Skin:—
At the beginning of the second week small rose-like spots of a light rose colour appear on the buttocks (roseola typhosa), which later on are also found on the upper legs, upper arms and back. They soon disappear, however, and leave no traces.
Pustular eczema is so rare in cases of typhus, that as a rule its appearance is taken to indicate that the disease is not a case of abdominal typhus. Frequently, however, urticaria, (nettle-rash) perspiration and other pustules are to be noticed.
The great variety of symptoms indicates that innumerable peculiarities may occur in the course of typhus. In some cases it is so light and indistinct (walking typhoid) that it is extremely difficult to diagnose it. In other cases pneumonia or unconsciousness, headache or stiff neck are indicated so overwhelmingly, that it is well-nigh impossible to recognize the underlying illness as typhus. In such cases one speaks of lung and brain typhus.
Recurrence:—
In about 10% of all cases recurrence is observed, mostly caused through mistakes in diet, leaving bed too soon, and excitement. Usually in such relapses the fever takes the same course as the original attack, but is much less intense. Although such secondary attacks are not very dangerous as a rule, great caution should be observed, especially in regard to diet, which must be followed in the strictest way until all danger has passed.
Complications and Subsequent Troubles:—are very frequent and a serious menace to life.
The most important are hemorrhage of the brain, meningitis, erysipelas, gangrene of the skin and bones, wasting of the muscles, fibrinous pneumonia; pericarditis, and frequently weakness of the heart with its consequences.
Purulent inflammation of the middle ear is one which deserves special attention.
Loss of hair is a frequent occurrence during convalescence, owing to the ill-nourished condition of the skin; this, however, is but a temporary feature soon succeeded by renewed growth.