TYPHUS Fl 



activity of the typhus poison. Persons who h:.ve once sutK-ml from typhus are 

 ruivly attacked a second time. Typhoid fever neither protects from nor predisposes 

 to typhus. 



People so seldom fall ill of this fever after only a single contact with a case of 

 the disease that some difficulty has been experienced in determining the time d i 

 which the poison may remain latent in the system without making its effects mani- 

 fest. The period of incubation is probably variable, and is supposed to range 

 a few hours to several days. 



Typhus fever usually begins with headache, loss of appetite, and general malaise. 

 The patient is dull, and out of sorts, and, in spite of a feeling of extreme fatigue, is 

 u liable to sleep, and is restless at night. For the first day or two it is often very 

 difficult to say what is the matter with the patient, or to form any idea of what he 

 is about to suffer from. Sometimes the disease begins suddenly with a shivering 

 fit, but this symptom is far less common than at the onset of small-pox and some 

 other acute diseases. For three or four days these general symptoms increase in 

 severity, and are accompanied by thirst, heat of skin, and very great prostration. 

 Typhus patients are usually knocked over by the disease far more quickly than 

 sufferers from typhoid fever or small-pox. A man who has typhus can seldom keep 

 about after the third day, and is only too glad to take to his bed. 



As the fever increases in severity the skin becomes hot and slightly reddened, 

 especially about the head and face, and noises in the ears are not uncommon. 

 Sometimes there are symptoms of a cold in the head, and the patient may sutler 

 from sneezing and a slight sore throat. 



The appearance of a typhus patient is very peculiar, and is to -a practised eye 

 eminently characteristic. The sufferer lies prostrate on his back, with a weary, dull, 

 heavy, absent expression. In fact, he looks very much like a man who has made 

 himself stupid with drink, and is just beginning to recover from the effects of the 

 -debauch. In the advanced stages of a severe attack, the patient sinks down in bed, 

 lying on his back, with his eyes shut or half -shut, moaning and too prostrate to 

 answer questions, to protrude his tongue, or make the slightest voluntary move- 

 ment. Despite this apparent quiet, he passes restless, uncomfortable nights, often 

 broken by delirium. From the very beginning of the fever the tongue is coated, at 

 the onset with a white, and later with a thicker yellow fur, which exhibits a strong 

 tendency to become dry. Thirst is a very constant symptom, so that in many cases 

 the only thing that is really relished is plain cold water. The condition of the 

 bowels varies with different patients, for there may be either diarrhoea or constipa- 

 tion. Even when diarrhoea is present the stools are not at all like those we have 

 described as being met with in the course of typhoid fever. 



The rash which is peculiar to and distinctive of typhus fever is known as the 

 mulberry rash. It usually make its appearance on the fourth or fifth day, but some- 

 times later and occasionally earlier. It comes out first on the backs of the wrists, 

 and about the armpits and navel, but in many cases it covers the whole trunk, and 

 frequently the arms and legs as well. Sometimes in the case of children it appears 

 on the face so copiously as to be mistaken for measles. The rash is usually 

 described as consisting of two portions, between which every conceivable connecting- 



