TERMINA TION— VA RIETIES 



1335 



A petechial eruption may also appear somewhat later, but is often 

 wanting, and when widespread is an indication of a bad prognosis. 

 A miliary eruption may appear later in the attack, and be followed 

 by a desquamation. After the appearance of the eruption the leuco- 

 cytosis becomes more marked, as do the nervous symptoms, the 

 patient suffering from severe delirium, which may become quite 

 violent; or he may show a stuporous condition, which becomes 

 a semi-coma, and in fatal cases deepens into a profound comatose 

 condition. 



Termination. — ^As a rule the duration of the fever is from fourteen 

 to eighteen days. On or about the fifteenth day the temperature 

 generally falls by crisis or by rapid lysis, which may extend through 

 three to five days, the rash fades, the spleen becomes normal, the 

 leucoc^^tosis increases, and convalescence begins. 

 ,In more serious cases the toxaemia may become severe during the 









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Fig. 652. — Temperature -Chart of Typhus Fever. 

 (Chart made by Dr. G. C. Shattock.) 



first week, and the patient may die from the seventh to tenth day 

 or even earlier. 



Convalescence. — ^This may be slow, and not rarely there is danger 

 during this stage, as the general condition^may not improve with the 

 cessation of the fever, and death may ensue some two to three 

 weeks after defervescence. In such cases the pulse does not 

 improve, and the patient becomes weaker and weaker until he dies. 

 These are very trying cases for the medical practitioner. Myocarditis 

 may develop during this stage, and shows a weak irregular pulse. 



Varieties, — ^The varieties which may be mentioned are: 

 (i) Mild or ambulatory cases. (2) Abortive attacks. (3) Malignant 

 attacks, causing death on the second or third day. (4) Typhus sw^ 

 exanthem — i.e., typhus without the rash. (5) Typhus in children. 

 This is usually mild, and it is said that death in uncomplicated 

 cases properly looked after is rare. Moreover, these cases are im- 



