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.

The prognosis or forecast of typhus is not altogether bad, notwithstanding the gravity of its symptoms and the dangers of its course.

Statistics show that the mortality from typhus does not exceed 7% but each complication makes the result more uncertain and the outlook less hopeful.  In the event of perforation of the intestines and severe internal hemorrhage supervening, the chances of saving life are slender.

D.  Treatment.

The treatment of typhus requires, in the first place, a correct judgment of the physical condition of the patient in determining the fever treatment to be applied.  Success in severe cases of typhus will only be secured by those who understand the correct methods of treating the skin.  Robust patients, with reserve energy and resisting power, may receive the unrelaxing application of repeated whole packs or cool full baths.  There is, however, a species of endurance, which may prove unable to endure the sustained and active force of these applications.  In such cases milder applications and more frequent changes are recommended.  Packs, interchanged with baths, clysters or enemas which subdue fever, alternated with ablutions, and similar methods.

Extremely stout and nervous patients must be treated with the greatest caution.

As typhus cases gradually develop, care must be exercised to prevent too violent treatment in case of serious complications.  In fact the physician must not be guided by fixed rules, but must be able to individualize with prompt discretion.

During the severest stage the diet must be absolutely a fever diet, prescribed in Form II, while patients suffering from lighter attacks, and convalescents, may be permitted the milder fever diet, given in Form III.

Mental Condition. Great care and observation is necessary with regard to the patient’s mental state.  The observance of a quiet demeanour on the part of everyone about the sick room should help to keep the patient quiet and undisturbed and may serve to preserve his consciousness.

I have treated very severe cases of typhus, with extremely high fever, during which, however, consciousness remained.  Inexorable strictness in this respect is often resented and misunderstood by those surrounding the patient until they realize the far-reaching importance of the orders by comparison with other cases.