Typhus Fever.

This disease presents an extreme similarity to the one just
described — typhoid — as is indicated by the respective names. Indeed,
it was for a long time uncertain whether they were really two sepa­
rate and distinct diseases, or were merely two manifestations of the
same disease. The question, however, has long since been decided,
not only by a closer study of the appearance of the disease, but
also by the evidence that they occur under different circumstances
and from different causes. Typhoid fever occurs, as has been stated,
not only as epidemics, but also in sporadic or scattered cases, which
may occur in any class of society, and among individuals whose
hygienic surroundings are good. Typhus fever, on the other hand,
is almost always traceable to the accumulation of the effluvia from
human bodies, especially when closely crowded. It occurs in the
crowded and filthy quarters of towns, in ill-kept jails, on board
ships, and in military camps. It is especially frequent in the winter,
because during this season people are more closely crowded in these
locations, and spend a greater number of hours per day in the close
and foul air of their dwellings. So common, indeed almost ex­
clusive, is the origin of this disease in crowded quarters, that it is
variously termed ship fever, jail fever, and camp fever. In our
country it is usually confined to the large cities on the sea coast, to
which it is brought by ships, especially by the emigrant vessels
arriving from Ireland. This is well illustrated in an epidemic which
occurred in the years 1861-5, in New York city. A committee of
the Medical Board of Bellevue Hospital, appointed to investigate
the origin of the disease, ascertained that the first case observed
was that of a child who had come from Ireland to this country two
weeks before the development of the disease. From this child the
fever attacked other individuals in the same tenement house and in
an adjoining building, so that sixteen cases of the disease occurred
in the two ^houses within three months. During the two succeeding
years the cases of typhus fever which were received into Bellevue
Hospital came almost entirely from these houses and their immediate
vicinity.

Unlike typhoid fever, the disease under discussion is eminently
contagious. While typhoid fever seems to be communicated through
the discharges of the patient, and by the use of infected drinking
water, it is by no means established that it is ever acquired by
simple contact with a sufferer from the disease ; typhus fever, on
the other hand, is readily communicated by simple presence in the
patient’s room. This was well illustrated in Bellevue Hospital,
during the epidemic to which reference has already been made. At
this time there were in the hospital twenty-two resident medical
officers, of whom fifteen were attacked by typhus fever ; ten of these
fifteen acquired the disease while performing medical duty in the
fever wards, two others while taking care of an associate who had
contracted the disease. Quite a number of the hospital attendants,
and of patients admitted to the hospital for other complaints, also
contracted the disease. Yet immediate contact with a patient seems
to be necessary, and even then the danger of contagion is much dim­
inished if the room be well-aired and ventilated.

Symptoms*—The stage of incubation seems to be somewhat
shorter than that of typhoid fever, and the patients are usually com­
pelled to take to bed within two or three days after the manifesta­
tion of the first symptoms. During this time the appearance and
history of the case are essentially the same as in typhoid fever, with
the exception of one feature : the signs of intestinal difficulty—
diarrhea, pain, tenderness, and swelling of the abdomen — are
usually absent. The countenance usually exhibits the same features
as in typhoid, except that mental activity is arrested earlier in the
disease, and hence the dull, listless expression is earlier exhibited.
The delirium and prostration are manifested earlier, as a rule, than
in typhoid fever. The tongue presents less frequently the brown,
glazed, fissure appearance characteristic of typhoid, but is more
commonly covered with a thick black coating. The symptoms
indicating inflammation of the bowels, characteristic of typhoid
fever, are usually absent in typhus; hemorrhage from the bowels
and perforation of the intestines are accordingly rare events.

The skin, too, usually presents a marked difference between the
two diseases. An eruption very similar indeed to that of typhoid,
but more profuse and generally distributed, is, in the great majority
of cases, present at some period in every case of typhus fever. The
spots, too, are not raised as in typhoid fever, but are simple dis-
colorations of the skin which cannot be distinguished by the finger
from the surrounding skin ; they are smaller than the papules of
typhoid, do not come and go as in the case of the latter, and
sometimes terminate in small hemorrhages.

Typhus fever is usually of shorter duration than typhoid, the
average period being fourteen to sixteen days. It attacks adults
more frequently than children, though the latter are by no means
exempt.

Treatment.—The general principles recommended for the
treatment of typhoid fever are applicable also to this allied affection,
yet one feature, important as it is in the treatment of typhoid, is
absolutely essential in all cases of typhus fever, and that is fresh air.
The accumulated experience in hospitals, camps and jails shows
that the mortality is immensely reduced by treating these cases in
open air, tents, or sheds, the other essential remaining essentially
the same. During the New York epidemic, already referred to, the
average mortality in the hospital wards was one case in six, while
in the tents on Blackwell’s Island it was but one case in seventeen.

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