TYPHUS FEVER AND TYPHOID OR ENTERIC FEVER.
Typhus Fever is a very infectious fever. The infection seems to come off from a patient in the breath, and not, as in typhoid fever, in the motions from the bowels. The infectious matter, however, does not seem to thrive in the open air, nor does it attach itself to cloth ing, &c., or retain its poisonous characters as that of scarlet fever does. For free ventilation and plenty of fresh air are not favourable to the spread of typhus. It is probably for this reason that typhus is largely a disease of the poor, especially of the poor crowded together in small, ill-ventilated, and dirty houses. It is specially common in overcrowded parts of the poorer districts of towns in Great Britain and Ireland. It attacks both sexes almost equally, and at all ages, though the majority of those attacked are between the ages of ten and thirty. The greatest number of cases occurs during the winter and the smallest during summer, per haps because in the winter the very poor huddle together for warmth, and the condition of overcrowding is thus readily produced. It usually attacks the same person only once, although there are cases of the same person suffering from it twice or even thrice.
Symptoms.—Between five and twelve days may pass after the person is infected before the symptoms of the disease appear. The first symptoms are shivering, headache, loss of appetite, thirst, and perhaps sickness, general weakness, quick pulse, and increased heat of skin. The bowels are bound. A noticeable symptom is dulness and heaviness of the patient, who has a stupid, confused look, and cannot fix his mind upon anything; and sleep is disturbed. About the fifth or seventh day the rash comes out (Plate XXVII.). It is apt to be mistaken for measles, but the spots, which are of a dusky-red colour, are not so large and raised as those of measles. It appears first on the sides of the chest and belly (measles ap pears first on the forehead round the edge of the hair), and on the hands, wrists, and elbows, spreading over the body, arms, and legs in a couple of days, but not marked on face and neck. After coming fully out it remains out
for two or three days, and then begins to fade, disappearing by about the fourteenth day. In bad cases dark-coloured spots, due to the escape of small quantities of blood in the skin, may be present after the true rash has faded. During the second week of the illness the symptoms become worse. Delirium becomes constant, though, if sharply spoken to, the patient may be recalled to himself for a moment. Some times the delirium is violent, sometimes of a low, muttering kind. As the disease progresses the tongue becomes dry and brown, the pulse faster and weaker, and the general weakness so marked that the patient lies well down in the bed, on his back, with mouth and eyes half open, and motions and water are passed in the bed unconsciously. Often the hands wander aimlessly about, picking at the bed-clothes, a sign of great prostration. About the fourteenth day, in favourable cases, the patient falls into a gentle sleep, from which, after some hours, he awakes quite sensible, with the fever almost gone, but in a state of extreme weakness. With careful nursing appetite and strength gradually return, so that at the end of three or four weeks he is quite restored. If the case is going to end unfavourably the prostration increases, and instead of the turn at the thir teenth or fourteenth day, deep unconsciousness sets in, the fever runs up, and the patient sinks under it. Convulsions may occur, in such a case, before the unconsciousness comes on. The case may be milder than has been described, the delirium being limited to a "wandering," or it may be much worse, death taking place within the first week, instead of towards the end of the second, the usual time in fatal cases.
The chief complication in typhus is conges tion of the lungs, largely brought on by the intense weakness produced by the disease.