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On 11th September he had a shivering attack and complained of headache and
backache and took to his bed. The Ship's Surgeon found him to have a temperature
of 103° P. On 14th September he developed a macular rash, profuse on the abdomen,
chest, back and buttocks, but sparse on the arms and legs. The rash became petechial,
and was confluent in the loins, lower abdomen and groins. The patient was very dull
and stupid, and the Surgeon diagnosed Typhus Fever. Since embarkation he had
been berthed in the ship's hospital with his wife, and there he remained, a member of
the Chinese crew being detailed to attend on him.
On arrival in the Port of London the patient was found to have a temperature of
103° F., with pulse 130 and respirations 30. His face was somewhat bloated, the
conjunctivae were injected, his tongue was dry and brown, there were sordes on his lips
and his nostrils showed evidence of recent epistaxis. He was dull and apathetic, and
it was difficult to attract his attention. There was a punctate purpuric rash in the
abdomen, back, axillae, loins, buttocks and groins becoming confluent and markedly
hæmorrhagic in the groins, loins, lower abdomen and axillae. The skin was dry and hot;
there was some congestion at the base of the right lung. The spleen was not palpable.
The urine contained a trace of albumen. The bowels were constipated and only
a few scybala resulted from an enema.
No pediculi corporis or capitis were found, but pediculi pubis were in evidence.
Specimens of blood were taken for bacteriological examination, but, in the
meantime, your Medical Officers were all agreed that clinically the case was one of
Typhus Fever, and therefore not only were the patient and his wife taken with all their
bedding and effects to Denton Hospital, where they were deloused before being
admitted to the wards, but the ship was treated as being Typhus infected. All persons
on board were medically inspected. All were well and free from lice. Nevertheless,
since the Chinese Steward who had attended on the patient had lived in the forecastle,
he and 18 other members of the Chinese crew were taken ashore and bathed, and
their clothing disinfected. Meanwhile, their quarters and the ship's hospital were
put under fumigation with sulphur dioxide. The names and addresses of the
passengers and white crew were obtained and forwarded the same day to the Medical
Officers of Health of the districts of destination. The Chinese crew were prohibited
from leaving the ship while she remained in the Port of London. The ship was
released from quarantine at noon on the day of arrival. She left for Rotterdam on
21st September, and the Medical Officer of Health of that Port was informed by letter
of the circumstances.
In Hospital the patient remained in much the same condition for two days and
then rapidly improved and, on 22nd September, bis temperature had fallen to normal,
he was mentally quite alert and the rash had disappeared, only mottling remaining.
He made an uninterrupted recovery, and was discharged on 18th October perfectly
well.
On 19th September Dr. Scott, of the Ministry of Health, reported that he had
tested the blood serum against the three types, Malayan, Mediterranean and European
Proteus with completely negative results, but that he had got a good positive Widal
for B. Typhosus (titre 1 in 640), and that therefore he thought there was a strong
possibility that the case was one of Enteric, and not of Typhus.
On 26th September Dr. Scott reported similar results on a second blood sample,
except that the agglutination of B. Typhosus was to a higher titre, about 1 in 2,000.
He asked for specimens of faeces. A specimen was sent on 30th September, but
B. Typhosus were not isolated. However, a further specimen sent on 8th October
did yield a colony of B. Typhosus.
It is of interest that, though this case appeared clinically to be one of
Typhus Fever it was in fact Typhoid. The Weil Felix reaction was definitely not
obtained, the Widal reaction was strongly positive at the time of admission to Hospital,
and even more strongly positive a week later, and finally B. Typhosus was isolated
from the stools.