CHAPTER XLIX 



TYPHUS 



Synonyms. — Typhus exanthematicus, Synochus putrida, Spotted fever, 

 Gaol fever, Prison fever. Brill's disease; French, Typhus exanthematique; 

 Italian, Tifo esantematico, Tifo petecchiale; Spanish, El Tarbardillo; German, 

 Exanthematischer typhus, Fleckfieber; Dutch, Vlekkoorts; Arabic, Homma 

 typhuisa, Tkout fever; South Africa, M'betalala — black fever. 



Definition. — ^Typhus is an acute specific fever of unknown but 

 probably protozoal cause, spread by the agency oiPedicuIus corporis 

 de Geer, 1778, and characterized by a sudden onset, a maculo- 

 petechial eruption, and severe toxaemia, lasting some twelve to 

 fifteen days, and ending in a more or less abrupt lysis. 



History. — ^The early history of typhus is wrapped in obscurity by 

 reason of its confusion with plague ; for though Hippocrates mentions 

 the word ' typhus, ' he applied it to stuporous and delirious conditions, 

 and does not appear to have been acquainted with the fever in 

 question. This confusion with plague continued until Fracastorius, 

 in the sixteenth century, called it ' petechie,' and gave such an 

 account as enabled them to be separated from one another, though 

 the nomenclature at first indicated that they were related, and it 

 was not until 1760 that the term ' typhus ' was first applied to the 

 disease by Boissier de Sauvages. In an interesting historical paper 

 Crawford has shown that the only possible explanation of some of 

 the old outbreaks is by means of the louse. 



During the eighteenth and nineteenth centuries typhus was well 

 known in Europe, but included typhoid and relapsing fevers, from 

 the former of which it was distinguished by a long series of researches, 

 beginning with those of Strother, Gilchrist, and Huxham, in the 

 early eighteenth century, and ending with Still's classical work in 

 1837, while the history of the differentiation from the latter has 

 already been described in the chapter on the Relapsing Fevers. 



For a long time the disease passed unrecognized in the tropics, 

 and, indeed, in the Lancet of 1871 it is even debated as to whether it 

 could exist in those regions; but though it is impossible to deny 

 that Lyell, in his observations in 1852, mistook relapsing fever for it, 

 and that Fairweather in 1869 was confusing it with typhoid, it 

 would appear as though Lyons, in 1869, clearly recognized the 

 disease as occurring in North- West India, where it is now well known 

 to be endemic, and it has since been reported from many parts of 

 the tropics. 



Brill's disease appears to be a mild form of typhus fever, attenu- 



1326 



