Cooley's Cyclopaedia of Practical Receipts Volume Ii Part 278

The outbreak of typhoid fever in Marylebone, in 1874, which attacked some 500 persons, was traced to the milk vended by a certain company; this milk having been placed in cans that had merely been washed out and cooled with water obtained from a well into which it was discovered the excreta from a typhoid patient had percolated from an adjoining privy. After the statement of these facts, the thorough and efficient disinfection of all the excretions, immediately they leave the body of the patient, as well as of his body and bed linen, mattresses, &c., and also of the sick apartment, will be obvious.

The best method of effecting this will be to follow the instructions given by Dr William Budd, for the prevention of the propagation of this disease, which are as follows:

"The means by which typhoid fever may be prevented from spreading are very simple, very sure, and their cost, next to nothing.

"They are founded on the discovery that the poison by which this fever spreads is almost entirely contained in the discharges from the bowels.

"These discharges infect (1) the air of the sick room; (2) the bed and body linen of the patient; (3) privy and the cesspool, or the drains proceeding from them.

"In these various ways, including the contamination of drinking water, already described, the infection proceeding from the bowel discharges often spreads the fever far and wide. The one great thing to aim at, therefore, is to disinfect these discharges on their very escape from the body, and before they are carried from the sickroom. This may be perfectly done by the use of disinfectants. One of the best is made of green copperas.

"This substance, which is used by all shoemakers, is very cheap, and may be had everywhere. A pound and a half of green copperas to a gallon of water is the proper strength. A teacupful of this liquid put into the night-pan every time before it is used by the patient renders the bowel discharge perfectly harmless. One part of Calvert's liquid carbolic acid in fifty parts of water is equally efficacious.

"To disinfect the bed and body linen, and bedding generally, chloride of lime, or Macdougal's, or Calvert's powder is more convenient.

"These powders should be sprinkled by means of a common dredger on soiled spots on the linen, and about the room to purify the air.

"All articles of bed and body linen should be plunged, immediately on their removal from the bed, into a bucket of water containing a tablespoonful of chloride of lime, or Macdougal's or Calvert's powder, and should be boiled before being washed; a yard of thin white gutta percha, placed beneath the blanket, under the breech of the patient, by effectually preventing the discharges from soaking into the bed is a great additional safeguard. The privy or closet, and all drains communicating with it, should be flushed twice daily with the green copperas liquid, or with carbolic acid diluted with water.[243]

[Footnote 243: See SPOROKTON.]

"In towns and villages where the fever is already prevalent, the last rule should be put in force for all the houses, whether there be fever in them or not, and for all public drains.

"In the event of death, the body should be placed as soon as possible in a coffin sprinkled with disinfectants. Early burial is on all accounts desirable.

"As the hands of those attending on the sick often become unavoidably soiled by the discharges from the bowels, they should be frequently washed.

"The sick room should be kept well ventilated day and night.

"The greatest possible care should be taken with regard to the drinking water. When there is the slightest risk of its having become tainted with fever poison, water should be got from a pure source, or should at least be boiled before being drunk.

"Immediately after the illness is over, whether ending in death or recovery, the dresses worn by the nurses should be washed or destroyed, and the bed and room occupied by the sick should be thoroughly disinfected. These are golden rules.

"Where they are neglected the fever may become a deadly scourge; where they are strictly carried out it seldom spreads beyond the person first attacked."

No part of the globe appears to be exempt from the visitations of typhoid fever, since it occurs not only in all the older countries of Europe and Asia and Africa, but in those also included in the North and South American Continents, as well as in Australia, Tasmania, and New Zealand.

It would appear also to have prevailed in the earliest ages, since it is evidently alluded to in the works of Hippocrates, Galen, and others. Later writers, including Sydenham and Hoffman, also constantly refer to it under a different name.

Pathologists differ as to the time that this disease lies dormant in the system before developing itself. Some pract.i.tioners contend that the usual period is from ten to fourteen days, whilst others think it is much less than this, and, in some instances, that it may not exceed one or two days.

The late Dr Murchison entertained the latter opinion. The symptoms, when they show themselves, are as follows:--An irritable condition of the stomach, accompanied by sickness or vomiting; pain, with more or less tenderness, about the abdomen; sometimes the patient suffers from great constipation, at others from diarrha; he also experiences great prostration of strength, has a feeble pulse, and a brown furred tongue; he is extremely restless, and at night frequently delirious; the lower limbs are frequently cold; he pa.s.ses but little urine, and that of an offensive smell; the stools are dark, offensive, and very frequently b.l.o.o.d.y, this latter being a very characteristic accompaniment of typhoid fever.

Bleeding from the nose sometimes occurs. The perspiration has a sour and fetid odour. After seven or eight days, small rose-coloured spots or _petechiae_ make their appearance on the skin.

_Treatment._--The abdomen should be leeched, and mustard poultices applied. If not too prostrated, the patient should be given a hot bath; but if he be not sufficiently strong to venture upon this, ablution of the whole of the body with hot water and soap should be had recourse to, the operation being performed by means either of a sponge or a flannel.

An effervescing draught, consisting of twenty grains of carbonate of ammonia, dissolved in water, to which a tablespoonful of lemon-juice should be added, ought to be administered, and drunk whilst effervescing, every three or four hours. The diet should consist of beef tea, nutritious broth, milk, and eggs.

The necessity of thorough ventilation of the patient's apartment, together with the methods of disinfection of the bodily discharges, the linen, &c., have been already emphasised in the directions given by Dr Budd for the prevention of the propagation of this fever.

It is, perhaps, needless to state that the outline of treatment given above is intended only for adoption by the emigrant, or of any one so unfortunately situated with regard to locality as to be unable to secure the services of a medical pract.i.tioner. Where these are obtainable the patient or his friends should use all speed in procuring them.

_Horses._--Horses are occasionally attacked with typhoid fever, the symptoms of which bear a general resemblance to those which characterise the disease in the human subject. The appearances presented after death are also very similar, particularly in the lesions observable in the mucous membrane of the intestines. As in man, the disease is greatly aggravated by insanitary surroundings and depressing external agencies, and by the animals partaking of water containing decaying organic matters.

Upon the commencement of the attack give a few doses of calomel or laudanum, or of tincture of aconite, and if the bowels are costive two or three drachms of aloes, afterwards keeping up the laxative effect by mild clysters and mashes. Afterwards administer, three or four times a day, a drachm each of chlorate of potash and chloride of ammonium, adding to these an ounce of oil of turpentine or ether, or sweet spirit of nitre, if the animal exhibit dulness or weakness. If there is tenderness or pain about the abdomen, apply hot fomentations constantly, and should there be much flatulence give occasional drenches of ammonia, carbonate of ammonia, or whiskey and water.

The food of the animal must be nutritive and generous. He should be kept in a loose box, his legs should be bandaged in flannel, and warm rugs should envelop his body. Rest and quiet are essential. During convalescence let him have small doses of gentian, chloride of iron, with ale.[244]

[Footnote 244: Finlay Dun.]

=TYPHUS FEVER.= This fever is known under various names, such as SPOTTED TYPHUS, JAIL FEVER, s.h.i.+P FEVER, CAMP FEVER, MILITARY FEVER, IRISH AGUE, FAMINE FEVER, BRAIN FEVER, PESTILENTIAL FEVER, MALIGNANT FEVER, OCHLOTIC FEVER, TYPHO-RUBEOLOID.

"1. Typhus prevails for the most part in great and wide-spread epidemics.

"2. The epidemics appear during seasons of general scarcity and wants, or amidst hards.h.i.+ps and privations arising from local causes, such as warfare, commercial failures, and strikes among the labouring population.

The statement that they always last for three years and then subside is erroneous.

"3. During the intervals of epidemics, sporadic cases of typhus occur, particularly in Ireland, and in the large manufacturing towns of Scotland and England.

"4. Although some of the great epidemics of this country have commenced in Ireland, and spread thence to Britain, appearing first in those towns on the west coast of Britain where there was the freest intercourse with Ireland, it is wrong to imagine that all epidemics have commenced in Ireland, or that typhus is a disease essentially Irish. The disease appears wherever circ.u.mstances favorable to its development are present.

"5. In many epidemics typhus has been a.s.sociated with relapsing fever, and the relative proportion of the two fevers has varied greatly.

"6. From the earliest times, typhus has been regarded as a disease of debility, forbidding depletion, and demanding support and stimulation.

"7. The chief exception to the last statement originated in the erroneous doctrines taught in the early part of this century, according to which the disease was looked upon as symptomatic of inflammation or congestion of internal organs.

"8. The success believed at one time to follow the practice of venesection was only apparent. It was due to the practice, for the most part, having been resorted to in cases of relapsing fever and acute inflammations, and to the result having been compared with those of the treatment by stimulation of the much more mortal typhus.

"9. Although typhus fever varies in its severity and duration at different times, and under different circ.u.mstances, there is no evidence of any change in its type or essential characters. The typhus of modern times is the same as that described by Fracastorius and Cordames. The period during which epidemic fever was said to present an inflammatory type was that in which relapsing fever was most prevalent, and the times in which the type has been described as adynamic have been those in which relapsing fever has been scarce or absent." (Murchison.)

In the article 'Typhoid fever' it has been stated that its propagation was mainly due, and had been very clearly traced, to the drinking of water contaminated by the alvine discharges of typhoid patients; in the dissemination of typhus, on the contrary, the air in the neighbourhood of the infected person appears to be the great medium for the conveyance of the disease, the poison, it is conceived, being disseminated into the surrounding atmosphere from the surface of the body or the lungs of the patient, or from the cloths, body linen, &c., worn and discarded by him.

Hence it is we find, as we should expect, in the past no less than in the present, that the spread and degree of virulence of the malady have always been a.s.sociated with overcrowding and bad ventilation. Although amongst the causes that predispose and induce susceptibility to its attacks, as shown above, are poverty and consequent deficiency of food and clothing, and squalor, it has been demonstrated that, with all these unfavorable conditions, patients may often recover from typhus provided they are supplied with a sufficiency of fresh air.

The fact that of late years typhus has rarely visited the inmates of our prisons, barracks, or shops, and that their comparative immunity from it has been coincident with improved ventilation and the avoidance of overcrowding, can lead to no other deduction than that previous to this reform these sanitary conditions were altogether neglected. We may narrate some of these outbreaks of typhus that have taken place previous to the application of hygienic principles to the treatment of the disease. During an a.s.size held at Cambridge in 1522, the disease which had broken out amongst the prisoners, spread to the justices, the bailiffs, and other officers, as well as to many people frequenting the court-house, with the result that many of those so seized died.

Another outbreak of a very malignant character occurred at Exeter in 1586.

Some Portuguese were captured at sea, and (the words of the old historian who records the fact clearly indicate the cause of the virulent nature of the malady) were "cast into the deep pit and _stinking dungeon_." When brought into court they imparted the contagion to those around them. The judge and eleven out of the twelve jurymen who were thus attacked died, whilst the disease spread through and devastated the whole country.

A fourth case is recorded by Howard "at the Lent a.s.sizes in Taunton in 1730. Some prisoners who were brought there from Ivilchester Jail infected the court, and Lord Chief Baron Pengelly, Sir James Shepherd, serjeant, John Pigot, Esq., sheriff, and some hundreds besides, died of the jail distemper."

Another eruption, which broke out during an a.s.size held at the Old Bailey in 1750, resulted in the contraction of the disease by the Judge, the Lord Mayor, and the Alderman, and caused the death of forty persons who were present in the close and narrow court-house during the judicial proceedings. One circ.u.mstance recorded in connection with this last attack needs no comment. It is to the effect that "a hundred prisoners were put into two rooms measuring fourteen feet by eleven feet, and seven feet high." The instances above quoted explain why it was this disease acquired the name of _jail fever_.

During the present century six different epidemics of typhus have broken out amongst the convicts on board the Toulon Galleys. They occurred in 1820, 1829, 1833, 1845, 1855, and 1856. Although the above statement of facts indisputably points to the intimate connection existing between the prevalence and violent character of typhus and overcrowding, and consequent contamination and vitiation of the air breathed by the patient, it is still a moot point with pathologists whether the disease can be generated _de novo_ by these conditions, or whether they merely a.s.sist to disseminate and intensify it. Dr Parkes, writing on this subject, says:--"With reference to the particular kind of fever in Metz, it may be noticed that an important argument against the production of exanthematic typhus from simple overcrowding has been drawn from the experience both of Metz and Paris. In both places during the sieges there was overcrowding, wretchedness, and famine, particularly at Metz; yet, as pointed out by Professor Chauffard to the Academie de Medicine, there was scarcely any or no typhus, as there had been in the wars of the first Napoleon. There was typhus in the German besieging force, but so strict was the blockade that it was not imported into Metz, and was not generated there."[245]

[Footnote 245: Blyth.]

The mortality which has been caused in large armies by the ravages of typhus has been enormous. During the 'thirty years' warfare that desolated Germany from 1619 to 1648, innumerable soldiers fell victims to it, the Bavarian army alone having lost 20,000 men from this cause. Typhus also committed appalling havoc among the legions of the first Napoleon, the Bavarian contingent of the French army in the Campaign in 1812, lost nearly 26,000 men from this cause; whilst in Mayence 25,000 of Napoleon's soldiers in garrison perished from the same cause in six months. More lately, viz. during the Crimean campaign (in 1856), typhus slew more than 17,000 French soldiers.