Diseased Brought on From Toxin Poisoning
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
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
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.
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.
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.
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 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
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
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
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.