The acute, often abrupt, onset of the Athenian pestilence, with profound depression, severe headache, and suffused conjunctivae, though met with in a moiety of cases of plague, is eminently characteristic of typhus. The striking appearance of the bloodshot eyeballs has led to much confusion between the two diseases.
The aspect of the tongue and fauces inclines rather to the side of typhus. In each disease the tongue is at first heavily coated with a thick white fur, and tends later to become dry and parched. But in typhus there is a special tendency, as the disease advances, for the tongue to bleed from fissures at the edges. So frequently is this the case, that this feature has been regarded as of diagnostic value in the presence of an outbreak of typhus. A boggy reddened appearance of the fauces is usual in typhus, and is seen also in a proportion of plague patients.
Unnatural and even foetid breath may be met with in any acute infectious fever, but foetor is in no way characteristic of any. Doubtless it was far more common in times when the alphabet of oral hygiene had not yet found acceptance as a necessary detail of medical regimen. Murchison describes the breath of typhus patients as foetid, and in addition it is well known that a repulsive odour may be given off from their bodies. Salius Diversus mentioned it three centuries ago, and it has been a commonplace of many subsequent writers. Curschmann failed to detect it, and attributed its absence to the free ventilation of the sick wards. A layman, as Thucydides was, might well ascribe to the breath a foetor permeating the whole atmosphere around the patient.
Sneezing has long been associated in popular tradition with plague, and an old legend refers the association to the plague of Rome at the commencement of the pontificate of Gregory the Great, when it is said that those who sneezed died. The most careful and observant of modern physicians do not, however confirm the connexion. Russell states that he was on the look out for it during the plague of Aleppo and did not observe it: Simpson does not even mention it. Nor does it appear to be noteworthy as a symptom either of typhus or of any other acute infectious fever, though it would be in accord with the swollen and congested state of the nasal mucosa in typhus, to which Curschmann has drawn special attention. Perhaps the tradition is a mere old wives’ tale, for sneezing has been regarded as an ominous sign from great antiquity, and as far back at least as the composition of the _Odyssey_. Aristotle frankly confessed himself unable to explain the connexion.