CASE HISTORY

Sudden onset of headache, abdominal pain, vomiting and slight diarrhoea on 23.2.36. Patient remained up and about for 3 days then took to bed and consulted her doctor. Two days later she became delierious and was admitted to hospital. On examination restless and confused with flushed face and injected conjunctivae and fauces. Pulse 100, regular and of good volume. Abdomen showed diffuse tenderness but no rigidity, 3.3.36. RBC 4,900,000, Hb 94%, WBC 8,800 with 71% polymorphonuclears. 4.3.36. Widal reaction: positive to S Typhi, 1 in 530, Spleen just palpable. Some rose spots visible on abdomen. 6.3.36. Weaker. Showing typhoid state, Signs of consolidation at right base. 8.3.36. Worse. Respirations rapid. 9.3.36. Died after a total duration of 15 days.

PATHOLOGY

The larynx has been opened from behind. Immediately posterior to each vocal cord, at the base of the arytenoid cartilage and on its inner surface, there is a rounded, ulcerated area covered by a dirty grey coloured slough. Over the posterior surface of the epiglottis there is a little superficial ulceration, visible as an area of reddening with loss of the epithelium. The remainder of the pharynx is deeply congested and shows small grey points of superficial necrosis. Sections were not taken from this specimen. Laryngeal ulceration is a recognized but uncommon complication of typhoid fever.