By the end of the first week the delirious or stuporous condition becomes more marked with a tendency to muttering delirium, tremors and subsultus, the coma-vigil of the older writers. Terrifying hallucinations may cause the patient to jump from the window and kill himself. There is a tendency to parotitis and otitis media connected with the mouth condition. On account of the circulatory weakness there is a tendency to gangrene of the extremities, especially the toes, rarely the fingers.
Fig. 143.—Temperature chart of typhus fever. (Pepper, American Text-book of Medicine.)
In cases which recover there is a critical change in the apparently desperate condition of the patient about the end of the second week, the sudden striking change for the better being more marked in typhus fever than in any other disease. At this time the urine changes from a high-colored, often albuminous one, to an abundant secretion of more or less normal character.
The sporadic mild cases of typhus, which occurred from time to time over a period of years in New York, were known as Brill’s disease. According to Brill these cases showed intense headache, apathy and prostration, with a continuous fever, maculo-papular eruption and a rapid lysis or critical fall of temperature at the end of about fourteen days. The spots only rarely became purpuric. There was almost never marked delirium and the mortality was less than 2%.
Symptoms in Detail
The Eruption.—This first appears about the fourth day as macules about loins, then spreading over abdomen, chest and back. It is often more pronounced on the back than elsewhere. It almost never appears on the face but may occur on the palms and soles. It has a resemblance to the rash of measles. At first disappearing on pressure it soon becomes permanent and then petechial. The livid color of the rash has brought about the designation “mulberry rash.” The rash lasts from a few days to two weeks.
The Fever.—The fever rise following a chill is much more rapid than in typhoid fever, reaching its fastigium in about three days. A more or less continuous range of fever (103° to 104°F.) follows until about the fourteenth day, when there is often a rapid lysis or possibly crisis, at which time the patient tends to fall into a refreshing sleep and to show a rather marked diuresis.
The Alimentary Tract.—Constipation is usually noted. Very marked is the tendency of the mouth and tongue to become dry and sordes to collect on the teeth. The dry black tongue has led to the designation “parrot tongue.” It is difficult to get the patient to protrude his tongue when told to do so.
The Circulatory System.—Very outspoken is cardiac weakness due to myocardial degeneration. The heart sounds are very weak and the pulse feeble. The blood pressure is very low, especially the diastolic. Bradycardia may be marked during convalescence.