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April 13, 1901


JAMA. 1901;XXXVI(15):1046. doi:10.1001/jama.1901.02470150042004

It is a well-recognized fact that there is often a marked want of agreement between the symptoms of a case of typhoid fever and the intensity and extent of the intestinal lesions. The latter, as has now been abundantly shown, may even be entirely wanting. It is, therefore, impossible to predicate in the individual case the occurrence of or the escape from perforation of the bowel and consecutive peritonitis. The latter event, it is believed further, may occur even without the intervention of actual perforation. In some instances perforation has been due to gangrene resulting from vascular occlusion and in others exceptionally also to rupture of other viscera than the intestines, as, for instance, the spleen, the mesenteric glands, the gall-bladder and to abscess of the liver.

Perforative peritonitis is one of the most common fatal complications of typhoid fever. Occasionally it occurs as the first pronounced manifestation in a