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50
Difficulty in Diagnosis of Typhus.—It may perchance be
thought surprising that so many medical men should have
seen one or other of these cases and yet have failed to recognise
the true nature of the disease. But a little consideration
may, possibly, modify any such feeling. The gentleman who
notified the case of the undertaker informed me that in twelve
years of practice he had never met with a case of typhus.
Then as regards the nine cases in Flat 20, it may be pointed
out that Dr. Ensor did not see Thomas B — — the first case ;
Dr. Thomson had been disabled ; Dr. Knaggs lived at a
distance, and had given temporary help only in an emergency.
These gentlemen had certified the case as influenza. Mrs. B
(Case 2) had been ill some days before she was seen by Dr.
Ensor and Dr. Davis, who were told that her husband had had
influenza : pneumonia was developing, and what more likely
than that it was consecutive to influenza ? the early symptoms
of which are not very dissimilar from those of typhus. The
young children's not severe illness seemed to admit of the
same explanation. John B — — , who died, and his sister Ellen,
were speedily removed to the Infirmary, and in the absence
of any clue, it is not remarkable that the symptoms generally,
and the ill-defined rash, were at first attributed to suppressed
measles—a disease very prevalent in the parish at the time.
Even in the case of Dr. Davis, who had been ill six days
before admission to the Western Hospital, it was apparently
not until some days later—probably on the twelfth day of
illness—that it became clear to the medical superintendent
that he was suffering from typhus. The diagnosis, moreover,
was probably facilitated by comparison with the case of the
undertaker, who was admitted four days after Dr. Davis. The
recognition of the true nature of these cases, communicated
to Dr. Ensor on the 21st March, led to speedy diagnosis of
the nature of the illness in the second family (cases 12,13 & 14)
when admitted to the infirmary at that date—after they had
been ill at home six days; from influenza, as was supposed ;