17,1 Gomez et al.: Diphtheria in the Philippines 45 
San Lazaro Hospital, which is practically the period that elapsed 
before the administration of the antitoxin, we find that there 
is no marked difference between the cases that recovered and 
those that proved fatal, as shown in Table 6. 
TABLE 6.—Number of days sick previous to admission to San Lazaro Hos- 
pital or antitoxin treatment. 
Cases. 
Days. 
Recovered. Fatal. 
Per cent. Per cent. 
Foes ow cccda decks ieee ee edansl Ceram eemancabeweares 3 7.6 2 8.6 
BN, aa ees Eke E BOR ane gkus ie ot 4 10.2 1 4.3 
bis ta ann Ms SA hy ar as Sg ae A 5 12.8 1 4.3 
8 cl oceania ere aewee ieee gudbites dupes on ecaaka 8 20.5 10 43.4 
Gr ew ek wate Sed bbeddn meray soekwaes toaetw aces 5 12.38 3 13.0 
ee ee abe eae sauce tacnedouser ecank gi 4 Lik Bee Eel pak commen 
Ri re ree ee 8 Se Ts AAS ku pn ee ee icons! 3 7.6 3 13.0 
Viciepiaiatiigtid anc saenahnen a= Kime wemies tena snore nna Sams 3 7.6 1 4.3 
a ee a oe peng cen we sk | ec 1 4.3 
WCU ROR tog Ga ied So ee ee ance ak ante end 4 10.2 1 4,3 
ga ER are AiR SP Rie ae ee ee iy aonaraaipe Se + Bescaria saed 
Brownlee(1) states that in England the disease is, as a rule, 
most fatal in towns where it is least prevalent, and Park and 
Bolduan(6) think that in some instances this is due to the fact 
that in years when the disease is not epidemic the proportion 
of laryngeal cases is greater than usual. This seems to tally 
with the experience in the Philippines where, as shown by 
the autopsy records, distinct diphtheritic laryngeal lesions were 
found in twenty-four out of twenty-seven cases of diphtheria 
autopsied by the pathologists of the University of the Philip- 
pines. Such lesions would naturally aggravate the disease by 
mechanical obstruction, increased toxemia due to the greater 
extent of the membrane, and greater liability to bronchopneu- 
monia that may be brought about by aspiration. 
SUMMARY 
1. Diphtheria occurs in the Philippine Islands and shows 
practically the same clinical manifestations and bacteriological 
and pathological findings as in other countries. 
2. It is rather infrequent and does not seem to be so con- 
tagious; nor does it develop in epidemic form. 
3. It occurs in all races and is more frequent in children dur. 
ing the first five years of life. 
