Ill 



CLINICAL OBSERVATIONS 



1. METHODS, CHARACTER OF MATERIAL 



THE clinical cases upon which the studies of the Commission 

 were based were found at the St. Stanislaus Hospital, Warsaw, 

 Poland. There, an arrangement was made by which selected 

 patients were transferred for the active course of their disease to 

 a division of the hospital which was entirely under the control 

 of the Commission. The St. Stanislaus Hospital was the chief 

 hospital in Warsaw for typhus fever patients. To it were sent 

 cases diagnosed as typhus by the health officers of the city. No 

 cases were recommended to it except those believed to have 

 typhus. As a precaution against error, however, all cases ad- 

 mitted were retained in receiving wards until the officer of the 

 St. Stanislaus Hospital Staff in charge of these wards was satis- 

 fied that the diagnosis was correct. When the diagnosis was 

 thus confirmed patients were transferred to the general typhus 

 wards. It was from patients thus admitted to the general wards 

 with confirmed diagnosis that cases were selected by the Clin- 

 ical Officer of the Commission, in consultation with one or more 

 members of the St. Stanislaus Hospital Staff, for transfer to our 

 Division. All cases admitted to our Division, therefore, were 

 cases in which the diagnosis of typhus fever was considered 

 unquestionable as the result of not less than three examinations 

 by four or more physicians familiar with the disease. 



On admission to our Division, after a careful delousing 

 process, an independent history was taken and a complete 

 physical examination was made. As a routine the urine was 

 examined, and the percentage of hemoglobin and number of 

 white cells in the blood was ascertained. In many cases, there 

 was done also a differential count of the white cells, an exam- 

 ination of smears for the organisms of relapsing fever and mala- 



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