Excerpt from The Practitioner: A Medical Journal; January-June, 1904

The diagnosis of typhoid fever is admirably set forth in Dr. Claude Ker's contribution on another page. It cannot be made with confidence in the first few days of the disease, and the difficulty of its early and certain recognition has been increased since influenza became prevalent. Influenza, indeed, not infrequently ushers in an attack of typhoid; and, instead of the gradual rise of the temperature and development of the symptoms, the onset has the suddenness and violence of influenza, and the characteristic features of typhoid may super vene without any marked fall of the temperature, or the influenza] pyrexia may subside and be succeeded by the gradual typhoid rise. Influenza apart, the old rule holds good that feve'r steadily increasing for a week without local inflammation may, with few exceptions, be set down as typhoid. Cor roborative symptoms will usually have set in by this time, and we must continue to rely on clinical indications for early diagnosis. The exceptions, excluding tuberculosis, will mostly be examples of fever due to colon-bacilli which have acquired special virulence and such cases may prove fatal. The Widal test is of great service in rendering the diagnosis certain, and may be said to have displaced the less trustworthy diazo reaction of the urine. Recourse should be had to it in every case, since it may also yield information as to the virulence of the typhoid poison; but it is not available at a very early stage, and, as it depends upon the formation of an antitoxine, the clumping of the test-bacilli may be imperfect in cases in which the constitutional resistance is deficient and the danger therefore serious. It is sometimes useful to try cultures of different strains of bacilli when the reaction is equivocal.

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