498
(6.) In conclusion, I am inclined to the opinion that the Chinese suffer from enteric fever as frequently during adult as during infantile life, and were the customs of the people and the conditions of life regulated in a manner similar- to that obtained in the Occident, the incidence of this disease would differ but little from that found in Western countries. In the latter, typhoid fever is also found in infants and children, but its incidence in the young is smothered up by large figures which mark the occurrence of the disease in adults.
The Occurrence of the Disease in Infancy and Childhood.
It was formerly generally believed that infants and children were not subject to typhoid fever. They were known to be liable to fever attended by gastric and intestinal symptoms, which was usually called "infautitle remittent fever." Since the researches of RILLIET in 1840. showing that the majority of cases of so- called remittent fever in children were really instances of enteric fever, a number of investigations have been made into this subject, notably by PROUSSEAU, GEB- HARDT, CURSCHMANN, HILDEBRAND, OSLER, and many others. The majority of writers on this subject have confirmed the view that infants and children are particularly susceptible to typhoid infection.
In view of the fact that a considerable number of cases of infantile typhoid is met with at the Public Mortuary, I feel bound to record the results of my investi- gations. I shall confine my remarks to the cases which occurred during the past
30 cases of the disease occurred in children under the year.
age of 5 years, of which 16 were found in infants under 1 year, and 14 in infants between the ages of 1 and 5 years.
The following table gives details regarding the age incidence :-
0-2 months,
2-3 months,
3-6 m nths,
6 months-1 year,
1-2 years,
2-3 years,
3-4
years,
4-5 years,
Total,
1
7
4
*5
1
30
One case was found in a child under 2 months old. I found it difficult to determine the age of this infant more definitely. The child was found dumped". The youngest, case on record would appear to be that reported by GEBHARDT, in a child 3 weeks old. OSLER published an account of a case in an infant 5 days old, but this undoubtedly was an instance of "foetal typhoid".
The post-mortem appearances of the cases, which have come before me, are those of early typhoid infection. As one would expect the lesions found in infants and children are less defined and characteristic than those met with in adults.
The peyers patches and solitary follicles were swollen and were in a condi- tion of medullary infiltration just before commencing ulceration. The preliminary general hyperaemia and swelling of the mucous membrane had, in the majority of cases, more or less disappeared. The intestinal patches were usually of a greyish red colour and to the touch were soft (plague molle). The mesenteric glands were swollen, greyish red, and on section the parenchyma bulged with cortical congest- ion. The spleen was enlarged, soft and friable, and full of dark fluid blood. The enlargement of the spleen would appear to be more common than in adults,
Judging from the post-mortem appearances the cases met with in infants had a duration of about 10 to 14 days. Those found in older children varied from 14 days to 3 weeks.
Bacteriological examination of the liver and spleen in several of these cases was made. The bacillus typhosus was isolated without a great deal of difficulty and responded to the usual differential tests. In one case, a micro-organism was isolated which failed to correspond exactly with the classical B. typhosus. The