TYPHOID FEVER IN THE PHILIPPINES. 



313 



recently, on re-testing a number of organisms isolated in the Philippines, all 

 except that one failed to give the blue reaction. Tlierefore, it is, probable that 

 the blue strain occurs with no greater degree of frequency in the Philippine 

 Islands than in the United States. The distinction in type is probably of no 

 iiuportance and the variations reported may at times be due to the use of milks 

 containing variable quantities of monosaccharid. In fact, acidity followed by 

 alkalinity is given as the type for typhoid by Hiss and Zinsser.(20) 



It appears that there is no constant difference, either in their litmus- 

 milk reaction or in their behavior in the presence of immune sera, 

 between the strains of Bacillus typhosus found here and those met 

 with in the United States. 



WIDAX EXAMINATIONS, 192 POSITIVE, 261 NEGATIVE. 



The 193 positive examinations were made on the blood of 177 indi- 

 viduals of whom 5 had received antityphoid vaccination and two others 

 gave a clear history of previous typhoid, leaving 170 eases in which 

 the positive reaction was of diagnostic value. j 



Only the microscopic method was employed by us in making the agglutina- 

 tion test, both loss of motility and clumping being required before making a 

 positive report. A dilution of 1 to 50 was used and one hour allowed to elapse 

 before recording the result. Part of these tests were made with fluid blood and 

 the remainder with dried blood, the dilution in the latter cases being, of course, 

 only approximate. 



Nichols (11) and Bruns(l2) in the Islands of Leyte and Panay inves- 

 tigated two epidemics in which they found an absence of the Widal 

 reaction until very late in the disease. In 11 cases Nichols found it 

 absent on an average till the twenty-fifth day. In the 177 positive 

 Widal reactions obtained by us we were often dependent on others for 

 the statement of the day of the disease. As thus given, the figures are as 

 follows : 



Tabie XII. — Days on which positive Widal reactions were obtained. 



Day. 



Num- 

 ber. 



Day. ■ 



Num- 

 ber. 



Day. 



Num- 

 ber. 



Day. 



Num- 

 ber. 



Second 



Third 



13 



13 



12 



14 



8 



14 



12 



6 



5 



Eleventh 



Twelfth 



Thirteenth 



Fourteenth 



Fifteenth 



Sixteenth 



Seventeenth 



Eighteenth 



Nineteenth 



7 

 1 

 5 

 3 

 2 

 2 

 1 

 3 

 3 



Twentieth. ...__ 



Twenty-first 



Twenty-third .. 



Twenty-fifth 



Twenty-sixth .. 

 Twenty-seventh 



Thirtieth 



Thirty-sixth 



Thirty-seventh . 



1 

 3 



1 

 1 

 3 

 1 

 2 

 1 

 2 



Forty-fifth 



Fifty-eighth 

 Seventy-third __ 

 Unknown^..... 



Total 



1 



1 



1 



35 



Fourth — ^ 



Fifth 



Sixth . _ - 



177 



Seventh 



Eighth... 



Ninth 



Tenth 





« This "unknown" group contains 5 positive Widals obtained in persons who had been 

 vaccinated against typhoid and who did not have the disease, 2 obtained in persons not 

 suffering from typhoid but giving a clear history of a previous attack, a few from whom we 

 never, received records, and a series of 20 natives found at San Fernando who undoubtedly 

 had the disease but from whom no history was obtainable. 



