Enteric fever

“ 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. ”

“ Typhoid fever can of course be known if rose-spots, a splenic tumor, or the characteristic delirium are manifested, or if the fever-curve conforms to the type; but in children all these symptoms may be negative; even the fever has great variability. If fever is continued beyond ten days, and is accompanied by progressive anæmia and emaciation and debility, the attack is enteric fever if all local causes of fever can be excluded. ”

“ The infectivity of enteric fever has been underrated in the past. When patients with this disease are nursed at home by relatives who do not appreciate the full importance of the necessary precautions, it is rather the rule than the exception for them to fall victims to its infection. Probably, sometimes the infection has been scattered as dust, owing to small particles of fæces or of urine having become dried on bed linen. The most absolute cleanliness is essential in nursing this disease. In hot climates there is reason to believe that infective dust may be blown about from privies. ”

“ The balance of evidence is in favour of the view that in order to produce enteric fever water must be contaminated with the stools or urine of a patient who has suffered from this disease. Numerous instances are on record in which villages, the inhabitants of which drink sewage-contaminated water, have remained free from enteric fever, until a patient suffering from it has come to the village, when the spread by water has been very rapid. ”

“ First, that agricultural laborers do not spend all their time in the fields, but sleep in rooms from which, as a class, they carefully exclude all ventilation; second, that, for some unexplained reason, enteric fever seems to have a selective affinity for robust young males. It is an affair of common observation that, under apparently precisely similar conditions, fragile women may resist the infection to which strong men succumb. ”

“ The means of prevention of enteric fever are the discovery and removal of the cause of an outbreak, and the isolation of each patient and disinfection of all discharges. An early means of diagnosis is secured by Widal’s reaction. This is especially useful in cases not presenting characteristic clinical symptoms. The recognition of a disease or at least the suspicion of its presence is an indispensable first step for the taking of precautionary measures. ”

“ It is due to a bacillus, difficult to detect, but during an attack found in many of the internal organs as well as in the stools, urine, and blood of the affected person. Enteric fever occurs in all parts of the world, and in most countries it is endemic, with occasional outbursts of epidemic prevalence. In Great Britain it is most common in the autumn, but epidemics may appear at any season. The great majority of cases occur between ten and twenty-five years of age; less common in middle life, it is rare after sixty. ”

“ Sex has little or nothing to do with the incidence of the infective virus. As to age, enteric fever rarely befalls infants, and, in the general belief of practitioners, is a less frequent cause of death among children than among adolescents and adults. ”

“ Again, many facts in the occurrence and diffusion of enteric fever point to an intimate connexion between its origin and certain conditions of locality. Epidemics rarely spread over any considerable tract of country, but are nearly always confined within local limits. ”

“ In like manner, the escape or reflux of excremental gases from pipes or sewers, or the leakage into basements or foundations from faulty plumber-work, are causes, real no doubt, but of limited application, which do not conflict with, as they do not supersede, the more comprehensive and cognate explanation of enteric fever as an infection having its habitat in the soil and an incidence upon individuals after the manner of other miasmatic infections. ”

“ The disease, in fact, is so slightly contagious that many excellent observers have doubted if it be so at all. It is probable that certain meteorological conditions, such as a high temperature, a defective supply of ozone, or a peculiar electrical state, may be necessary for the production of the poison of enteric fever; and thus, nuisances which are offensive to the senses may exist for a long time without producing the disease. ”

“ The main incidence of the disease was upon a group of houses, which formed an irregular square, containing twenty-three cottages, occupied by eighty-eight persons. Up to the first week in June the inhabitants of this locality had been free from fever, but at that date a series of attacks of well-marked enteric fever occurred almost simultaneously in a number of houses, fresh attacks taking place day by day until, in the space of a few weeks, one or more inmates in fifteen out of the twenty-three cottages had been attacked, the number of patients amounting to thirty-five. ”

“ The irritation produced by the absorption of this permeating dust into the system militates to some extent against the rapid recovery of men who suffer from diseases like dysentery or enteric fever. It travels under doors and through window sashes, and a patient is obliged, whether he will or no, to swallow a certain amount of it daily. ”

“ The necessity of a high temperature is undoubted, and is itself a strong alignment against the view which makes drains merely the vehicle of transmission of the poison. It is well known that enteric fever, like ordinary diarrhoea, becomes epidemic in this country every autumn, and almost disappears in spring, while the autumnal epidemics are always greatest in seasons remarkable for their high temperature. Enteric fever is much later in commencing and in attaining the acme of its autumnal prevalence than diarrhoea, showing that a longer duration of hot weather is necessary for its production ”

“ At the present moment, when the subject of epidemics is attracting so much attention, it may be interesting to call attention to the more important diseases comprised under that head, and to point out some of the main facts connected with their origin and distribution. {422} The principal epidemic diseases, then, are: small-pox, scarlet-fever, measles, typhus, relapsing fever, Oriental plague, yellow fever, diarrhoea, typhoid or enteric fever, cholera, dysentery, ague and remittent fevers, influenza, the sweating sickness, and the dancing mania. ”

“ TYPHOID FEVER. Typhoid or enteric* (Gr. Ev-repov, the intestine) is a specific infectious fever characterized mainly by its insidious onset, by a peculiar course of the temperature, by marked abdominal symptoms occurring in connexion with a specific lesion of the bowels, by an eruption upon the skin, by its uncertain duration, and by a liability to relapses. This fever has received various names, such as gastric fever, abdominal typhus, infantile remit tent fever, slow fever, nervous fever, “ pathogenic fever, ” Src. ”

“ Typhoid fever, also known as enteric and gastric fever, is thus known to be produced, and its germs to breed, amongst the insanitary conditions represented by foul drains and collections of filth wherever found. Experience amply proves that by attention to those labours which have for their object the secure trapping of drains, flushing of sewers, and abolition of all filth-heaps, the chances of this fever being produced are greatly decreased. ”

“ A fever with relapses, and a fever with sloughing of the follicles and lymph glands of the intestine, were not the only novelties in the first thirty or forty years of the 19th century. Relapsing fever and enteric or typhoid fever were each clearly separated, at a later date, from typhus fever. ”

“ In this way some of the germs are rubbed off and adhere to the food and are swallowed with it by human beings. The diseases most commonly disseminated in this manner are those of the alimentary canal known as enteric diseases, such as typhoid fever, cholera and dysentery, the germs of which are voided in fecal matter, which if left exposed is certain to be visited by hundreds of flies, and some of the causative bacterial germs of these diseases are thus transferred to food, and infection is thus made possible. ”

“ The patient’s bowel-movements, at first normal, now becomes diarrhoeal, while certain psychic disorders also manifest themselves, usually in the form of a heavy somnolence. In the third week the patient’s life is threatened by complications in the intestines—haemorrhage or perforation. Characteristic of the disease are the anatomical changes of the small intestine—at first enlargement, and later ulceration of Peyer’s patches. The infective agent in the case of typhoid fever is a bacillus, identified by Gaffky in 1882. ”

“ One attack usually confers immunity.
Symptoms.—Incubation is about three to four days. There may be a fore-warning period, but the attack is usually sudden, with chills, headache, backache, rise in fever, and general feverish symptoms, vomiting, and constipation. Early in this disease the face is flushed, while the conjunctiva and the mucous membrane lining the eyelids is congested and slightly jaundiced. Fever is 102 or 103 degrees, and falls gradually after one to three days. Pulse is slow, and while the temperature rises, it again falls. ”

“ Suppuration of the tissues involved is common in the severer forms. Should the tongue become dark and diarrhea set in, attended with great prostration, the case is very serious, and energetic means must be employed to save life. A retrocession of the inflammation from the surface to a vital organ is an extremely dangerous symptom. The disease is not regarded as contagious, but has been known to become epidemic.
Treatment. The treatment during the initial stage of this disease should correspond with the general principles laid down for the treatment of fever. ”

“ This contagion is beyond question a living something which multiplies with great rapidity under proper conditions, and, escaping from the bodies of those infected with the disease, in one way or another, reaches other individuals. It is beyond question true that the virus passes from the body of those infected by means of the urine and feces, and it [Pg 189] is likely that the secretions from the mouth and nose frequently contain the germs that cause the fever. ”

“ As a rule the disease begins with headache, stiffness of the neck and chilly sensations. There may be vomiting, and the temperature is raised. The mind is often confused, and the patient may be delirious. The skin eruption, which occurs especially on the back and about the joints, and which is responsible for the name “spotted fever,” is not very frequently seen, and can hardly ever be detected on a dark skin. In very bad cases there is violent delirium, laboured breathing, and a purulent discharge from the nostrils. ”

“ Las infecciones intestinales conocidas como gastroenteritis, son causadas por Intestinal infections, known as gastroenteritis, are caused by bacteria, viruses or parasites that harm the intestinal mucous causing diarrhea, vomiting, abdominal pain, and fever.
Depending on the intensity of the medical condition or the type of infection, the patient may become dehydrated. Children and the elderly are at risk for dehydration. Infectious diarrhea is considered one of the most serious health problems in undeveloped countries, being one of the main causes of childhood diseases and mortality. ”

“ Indeed, what would authorize us to regard any subject as affected with yellow fever, who would not present the pain in the stomach, the redness of the tip of the tongue, the thirst, irritability of the stomach, and vomiting either of simple mucus, or black [Pg 56] matter? And, on the other hand, how many have died with these symptoms, who were not affected with all the others we have noticed, and, on dissection, have shown no mark of disease, except in the digestive apparatus? Finally, can pain in the head, affections of the kidneys, vomiting of bile, &c. ”

“ The contagion, -like that of typhus, appears to be most active in the immediate vicinity of the patient and to be greatly lessened by the access of fresh air. It is capable of being conveyed by clothing. The incubation of the disease is about one week. The symptoms of the fever then show themselves with great abruptness and violence by a rigor, accompanied with pains in the limbs and severe headache. ”

“ Almost the only cause for a fever is disease germs growing in the body. We can make a person have any kind of fever by planting a few of the germs of the fever in the right part of his body.
We are made sick by the germs of fevers more often than by all other causes put together. Here is a list of common diseases caused by fever germs:—colds and sore throats, most stomach aches, blood poisoning in wounds, boils and pimples, tuberculosis, whooping cough, measles, chicken pox, diphtheria, scarlet fever, typhoid fever, smallpox, and malaria. ”

“ Occasionally the stomach and bowels are attacked so that violent vomiting and diarrhea occur, while other members of the same family present the ordinary form of influenza. There is a form that attacks principally the nervous system, the nasal and bronchial tracts escaping altogether. Continual fever is the only symptom in some cases. ”