16 CLINICAL OBSERVATIONS 



ria, serum reactions for typhoid and paratyphoid A and^B 

 agglutinations, and a Weil-Felix reaction. Four-hourly charts 

 of temperature, pulse, and respiration were kept by our nurses. 

 Each case was visited and examined daily by the Clinical Offi- 

 cers and a daily note of progress was recorded. Patients were 

 retained in our Division only until it was concluded that they 

 had passed the active stage of typhus fever, when they were 

 returned to their original wards to complete their convales- 

 cence. In fatal cases arrangements were made to hold autopsies 

 very shortly after death. 



The group of 181 cases studied is a selection of the most 

 typical of the severer cases received by the hospital. Our 

 cases were chosen first for certainty of diagnosis, second for 

 gravity of prognosis, and third for early recognition in order 

 that the louse-feeding experiments might include early as well 

 as late cases. Owing to the well-known fact that the mortality 

 in typhus fever is higher in older patients, age was often a factor 

 in our decisions as to which patients should be transferred to 

 our wards. Our material, therefore, differed from that of the 

 remainder of the hospital in the relatively small number of 

 young and mild cases. We were unable, however, to accept all 

 of the severe cases, so that certain patients died and became 

 available for autopsy who had not been transferred to our care 

 in life. Still, in his rounds for the selection of cases the Chief 

 Clinical Officer of the Commission was able to see practically 

 all of the important clinical material of all wards of the hos- 

 pital. Of the fourteen cases coming to autopsy not from our 

 Division he had seen and examined eight sufficiently to vouch 

 for the diagnosis on clinical grounds. In the remaining six 

 cases the clinical diagnoses of members of the St. Stanislaus 

 Hospital Staff is accepted. 



From the selected clinical material gathered in this way it 

 was possible to obtain facts as to the course of the disease in 

 each case; they are, here published for their descriptive value. 

 In connection with the data obtained from history, it is neces- 

 sary to explain that the difficulties of communication resulting 

 from ignorance and delirium of many patients, as well as the 



