TYPHOID FEVER. Typhoid is a specific infectious fever caused by B. typhosus (see BACTERIA AND DISEASE) and charac terized mainly by its insidious onset, peculiar course of the tem perature, specific lesion of the bowels and eruption upon the skin. The disease has received various names, such as enteric fever (q.v.), gastric fever, abdominal typhus, infantile remittent fever, slow fever, nervous fever, "pythogenic fever," etc. Here, typhoid fever according to its modern interpretation is considered, but much that is said on dissemination, prevalence, etc., is also true for the paratyphoid fevers.
Though typhoid fever is a general infection producing respi ratory (bronchitis), cutaneous ("rose spots") and occasionally periosteal lesions the most noticeable effects occur in the lower part of the small intestine (ileum), particularly about the ileo caecal valve and concern the "solitary glands" and "Peyer's patches." These glands, comparatively indistinct in health, be come inflamed, large and prominent during the first 8-10 days of the fever. During the second week these enlarged glands necrose and are cast off in mass or in fragments into the lumen of the gut, leaving ulcers in its walls. These ulcers may be few or many in number, and are usually oblong, with their long axis in that of the bowel, and have thin and ragged edges. They may extend through the thickness of the intestine to the peritoneal coat and in their progress erode blood-vessels or perforate the bowel. This stage of ulceration exists from the second week onwards during the remaining period of the fever, and even into the stage of conva lescence. In favourable cases the ulcers heal by cicatrization with out contraction of the calibre of the bowel. The intestinal lesions do not appear synchronously so that all the above stages may be found at the autopsy of a fatal case. The mesenteric glands and the spleen become enlarged during the progress of the fever, but usually subside after recovery.
Symptoms.—The onset of typhoid fever is very much less marked than that of most other fevers. Early symptoms are head ache, lassitude and discomfort, together with sleeplessness and feverishness, particularly at night. The peculiar course of the temperature is also one of the most important diagnostic evidences of this fever. During the first week it rises by steps. Thus the morning temperatures on the first four days might be 99°, Ice, me, 102° F, the corresponding evening temperatures being Ice, 102', 104° F. About the eighth day, in an average case the
highest point is attained. During the second and third weeks tem perature remains high with but slight morning remission. In a favourable case during the fourth week gradual return to normal begins to take place. Although the patient may, during the earlier days of the fever, be able to move about, he feels languid and uneasy; and usually before the first week is over he has to take to bed. He is restless, hot and uncomfortable, particularly as the day advances, and his cheeks show a red flush, especially in the evening or after taking food. From an early period in the disease the abdomen is somewhat distended and pain accompanies light pressure about the lower part of the right side close to the groin— the region corresponding to that portion of the intestine in which the morbid changes already referred to are progressing. Diarrhoea is a frequent but by no means constant symptom. When present it may be slight or extremely profuse, and it corresponds, as a rule, to the severity of the intestinal ulceration. The discharges are light yellow and resemble pea soup. Should intestinal haemor rhage occur, they may be dark brown, tarry or composed entirely of blood. About the beginning, or during the course of the sec ond week of the fever, an eruption frequently makes its appear ance on the skin. It consists of isolated oval or round spots, of a pale pink or rose colour, and of about one to one and a half lines in diameter. As a rule they are few in number and are seen chiefly upon the abdomen, chest and back, and come out in crops, which continue for four or five days and then fade away. When present crops continue to come out till nearly the end of the fever, and they may reappear should a relapse subsequently occur. The symptoms persist throughout the third week, usually, however, increasing in intensity. By the end of the third week the patient is prostrate and emaciated ; the tongue is dry and brown, the pulse quickened and feeble, and the abdominal symptoms marked ; while nervous disturbance is exhibited in delirium in tremors and jerk ings of the muscles. Convalescence proceeds slowly and is apt to be interrupted by relapses.