Attack Of Typhoid Fever Research Articles

Second attacks of typhoid fever.

1. Second attacks of typhoid fever are uncommon. In the literature this has been taken to imply that an attack of typhoid fever confers a high degree of immunity which, nevertheless, may be overcome by such factors as re-infection by a large dose, an organism of a different strain, or one of high virulence.2. Two large outbreaks of typhoid fever in the same community within 5 months produced eleven examples of second attacks. Clinical descriptions of four of these are given.3. Details are given of the population at risk and the attack rates in various groups.4. The evidence of these facts and figures, though inconclusive, suggests that an attack of typhoid fever does not confer more than a moderate degree of specific immunity. The influence of chloramphenicol upon immunity remains sub judice.

An outbreak of water-borne typhoid investigated by bacteriophage typing and ‘selective’ sewage examination

1. By means of phage typing of Bact. typhosum, the source of infection in a boy who drank water from a polluted stream was traced backwards via water, sewage effluent, crude sewage and faecal specimens to unsuspected typhoid carriers in a large institution.2. A nurse in the institution contracted typhoid fever, caused by the same phage type (C) of Bact. typhosum as was found (a) in the stools of typhoid carriers in the wards in which she was on duty, (b) in the crude sewage and sewage effluent from the institution, (c) in the stream into which the sewage effluent discharged, and (d) in the stools of the boy who drank the stream water. The nurse's sister, who had had an attack of typhoid fever a few months earlier, was infected with a different type (E 1) of Bact. typhosum and was therefore not the source of her sister's infection.3.The laboratory technique is described for the examination of (a) samples of water, sewage effluent and crude sewage, using different selective and enrichment media, (b) large numbers of faecal specimens for enteric organisms by a preliminary pooling of specimens in batches of six or seven, and further examination of the individual specimens comprising a positive batch, thus effecting a saving of time and economy of media.We wish to thank the Medical Officers of Health, sanitary inspector and the medical and nursing staff of the institution for their enthusiastic co-operation in the investigation.

Note on Agglutination Reactions in the Typhoid Carrier State

In any search for enteric carriers the patient with a positive blood-agglutination must be regarded as suspect. Earlier workers were of opinion that the converse of this was true—that a negative agglutination reaction implied that the case was not a carrier. It is true that McCowan and Mann (1925) described a series of nine carriers, of whom two showed a negative agglutination reaction during the clinical attack of typhoid fever, but the subsequent history of the agglutination reactions is not given. Ashby (1931) indicates in his series the prevailing belief that carriers show significant alterations in their agglutination reactions. Although repeatedly controverted in the medical literature by the publication of small groups of cases where the carrier state has been accompanied by negative blood-agglutination reactions, this view dies hard, and was revived during the recent discussions centring around the Croydon typhoid epidemic.

ACUTE CHOLECYSTITIS IN CHILDHOOD

Pathologic conditions of the gallbladder are admittedly of rare occurrence in infancy and childhood. Textbooks dismiss the subject of disturbances of the gallbladder with a few lines. Thus, Porter¹stated that "pathological involvement of the gallbladder during childhood is practically unknown," and Griffith and Mitchell²mentioned "cholelithiasis of a chronic nature as an occasional complication of typhoid fever." A search of the literature reveals that about 150 cases of all types of diseases of the gallbladder in children have been collected to the present time. In 1923, Kellogg³tabulated 64 cases, and Beals⁴collected 60 additional cases. Reed and Montgomery⁵reported a series of 18 cases of acute cholecystitis in children up to the age of 10 years, occurring during or immediately after an attack of typhoid fever. In 10 per cent of these cases the patients were operated on and the gallbladders were removed.

Cholecystitis with Stone Producing an Atypical Shadow: Report of a Case

A woman, aged forty-eight years, came to the clinic complaining of loss of weight and appetite over a period of nine months. She had had a severe attack of typhoid fever at the age of eighteen, but for many years had enjoyed excellent health. From November, 1924, to May, 1925, she had nursed an aged relative and was under an unusual strain. About February, 1925, she commenced losing weight. In seven months she lost 30 pounds. About May her appetite failed; she had no food intolerance, but food did not appeal to her and she ate less. There was no apparent loss of strength. For fourteen years she had experienced a sensation of pressure over the gall-bladder area. At times she thought she could palpate a mass. There was never any jaundice, nausea, or emesis. During the last week before coming to the clinic she suffered daily attacks of cramps in the upper abdomen, lasting for a few hours. Physical examination elicited some fullness in the right upper abdominal quadrant, with rigidity of the right rectus musc...

Congenital Syphilis of the Bones and Joints

THIS paper is based upon the examination and treatment of fifty cases of syphilis of the bones and joints and represents about 6 per cent of all cases of congenital syphilis treated by the writer. He does not intend to convey the impression that he has added anything new to either the diagnosis or treatment of these conditions, but he wishes to center attention upon some of the outstanding features that are commonly overlooked or disregarded. (a) Twenty per cent of these cases had a negative serology. Some investigators report as high as 40 per cent. (b) Forty per cent had no sign of congenital syphilis excepting the bone condition and this characteristic finding was made possible only by the use of the X-ray. (c) Of the 60 per cent who had some of the stigmata of congenital syphilis, only ten patients had interstitial keratitis and five had Hutchinsonian teeth, the most constant external finding being the saddle nose. (d) The disease in the long bones was nearly always preceded by a history of trauma. (e) In two cases the bone disease appeared at the termination of typhoid fever. (f) Many of the cases started acutely and had the appearance of an acute osteomyelitis. Since nearly all of these children had a hyperplasia of the lymph and lymphoid tissues, infected tonsils, adenoids and sinuses were the rule; consequently the syphilitic bone manifestations may be and often are infected with pus-forming organisms from the very beginning and the train of signs and symptoms which follow are clinically indistinguishable from ordinary acute infective osteomyelitis. (g) In a large percentage of cases all the other children of the family are apparently free from any signs or symptoms of congenital syphilis. Since these facts are true, the following procedure should be followed in all cases of bone disease in children, excepting in those cases in which the physician feels absolutely sure that the case is one of infection or malignancy. (a) A careful examination of the patient for the stigmata of congenital syphilis. An especially careful examination of all the rest of the family. Thirty per cent of the parents will show active manifestations of syphilis or evidence of its past ravages. The mothers are almost as often affected as the fathers. (b) The serology of the entire family is investigated, and will often confirm a rather shaky diagnosis. (c) Radiographs of the long bones of the other children will often show that the child immediately preceding or following the patient has the characteristic thickened cortices of the tibiæ. (d) Do not accept as conclusive the history of typhoid or any other acute infective disease, since these diseases often precipitate a latent congenital syphilis or activate foci which had already started. In two of this series of cases, bone disease immediately followed an attack of typhoid fever and was diagnosed typhoid osteomyelitis. The bone pictures in both cases were unmistakably those of congenital syphilis.

ATYPICAL CASE OF SPLENOMEGALY

The case of splenomegaly to be reported shows such an atypical course that we feel that it will be justifiable to report it now, while the patient is yet under observation. REPORT OF CASE A woman, aged 60, with a negative family history, had an attack of typhoid fever, at the age of 10. At 29, during the seventh month of pregnancy, she suffered from eclampsia, with miscarriage. The next year, she had a second miscarriage, in the eighth month of gestation. For the following five years, she felt very weak, and gave birth to a delicate child. For the next six years, there was some improvement, during which time she gave birth to two healthy childrean. At 41, during her sixth pregnancy there was a recurrence of the weakness, with constant pain in the region of the spleen. A diagnosis of enlarged spleen was made and extirpation of the

Calcified Areas in the Abdominal Cavity

Calcification of an Intracapsular Renal Hematoma Case 1 (A126067). A man, aged 59 years, had sustained a severe accident while coasting, thirty years before. Several ribs were fractured, and it was believed that there were abdominal and spinal injuries. There was motor and sensory paralysis for the first three weeks, and loss of sphincteric control of the bladder and rectum for four or five days. He was in bed for three months, and had been able to work only about ten of the thirty years since the accident. Examination disclosed a large, hard mass in the left upper quadrant, apparently in the kidney. The X-ray (Fig. 1) revealed two stones in the right kidney and a large pear-shaped mass on the left side, from the eleventh rib to the crest of the ilium. Urologic investigation demonstrated that the left kidney was functionless; only a remnant of the pelvis remained, the kidney substance being almost entirely destroyed. A diagnosis was made of an intracapsular renal hematoma with calcification. Myocarditis was causing the patient considerable distress, and this, with the condition of the kidney, contra-indicated surgery. He returned home, and died seven months later; necropsy was not performed. Post-Typhoid Enlargement of the Spleen Case 2 (A198574). A man, aged 50 years, came to the Clinic with Bright's disease and marked edema of the legs. He had had typhoid fever four years before. Enlargement of the spleen had been noted during the attack of typhoid fever; there had been no noticeable change in its size since. At examination a large mass was palpated in the left abdomen, reaching from the level of the sixth rib anteriorly to the crest of the ilium. The Wassermann blood reaction was negative, and there was nothing in the history to suggest syphilitic infection. X-ray revealed a large calcified area on the left side (Fig. 2), and the urologic investigation proved this to be extrarenal. A clinical diagnosis was made of post-typhoid enlargement of the spleen; surgery was not advised. Post-Typhoid Lumbar Abscess Case 3 (A221665). A man, aged 32 years, had had typhoid fever six months before coming to the Clinic. In the sixth week he had had a severe nasal hemor-rhage, and two days later pain in the left side, with infection that necessitated rib resection and pleural drainage at the end of three weeks. The wound had continued to drain. X-ray examination disclosed slight fixation of the diaphragm at the costophrenic angle, probably due to adherent pleura. At operation an old encysted empyema with a small cavity, about 7 cm. in diameter, as found, but no extension could be felt or probed. Nine months later the patient returned and the X-ray (Fig. 3) revealed a large circumscribed calcified area on the left side, extending down to the upper level of the fourth lumbar vertebra. A pyelogram revealed an evident reduplication of the pelvis of the kidney; the area apparently was extrarenal.

INFECTION OF OVARIAN DERMOID CYST WITH TYPHOID BACILLUS

Many cases have been reported of the unusual location of the typhoid bacillus. Thus, the bacilli have been found in abscesses of the liver and spleen, in subphrenic abscesses, and in sacculated and general peritonitis, osteomyelitis, periostitis, etc. The following case, if not unique, seems sufficiently rare to justify recording it. Besides the unusual location of the typhoid bacillus, the definite history of a recent attack of typhoid fever is to be noted, and also the quantity of pus produced in which no other bacteria except the typhoid bacilli were found. Miss M. S., aged 21, schoolteacher, a native of this country, entered the New Haven Hospital, May 21, 1914, on account of enlargement of the lower part of the abdomen. About April 21 she first noticed a mass in the lower part of the abdomen, which rapidly enlarged but was accompanied by no pain. Last Christmas she was ill,

Case of Caries of Frontal Bone and Intracranial Abscess Due to Bacillus Typhosus Eleven Years after Attack of Typhoid Fever

Case of Caries of Frontal Bone and Intracranial Abscess Due to Bacillus Typhosus Eleven Years after Attack of Typhoid Fever

EPIDIDYMO-ORCHITIS COMPLICATING TYPHOID FEVER.

The following case is reported because epididymo-orchitis is a comparatively rare complication in typhoid fever, being discussed by most writers as orchitis, occurring after convalescence has begun, and usually with a previous history of specific urethritis. This case is un-usual in its differences. History. —L. B., white, male, aged 25, book-keeper, was seen Sept. 28, 1907. The family history was negative. He was of good habits and did not use alcohol or tobacco. He had had the diseases of childhood but no serious illness. He positively denied a history of urethritis or other venereal disease. His present illness began with an attack of typhoid fever of mild type beginning six weeks previously. Temperature reached normal on twentieth day. Four days later, after indiscretion in diet, he suffered a relapse. This was uneventful with the exception of frequent attacks of marked pain over a greatly enlarged spleen until the nineteenth day of

The Role Of The Typhoid Bacillus In The Pulmonary Complications Of Typhoid Fever.

The fact that typhoid bacilli are not infrequently found in the lungs during an attack of typhoid fever is well established, but the effect of their presence is still uncertain. Artaud in 1885 was the first to mention the possibility of pulmonary invasion by typhoid bacilli, and he described typhoid-like bacilli in the lungs of two typhoidal patients dying of pulmonary apoplexy. According to Curschmann, lungs, the seat of gangrene, hypostatic splenization, or even lobar pneumonia due to the pneumococcus, undoubtedly may be invaded by typhoid bacilli. When one considers the constancy with which the typhoid bacillus enters the general circulation, and also that the organism has been obtained by a number of observers (Polgu&re, Montier, Koque and Bancel) from lungs in a state of congestion only then it is clear that the organism quite regularly enters the lungs during typhoid fever. Roque and Bancel obtained the bacillus six times in 16 attempts by lung puncture during life from cases showing only bronchitis or pulmonary congestion. They think that the typhoid bacillus is present in greater numbers in the pulmonary than in the systemic circulation and plays an important rCle in pulmonary complications of typhoid fever. Although the organism has been recovered repeatedly from the lung, there are in the literature but few cases in which the typhoid bacillus seems surely to have produced a definite pulmonary lesion. Several observations have been made recently at the Pennsylvania Hospital which throw some light upon the significance of the typhoid bacillus in pulmonary complications of typhoid fever.

HEMIPLEGIA OCCURRING DURING THE THTRD WEEK OF TYPHOID FEVER.

In the Medical Record , Dec. 19, 1903, I reported a case of sudden hemiplegia with aphasia occurring during the fourth week of an attack of typhoid fever in a boy aged five years, and I also referred to several other reported cases. Inasmuch as this complication of typhoid fever seems to be a rare one. I have though it worth while to briefly record the clinical notes of a second case which has since come under my observation. Patient. —A married man, aged 38, a bricklayer, habits good, previous history not significant. History. —The patient was in the fourth week of a simple uncomplicated attack of typhoid fever, when on Aug. 9, 1904, he developed the hemiplegia to be described. His physician saw him at 5 p. m. on the date mentioned, and noted nothing unusual. He saw the patient again at 9 p. m.

INTESTINAL PERFORATION COMPLICATING TYPHOID FEVER.

Perforation of the bowel is one of the most serious complications which occurs in this disease, and it demands prompt attention first from the medical man, next from the surgeon. Before proceeding with the paper proper, I desire to report, in more or less detail, 12 operative cases which have occurred in my practice in the last twenty-one months. These cases, in conjunction with 7 previously reported, 1 making a total of 19, have given eight recoveries, making a recovery percentage of 42.10. Case 1. —Referred to me by Drs. T. L. Disque and Lawrence Litchfield, Pittsburg, Pa. Perforation, peritonitis, death. Patient. —G. K. H., male, aged about 24, had an attack of typhoid fever with a relapse in December, January and February, 1902 and 1903, respectively. History. —The initial course of the fever was mild. Dr. Disque attended him in this attack and made his

A CASE OF TYPHOID FEVER WITH AN UNUSUAL COMPLICATION.

Hemorrhage as a complication of typhoid fever presents some interesting phases. The literature on the subject of enteric fever abounds with discussions of hemorrhage from almost every organ in the body, but the uterus seems to have been overlooked. In the literature at my command I have been able to find but very little. By most authorities on the subject no mention whatever is made of uterine hemorrhage as a complicacation of typhoid fever. Osler, however, does mention "a rare and fatal form of typhoid fever characterized by cutaneous and mucous hemorrhages." Montgomery, in his work on gynecology, draws attention to the fact that "severe uterine hemorrhage may frequently usher in an attack of typhoid fever," and this is not uncommon, especially if it happens to be about the time of the normal menstrual flow. In the case, however, presented here for your consideration, the hemorrhage did not usher

DISSECTING ABSCESS OF THE ABDOMINAL WALL PRODUCING DEFORMITY SIMULATING POTT'S DISEASE.

The case which forms the basis of this report presents features which render it of sufficient interest, it is believed, to warrant its presentation to this Section. The patient was a lad of 16, who was taken sick in January, 1900, with a typical attack of typhoid fever. He remained In bed six weeks, when, on getting up after the subsidence of the fever, there was observed a certain amount of inability to raise the left leg in drawing on the trousers. By the middle of May he developed a general antero-posterior curvature of the spine from the sacrum up with a lateral deviation with the convexity to the right side, and at this time was seen by Dr. Ap M. Vance of Louisville. There was some fever at the time, though no record was kept, and there was a certain fulness in the right loin which caused a suspicion

ABENTERIC TYPHOID FEVER

As an argument against the employment of the term enteric fever to designate the specific morbid process dependent upon the activity of the typhoid bacillus, it has properly been pointed out that the lesions are by no means confined to the intestinal tract, which may, and, in fact, occasionally does, escape involvement entirely. Accordingly, the derivatives, splenotyphoid, pneumotyphoid, pleurotyphoid, have already found their way into the literature as descriptive of special localizations of the morbid process. To these there has recently been added the designation arthrotyphoid, to describe the condition present in a case of typhoid fever reported by Barjon and Lesieur¹in which there was articular involvement. The patient was a boy, 17 years old, who had had an attack of typhoid fever at the age of 8 years, and one of acute rheumatism at the age of 11 years; and now, again presented symptoms of the former

ENDOTHELIOMA OF THE GASSERIAN GANGLION; TWO SUCCESSIVE RESECTIONS OF THE GANGLION; FIRST, BY THE EXTRADURAL (HARTLEY-KRAUSE) OPERATION, AND, SECONDLY, BY AN INTRADURAL OPERATION.

DR. DERCUM'S CLINICAL REPORT. The following case, both because of the rarity of the affection from which the patient suffered and because of the interesting nature of the symptoms, is worthy of record. Mr. X., a business man, 32 years of age, married, a native of Louisville, Ky., came under my care on Nov. 20, 1899. Family History. —The father died at 68 years of age, of some affection of the heart. The mother is living and well at 60, also a brother and sister. The family history is negative as regards mental, nervous and other diseases. Personal History. —The patient was rather delicate as a baby, suffered from various diseases of childhood, had an attack of scarlet fever which resulted in disease of the ears, but in youth he seemed to be rather healthy. Twelve years ago he was said to have had an attack of typhoid fever. Some

SOME OF THE LESIONS INDUCED BY TYPHOID FEVER.Read before the Cambridge Society for Medical Improvement, February 23, 1891.

Perhaps no disease whose records have been embodied in medical literature is attended or followed by a greater variety of lesions than is that of typhoid fever. The functions of the great nerve centres, including the brain and spinal cord, as also those of the nervous system generally, are liable to be seriously influenced, weakened or interrupted, for periods of uncertain duration, by the occurrence of an attack of typhoid fever. Among the sequels or complications that have been observed is dementia, insanity, loss of sight, aphasia, paraplegia and other forms of paralysis. Sometimes only one limb, as a leg or an arm; rarely, only an arm and a leg at the same time. At other times disturbances are limited to the functions of speech. Cases now and then occur, in which we have paralysis without appreciable anaesthesia. The more common forms are those in which both the motor and