A Treatise on Fever

by Southwood Smith

Of Typhus: Division into Mitior and Gravior, and into Cerebral, Thoracic, and Abdominal. Typhus Mitior, with Subacute Cerebral Affection; with Acute Cerebral Affection; with Thoracic Affection; with Abdominal Affection. Typhus Gravior: in what it really consists: dangerous Nature of the Error that it consists in Debility.

The appearance of a person labouring under typhus is so different from that of a person affected with synochus, that no one ignorant of the disease, who saw these two patients for the first time, would believe that both were afflicted with one and the same malady. And yet dissection after death demonstrates, that the physical condition of the organs is precisely the same in both; and careful examination of the symptoms during life, shews that they are really identical, both in their nature and their succession, however, at first view, they may appear to differ. The difference between these two diseases arises entirely from a difference in intensity: still this difference produces a very important modification in the character of the disease; important, because it materially affects both the safety of the patient, and the nature of the remedies that are best adapted to rescue him from his danger.

Typhus, like synochus, presents itself under two degrees of intensity, which, like those of the latter, may be conveniently designated by the terms mitior and gravior. All the important symptoms which belong to both are found in the same cavities, and relate to the same organs, as in synochus, and, therefore, must in like manner be divided into cerebral, thoracic, and abdominal.

I. Typhus Mitior, with Cerebral Affection.

Cerebral affection in typhus, as in synochus, presents itself under two degrees of intensity, which may be distinguished by the same terms as in the latter, the subacute and the acute.

1. Typhus Mitior with Subacute Cerebral Affection.

The symptoms which denote this affection in typhus, are perfectly similar to those which have been stated to characterise it in synochus, but they undergo certain modifications, the true nature of which appears to me to have been greatly mistaken, and, after the most careful attention which I have been able to give the subject, the mistake seems to me to be of so much magnitude, that I think whosoever shall effectually correct it, will do the greatest possible service to medicine, and, through it, to his fellow men.

1. There can be no question that, from the very first commencement of the attack, as well as through the whole course of the disease, the prostration of strength, both physical and mental, is greater in typhus than it is in synochus. This greater loss of energy is indicated by every sign that can be conceived to denote it. The loss of power in the muscles which support and move the body is oftentimes so complete, as to be most alarming to the patient and his friends; while the contrast between the vigor and the torpor of the mind, in the course only of a few hours, is most striking. From the full and active exercise of its faculties, it becomes, in that short space of time, quite incapable of performing any intellectual operation. It is confused and stupid, always in a greater degree than in synochus, and sometimes to such a degree, even on the very first day of the attack, as to excite the utmost apprehension in every one around the patient who takes any interest in his fate.

2. The chilliness is, upon the whole, greater and longer-continued than in synochus: yet there is less constantly shivering, and the heat, when it succeeds this state of chilliness, is seldom as great as in the latter; while there are cases in which the heat never exceeds the natural standard.

3. The febrile uneasiness is greater; the restlessness is incessant; the face is pallid; the features are shrunk; the expression of the countenance is most peculiar; it is strikingly indicative of weakness and suffering; the experienced eye can tell at a single glance, even at this early period, to which of the two types that countenance belongs. The pulse is always weaker and more rapid than in the corresponding stage in synochus.