This paper reviews a large series of typhoid cases from an endemic area. One of the most important features to emerge from this study is that there are recognizable clinical and laboratory differences between endemic and the classical description of epidemic typhoid fever presented in most textbooks. Over all, apart from the high titres of antibodies detected during the early phase of the illness and the long persistences of organisms in the blood stream, the clinical picture was not only different but distinctive.Young doctors practising in an endemic area for the first time experience especial difficulty in making an accurate and prompt diagnosis of endemic typhoid fever while, when complications of the disease arise, the diagnosis is often missed even by the most experienced clinicians.The findings reported in this paper emphasize that a confident and positive presumptive diagnosis of typhoid fever should be made within 24 hours of the patient's admission. This approach is preferable both in terms of anticipating complications and of instituting definitive treatment, to that exemplified by the adoption of the umbrella diagnosis of pyrexia of unknown origin, and reaching a definitive diagnosis only by exclusion.
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