The same conditions were some time ago noticed in Berlin. Out of 14 people invited to a dinner, nine fell ill—5 of them very seriously—under symptoms of typhus, after having eaten oysters from Heligoland. Part of the personnel of the kitchen and some of the servants were taken ill with the same critical symptoms.
Abdominal typhus is a general illness of the whole body, and consequently all organs of the body are more or less altered in a morbid way while the disease lasts. The main change occurs in the lymphatic glands of the intestines and in the spleen.
The following are its anatomical symptoms: With the beginning of the disease the lymphatic glands of the mucous membrane of the intestines begin to swell; they are constantly growing during the course of the disease and attain the size of a pea; extended over the level of the mucous membrane they feel firm, hard and tough. In favourable cases the swelling may go down at this stage, but generally the formation of matter begins through the dying of the cells, caused by insufficient nourishment. This is gradually thrown off, and a loss of substance remains—the typhoid ulcer. This varies in size and in depth. Light bleeding in no great quantity ensues. If the ulcer has gone very deep, the intestines may be perforated and then the faeces and part of the food enter the abdominal cavity. The result is purulent and ichorous peritonitis. As a rule, however, the ulcers are purified and heal by cicatrization. Usually the spleen is enormously enlarged (through a rapid increase in the number of its cells). The swelling of the spleen can easily be detected by external touch.
(C) Symptoms and Course.
During what is termed the earlier stage, which as a rule last about two weeks and precedes the breaking out of the disease proper, the patient still feels comparatively well, or only begins to complain of headache, tired feeling, prostration in all the limbs, dizziness, lack of appetite. It is thus absolutely impossible to fix a definite date for its development. In most cases the patient complains of a chill, followed by feverishness,—symptoms which confine him to bed,—although no actual shivering takes place. It is expedient, although quite arbitrary and subject to many modifications, to divide the course of the illness into three periods:—