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Impaired Health Its Cause And Cure by J. H Tilden, M.D.

Diseased Brought on From Toxin Poisoning

   Definition.--According to modern medical science, the cause of typhoid fever is a germ known by the name of bacillus typhosus. The disease is characterized anatomically by hyperplasia and ulceration of the intestinal lymph follicles, swelling of the mesenteric glands and spleen, and parenchymatous changes in other organs. There are cases in which the local changes are slight or absent; in some others there is ulceration. In severe cases there is a secondary disease set up in the lungs, spleen, kidneys, or cerebro-spinal centers. The disease is marked by fever, and on about the seventh or eighth day red spots appear on the abdomen. Sometimes there is diarrhea, and then again constipation; always abdominal tenderness where the disease is fully developed. Tympanitis is very distressing, and in some cases there is overstimulation of the heart from pressure. Osler declares that these symptoms are extremely inconstant, and even the fever varies in its character.

   The above is as good a definition as can be given of the opinions of the leading authorities. For the benefit of my readers, I shall give my opinion of this disease, and as the treatment proves my opinion right, that should be proof enough.

   Etiology.--Typhoid fever is the result of imprudent eating, bringing on decomposition in the stomach and bowels. Any case of typhoid fever treated properly will not last beyond eight to fourteen days. After the third day there will be no special pain or discomfort, and the patient will rest all night, so that, when asked how he is at the morning call, he will say he is "feeling fine" and rested well. In cases where complications appear, they are produced by improper treatment, and no doubt, on account of the decomposition in the bowels taking place in cases that are treated improperly, there will be developed germs galore; but they are an after-consideration and have nothing at all to do with the beginning of the disease.

   Typhoid fever prevails in temperate climates and constitutes the most common form of continued fever. Indeed, all continued fevers, if badly treated and nursed, will develop typhoid complications to such an extent that they cannot be distinguished from the regular type.

   The disease is pretty generally distributed throughout the World, and of course presents the same characteristics. Why not? The treatment is very much the same in every country, the initiative symptoms are very much the same, and the cause must be the same. In an experience running over many years I can say that I have not seen a case of septic development except in cases that have been badly managed, and there are certainly no germs of typhoid fever until after sepsis has developed.

   According to Osler, the United States has a disgraceful amount of typhoid fever. From 1900 to 1904 the death-rate from this cause was 33.8 per one hundred thousand. It is estimated that from thirty-five to forty thousand persons die of it every year. It is more prevalent in country districts than in the cities. Why? Because cities are better drained; sanitary conditions generally are very much better in cities and towns than in the country.

   In the Spanish-American War one-fifth of the soldiers in the National Encampment had typhoid fever. The disgrace was on the army physicians, who did not do their duty in looking after the sanitary conditions of the army. Today the armies are being taken care of in an enlightened manner, so far as sanitation is concerned. The credit for doing away with so-called typhoid fever is given to typhoid inoculation; but it would be very easy to knock the inoculation belief into discredit, if the sanitary condition of the armies would be allowed to retrograde to the state that existed during the Spanish-American War.

   Sex.--Males and females are equally liable to have the disease.

   Age.--Typhoid fever is a disease of youth and early adult life. Why? This is the age when indulgences are greatest. This is the age when overeating is more common than at any other age, and, as the disease starts from gastro-intestinal derangement, it is perfectly natural that young people should have it.

   Immunity.--Not all who are exposed take the disease. In other words, not all who are imprudent in bringing on gastro-intestinal derangement will take down with the fever. Quite a good many who are imprudent will have a short sick spell, lasting for a few days, with vomiting, sometimes diarrhea, which clears out the stomach and bowels; and the disease goes no farther. Of course, such cases as this will be recognized as gastric fever. But a badly treated case of what is known as gastric fever to start with is often developed into a typical typhoid fever, Those interested in the germ theory are referred to the encyclopedia or some leading text-book on theory and practice. As regards the distribution of germs, those outside of the body, those found in milk, the mode of conveyance, infection in water, typhoid-carriers, infection in food, oysters, flies, etc., the history of these things may be gotten from any first-class text-book; but it does not appeal to me to incumber this work with a lot of history with which I am not in sympathy. I do not teach it, because I do not believe in it. I believe in cleanliness, but not in the germ delusion.

   Morbid Anatomy.--In so-called typical cases there is a catarrhal condition existing throughout the small and large bowels. Specific changes, such as ulceration, are found chiefly in the region of the ilium. This is why this disease is often confounded with appendicitis. Peyer's glands in the jejunum have always been credited with taking on ulceration in typhoid fever, and it is considered diagnostic. These glands, however, will never be involved in any case that is not fed and medicated.

   Necrosis and Sloughing.--When the hyperplasia has taken on ulceration, necrosis or death of the tissues often takes place from a shutting-off of the circulation. This favors sloughing, and even fatal hemorrhage takes place. But, as stated before, no case will ever develop these symptoms unless it is fed and medicated.

   Symptoms.--There is a period, described by the leading authorities on the subject as lasting from eight to fourteen days, known as the stage of incubation. This means that the disease which is to follow the first two weeks is being hatched. In the first fourteen days, if the case has been properly treated, the patient will probably take his first walk in the open air and sunshine at the end of this so-called incubation stage. This opinion, being based on years of private practice, would naturally put me completely out of sympathy, and wholly unfit me for devoting twenty to thirty pages to describing conditions that never can occur except when the disease has been subjected to malpractice.

   There surely could be nothing so unreasonable or absurd as for me to give the amount of space occupied by such a work as Osler's in giving the details of a type of disease that cannot have an existence unless a physician is educated into a plan of treatment that brings out these symptoms.

   All the symptoms anyone will ever see, in treating a case of typhoid fever according to my plan, will be a feeling of discomfort, perhaps dizziness, slight headache, and a feeling of heaviness and dullness, with the patient rather inclined to be stupid. The first day or two, when these symptoms present, there will be no temperature. If there is, it will seldom be above 99-1/2 to 100 F. The tongue will look a little red around the edges. If the case is to be of a nervous type, the tongue will be long and pointed. Most cases will have the usual appetite, and feel rather impatient when told that they should not eat anything. If the food is withdrawn at once, the slight discomfort may continue for seven days--usually only three days. If the patient is sick enough to go to bed, there will usually be backache, aching in the loins, and the legs probably will ache. Some cases of a nervous type will have considerable headache, and the first night or two will be spent in tossing about. The sleep will be very fitful. At the end of the first week the temperature may come up to 101 F.; and from that time on there will be decline. In all cases there will be a sluggish state of the bowels. Just a few will start with a little vomiting and diarrhea. If the case is treated properly, the symptoms enumerated will be all that will ever develop. About the seventh or eighth day there will be rose-colored spots on the abdomen, characteristic of the disease.

   There may be some readers who would like to know what the symptoms will be the first week, if the case is not treated according to my plan. The thermometer will show an increase in temperature; the pulse will run higher; the patient will become more nervous; the tongue will become more coated; the breath will develop a foulness that it has not had before, and the patient will complain of more aching in the back, limbs, and head, with perhaps nose-bleed. It is just possible that the case may have enough gastro-intestinal derangement to start off with symptoms as severe as those just named. The treatment, however, should be identically the same, and if a patient has an increase in symptoms at the seventh day, it will be almost positive proof that the instructions have not been followed, and that the patient has been fed without the physician's knowledge. If this could be proved not to be true, it would be necessary to look for complications. The urine should be examined to see if there is an inflammation of the kidneys developing. The bowels should be thoroughly examined. There may not have been a thorough cleaning-out, in spite of the enemas; hence the enemas should be given every three hours until the temperature goes down and the symptoms decline in such a manner as to convince the nurse or physician that the cause of the complication has been removed.

   If no trouble can be found with the bowels, there should be an examination of the bladder to see if, from some cause, there be a retention of urine. All these suppositions are far-fetched, because, if the disease is to be typhoid, and the case has been started right in its incipiency, and treated correctly, it is almost, if not quite, impossible to have a complication of any kind spring up. Where there is an unusual symptom, the disease is not typhoid. Complications never occur except where there is septicemia; and septicemia cannot develop unless there is decomposition taking place in the alimentary canal; and decomposition and sepsis cannot develop in the canal unless the patient is fed.

   Treatment.--Osler says: "The profession was long in learning that typhoid is not a disease to be treated mainly with drugs. Careful nursing and a regulated diet are the essentials in the majority of cases." I presume that is in a nutshell what all the leading teachers of the world will say regarding typhoid fever. Then, after making that statement, they will go ahead and tell about how to get the room ready; what kind of a bed the patient should lie on--just the kind of mattress and springs, how the bed should be made up, and the necessity of placing rubbercloth under the sheet, etc.; and then about the necessity of selecting a first-class nurse. Why all this preparation? Because feeding and nursing, along with what little medicine it is considered proper to give, prolong this disease twice to three times the duration it will have on the drugless and foodless treatment; and, when this is true, it is necessary to make extra preparation for the comfort of the patient.

   The very best clinicians, including Dr. Osler, recommend milk, eggs, buttermilk, boiled milk, koumiss, peptonized milk, meat-juices, strained vegetable soup, barley water, iced tea, ice cream, etc.

   The food taken into the stomach at such a time decomposes, the rotting processes that take place in the bowels cause septic poisoning, and every complication that is named in the best works on the practice of medicine is produced by this septic condition. If patients are allowed no food at all, no sepsis will occur; hence there can be no complications; in fact, the prospective typhoid fever is jugulated and in reality never develops. All diseases threatening to take on a typhoid condition, even typhoid fever itself, will thus be expunged from the nomenclature; for they will never have an existence, if treated properly.

   This no doubt sounds exceedingly radical even to liberal-minded physicians.

   A person who is just developing the fever, and who has no well-defined symptoms (indeed, the patient can hardly describe his feelings--he simply knows that he is not feeling well), should be told that he is threatened with typhoid fever, but that, if he will follow instructions, it need not develop. He should go to bed, and stop eating. There is no objection to drinking all the water desired. Every night he should have an enema of two quarts of water and a tablespoonful of salt. If in two or three days there is a feeling of discomfort in the abdomen, a towel wet in cold water should be placed on the abdomen, and a dry towel pinned around the body in such a manner as to keep the wet towel in place. The wetting may be renewed about three times in twenty-four hours. The feet should be looked after; if there is a tendency for them to be cold, or cool, something warm should be put in the foot of the bed--a hot jug or a hot-water bottle. The feet must not be neglected. If they are, it will cause the patient to be sick much longer than necessary.

   Company should not be permitted. If the patient is not suffering, has no discomfort of any kind, there is no objection to the nurse reading to him for a half-hour in the forenoon and a half-hour in the afternoon; but he must not be worried or tired out by company, nor must he tire himself out attempting to read papers or books. Often these patients are so comfortable that they will insist on being allowed to entertain themselves by reading; but this uses up nerve-energy, and the reflex irritation from reading will make them unnecessarily nervous, and tends to prolong the disease.

   At bedtime, after using the enema, the patient is to be sponged with tepid water. The sponging should be carried over the entire body quickly, and then followed with dry-towel rubbing, not too harsh; and, last of all, the spine should be gently rubbed for fifteen to twenty minutes. This rubbing, when done properly, will prove to be quieting. It will cause the patient to drop off to sleep, and he will probably rest comfortably until morning. The following is a description of the rubbing: Lay the hand flat on the patient's spine, and then begin a rotary movement, describing a circle. Each time the hand passes over the spine, the heel, or the part at the root of the thumb, may be pressed gently on the spinal column, and each circle made with the hand should be about two inches lower than the previous; in this way the hand travels slowly down to the end of the spine. Then it should be slipped back again, begin at the neck, and the movement repeated. Continue to repeat in this manner for ten to twenty minutes. If the patient appears comfortable and inclined to rest, continue the rubbing for the maximum time--twenty minutes. If at any time through the night the patient should get nervous, this rubbing may be given for five minutes, or even ten, if it appears to bring the quiet for which it is given. I do not encourage night nursing. I have found that this rubbing quiets the nervous system, and certainly takes the place of remedies that are generally used for securing rest. Where the patient is extremely nervous, the rubbing can be over the entire body first, then on the abdomen, and lastly on the spine.

   As a rule, most of the discomfort will pass away at the end of the third or fourth day. From that time on there will be no special discomfort, except being tired of the bed--and the rubbing will relieve this. After the nervousness has passed off, and the discomfort is well under control, if the patient has a little craving for acid, a quarter of a lemon may be squeezed into a glass of hot water and taken about every three hours.

   If the abdomen is closely watched, the rose-colored spots will be seen to appear in the neighborhood of the seventh or eighth day, even in those cases where the temperature never runs higher than 101 F., in the evening and 99-1/2 to 100 in the morning. The pulse in such cases will range from 80 to 100. After the fifth day the pulse may not go higher than 80. When the temperature and pulse come down to the normal--be that the seventh, eighth, or fourteenth day--the patient may be permitted a little fruit--at first just the fruit-juice, which should be fruit juice and water, half and half. There is no objection to a little fresh sweet cider, or the juice of orange, grapefruit, or any fruit desired that can be taken without sugar. Sugar will cause fermentation, and should not be permitted. After two days of fruit-juice, fresh fruit may be eaten. It must be thoroughly masticated.

   If all goes well the next day, fruit may be taken for breakfast; salad at noon. If the afternoon is spent in comfort, a little meat may be taken for the evening meal--a lamb-chop with a dish of salad. If the patient is improving right along, by this time he will be going out, perhaps walking. In fact, patients lose so little strength, when treated in this way, that they recuperate rapidly. Within a week or ten days they are as strong as ever. Why not? There has been no septic poisoning that causes a long convalescence.

   When called in consultation, or called to take charge of a case that has been subjected to malpractice, at the end of three or six weeks, the physician must at once stop all that is being done in the line of feeding, medicating, and a great deal of the officious nursing.

   Nurses should be instructed about putting the lights out at nine o'clock, and they themselves must retire and stay away from the patient until six in the morning. Water can be left by the bedside for the patient to relieve thirst during the night.

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