Deaths in the first week from an over whelming disease are rare. Death from asthenia is usually delayed until the third or fonrth week. A continued high tern perature, delirium, and ataxia, with tremors and diarrhoea, may have been present throughout.
When true meningitis symptoms occur in the course of typhoid it is nearly always fatal. Maragliano (Gazz. degli Osp. e Belle Clin., April 16, '99).
Personally cannot recall one instance in his experience in which there has been a recovery from typhoid when a perfora tion existed. The first fifteen or twenty hours is the most important to the pa tient. Osler (Jour. Amer. Med. Assoc., Feb. 16, 1901).
Prognostic sign suggested by Trous seau many years ago: When deafness is present only on one side the prognosis ought to be guarded, for the patient al most always dies, although the disease at that time may appear very mild. If the deafness occur on both sides, how ever, the prognosis is good, for it is said that persons are almost never seen to die when this symptom is present. No ex planation for this unusual phenomenon is offered, but its value may be learned by experience. W. C. Doane (New York Med. Jour., April 26, 1902).
A fatal result should not be confidently predicted, even in the most severe cases. It is surprising how weak a patient may become and how long the weakness may continue and recovery still take place. Sudden death from cardiac complica tions, as heart-failure or delirium cordis, occurs more frequently in men than in women. Persistent vomiting is a grave prognostic symptom.
In cases of pregnancy abortion occurs in a large proportion, and death often follows. The mortality is about 20 per cent. When typhoid occurs in childbed the prognosis is unusually grave. In seven cases reported by Liebermeister, three died.
The previous habits of the patient, especially the alcohol habit, has a strong influence in increasing the mortality. Of nineteen notorious drunkards ad into the Basel hospital seven died, more than one-third (Liebermeister).
The prognosis is rendered more grave by the presence of intercurrent diseases: bronchitis, lobar pneumonia, the invasion of the streptococcus and staphylococcus.
It has recently been shown by Martin that the typhoid bacilli arc more virulent when other organisms are present in the system. When patients suffering from tuberculosis, emphysema, and diabetes are attacked by typhoid fever, the out look is grave. This is also the case with elderly people.
Death from hmmorrhage occurs in 3. per cent. of all cases, according to Murchison's statistics. A moderate amount of hmmorrhage may take place without danger. When frequent small extravasations occur daily, patients may still recover, although they indicate act ive ulceration and consequent danger of perforation. They are premonitory symptoms of severe hemorrhage, al though the latter may occur in cases which have been running a mild course. The possibility of sudden death from cardiac weakness should always be borne in mind.
Conclusions based upon a series of ex periments: 1. No law can be established determining the ratio between the se verity of typhoid fever and the aggluti nizing power of blood-serum. 2. In cer tain instances an apparent relation can be shown between the outlines assumed by the agglntinizing masses and the in tensity of the infection; it is a proba bility, and is evident only after the crisis, when the graphic curve of the ag glutinizing power of the serum is com plete. 3. The agglutinizing, power is a variable quantity: the cause of its fluctuations cannot generally be deter mined. 4. Complications of convalescence are often announced by an augmentation of agglutinizing power, which remains marked for some days. 5. To be exact, the curve (graphic) of agglutinizing power should be constructed from the results of daily tests. 31. J. Rouget (Archives de Mod. et de Pharm. Milit., No. 3, 1900).
Treatment—PnoPHYLAXIS.—The im portant measures for the prevention of typhoid fever are: 1. The isolation of the patient and thorough disinfection of the excreta.
2. The careful inspection of the drink ing-water, as well as the source of supply and the means by which it is conveyed.