The combined group of symptoms which establishes the diagnosis of typhoid fever are: a gradually increasing fever with evening exacerbation and morning remission; general malaise with headache; a furred tongue with red edges and tip; nose bleed; a relatively slow pulse (possibly dicrotic); abdominal distension with tympany, gurgling and tenderness in the right iliac fossa on firm pressure; a roseolar eruption confined principally to the abdomen and chest; enlarged spleen, and the physical signs of bronchial catarrh.
Should every case of typhoid fever present the foregoing symptoms, the diagnosis would be simple and mistakes would not be common, but unfortunately this is not true and I believe the classical history, as portrayed in the books, is the exception rather than the rule. Because of the great variability in the symptoms and the tardiness of the appearance of many of them, the diagnosis is often not clear until the patient is
BRIDGES WO. THE DIFFERENTIAL DIAGNOSIS OF TYPHOID FEVER.. JAMA. 1902;XXXVIII(20):1300–1302. doi:10.1001/jama.1902.62480200014001e
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