THE DIAGNOSIS OF INTESTINAL PERFORATION IN TYPHOID FEVER

Without doubt the greatest bugbear to physician and surgeon alike in the management of typhoid fever is the ever-present liability of intestinal perforation. This complication occurs in from 2.5 to 3 per cent. of all cases of typhoid. Furthermore, according to Osler, one-third of all the deaths in typhoid are due to intestinal perforation; and when we come to consider that, from statistics collected by Taylor, in the United States alone there are estimated to be 500,000 cases of typhoid annually, with 75,000 deaths, we are confronted by the astounding fact that about 25,000 persons die annually from intestinal perforation due to typhoid fever. It therefore seems that anything which may add to the knowledge of this condition is acceptable. Twenty-four years ago Leyden advocated the surgical treatment of typhoid perforation and Mikulicz performed the first successful operation for the condition, and for the first time a ray of hope