Disturbances of the nervous system are very frequent, hence the name “nervous fever.”

Consciousness is, in nearly all cases, more or less benumbed, and at times completely lost.  The patient is either lying absolutely indifferent, or he is delirious, cries, rages, attempts to jump out of bed and can only be subdued by the strongest efforts.

Patients lose control of urinary and faecal movements and require feeding.

These disturbances disappear as soon as convalescence sets in and consciousness returns.

As a rule the patient, on return to consciousness, knows nothing of what he has gone through, and has no reminiscences of the immediate past.

Sometimes cramps in the masticatory muscles have been observed, which explains the grinding of teeth apparent in some instances.  Convulsions in the limbs and facial muscles sometimes appear, but most of these disturbances are of short duration.

Urinary and Sexual Organs:—­

With high fever albumen appears in the urine.  In some instances it may lead to inflammation of the kidneys, the symptoms of which may at times completely overshadow the symptoms of typhus.  Fortunately this complication is very rare.  Catarrh of the bladder occurs, because the patient retains the urine too long, while in a state of unconsciousness.  Inflammation of the testicles has been observed with male patients, and pregnant women have miscarried or given birth prematurely.

Bones and Joints:—­

Inflammation of the joints is infrequent and in a few cases only, inflammation of the periosteum has been observed.

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.