ENTERIC FEVER

or TYPHOID FEVER, is an acute infectious fever, characterized by much general disturbance, and giving rise to ulceration in the small intestine. The distinction between this fever and typhus fever was only established in the middle of ast century. It is due to a bacillus. difficult to detect, but during an attack found in many of the internal organs as well as in the stools, urine, and blood of the affected person. Enteric fever occurs in all parts of the world, and in most countries it is endemic, with occasional outbursts of epidemic prevalence. In Great Britain it is most common in the autumn, but epidemics may appear at any season. The great majority of cases occur between ten and twenty-five years of age; le common in middle life, it is rare after sixty. The most common source of infection is from the feces and urine of infected persons, hence the channels of infection are contaminated water, milk, and food-stuffs. Much public interest has been roused by the infection, through contaminated sewage-water, of watercre , celery, oysters, and other shell-fish, and various outbreaks have arisen through these agents. A further danger is the‘‘enteric carrier, ’a person who has once had enteric fever, and who is harbouring the bacillus for many years in his gall-bladder or elsewhere, and whose stools and urine may be infectious for an indefinite period. The incubation period is very variable, ranging from one to three weeks, while the onset of the disease itself is usually insidious. The patient complains of feeling out of sorts and of headache, soon followed by the signs of chill, due to the rising temperature, and a ociated with sleeple ne , occasionally severe head symptoms, and much digestive disturbance. Attacks vary much in intensity, but during the first three weeks so-called mild cases may suddenly develop more severe symptoms. Convalescence is slow and protracted, as in severe cases emaciation and debility are marked. The chief complications during the acute stage of the illne are perforation of an ulcer through the bowel, demanding immediate surgical interference, and intestinal bleeding resulting from hemorrhage from an ulcer. During convalescence relapses are frequent, brought on by indiscretions of diet, chill, and undue exposure, or some unknown cause. The most common sequele arising from the disease are thrombosis of a vein, usually in the thigh; bronchitis; one sided parotitis; outbreaks of boils and superficial absce es; and more occaCare, heart weakne and disease of one. _In its early stages enteric fever is difficult to diagnose, and confusion may arise between it and lobar and broncho-pneumonia, influenza, diarrhoea a ociated with septic infection, typhus fever, appendicitis, or septiegemia, q 192 ENTERITIS In treatment, good nursing is of first importance. The patient must have suitable nourishment and stimuJation, and requires to have the greatest care, whatever special form of treatment is being carried out, while constant watch must be kept for the appearance of any complication. Great differences in the treatment are observed in different countries and by different schools of medicine. _ ENTERI'TIS (Gr. enteron, intestine) is inflammation of the intestines. It varies from a mild intestinal catarrh, causing slight symptoms, and yielding to treatment in a few days, to cases of severe vomiting and diarrhea with extreme prostration. These severe forms are most frequently seen in infants and young children during the summer months, and frequently prove fatal. Removal of the cause of irritation and complete rest to the intestines are to be aimed at, as far as Geetha in the treatment of the coni on.