The citizen. (Frederick City, Md.) 1895-1923, 1896-07-10
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spread. IL more frequently pIeVails III w. tiS
temperate zones than in the Iorlld OF IrlglG
zones but il is possible for IL to be developed
in ali zones and countries. The American
writers descr be it under the name OF y pnolu
fever the French call ii typhoid affection or
dol hfnenteria, the English writers descfibe the
same firm of disease under The head OF en-
terlc fever, - lille the Germans call IL aDuoIhi
nal fever or gastric fever.
Soleen-Tne organ in which parenchyma-
tous degeneration occurs earliest ana most eA-
tensiVeIy is the pleen. We ind the organ UNI
dergolng three distinct changes:
First: 1t is increased in size sometimes enof-
mousIy. the enlargement begins soon alter
the coilmeucement OF the disease and goes on
until the third week, after which IL ceases ana
within a few days begit TO diminish. II re-
covery takes place, by the time 1t IS reached,
the spleen has returned To its normal size.
Second: AS soon the spleen reaches It's
maximum size, its consistency dllnlnlshes, ana
this sottening is sometimes SO m trkeu thdl II
a pOst-mortem be made at the emu OF The thlrd
week, il will present the appearance of dark,
ieliy-iike mass, which is easily broken down.
Third: The organ becomes almost dark in
color, owing to the intense congestion which
attends lis Enlargement and To lie deposit of
"a brown pigment in its substance. These
changes il the spleen take place, IN greater
less degree. in % cases out of every 100
Liver: Changes in the liver are by no means
as common those in the spleen The liver
may be found presenting its normal appear
ance it may be soft and hdbby.
hidneYs: DegeneratiVe changes i'll the kid
news are of not infrequent occurrence in the
course OF typhoid fever.
Heart: The parench matous changes which
heart than in any other organ except the
spleen. II a large proportion of the cases II
becomes soft and fabby, ana is of a graytsh or
brown color. ~ometimesi it is so much changed
that its tissue Is easily broken down by moder-
ate pressure.
Lungs: The lungs undergo changes which
have received the name of specialization, from
tue close resemblance which the affected pOf
ton of the Jung then bears to the spleen. 50
constantly is bro! chitis (catarrhaD present III
The fever that Ilr Stokes proposed 10 Call ty
phoid fever bronchial typhuS. in most cases,
Ffsfg IL
the larger bronchi; II may, however, extend
to the sma Ter tubes and give rise TO capillary
br nchilis and bronchO- pneumonia.
Ldryn1: he Iarynx, as well as the bronchial
tubes, is frequ. nifty The seat OF catarrhal iu-
hammation; less frequently il is the seat OF
diphtheritic Inflammation. Accom- panyIDg tine
laIyngeal Inflammation, are ulcers, which Up
pear in the iarynX, these have received the
name of ''tuDtoid ulcers Of me Ld15ltI:' some
times they give rise to extensive hemOrThageS.
liberation of the mucous membrane of he
mouth and arynx may also occur
The SdtiC0TY glands enlarge, become firm
and tense, ana assume more or less brown
yellow color.
Etiology. The generally accepted meaning
OF the word cOntdgi0ttS however, makes ii de-
sirabe 10 con iEue this clasSi ficatOn. Usually
il has been regarded as an epidemic form OF
disease II ere seems 10 be no connection be-
tween its development aud restitution. 1t
may occur as an isolated case, OF whole house
holds and neighborhoods may be stricken
down " it'll the disease. 1t is possible for il 10
prevail as an epidemic, but it must first have
been endemic. Persons now SICK with This
pitfalls, and are placed by the side OF patients
with pneumonia, or any form OF chronic dis
ease, without endangerlng toe lives of such
persons. ms fact SHOWS how generally the
profession regard this disease as non conta-
gious. Undoubtedly there two principal
channels of Infection, namely, the air we
breathe and The water we drink This poison
may be cons aimed in gases which emanate
from privles, sewers, etc, which nave been
the receptacle OF excrement from Uphold pa
tIenis, and also from springs and wells from
which we get water, which have become con-
taminated by matters from adjoining privies
and cess pools. 1T is an established fact that
water remains contaminated, though far re-
mote from IN point where ii came contact
win defective sewer or Water-clOset Soil
pipes and sewerage may be defective for a
long time nd no case OF typhoid fever occurs,
when suddenly an epidemic of typhoid fever
breaks out, and careful investigation SHOWS
that development preceded by the intro
ducton Of the excrement of a single lndiviu-
ual sick With the disease. Typhoid fever fire.
quentiy occurs in the same locality year after
year, when the surrounding conditions ia
Vorable 10 its development. Those conditions
are more frequently present in the autumn
than in any other season of the year, and tor
this reason 1t has been called d1ttltnnaJ feUer
Usually IL makes It's appearance in ii locality,
each year, AT about the same time; case after
case is developed until entire households and
neighborhoods bee me its victims Individ-
ualS who come to for the sick may con
tract the disease, and even persons who visit
houses in which the disease is prevailing may
afterwards develop the fever, contracting il,
not from tie sick, but from the infected at
moSphere of the locality. 1t is much more
IL occurs most frequently between the ages OF
fifteen and twenty five and is rarely met with
in persons over fifty. Some contract ii upon
the slightest exposure TO the influence OF the
poison, while others, frequently brought in
contact with il, escape for a iong time. Again,
any Individual may have repeated attacks of
typhoid fever.
Symptoms: This fever comes on with a Ger
taln degree OF uneasiness throughout the sys-
com portable and that he is about to be sick
lie has grumbling headache, aching of the
nmbs, "a tired feeling all over chilly sensa.
lions, alternating with flashes OF heat and loss
OF appetite and not unfIequently has nausea
ana vomiting. The patient is generally com
PEELED 10 take to his bed on about th,. fifth or
sixth day. There may be a slight diarrhoea at
at an early period. In typhoid fever VARIATION
in temperature is one OF the most irnnortant
early symptoms DiarrhOea usually comes
on In the first week. In some cases il NAV
have ceased before the second week Between
Inc seventh and twelfth day the characteristic
eruption appears, and at this time the head
acne abates and more or less somuolence and
dellrium comes on. The delitium at first is
SnSnt ana Is only observed during the night
J H. patient daily loses flesh and strength and
becomes more and more unconscious, ana ali
Inc phenomena of the ty phoid state are deveI.
oped, viz: dry brown tongue feeble mise
low muttering deliTium, stupor, tremors sub.
sultus, Involuntary excavations and the other
Phenomena of great prOStr4tlon. The first
sign OF improvement is q decided rem ission of
the fever.
The Physiogony: AS a rule the counten-
ahce mas nothing peculiar IN its appearance:
but If the disease is of a severe TYNE Inv The
second week the cOuntenance assumes n char
acterlstlc app earance-there is a pale olive
leaden look, the eyes becomes dull and the
conJunctlva congeSted usually there is a small
rose coiored spot IN the centre of each cheek
Tongue: From the very onset the tongue is
covered with light white coat, but there is
nothing special in its appearance before the
END OF the first week, then il becomes red
upon the sides and tip, and shows slight dis
position TO dryness in its centre As the dis
ease passes into the second and third weeks
me tongue becomes more heavily coafed the
coating becomes more brown and dry and
sordes collects upon the teeth and sides of the
mouth in sufficient quantities 10 form crusls
AT any period of the disease, the tongue NAV
Clear OH suddenly and present shining red
beef colored" appearance. The tongue and
lips may become dry, cracked AID Insured
AS The soTdes are removed from the lps they
VIII often bleed, and in certain cases more es-
peclaily In the severer forms OF the disease
the entire mouth and tongue may be covered
with dark coored incrustations which are
seen early in connection with those cases
where there are extensive blood chances.
Wnen present they are of a grave significance
one OF the first Indications OF conValescence
Is moist condition about the end of tine
tongue: The whole tongue is moist and i'm lie
natural condition when commissioners is fully
established. 10 i"iJ
0astflc symptoms are more or less pro1,,i.
neht; loss OF appetite is one of the earliest
SYMPTOMS, ana nausea aud vomiting are ouite
common during the first week of the fever
me vomlled matter generally consists Of u
greenlsh fluid. In some cases hemorrhoi &c
o. ms