§ 71. General symptoms of typhus; diagnosis.

There is no violent chill in the commencement, but slow chills alternating with heat. The brain and nervous system are principally affected from the commencement, as may be inferred from the following symptoms: dulness and tightness of the head, gloomy mood, headache, vertigo, sometimes syncope, trembling, subsequent delirium, sopor, spasms of every kind, both external and internal; convulsions, great debility and prostration; small, feeble, soft, easily compressible, moderately frequent, sometimes slow, very variable pulse, which does not harmonize with the respiration; for instance, is rapid when the breathing is calm (Hufeland).

There are three kinds of more or less distinct forms of typhus:

1. Typhus cerebralis, affecting principally the brain, spinal marrow, or the nervous system generally. This variety of typhus is principally characterized by symptoms which denote a deep alteration of the functions of those organs without any inflammation being present; there will always be delirium, sopor, or paralysis of the organs of sense, when the irritative stage - great hurriedness in all the movements and manifestations of the senses - has passed over. At this stage of the disease there is the most remarkable difference in the quantity of blood contained in the brain and spinal marrow and their membranes, from extreme congestion to anaemia; sometimes those organs are compact and tenacious, sometimes they are inter-stitially distended.

2. Typhus abdominalis, where a portion of the abdominal organs is the principal seat of the disease. This variety contains a great number of shades and has a slow course. The brain is only gradually invaded; the cerebral disturbance manifesting itself with a certain rapidity in full-grown persons only, where the organs, which are the principal seat of the typhus, have attained a normal size without showing any striking changes in the reproductive functions. We now know from post-mortem examinations that the principal seat of the typhus abdominalis is the mucous membrane of the ileum which exhibits various forms of degeneration, congestion, infiltration, ulceration, induration, interstitial distention, softening, exanthe-matic spots, gastro-enteritis, open or cicatrized ulcers. Little by little the mesenteric glands and the spleen are likewise affected, becoming considerably enlarged, and from the spleen the affection frequently extends to the mucous membrane of the cul-de-sac of the stomach.

3. Pneumo-typhus, the organs of the thoracic cavity, especially the lungs, being principally affected. This variety of typhus frequently sets in in the shape of a catarrh, or of an imperfectly-developed and therefore not distinctly marked pneumonia; the heart and the larger vessels are sometimes affected. The patient complains of great anxiety, hurried, incomplete, labored breathing, with short, croaking, exhausting cough; the expectoration has a bad colour, is purulent and blood streaked; certain regions in the chest are more or less painful. A post-mortem examination reveals the following appearances: degeneration of the lungs by inflammation and gangrene, hepatization, adhesions, effusions in the mucous membrane of the bronchia and the parenchyma of the lungs; the heart is flaccid, pale or of a dingy-red. The diagnosis is not very difficult. The excessive prostration, the violent and universal irritation of the sensus communis, the appearances about the head (the humming and buzzing about the ears) the tendency of the fever to become continuous, inform the physician that the disease is not a simple catarrh but that there is an approaching typhus which although it may be kept in check for a time, will break forth in all its violence on the seventh day. The physical signs resemble those of croupous (catarrhal) pneumonia; the percussion-sound becomes more and more dull; auscultation reveals crepitation which, in the stage of hepatization, is changed to a consonant rattling.

The course of typhus is very irregular and uncertain; the precursory symptoms sometimes exist for days, even weeks, such as tightness and dulness of the head, vertigo, tremulousness of the extremities, headache, sleeplessness, dreams, even visions. Typhus may last from 21 to 28 days, and even longer; the convalescence is slow and the patient is liable to relapses.

§ 72. Typhus is divided into varieties according to its intensity, its type and complication. We distinguish a typhus mitior and gravior, a typhus continuus and remittens, a typhus simplex, inflammatorius, putridus, gastricus, rheumaticus, catarrhalis. In homoeopathic treatment such a classification has no practical value, as the selection of the remedy depends upon the symptoms of every case in particular, not upon the characteristic symptoms of the genus. Full-grown persons are more liable to typhus than children and old people.

The remote causes of typhus are: privation or bad quality of the necessary food, (hunger, famine, bad nourishment); air which has become vitiated by crowding a number of men into close rooms, or by uncleanliness: depletion by venesection, hemorrhage, etc.; exhaustion of the nervous power by excessive irritation, excessive exertions of the body or mind, venereal excesses, excessive heat, etc.; depressing emotions: chagrin, sadness, grief, care, disappointed love; nervous or putrid contagia, dampness, cold, an atmosphere which does not furnish sufficient sustenance to the vital forces and favours the development of an epidemic typhus; such an atmosphere arises from a continuance of wet weather and easterly winds.

§ 73. The prognosis depends upon the form of typhus, the typhus in our climate is less dangerous than the pest or yellow fever; also upon the stage in which we find the fever, a typhus which has been continuing for a time, is more uncertain than an incipient one; upon the course, the more regular the course, the more favourable the prognosis; upon the violence of the symptoms, constant delirium, floccilegium, subsul-tus tendinum, constant sleeplessness, colliquative secretions, sopor, difficult swallowing, are very unfavourable.