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Typhus Fever

disease, typhoid, patient, day, usually and seldom

TYPHUS FEVER, a highly contagious eruptive fever, one of the exanthemata (q.v.), formerly known as putrid, ship, jail or camp fever, and by other names. The disease is very rare in the United States, and when it appears it is usually in the line of immigrant travel. But owing to the very strict quarantine regula tions of the American and Canadian govern ments it is seldom imported, or if introduced is stamped out by thorough isolation and dis infection. A constant vigilance is exerted to prevent the importation of old rags, which are seldom free from infection. The disease is also rare in the great centres of population in Europe and elsewhere, but it is epidemic in certain towns of the Old World and in some parts of Latin America where sanitation is of a most primitive kind. It is a filth-disease, therefore a disgraceful disease, and its oc currence is favored by overcrowding, had ventilation, poor food, etc., and is especially more likely in winter. The body louse is the carrier of the disease. Though resembling typhoid fever in some respects, it is easily recognized, quarantined, disinfected and con trolled. It is caused by the bacillus typhi exanthematici, discovered by Dr. Harry Plotz in 1915. There are no characteristic lesions, ex cept that the blood contains but little fibrin and is darker than normal, and the spleen and liver are engorged and softened. Sometimes the stomach and lungs are also softened. The real cause of death is not usually acertained. The mortality of typhus fever is not much more than that of typhoid fever when there is good ventilation and strict attention to other hygienic measures, but in overcrowded and badly ventilated prisons, etc., it is very great.

The average duration of typhus (14 to 21 days) is less than that of typhoid fever. The incubation period varies from one to two weeks. The fever begins much in the same way as typhoid, with lassitude, aching in the limbs, headache, chills or chilliness, rapidly rising temperature and dark flushing of the skin. The

eyes are moderately congested; there is little disposition to diarrhoea; the abdomen is not swollen or tender; and the patient is not likely to vomit, or to have nosebleed. The tongue soon becomes dry and dark, and sordes form; the pulse is frequent; as the fever reaches its height the breath and perspiration have a pecu liar musty odor, and the patient passes from a state of delirium into a nearly comatose con dition. Toward the end of the first week (usually the fourth or fifth day) an eruption appears on the sides of the abdomen, in the axillm and about the wrists. For the next two days it continues to appear over the rest of the skin, except that of the face, and is most abundant on the trunk. After the third day it ceases to come out. At first the spots dis appear under pressure, but after a day or two they fade out like black-and-blue spots, and in another day or two a small petechial hemor rhage appears in many of them. At its height the rash has a dull red color which Sir William Jenner compared to the juice of a ripe mul berry. When the spots coalesce and spread over a large space much danger is indicated. Treatment consists in combating the evils which give rise to the disease. The patient should be kept in a well-ventilated room with windows open even in winter; but he must also have plenty of bed-clothes, and there must be a fire in the room. Keep the room and patient thoroughly clean, and see that he has an abundance of good and easily digested food. Stimulants and other medicines will be seldom needed, yet a physician must not be dispensed with, since complications such as erysipelas and abscesses may occur. Plotz used a vaccine with considerable success in Serbia during the great epidemic there in 1915. Consult Vaughan, C. C., 'History and Epidemiology of Typhus Fever' (Journal of the American Medical Association, Chicago, 29 May 1915).