Treatment.—The patient should be treated in a large well-aired room, fresh air being in this case the best disinfectant. He should be kept strictly to bed. Careful feeding is neces sary. Sips of milk, beef•tea, nourishing soups from which all vegetables have been strained off, should be given at short intervals. The patient will in this way be induced to con sume a large quantity in twenty-four hours, which he would not otherwise take. Thirst is to be relieved by barley-water, lemon-juice in water, or plain water. Au occasional dose of castor-oil may be necessary to relieve the bowels, and at proper intervals the patient must be told to make water, since the intense listless ness of the patient may lead him to fail to do so. Sometimes the water requires to be drawn off. •11igh fever should be controlled by repeated cold sponging, or an occasional cold pack or cold bath (p. 510), and the general management of fever cases as discussed in detail on p. 508 is wholly applicable to cases of typhus. The patient must never be left unwatched. Delirium, which sometimes needs restraint, is to be met mainly by quiet, darkening the room, and ap plying cold cloths to the head. Stimulants, though not always necessary, are sometimes of great use towards the end of the second week, when the weakness is extreme, specially if the pulse is very fast and weak. They are doing good if the pulse becomes less frequent and stronger. The best stimulant is perhaps wine, to be given, in tea-spoonful doses at intervals, to the extent of two wine-glassfuls in twenty four hours, or brandy or whisky in milk, half a wine-glassful to be mixed with a breakfast cupful of milk, and given in doses of two or three tea-spoonfuls at a time, the whole cupful to be given in twenty-four hours. If cough, spit, and increased difficulty of breathing indi cate congestion of the lungs, stimulants are to be used in this way. Twice the quantity noted may, in such a case, be given in twenty-four hours if it seems doing good. During the period of extreme weakness the attendant must guard against bed-sores by keeping the patient scrupulously clean, and by changing his position occasionally, so as to prevent the same parts being constantly pressed upon. During recovery strength is to be aided, not by stimulants, but by careful nursing and feeding, frequent small quantities of nourishing beef - tea, soups, &c., being given.
Typhoid Fever (Enteric Fever — intestinal Fever—Bilious Fever—Gastric Fever).—Up till 1840 two fevers were confounded under the term typhus fever, but that two essentially different diseases were included under the one name was pointed out at the time mentioned by Dr. A. P. Stewart. Later a complete dis tinction was drawn between the two by Dr. William Jenner ; the one described in the pre ceding paragraphs retained the name typhus, and to the other, because it was very like typhus in many particulars, the name typhoid was given. This fever (typhoid) is accompanied by serious disease of the bowel, and conse quently to it the name enteric fever (from enteron, Greek for the bowel) has been given by sonic who do not like the confusion that two words so like one another as typhus and typhoid may occasion. The phrase "intestinal fever" is thus simply phrase for "en teric" fever. Further, this fever is marked by sickness and by very decided diarrham or looseness of the bowels, and thus, as the symp toms marked out the stomach and bowels as the chief seats of the disturbance, the name gastric fever has also been used for it. This
term is essentially a bad one. Typhoid fever is an extremely serious and a very commonly fatal disease, but there may be many distur bances of the stomach, accompanied by fever, but attended by no risk, to which the term "gastric fever" might be applied by some. It is a matter of the utmost moment that wherever typhoid fever exists it should be discovered ; and the use of any term that would in any way tend to disarm suspicion as to the true nature of the disease is undesirable. Typhoid fever is often accompanied by severe vomiting, in which bilious matters are vomited, and hence some have called it bilious fever.
The cause of typhoid fever is a living organ ism or germ, such as have been described on p. 495. In the vast majority of cases it gains entrance to the body in food or drink. It multiplies in the bowel, finds its way into the blood, and by it to other organs, and is given off in the discharges from the bowel and bladder. If these discharges be not disinfected they may infect wells, streams, lochs, &c., and thus the disease spreads. But the infection is not cast off in the patient's breath or by the skin, like measles or scarlet fever and small-pox. These facts are of immense practical importance, since they show that a person may attend on a case of typhoid fever without fear, if care be taken that all discharges from the patient, and all linen soiled with them, are carefully disinfected.
Typhoid fever may occur at any age, though it becomes less frequent as age advances. No class or condition of men is free from its at tack. It is most frequent in warm seasons of the year, and least frequent during cold weather.
It appears that some persons are able to resist the typhoid fever poison much more suc cessfully than others, so that not only must the poison be introduced into a person's body, but the person must be in a favourable condition for its growth within him. A lowered state of general health is undoubtedly one of the most favourable conditions for the attack of this disease as of many others. While one attack of the disease seems to afford some protection against a second, many second attacks have been recorded.
is uncertain what time elapses between the period of the introduction of the poison into the body and the commencement of the disease. It appears to be about three weeks. The disease usually begins by the person feel ing unwell and losing appetite. The loss of strength and general feebleness are marked. He complains of feeling chilly, and then of feverish turns, of being drowsy, troubled with headaches, and of restless sleep at night. These are all vague general symptoms. But there are also disorders of the stomach and bowels, vomiting and looseness, and bleeding at the nose is not uncommon. These are often the most striking symptoms, and should make one suspicious. The temperature of the person should be taken. It will be found higher than usual (see p. 507). The pulse will be found fast, and the tongue coated and brownish down the centre. One symptom should be sought for. It is pain on pressure in the right groin. If one presses this part with the fingers, generally gurgling will be felt, and the patient complains of sonic degree of pain.