5 GO THE TREATMENT OF DISEASES. 



'ink may be found. One is a faint irregular dusky-red fine mottling which looks as 

 if it had its seat some distance below the surface ; the other is formed of separate 

 spots of small size and purplish colour scattered over the mottled surface, and look- 

 ing more or less superficial. These spots are irregularly roundish in shape, and at 

 their first appearance are slightly elevated above the skin. The mottling often 

 exists without the distinct spots, but the spots very seldom without the mottling. 

 From the first to the third day after the appearance of the rash no fresh spots are 

 seen, but each spot, although it becomes less elevated and more dark and dingy, 

 continues visible till the whole rash disappears. During the first three days, typhus 

 spots temporarily disappear under the pressure of the finger, but after that time they 

 remain unaltered by pressure. They usually subside between the fourteenth and 

 twenty-first days, but in fatal cases they remain after death. 



It will be important to consider the course of the temperature in this disease. 

 On the evening of the first day of the fever the temperature may be as high as 

 103 Fahr., and it continues rising until the third day, when it often reaches 

 106 Fahr., or more. The difference between the morning and evening temperature 

 is less marked than in typhoid fever, it seldom amounting to much more than a 

 degree. The highest temperature is usually reached on or about the fourth day, 

 and then a slight fall takes place. On the seventh day there is commonly a more 

 marked fall, but in severe cases this may be indicated only by the absence of the 

 usual evening rise, or it may even be totally absent. During the second week the 

 temperature rises again, but only for a day or two, and it is rarely so high as in the 

 first Aveek. On or about the fourteenth day there is usually a considerable fall in 

 the temperature, and this occurs even in those severe cases in which there was iio> 

 fall on the seventh day. In favourable cases the temperature becomes normal about 

 the end of the first half of the third week. The suddenness with which the fever 

 leaves the patient is very characteristic of this disease, the temperature not un- 

 frequently falling as much as three or four degrees in the course of a night. In 

 cases which are about to terminate fatally the temperature remains high, about 

 105 Fahr., until the last, and very frequently there is a very rapid rise a few hours 

 before death closes the scene. 



The duration of an uncomplicated case of typhus fever varies from twelve to 

 twenty-one days. It is extremely uncommon for a relapse to occur. The greatest 

 danger is usually during the second week of the illness, death seldom ensuing before 

 the seventh day. The recovery from typhus is usually very rapid, a wonderful 

 change in the condition of the patient often occurring in twenty-four or forty-eight 

 hours. The sequelae of this disease are very few, especially when compared with 

 typhoid or scarlet fever, and an attack seldom results in any permanent injury to 

 the health. 



The mortality in typhus fever, taking the average of all cases, is about ten per 

 cent. In children it is as low as five per cent, but in elderly people it rises to fifty 

 or sixty per cent., or upwards. Bulky, fat people are found to bear the disease 

 badly, and previous habits of intemperance add very greatly to the gravity of the 

 attack. Although people in the upper classes of society seldom catch typhus, yet 

 when they do have it they are said to suffer much more than their poorer brethren. 



