TYPHOID FEVER, in pathology, a kind of continued fever which is known by many names. It was called "typhoid" and "abdominal typhus" from its sup posed resemblance to typhus or jail fever. It is often known as "low fever" and "slow fever," from its duration; and as "autumnal" or "fall" fever, from the time of the year at which it is most prev alent. The term "enteric fever" was ap plied to it from the fact that the in testines are always attacked in this dis order; but "gastric fever" is a mis nomer, for there is never any organic disease of the stomach. Typhoid fever results from the introduction of a spe cific poison into the system, and is said to be due to the development of a specific bacillus. It is not contagious, and the poison appears to be communicable only from the discharges. The diffusion of the disease is generally due to the excre ment of some patient finding its way into the drains, and thence into wells, or into streams or rivers, the water of which is used for drinking purposes. Hence it is of the highest importance that the excreta of patients suffering from typhoid should be thoroughly dis infected, and, if possible, buried at some listance from any dwelling house; but as in large towns this latter precaution is impossible, disinfectants must be lib erally used. In places where the supply of water is from wells, all drinking water should be boiled, and it is a wise precau tion during an epidemic to have the milk scalded, as the prevalence of typhoid in London in 1873 was clearly traced to the contamination of the milk by the excreta of a man who had died of typhoid on a milk farm. The period of incubation usually extends over two weeks, being preceded by loss of appetite, languor, headache, dizziness, and bleeding from the nose in many cases.
From the 10th to the 12th day the rash usually appears. It is very slight, and, unless care is taken, may be entirely overlooked. The spots are rose-colored, about the size of a pin's head, disappear ing on pressure,, but reappearing as soon as the pressure is removed. The pa tient suffers from debility and diarrhoea, and there is dullness over the region of the spleen, which is enlarged. The stools
are of a pea-soup color, and the special lesion observed is enlargement of and deposit in Peyer's glands and the minute solitary glands of the smaller, and some times of the large intestine. Sometimes the mental condition is irritable, with il lusions and hallucinations, and patients speak in a loud voice and gesticulate wildly. In the third week the symptoms continue with undiminished vigor, and sometimes increase in intensity, with stupor i to such a degree that great diffi culty s experienced in rousing the pa tient. In favorable cases, in the fourth week there is a change for the better; the temperature falls, the symptoms are alleviated, the sleep becomes more nat ural, the motions firmer and less fre quent, and the appetite slowly returns. After the 30th day, in the majority of cases, no more spots appear, the fever is at an end, and the patient passes slowly into a stage of convalescence. In typhoid fever relapses are common, and dangerous complications, especially of the lungs, may ensue. If the ulceration of the intestines proceeds so far that they are perforated, death almost in variably follows, and in all cases the mortality is high. The main chance of recovery depends on careful nursing, un der the direction of a skilled medical man. The chief treatment consists in reducing the temperature, usually by cold baths or sponging. The fever pro duces intense thirst, and plenty of fluid should be given. From the ulcerated state of the bowels, solid food must be strictly avoided, beef tea, mutton broth, arrowroot, milk, and eggs being the best forms of nourishment. Stimulants are rarely needed in the early stages of the disease, but may be used with advantage, under medical direction, if the heart's action is weak and the pulse intermittent. Immunization against typhoid fever is conferred by a specific vaccine. This is so effective that during the World War typhoid, formerly one of the worst plagues of war, ceased to be a serious problem. See TYPHUS FEVER.