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\b[The <delirium> of <typhus> calls for treatment of systemic illness and careful nursing; severe <diarrhoea> in <typhoid fever> additionally demands replacement of losses and vigilance for intestinal injury.] These are different <infections>, despite the similar names.
For an 1865 description of <typhus>, provide a quiet, ventilated room, continuous attentive nursing, fluid and nourishment, mouth care, and protection from falls or wandering. Examine for retention of <urine>, constipation, chest complications and exhaustion. A restless sleepless patient was sometimes given a cautiously selected <opium> preparation; wine or other alcoholic stimulants were also employed in supposed exhaustion. Such practice was contested: contemporary observations warned that recovery after a drug did not establish that the drug had caused recovery. Sedation was especially questionable with deepening stupor or respiratory impairment. Routine depletion of an already prostrate patient was not a rational substitute for support.<Typhus Statistics of the Dundee Royal Infirmary, with Remarks by Thomas John Maclagan>[1865, discussion of stimulants, nursing and inference from recovery]{ref}
Modern epidemic <typhus> is caused by <Rickettsia prowazekii> and requires prompt <doxycycline>, alongside management of <hypoxia>, <dehydration>, organ dysfunction and the precipitating <infection>. Testing should not postpone treatment when the clinical suspicion is strong. A low-stimulation environment and observation remain useful, while historical alcohol stimulation and indiscriminate <opioid> sedation are not disease-specific therapy. Control of the transmitting body lice is part of preventing further <infection>.<Clinical Overview of Epidemic Typhus by CDC>[treatment, severe manifestations and transmission]{ref}
In the historical treatment of severe <typhoid diarrhoea>, rest, readily tolerated nourishment and measured replacement of drinks were accompanied by attempts to quiet the bowel with <opium>, sometimes with an <astringent> such as chalk or a lead-containing preparation. These aimed at reducing stool frequency; they did not eliminate the cause. An apparent reduction of stools could conceal deterioration, and intestinal pain, distension, bleeding or collapse required renewed examination. Contemporary criticism of routine <opium> use in febrile bowel disease shows that this was never a uniformly established cure.<Opium in certain forms of fever and in diarrhoea and dysentery (1865 lecture)>[lecture read 1 December 1865, published February 1866, pp. 76–81; adverse effects and disputed indications]{ref}
Today <typhoid fever> requires an effective <antibiotic> selected with travel history and local <antimicrobial resistance> in mind, then refined by <bacterial culture> and susceptibility results. Assess fluid balance, circulation, <electrolytes> and kidney function, using oral or intravenous replacement as severity requires. <Gastrointestinal bleeding>, increasing abdominal tenderness, guarding, distension, <shock> or a sudden change in condition can indicate <intestinal perforation> or other severe complications and need urgent hospital assessment. Historical lead preparations are toxic; suppressing <diarrhoea> is not a substitute for treating the <infection> and its complications.<Clinical Guidance for Typhoid Fever and Paratyphoid Fever by CDC>[diagnosis, antibiotic use and complications]{ref}
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