TWO CASES OF TYPHUS FEVER IN

KUMAON.

By R. N. BANERJEE, b.sc., m.b., b.s.,

Allahabad.

It has long been known that typhus or tick- typhus is endemic in the Kumaon Hills; most of the cases occur among- Indians, but as I

have recently had the opportunity of seeing two oases in Europeans who were under ob- servation in 'hospital I think a short note on them may be of interest.

Case 1.?T. F., a school girl of 12, and a

boarder at one of the girls' schools in Naini Tal was attacked with fever on 29th August,

1926. She vomited at the onset, and again several times the next day. By the 31st it was obvious that the illness was severe, she had much pain in the back, she was constipated, and complained of headache. The following day she was admitted to the Ramsay Hospital as there was a slight rash appearing on the body. The mental condition was already rather dull, the face flushed, and the eyes bright and slightly suffused. The tongue was

very thickly coated and throughout the rest of her illness presented a wash-leat'her ap- pearance except for a few days when it was

dry. The urine contained much albumin. A

day later the rash had become "typical, there was a measly mottling all over the body, with papules like those of enteric fever scattered about. Subcutaneous haemorrhages were not

T.F. Aged....12.

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May, 1927.] TYPHUS FEVER IN ICUMAON: BANERJEE. 265

Present. On 4th September she had all the

appearance of a severe case of typhus. There was delirium, and though she could answer

questions she did so with a peculiar slowness, with a long reaction period which has been

described elsewhere as very typical of typhus/* In spite of constant cleansing", the teeth and lips were covered with sordes. The same day she bled repeatedly from the nose, and later Passed a large amount of blood from the

bowel after an enema. The next day there Were several discharges of blood from the

bowel but no further epistaxis. On account ?f the haemorrhage she was given an injection ?f horse serum and no more bleeding occurred. ^ is however impossible to claim this as a

result of the injection as the blood may have been swallowed, and the bleeding from the

nose had already ceased. At the time, as the blood was both bright and copious I thought *t must be intestinal, but since then I have seen blood equally bright and equally copious from a case of haemorrhage after tonsillec-

tomy. After the 'haemorrhages she was rather

cyanosed, there was a loud murmur in the

Pulmonary area, and the tongue was dry. On the 6th the rash had faded and the mental c?rtdition began to improve. From now on- wards her general appearance was much better than before, in spite of an attack of n?n-suppurative parotitis. On the 11th the

temperature fell by crisis after which the paro- t'tis rapidly cleared up. The nurses commented that she

" smelt like a box full of dirty socks," which strikes me as an excellent description of the characteristic ?dour of typhus.

Culture of the stool for the enteric group was negative and the blood culture in bile broth

^aS ne.?ative also. The Widal reaction on

the 11th day was negative. I am indebted to

Major Bridges, r.a.m.c., for these examina- tions.

Case 2.?J. N. S., male, aged 64, was admitted ?n 9th September on about the 7th day of his ill-

ness, from Naukatchiatal, a journey of about 15 miles. He g'ave a history pf low continuous fever and of sleeplessness. He was riather confused and flushed and his speech and the Appearance and mental condition were sug- gestive of intoxication, though he had not

taken alcohol. The tongue was very heavily ?oated, the eyes suffused, and the throat con- gested. (He suffered from chronic nasal

catarrh.) The urine gave a faint cloud of albumin on examination. The heart, lungs, and abdomen were found normal and the

pulse was firm?perhaps a little too firm.

Vomiting- was severe and it was difficult to

supply sufficient fluid. There was a faint rash on the chest and axillce on admission and this was marked and widespread by the

following day. On the 16th the Widal reac- tion was negative and on the 17th the Weil- Felix reaction was negative. For the latter

Major Bridges used ia strain obtained from Kasauli.

On the 19th the patient was in a grave condition. He was nearly comatose and was picking at the bedclothes. The pulse was

softening and the excretion of urine appeared to be scanty. There were muscular twitch-

ings, as in uraemia, which condition his whole

appearance suggested. He was given an injection of 10 c.c. of the

serum obtained from Case 1, ibut as the serum was not quite free from blood cor-

puscles it was given intramuscularly. Two hours later he had a short rigor followed by a fall of temperature to below normal. The

temperature rose to 100?F. on the following day but the general condition remained the same and he died on the 21st September, the 13th day of the illness.

I could find no clue to the source of in- fection in the first case, in the second, a

daughter of an Indian employee of the patient had typhus just before his illness. Neither case infected the attendants and neither

gave a history of tick bite, nor did they harbour lice, for which a careful search was made. >.* Husband and McWatters?Typhus fever

?Northern India?Indian Medical Gazette, 1908.

J.N. 5. Aged.... 64.