Part 11 (1/2)
When once the outer wall has been pierced, the sack of the city rapidly proceeds. The bacilli multiply everywhere, but seem for some reason to focalize chiefly in the alimentary ca.n.a.l, and especially the middle part of it, the small intestines. After headache, backache, and loss of appet.i.te comes usually a mild diarrh[oe]a. This diarrh[oe]a is due to an attack of the bacillus or its toxins upon certain clumps of lymphoid tissue in the wall of the small intestine, known as the ”patches of Peyer.” This produces inflammation, followed by ulceration, which in severe cases may eat through the wall of a blood-vessel, causing profuse hemorrhages, or even perforate the bowel wall and set up a fatal peritonitis. The temperature begins to swing from two to five degrees above the normal level, following the usual daily vibration, and ranging from 100 degrees to 101 degrees in the morning up to 102 degrees to 105 degrees in the afternoon. The face becomes flushed.
There is usually comparatively little pain, and the patient lies in a sort of mild stupor, paying little attention to his surroundings. He is much enfeebled and seldom cares to lift his head from the pillow. A slight rash appears upon the surface of the body, but this is so faint that it would escape attention unless carefully looked for. Little groups of vesicles, containing clear fluid, appear upon the chest and abdomen. If one of these faint rose-colored spots be p.r.i.c.ked with a needle and a drop of blood be drawn, typhoid bacilli will often be found in it, and they will also be present in the clear fluid of the tiny sweat blisters.
This condition will last for from ten days to four weeks, the patient gradually becoming weaker and more apathetic, and the temperature maintaining an afternoon level of 102 to 104 degrees. Then, in the vast majority of cases, a little decline of the temperature will be noticed.
The patient begins to take a slight interest in his surroundings. He will perhaps ask for something to drink, or something to eat, instead of apathetically swallowing what is offered to him. Next day the temperature is a little lower still, and within a week, perhaps, will have returned to the normal level. The patient has lost from twenty to forty pounds, is weak as a kitten, and it may be ten days after the fever has disappeared before he asks to sit up in bed.
Then follows the period of return to health. The patient becomes a walking appet.i.te, and, after weeks of liquid diet, will beg like a spoiled child for cookies or hard apples or pie, or something that he can set his teeth into. But his tissues are still swarming with the bacilli, and any indiscretion, either of diet, exposure, or exertion, at this time, may result in forming a secondary colony, or abscess, somewhere in the lungs, the liver, or the muscles. He must be kept quiet and warm, and abundantly, but judiciously, fed, for at least three weeks after the disappearance of the fever, if he wishes to avoid the thousand and one ambuscades set by the retreating enemy.
Now, what has happened when recovery begins? One would suppose that either the bacilli had poisoned themselves, exhausted the supplies of nourishment in the body of the patient, so that the fever had ”burnt itself out,” as we used to say, or that the tissues had rallied from the attack and destroyed or thrown out the invaders. But, on the contrary, we find that our convalescent patient, even after he is up and walking about, is still full of the bacilli.
To put it very crudely, what has really happened is that the body has succeeded in forming such antidotes against the poison of the bacilli that, although they may be present in enormous numbers, they can no longer produce any injurious effect. In other words, it has acquired immunity against this particular germ and its toxin. In fact, one of our newest and most reliable tests for the disease consists in a curious ”clumping” or paralyzing power over cultures of the _Bacillus typhosus_, shown by a drop of the patient's blood, even as early as the seventh or eighth day of the illness. And, while it is an immensely difficult and complicated subject, we are justified in saying that this immunity is not merely a substance formed in the body, the stock of which will shortly become exhausted, but a faculty acquired by the body-cells, which they will retain, like other results of education, for years, and even for life. When once the body has learned the wrestling trick of throwing and vanquis.h.i.+ng a particular germ or bacillus, it no longer has much to dread from that germ. This is why the same individual is seldom attacked the second time by scarlet fever, measles, typhoid, and smallpox.
While, however, the individual may be entirely immune to the germs of a given disease, he may carry them in his body in enormous numbers, and infect others while escaping himself.
This is peculiarly true of typhoid, and we are beginning to extend our sanitary care over recovered patients, not merely to the end of acute illness, but for the period of at least a month after they have apparently recovered. Several most disquieting cases are on record of so-called ”typhoid carriers,” or individuals who, having recovered from the disease itself, carried and spread the infection wherever they went for months and even years afterward. This, however, is probably a rare state of affairs, though a recent German health bulletin reports the discovery of some twenty cases during the past year. The lair of the bacilli is believed to be the gall-bladder.
As to treatment, it may be broadly stated that all authorities and schools are for once practically agreed:--
First, that we have no known specific drug for the cure of the disease.
Second, that we are content to take a leaf out of nature's book, and follow--so to speak--her instinctive methods: first of all, by putting the patient to bed the moment that a reasonable suspicion of the disease is formed; this conserves his strength, and greatly diminishes the danger of serious complications; cases of ”walking typhoid” have among the highest death-rates; second, by meeting the great instinctive symptom of fever patients since the world began, thirst, encouraging the patient to drink large quant.i.ties of water, taking care, of course, that the water is pure and sterile. The days when we kept fever patients wrapped up to their necks in woolen blankets in hot, stuffy rooms, and rigorously limited the amount of water that they drank--in other words, fought against nature in the treatment of disease--have pa.s.sed. A typhoid-fever patient now is not only given all he wants to drink, but encouraged to take more, and some authorities recommend an intake of at least three or four quarts, and, better, six and eight quarts a day.
This internal bath helps not only to allay the temperature, but to make good the enormous loss by perspiration from the fevered skin, and to flush the toxins out of the body.
Third, by liberal and regular feeding chiefly with some liquid or semi-liquid food, of which milk is the commonest form. The old att.i.tude of mind represented by the proverb, ”Feed a cold and starve a fever,”
has completely disappeared. One of the fathers of modern medicine asked on his death-bed, thirty years ago, that his epitaph should be, ”He fed fevers.”
Fourth. We respond to the other great thirst of fever patients, for coolness, by sponge baths and tub baths, whenever the temperature rises above a certain degree.
Simple as these methods sound, they are extremely troublesome to put into execution, and require the greatest skill and judgment in their carrying out. But intelligent persistence in the careful elaboration of these methods of nature has resulted in already cutting the death-rate in two,--from fifteen or twenty per cent to less than ten per cent,--and where the full rigor of the tub bath is carried out it has been brought down to as low as five per cent.
Meanwhile the bacteriologists are steadily at work on a vaccine or ant.i.toxin. Wright, of the English Army Medical Staff, has already secured a serum, which has given remarkable results in protecting regiments sent out to South Africa and other infected regions.
Chantemesse has imported some six hundred successive cases treated with an ant.i.toxin, whose mortality was only about a third of the ordinary hospital rate, and the future is full of promise.
CHAPTER X
DIPHTHERIA
That was a dark and stern saying, ”Without the shedding of blood there is no remission,” and, like all the words of the oracles, of limited application. But it proves true in some unexpected places outside of the realm of theology. Was there something prophetic in the legend that it was only by the sprinkling of the blood of the Paschal Lamb above the doorway that the plague of the firstborn could be stayed? To-day the guinea-pig is our burnt offering against a plague as deadly as any sent into Egypt.
Scarcely more than a decade ago, as the mother sat by the cradle of her firstborn, musing over his future, one moment fearfully reckoning the gauntlet of risks that his tiny life had to run, and the next building rosy air-castles of his happiness and success, there was one shadow that ever fell black and sinister across his tiny horoscope. Certain risks there were which were almost inevitable,--initiation ceremonies into life, mild expiations to be paid to the G.o.ds of the modern underworld, the diseases of infancy and of childhood. Most of these could be pa.s.sed over with little more than a temporary wrinkle to break her smile. They were so trivial, so comparatively harmless: measles, a mere reddening of the eyelids and peppering of the throat, with a headache and purplish rash, dangerous only if neglected; chicken-pox, a child's-play at disease; scarlatina, a little more serious, but still with the chances of twenty to one in favor of recovery; diphtheria--ah! that drove the smile from her face and the blood from her lips. Not quite so common, not so inevitable as a prospect, but, as a possibility, full of terror, once its poison had pa.s.sed the gates of the body fortress. The fight between the Angel of Life and the Angel of Death was waged on almost equal terms, with none daring to say which would be the victor, and none able to lift a hand with any certainty to aid.
Nor was the doctor in much happier plight. Even when the life at stake was not one of his own loved ones,--though from the deadly contagiousness of the disease it sadly often was (I have known more doctors made childless by diphtheria than by any other disease except tuberculosis),--he faced his cases by the hundred instead of by twos and threes. The feeling of helplessness, the sense of foreboding, with which we faced every case was something appalling. Few of us who have been in practice twenty years or more, or even fifteen, will ever forget the shock of dismay which ran through us whenever a case to which we had been summoned revealed itself to be diphtheria. Of course, there was a fighting chance, and we made the most of it; for in the milder epidemics only ten to twenty per cent of the patients died, and even in the severest a third of them recovered. But what ”turned our liver to water”--as the graphic Oriental phrase has it--was the knowledge which, like Banquo's ghost, would not down, that while many cases would recover of themselves, and in many border-line ones our skill would turn the balance in favor of recovery, yet if the disease happened to take a certain sadly familiar, virulent form we could do little more to stay its fatal course than we could to stop an avalanche, and we never knew when a particular epidemic or a particular case would take that turn.
”Black” diphtheria was as deadly as the Black Death of the Middle Ages.
The disease which caused all this terror and havoc is of singular character and history. It is not a modern invention or development, as is sometimes believed, for descriptions are on record of so-called ”Egyptian ulcer of the throat” in the earliest centuries of our era; and it would appear to have been recognized by both Hippocrates and Galen.
Epidemics of it also occurred in the Middle Ages; and, coming to more recent times, one of the many enemies which the Pilgrim Fathers had to fight was a series of epidemics of this ”black sore throat,” of particularly malignant character, in the seventeenth century.
Nevertheless, it does not seem to have become sufficiently common to be distinctly recognized until it was named as a definite disease, and given the t.i.tle which it now bears, by the celebrated French physician, Bretonneau, about eighty years ago. Since then it has become either more widely recognized or steadily more prevalent, and it is the general opinion of pathologists that the disease, up to some thirty or forty years ago, was steadily increasing, both in frequency and in severity.