"After ingestion, the organisms attach to the small intestinal mucosa, penetrate it, and are transported by the lymphatics to mesenteric lymph glands. There they multiply, and enter the bloodstream via the thoracic duct. The main location of bacilli is within macrophages. From this bacteraemia, which corresponds to the end of the incubation period, organisms are carried to the bone marrow, spleen, liver and gallbladder.
There is now a secondary invasion of the bowel via the infected bile...[leading to inflammation of the peyers patches in the ileum]. If the inflammation does not resolve, necrosis occurs within 7-10 days and the patches ulcerate. Involvement of the blood vessels may lead to bleeding [typically in the third week] and if the whole thickness of the bowel is involved, perforation follows [typically in the third week].
...More diffuse organ involvement also occurs, such as cloudy swelling of hepatocytes, necrosis, degeneration and fatty infiltration of the myocardium, degenerative changes in kidney tubules, and interstitial pneumonitis. Late in the disease there may be abcess formation...most often affecting bone, brain, liver or spleen.
The incubation period is around 14 days on average but can vary from less than a week to more than three weeks. The only almost constant symptoms are fever and headache. The untreated illness normally runs its course in about three weeks but can extend to months in exceptional cases.
The onset of fever is usually gradual...fever increases day by day in the first week, often with an evening rise. A remittent fever then continues for another week or more, then falls by lysis in the third week. Patients with typhoid usually feel very unwell in general, with malaise, generalised aches and pains, and anorexia. The following symptoms are also common: abdominal pain/discomfort, constipation, diarrhoea, deafness, cough.
...the maintenance of fluid and electrolyte balance is also vital to achieve good survival rates. But the mainstay of treatment is effective antimicrobial chemotherapy."
Modern day treatment of complicated Typhoid includes surgical resection (if bowel perforates), antimicrobial therapy and IV rehydration, none of which was available to Jessie in India in 1900. In many people the disease runs its course and they recover with a period of convalescence. It appears that Jessie had complications which led to her death, specifically what they were we may never know. Typhoid vaccination was introduced in India in 1910.
Chronic carriers of Typhoid carry the Typhoid infection in their gallbladders or urinary tract, and if employed in a food handling capacity can infect large numbers of people.
Bell, D R (1990) Lecture Notes on Tropical Medicine (3rd ed) Blackwell Scientific Publications: Oxford, pp 72,77
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