Digestive Symptoms.—The tongue is coated, white and moist at first, and in the second week it becomes red at the tip, and at the edges. Later it is dry, brown and cracked. The teeth and lips are covered with a brown material, called sordes.
Diarrhea.—In some cases constipation is prominent, in others diarrhea is a prominent symptom. Bloating is frequent, and an unfavorable symptom, when it is excessive. Bleeding from the bowel occurs usually between the end of the second and the beginning of the fourth week. A sudden feeling of collapse, and rapid fall of the temperature mark it. It is not always fatal.
Perforation of the bowel is usually shown by a sudden sharp pain coming in paroxysms generally localized in the right lower side. The death rate varies very much; in hospitals it is seven to eight per cent. Unfavorable symptoms are continued high fever, delirium and hemorrhage. Persons who are hard drinkers do badly and very many of them die.
TREATMENT. Prevention. Sanitary Care.—Do away with the causes. Keep your cellars clean; do not have them damp, filthy, and filled with decaying matter, as these all tend to weaken the system and make you more susceptible to the poison. In the country, no drainings should come near the wells or springs. Not all water that looks clear and nice is pure. The "out-houses" must be kept clean, and emptied at least twice each year. In the small cities, especially, the water should be boiled during the months when the supply is limited and the wells are low. If more attention was paid to our water supply to make certain that it was not contaminated, and to our foods, especially milk, and to keeping our cellars and drains in a good clean and dry condition, we would have little typhoid fever. Carelessness is the real cause of this terrible disease. The milk should be boiled as well as the water when there is an epidemic of typhoid.
[198 MOTHERS' REMEDIES]
Sanitary Care of the Household Articles.—Dishes must be isolated, washed, dried separately and boiled daily. Thermometers must be isolated, kept in a corrosive sublimate solution one to one thousand, which must be removed daily. Linen when soiled must be soaked in carbolic acid, one cup of carbolic acid to twenty of water, for two hours before being sent to the laundry. Stools must be thoroughly mixed with an equal amount of milk of lime and allowed to stand for one hour. Urine must be mixed with an equal amount of carbolic acid, one to twenty, and allowed to stand one hour. Bed pans, urinals, must be isolated and scalded after each time of using. Syringes and rectal tubes must be isolated, and the latter boiled after using. (See Nursing Department). Tubs should be scrubbed daily, canvasses changed daily and soaked in carbolic acid as the linen is. Hands must be scrubbed and disinfected after giving tubs or rubbing over typhoid fever patients. Blankets, mattresses, and pillows must be sterilized after use in steam sterilizer. I know some people have not all the necessary conveniences, especially in the country, but the greatest care must be taken. A professional nurse was once taking care of a very severe case of typhoid for me. I was continually cautioning her to be more careful of herself. She did not heed it, and finally took the disease and battled eight long weeks with it, before there was much improvement. Careful nursing and a well regulated diet are the essentials in a majority of cases. Put the patient in a well ventilated room, and confine him to the bed from the beginning, and have him remain there until well. The woven wire bed with soft hair mattress, upon which there are two folds of blanket, combines the two great qualities of a sick bed, smoothness and elasticity. A rubber cloth should be placed under the sheet. An intelligent nurse should be in charge; when this is impossible, the attending physician should write out special instructions, regarding diet, treatment of the discharges and of the bed linen.
Much of the above on typhoid is from the world-wide authority, Dr. Osler, and should be-followed in all cases if possible.
Diet and Nursing in Typhoid Fever.—Milk is the most suitable food. Three pints every twenty-four hours may be given when used alone, diluted with water or lime-water.
The stools will show if the milk is digested. Peptonized milk, if not distasteful, may be used. Curds are seen in the stools if too much milk is given and is undigested. Mutton or chicken broth or beef juice can be used; fresh vegetable juices can be added to these, instead of milk. The animal broths are not so good when diarrhea is present. Some patients will take whey, buttermilk, kumiss, when ordinary milk is distasteful. Thin barley gruel well strained is an excellent food for this disease. Eggs may be given, either beaten up in milk or better still, in the form of albumin water, This is prepared by straining the whites of eggs through a cloth and mixing them with an equal quantity of water, which may be flavored with lemon. Water can be given freely; iced tea, barley water, or lemonade may be used, and there is no objection to weak coffee or cocoa in moderate quantities. Feed the patient at stated intervals. In mild cases it is well not to arouse the patient at night. When there is stupor, the patient should be aroused for food at the regular intervals night and day. Do not give too much food. I once had a case in which I did not give more than one quart of liquid food in four weeks, as it distressed her. She made a good recovery on plenty of water.