TYPHUS FEVER 379 



Stimulants should be avoided. 



Purgatives and emetics tend to increase the muscular pain. 

 Massage. Electricity and iodides can be applied. 

 Change of air and place are necessary. 



TYPHUS FEVER. 

 DEFINITION. 



An acute specific contagious fever of unknown causation, charac- 

 terized by sudden onset, marked nervous symptoms, macular eruption 

 terminating by crisis. 



DISTRIBUTION. 



It is a disease of temperate and cold climates, but in the tropics it 

 may occur in high altitudes and during cool seasons. 



It is present in Xubia, Egypt, Tripoli and Morocco, Asia Minor 

 and Persia, and from thence to India. 



It is also found in North China and Hiogo, Japan. 



It is endemic in Mexico and common in Peru and North Chili. 



It is prevalent among the Balkan States and Austria, who lost 

 30,000 of 150,000 cases. 



It has been present in Ireland for centuries. 



In Egypt, 1914-1915, there were 23,855 cases with 6,132 deaths. 



^ETIOLOGY. 



The specific organism is unknown. It exists in the blood, which 

 is virulent from the third to the tenth day of the attack (Nuttall). 

 The disease has been transmitted to apes by typhus blood. 

 Human body lice carry the causative organism. 

 It is associated with dirt and filth. 



SYMPTOMATOLOGY. 



Incubation about twelve days. 



Onset sudden, frontal headache, pains in body, sometimes in chest, 

 temperature rises rapidlv, 101° to 104° F., pulse Cjuick, 100 to 120, face 

 flushed, appearance dull, heavy and pathetic. 



Tongue thickly furred, rapid exhaustion, a mousy odour from the 

 skin. Delirium sometimes early. 



Rash on abdomen or chest about the fifth day. At first a transient 

 erythema, then a macular, measly eruption, followed by the petechial 

 form. The rash is mild or absent in 20 per cent, of cases. When 

 present it covers the whole body quickly, except the face, palms and 

 soles. 



The typhoid state comes on rapidly with low muttering delirium. 



The pupil, before contracted, is now dilated. 



