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TYPHOID contagious disease, the seat of which is chiefly in the intestine. The cause of this affection has been found to be a bacterium, the Bacillus typhosus. How the bacteria enter the human body has not yet been definitely established ; but infection probably takes place by way of the intestinal canal. Typhoid occurs sporadically as well as in epidemics. Dissemination of the germ is generally through the intestinal or urinary evacuations of the patient, as the urine and faces contain typhoid-bacilli.

These bacilli may adhere to the bed, to the clothing, to the chamber, or to any other articles used by the patient ; and they are capable of conveying the disease even weeks after they have dried. On the other hand, direct contagion from person to person does not seem to take place, as in the cases of measles, scarlet fever, smallpox, etc. According to the ground-water theory of the Bavarian hygienist, Max von Pettenkofer r90r), the earth is the chief breeding-place of the typhoid-bacillus. The disease is ahvays most prevalent in places where the ground-water is deep. Also the drinking-water, the character of which is often dependent upon the composition of the earth, is an important factor in the dissemination of typhoid. In a large number of epidemics it has been proved, beyond a doubt, that the disease originated in places where the drinking-water was drawn from wells which were situated near drains, sewers, and the like. The contamination of a spring from polluted earth may cause an entire district to become infected with typhoid. In some cases—less frequently, however— the germs have been transmitted through the medium of milk or other articles of nourishment. The intestine is the place in which the bacilli primarily attach themselves. A certain natural predisposition seems, however, to be necessary ; for, even in the most severe epidemics, there are always some individuals who escape contagion, even though they come in close contact with typhoid patients.

The development of typhoid usually takes place in about ro to 14 days after infection. During that time the patient may feel in the best of health ; or he may complain, toward the latter part, of chilliness and general lassitude. A slight headache may be present. As the general infection spreads—for typhoid is to be considered as a general, not as a local, disease—the malaise increases, the headache becomes more severe, the bones become painful, and there may be nausea, vomiting, and diarrhoea. Constipation may, however, be present in the early period.

The rise of the fever is very characteristic in typhoid. For the first week it goes up slowly, each evening higher than the evening before, and falling each morning ; yet steadily ascending day by day. The patient feels worse and worse. On the fourth, fifth, or sixth day, a mild eruption may appear. During the second week the temperature remains high ; about ro4° to 105° F. every evening, and 102° to 103° F. every morning. During this period the weakness of the patient becomes more and more pronounced. The tongue is dry and red lined ; the lips and gums are apt to be dry ; the back aches ; and the patient emaciates. He may be delirious at night—either wild, or in a low and muttering state (typhoid state). At this time the diarrhoea may be very persistent, or there may be a distinct constipation. At the beginning of the fourth week the temperature descends as gradually as it went up in the first week ; and convalescence usually begins at the end of four weeks. The patients are still sick, however ; and great care must be taken that they do not get up too early, even if they feel yell. See temperature chart of typhoid fever (Fig. 67, d ; p. 18o).

The majority of cases of typhoid fever occur in the autumn and in the early part of winter. The disease generally attacks young persons between the ages of fifteen and thirty years, frequently also children ; never infants, and very rarely aged people.

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