It is impossible to give a full account of the enteric fevers here, and moreover the presence of a medical man, still more of a good nurse, is absolutely necessary for their proper treatment. The chief early symptoms, however, will be given, and a few hints as to their treatment. For all practical purposes paratyphoid fever may be considered as a mild variety of typhoid.
The disease is characterised by ulceration of the small bowel, with continued high fever, and is usually accompanied by diarrhœa.
Causes.—It is generally caused by the drinking of impure water, but may also be transmitted by all the causes operative in the case of dysentery (see [p. 185]).
The incubation period is from ten to fifteen days.
Symptoms.—The early symptoms of the disease are often so slight that the patient will not believe he is really ill; he may just feel out of sorts, or complain of headache, but still go about his work. There may be diarrhœa, or occasionally constipation. After five or six days the patient is generally compelled to give up and go to bed, headache or diarrhœa, or both, being the chief complaint. The temperature goes up in a characteristic manner, rising a little more every evening till it eventually reaches 103° or 104° F. There may be some cough, and often this symptom is a very troublesome one.
The belly is usually distended and slightly tender, and there may or may not be the characteristic typhoid rash, consisting of rose-pink circular, slightly raised spots, about the size of a large pin’s head. They occur chiefly on the chest and abdomen, and come out on successive days, often only three or four at a time. These spots are frequently absent, and then one must be guided by the presence of other symptoms. They are difficult to be seen upon a dark skin.
The possibility of enteric fever should always be remembered in cases where there is constant fever, unaccompanied by any definite symptoms, such as the recurrent shiverings of malaria, or the spitting of blood in pneumonia.
Prophylaxis.—As for dysentery (see [p. 186]). Preventive inoculation is very important and confers immunity for a considerable period (see “Inoculation,” [p. 168]).
Treatment.—Absolute quiet in bed. If constipated, bowels should be kept open by soap and water enema only.
Milk only (three to four pints daily) should be given during the whole course of the illness and till ten days after the temperature has descended to, and remained, normal. Stimulants, if pulse is feeble and rapid; opium only if there is much pain. If bleeding occurs from the bowel, an ice poultice or cold-water cloths should be applied to the belly; ice may be given to suck; opium and an astringent, such as tannin, administered by the mouth, or an opium enema be given. Milk should be given in small quantities only, and to each half-pint five grains of bicarbonate of soda should be added.