The general appearance of a Typhus patient is very characteristic, and affords a very ready means of diagnosis. In an average attack the patient lies prostrate on his back, with a most weary and dull expression of face, his eyes heavy, and with some dusky flush spread uniformly over his cheeks. In the advanced stage of a severe attack he lies with his eyes shut or half-shut, moaning, and too prostrate to answer questions, tom protrude his tongue, or to move himself in bed; or the mouth is clenched, the tongue and hands tremble, and the muscles are twitching and half rigid. The dryness of the mouth, the sordes on the teeth and lips, the hot, dry skin, and the deafness, or other symptoms which strike an observer so immediately as to deserve to be included in the physiognomy of the disease (G. Buchanan, M.D.).
During the first week the patient complains much of headache, noises in the ears, and, consequently, deafness; the conjunctivae are injected, the pupils contracted,
DIFFERENCE BETWEEN TYPHUS AND ENTERIC
(TYPHOID) FEVER.
TYPHUS.
1.– Come on quickly, after incubating about nine days, or less.
2.– Occurs at any age.
3.– Is rare among the wealthy classes, excepting doctors, students, and visiting clergyman.
4.– The eruption is of a MULBERRY COLOUR, comes out in a single crop, about the fourth or fifth day, and lasts until the termination of the disease. The spots generally appear first on the extremities.
5.– The brain is chiefly affected, and the bowels are often but little so; the abdomen is natural, and the evacuations dark, but never bloody (These symptoms are occasionally reversed).
6. There is a dusky blush on the face, neck and shoulders, injected eyes, and contracted pupils.
7.– Runs its course in about a fortnight.
8.– Relapses are of rare occurrence.
9.– The tendency to death is by Coma, or Congestion of the lungs.
10.– Typhus arises in conjunction with destitution and overcrowding, with defective ventilation, and spreads by contagion.
ENTERIC.
1.– Commences slowly and insidiously, the period of incubation lasting about thirteen days.
2.– Is most common in youth and childhood; rarely occurs after forty.
3.– Is as common among the rich as the poor.
4.– The eruption consists of ROSE-COLOURED spots, few in number, situated generally about the abdomen; comes in successive crops;. beginning generally on the sixth day, which in their turn fade and disappear.
5.– The bowels are chiefly affected, the evacuations being ochre-coloured and watery with congestion of the intestinal mucous membrane, sometimes haemorrhage, or even ulceration, and the abdomen is tumid.
6.– The expression is bright, the hectic, blush is limited to the cheeks, and the pupils are dilated.
7.– Continues at least three weeks, and if relapses occur of the five or six, or even more.
8.– Relapses frequently occur, especially in certain epidemics.
9.– The tendency to death is by Asthenia, Pneumonia, Haemorrhage, or Perforation of the intestine.
10.– Enteric, arises from bad drainage and poisoned drinking- water — as from a drain leaking into a well or through milk, when milk has been adulterated with infected water, or milk cans washed out with it.
eyes painfully sensitive to light, and therefore often closed. He becomes irritable, and his answers short and fretful. After the lapse of a short period, usually between the fourth and eight days, the mind passes from a state of excitement to one of delirium. This symptoms is usually more severe, and appears earlier, when the disease attacks persons in the upper classes of society, in consequence, no doubt, of the greater activity of their brains. This is especially the case with confusion of ideas as to time, place, persons, and even personal identity, with vague, rambling talk, of which occasionally he seems conscious, nd from which he can be roused. Afterwards the delirium may become active nd maniacal, or low and muttering. The patient often fancies that he is two or three persons, and the subject of a series and miseries and violence; confined in a dungeon, pursued by enemies from whom he vainly flies, or with whom he struggles; and he attempts to spring from bed to reach the door or window to fly from his tormentors. Sometimes the delirium passes into a heavy stupor, with tremulousness of the tongue and hands and twitching of the muscles (subsultus tendinum); but in favourable cases it subsides in two or three days. Improvement sometimes sets in quite suddenly. Between the thirteenth and seventeenth days the patient may fall into a long, deep, quite sleep, awaking in twelve or more hours quite refreshed. The powers of the mind begin again to dawn, the countenance assumes a more tranquil aspect, sleep becomes natural, and at length convalescence is fully established.
Diarrhoea sometimes occurs, but at other times the bowels are confined; the evacuations are natural or dark (contrasting strongly with the yellow ochre colour of the stools in Enteric fever), and may be involuntary.
THE PULSE.– In Typhus the pule is rarely less than 100, sometimes 120, 130, or even 140 in the minute. In the last case, however, in adults, it is indicative of great danger. As a rule, the pulse pursues a gradually increasing rate of frequency up to the ninth or twelfth day, and afterwards undergoes, in favourable cases, a somewhat sudden decline. Cases so marked almost invariably get well. On the other hand, departures from the gradual rise in the pulse, especially if considerable, mark the existence of complications or dangerous symptoms. In fatal cases of Typhus the pulse become more and more rapid, and also weaker and smaller, up to the very hour of death. The first glimpse of dawning convalescence is afforded by watching the pulse (the temperature, as measured by the thermometer, is a valuable but less available sign), and whenever the pulse is fairly on the decline, especially if it becomes stronger and fuller, we may confidently conclude that the patient will recover. The crisis of Typhus is often indicated by no other symptom than the fall of temperature indicated by the thermometer, and the decline of the pulse after having gradually reached its maximum degree of rapidity. There may be no marked perspiration, no critical diarrhoea, no striking alternation in the urine, or notable phenomena of any kind besides.
THE ERUPTION. The Typhus rash appears between the fourth and seventh days, and consists of irregular, slightly elevated spots of a mulberry hue, which disappear on pressure, and may be singly scattered and minute of numerous and large; in the latter case two or more spots coalesce. They are usually first seen on the abdomen, and afterwards on the chest and extremities. Murchison says the spots generally appear first on the extremities, especially the wrists and arms. From the first to the third day after the appearance of the rash no fresh spots appear; but each spot, although it undergoes certain changes, continues visible till the whole rash disappears and the disease terminates. The first three days of the Typhus spots are temporarily obliterated by the pressure of the finger, but after that time they nare indelible, thus differing from enteric spots, which may be at any time momentarily obliterated by such pressure. In fatal cases the Typhus spots remain after death.
ODOUR. The odour of Typhus patients is characteristic. It is offensive, pungent, and ammoniacal. Nurses familiar with Typhus are thus alone able to recognize it, and they estimate the amount of danger by the badness of the smell.
NERVOUS SYMPTOMS.– It is from the constancy and prominence of these symptoms that the name of Typhus ( stupor) was first employed; and it is almost certain that it is through the nervous system that the poison of the disease chiefly operates. Hence extreme restlessness ringing noises in the ears, and low delirium or stupor, are invariably present to a greater or less extent. In fatal cases, about the ninth or tenth day delirium merges into profound coma, or the condition described as coma- vigil may come on. In this latter condition the patient lies on his back with his eyes open, and certainly awake, but indifferent or insensible to everything transpiring around him. His mouth is partially open, his face expressionless, and he is incapable of being roused. The contents of the bladder and rectum are evacuated involuntarily. At length the breathing becomes nearly imperceptible, the pulse rapid and feeble, or it cannot be felt, and the transition from life to death occurs without any gleam of returning consciousness, and can only be recognised by the eyes losing their little lustre, and the chest no longer performing its slow and feeble movements.
UNFAVOURABLE INDICATIONS.– Early, furious, and persistent delirium, with complete sleeplessness; coma-vigil; convulsions; involuntary twitchings of the muscles of the face and arms; abundant and dark rash nearly unaffected by pressure; great duskiness of the countenance, or lividity of the surface; involuntary, uncontrollable diarrhoea; pus in the urine, or Albuminuria; a brown, hard, tremulous tongue; a temperature gradually rising to 107 degree, F., or higher; a great, sudden elevation of temperature in the third week; a small, weak, irregular, or imperceptible pulse, stationary at above 120 degree, bed sores, inflammatory or erysipelatous swelling, and other complications; a strong presentiment of death on the part of the patient, etc. The prognosis is far more favourable in children from ten tom fifteen years old, in whom the mortality is very small, than in patients over fifty, for then the mortality is very great.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."