Parkinsonism in Typhoid Fever

Sir.?With reference to the report in your journal of March 1947 of a case of typhoid fever, complicated by Parkinsonism, I wish to draw your attention to the following points :? To me, the case looks one of typhoid with signs of meningeal irritation, the points in favour of the latter being 1. Muscular rigidity, 2. Positive ICernig's and Brudzinski's signs, and 3. C.S.F. findings, namely increased pressure, increased proteins, i.e. 1.2 per cent, complete absence of sugar and the presence of a few monocytes. The cause of meningeal irritation is not quite obvious +i?re' canno? be the simple case of meningism, as there is a definite increase in the C.S.F. proteins, complete absence of sugar, and the presence of some cellular reaction though the clinical course of the case very much favours this diagnosis. In view of the otitis media or mastoiditis _ complicating the case, we have to think of : (1) Septic meningitis which is ruled out in this case by the absence of a marked polymorphonuclear cell reaction and growth in culture; (2) Serous meningitis' which is difficult to exclude m this case (granting the existence of such a pathological entity). Though mentioned ns a rather rare complication and as being attended with grave prognosis, typhoid meningitis has got to be thought of. The issue could have been settled if only the C.S.F. has been collected straight into ox-bile medium and cultured for Eberthella typhosus. The total absence of sugar in the C.S.F. militates against a diagnosis of encephalitis the aid of which the author invokes in this connection. I wish the author had been a little more clear about the nature of the inflammation in question.