CHOLERA IN CHILDREN. 365 



The reporting of cases of commumcable disease in the Philippines is 

 compulsory under the Sanitary Code. Living cases, especially light 

 ones, may go unreported or unrecognized and the error not be discovered. 

 In fatal eases, the Bureau of Health has more perfect control. All 

 interments necessitate a burial permit from the Bureau, and before grant- 

 ing this a death certificate from a municipal or a private physician, 

 countersigned by a medical inspector of the Bureau of Health, is neces- 

 sary. These death certificates are scrutinized very closely at the central 

 office of the Bureau. Practitioners might interchange the diagnosis 

 as between cholera and acute enteritis, but they would scarcely dare to 

 attempt gross deception. The cases of cholera which have not been 

 reported as such have been reported usually as acute or chronic gastro- 

 enteritis, enteritis, entero-colitis, acute or chronic dysentery, and acute 

 meningitis. 



It was noted that the deaths from the above causes always increased 

 just before or during an outbreak of cholera. I decided to investigate 

 these fatal cases, and the results given below corroborated my suspicion 

 that cholera cases were frequently unrecognized and unreported in 

 Manila. Some of these cases were sent to the moi'gue for autopsy; in 

 others, samples of the intestinal contents were taken in lieu of an autopsy. 

 The following cases are examples : 



Case 1. — D. G. — Age, 1 year 8 months. Male. Duration of illness, three 

 months. Diagnosis and history by municipal physician. Diagnosis, chronic 

 gastro-enteritis. Absence of symptoms of cholera other than diarrhoea of a 

 fopculent character. Post-mortem findings obscured by decomposition of organs. 

 Cholera vibrio recovered from intestinal contents. 



Case' 2. — T. P. — Age, 3 years. Male. Case diagnosed as chronic enteritis, of 

 six months' duration. No vomiting, cramps, or other symptoms of cholera. 

 Diagnosis and history by Dr. L. L. Specimen taken from intestine positive for 

 cholera vibrio. 



Case 3. — J. V. — Age, 5 years. Female. Diagnosis and history by municipal 

 physician. Dr. H. Diagnosis, acute dysentery. Duration of illness, fifteen days. 

 Diarrhoea, bloody stools, no vomiting or other symptoms of cholera. Post-mortem 

 findings atypical of cholera. Examination of intestinal contents positive for 

 cholera vibrios. 



Case .'i.—D. E. — Age, 6 years. Female. Diagno.sis, chronic enteritis. Dura- 

 tion, three months. None of the symptoms of cholera were present except diar- 

 rhwa, the stools were not of a rice-water character. Diagnosis and history by Dr. 

 B., a private physician. Post-mortem findings, acute specific enteritis, cloudy 

 swelling of the kidneys and other lesions suggestive of cholera. Examination of 

 intestinal contents positive for cholera. 



Case 5. — F. S. — Age, 2 years. First appearance of illness, August 7. Visited 

 by municipal physician August 14. Patient weak, thin. Diarrhoeal stools, two 

 to 3 a day. Slight fever. Above conditions continued, gradually reducing the 

 child's strength until on August 25 a slight cough and vomiting began. Some 

 meteorism and great emaciation. No meningeal symptoms nodceable. History 

 and diagnosis of acute enteritis by Dr. C, municipal physician. Examination of 

 intestinal contents positive for the cholera vibrio. 



