Page:The American Cyclopædia (1879) Volume VII.djvu/176

 168 FEVERS evacuations, and that the disease may be dif- fused by means of drinking water into which excrement in ever so small quantities has found access. Outbreaks of this fever have been re- peatedly traced to defective waste pipes and obstructed drains or sewers. This fever is not restricted in its prevalence to any particular sections, but it is indigenous in every quarter of the globe. All ages are not alike liable to it. It is rare in infancy, but not very unfre- quent in childhood, and occurs very rarely after the age of 50 years. It is more apt to prevail in the autumnal months than at other seasons. It was observed by Louis that in Paris persons who had resided there but a short time were more likely to be affected than native or older residents, and this has been observed in other cities. In most cases typhoid fever is developed gradually. The average pe- riod from the first evidence of illness to the time of taking to the bed is about five days. The early symptoms are chilly sensations, pain in the head, loins, and limbs, lassitude, and looseness of the bowels. Bleeding from the nose is of frequent occurrence. During the course of the fever stupor, as in cases of typhus, is more or less marked. Low muttering delir- ium is common, and in severe cases subsultus tendinum. The symptoms which are espe- cially distinctive, as contrasted with typhus fe- ver, are those referable to the iritestinal affec- tion, namely, diarrhoea, flatulent distention of the abdomen, tenderness in the iliac regions, and a sound of gurgling when pressure is made in these regions. These are known as the ab- dominal symptoms of typhoid fever. In the majority of cases there is a characteristic erup- tion, usually confined to the trunk, but some- times extending to the limbs. The eruption, however, is rarely abundant, differing in this respect from that of typhus. It also differs in character, that of typhoid fever being pap- ular (pimples, not spots) ; the color is rose red (hence called the rose papules) ; the red- ness disappears momentarily on pressure with the finger ; the papules are not persistent, but come and go throughout the disease, and all appearance of the eruption disappears after death. The eruption appears later than in ty- phus, not being discoverable until about the seventh day from the time the patient takes to the bed. The duration of the fever is lon- ger than that of typhus, the average, dating from the time of taking to the bed, being about 16 days in the cases which end in recovery ; it is somewhat less in fatal cases. In some cases the duration is greatly protracted, and may extend to 60 days. Kelapses sometimes occur, the patient during convalescence or shortly after recovery being again seized and passing through a second course of the fever. These second attacks rarely prove fatal. Con- valescence is preceded by a decline in the tem- perature of the body (called defervescence); and frequently before a persistent reduction there are notable variations, as shown by the thermometer, between the morning and even- ing temperature. The average mortality is about the same as that from typhus, 1 to 5 or 6 ; the rate varies much, however, at different times and places. Generally death is attribu- table to accidents, such as perforation of the intestine and haemorrhage ; to complications, as for example pneumonia; or to the existence of antecedent disease. The general principles of treatment are the same in cases of typhus and typhoid fever. It is doubtful if the cause of these diseases be ever arrested, but they appear sometimes to end prematurely ; abort, as it were, spontaneously. It may be said, at all events, that there are no known measures which can be relied upon for cutting short their course. The great object, therefore, is to aid in bringing them to a termination in recov- ery. The mineral acids have been found to di- minish the rate of mortality. The use of cold water, by means of the bath, the wet pack, and sponging the surface, not only affords re- lief by the abstraction of heat, but clinical observation has shown that it conduces to re- covery. Supporting the powers of life by a proper alimentation, and resorting to alcoholic stimulants when these powers begin to fail, con- stitute essential measures of treatment. Milk is preeminently the appropriate article of diet, and alcoholic stimulants are sometimes tolerated in very large quantities without any of the ex- citant or intoxicating effects which they would produce in health. There is reason to believe that lives are sometimes saved by the very free use of alcoholic stimulants, but it is important always to be governed in their use by the indi- cations afforded by the symptoms. Favorable hygienic conditions are important, such as free ventilation, a proper temperature, and cleanli- ness. The benefit of an abundance of pure air is illustrated by the success with which these fevers have been treated in tents. In addition to the general principles of treatment, particu- lar symptoms and events claim, of course, ap- propriate therapeutic measures. As already stated in the account of periodical fevers, the special cause of these (malaria) may act in conjunction with the special cause of typhoid fever, giving rise to a combination of the symp- toms of both kinds of fever, the disease be- ing then known as typho-malarial fever. In cases of this compound fever the indications for treatment relate to the twofold causation. 5. Spotted Fever. This name was given to a fever which prevailed in New England, New York, and Pennsylvania from 1807 to 1815. It was considered at that time to be a form of typhus fever, and was called also typhus petechialis, typhus syncopalis, and typhus gra- vior. The name has recently by some writers been applied to the disease generally known as cerebro-spinal meningitis, or cerebro-spi- nal fever (see BRAIN, DISEASES OF THE), the opinion being held that the latter disease is the same as that to which the name was for- merly given. The reason for the name is the