TYPHOID FEVER. 4 8 5 



until later. Most cases, however, react well in the 

 second week, and nearly all show reaction in the third 

 week. Rarely the reaction is delayed still later. 



In rare cases of typhoid the reaction may never occur, 

 even though the case prove fatal. 



Together with Prof. James M. Anders, of the Medico- 

 Chirurgical College, I 1 made more than a thousand 

 blood-examinations to determine the value of the serum- 

 test in typhoid fever and as an aid in the diagnosis of 

 febrile diseases. 



The Widal test was properly and continuously applied 

 to 230 cases of typhoid fever among soldiers who had 

 enlisted in the Spanish-American War and who were 

 treated in the Medico-Chirurgical Hospital. Of these, 

 219 reacted positively, or 95.64 per cent, of the total 

 number examined. One of the fatal cases, which was 

 otherwise typical typhoid fever, failed to show a reaction 

 so late as the seventeenth day of the illness ; this was 

 excluded, for the obvious reason that had the patient 

 survived for a longer period a positive reaction might 

 have been obtained. Thus in 10 of the cases no Widal 

 reaction was present ; these were tested from time to 

 time so late as the end of the first week of convalescence, 

 or return of normal temperature. The percentage of 

 cases, therefore, showing absence of the reaction was 

 4.36 per cent, as against 4.5 per cent, indicated by the 

 table of Drs. Stengel and Kneass. 



Of the 219 cases giving a positive result, 128 showed 

 the reaction prior to the appearance of the rose-spots, or 

 before the eighth day ; 36 showed the reaction during the 

 second week ; 45 between the seventeeth and twenty-first 

 day of the disease ; 8 not until the twenty-fifth day, and 

 2 as late as the twenty-eighth day of the illness. 2 



1 Phi/a. Med. /our., April 8-1 5, 1899. 



1 These results may be misleading, as they might seem to indicate that the 

 blood of these cases was tested every day and the reaction first noted on the 

 day given. In reality the blood was sometimes not examined until the day 

 mentioned. 



