40 
TYPHUS FEVER. 
Spotted (tick) fever, I think, more closely resembles typhus fever than 
any other disease, and cases of typhus fever occurring in a locality in 
which spotted fever pi’e vails would, without a blood examination and 
close bedside observation, cause much trouble in diagnosis. In typhus 
we have the longer period of incubation, absence of a histoiy of tick 
bites, the eruption which first appears on the abdomen and chest, its 
intensely contagious character, especially prevalent in the winter 
months, not limited to a short time in the spring, and marked nervous 
symptoms. As before mentioned, two cases of spotted fever have 
never been known to occur in the same famil}- the same season, thus 
conclusive!}" showing the noncontagious character of the disease. 
TREATMENT. 
Until the past season the treatment of the disease has been purel}" 
symptomatic, but after the discovery of the parasite Dr. Wilson and 
the writer suggested the use of quinine in large doses, preferabW 
hypodermatically. In five cases in which it was used systematically 
and in large doses the results were most happy, all recovering. Fiv^e 
cases which did not have the treatment died. Of course, 10 cases is 
too small a number on which to base very positive conclusions, ))ut I 
hope that the use of quinine will be followed in the future treatment 
of the disease. 
Quinine bimuriate, 1 gram, should be given hypoderniaticall}" eveiy 
six hours. If there is great objection to the use of the needle, the 
sulphate, 1 gram, every four hours may be given bv mouth; but the 
irritable condition of the stomach at times may prevent. The use of 
quinine should l>e begun as soon as the diagnosis is made and persisted 
with in decreasing doses as convalescence begins. 
Some of the A^alley ply^sicians seemed to fear that quinine depressed 
the heart and caused nervous symptoms; but I am of the opinion that 
the great good the drug does more than counterbalances these efi'ects. 
I strongly advise the early and continuous use of large doses of 
quinine. 
Some physicians speak well of calcium sulphide, and others of 
creosote. 
The heart should be supported with strychnine, whisky, or other 
appropriate cardiac stimulants. 
For the severe pain in the head and back during the first week 
Dover’s powders or morphine sulphate may be used. The patient 
should be encouraged to drink large quantities of water to flush out 
the kidneys. For the fever, warm sponge baths or packs are useful J 
and refreshing to the patient. After a bath the spots lose their dark ! 
