Volume 1
A text-book of medicine for students and practitioners / by Adolf v. Strümpell.
- Adolph Strümpell
- Date:
- 1911
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf v. Strümpell. Source: Wellcome Collection.
64/874 page 36
![the time, but great doubt has since been thrown upon the correctness of the diagnosis.] Course and Symptoms of the Disease.—If we try to sketch the characteristic behavior of typhus fever, especially as contrasted with typhoid, we may say that the disease begins much more abruptly and rapidly, and that the fever quickly becomes very high and the general disturbance very severe, but the illness lasts a shorter time, seldom more than two weeks, and, with a favorable course, passes by crisis into recovery. The duration of the period of incubation seems to vary. It is usually about twelve days—never less than four, or more than fourteen days. Sometimes, though not invariably, slight prodromata precede by some days the actual out¬ break of the disease. These are languor, anorexia, headache, and pain in the limbs. Then the regular illness begins, as a rule, rather suddenly, and often with a pronounced rigor. With this the temperature rises quickly, and may on the very first evening reach 104° or 105° F. (40° to 40.5° C.). Vomiting is not rare, and may be repeated. A grave general condition, with fever, is developed in a few days. The patient feels exhausted. There is often violent pain in the loins and extremities. Nervous symptoms soon appear: persistent and intense headache, vertigo, spots before the eyes, ringing in the ears, and in many cases quickly increasing stupor and delirium. In severe cases the fever often reaches 106° F. (44° C.), and may be even higher, and it is almost constant, with but slight morning remissions. The skin is hot and dry, the tongue dry and thickly coated, the respiration moderate, the pulse very rapid. We very frequently find in the chest the signs of an extensive bronchitis. Nasal catarrh and conjunctivitis also occur. Serious intestinal symptoms are generally absent. The spleen is almost always greatly enlarged. The urine is concentrated and scanty, and sometimes has a trace of albumen. There is usually a moderate leucocytosis (in contrast to typhoid fever). On the third to the seventh day of the disease the characteristic eruption appears. To this the disease owes its name of “ spotted fever.77 The eruption consists of rose spots, generally very numerous and widespread, upon the trunk and extremities, often also on the face. Sometimes the spots are larger, and may then bear great resemblance to a fresh eruption of measles. The skin between the separate rose spots is not infrequently diffusely reddened. After two or three days the roseolse become hemorrhagic, and change into lighter or darker petechiae. It is commonly only in the lighter cases that the rose spots fade away without first becoming petechial. In rare though well-substan¬ tiated cases the eruption has been scanty, or even wholly wanting. Herpes does occur, but only seldom. 4 he fever begins to abate in light cases as early as the second week, coin- cidently with an improvement in the general symptoms. Often this change is indicated about the seventh day by a considerable remission in the temperature. On the other hand, in severe cases, all the symptoms grow worse. The weak¬ ness increases. The nervous derangement reaches the extreme of a severe “ typhoidal state/7 expressed either by marked stupor, which sometimes passes into complete coma, or by violent delirium. Lobular pneumonia attacks the lungs, and the fever continues with unabated violence. These svmptoms may end with death, but in favorable cases they decline rapidly. Sometimes this decline is preceded by a great rise in temperature (perturbatio critica), espe-](https://iiif.wellcomecollection.org/image/b3136276x_0001_0064.jp2/full/800%2C/0/default.jpg)
