A Case for Diagnosis

as negative even up to the 30th day of illness, and positive thereafter at 1 : 100 or higher dilution. The negative agglutination test in this case appears to have been observed about the 17th day of illness. Tice, in his Practice of Medicine (1927), Vol. IV, p. 503. says that " while a positive result is highly presumptive of typhoid, a negative finding has no significance." There is a temperature chart on p. 484 of the same volume illustrating such a case, where the Widal reaction was negative on the 8th and 15th days and positive on the 47th day. It is possible therefore that the Widal reaction might have become positive in this case at a later stage. The hyperpyrexia and meningeal symptoms suggest complications of typhoid fever. It appears to be most unlikely that the case was one of malaria, as so much quinine was administered without affecting the fever. The blood film was also reported to show no malaria parasites.?Yours, etc.,