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One occasionally hears the statement that typhoid may have abdominal pain as its initial symptom, but I have never seen any amplified discussion of this interesting and important fact, or any definite statement as to the causation of the pain.
It is with this in view that the following report is made on the subject of abdominal pain as an initial symptom, especially with reference to its presence in affections of the gall-bladder, complicating typhoid.
The chief painful complications which may first call attention to the typhoid are: (1) acute catarrhal cholecystitis; (2) typhoid appendicitis; (3) intestinal perforation; (4) simple colic from gaseous distention (unimportant).
In the last 1,815 cases of typhoid occurring in the medical services of the Presbyterian Hospital, between 1897 and 1911, there were twenty-four cases of complicating, acute, catarrhal cholecystitis. In two of these the initial symptom of the typhoid was acute abdominal pain,
CARTER HS. ABDOMINAL PAIN AS AN INITIAL SYMPTOM IN TYPHOID, WITH SOME STATISTICS ON ITS CAUSATION. JAMA. 1912;LVIII(21):1565–1566. doi:10.1001/jama.1912.04260050241005
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