This is a highly contagious fever, attacking people of all ages, which occurs in an epidemic form, and generally in periods of famine and destitution. It has been known at different times under different names; thus it has been called pestilential fever, brain fever, putrid continual fever, camp fever, jail fever, &c.

Typhus is chiefly met with in cold and temperate climates; never in the tropics. The chief cause is contagion, or the transmission of the disease from one person to another; the other causes so called, such as mental depression, overwork, anxiety, insufficient food, overcrowding and bad ventilation, only render the system more liable to the action of the poison. It is very rare for a person who has had the fever once to have it a second time. Habits of intemperance increase the danger of those attacked: corpulent people die more frequently than thin ones; black people more than white; and those who are overworked and suffer from mental worry have the disease with most severity.

Symptoms

It is difficult to say how long the disease may be incubating in the system before it appears, but the period is certainly not constant, and it seems to vary from a few hours to several days. The onset is marked by a severe headache, loss of appetite and languor and aching of the limbs; the invasion of the symptoms is not so sudden as in relapsing fever, but much better marked than in typhoid fever. For three or four days the patient gets worse, being unable to go about, and feeling chilly and prostrate; he then is worse at night and restless; the skin is hot, the tongue coated; there is thirst and sometimes vomiting; by the third day of the disease most are obliged to take to their bed, while this is not the case in typhoid fever, which is a much more insidious disorder.

There is a general aspect of a typhus case, which an experienced person will at once recognize; the patient lies prostrate on his back with a dull and weary, if not stupid, expression; the eyes are suffused and watery, and a dusky flush overspreads the face. As the disease progresses the eyes are half shut and the mouth open; he lies moaning and unable to move himself or answer questions; the lips and teeth are dry and covered with sores and look black; the mouth is dry, the tongue dry, brown or black, and marked with cracks. The temperature rises from the first, and reaches 103 degrees or 104 degrees Fahr, by the middle of the first week; the highest temperature reached in the fever is seldom less than 105 deg., although it may be higher, but the higher the point reached the greater is the danger; the fever may slightly abate, in favorable cases, about the ninth or tenth day; no marked fall, however, takes place until the end of the second week, and generally on the fourteenth day, when defervescence may take place suddenly and the normal temperature (98.4 deg.) be reached in twenty-four hours, but more commonly it takes two or three days for the descent to be accomplished.

The temperature generally is highest of an evening; when defervescence occurs, the temperature always goes below the normal line so as to mark 97 deg. or even 96 deg., and in a few days it becomes natural. This fall is a very good sign, and then the patient is generally out of danger. A very high temperature (406 deg. or 107 deg.) is a serious sign. In mild cases the fever begins to leave on the twelfth day in many cases. The pulse is generally 120 in a minute, but is very easily compressed under the finger: the heart sounds, in very severe cases, are feeble, and the first sound may even be inaudible. A rash appears in nearly every case and is very characteristic; sometimes it looks as if there were a general mottling just beneath the skin, or distinct spots may appear of small size and purplish color; they are irregularly rounded, at first may disappear on pressure, but soon become patachial; oftentimes the two kinds occur together, but sometimes separately. The rash appears on the fourth or fifth day, rarely later: it comes on the back of the wrists first, in the armpits and over the epigastrium; then it more or less covers the trunk; it seldom comes on the face and neck; the rash has something of a measly look, but the other symptoms are much more severe than are seen in measles; the rash lasts a variable time, but generally until the fourteenth or fifteenth day.

No solid food can be taken, but the patient is always thirsty. The bowels in some cases are confined, in others they are open too much. There may often be heard rattling or wheezing noises in the chest, and the more so when the face is very dusky. The nervous symptoms are well marked; restlessness, loss of sleep and confusion of thought first come on; then headache, giddiness, a buzzing in the ears and deafness; in most cases there is delirium, and the patient is beset with horrid fancies. In bad cases he lies picking the bed clothes, twitching his hands and muttering to himself or moaning; or he may be quite unconscious, with wide open eyes, staring vacantly. Loss of the power of swallowing and insensibility are very bad signs and generally precede death. The urine is passed involuntarily as well as the motions in most cases, so that great cleanliness has to be observed. The duration of typhus may be from three to twenty-one days, but about fourteen or fifteen days is the average time; if a case live more than this time, it will generally recover. The termination in recovery is sometimes quite rapid, and the tongue will clean,  the temperature fall and the delirium cease in a day or two, but generally the improvement is more gradual and lasts over three or four days. Unlike typhoid fever, there is no relapse, so that when once the temperature has come down the best hopes may be entertained; nor is one liable to peritonitis or perforation of the bowls, as in typhoid fever.

Treatment

The patient must be placed in a large, well ventilated room, where draughts may be avoided; he should have his bed so situated that the light from a window will not fall upon his face, as this is annoying; all curtains, carpets and bed hangings should be at once removed: the bed should not be too soft, and a Macintosh or India rubber sheet should be placed under the patient. He should not be allowed to exert himself in any way, as it is absolutely necessary that he husband all his strength. The greatest cleanliness must be observed and all excreta removed at once, and carbolic acid or chloride of lime should be mixed with them: soiled linen should be put into a tub containing some carbolic acid. Bedsores are very liable to form on the back, and so the nurse must always be on the lookout and try to prevent them by smoothing the sheets, drying the patient and rubbing brandy and balsam of Peru over the part; better still to have a water cushion or water bed. The skin may be sponged down with tepid water, one part being sponged at the time, so as to prevent any undue chill of the surface from exposure; this relieves the patient and partly counteracts that disagreeable smell which the skin gives off in typhus cases.

None but the nurse and doctor should see the patient; all noises must be stopped and perfect quiet enjoined; at night there may be a small light in the room, but so placed as not to disturb the patient. Milk must be the chief article of diet, and is best given cold; an egg or two may be beaten up in it, and three or four pints of milk may be given in the twenty-four hours; this must be done at regular intervals of two hours, in equal quantities, special care being taken that it is given at night and in the early morning, when prostration is greatest.  Beef tea and broths, jellies, extract of beef, custard, &c., may be given if the patient can take them and wants them. For drinks in the early stage, lemonade, cold tea, or soda water may be given, but do not let him have too much effervescent drinks; in bad cases the nurse will have plenty to do to get the milk down.

Stimulants are very useful, but the quantity must vary with each case and be left tot he doctor's judgment. Brandy is the best stimulant, and may be given with iced milk; too much must not be given at first, as it causes oppression and inability to take nutrient food; but afterward, in the stage of great prostration, its proper and careful administration may save the patient's life. Albumen is often present in the urine in typhus, but calls for no special treatment. Much care must be taken, however, that there is no retention of urine in the bladder, as that organ is very likely to be paralyzed. When the crisis has passed and the tongue cleans, some boiled mutton may be given; also jellies, custards, light puddings, &c. The stimulants may then be diminished. If, however, convalescence is retarded by bedsores or the formation of abscesses, the stimulant must be continued and solid food given sparingly. In some cases of typhus the mind is childish for some time after recovery, but a trip to the country, good food, and plenty of fresh air will complete a cure. In order to prevent typhus spreading the patient must be completely isolated.