372 MCLAUGHLIN. 



Suificient work has already been done to show that many eases of 

 cholera in children during epidemics are iinrecognized and uure])orted as 

 such. Furtlier, careful investigation of all acute diseases and of deaths 

 of children during inter-epidemic periods is necessary before an opinion 

 can be expressed upon the possibility of cholera existing in Manila un- 

 reported for months. This work will be carried out as rapidly as 

 possible and I hope before long to be able to present additional interesting 

 data upon the actual findings in cases reported as "infantile" beriberi, 

 convulsions of children, acute bronchitis and other diseases of children. 



There were two cases of cholera reported in July but the epidemic 

 can be said to have commenced August 17.witli two cases in Bancnsay. 

 From August 17 to date, September 25, there has been a total of 83 

 cases. To accentuate the importance of the examination of the stools 

 of children reported- as suffering with other diseases, T need only call 

 attention to the fact that 27.7 per cent of the total cholera cases were 

 reported as victims of other diseases, and that without routine stool 

 examinations they would never have been recognized as cholera. 



CONCLUSION'S. 



Cholera in children is often unrecognized and unreported as such, 

 being reported as acute or chronic enteritis, gastro-enteritis, entero-colitis, 

 dysentery, acute or simple meningitis, and probably also as "infantile" 

 beriberi, convulsions of children, and other diseases. 



The occurrence of these errors in Manila makes it more than probable 

 that the same confusion exists in a greater degree in the provinces, where 

 skilled diagnosticians are more rarely found. 



The clinical picture of cholera in children is often atypical, and the 

 diagnosis may be extremely difficiilt if not impossible without a bacterio- 

 logical examination of the intestinal contents. Cerebral manifestations 

 in children suffering from cholera are very common, and their severity 

 is in inverse proportion to the age of the child. Acute meningitis is a 

 very rare 'disease in Manila, in spite of the statistics to the contrary. The 

 percentage of cliildren attacked by cholera is higher than shown by the 

 statistics of the Bureau of Health. 



Further investigation is necessary to demonstrate the relation between 

 "infantile beriberi," "acute bronchitis," "convulsions of children," etc., 

 and cholera in children. 



During cholera outbreaks and during June, July and August and 

 September, all acute diseases of children should be reported to the 

 Bureau of Health. A bacteriological investigation of the intestinal 

 contents should l)e made in everv case. 



