=Definition.=—An acute, infectious disease; characterized by sudden
invasion, high fever, marked nervous symptoms, a peculiar maculated
and petechial eruption and a termination by crisis about the fourteenth
day.
=Etiology= and =Pathology=.—Typhus fever is becoming less frequent than
formerly and is rarely seen in this country. It was very destructive
during the Great War, particularly in the Balkan states. Filth,
over-crowding, famine, intemperance and bad food are the predisposing
causes. Typhus fever is highly contagious and is transmitted by the
pediculus corporis (cootie) as was first discovered by the American
Red Cross workers in Serbia. Probably infection may come by contact
and fomites. The specific organism is the bacillus typhi exanthematici
(Platz).
=Pathologically=, there are no constant lesions. There is a general
hyperplasia of the lymph follicles, but no ulceration. The blood is
dark, thin and lessened in fibrin. Hypostatic congestion of the lungs
and bronchial catarrh are frequently met with. The liver, kidneys and
spleen are found to be somewhat enlarged and softened. The petechial
rash remains after death.
=Symptoms.=—The =incubation period= is about twelve days. The onset is
usually sudden, ushered in by chills. The temperature quickly rises
to 104 or 105 degrees F. There is headache, pains in the muscles,
especially of the back, and early, profound prostration. The pulse
is at first full and strong, 100 to 140, but soon becomes weak and
frequent. There may be distressing vomiting. The face is flushed, the
eyes injected, the expression stupid, and there is generally low,
muttering delirium. The tongue is furred and white, soon becoming dry.
The bowels are constipated and the urine is usually scanty and of high
specific gravity. There is great thirst. Conjunctiva injected; pupils
contracted; early prostration.
The =eruption= appears about the fifth or seventh day. It first makes
its appearance upon the abdomen and chest. It rapidly extends all
over the body with the exception of the face. The eruption is of two
kinds—rose spots, which disappear upon pressure, and those which become
hemorrhagic (petechial); pressure has no effect upon them. During the
second week the symptoms are increased. The tongue is dry, brown and
fissured, and sordes appear on the teeth. Retention of the urine,
due to paralysis of the bladder, is common. The breathing becomes
more rapid and the heart’s action more feeble; the patient may die
from exhaustion. This ushers in the typhoid state with low, muttering
delirium, ataxic symptoms, subsultus, tremors, and maybe bronchial
symptoms. In favorable cases the crisis occurs at the end of the second
week. Patient sinks into a sound sleep, the temperature falls rapidly,
there is profuse sweating and a critical diarrhea but the patient now
gains rapidly.
=Convalescence= is usually rapid; relapses rarely occur. The urine is
scanty, high colored and frequently albuminous. Bed-sores are common.
The temperature continues high, reaching 106 degrees F., or more, with
slight nocturnal remissions. In fatal cases the fever often rises to
108 or 109 degrees F. just before death.
=Diagnosis.=—The sudden onset, frequent chills, early profound
prostration, character of the rash, history of exposure to the poison
and unhygienic surroundings decide the diagnosis. During an epidemic
there is usually no doubt, but in sporadic cases the diagnosis is
sometimes extremely difficult.
=Prognosis.=—This is usually grave, but the mortality rate is being
greatly reduced in consequence of the better sanitary arrangements.
=Treatment.=—Typhus fever is highly contagious and great care should
be taken in controlling the disease. Isolation, disinfection and
extermination is imperative. So far as known none of the osteopaths
have had experience in the treating of typhus fever osteopathically,
but there is no reason why the disease should not be treated with the
same success as is met with by osteopathic treatment in other diseases.
It is claimed that the disease should be treated in the open air, in
tents, as the recovery of the patient and the safety of the attendants
are greatly favored.
For high temperature, besides the treatment given to remove any
disorder that may be found, the general fever treatment is indicated,
and hydrotherapy would also be of aid—sponging the surface of the body,
or the use of the bath. Asthenia is wherein the greatest danger lies,
and a stimulating treatment along the spine and to the heart should be
given; although correction of the primary trouble may be sufficient.
Hydrotherapeutic measures, the systematic use of the cold bath, would
be of service the same as in typhoid fever.
Headache and delirium which are apt to arise, caused by too much blood
in the head, may be relieved by treatment of the cervical spine.
Also cold applied to the head will aid. The bowels should be watched
carefully; treat the splanchnics thoroughly and the intestines and
liver directly. Nourish the patient as in typhoid fever by nutritious
liquids—milk, broths, etc.
Although typhus is now a comparatively rare disease, an outline has
been given to emphasize what correction of unhygienic conditions and
insanitary surroundings will accomplish. It is particularly a disease
of filth.