SYMPTOMATOLOGY 



1333 



Morbid Anatomy. — ^Death is most common about the tenth day, 

 being due either to the action of the virus of the disease or to com- 

 pHcations such as pneumonia and septic infections. The spleen 

 is enlarged and engorged if the post-mortem takes place up to the 

 middle of the second week, but not later. There is oedema of the 

 lungs and hypostatic pneumonia, cloudy swelling and fatty degenera- 

 tion of the heart, cloudy swelling of the liver and kidneys, and 

 hyperaemia of all the organs. The cerebro-spinal fluid may show 

 a slight lymphocytosis. 



The muscles are dry and the rectus abdominalis may show 

 Zenker's degeneration. The spleen is enlarged, dark red in colour, 

 with juicy dark red pulp, while the kidneys may show punctate 

 haemorrhages. 



Symptomatology — Incubation. — ^This varies from four to five 

 to twenty-one days, according to the older views, but the more 

 correct opinion is some four to ten to twelve days. 



Fig. 651. — Temperature Chart of Typhus Fever. 



Prodromal symptoms are often entirely absent, or consist of vague 

 feelings of fatigue, giddiness, and headache. 



Attack. — ^The onset is usually sudden, being characterized by 

 frontal headache; pains in various parts of the body, of which pain 

 in the chest, giving rise to the suspicion of pneumonia, is important ; 

 rigors; marked rise of temperature from 101° to 104° F. ; quick pulse 

 (100 to 120) ; flushed face and suffused eyes ; quickened respirations; 

 and a sensation of great weakness. Rarely, however, the onset is 

 slow and typhoid-like. 



Course.- — ^The duration of the symptoms is from fourteen to 

 eighteen days. During the first two or three days the temperature 

 continues to rise at night, with remissions in the morning, to a 

 maximum of about 104° to 105° F. on the second to fourth days, 

 during which time the tongue iDecomes dry, swollen, and cracked, 

 with a thick brown deposit on the dorsum, while the tip and sides 



