TYPHUS 



port ant because they are apt to be missed. Rigors are rare, and 

 often the temperature rises by steps, while the fever lasts only some 

 nine to thirteen days. Bronchitis is frequent. The spleen is 

 constantly enlarged, but the rash is generally scanty. Insomnia 

 is not frequent, but high temperatures often occur. Children remain 

 throughout the illness in a condition of semi-stupor, and waste in a 

 remarkable manner. (6) Typhus with an extensive exanthem all over 

 the body and into the mouth, with or without patches of gangrene. 



Complications and SequelaB. — Mixed infections with relapsing fever, 

 malaria, pneumonia, typhoid, and acute miliary tuberculosis occur. 

 Complications are: — ^Parotitis, ending often in suppuration, gangrene 

 of the feet, and polyarthritis, neuritis, hemiplegia, severe mental 

 depression, amounting almost to melancholia (seen during convales- 

 cence) may be mentioned. Also bubonic swellings, venous throm- 

 bosis, diarrhoea, otitis media, abscesses, and boils occur, while 

 jaundice, endocarditis, and meningitis are rare, but myocarditis 

 is fairly common. 



Diagnosis. — ^This may be most difficult, especially in children. 

 The cardinal points in the diagnosis are: — 



{a) Incipient Typhus. — (i) The sudden onset, with sometimes 

 headache, rigors, and vomiting. (2) The congested eyes and face, 

 and the subcuticular mottling of the skin over the chest. (3) The 

 mental confusion and stupor, associated with the log-like attitude 

 of the whole body. (4) The leucocytosis. 



[h) Fully Developed Typhus. — (i) The typical rash. (2) The 

 leucocytosis. (3) The history of the sudden onset, etc. 



Remarks on the Di-agnosis. — Leucocytosis averages 24,000 per 

 c.mm., and is present in proportion to the gravity of the illness; 

 it is therefore of double value, diagnostic and prognostic. It 

 persists through the fever, and declines after the return of the tem- 

 perature to normal, and reaches the usual count on or about the 

 twelfth day after defervescence. 



The differential count shows polymorphonuclear leucocytes 

 65-78 per cent., lymphocytes 23-34 per cent., mononuclear leucocytes 

 7-14 per cent. Eosinophile leucocytes are rarely met with, but in 

 rare cases may reach to 2-6 per cent. 



Weil- Felix Reaction. — From the blood of patients suffering from 

 typhus Weil and Felix isolated a bacillus, which they grew on 

 agar and called X^g, O. This was completely agglutinated hy the 

 serum of typhus patients. 



For the reaction the organisms must be grown on neutral agar 

 slants, and must be alive. Cultures of two to three days' growth 

 are best. The reaction is said to be positive on the sixth day of the 

 illness, and to be useful in retrospective diagnosis. Some observers 

 believe that the reaction is due to a mixture of the true virus with 

 B. pfoteus, but others consider it to be of the nature of a par agglu- 

 tination. The organism Xjg belongs to the Bacillus proteus group 

 of organisms. It is not suggested that the organism has any causal 

 effect in the production of typhus fever. It may give complement 

 deviation when used as an antigen with typhus serum, which'^is 



