The temperature amount gradually (“staircase” temperature), rising 2o every night and falling 1o every morning for the first week.
Just as during the increase of the disease the temperature gradually rises, so in recovery the decline in the temperature is gradual, not sudden as it is in Typhus.
A persistent temperature of 104o, after the end of the second week, is unfavourable, as is also persistent acceleration of the pulse.
Left to themselves, mild cases are over in twenty-one days, but severe ones may last four or five weeks, or even much longer.
DIAGNOSIS.- Enteric fever is sometimes mistaken for other diseases, especially for Pulmonary Phthisis. In Phthisis, cough and dyspnoea appear earlier and are more severe than in Enteric fever. There are also present the stethoscopic signs of tubercle in the former disease. The typhoid rash and enlargement of the spleen are absent from the consumptive patient. Enteric fever may be mistaken for Typhus, but Typhus is practically extinct in this country. The laboratory test, known as the Widal test, available after the first week of the disease, if positive is diagnostic of Enteric; as is also the discovery of the Bac. typhosus in the stools.
DANGERS.- Perforation of the bowel and fatal haemorrhage are possibilities, but they are not common in children. Danger may also arise from lung complications – Pneumonia, Bronchitis, or Pleurisy; or the fever may subsequently call into activity latent germs of tubercle.
TREATMENT.- Administered in the early stage, before diarrhoea has set in, Baptisia unquestionably modifies the symptoms, and even cuts short an attack. In the absence of complications we prolong its use until convalescence is established. When there is produce diarrhoea Arsenicum will probably be required.
INDICATIONS FOR THE ABOVE AND OTHER REMEDIES.
Arsenicum.- In a late stage of the disease when there is a good deal of purging of thin feculent matter of a light-ochre colour, with or without blood.
Baptisia.- Pain in the forehead, flushed face, sleeplessness, slight nocturnal delirium, thirst, thinly white-coated tongue, frequent soft pulse, and heat of skin.
Bryonia.- Stands next to Baptisia in its relation to the disease. It is indicated by the following symptoms : Headache, flushed face, bitter taste in the mouth, heat of skin, and pains in the limbs.
Muriatic Acid.- In putrid sore throat, great depression.
ADDITIONAL REMEDIES.- Belladonna (when the brain is involved) : Carbo V. (offensive and putrid exhalations and excretions); China (debility during convalescence); Ferrum (as for China); Hyoscyamus (restlessness); Mercurius (copious perspirations); Phosph. (pneumonia); Phosph.Ac (debility with much perspiration); Sulph. in convalescence).
SECONDARY DISEASES.- If any troublesome affections arise during convalescence, reference must be suggest Iodium, Bryonia, or Phosphorus, for disorders of the chest; Carbo V., Ignatia Mercurius, or Nux V., for indigestion; Belladonna, Hyoscyamus, Opi., Zincum met., or Rhus, for disorders of the brain. Deafness usually disappears with the return of strength, which may be promoted by China Phosphorus- Ac., or Sulph. China also moderates hunger, and facilitates the repair necessitated by waste of the fluids of the body. Sulph. aids recuperative efforts.
ACCESSORIES.- As in Smallpox and Scarlet fever, the ventilation of the apartment should be as thorough as open doors and windows and a good fire can make it, while the patient should be protected from draught and kept comfortably warm by additional blankets. Light and sound should be subdued. All unnecessary furniture, and every vessel that is not clean, should be removed. Vessels to receive the excretions should be ready prepared with some disinfectant freely employed, and afterwards, removed immediately. A second bed or cough, to which the patient could be removed, affords relief and change of air immediately around his body.
But the recumbent posture must be maintained, even during early convalescence. Any violent or sudden movement might occasion a relapse. The linen, including blankets, should be frequently changed. The mouth may be often wiped out with a soft towel, wetted in the water which contains a little Condy’s fluid, to remove the sordes which gather there in low forms of fever. Frequent sponging with tepid or cold water or vinegar and water, drying quickly with a soft towel, is very refreshing and healthful. The body may be sponged piecemeal to avoid fatigue. Spots subject to pressure like the lower part of the back should be carefully washed with methylated spirit, then carefully dried and dusted with a mixture of starch powder and zinc oxide, to prevent the formation of bed-sores. An air-ring or an air-bed may also be used for the same purpose. Where a bed-sore has formed, it should be kept scrupulously clean and calendula ointment used as a dressing.
DIET.- At the commencement of the fever, pure water, toast-and- water, gum-water, sweetened (1oz. gum arabic, 1/2 loaf sugar, to one pint of hot water), soda-water, or lemonade is nearly all that will be required. Cold water lowers the temperature of the body, and aids the medical treatment. On account of the dry and shriveled stage of the tongue, the patient is often unable to relish or swallow any food. To lubricate the mucous membranes and stimulate the salivary glands, a little lemon-juice and water may be given a few minutes before the food.
Every-thing taken into the stomach should be fluid or semi-fluid, until convalescence is established. Milk, arrowroot made with milk, blancmange of isinglass, cornflour, or ground rice, yolk of egg beaten up with milk, white of egg in water (“albumen water”), cold beef-tea, and slightly thickened broths, are nutritious. Nourishment should be given with strict regularity, and frequently. If milk is being given, the stools should be inspected for curds; if curds are found, diminish the amount of milk. If there is diarrhoea, animal broths and beef-tea are liable to aggravate it. During convalescence, food should only be allowed in great moderation, and never to the capacity of the appetite till the tongue is clean and moist, and the pulse and skin normal. Solids given to early have caused relapse. Change of air, when the child is able to walk, will prove serviceable in establishing his health.
24. Diphtheria.
DEFINITION.- A contagious febrile disease in which there is exudation of lymph on the lining of the throat, especially the tonsils, soft palate, and upper part of the air-passages, attended with much general prostration, from blood-poisoning; the throat symptoms being secondary to the blood contamination. It is most important to distinctly recognize the fact that Diphtheria is a constitutional disease; that the constitutional disturbances are the primary symptoms, and not secondary to the physical changes about the throat; and that, therefore, efforts should be made to deal with the whole systemic mischief, rather than to concentrate the attention on the tangible local efforts.
CAUSES.- The real or microbic cause of Diphtheria is the Klebs- Loeffler bacillus. The infection is carried from person to person, mainly amongst the young, but fairly often also amongst adults. The virus, which is carried mainly from the membranous exudates and discharges, whether of throat or nose, adheres persistently to walls and furniture, and is apt to attack several members of the same family. Autumn is the diphtheria season. This is one of the diseases communicated by healthy “carriers” who are either convalescent from the disease or have never had it. Enlarged tonsils and a general unhealthy condition of the mucous membrane of the mouth and throat are probably predisposing causes.
SYMPTOMS.- The early symptoms are those of fever, the temperature not usually rising above 101o or 102o, with redness and soreness of the throat. Then a patchy greyish-white exudation (the “membrane”) appears on the tonsils and gradually spreads over the soft palate and uvula, and it may be, on to the pharynx. The glands in the neck are swollen and there is greater or less dysphagia (pain on swallowing).
In severe cases the local lesions progress, the membrane extends downwards into the larynx and upwards into the nose, there is severe sloughing and great fetor, the glands become greatly enlarged, the temperature sinks, the pulse becomes weak and rapid, there may be uncontrollable vomiting and partial or complete suppression of urine, the patient is of an ashy pallor and collapse threatens. This condition, which is one of profound systemic toxaemia, comes on about the eleventh day. Where the larynx is involved, there may be violent attacks of dyspnoea, ending finally in suffocation or coma.
DIAGNOSIS.- For diagnosis from Croup, see Section 48. The main diagnostic difficulty connected with Diphtheria is to distinguish it from other forms of sore throat. The chief practical difficulty is to distinguish a diphtheritic exudation from that seen in Follicular Tonsillitis (where there are multiple yellowish-white spots at the orifices of the tonsillar crypts). The chief diagnostic points are as follows :- the higher temperatures are seen in Follicular Tonsillitis, the lower in Diphtheria; there is greater prostration and depression in Diphtheria; albuminuria and loss of knee-jerks point to Diphtheria; removal of the exudation with a wool-tipped probe is difficult in Diphtheria owing to the adherence of the membrane, and is apt to be attended with bleeding. If there is any doubt as to the nature of an exudation on the tonsils or fauces, a swab should be taken and sent to a laboratory.
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."