Typhus fever is now happily rare, only small outbreaks occasionally occurring. This is chiefly due to the general improvement in sanitation, and the fact that badly built and over-crowded hovels are gradually giving place to clean tenements and model dwellings.
Causes.—Typhus is met with in both sexes and at all ages, though it is rare in young children. Famine, bad food, dirt and over-crowding are all important factors in its production. In all probability the essential factor is a micro-organism, but this as yet has not been demonstrated. Neisseria petechialis is however found associated with the disease.
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 seems to vary from five to twelve days. The onset is marked by a severe headache, loss of appetite and languor, and aching of the limbs. For three or four days the patient gets worse, is unable to get about, and feels chilly and prostrate; he is then worse at nights and restless; the skin is hot, the tongue coated; there is thirst and sometimes vomiting. The patient then lies prostrate on his back, with a dull and weary if not stupid look; 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; the tongue dry, brown or black, and marked with cracks. The temperature rises from the first, and reaches 103° or 104° F. by the middle of the first week; the highest temperature reached in the fever is seldom less than 105°, although it may be higher. The fever may slightly abate, in favourable 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, usually takes place suddenly. The other symptoms then quickly disappear and convalescence is rapid, the normal temperature being reached in 24 hours. A rash appears in nearly every case. Sometimes it looks like a general mottling just beneath the skin, or distinct spots may appear of small size and purplish colour. 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.
Treatment.—The patient should be placed in a well ventilated room. The windows should be kept open, for the specific poison of typhus loses its potency when well diluted with air. The diet and treatment is the same as for any other infectious fever. When the temperature has fallen, fish and poultry may be added to the diet sheet.
Fever and delirium should be treated by cold sponging. Isolation should be continued for four weeks from the commencement of the attack.
Influenza—is the name applied to an acute febrile disease, which is always present in this country, but sometimes takes an epidemic form,
