A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck.
- Adolph Strümpell
- Date:
- 1901
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![fever, and in a number of complications which may appear in both. There is, however, an essential difference in the whole course of the two diseases, and espe- cially in the circumstance that the intestinal lesion which is characteristic of typhoid is never seen in typhus. The chief distinction between the two affections, which must undoubtedly lie in the difference in their causes, can not yet be dem- onstrated. We do not yet know the organized pathogenic agents of typhus fever, although it must be presupposed that they exist. .Sltiology.—As to the way in which infection occurs, we have much less infor- mation even than in relation to typhoid. We know nothing as yet as to the supposed specific agents which produce typhus, although micro-organisms have been repeatedly found in the blood. It is an incontestable fact that the appear- ance of typhus in a place previously free from the disease is always to be referred to an importation of the pathogenic poison from without. It is likewise deter- mined, through numerous observations, that typhus is one of the contagious dis- eases—that is, that the specific poison can be directly transferred from the patient to others around him. How it is transferred we have no certain knowledge. Per- haps the poison is contained in the expired air; or, as is still more probable, in the scales of epidermis; or, perhaps, in the other excretions and secretions of the patient. We are equally ignorant through what channel the infectious agent enters the system—whether it is inspired or swallowed. It is certain that the poison may be transferred in the clothes, etc., of the patient (fomites). Favorable hygienic surroundings decidedly diminish the contagiousness of typhus fever. For example, in the well-ventilated pavilions of the Leipsic hos- pital there have rarely been cases of transfer of the disease to physicians, nurses, or other patients. On the other hand, if the hygienic influences be unfavorable, typhus fever may appear in very widespread epidemics. Those terrible epidemics which have been described under the names of famine fever, camp fever (Hungertyphus, Kriegstyphus), etc., were for the most part typhus fever. In the smaller epidemics it is often possible to trace the disease to some wretched, over- filled tenement-house. At present typhus fever appears constantly in Great Britain. Ireland has been notorious for many years as a breeding-place of the disease. It is also frequent in the eastern part of Germany (Posen, East Prussia and West Prussia, Silesia), in Poland, Galicia, Russia, and in parts of southern Europe. The isolated cases which occur every year here and there in central Germany, though more or less numerous, are, almost without exception, to be referred to an importation of the disease. Typhus fever attacks by preference young adults of twenty to forty years; but it occurs in children, and is comparatively frequent in elderly persons. There is no marked dependence of the epidemics upon any particular season of the year. As in the case of typhoid fever, a person who has once had the disease seems to enjoy immunity from any fresh attack. [The practical acquaintance of American physicians with typhus fever is, for- tunately, limited. Many of the outbreaks which have occurred were traceable to immigrants, especially from Ireland. During our civil war the disease broke out neither among the armies in the field nor among the prisoners of war. A number of cases were reported at 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 generally passes by crisis into recovery.](https://iiif.wellcomecollection.org/image/b21206296_0059.jp2/full/800%2C/0/default.jpg)
