Overcrowding and bad food predispose, so it may occur in prisons. Spread is by contagion and tolerably close contact with the bodies of those afflicted, thus nurses in fever wards rarely escape the disease. The better classes seldom suffer.
Typhus fever sets in eight or 10 days after exposure to the contagion, with intense headache, languor and weariness gradually passing into confusion and stupidity. By the fifth day a mottling and mulberry spots appear, at first on the backs of the wrists and sides of the abdomen. A sudden rise in temperature on about the seventh day is an evil omen.
The tongue soon becomes as dry as a chip and later, in a bad case, resembles a black, shrunken ball. The breath is offensive and may yield crystals of ammonia. The patient is restless, dull and stupid, with delirium of the low muttering kind.
It reaches its height in about 14 days from the commencement of the symptoms.
When the complaint is severe, delirium, coma and utter prostration come on followed often by death between the twelfth and twentieth day. The eruption by which typhus is distinguished from other fevers, and which is said to be present in 90 cases in 100, appears often as early as the third day on the arms, chest or on the abdomen, lasting generally for a week or more, at first disappearing by the pressure of the finger, but afterwards persistent and remaining so in many cases after death.
Treatment consists of beef tea, whey and blancmange, given per rectum if the patient cannot swallow. Claret and water makes a pleasant drink to be taken ad libitum. A large well-ventilated apartment is best. It implies greater safety to the attendants.
Taken from Practical Medicine by Alexander Silver MA MD, published in 1874 by Henry Renshaw of London.