The recent prevalence of typhoid fever in Brooklyn gives especial interest to the following from "Goodholme's Domestic Cyclopedia."

Typhoid Fever

A continued infectious fever, caused, according to present views, chiefly by defective drains, neglected privies, and sewer gas, lasting an uncertain period of from four to six weeks, and sometimes followed by a relapse. The exciting causes are contagion and spontaneous degenerations. Those nursing the sick from this disease sometimes catch it, but probably from the emanations of the excrement or clothing. No station in life is exempt from this insidious malady; rich as well as poor are attacked by it. Whenever any drainage soaks from the surface into a well used for drinking purposes, or when sewer gas escapes into the house by a leaky pipe, or when the traps are out of order, or when one drinks foul and stagnant water, into which any drainage from manure can enter, then arise the conditions which excite the disease.

Symptoms

The onset of typhoid fever is always very gradual and insidious; it begins with feeling out of sorts, aching pains in the limbs, headache, loss of appetite, and chilliness; for many days the sufferer is able to go about and think that there is not much the mater. Sometimes there is diarrhea, or some intestinal disturbance, then the pulse is quicker, the skin hot, and the tongue red and dry. The nights are disturbed and restless, and he does not care for any exertion. At the end of the first week, or often later, he takes to his bed, and it is found that he is feverish, has no appetite, is thirsty, and his bowels are generally relaxed.

The urine is scanty and high colored; there is still more restlessness at night; there is no stupid, heavy expression as in typhus, nor are the eyes suffused; on the contrary, the face is often pale and the cheeks have a pink flush, and the eyes are clear and bright. Between the seventh and the twelfth day the peculiar eruption appears on the chest, abdomen, and back, and it consists of a few, slightly raised, rose colored spots, which disappear on pressure under the finger and fade away in two or three days, but in the meantime others appear, so that several crops are noticed, and fresh ones may be seen every day. If now the hand is pressed over the right side of the abdomen there may be a feeling or expression of pain, and one may also feel a gurgling under the fingers. About the middle of the second week delirium comes on, at first slight and only noticed at night, and then more constant, intense, and noisy. The tongue is dry, red, and glazed, and often cracked in various directions; in children, however, it may sometimes remain moist and white the whole time, and in very young cases also you do not always see any rash at all.

As the disease advances the patient loses flesh and strength; he lies prostrate and perhaps unconscious of what is going on around, and if it end fatally he will become quite insensible, have a markedly high temperature, and fumble at the bed clothes. If the disease progress favorably the amendment is very gradual, and for this the temperature is a pretty good guide. The temperature rises from the first, but not so suddenly as in typhus and relapsing fevers; at the end of the first week it may be 104 degrees to 105 degrees, being generally highest toward evening; it keeps high with slight oscillations fro about twenty-one days, and then a fall may often be noticed in the morning, although it ascends again at night, and these daily variations are very marked and may cover three or four degrees; at about the thirtieth day, or a little later, the symptoms are decidedly less severe in ordinary cases; the tongue cleans; there is less prostration and delirium, and a general improvement is manifested. But then a relapse may ensue, and the temperature will again rise, and the patient go through the second attack, but this is much shorter than the first.

Complications

Typhoid fever is a very dangerous disease, because there are so many accidents to which patients are liable. Diarrhea may be very profuse and exhaust the patient, but as a rule diarrhea is not a very bad symptom, and should be left alone, unless very profuse. Bleeding from the bowels, when it occurs in any large quantity, is a very dangerous sign; it is due to the ulceration of the intestines. Bleeding from the nose is not often a bad symptom. Perforation of the bowel is very likely to occur between the twenty-fifth and thirty-second day, and even later, and this may be brought on by an error of diet; it is attended by collapse, and is very fatal. Inflammation of the peritoneum, either with or without perforation, adds greatly tot he danger. Bronchitis and pneumonia may supervene and increase the general mischief. Some cases are very mild, others very severe, and there is, perhaps no fever which varies more in its forms, nor about which so much anxiety and uncertainty must exist with regard to a successful issue, nor is one safe till recovery is fully established. In many cases it is most difficult to be certain of the nature of the case in the first week. It is most likely to be mistaken in children for acute tuberculosis; or it may be looked upon as the so called gastric fever or gastric irritation: or it may resemble the symptoms of arsenical poisoning. It may be as well to say here that there is no such disease as gastric fever; it either means typhoid fever or it is a disturbance of the stomach and intestines from poisoning or eating unripe fruit.

Treatment

As regards ventilation, nursing, cleanliness, disinfectants, etc., the rules laid down in the article on typhus fever apply to typhoid fever also, and need not be repeated here. Yet there are some special points which are of importance. The diarrhea need seldom be checked unless excessive, and then a starch injection with laudanum may be given; if there is much bleeding, it may be necessary to give turpentine. There is no medicine which can cure the fever; the diet must be very light, and no solid food should be given under six weeks or two months because in consequence of the ulceration of the bowels, the coats are very thin and liable to burst. Eating an orange, or a piece of potato, or drinking an effervescent draught, will cause distension of the bowel and may rupture it, just when the patient is doing well otherwise; the greatest precaution should be taken during the third and fourth weeks, as then it is most liable to occur. Milk must form the main article of diet, and then an egg or two may be beaten up in it, or a custard may be given, and beef tea; then a small piece of mutton, and so on gradually to mere solid food. If there is much distension of the bowels hot flannels on which is sprinkled a little turpentine should be applied.