TYPHOID FEVER.
Definition.—Typhoid fever is an acute contagious self-limited disease, which is characterized by inflammation and ul ceration of Peyer's patches and the soli tary glands of the small and large in testine. Although these lesions are present in such a number of cases that the term "enteric fever" has been widely used in designating the disease, it must be remembered that fatal cases occur in which the intestines are quite normal and the lesions are found in other parts of the body.
Varieties.-1. The abortive form, in which the temperature, after eight or ten days, falls to normal. The hyper plasia of Peyer's patches is not followed by necrosis and ulceration, but resolu tion takes place at once.
2. The mild type, in which the tem perature reaches its maximum by the end of the second and becomes normal dur ing the third week. The disease runs an uncomplicated course and the abdom inal symptoms are not severe.
3. The severe form, in which the pa tient during the second or third week passes into a low adynamic condition.
1. The ha'morrhagic form, in which there is a tendency to extravasation of blood in different parts of the body.
5. The renal and (6) the pneumonic varieties, in which the kidney and lungs are early and extensively diseased.
7. The ambulatory cases in which the patient continues to go about notwith standing the presence of the disease.
3. The typhoid fever of children, in which the temperature-curve does not present the gradual rise and fall of typ ical cases, the abdominal symptoms are not so marked as in the disease of adults, and in which bronchitis and nervous symptoms are especially prominent.
9. The typhoid fever of old age, in which the disease runs a severe and often fatal course and in which pneumonia is a frequent complication.
10. The typhoid fever of pregnancy, which usually occurs in the first four months and frequently produces abor tion or premature delivery.
Symptoms.—The stage of incubation varies much in duration, and is generally considered to be two or three weeks. It is sometimes much shorter. Wilson men tions a case in which the disease appeared four days after exposure.
The onset is, as a general rule, slow and gradual. The patient complains of a general feeling of weariness, of loss of appetite, slight nausea, and sometimes of diarrhoea, which is increased by mild cathartics. Headaches, usually frontal, which become more intense toward even ing, as well as pains in the back and limbs, are frequently experienced. Chills, more or less severe, are often present and they are sometimes followed by sweats. The countenance is dull, there is slight nose-bleeding, and the tongue is coated with a white fur. The symp toms come on so gradually in many cases that the patient does not consult a phy sician until the disease is well established, and the temperature is found as high as 102° or 103°. On the other hand, the onset is sometimes sudden and the tem perature rises rapidly.
In some cases the headache is so se vere and continuous that the case is mis taken for one of meningitis. The pain causes the greatest suffering and distress, and anodynes require to be administered for its relief. Pain in the back of the neck is occasionally severe and accom panied by local tenderness. This leads to the diagnosis of cerebro-spinal menin aitis The differentiation sometimes can not be easily made for the first few days. In rare cases lethargy is a very pro nounced symptom.
Delirium is sometimes a marked symp tom at the onset. A patient once came to my consulting-room for the first time when in a state of delirium.
In cases of pneumonic typhoid the onset may be very similar to that of a pneumonia, and the typhoid character of the case may not become manifest until after eight or ten days, when the fever does not terminate by crisis, but continues on in the ordinary course of typhoid.
Bronchitis, especially in children, is sometimes severe at the onset. The con tinued elevation of temperature will lead the medical attendant to a correct diag nosis. In a few cases the disease begins as an acute nephritis, and the symptoms of the latter may be so severe as to alto gether obscure the real disease.