The morbid appearance presented by the intestinal mucous membrane, varies with the time that elapses between the period of seizure and death. If the patient dies within the week, the follicles on the membrane present a thickened appearance, and are raised above it, whilst they are seen to be filled with a yellowish, cheesy-looking substance. The result of these details is to give the bowels the appearance of being covered with pustules.
When death has occurred at a later period
ulceration more or less extensive has been observed to have set in.
The influence of age in predisposing to typhoid fever is forcibly illustrated in the following table extracted from Dr Walter Blyth’s ‘Dictionary of Practical Hygiène’:
| Years of Age. | Per cent. | |||
| Under 5 | 0·98 | |||
| From | 5 | to | 9 | 9·44 |
| ” | 10 | ” | 14 | 18·16 |
| ” | 15 | ” | 19 | 26·86 |
| ” | 20 | ” | 24 | 19·69 |
| ” | 25 | ” | 29 | 10·15 |
| ” | 30 | ” | 34 | 5·36 |
| ” | 35 | ” | 39 | 3·40 |
| ” | 40 | ” | 44 | 2·09 |
| ” | 45 | ” | 49 | 1·08 |
| ” | 50 | ” | 54 | 0·60 |
| ” | 55 | ” | 59 | 0·33 |
| ” | 60 | ” | 64 | 0·33 |
| ” | 65 | ” | 69 | 0·08 |
| ” | 70 | ” | 79 | 1·33 |
Dr Murchison asserts that those under thirty are more than four times as liable to be attacked by typhoid fever as persons over that age. The practical bearing of the above figures is obvious. Typhoid patients should only be nursed by the middle aged.
The season of the year also exercises an influence over the development and spread of this disease. In most countries it prevails with the greatest violence, and is most general, in Autumn, and much more frequently follows a very hot and dry summer than a damp one. The carriers of the typhoid poison are the alvine and possibly the cutaneous and other excretions. The disease may therefore be conveyed by contact with the hands or skin of an infected patient, by his urine, by his body linen, the bed clothes, or by dissemination from these into the surrounding air. But the most fertile and unquestionable cause of propagation is the contamination of drinking water by matter derived from the fœcal discharges of typhoid patients, which having soaked into the soil from the privy into which they had found their way, filtered from thence into a neighbouring well, or by means of drains proceeding from a privy or cesspool, into a stream. We can easily understand that the disease when traced to potable water, should always assume so virulent and frequently fatal a character. The fever poison is thus directly conveyed into the stomach, and hence easily reaches the intestines, whence the disease originates. This will also account for the very small quantity of infected water which it has found communicates the disease.
The outbreak of typhoid fever in Marylebone, in 1874, which attacked some 500 persons, was traced to the milk vended by a certain company; this milk having been placed in cans that had merely been washed out and cooled with water obtained from a well into which it was discovered the excreta from a
typhoid patient had percolated from an adjoining privy. After the statement of these facts, the thorough and efficient disinfection of all the excretions, immediately they leave the body of the patient, as well as of his body and bed linen, mattresses, &c., and also of the sick apartment, will be obvious.
The best method of effecting this will be to follow the instructions given by Dr William Budd, for the prevention of the propagation of this disease, which are as follows: