Memorandum on typhoid fever.

Date:
1939
Catalogue details

Licence: Public Domain Mark

Credit: Memorandum on typhoid fever. Source: Wellcome Collection.

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    Prevalence. Few facts are more striking in epidemiological history than the enormous decrease both in the incidence and in the mortality of the enteric fevers in this country since the later years of the nineteenth century. The long range trend is well illustrated by a comparison of the figures relating to the annual death rates per million living between 1871-75 and 1936. In the former period the rate averaged 371; in 1936 it was 6. Between 1871-75 and 1886-90 the rate fell from 371 to 181; in I914 it was 47. Since then there has been an almost unbroken decline - to 6 for 1936. Typhoid fever proper is always more prevalent in the autumn; hence its former popular name of “‘ autumnal fever’’. It is stated to be most common among young adulis, the greatest susceptibility being between the ages of 15-25, but it is probable that the incidence on children is greater than was formerly thought as their attacks are often atypical. There is little or no difference between the sexes in the attack rate. The mortality varies greatly in different epidemics; it may be as low as 5 or as high as 20 per cent. or even higher. The prognosis is more serious in elderly patients. Persons who have once contracted the disease and recovered are generally immune for life, though a second attack is not unknown. The immunity is specific; no protection is afforded by typhoid against the paratyphoid fevers and the converse is equally true. Paratyphoid fever is usually milder, runs a shorter course and is less fatal than typhoid fever. Diagnosis. In a typical case of typhoid fever the diagnosis presents little or no difficulty, especially after the first week, but suspicion should always be aroused by a fever which has continued for a week with few or indefinite physical signs and without an erup- tion characteristic of another disease. Confirmatory indications are a history of epistaxis, a dicrotic pulse, deafness, a rose-spot rash, a palpable spleen and some degree of bronchitis. Atypical cases in children may be overlooked by reason of their mildness. ‘‘ Ambulant ’’ cases and those in which pulmonary, nephritic or meningitic symptoms are prominent may prove difficult of diagnosis. The principal diseases which give rise to confusion are influenza, pneumonia, particularly the broncho- meningitis or peritonitis, acute miliary tuberculosis, undulant fever and appendicitis. The distinction from typhus fever has scarcely ever to be made in this country and the same is true of malaria and certain other exotic diseases; the use of the laboratory facilities which are now provided by most local authorities will usually suffice to confirm or correct the