Don’t fear from typhoid. Here is the treatment.

Don’t fear from typhoid. Here is the treatment.

          Typhoid is also known by the name Enteric Fever. This is an acute specific infectious fever characterised by diarrhoea and a rose-coloured rash which appears by diarrhoea and runs a prolonged course of about twenty-one days and ends by lysis or gradual fall of temperature. It is accompanied by characteristic ulcerations of the small bowels or intestines and by enlargement of the spleen and mesenteric glands.

Cause

          It is due to a specific microbe, called typhoid bacillus of Eberth. It is always a serious on account of the numerous complications, prolonged course and its exhausting nature. The incidence of typhoid in a community is a fair index of the purity of its water supply. The period of incubation is usually ten days. The onset is insidious.

          Typhoid, like cholera, is caused chiefly by polluted milk and water. It is a water-borne disease. If you are careful about the purity of water and milk, if you drink boiled water and milk, you will not get typhoid. Attendants on the patients develop typhoid through soiled hands.

          The germs are found chiefly in the stools are thrown about carelessly anywhere they dry up and get blown about by the wind. They enter the water and milk. The germs may remain in an active state in the form of dust for a long time. Stored water should be protected against contamination by dust and flies.

          Typhoid fever is often connected with inefficient conservancy arrangements such as a water-closet out of order or escape of sewer gas into a house. It also arises from drinking water contaminated from sewer and particularly from sewers into which the motions and urine of typhoid fever patients have been thrown. Milk also has conveyed the be conveyed by clothing soiled by the stool of a typhoid patient or which has been washed in contaminated water.

          The poison is conveyed also uncooked vegetables grown on infected soils, direct contact with stools of patients, soiled linen or patients and public laundries (stools or urine) and “typhoid carriers”.

          Flies are a great source of danger. They sit on the excreta of patients and with soiled feet sit on the food.

Symptoms

          The most important early symptom is headache; otherwise there are simple malaise, lassitude, constipation, bleeding from the nose (epistaxis), cough, slight abdominal pain and looseness of the bowels.

          The typhoid microbes attack particularly the small intestines and exert a toxic influence generally on the body. It causes wounds or intestines. The walls eventually give way on account of perforation and the patient dies.

          Typhoid is not spread by touch or odour. It is spread by germs swallowed with contaminated food, water or milk. It is most infectious during the third week.      

          In certain cases, after recovery, the germs may persist for years in the intestine or gall bladder and sometimes in the kidney or bladder whence they pass out in the urine. The stools or urine of such persons, who are known as “typhoid carriers” may be constant sources of infection.

          The onset of typhoid fever is gradual. It is insidious. The patient gets feelings of malaise, aching in the limbs, headache, loss of appetite, chillness, nausea, vomiting, bleeding from the nose, slight abdominal pain. There is an increase in the pain, fever in the afternoon and a slight remission or diminution in the morning. There is diarrhoea. The stools are thin, of a yellow colour resembling pea-soup. The abdomen becomes tense and resonant.

          There is an eruption of rose-coloured spots on the chest, abdomen and back between the seventh and twelfth days. It comes in successive crops.

          The typhoid chart is one of the most characteristic features of the disease. In the first week it is a ladder-like or staircase likes gradually rising with diurnal remissions. It rise two degrees in the evening and falls one in the morning. It reaches the highest point 103 to 105 degrees about the end of the first week. During the second stage which lasts for a week or more it remains continuously high. Defervescence usually takes place about the fourth and then evening temperature also hradually becomes normal.

          The spleen is generally tender and enlarged throughout the disease. There is lympanitic distension of the abdomen.

          The small bowel has numerous ulcers. The bowel becomes very thin on account of the ulcers. The ulceration causes bleeding at times.

          The fever may last from 21 to 40 days. Relapses are common on account of injudicious feeding.

          In favourable cases there is a diminution of the fever after the appearance of the eruption. The patient will improve about the beginning of the third week. The diarrhoea lessens; the tongue becomes clean, appetite returns. In more severe cases delirium comes about the middle of the second week. The “typhoid state” comes in. the patient is in a state of collapse. He becomes unconscious. He picks at the bed clothes.

          The duration of typhoid fever is from three to four weeks. The temperature gradually becomes normal I the fourth week. There may be relapses. The mortality is one in every seven cases attacked.

          Bleeding from the bowels, nose or mucous surfaces, perforation of the bowels, peritonitis, and extensive distension of the belly on account of too much gases, pneumonia, bed sores, and inflammation of the kidneys are complication.

Type of typhoid

          There are four types of typhoid, (1) the ambulatory type in which the patient may be able to move about during the entire illness, (2) cases with sudden onset market nervous symptoms, (3) cases which termination of the fever takes place by crisis (sudden fall of temperature) in the second week (abortive type) and (4) cases where Defervescence is delayed till the fifth or sixth week.

                                                  DIET

         Wheat, butter-milk barely water, green cocoanut water, fruit juice are beneficial. Add barely water or lime water to milk or add sodium bicarbonate, or sodium citrate 2 grains to an ounce of milk. This will prevent the formation of curds. No solid should be taken until at least one week after the temperature becomes normal. Nothing which would not readily pass through a fine sieve should be given to the patient. Milk, if it agrees can be given at regular intervals and in definite quantity. No food which wills increases the risk of perforation should be given. Arrowroot and core flour are permissible.

          Eating of an orange or a piece of potato or drinking soda or lemonade may produce distension of the bowel and rupture particularly during the third and fourth weeks. Many typhoid patients die on account of the ignorance of their friends and relatives. They give them biscuits and fruits with stones etc., which cause rupture of the thin bowels.

Treatment

          In typhoid fever the patient has at prepared for confinement to bed for 4 weeks without practically any food.

          The strength of the patient must be kept up. Bleeding or perforation must be prevented by absolute rest and suitable diet. The poisonous effects of the germ must be counteracted by vaccination. The toxin of the germ must be neutralized by serum therapy. The patient should not lie continually on his back as this will tend to congestion of the bases of the lungs and formation of bed sores. He should lie on his side. He should be carefully turned every two hours on either side alternatively.

          The stools must be burnt be immersed in phenyl or izal. All linen must be first steeped in Lysol or izal for several hours and boiled. All utensils must be disinfected.

          If constipation is troublesome give enema. No purgative should be given after the first week. If there is bed sore we water bed, spirit lotion. If there is high fever gives tepid sponging. During convalescence the diet must be increased with great caution. The possibility of relapse must be remembered.

          Those who attend on the patient should be inoculated with the Anti-typhoid vaccine, (Wrights). The is an established success. The vaccine which is injected contains the white blood calls. They acquire fresh power to destroy the living bacilli, just as a soldier can kill more enemies if he is equipped with better guns.

          When the temperature is high ice pack to the head, cold or tepid sponging is highly beneficial.

          More help is typhoid by careful and good nursing than by medicine.

          Inoculation, improved sanitation of the kitchen, control of flies and water supply, tracking down of “typhoid carriers” pave a long way to eliminate the disease to a very great extent.

          Treatment by drugs is chiefly symptomatic. All food should be protected from dust and flies.

          Slight movements do positive harm to ulcerated surfaces of the bowels.