Enteric or Typhoid Fever

Cause—The cause is a germ (Eberth’s Bacillus Typhosus) which gains entrance into our body through food or drink. This germ is eliminated in the patient’s sweat, sputum, urine and saliva. Any of these excreta may get into our food and drink and a healthy man partaking of such food or drink, is liable to get it. [See Appendix C. (4)]. From 10—15 days after the ingestion of those contaminated food or drink, symptoms begin to develop. This period is called the Incubation period of this disease.

Symptoms: (1) A continued type of fever, increasing daily by one degree or so, during first week remaining more or less stationary during the second and gradually coming down to normal in the third week. (2) Slightly enlarged and tender spleen. (3) Distention of abdomen with gas, especially in the afternoon and particularly in the right lower abdomen, where some tenderness is also felt. (4) . Bronchial catarrh.

Complications— (1) Nose-bleed—especially at the commencement. (2) Bloody-stools—or discharge of pure blood (malaena). (3) Diarrhoea—stools resembling “pea- soup.” (4) “Typhoid condition”—i.e., patient lies listless and apathetic, with eyes half open, dry tongue and lips apart and with sordes collected on teeth. (5) Retention of urine, Bed-sore.

Pathology—The portion of small intestines called ileum is the seat of inflammation and ulceration. Hence, this spot (corresponding roughly to the right lower abdomen) is tender on pressure and often gives a sort of gurgling sensation to the examining fingers. This spot causes poisons to be discharged into blood, burning about a sort of blood-poisoning, which is called the typhoid fever. About the 10th day, in very fair coloured people rose-red pimples or rashes appear on the upper abdomen. The tongue is coated brown in the middle and is dry.

Treatment—Preventive            Typhoidinum 30-200. For Fever: Bry., Gels., Baptisia, Arsenic, Rhus T.; For delirium: Bell., Hyos., Stram., Agaricus. For meloena Hamamelis, Ipecac, Terebinth, Ac. Nit. For nose-bleed: Aconite, Ipecac, Hamamelis. For Internal troubles Puls., Canth., Hydrastis. For diarrhoea Rhus T., Mercurius. Cup., Ars., Phos. ac. For headache: Bell., Hyosc. For Pneumonia: Phos., Lyco., Agaricus, Ign., Bell., Hyosc. For peritonitis: Arsenic, Bell., Rhus T., Terebinth. For Biliousness Merc. Hydrastis. For Flatulence Rhus T., Terebinth, Arsenic, Phos. Ac. For worms: Cina, Spigelia, Teucrium. For Coma: Bell., Opium Nux M., Ac. Phos., Helleborus, Rhus T., Apis, Stram., Hyosc., Zincum. During collapse: Arsenic, Carbo Veg., Acid Mur., Secale, Veratrum, Camph. For liver troubles Chel. M., Merc. Iod. flav. 3x, Leptandra, Melilotus.

For Complications during Convalescence: Puls., Gels., Rhus, Bell., Cocculus, Nux V., China, Sulph., Psorinum, Calc. C., Phos., Ign., Anac. Verat. A are the remedies that are most commonly used. All the above remedies are to be used in their 3—200 potencies. For debility after cure; Acid Phos. 6, Ammon C. 4, Nux V. 6.

Leading Indications of some of the Remedies

Bryonia Alb. 3, 6, 30—Bitter taste in the mouth; tongue coated and rough; intense headache; pain in the chest and all over the body, aggravated by least motion. Great thirst; mouth, tongue and skin dry; stools ‘hard and dry. Dreams of business and talks of business in delirium. If delirium is of slow onset, give Bryonia; if acute, Rhus Tox. Do not use Bryonia if diarrhoea is present. In the initial stage and in the absence of complication, all through, Bryonia is the proper remedy.

Baptisia 1x-30—Pulse is full, soft and quick; delirium; apathy; drowsiness; falls asleep in the midst of conversation; headache; pains and aches all over the body; lips and tongue dry; vacant looks; restlessness or coma; physical and mental depression; patient feels tired of lying in bed, cannot lie in same position, slides down on bed; bed-sore; tongue dry, the tip of tongue red with a yellow line in the middle; sore thoat; foul breath; nausea or vomiting. Useful in the first stage; some advise to give it all through the disease. Stool slate-coloured; similar stools may be seen in the second week. Patient feels that his limbs are scattered about in bed, tries to get them together. All secretions—breath, sweat, stool, urine etc. are offensive.

Gelsemium 1x-6—Heavy eye-lids; face flushed; eyes shut; headache. Dullness, Dizziness & Drowsiness from the beginning of typhoid; trembling of the whole body, he cannot move his limbs freely, it trembles at the attempt; he cannot speak as his tongue trembles. It is followed well by BaDt. (especially useful to children and in the first stage).

Arnica Montana 3-200—Fetid breathe; apathy. Red yellow or blackish eruption on skin; sensation of bruises all over the body as if beaten ; inability to express onself; says nothing has happened to him; delirium; coma or insensibility; unconsciousness, answers correctly but unconsciousness returns very soon, much prostration; lower jaw hangs down; often changes position, bed feels too hard, bed sore; unconscious evacuations; pain all over, as if patient were beaten; nosebleed. Tongue dry, brown at the middle. [There is much in common between the symptoms of Arnica and Baptisia].

Rhus Tox. 6-30—When an acute fever turns into typhoid Flatulence; tenderness of abdomen; exhaustion; occasional mucous diarrhoea; unconscious evacuations; offensive odour in stools; tremors of the jaw; loss of memory; drowsiness in the day time; fever with rigor; sweats only on one side, muttering delirium; nose-bleed; tongue coated white except for a red triangle at the tip; restlessness due to soreness all over the body; which is relieved by movements and aggravated by rest, mentally restless but physically too weak to move (Ars.)

Arsenic 6-30—Pulse quick and hard; fear of death; extreme prostration and yet patient is restless; moves his limbs about, but cannot move his trunk for physical weakness; skin rough; burning heat of skin; cold sweat; much thirst and desire for frequent small sips; tongue inflamed; eruptions on skin and diarrhoea; aggravation of disease after midnight; picking up of bed-clothes; tongue clean; exhaustion with the onset of disease. [Arsenic is rarely used in the acute condition].

Acid Mur. 6—In the last stage of the disease profound nervous prostration, patient lies unconscious; pale sinking face; sore-throat; extremities cold; tongue dry; coating on tongue and gums; cannot stand cold; pulse quick and small; mild delirium, white pimples on upper lip; dropped lower jaw; sores in mouth; foetid exhausting diarrhoea; slides down in bed; passes involuntary stools when passing urine; picks the bed clothes; pimples on skin. Loud moaning and muttering.

Acid Phos. 6-30—Apathy and other mental troubles developed before any of the disease-symptom is manifest. The patient lies quickly on his back, does not like to speak. Rigor; no thirst; toes and fingers are icy-cold; much heat during the hot stage; but there is no thirst; hot sensation inside the body but chilly outside of it. Sweat marked at night and morning. Acid phos. is prescribed, to give strength when delirium has subsided under other remedies. Painless diarrhoea, light coloured stool. Best adapted to persons given to excessive sexual indulgence or when there are frequent night emissions during the disease.

Carbo Veg. 3-30—In the collapse stage; extremities cold icy coldness, tip of fingers covered with cold sweat; coldness of legs, cold from knees down; cold sweat; eructations; no pulse at wrist; foetid diarrhoea; face and body pale like those of dead man, when the pulse is sinking, sight failing; deafness coming on, and the patient gasps for breathe.

Terebinthina 6—Tympanitis, bleeding from the bowels; bloody stools and urine; urine suppressed; nose bleed; burning sensation in the intestines; mucous diarrhoea; repeated diarrhoea during convalescence. It is a valuable remedy in flatulent distention of abdomen. If it fails, apply the oil of turpentine on the abdomen by means of rag soaked in it.

Apis Mel. 3-30—Skin dry and hot; tongue and lips are swollen and tremulous. Sudden shrill screams, while sleeping, or on waking; sudden starting during sleep. (Edema of the face, hands and feet, bag-like swelling of the lower eye-lids; little or no thirst, trembling of the body.

Zincum Met. 6-30—In threatened paralysis of brain and when the indicated remedies fail. Moves his feet constantly.

Pyrogenium 6-200—Septic stages all secretions-stools, urine, sweat, breath are horribly offensive (Bapt., Psor). Bed feels too hard, in whatever position the patient lies; the parts rested upon feel sore and bruised (Am. Bapt.) Tongue clean, fiery red, dry, cracked: speaks with difficulty; taste sweetish or foetid. Obstinate constipation, stools large, black, or like small black balls; diarrhoea, stool very offensive. Pulse abnormally rapid, does not correspond with the temperature.

Psorinum 200—When the disease is suspected to have been due to suppression of any skin-disease or if there is previous history of skin-disease the reaction is slow; where the patient is naturally sensitive to cold, wants warmth; all discharges are offensive and, foul-smelling. When all well selected medicines fail, a dose of this wonderful medicine satisfies the patient and the physician alike.

Echinacea Ө—Cold sweat all over; destructive sores; black, bloody, offensive discharges, foetid breath, profound exhaustion. Septic condition diarrhoea.

Hyoscyamus 3-6—Pulse full, quick and hard; face hot; staring eyes; twitchings of body; tongue half paralyzed; sordes on the teeth; low delirium; picking of bed clothes and sudden attempts to jump out of bed; constantly thinks and speaks of sexual matters, exposes the genitals and keeps his hand constantly on them. Involuntary urination and involuntary stools; unconscious evacuations.

Belladonna 6-30—Throbbing headache; flushed face; stiff neck; dilated pupils; delirium furious; tries to bite and strike and to escape; temperature high; full, quick, throbbing pulse; sweating of the covered parts.

Stramonium 3—Delirium; talks much and unceasingly; laughs, prays, sermonizes, makes verses, claps hands over head; eyes wide open. Looks terrified; sees ghosts and strangers, hears voices; imagines wild animals are after him, tries to hide or escape; cannot remain alone and in darkness must have someone near him and must have light. Strange ideas, thinks himself tall, double; lying crosswise or on back, raises head frequently from pillow. Sensation of heat in head; headache; changeable mood, now jolly, now sad.

Cina 2x-200—For the patients who suffer continually from worm-complaints, and when the best selected remedy fails to produce the favourable effects, a dose of Cina clears up the case. The patient constantly bores his fingers into the nose, grinds the teeth in sleep, hungry soon after his meals; irritable and cross. Face pale, blue rings around the eyes, cheeks red.

Arum Tri. 6-30—Delirium; boring head in pillow, boring in the nose. Constant picking of nose and lips until they bleed. Red raw condition of tongue and mouth; comers of mouth cracked and sore; hoarse voice; suppressed urine.

Nux Moschata 2x-200—coma; rumbling inside abdomen; stinking stools, mouth and throat dry, no thirst.

Verat. Alb. 6–30—Onset with vomiting and purging; unconscious evacuation of rice-water stools, nausea and vomiting; pain in abdomen; cold sweat on forehead, extremities cold; rapid prostration.

Mercurius Sol. 3 or 6—Bleeding from ulcerated intestinal glands with rise of temperature accompanying bitter or foetid sensation inside mouth; sore gums or throat, tongue large, ulcerated; sweat all over the body with little or no relief.

Merc. Cyanatus 3—If diphtheria ever complicates typhoid; great prostration.

Lycopodium 12-200—Tympanitis, constipation, sensation of fermentation inside the abdomen; patient is very emaciated; comatose; brick-red sediment in urine; typhoid complicated with pneumonia; aggravation of all symptoms during 4-8 p.m.

Hamamellis 3x—Bleeding of pure blood, bed-sores; sore, bruised feeling over the whole body.

Causticum 6—Polyuria during convalescence.

Typhoidinum 30-200—May be used as a prophylactic and also therapeutically all through the course of illness.

Carbo veg., Opium, Cina, Sulphur. Apis—See under Intermittent fever. For other medicines, see under Meningitis.

Diet etc.: Water in moderate quantity, whey, barley gruel, fruit-juices (strained), milk diluted with water or barley-water; Plasmon arrowroot; thin vegetable-soups but no meat or egg preparations.

The room should be kept clean and freely ventilated. Incense may be burnt in the room after removing the medicines elsewhere. Food should be kept covered. Excreta must be instantly removed from the room and treated with a strong anti-septic solution and the remover must clean his or her hands with soap-water followed by an antiseptic lotion.