1. (1) The injection of serum prepared especially against strains of typhoid bacilli strong in "O" and "Vi" antigens appeared during the epidemic at Singapore to be of value in the treatment of serious cases of typhoid fever, even at a comparatively late stage of the disease. The time for the routine use of such serum in treatment has perhaps not yet come, but strong indications for its use are severe toxaemia, or failure to improve with general treatment. 2. (2) The absence of eosinophil cells in a differential white blood count is of value in the diagnosis though it is not an absolute sign in either a negative or positive direction. 3. (3) Congenital immunity against typhoid fever appears to be powerful for several years of childhood, in Malaya and presumably elsewhere also. 4. (4) Compulsory inoculation is advocated as a public health measure of protection against typhoid fever in countries where the disease is endemic, but not earlier than the 5th year of age. c 1941
A NEW antibiotic Chloromycetin has been clinically tested in the treatment of typhoid fever and has been found to exhibit significant chemotherapeutic effects. A description of the results in 10 cases is submitted as a preliminary report.
The pattern of phage types of 2553 strains of Salmonella typhi isolated over the 10-year period 1970-9 was studied. During the period 29 different phage types were encountered, not including the categories of 'untypable strains', 'degraded Vi-strains' and Vi negative strains. For the period as a whole, the commonest phage types encountered were A (20.9%), E1 (14.8%), D1 (10.3%), degraded Vi positive strains (10.3%), untypable Vi strains (7.3%), C4 (7.1%), D2 (4.4%), E2 (3.9%) and type 25 (2.6%). There were phage types which appeared in the early years of the period and then disappeared (types B2, D9 and D1-N). Others only made their appearance in recent years (K1 and 53). Notable differences were also seen in the predilection of some phage types for certain geographical areas.
The diagnostic value of the Widal test was assessed in an endemic area. The test was done on 300 normal individuals, 297 non-typhoidal fevers and 275 bacteriologically proven cases of typhoid. Of 300 normal individuals, 2% had an H agglutinin titre of 1/160 and 5% had an O agglutinin titre of 1/160. On the basis of these criteria a significant H and/or O agglutinin titre of 1/320 or more was observed in 93-97% of typhoid cases and in only 3% of patients with non-typhoidal fever. Of the sera from typhoid cases which gave a significant Widal reaction, the majority (79.9%) showed increases in both H and O agglutinins and 51 of 234 (21.8%) of these sera were collected in the first week of illness. The significance and implications of these findings are discussed.
We studied 1,629 febrile patients from a rural area of Malaysia, and made a laboratory diagnosis in 1,025 (62.9%) cases. Scrub typhus was the most frequent diagnosis (19.3% of all illnesses) followed by typhoid and paratyphoid (7.4%); flavivirus infection (7.0%); leptospirosis (6.8%); and malaria (6.2%). The hospital mortality was very low (0.5% of all febrile patients). The high prevalence of scrub typhus in oil palm laborers (46.8% of all febrile illnesses in that group) was confirmed. In rural Malaysia, therapy with chloramphenicol or a tetracycline would be appropriate for undiagnosed patients in whom malaria has been excluded. Failure to respond to tetracycline within 48 hours would usually suggest a diagnosis of typhoid, and indicate the need for a change in therapy.