116 HEISER. 



Exist in the Philippine Islands, states that the average yearly 

 deaths in Manila amount to 82.4 which would indicate a 

 yearly incidence of 412 cases. There is considerable question 

 as to the correctness of the figures as regards Manila. For 

 instance, in the Annual Report of the Director of Health for 

 1906 it is stated that 



"In the last annual report mention was made of the fact that it was 

 believed that typhoid fever was not so prevalent as the statistical tables 

 seemed to indicate. At that time a number of cases had already been 

 investigated by laboratory methods of diagnosis and a considerable num- 

 ber of them were found not to be typhoid fever. These investigations were 

 continued during the present year and the results have fully confirmed 

 the presumption that mistakes are frequently made in the diagnosis of 

 this disease. 



"During the year 45 deaths from typhoid were reported in the city of 

 Manila. Of these only 4 were found positive to the Widal reaction. 

 Among those who recovered from diseases diagnosed as typhoid, 9 cases 

 were found positive, or a total of 13 found positive during the year." 



Be that as it may, there can be but little question that the 

 disease does prevail to a considerable extent in many portions 

 of these Islands, and the first step necessary in order that we 

 may be in a position to attack the problems of the prevalence 

 and distribution of the disease and of the local factors favoring 

 its spread is the collecting and recording of reports of all cases 

 and their history. 



DIAGNOSIS. 



It is not the purpose of this paper to discuss at length the 

 diagnostic features of typhoid, but it will not be out of place 

 to refer to a few points. The literature of the disease shows 

 that errors in diagnosis are most common. In order that this 

 factor may be reduced to a minimum, it is desirable to have a 

 Widal blood-test made in all cases. To this end the Bureau of 

 Health will have made, free of charge, a Widal reaction for 

 any practitioner who may desire it. It will only be necessary to 

 place a drop of blood on a sheet of paper, write upon the paper 

 the name of the patient, the sex, the town and province, and send 

 it to the Bureau of Health. The result of the examination will 

 be communicated to the doctor who sent the specimen as soon as 

 it is known. Preferably, the blood should not be taken until 

 the tenth day of the fever, and if the first result is negative and 

 the fever persists, another specimen should be sent. 



Attention is also invited to the fact that although diarrhoea 

 is a common symptom in typhoid, it is not unusual to have 

 epidemics in which constipation is a marked feature. 



