Typhus fever

“ But until the past year we knew neither the parasitic germ which causes typhus fever nor the mode by which it passes from one individual to another. A vague idea that it was spread through the air prevailed. Typhus is remarkable for the frequency with which [Pg 232] the nurses and doctors attending a case become infected. About 20 per cent. of those attacked by it die, but in persons above forty-five years of age the mortality is much greater—about half succumb.
Dr. Nicole and his colleagues of the Institut Pasteur in Tunis have recently had the opportunity of studying typhus there. ”

“ But Scrive says that this number of typhus-fever patients is too small; it must have been increased by the number of persons who contracted the disease in the field-lazarets and hospitals, 4,502 of whom succumbed to it, and the number who contracted and succumbed to it in Constantinople and France, making 7,000 all told. According to Scrive, therefore, the total number of deaths due to typhus fever in the French army was no less than 17,515, from which he assumes that at least 35,000 men contracted the disease. ”

“ The evidence in favor of the contagiousness of typhus fever is conclusive, and may be briefly stated as follows: When it breaks out in a community the disease not only attacks those persons who have been subjected to the same influence as the sick—as, for instance, members of [p. 344] their own families, occupants of the same house, etc.—but also those who have come from healthy localities to visit them. ”

“ While typhus fever is a disease of overcrowding and poverty, typhoid may occur where such conditions are entirely excluded; and the connexion of this malady with specific emanations given off from decomposing organic or fæculent matters, or with contamination of food or water by the products of the disease, is now almost universally admitted. Alike in sporadic cases and in extensive epidemic outbreaks the existence of insanitary conditions in house drainage, water supply, &c., can in the majority of instances be made out. ”

“ Other diseases which have occasionally been mistaken for typhus fever are remittent fever, Bright's disease, giving rise to uræmia and purpura. It does not seem likely that even the severest forms of malarial fever should ever present such a resemblance to typhus fever as to make the differential diagnosis a matter of difficulty ”

“ We have only to consider what is the chief channel by which the contagion gets exit from the system, to know by what means we are most likely to prevent its passing into the surrounding atmosphere. In typhoid fever the poison passes off in the stools; and what we have to do is to see that these are promptly and properly disinfected and disposed of. In small-pox, scarlet fever, typhus fever, and measles, it is eliminated by the skin, and we can not altogether prevent its getting into the atmosphere ”

“ But, to regard typhoid fever as contagious in the sense that small-pox and typhus fever are so, is to divert attention from the true source of danger, to lead to the adoption of measures which are uncalled for, to the neglect of those which are urgently required; is to cause unnecessary concern to the sufferer and his friends, and to deprive him and them of the mutual comfort and solace which a little daily intercourse affords. The peculiarities of the illness may be such as to make it right to exclude the friends ”

“ Accordingly, I warn all military physicians not to congregate all their typhus fever patients in a single room by themselves; for few would come forth from such a room alive, while the poisoned atmosphere of the room would pervade the entire lazaret, infect the physicians and attendants, and finally spread throughout the immediate neighbourhood. People think that they can prevent the disease from spreading by congregating and isolating the patients, but as a matter of fact this has the opposite effect. ”

“ But if the bacillus finds its appropriate food—dead or decomposing matter—in the glands, it at once takes up its abode in them and “begins housekeeping;” that is, it begins to multiply according to the method of fission of its cell and rate of multiplication, already described. During this process the multiplying cells excrete a toxin, which, being absorbed, creates a fever, the result of a true blood poisoning. This fever is called typhoid, because its prominent symptom, stupor, resembles that of typhus fever. The name, therefore, signifies nothing as to the nature of the disease. ”

“ As yet there have been no cases of typhus fever in the British Army in France, though it has occurred to a greater or less extent in Germany, Austria, Russia and Serbia. The quarantine services at the ports of the countries bordering on the Mediterranean have prevented it spreading to any other country.
Typhus fever is known as a dirt disease, and its control is possible through the plentiful use of soap and water. The most difficult thing for a soldier to obtain in the field is a bath. ”

“ Typhus fever, the scourge of modern Europe, may not originate in any condition of the soil produced by man, but it sweeps thousands in the prime of life from the earth when placed in circumstances clearly dependent on man himself. Ten thousand young men are lodged in a barrack; speedily hundreds of these are swept off by typhus or consumption of the lungs; now something causes this, and the cause may rest with man himself. Pestilence and typhus follow in the train of famine ”

“ During the early part of the present century it still occurred to some extent in this region, where it prevailed as an epidemic for the last time in 1841.
Typhus fever, like smallpox, is a disease which is transmitted by personal contagion, and its dissemination depends upon human intercourse. It prevails chiefly in temperate or cold regions, and is unknown in the tropics except at considerable elevations above the sea level. In temperate regions its season of greatest prevalence is the winter and spring. ”

“ In our own country typhus fever has appeared several times during the present century, but the outbreaks have rarely attained the magnitude of epidemics, such as are seen in Europe, and have usually been distinctly traceable to importation from abroad. ”

“ Typhus fever is very infectious, and is apt to attack those who are much exposed to it for the first time; therefore engage a nurse who has been previously attacked. The poison is thrown off by the skin and lungs and readily affects clothing, furniture, and everything in contact with the air of the room. ”

“ Very few attacks of typhus fever run their course without the occurrence of some pulmonary complication. When this is slight it demands no special modification of the previous treatment, and it is sufficient to apply mustard poultices or stimulating liniments to the chest. But in cases of greater gravity, it matters not whether the complication is bronchitis, congestion of the lungs, or pneumonia, a more active treatment is required. ”

“ Typhus fever may, however, prove fatal during any stage of its progress and in the early convalescence, either from sudden failure of the heart's action—a condition which is specially apt to arise—from the supervention of some nervous symptoms, such as meningitis or of deepening coma, or from some other complication, such as bronchitis. ”

“ In approaching a sick bed of this kind, a person not much accustomed to such visits will be very liable to receive the infection; and the unpleasant smell will be much sooner perceived than by the physician or other attendants. We conclude that a malignant typhus is more apt to generate contagion, because slight cases are found not to extend to others, even though no mode of precaution has been used. The disease itself is incapable of generating infection, till after a certain period ”

“ Epidemics of typhus fever have frequently occurred in various parts of Europe during the present century, although they have, on the whole, shown a greater tendency than before to confine themselves to the place in which they first appeared. ”

“ But simple prominence or congestion of Peyer’s patches may occur in typhus fever, or in relapsing fever; nor would a slight erosion, or “superficial ulceration” raise in all cases a suspicion of enteric fever.
The observations of Home, Reid’s predecessor as pathologist to the Edinburgh Infirmary, from 1833 to 1837, were however conclusive that true enteric fever had occurred now and again during the steady prevalence of typhus fever from year to year. In that space he made 101 post-mortem examinations in fever-cases ”

“ The prevailing diseases during the past season have been typhoid fever, dysentery, diarrhoea, scarlet fever, measles, and a few cases of variola.
Sixth Ward: The seeds of disease exist everywhere, and although removable and susceptible of sanitary control, they are yet uncontrolled, and at any time may spring into Seeds of Disease
Uncontrolled activity and a terrific life, that shall only have105 the power and effect of death. Cholera, when it visits these shores again, will first break forth here, if proper sanitary measures be neglected. Typhus fever nests exist in all parts of the district ”

“ If a score, or a dozen or half-a-dozen deaths in a week are set down to spotted fever, it probably means that a large part of the remaining hundred, or seventy, or fifty cases of “fever” not called spotted were really of the same kind, namely typhus. In the plague itself, the “tokens,” which were of the same haemorrhagic nature as the larger or more defined spots of typhus, were exceedingly variable [19] . One of the synonyms of typhus (the common name in Germany) is spotted typhus ”

“ The guinea pig is susceptible to the virus as well as the monkey but only shows temperature rise. Nicolle has shown that lice do not become infective until about the tenth day after feeding on typhus blood. The virus is found in the blood of man and in the spleen and blood of monkeys and guinea pigs.
Plotz has isolated a Gram-positive pleomorphic bacillus from the blood of typhus patients which has been named B. typhi exanthematici. This organism is of historical interest only and apparently has nothing to do with the causation of typhus fever. ”

“ With the differentiation of typhoid fever from typhus fever by Gerhard in Philadelphia in 1837, and by Stewart and W. Jenner in Great Britain in 1849, it became possible to associate the former with excremental, the latter with respiratory filth, “the non-removal of the volatile refuse of the human body.” The question still remained whether typhoid fever was producible by “emanations from decomposing organic matter,” whether it was “often generated spontaneously by faecal fermentation,” as contended by Murchison, who in 1858 proposed the name “pythogenic fever” for typhoid fever ”

“ One in ten is probably too small a fatality for the old pestilential fever; but that is the usually accepted proportion of deaths to attacks in the typhus fever of later times. The rate of fatality is got, naturally, by striking an average. But in truth an aggregate of typhus cases, however homogeneous in conventional symptoms or type-characters, was not always really homogeneous. We have seen that ninety cases of typhus could occur in the slums of Manchester with only two deaths. On the other hand there were outbreaks of gaol-fever in which half or more of all that were attacked died ”

“ This description of fever is usually termed typhus or nerve fever. It characterizes all forms of typhoid disease of which the following features constitute the prominent symptoms.
To a peculiar degree, chiefly young and strong individuals of from 15 to 30 years of age are attacked by this disease, while those in early youth and of more advanced years are much less subject to the same.
It is a complaint very dangerous to those who eat and drink to excess and without discretion. Strong excitement of the mind, such as a shock or great anguish, will undoubtedly favor the appearance of typhus. ”

“ The disease always began with a chill, and was characterized now by obstinate constipation, now by diarrhoea; no patient who survived the thirteenth day died. And even if an exanthema was not 144observed, there can be no doubt that it was typhus fever which raged in Kiel. Weber himself calls the disease contagious typhus.
4. The Appearance of Typhus Fever in South Germany Typhus fever was conveyed to various places throughout South Germany by the few soldiers that returned from Russia. ”

“ A man in robust condition must certainly become infected in a few weeks, and there was little hope for the recovery of the sick. All the worst disorders were to be found among the patients; scurvy, typhus fever, typhoid fever, acute bronchitis, rheumatism and syphilis. Only the patients affected by malignant typhus were isolated in a single ward. ”

“ In the same manner as pathologists disagree as to the question, whether the typhus and typhoid fever in man are one and the same disease, so should we long debate, without coming to an agreement, as to that which relates to the typhus and typhoid fever of the ox. ”

“ Walking typhoid is dangerous for that reason. The food must be of such nature that it is all digested. It must not leave lumps to press upon the sore places in the bowels causing more trouble there and more diarrhea.
[200 MOTHERS' REMEDIES] TYPHUS FEVER, (Filth Disease) .—Typhus fever is an acute, infectious disease, characterized by a sudden onset, marked nervous symptoms, and spotted rash and fever ending quickly after two weeks. Also called jail, camp, hospital, or ship fever. Filth has a great deal to do with its production. There is no real characteristic symptom except the eruption. ”