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Typhus

ulcers, treatment, fever, disease, patient and usually

TYPHUS FEVER.—An infectious febrile disease ; called also gaol-fever. It has nothing in common with typhoid, except that, like the latter disease, it occurs almost exclusively in epidemics. Typhus is principally a disease affecting people who live under unfavourable conditions ; and, for this reason, it is frequently called " hunger-typhus." Neither the cause of the disease, nor the mode of dissemination, nor the part of the body which it prmarily affects, are known.

Following the prodromi, or premonitory signs—which persist for several days, and consist. of lassitude, headache, and pain in the limbs—the attack commences suddenly, with a violent chill and high fever, often followed by vomiting. An intensely severe headache soon sets in ; or the patient may fall into a stupor and become delirious. The skin is hot and dry, and is covered with a rash which rapidly spreads over the entire body, and which resembles the eruption of measles. After a few days these spots show signs of bleeding. The fever, which is constantly high during the first week, usually recedes during the second week, and the general condition then begins to improve. The temperature usually becomes normal in a day or two rarely by more gradual stages. Finally the rash fades, and recovery soon sets in. In severe cases, however, death occurs under increased cerebral disturbances, which result from intoxication by bacterial poisons that have passed into the blood. The mortality in typhus epidemics fluctuates between 6 per cent. and zo per cent.

There is no remedy known which influence the course of typhus fever. The danger arising from the high fever and the brain symptoms are best combated by cold baths. This, as well as the treatment of secondary affections that may supervene, is the concern of the physician.

ULCER.—An open sore on an internal or external body surface. It is due to an inflammatory process in the skin or in the mucous membrane, which process causes more or less destruction of these tissues and of the underlying structures. Some ulcers are caused by external agents, such as

burns, injuries, corrosions, etc. ; others are due to local disturbances in the nutrition of the skin, owing to nervous influences or to impaired circulation of the blood ; still others are caused by acute or chronic infectious diseases, such as diphtheria, typhoid, tuberculosis, syphilis, etc. ; and others again represent malignant growths, which appear as ulcers only because of tissue disintegration.

It follows that the variety of ulcers from which a patient may suffer cannot always be determined off-hand. A careful examination is often necessary to discover the underlyingcause. Certain varieties of ulcers, how ever, have characteristic forms and appearances, which render them easy of recognition. A venereal ulcer, for instance, has a greyish or sloughy floor and a well-defined sloping edge.

The treatment of an ulcer depends entirely upon its cause, and to estab lish this is, therefore, of primary importance. Many ulcers will not heal, in spite of the greatest care, until the underlying affection has been removed. Diabetes furnishes an illustration of fins. Unprofessional treatment, though it may sometimes result in alleviation or improvement, is usually inefficacious, and very often harmful.

The dangerous nature of an ulcer nas, in many cases, no relation what ever to its size or to the inconvenience it causes. Many small ulcers, as cancer of the lips or of the tongue, may eventually, with improper treatment, endanger the life of the patient.

From this it follows that careful medical observation is necessary in such cases. For internal ulcers, as of the stomach, intestine, and other organs, see the various head ings. Ulcers of the leg are discussed in the following article.