Typhus fever may prove fatal during any stage of its progress, either from sudden failure of the heart from the supervention of some nervous symptoms, such as meningitis or of deepening coma, or from some complication, such as bronchitis.
The mortality from typhus f ever is estimated by Charles Murchison (183o-1879) and others as averaging about 18% of the cases, but it varies much according to the severity of type (particularly in epidemics), the previous health and habits of the individual, and very specially the age—in children under fif teen the death rate is only 5%, in persons over fifty, about 46%.
treatment of a patient with typhus fever is general and symptomatic. So far as preventive treatment is con cerned, chief importance attaches to methods for delousing the population. Naturally all methods tending towards personal cleanliness, good housing, sufficiency of food militate against the occurrence of epidemics.
The main element in the treatment of this fever is good nurs ing, and especially the regular administration of nutriment, of which the best form is milk, although light plain soup may also be given. The food should be administered at stated intervals, not, as a rule, oftener than once in one and a half or two hours, and it will frequently be necessary to rouse the patient from his stupor for this purpose. Sometimes it is impossible to administer food by the mouth, in which case recourse must be had to nutrient enemata. Alcoholic stimulants are not often required, except in the case of elderly and weakly persons who have be come greatly exhausted by the attack and are threatening to collapse. When the pulse shows unsteadiness and undue rapidity,
and the first sound of the heart is but indistinctly heard by the stethoscope, the prompt administration of stimulants (of which the best form is pure spirit) will often succeed in averting danger. Should their use appear to increase the restlessness or delirium they should be discontinued and the diffusible (ammo niacal or ethereal) forms tried instead.
Many symptoms demand special treatment. Opiate and sed ative medicines in any form, although recommended by many high authorities, must be given with great caution, as their use is often attended with danger in this fever, where coma is apt to supervene. When resorted to, probably the safest form is a combination of the bromide of potassium or ammonium with a guarded amount of chloral. Alarming effects sometimes follow the administration of opium. The height of the temperature may be a serious symptom, and antipyretic remedies appear to have but a slight influence over it as compared to that which they possess in typhoid fever, acute rheumatism, etc. Hugo Wilhelm von Ziemssen (1829-1902) strongly recommended baths in hyperpyrexia, the temperature of the bath being gradually re duced by the addition of ice. Cold sponging of the hands and feet and exposed parts, or cold to the head, may often considerably lower the temperature. Throughout the progress of a case the condition of the bladder requires special attention, owing to the patient's drowsiness, and the regular use of the catheter be comes, as a rule, necessary with the advance of the symptoms.