Dr. William Osler of Baltimore—The question of meningitis in typhoid fever is an extremely interesting one. Dr. Ohlmacher's1 is the first communication presented in this country in which the typhoid bacillus has been definitely demonstrated in the meningeal exudation. It is an excessively rare complication. I have never met it personally, and I have records of over one hundred autopsies of typhoid fever. The interesting point is that in neither of these cases reported by Dr. Ohlmacher were there any clinical suggestions as to the occurrence of meningitis. Clinically I have seen meningitis diagnosticated in many cases, but as Stokes pointed out many years ago, there are no definite criteria by which we can make an absolute diagnosis of menigitis in typhoid fever. Just as in the cerebral type of pneumonia, so in the cerebral type of typhoid fever, there may be every symptom of meningitis, even to retraction
OPEN DISCUSSION ON THE SEVERAL PAPERS ON TYPHOID FEVER. JAMA. 1897;XXIX(7):313–314. doi:10.1001/jama.1897.02440330013001c
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