Charles O. Wagenhals, M.D.; Joseph Tannenberg, M.D.
JAMA. 1960;173(4):355-359. doi:10.1001/jama.1960.73020220001008.
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We are reporting a water-borne outbreak of typhoid fever that was initiated by a case which clinically presented the picture of ordinary, acute purulent meningitis. It occurred in a region that for years had been practically free from typhoid fever.

First Case of Outbreak 

History.—  On Aug. 28, 1959, a 33-year-old man was admitted to the Wyoming County Community Hospital. He had been well until four days prior to admission, when he became ill, with slight pain in the back and some diarrhea. The back pain improved on application of a heating pad. The diarrhea subsided within 24 hours, and he worked during the next three days. On the day of admission he did not feel well but drove to work; however, he returned home soon, collapsed at 10 a. m., and had a shaking chill followed by profuse sweating. The patient was weak and could not walk. One


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