Cases of typhoid fever take the following course.
The patient feels depressed and moody—a condition which grows rapidly worse until it amounts to acute despondency. At the same time he is overpowered by physical weariness, not only of the muscles and sinews, but also of the organic functions, in particular of the digestion—so that the stomach refuses food. There is a great desire for sleep, but even in conditions of extreme fatigue the sleep is restless and superficial and not refreshing. There is pain in the head, the brain feels dull and confused, and there are spells of giddiness. An indefinite ache is felt in all the bones. There is blood from the nose now and then, without apparent cause.—This is the onset.
Then comes a violent chill which seizes the whole body and makes the teeth chatter; the fever sets in, and is immediately at its height. Little red spots appear on the breast and abdomen, about the size of a lentil. They go away when pressed by the finger, but return at once. The pulse is unsteady; there are about a hundred pulsations to the minute. The temperature goes up to 104°. Thus passes the first week.
In the second week the patient is free from pain in the head and limbs; but the giddiness is distinctly worse, and there is so much humming in the ears that he is practically deaf. The facial expression becomes dull, the mouth stands open, the eyes are without life. The consciousness is blurred, desire for sleep takes entire possession of the patient, and he often sinks, not into actual sleep, but into a leaden lethargy. At other intervals there are the loud and excited ravings of delirium. The patient’s helplessness is complete, and his uncleanliness becomes repulsive. His gums, teeth, and tongue are covered with a blackish deposit which makes his breath foul. He lies motionless on his back, with distended abdomen. He has sunk down in the bed, with his knees wide apart. Pulse and breathing are rapid, jerky, superficial and laboured; the pulse is fluttering, and gallops one hundred and twenty to the minute. The eyelids are half closed, the cheeks are no longer glowing, but have assumed a bluish colour. The red spots on breast and abdomen are more numerous. The temperature reaches 105.8°.
In the third week the weakness is at its height. The patient raves no longer: who can say whether his spirit is sunk in empty night or whether it lingers, remote from the flesh, in far, deep, quiet dreams, of which he gives no sound and no sign? He lies in total insensibility. This is the crisis of the disease.
In individual cases the diagnosis is sometimes rendered more difficult; as, for example, when the early symptoms—depression, weariness, lack of appetite, headache and unquiet sleep—are nearly all present while the patient is still going about in his usual health; when they are scarcely noticeable as anything out of the common, even if they are suddenly and definitely increased. But a clever doctor, of real scientific acumen—like, for example, Dr. Langhals, the good-looking Dr. Langhals with the small, hairy hands—will still be in a position to call the case by its right name; and the appearance of the red spots on the chest and abdomen will be conclusive evidence that his diagnosis was correct. He will know what measures to take and what remedies to apply. He will arrange for a large, well-aired room, the temperature of which must not be higher than 70°. He will insist on absolute cleanliness, and by means of frequent shifting and changes of linen will keep the patient free from bedsores—if possible; in some cases it is not possible. He will have the mouth frequently cleansed with moist linen rags. As for treatment, preparations of iodine, potash, quinine, and antipyrin are indicated—with a diet as light and nourishing as possible, for the patient’s stomach and bowels are profoundly attacked by the disease. He will treat the consuming fever by means of frequent baths, into which the patient will often be put every three hours, day and night, cooling them gradually from the foot end of the tub, and always, after each bath, administering something stimulating, like brandy or champagne.
But all these remedies he uses entirely at random, in the hope that they may be of some use in the case; ignorant whether any one of them will have the slightest effect. For there is one thing which he does not know at all; with respect to one fact, he labours in complete darkness. Up to the third week, up to the very crisis of the disease, he cannot possibly tell whether this illness, which he calls typhoid, is an unfortunate accident, the disagreeable consequence of an infection which might perhaps have been avoided, and which can be combated with the resources of medical science; or whether it is, quite simply, a form of dissolution, the garment, as it were, of death. And then, whether death choose to assume this form or another is all the same—against him there is no remedy.
Cases of typhoid take the following course:
When the fever is at its height, life calls to the patient: calls out to him as he wanders in his distant dream, and summons him in no uncertain voice. The harsh, imperious call reaches the spirit on that remote path that leads into the shadows, the coolness and peace. He hears the call of life, the clear, fresh, mocking summons to return to that distant scene which he had already left so far behind him, and already forgotten. And there may well up in him something like a feeling of shame for a neglected duty; a sense of renewed energy, courage, and hope; he may recognize a bond existing still between him and that stirring, colourful, callous existence which he thought he had left so far behind him. Then, however far he may have wandered on his distant path, he will turn back—and live. But if he shudders when he hears life’s voice, if the memory of that vanished scene and the sound of that lusty summons make him shake his head, make him put out his hand to ward off as he flies forward in the way of escape that has opened to him—then it is clear that the patient will die.