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145
This case presented many unusual features. The practitioner in
charge of the case communicated with the Public Health Department
on the 20th of December, and the patient was seen with him in consultation.
The signs and symptoms were not typical of typhoid, but
admission to hospital for diagnosis and treatment was urged. The
parents did not consent to his entering hospital. A specimen of the
feces was obtained and was examined for organisms of the typhoid
group with negative results. The child did not make any progress,
and on the 24th of December was admitted to Hospital. A Widal
reaction was positive (B.Typhosus in 240) on the 28th, but a specimen
of blood taken on the 29th did not agglutinate suspensions of
B.Typhosus or Paratyphosus. A Post-mortem examination made on
the 6th of January showed that the cause of death was septicaemia due
to typhoid fever, and the bacillus was recovered from the blood.
In spite of exhaustive enquiry, no source of infection in this case
was discovered. The child had not left the Borough for at least two
months before the onset of his illness. He was taken to school and
brought home by his mother every day and had not, as far as could
be discovered, been in contact with anyone who might conceivably
have infected him. There was no obvious connection between this
case and the epidemic existing at that time in the County Borough of
Croydon.
The patient was an only child, and neither of the parents gave
a history of any recent illness or of any former illness suggestive of
typhoid. There had been few visitors, and none of these could be
implicated. The feces of the parents were examined with negative
results. No record of the consumption of any unusual food could
be obtained, and indeed, it appeared that great care had always been
exercised in regard to the child's dietary. The water supply was
investigated chemically and bacteriologically, and found to be pure,
while milk samples showed no bacteriological abnormality. Both the
parents were given injections of anti-typhoid vaccine immediately the
diagnosis was established. There were no further cases.
Isolated cases such as this, which appear out of the blue, occur
periodically. However exhaustive the investigation, the source of
infection is not unearthed, neither are any contact cases brought to