300 CHAMBERLAIN. 



vaccination has been coming into quite general use among the American troops. 

 As is well known, a typhoid vaccination will cause a positive Widal reaction, 

 and of late it has been becoming obvious to us that the more general use of 

 antityphoid vaccination would largely vitiate any dedifctions in the future 

 which could be drawn from positive Widal reactions in fevers of doubtful nature. 

 For this reason we have decided to compile the results of our work to date, 

 the possibility of typhoid vaccination having been excluded in all of the cases 

 referred to below. 



While several articles from the pens of different authors have appeared on 

 certain typhoid epidemics in the Philippines, (ID (12) (15) nothing, so far as 

 we are aware, has been written which gives a comprehensive view of the typhoid 

 situation throughout the Archipelago. Therefore, we feel that such a report 

 can not fail to be of value to those interested in the sanitary problems of the 

 Philippines. 



TYPHOID IN THE TEOPICS. 



. Typhoid fever, although not classed as a tropical disease, nevertheless 

 is one wliich is of gi-eat interest and importance to those practicing 

 in warm countries where it should always be born in mind when the 

 physician is confronted by a patient with any febrile disturbance. 



Manson saj^s: "The existence of typhoid fever in the tropics was for 

 long not only ignored but actually denied, even by physicians and 

 pathologists of repute." d) Malaria has been the scapegoat for the 

 diagnostic shortcomings of the tropical practitioner. At the present 

 day it is quite generally conceded that typhoid is a common disease among 

 white men resident in low latitudes and that it is alarmingly prevalent 

 among young Europeans in many parts of the tropical Orient. Caste- 

 ilani(2) and Eogers(3) agree with Manson in this opinion. Eogers 

 found that among Europeans born and bred in the Tropics the incidence 

 of the disease was especially marked in children under 15 years of age. 



As regards the occurrence of enteric fever among natives of warm countries 

 less is known. Castellani (2) states that it is common. He says: "In most 

 cases the temperature does not run the typical course described in text books 

 on general medicine, having sometimes a high remittent type, and at others 

 an intermittent type, while eases of mixed infection with malaria are not rare." 

 Eogers (3) found typhoid to be common among natives in India and believes 

 it would be more frequently observed were it not that adult natives have 

 acquired an immunity as a result of an attack in childhood. The sick native 

 children are not often seen by competent attendants. 



REPUTED OCCUBEENCE OF TYPHOID FEVER IN THE PHILIPPINES. 



In the early days of the American occupation of the Philippines 

 it was the commonly accepted view that the occurrence of typhoid in 

 these Islands was unusual. (10) That this opinion still has adherents 

 is shown by the statements published in 1910 by Dr. Victor G. Heiser, 

 Director of Health of the Philippine Islands. He says: "While cases 



