TYPHUS FEVER.
Synonyms. — Typhus gravior; camp fever; ship-fever; spotted fever; ex anthematous fever.
Definition.—An acute infectious feb rile disease, commencing abruptly, con tinuous in type, reaching its crisis in about two weeks, accompanied by macu lated or petechial spots on the surface and prominent nervous symptoms.
Symptoms.—The period of incubation is between seven and fourteen days, at the end of which time the patient is at tacked rather abruptly with pains in the head, back, and limbs, accompanied by a decided chill or alternations of heat and cold, which soon give place to de cided fever-heat. The face becomes flushed, the skin generally dry and red, the vessels of the conjunctiva injected, and the temperature high. The tongue is usually covered with a white coat, the mouth dry, pulse frequent and moder ately full, bowels inactive, and urine high colored and less abundant than natural. There is much restlessness and sense of or mental dullness with indications of delirium. All the symptoms usually increase during the first week, reaching their climax in from five to seven days. The temperature ad vances with but little or no morning re missions from 103° F. on the first day to 104° or 106° F. on the fifth or sixth day, after which it recedes one or two degrees each morning, but returns to the higher grade in the afternoon and even ing.
During the same period of time the tongue becomes more thickly covered with a dry, brown coat, some sordes ap pear on the lips and teeth; the pulse in creases in frequency, often reaching 120 to 130 per minute, though less full. The respiratory movements increase in fre quency, with less fullness, and a dry, con gested condition of the mucous mem brane of the air-passages is generally present, and in the later stage more or less hypostatic engorgement of the lungs. In a large majority of cases a rash ap pears on the skin between the third and fifth days of the disease, first over the abdomen and upper part of the chest, then, in two or three days, it extends to the face, neck, and extremities. Many
of the spots present a dull-red color and appear as though beneath the cuticle. Other spots are more papular, and in se vere cases they become petechial or hiemorrhagic and only partially disap pear on pressure. In mild cases the eruption is generally slight, and in some altogether absent. In a few severe cases paroxysms of vomiting and diarrhoea have occurred early in the progress of the disease, but, as a general rule, the stomach and bowels are inactive and the abdomen free from gurgling and tym panites.
In the most severe class of cases the patient becomes early and persistently delirious, the vessels of the conjunctiva are injected, the pupils small, the tongue dry and brown with sorties on the teeth and lips, the skin hot and dry. A copi ous eruption of petechial or htemorrhagic spots appears, the temperature rises to 105.S° or 107.6° F., the pulse to 110 per minute and weak, the cardiac impulse and first sound are weak, respirations fre quent and shallow with rapidly increas ing hypostatic engorgement of the lungs. The urine scanty and albuminous. Sub sultus tendinum is marked. Such cases generally terminate fatally before the end of the first week. In a larger num ber of fatal cases these unfavorable symptoms develop more slowly and do not end in death until the end of the second week or the first half of the third. When the patient is progressing toward recovery the patient's mental condition is more that of dullness and light de lirium, from which he can be more readily aroused especially during the morning hours, when the temperature is a little lower and the pulse less frequent. and the renal secretion more natural. Such cases reach the crisis about the end of the second week, when the patient falls into a more protracted and natural sleep, from which he awakes with his mind clear, skin moist, urine free. After one or two evacuations from the bowels, rapid defervescence follows, and in two or three days convalescence is fully es tablished, though accompanied by great prostration.