TYPHOID FEVER. 551 



Sometimes tin- ulcers will eat their way tli rough tho bowel, and allow 

 contents to be poured out into tin- abdominal cavity. The bowel is often so thinned 

 liy inflammation, and ulceratioii that the sliu r ht<^t force will rupture it. Straining 

 at stool, violent vomiting or coughing, or a sudden change in position, may do the 

 mischief. In some cases it has been found, at the post-mortem examination, that tin- 

 perforation of the bowel had been caused by the movements of a common round 

 worm which happened to have taken up its residence in that part of the body. The 

 patient often experiences at the moment of perforation a sudden and violent pain 

 which may be so severe as to produce faintness. A condition of collapse usually 

 rapidly ensues, and this may at once prove fatal, although in many cases life is 

 prolonged for a day or two longer. The pouring out of the contents of the i 

 usually gives rise to inflammation of the peritoneum, or lining membrane of 

 abdomen, a condition known as " peritonitis." Peritonitis not uncommonly arises 

 independently of perforation, the inflammation gradually spreading from the bowel. 



A cold on the chest is a frequent complication of typhoid fever. Sometimes 

 there is no cough, and its existence is detected only when the doctor examines the 

 patient's chest. Usually, however, there is a cough attended with the expectoration 

 of phlegm. Other and more serious mischief is sometimes detected in the lungs. 



After recovery from typhoid the patient is often subject to fainting-fits, which 

 come on whenever he assumes the upright position. Should he fall to the ground 

 this may be sufficient to restore the circulation of blood in the brain ; but should it 

 so happen that he cannot fall, as when sitting propped up in an easy chair, the attack 

 may prove fatal. 



Bed-sores form a very dangerous complication, which nothing but the strictest 

 attention will avert. The patient should be rolled over on his side, and his back 

 examined every day. 



After a severe attack of typhoid fever the hair usually falls off. This ordinarily 

 occurs from the fourth to the eighth week of convalescence, and before it is complete 

 the new hair may be seen cropping up. At first this is crisp and lustreless, but 

 gradually it assumes a natural appearance. 



The Registrar-General's reports show that 20,000 people die annually of typhoid 

 fever in this country. As the mortality is about one in five or six, it follows that 

 from 100,000 to 120,000 people must be attacked every year. Medical men enter- 

 tain no doubt that if proper precautions were taken this disease might be effectually 

 stamped out, and that it would disappear like the plague or ague. 



In any individual case it is extremely difficult to arrive at a definite conclusion 

 repecting its ultimate termination. Children bear the disease very much better than 

 adults. 



Let us now pass on to the consideration of the means which are at our disposal 

 for the prevention of typhoid fever. Prophylactic measures, if attempted at all, 

 must, to be of any service, be carried out thoroughly. 



When a case of typhoid fever is introduced into a community, a town or village 

 for instance, previously free from the disease, there should be no difficulty in 

 preventing it from spreading. The essential point is to thoroughly disinfect the 

 stools. A porcelain bed-pan should be obtained, the bottom of which should be 



