1338 



TYPHUS 



To facilitate the diagnosis in cases of typhus with a faint rash Dietsch 

 recommends applying a rubber band round the arm. This procedure makes 

 the rash below the point of application more visible, and may cause forma- 

 tion of petechise. 



Prognosis. — ^The case-mortality is variously stated as being from 

 10 to 50 per cent. The signs indicative of serious trouble and grave 

 prognosis are the absence of eosinophils in the blood, decrease in 

 the number of the mononuclears, slow pulse, severe petechial erup- 

 tion or nervous symptoms, alcoholism, pulmonary complaints, 

 meteorism, gangrene, and cyanosis of the face. 



The signs indicative of a hopeful prognosis are an increase in the 

 eosinophiles and mononuclears, the absence of the petechial erup- 

 tion and slight nerve symptoms. 



Mortality is low in the young and extremely fatal in the old; 

 it is slightly more fatal in males than in females, while alcoholism, 

 kidney disease, are bad prognostic elements, as is a fat or very 

 muscular subject. Pregnant women generally abort, and this 

 complicates the chance of recovery. Complications are generally 

 serious in regard to prognosis. 



Treatment. — ^The patient should be placed in an airy, well-lighted 

 room, sparsely furnished, and placed upon a diet of milk, broths, 

 jellies, etc., while plenty of water is allowed to be drunk. Careful 

 attention and nursing are required, especially when delirious 

 The temperature should be controlled by cool sponging, and the 

 nervous symptoms by ice to the head, hyoscin, bromides, or mor- 

 phine, while the heart is supported by hypodermic injections of 

 strychnine, digitalin, etc. Nicolle finds that the serum of convales- 

 cent cases for ten to twelve days after the temperature has fallen 

 to normal has prophylactic and curative properties when given in 

 doses of 20 c.c, repeated if necessary, and has manufactured a 

 special horse serum for this purpose. He suggests that in grave 

 cases it should be given intravenously. Salvarsan and neosalvarsan 

 have been tried without any great success. 



Prophylaxis. — ^This is summarized in one word, ' lousing,' in which 

 we include the destruction of lice on the person and on the clothes. 



The procedure is sufficiently simple: the person goes into a room, 

 takes off the clothes, which are steamed or boiled, passes into 

 another room, and is sprayed with kerosene oil or petrol, passes 

 into a third room, and receives clean or sterilized clothes. 



The sterilization of the clothes may be conducted by boihng, 

 but better still by making them into lightly packed bundles and 

 placing them into a truck or room into which steam is blown. This 

 is easiest done in a truck, the steam being brought from the engine. 



A campaign against lice may be conducted on the following lines : — 

 A. Methods applied to Man: — 



I. Give illustrated lectures, so that people may understand about 

 the louse, its habits, its association with disease, and its 

 prevention. 



II. Advocate the use of soap and water and of the frequent bath, 

 as well as of clean linen frequently changed. 



