This section is from the book "Smith's Family Physician", by William Henry Smith. See also: Natural Physician's Healing Therapies: Proven Remedies that Medical Doctors Don't Know.
The delirium is peculiar. The patient wanders, at first, in the night only, and the delirium commonly shows itself on his awaking from disturbed sleep. Sometimes he is desirous of getting up, and talks incessantly and earnestly in a loud voice, and can only be kept in bed by the imposition of some restraint. Usually, however, his rambling is of a tranquil kind, and without agitation. His mind seems elsewhere; he is inattentive to all that passes around him; but he lies still, muttering disjointed sentences, like a man talking in his dreams. From this state he may sometimes be roused by loud speaking addressed to him, or by the sight of a strange face; so that though incoherent and delirious just before, he may become collected when his medical attendant enters the room. But he soon relapses. The patient is generally deaf. Imperfection or loss of sight is rarer, and much more alarming than deafness; yet the eye is generally dull. Sometimes, as the disease advances, black spots like flies on the wing, appear before the patient's eyes: he attempts to grasp or catch these in the air, or to pick them from the bedclothes. After these symptoms, recovery is not common. The mouth and tongue are dry, yet the patient no longer complains of thirst. The taste, the smell, the sense of touch are all impaired. One trivial, yet expressive mark of this dullness of the senses, mentioned by a recent author, is that the flies crawl unnoticed, over the patient's face. Even external ulceration may occur, especially about the hips and back, and go on to gangrene without eliciting any complaint of pain from him. He seems altogether careless about the issue of his disorder, and, if you ask him how he is, will probably declare that he is quite well.
This is also a bad sign.
As the patient is apt to pass both his faeces and urine involuntarily, it is necessary that great attention should be paid to keeping him clean and dry, to prevent ulceration of skin, and also to ascertain by examination over the region of the bladder that it does not get over-distended with urine, as much mischief might thus arise.
The eruption which is peculiar to and distinctive of Typhus fever is called by Sir William Jenner the Mulberry rash. It commences usually from the fifth to the eighth day of the disease: sometimes later; occasionally earlier. After the third day of the eruption no fresh spots appear. It consists at first, of very slightly elevated spots, of a dull crimson colour. Each spot is flattened on its surface, irregular in outline, fades insensibly into the hue of the surrounding skin, and disappears completely under the pressure of the finger.
In two or three days these spots undergo a marked change. They are no longer elevated, become darker, dingier, and rather more defined: and now they fade only without disappearing, on pressure. From this condition the spots in most instances, grow paler, pass into faintly marked reddish-brown stains, and finally disappear. Sometimes a third stage is reached. The centres of the spots take a dark purple colour, and remain unaltered by pressure, although their outer edges fade; or the entire spots change into true petechias, that is, into spots of a deep crimson or purple colour, quite flat, with a well-defined margin and unaffected by pressure. The spots occur most frequently on the back, at the bend of the elbow and in the groin; now and then they are seen on the face. Each spot remains visible till the whole rash disappears. To this rule there is one exception. The eruption sometimes shows itself first on the backs of the hands, and leaves those parts within twenty-four hours. When numerous, the spots have not all the same depth of colour; some being paler than others; hence the surface has a mottled look.
On account of the eruption, the disease has frequently been called the spotted fever.
With respect to the Mulberry rash, Sir William Jenner states that in patients less than 15 years old, it is mostly either absent or pale in hue, and scanty in quantity. And the mortality from Typhus at this early age is comparatively trifling, not more than 2 or 3 per cent.: while in persons more than fifty years of age, it is about 56 per cent., and in them the rash is always present, and ordinarily dark and abundant. Among 25 fatal cases of Typhus Fever noted by Sir William Jenner, 9 deaths only occurred after the 15th day; not one after the 20th.
As the disorder approaches its fatal termination, symptoms which are not unfitly called putrid very often show themselves; a peculiar fetor is exhaled by the patient's body; his tongue becomes dry, black and fissured; and he is perhaps unable to protrude it when asked to do so; his teeth are covered with dark, sticky sordes; sloughs form from the mere pressure of the bed on which he lies; in extreme cases the toes have mortified; and Dr. Roupell relates one terrible instance in which both legs rotted away to the bones, which it became necessary to saw through: yet this patient recovered. Besides the fetor mentioned above, which is probably caused by commencing decomposition of the bodily tissues, Typhus Fever, after the first week, has, like small-pox, a characteristic odour of its own, by which nurses learn to know it. It is likely, as Dr. Murchison suggests, that the vapour which imparts this smell imparts with it the Typhus poison.
During the third week of Typhus Fever, the patient's chance of recovery improves; unless indeed some local mischief which preexisted, or which has sprung up during the course of the fever, shuts out or obscures this more favourable view.
When the disorder is about to end favourably, the more formidable of the symptoms diminish and abate; often almost suddenly, after perhaps a prolonged and quiet sleep, he wakes up an altered man; begins again to attend to questions that are put to him; the air of stupor which has hung over his countenance clears away; he once more shows an interest in what is going on around him the temperature of his skin becomes more natural; the tongue moist and cleaner at its edges; appetite returns; and the pulse becomes slower. The evacuations from the bowels gradually regain their natural qualities; and the patient is aware when the necessity for passing them or for emptying his bladder arrives, and he gives notice, or asks for assistance. Generally, at the same time with these tokens of improvement, the emaciation which has taken place becomes remarkably conspicuous.