The word typhus, from a Greek word signifying stupor, means stupid, dull or low; and, when applied to a fever, implies that is low, or characterized by great nervous depression.
Typhus and typhoid fevers, if not identical, are so similar in history and treatment as to make unnecessary their consideration under separate heads. The following is one of the differences claimed to exist between the two: namely, in typhus fever, the belly is flat; there is no marked disease of the bowels, and generally no diarrhea until the second or third week. In typhoid fever, on the contrary, some small glands, called Peyer's glands, situated in the lower part of the small intestines, are always inflamed, and sometimes ulcerated; and consequently, among the symptoms most frequently noticed, are diarrhea, and drum like swelling of the belly, called tympanites.

Symptoms. The disease often has precursory symptoms. For several days before its actual beginning, the patient droops. He may attend to his various duties, but does not seem well; he is low spirited and languid; is indisposed to any exertion of body or mind; has pains in the head, back, and extremities; loses his appetite; and although dull and perhaps drowsy in the daytime, his sleep is interrupted and unrefreshing at night. The immediate harbinger of the fever is a chill, often so marked as to cause violent shivering.
The history of the first week shows increased beat of the surface j, frequent pulse ranging from eighty to one hundred and twenty; 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 frequently distinguished by an eruption of small, rose colored spots upon the belly, and by a crop of little watery pimples upon the neck and chest, having the appearance of minute drops of sweat standing on the skin, and hence called sudamina, or meat drops; the tongue is dry and black, or red and sore, the teeth are foul. there ma be delirium and dullness of hearing; and the symptoms generally are more serious than during the first week. Occasionally, at this period, the bowels are perforated or eaten through by ulceration, and the patient suddenly sinks.
If the disease proceeds unfavorably into the third week, there is low muttering and delirium; great exhaustion; sliding down of the patient towards 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, recovery takes place, the countenance brightens; the pulse moderates; the tongue cleans, and the discharges assume the appearance they have in health.

New Treatment of Typhoid Fever. The systematic treatments of typhoid fever heretofore in force are apparently about to be reinforced by the administration of a vaccine in a manner similar to, though not identical with, the present treatment of diphtheria by antitoxin. The difference in the new treatment for typhoid fever will be the cultivation of a vaccine from the disease germs in the person infected rather than from a horse that has been inoculated from blood obtained from other infected beings. This is known as "autogenous therapy." The results seem to be better than a vaccine made from any culture. The dosage is used according to the severity of the disease and the reaction of the patient to the injection. The preparation of this serum may be briefly described according to the manner devised by Dr. Mac Fadyen.
The cultures of the bacillus of typhoid fever are ground up in a mortar in a temperature of liquid air and then injected into a horse and the blood serum of this animal acquires an "anti toxin power" toward the bacilli, similar to the preparation of diphtherial bacilli.
Tests for the strength are made in the same manner and then the patients are injected with the vaccine. From thirty to forty million bacilli are given once or twice on successive days. Should unpleasant effects occur the interval would be lengthened or discontinued until the effects have passed off. In many cases where three series of inoculation were used, of about 90 per cent of the cases reported, it was the consensus of opinion that while no appreciable shortening of the disease below the usual three weeks occurred, the cases seemed milder and were decidedly benefited by the treatment, and the number of lengthy cases with complications were distinctly diminished. The vaccination of people to prevent typhoid is at present being carried out, and in some of the large hospitals nurses are not accepted who will not be inoculated to prevent their contracting the disease.
In the effort to make the army immune from typhoid fever wholesale inoculation (or vaccination) with typhoid serum is going on at Fort Banks, Boston Harbor; although it is not compulsory, the men are prompt to volunteer for the sake of the advancement of science. Officials in charge of the anti typhoid crusade expect to render the entire army immune, that the vaccination will then be carried out in the navy and eventually among the people at large.
Four hundred and sixteen persons were inoculated in Ceylon and not one of them contracted the disease, although typhoid fever is very common in that country.

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