II. Other Fevers, Infectious in Character.

Paratyphoid Fever.

Definition:—Fevers possesing many of the characteristics of developing typhoid have long been recognized and usually classed as typhoid. Scudder uses the term syno-choid to describe a simple form of continued fever. Bar-tholow describes the milder preliminary manifestations of typhoid, in which the patient was not confined to the bed, as ambulant typhoid. More recently, since the discovery of a bacillus differing from that of typhoid, the term paratyphoid has been applied to fevers with these various manifestations, thus placing them in a distinct class.

Etiology:—The bacilli have been found in the body fluids and in the glandular organs and their secretions. The disease occurs early in adult life and is as yet not traceable to a definite cause other than the bacillus, which occupies an intermediate position between the bacillus coli communis and the bacillus of typhoid, to which, however, it bears a closer resemblance, and is therefore called the paratyphoid bacillus. The disease is more prevalent in autumn, and, like typhoid epidemics, has been traced to infected water.

Symptomatology:—Clinically, this fever closely resembles typhoid. There is an absence of intestinal complications unless the fever is greatly prolonged. The incubation period is shorter and there is a rather sudden onset of the fever, with an immediately high temperature. Headache is premonitory and persistent, and mental dullness occurs early. There is anorexia, lassitude and debility, and often slight bronchitis.

Splenic enlargement is an almost pathognomonic phenomenon. It occurs early and is persistent and constipation usually prevails during the course of the disease. Rose-colored spots appear later, if at all.

Treatment:—In the treatment of this form of fever the indications are largely those of typhoid and are combated with the specifically indicated measures and medicines of that disease. With us the indications are all-important and the nomenclature of secondary value.

The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.