Symptomatology
The period of incubation varies from five to fifteen days, usually, however, about twelve days. The period of onset may cover about two days, during which time the patient has headache, giddiness, backache, anorexia, perhaps nausea, and general malaise. There may be rigors or chilly sensations.
Fig. 142.—Female Pediculus corporis.—(Schamberg After Kuechenmeister.)
About the end of the second day the temperature rises fairly rapidly to become 103° or 104°F. by the third or fourth day. With the rise of fever the face becomes flushed, the eyes injected and the expression apathetic. The headache is usually quite severe and may be frontal, occipital or generalized. The temperature remains elevated with slight morning remissions for from twelve to fourteen days when it may fall by crisis or more gradually by rapid lysis.
Well-marked prostration and cardiac weakness are early noted. There is a tendency to constipation and the mouth becomes foul and the teeth rapidly covered with sordes, unless the greatest precautions in oral cleanliness are observed.
There is a marked tendency to clouding of the consciousness. At times the disease shows an abrupt onset rather than that described above.
The eruption first appears about the fifth day and shows as slightly elevated rose spots, which at first disappear on pressure, but quickly tend to become permanent and later purpuric. The eruption first appears in the flanks and then extends to the abdomen, chest and later to the extremities.
The term mulberry rash is sometimes used to describe the rash of typhus. In addition to the above there is a subcuticular mottling.
Along with the appearance of the rash the symptoms become aggravated, the effect on the heart is more marked and the pulse becomes feeble. The face is often dusky. There may be a bronchial catarrh with an annoying cough.