Fever

Typhoid Fever 

          Is an acute infectious, the exciting cause of which is probably a specific pathogenic bacterium known as the typhoid bacillus. Owing to the frequency of its occurence it is one of the most dangerous of all the fevers. The water we drink is undoubtedly the chief vehicle by which the germs gain access to the system, although other articles of food contaminated with the virus may be the source of infection. Once having entered the alimentary the germs attach themselves to the intestinal walls, here they penetrate the solitary and follicles and peyer's patches, which become interested and swollen, finally under going necrotic changes and leaving large ulcers. They then pass into the blood, being thus carried to spleen and liver. 

         The faeces of typhoid fever patients containing as they do millions of the bacteria are especially dangerous, affording a ready menas the propagation of the disease. It is therefore imperative that they be disinfected, as well as all linens and clothing that have been contaminated by the patient. Poisoned water can be disinfected by boiling. 

Period of incubation 

       The period of incubator is generally about two weeks;it may, however, be form three to four weeks in exceptional cases. In large cities sporadic cases happen at any season;epidemics of typhoid fever occur most frequently from August to November. The greatest individual disposition to take the disease seems to prevail between the ages of fifteen and thirty years. Children less than one year old are very seldom attacked ; after this upto fifteen years the predisposition steadily increases, while after the age of thirty years it steadily decreases. On the whole the disease attacks by preference the stronger and healthy;it avoids those already suffering with chronic ailments, and also pregnant and puerperal women, and those who are nursing infants, although exceptions exist. Persons who have passed through the disease once before are not always exempt from another attack and "real recurrences", that is a new attack comming on soon after the first has run it course, and relapses before the completion of the disease are often seen. 

     The principal anatomical changes which typhoid fever produces, are;catarrh in the chest, even in the finest bronchial tubes;enlargement of the spleen to double and even six time it's natural size;ans ulceration if the small intestines. These last, more or less constant, anatomical changes has given rise to the appellation of ileo typhus. There are four distinct stages of the typhoid process upon the mucous membrane of the small intestines

1. The congressive stage, by which the whole membrane appears swollen, injected and covered with slime, worse so, however, on its lower portion in the neighbourhood of vaivula bauhini. 
2. The state of infiltration, by which the general redness and swelling gradually disappers and becomes concenrated to the solitary and peyer's glands in the lower part of the ilium. 
3. The state of softening, by which the swelling of the glands is absorbed or the glands burst and become covered with a dry, crumbly crust, or they burst and discharge their contents without getting covered with crust. 
4. The state of ulceration, by which the affected glands suppurate and form the typhoid ulcer. These ulcers are round when originating out of a sollitary folicle and elliptic when originating out of payers plaques;their size varies from that of a hemp seed or pea to the size of half a dollar. Their basis is submucous cellular tissue which lines the muscularis of the gut. 

Symptoms:The patient has generally several days previous to the attack

a sense of general indisposition, weakness and debility, with headache, dizziness or soreness of the limbs, and sometimesrepeated  attacks of bleeding from nose, or none at all. The attack itself begins almost always with a more or less violent chill, or repeated chilly sensations, but sometimes without a chill. It is therefore, not always possible to fix accurately the time of the disease. The chill is followed by heat, which keeps  a regular. Quitecharecteristic, typical rise and fall every day for the first three or four days, rising about 1.8 to 2.7°F from morning till evening, and falling from every evening till next morning about 1°to 1.3° F, so that on the third or fourth evening a temperature of 104°F , is reached, or a little exceeded. The formula of this ascent is nearly as follows: 

First day morning 98.6°F evening 101.8°F

Second day morn 100.3°F evening 102.5°F

Third day morn 101.6°F evening 103.6°F 

Fourth day morn 104.6°F evening 104.6°F 

                 

          

                     Dr. Mahalakshmi Raghunath