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.