DANGERS.-(I) Haemorrhage.-This may occur from the ulcerated patches in the ileum, during the separation of the gland-sloughs, and may be either capillary or from the opening of a large vessel. The discharge of blood may be so great as to be immediately fatal, or it may be remotely fatal, by exhausting the patient so that he has no power to bear up against the fever in its subsequent course. Sometimes, without any escape of blood from the orifice of the bowel, the patient becomes suddenly blanched and dies in a swoon. In such a case a post-mortem examination finds the intestines distended with clotted blood. (2) Exhaustion from profuse and persistent Diarrhoea, in cases in which the affection of the mucous membrane has been very severe and obstinate. (3) Perforation.-The ulceration may extend till the coats of the bowel are perforated, and cause fatal Peritonitis; this may happen during the second or third week, or, more frequently, during prolonged and imperfect convalescence. The symptoms of this occurrence are, a sudden pain and tenderness in the abdomen with swelling, more or less nausea and vomiting, an altered expression of the features, and death in one or two days. (4) Congestion.-The lungs may become congested, giving rise to Bronchitis, Pleurisy with effusion, or Pneumonia; or latent tubercle may be called into fatal activity; in short, there is a tendency to congestion in the three great visceral cavities the head, the chest, and the abdomen. (5) Relapse.-This is not unlikely to occur from inattention to diet, or from abandoning the recumbent posture too soon. After recovery from Enteric fever, the germs of the disease sometimes live on in the body in the gall bladder, and bile ducts. Thence they may pass into the intestine and faeces, and be discharged from the body, able to cause the disease again if they happen to infect a water supply, or in other ways gain access to human beings. These persons who harbour enteric germs are known as Typhoid carriers, and may be innocent agents in spreading the disease.
It will be inferred from the preceding observations that this disease does not run a uniform course; indeed, cases have been recorded in which a fatal termination has been reached without the manifestation of any characteristic symptom. In our practice we have met with the greatest conceivable varieties, so that enteric fever may be said to present, in the mode of its accession, in the course, gravity, and termination of the symptoms, so many forms, complications, and accidents, as to justify its being considered an epitome of the whole practice of medicine.
MORTALITY.-Upon referring to the Registrar-General’s report of some thirty years ago we find that 20,000 persons died annually of Enteric fever, and probably 150,000 are laid prostrate by it. Amongst its many victims, it carried off the Prince Consort in 1861, twenty-one days from the commencement of the attack, and ten years later almost proved fatal to the Prince of Wales. Several members of the royal family of Portugal came to an untimely end by it. We are much gratified to see that within the last few years there have been nothing like so many fatal cases, the total deaths for 1890 being 5,146, in the proportion of 179 to a million of persons living. In 1910 there were only 1,898 deaths from Enteric in England and Wales, in 1916, 1,122 a gratifying tribute to the efficiency and zeal of our Public Health officers.
TREATMENT.-Unless distance absolutely forbids it, the treatment of this disease should only be confided to a medical man. Before the true character of the fever is detected, the remedies prescribed in Section 45, on Simple Fever, may be given.
PREVENTIVE TREATMENT.-Since the discovery of the germ of Enteric fever, processes have been developed whereby, by means of growing the germs outside the body, doses of weakened germs can be injected into the healthy (Typhoid vaccination), which protect thereafter against the disease. The result of injection is a more or less severe reaction of pain, discomfort, fever, etc., but is not a thing of importance compared with protection from the disease. This vaccination is now largely performed in armies and other bodies of people likely to be exposed to enteric fever.
EPITOME OF TREATMENT.
1. Invasive stage.-Baptisia
2. Great prostration.-Arsenicum, Ac.-Mur.
3. Excessive Diarrhoea.-Arsenicum, Ver-Alb. (involuntary), Ipecac., Carbo vegetabilis Constipation, Bryonia
4. Haemorrhage from the bowels.-Terebintha, Ac-Nit., Ipecac.
5. Complications.-Phosphorus, Belladonna, Opi., etc. See Sequelae.
6. Debility following.-Ac-Phosphorus, Ignatia, Ferrum, Sulphur, China, Nux vomica
7. Perforation.-The possibility of immediate surgical interference gives virtually the only chance of saving the patient.
SPECIAL INDICATIONS.-Baptisia.-As soon as Enteric fever is suspected, this remedy should be administered, one or two drops of 1x dil. or of the strong tincture, every two or three hours. This remedy is of great value, modifying, and even cutting short, the attack by destroying the poison in the blood. Its influence in this disease is comparable to that of Aconite in simple fever; but Aconite exercises little or no curative power in Enteric fever, which depends on the presence of a specific blood-poison, and requires the action of an antidote. Should, however, the administration of Baptisia have been much delayed, and the specific poisonous effects produced, other remedies must be resorted to; especially Arsenicum and Rhus.
Arsenicum.- Frequent, copious Diarrhoea, which may become involuntary, of drab or ochre-coloured evacuations, enlargement, sensitiveness, and gurgling of the abdomen; excessive prostration; thirst; nearly imperceptible, intermittent pulse. This remedy is of priceless value, and its administration should be persevered with even in the most disheartening cases.
Carbo Veg.- Offensive smells from the patient, foetid evacuations; also cold extremities, cold sweats, and rapid sinking.
Mercurius.- Greenish or yellowish evacuations, but less serious DIarrhoea than described under the previous medicines; thickly- coated tongue; copious perspirations.
Bryonia.- Generally when constipation is present instead of diarrhoea. Pains which are markedly worse on movement.
Belladonna, etc.- When the brain is much involved, Belladonna, Hyoscyamus, or Opium. is required. These remedies may be administered by inhalation from boiling water, to which a few drops of strong tincture have been added. See Section on Typhus fever.
Terebinthina.- Haemorrhage from the bowels, and retention of urine.
Acid-Muriat.- Great nervous depression; stupor; sinking down in the bed; putrid sore throat, etc. It probably ranks next to Arsenicum in the gravest symptoms of low fever. For the throat it may also be used locally. Ac-Nit. may also be of service in similar conditions.
Acid-Phosphorus- Milder forms of Typhoid, especially for the nervous prostration; also after the severity of a bad attack has been moderated by other remedies.
SEQUELAE.- During convalescence various affections are liable to arise, such as troublesome Cough, Indigestion, Headache, Deafness, etc. For these it is only necessary to suggest such remedies as are elsewhere prescribed. For brain symptoms, Belladonna, Hyoscyamus, Zincum met., Opi., Rhus. for chest symptoms, Phosphorus, Bryonia, Iodium for Indigestion, Nux vomica, Carbo-V., Ignatia, Mercurius Deafness usually disappears with the general nervous prostration, under the use of Ac-Phosphorus, China, or Chin-Sulph. China also moderates the excessive hunger often experienced during convalescence, and is especially useful if there has been much waste of the fluids of the body. Lastly, Sulphur aids the recuperative efforts of nature, and may be administered for some time after the more specific remedies are discontinued.
ACCESSORY MEASURES.- The following points require special attention in nursing fever-patients; the render is, however, requested to study the more detailed hints on nursing the sick (Secale 33), and the various accessory measures that are described in Part II. Persons having the charge of extreme cases of illness should be familiar with the several accessories there indicated, as their efficient carrying out is second only to the administration of medicine.
1. The Apartment.- The patient should, if possible, be placed in a large, well-ventilated apartment provided with a window, door, and fireplace, so contrived as to allow of an uninterrupted admission of fresh air and the escape of foul air. A blazing fire also assists ventilation. The room should be divested of carpets, bed-hangings, and all unnecessary furniture. A second bed or convenient couch should be provided, so that, by removing the patient to it for a few hours every day, the fever atmosphere around his body may be changed. The light from the window may be subdued, and noise and unnecessary talking forbidden.
2. Rest.- The patient should be but little disturbed, and enjoy complete physical and mental rest during the whole course of the disease. The importance of this is proved by post-mortem examinations, which often show vigorous attempts on the part of neighbouring structures to limit, by union and adhesion, the results of perforation, obviously indicating the necessity of absolute rest throughout the disease. Any efforts made when the ulcers in the ileum are healing might affect that progress unfavourably, and even re-excite that morbid action which ends in perforation.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."