314 



CHAMBERLAIN. 



From, a study of the temperature charts of the patients we feel sure 

 that many of the cases were somewhat further along in the disease at 

 the time of the appearance of the Widal reaction than would be indicated 

 by the above figures. On the other hand, most of the cases reported 

 above as having a very late serum reaction undoubtedly would have shown 

 one earlier, but none was done till the date indicated in the table. 

 In a series of cases in which a negative followed by a positive reaction 

 was obtained and in which the onset of the disease has been fixed with 

 reasonable accuracy from the clinical records we found no notable pro- 

 longation of the pre-agglutination stage. The figures appear in Table 

 XIII. 



Table XIII. — Days on lohich Widal appeared in patients loho liad previously 



given a negative reaction. 



Case 

 num- 

 ber. 



Day. 



Case 

 num- 

 ber. 



Day. 



Widal negative. 



Widal positive. 



Widal negative. 



1 

 Widal positive. 



5 

 21 



7 



4 



3 



258 



1076 



350 



352 



383 



137 



Sixth and seventh 



Tenth _. 



Eighth. 



Eleventh. 



Eighth. 



Ninth. 



Thirteenth. 



Ninth. 



Seventh. 



Fourth. 



Eighth. 



Twenty-fourth. 



Tenth. 



117 

 108 

 138 

 131 

 128 



213 



402 



Seventh and eighth-. _ 



First and third 



Sixth 



Tenth. 



Fourth. 



Seventh. 



Fourth. 



Fifth. 



Eighth. 



Tenth. 



Twelfth. 



Seventh 



Seventh 



Twelfth 



Second _ 



Second __. 



Sixth 



Seventh _ 



Sixth. 



Fifth 



Second 



Sixth and seventh 



Average — 



Spvpnth 



Fifteenth 



Ninth. 



Fourth and seventh 





From our 89 characteristic cases of typhoid fever, analyzed below and in 

 which the date of onset could be quite definitely fixed, we obtained positive 

 Widal reactions on or before the tenth day of the disease in 72 per cent and 

 on or before the fifteenth day in 87 per cent. In all but one of the remaining 

 13 per cent no serum test had been performed prior to the fifteenth day, and 

 it is probable that all or nearly all were positive before that time. 



From the above figures it is evident that the experience of the Board 

 does not indicate any general tendency toward unusvM delay in the 

 development of agglutinins in the blood of patients suffering from 

 typhoid fever in the Philippines. 



We have analyzed the clinical records of over 100 patients with elevations of 

 temperature and for whom negative Widal reactions were obtained. In only 

 one instance was there the slightest reason to believe that the febrile condition 

 was enteric fever, and in this single case the temperature curve and symptoms 

 were not entirely characteristic. Repeated typhoid serum reactions were negative 

 up to the fourteenth day, after which time no specimens were submitted. Serum 

 reaction with Bacillus paratyphosus was reported negative but fell in the class 

 of reactions which some observers report as "partial." The leucocyte count was 

 9,000 and there was ,33.8 per cent of small lymphocytes and 9.2 per cent large 



