Such extreme developments as these, however, are infrequent, since the illness, by timely attention according to the methods herein prescribed, will, as a rule, respond to the treatment and take a favourable turn.
In the course of typhus, intense bleeding of the nose is not infrequent. In the severer cases this is a sign of decomposition of the blood, but in lighter cases it merely serves to alleviate the intense headache which is a feature of the case. The throat is liable to be affected; hoarseness and coughing occur; hardly any case of typhus catarrh. This sometimes extends into the air-passes without a more or less intense bronchial cells and causes catarrhal pneumonia, which--if not promptly treated according to the instructions herein detailed--may become extremely dangerous.
With the exception of a strongly accelerated action, no change is noticeable in the heart. It may, however, suddenly become paralyzed and cease entirely, owing to the general weakness of the patient and the intensity of the fever. Weakness of the heart and possible cessation occur only during the climax or convalescence.
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.
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.