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Prevention of Communicable Disease: Typhoid

TYPHOID FEVER Typhoid Fever (Enteric Fever, Abdominal Typhus) is an infectious disease caused by a specific germ known as the typhoid bacillus. This is a low form of vegetable life belonging to the group of bacteria. It was discovered by Eberth in 1880.

Each germ is a minute vegetable cell shaped like a cylinder with round ends. Each is equipped with a number of long, leg-like processes called flagella which give it the power of swimming rapidly in liquids. These bacteria can be seen only by the aid of the most powerful microscope.

They are so small that half a million would scarcely cover the head of a pin. Yet, each is descended from another germ of the same kind, has its own individual life and can be produced in 1.0 other way. These germs, under favorable conditions, multiply very rapidly. Each splits into two, each two into four, each four into eight and so on. A single colony of a few score germs may, within forty-eight hours, develop into a billion.

We do not "catch" typhoid, we swallow it. The germs invariably enter the system through the mouth.

Thence they pass into the stomach.

Here they may be destroyed by the acids present in the gastric juice, a fact which may explain why some persons who are known to have swallowed the germs do not develop typhoid fever. But if not destroyed in the stomach, they pass on into the intestine. The conditions present in the lower third of the small intestine seem especially to favor their growth. Here they multiply rapidly and become very active. It takes anywhere from seven days to three weeks to bring on the symptoms of the disease after the germs are swallowed. This is called the incubation period. The average is from ten to twelve days. The germ attacks primarily the glands of the intestines, causing small abscesses by which the intestinal walls are often perforated through and through. It also attacks other organs during the course of the disease and may attack any part of the body.

PREVENTION OF COMMUNICABLE DISEASE 149 Typhoid fever exists at all seasons of the year, but is most prevalent in autumn. The greatest number of deaths occur in September and October. a Symptoms. Typhoid fever is very insidious disease since there may be no symptoms whatever during the period of incubation, that is, on an average, for ten to twelve days after infection has taken place. It is often difficult to determine the day on which the disease begins to make itself manifest. Cases are usually dated from the day on which the patient gives up work and takes to his bed. The disease may then have been in existence for a considerable time. In cases known as "walking" typhoid, the patient is never prostrated. The patient and his family may be unaware the nature of the disease. Yet germs are being given off which may infect others with typhoid in its most malignant form. For these reasons it is advisable to summon a physician promptly in all suspected cases and to treat every case of fever as typhoid until the physician has completed his diagnosis.

Every case of so-called "typhomalarial fever" and every case of doubtful origin continuing more than seven days, should be reported to the local health officer, and due precautions taken.

Painless diarrhea, or simple "looseness of the bowels," occurring in one who has never had typhoid fever should excite suspicion if the disease is known to exist in the neighborhood. The mild, "walking" cases are by no means uncommon.

Hence it is advisable that all diarrhœal discharges should be disinfected especially during the existence of typhoid fever in a community.

As a rule the disease comes on slowly. The first symptoms are headache, with a general sense of fatigue and loss of appetite. The headache may be severe and confined to the top of the head, or may consist of more or less general soreness. Abdominal pain occurs in about one-third of all cases. A low fever is almost always present from the outset. But this may be so slight that the patient is unaware of it. Women or chil dren in the first stages of the disease often keep up about the house, or they may be compelled to lie down a part of the day. Men frequently give up work for a day or two and after a little rest go to work again.

When such symptoms are observed as tiring easily, digestive disturbances, headache, drowsiness, and abdominal pain that cannot be attributed to any special condition, a physician should be promptly consulted. If the onset of the disease is more sudden, there may be nausea and vomiting, accompanied by a chill and high fever. A slight cough and occasional nosebleed may be present. Whenever there is doubt as to the diagnosis, the attending physician should have a blood test made. The Widal test is made free for health officers and physicians in the public laboratories of most states.

Prognosis. During the first week of the disease, the symptoms gradually grow worse, fever develops and the patient suffers chilly sensations.

The temperature gradually rises to a height of 102 to 105 degrees F. In severe forms of the disease, diarrhœa commences during the first week and is then continuous.

During the second week the above symptoms become more severe. Nervousness and delirium develop. Minute reddish spots resembling flea bites are frequently observed over the chest, abdomen and thighs.

These spots disappear after a few days. Then a fresh crop appears in other situations. The bronchial tubes frequently become inflamed. Sometimes pneumonia develops. Bleeding from the bowels is an occasional symptom in the second week of this disease and is highly characteristic.

During the third week, in normal cases, the symptoms gradually abate.

The fever lessens. The diarrhœa improves. The nervous symptoms and delirium diminish. The patient, though much emaciated, gradually returns to a normal condition. Or the symptoms may increase in severity, the patient become profoundly prostrated, the delirium deepen and death occur. The hemorrhage from the bowels in some instances may be so severe that death is produced even in comparatively early stages of the infection. This is quite as frequent in the mild cases known as walking typhoid as in others; hence the patient should receive equally careful attention.

The mortality varies from five to twenty per cent, depending upon the The germs, or typhoid bacilli, can enter the body in no other way than through the mouth. Direct infection is thought to occur most often through contaminated milk or drinking water, but secondary infectionthat is, where one member of a family "catches" the disease from another-is believed to occur chiefly by transmitting the germs to the mouth with the fingers. This may come about by handling the patient or something which has come in contact with him, or by means of food or other articles which have been handled by the nurse or others with unwashed hands after coming into contact with FILTH AND TRASH.

TYPHOID Privy vaults and wells which connect underground lead to funeral processions. character of the disease and the nature of the nursing and treatment. A physician should be summoned and his directions implicitly followed.

Nothing in this disease is of more importance than careful nursing. It is absolutely necessary that the patient receive only liquid diet until the physician permits other food.

Solid food given prematurely will cause death.