A reference hand-book for nurses

by Amanda K. Beck

TYPHOID OR ENTERIC FEVER.

Typhoid fever is an acute infectious disease, excited by the typhoid bacillus. It is most prevalent in the autumn, although it occurs at all seasons. The disease is not directly contagious, and can only be acquired by taking the special bacillus into the alimentary canal. This is usually accomplished through the medium of polluted water, milk contaminated with infected water, raw vegetables (celery, lettuce, water-cress) which have grown in infected soil, or raw shell-fish (oysters) taken from the beds of polluted streams. Occasionally physicians and nurses are infected directly in handling the patient or his clothing which has become soiled with his discharges.

The bacilli are contained in nearly all the secretions of the patients, especially in the stools and urine.

While the bacilli are widely distributed through tissues, the only characteristic lesions of the disease are in the glands of the intestines (Peyer’s patches), which in the first few days become red and swollen, about the beginning of the second week soft and pale, and in the third week ulcerated. If the patient survive, cicatrization usually begins in the fourth week.

Death may result from exhaustion, the result of the systemic poisoning, from perforation of the bowel by an ulcer, from intestinal hemorrhage, the result of erosion of a blood-vessel, or from some complication, like pneumonia.

Symptoms.—The initial symptoms, which may last a week or two before there is any fever, are headache, weakness, loss of appetite, nose-bleed, and perhaps slight diarrhea.

The fever rises gradually, reaching its maximum (104°-105° F.) in about a week; it remains stationary for one, two, or three weeks, and then falls, reaching the normal in another week, thus making the febrile period of the disease of four or five weeks’ duration. Throughout its course the evening temperature is apt to be two or three degrees higher than the morning temperature.

The abdominal symptoms consist of distention of the abdomen (tympanitis), pain and tenderness in the right iliac region, and often diarrhea.

Between the seventh and ninth days a rash usually appears on the abdomen, consisting of small rose-red spots. These come out in crops and disappear on pressure.

The pulse becomes rapid and feeble, and the heart sounds become weak and dull.

The respiratory symptoms include cough, hurried breathing, and slight expectoration.

Nervous symptoms are not always marked. In severe cases there may be delirium, stupor, twitching of the muscles, picking at the bed-clothes, and coma.

The face is dull and listless. The tongue is coated and tremulous. In severe cases it becomes dry, brown, and fissured, and sordes tend to collect upon the teeth.

Relapses are common. In some cases they are due to the too early use of solid food, to excitement, or to overexertion.

When typhoid fever is prevalent, the most reliable preventive measures consist in thorough boiling of all water and milk used for drinking purposes and the avoidance of uncooked vegetables, oysters, and shell-fish.

Management.—Unless otherwise directed take temperature, respiration, and pulse every three hours, in mouth or axilla, as desired. If for any reason a change is made in taking temperature, it should be noted on the chart. Note the effect of sponging or of bathing upon temperature and pulse. Note the character of pulse, and effect, if any, which stimulants have had upon it. Note the amount of cough, and the character and quantity of the expectoration; also any pain that may occur in the chest.

Note the amount of flatulence and the number and character of the stools; especially be on the lookout for blood or undigested food in the discharges.

Note carefully any abdominal pain, any increase in the distention, as these symptoms, with or without a rather abrupt fall in temperature, chills, and pinched features, are suggestive of perforation.

Treatment for Hemorrhage.—Stop all orders immediately, including diet. Elevate the foot of the bed. Give morphin sulphate, gr. ¼ (gm. 0.015), hypodermically, and apply an ice coil or iced compresses to the abdomen until the physician arrives.

Note the occurrence of vomiting and the character of vomit.

Be on the lookout for retention of urine, which is quite common. Note the amount of urine passed in a day and any abnormalities connected with its appearance.

Note the condition of the skin and tongue.

Note the amount of sleep, its character, whether quiet or restless and whether or not there have been delirium, stupor, or twitching of the muscles.

Note the exact amount and character of nourishment taken, and the time it was given; also the amount, time of administration, and effect of medicines and stimulants.

Cleanse the mouth and teeth frequently with some antiseptic wash, such as listerine, 1 part; water, 3 parts.

Bed-sores can nearly always be prevented by keeping the patient and bedding perfectly clean, the skin absolutely dry, and the bed-linen smooth. Changes of position are also important. Parts subjected to pressure and soiling should be washed at least twice daily with soap and water, thoroughly dried, gently rubbed with alcohol, and then dusted with a powder like the following:

Boric acid,	1	part;
Starch,	1	“
Zinc oxid,	1	“

If the skin be reddened and tender it may be painted with collodion and then dusted. When the part cannot be kept dry, it should be smeared with zinc ointment and powdered. In very prolonged cases it usually becomes necessary to use water- or air-pillows or water- or air-beds.

To disinfect the feces and urine, use a solution of chlorinated soda (Labarraque’s solution). Cover the urine and feces with the solution and leave the contents stand for an hour. Cleanse pan thoroughly and pour into it the Labarraque solution.