The Smell of Death: An Era Gone By

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    This is the third in the series “An Era Gone By” looking this time at how disease modes of transmission are the same as the 1900s, but treatment and prevention has changed. We focus on typhoid fever, looking at signs and symptoms and compare treatments from then to now.

    The cold sticky wetness between Oscar’s legs stirred him out of his feverish sleep. His fingers brushed his thigh as he pulled the blanket over his shoulders. Opening one eyelid he tried to focus on his fingers. Seeing the red he groaned, knowing it was blood. Inhaling, the smell of death skulked up to his nose. Fighting the pain he felt with every movement, he managed to sit on the side of the bed. His head felt as heavy as the boulders he moved working at the railroad. Once he got on his feet, he took a step forward only to fall on his face. Lying on the cold wood floor the room swirled around him then suddenly he retched. With a moan he opened his eyes to see more blood next to his face. Fear squeezed his heart, giving him enough momentum to get to his feet. He stumbled out the door and headed to the outhouse. Just inside the outbuilding Oscar’s vision closed in until darkness enveloped him as he slumped to the dirt.

    Methods of infection transmission has not changed over the years, but prevention and treatment has. A.S. Blumgarten M.D., F.A.C.P. gives us insight into nursing instructions in his book "A Text Book of Medicine For Students in Schools of Nursing". Familiar concepts to modern nursing are talked about in his chapter on “Infectious and Allergic Diseases,” such as the five modes of transmission: direct contact, food, air, carriers, and an intermediate host.

    The difference is the diseases he discusses such as typhoid fever, tuberculosis, diphtheria, and malaria. Although we are familiar with these diseases, in the United States they are rare due to preventative measures such as better food preparation and improved public health and sanitation.

    Blumgarten states that the most common diseases of the 1920s and 30s were typhoid and diphtheria. An interesting fact about typhoid is that it can live in the gallbladder for months to years after a patient had recovered. Therefore, they continue to pass it along through stool, sharing the bacteria to family and possibly the community. Diphtheria can live in the throat for months, making it difficult to eradicate. Treatment did not include antibiotics in the 1930s, neither did proper diet and hydration resulting in many deaths.

    Focusing on typhoid fever we will learn the signs and symptoms along with treatment in the early 1900s as compared to present day. Typhoid is caused by the bacteria Salmonella typhi which sounds familiar to us because salmonella still rises it’s ugly head in improperly prepared food. The typhoid bacteria lives in food and water contaminated by infected stool.

    The incubation period is one to two weeks and the duration of illness is four to six weeks. Although it is rare in America, other countries still have a large affected population. Common signs and symptoms are: poor appetite, fever up to 104 degrees, GI bleeding, headaches, aches in the joints, lethargy, pericarditis, cholecystitis, and optic neuritis. Although the long list of problems caused by typhoid are the same now, the treatment has changed tremendously.

    Due to improved health care and understanding of the disease process, treatment for typhoid fever has decreased the mortality rate. In the 1920s there were 35,000 annual reports of typhoid fever compared to 5,700 annually in the 21st century. The fatality rate was twenty percent before antibiotics began being used to treat it. Treatment for typhoid in the 1920s was very specific allowing only 1500cc of fluid daily along with a small residue diet.

    They were to drink three pints of milk a day and no fruit but they could have mutton, fresh vegetable juice and beef or chicken broth or just cold water. IV fluids were not used for hydration and the only medicine used was antipyretics.

    The 1200 calorie diet led to iron deficiencies and edema along with fat and protein deficiencies. It was no wonder that people did not get better since they were dehydrated, under nourished, and severely anemic. Cipro is most commonly used to treat typhoid now, along with IV fluids to relieve dehydration.

    Our journey back in time allowed us to see that while the modes of disease transmission has not changed much, treatment has. Nurses were instructed on what to look for when treating patients with malaria, typhoid, or diphtheria but not how to teach prevention such as washing the hands, especially if they handled food or milk. In this “Era Gone By” article, we once again realize the foundation that was built for us by doctors and nurses so that many diseases can be prevented or treated properly to decrease overall incidents as well as mortalities. See my other articles in this series if you enjoy our history in health care.

    "I Know How to Wash My Hands": An Era Gone By
    Don't Hide Your Pregnancy with A Corset: An Era Gone By

    References

    Blumgarten, A.S., M.D. F.A.C.P. A Text Book Of Medicine For Students in Schools of Nursing. New York: The Macmillan Company, 1930. Print.

    Meakens, Jonathan C. “Typhoid fever in the 1890s and 1930s.” Pmc US National Library of Medicine National Institute of Health. CMAJ-JAMC. Jan 1940, pg. 81,82. Web. 22 Jan. 2015.

    “Typhoid Fever.” MedicineNet.com. Jan. 2015. Web. 22 Jan. 2015.
    Last edit by Joe V on Oct 20, '17
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    About Brenda F. Johnson, BSN, RN

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    RN at Gi Lab; from TN , US
    Specialty: 23+ year(s) of experience in Gastrointestinal Nursing

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    7 Comments

  3. by   LadyFree28
    Great article!
  4. by   Mommytracknurse
    So true!! There's so much coverage now of scary illnesses in the media too!! People are being educated even when they just watch the nightly news great article tho! Makes me feel very grateful to have been born in this era!
  5. by   anon456
    This is great! I will have to read your other ones. I would love to hear about the Spanish Flu epidemic which does not seem to be well-known anymore.
  6. by   Brenda F. Johnson
    Quote from anon456
    This is great! I will have to read your other ones. I would love to hear about the Spanish Flu epidemic which does not seem to be well-known anymore.
    Thank you! Will look into the Spanish flu.
  7. by   icuRNmaggie
    Excellent article. Fever dehydration and currant jelly like stools are what recall most about typhoid patients from India.
  8. by   Brenda F. Johnson
    Quote from icuRNmaggie
    Excellent article. Fever dehydration and currant jelly like stools are what recall most about typhoid patients from India.
    That sounds like an interesting experience, would make a good article!
  9. by   LynnHaney
    Thanks! There is just not enough education about these diseases anymore. These uncommon (today) diseases are usually overlooked

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