370 MCLAUGHLIN. 



The following diagnoses were made by municipal plij'sicians and private 

 physicians, apparently acting in good faith. An effort was made to in- 

 vestigate cases of acute intestinal troubles in living children, and a 

 circular letter was addressed to all practicing physicians in Manila re- 

 questing samples of the dejections of children ill with enteritis, dysentery 

 and allied disorders. Municipal physicians and medical inspectors were 

 directed to secure such samples wherever possible. The medical pro- 

 fession was apathetic and but few physicians, responded. The municipal 

 physicians and the medical inspectors, however secured a considerable 

 number of samples, and of these several with very atypical symptoms were 

 found to be positive for cholera organisms as described below. 



LIVING CASES. 



Case Id. — 1. M. — Age, three months. Male. Slight diarrhoea; mother stated 

 that child had vomited. Seen in convulsions. Admitted to San Lazaro Hospital 

 September 9. Temperature normal. This case may be regarded as an example 

 of what is commonly diagnosed as acute meningitis in Manila. It presented 

 symptoms of cortical irritation, twitching and convulsive movements; some 

 apparent but not real rigidity of tlie neck, and spasmodic movement of the 

 head from side to side. After admission to the hospital, no vomiting or 

 diarrhoea occurred; the stools were soft and faeculent. There was no collapse 

 and no anuria. The urine was highly albuminous, and during the following 

 ten days the temperature was always normal or slightly elevated. Examination 

 of the intestinal contents revealed the presence of the cholera vibrio, and this 

 organism remained present for ten daj^s as was demonstrated by daily baeterio 

 logical examination. The patient recovered. 



Case 17. — P. M. — Age, 5 years, ilale. A diagnosis of acute dysentery and 

 meningitis was made by a municipal physician. Duration of illness, one week. 

 Blood and mucus in stools. No vomiting or other symptoms of cholera. Ad- 

 mitted to San Lazaro Hospital on September 14. Had cerebral symptoms, 

 twitching, rigidity of muscles of neck, head drawn back, urine scanty and highly 

 albuminous. Examination of the intestinal contents positive for cholera vibrios. 

 The urine increased in quantity, the cerebral symptoms disappeared, the vibrios 

 disappeared from the intestines, and the patient was discharged cured on Septem- 

 ber 2L 



Case 18. — E. P. — Age, 4 years. Female. Duration of illness, fifteen days. 

 Fever but no vomiting. Diarrhoea, alternating with constipation was present. 

 The patient was treated for worms and later for meningitis by Dr. G., municipal 

 physician. Admitted to San Lazaro Hospital September 10. No symptoms of 

 cholera. Temperature 100.4 on entrance. The temperature reached normal on 

 the next day and i-emained normal until recovery. Cerebral symptoms, muscular 

 twitchings and convulsive movements were present. The patient was semi- 

 comatose at times. There was no anuria. The urine was albuminous. The 

 cerebral sj'mptoms disappeared within twenty-four hours after admission to the 

 hospital. Examination of the intestinal contents was positive for the cholera 

 spirillum. The patient was discharged cured, September 20. 



Case ID. — M. M. — Age. 1 year 7 months. Male. September 20, had fever; 

 two liquid stools, no vomiting, slight meteorisni. September 21 and 22, two 

 stools per daj', of a yellow color. Semi-comatose at times. Diagnosis, acute 

 enteritis. History and diagnosis by Dr. G., municipal physician. Admitted to 

 San Lazaro Hospital on September 23. Pulse, good; respiration, good. Large 



