TYPHOID FEVER IN THE PHILIPPINES. 315 



mononuclears. No pigmented leucocytes were seen. A relapse occurred in 

 this patient which promptly yielded to hypodermic use of quinine although 

 previous examinations for parasites and previous use of quinine by mouth had 

 resulted negatively. The true nature of this case remains in doubt. 



TYPHOID BACILLUS CAKEIERS. 



Failure attended our efforts to detect carriers as a result of 517 stools 

 cultures made on 199 individuals and 339 urine cultures made on 

 164 indi\dduals. However, we discovered one typhoid bacillus carrier 

 by accident while examining for dysentery the stool of a patient vi^ho 

 had been having loose movements of variable frequency for nearly 4 

 months. 



The patient, aged 30, gave no history of typhoid fever. He had been in the 

 Philippines one year and had ten years' service in the Army. He had dysentery 

 in 1907. The last part of June, 1910, while on a mJapping detail in the field, 

 he developed a very severe attack of diarrhoea with some blood and mucus. Did 

 not go on sick report and diarrhoea persisted. Lost about 28 pounds in weight. 

 On admission to Division Hospital September 5, 1910, he was having about 4 

 stools daily, usually liquid and yellowish or clay-colored. They contained neither 

 blood nor mucus. During his stay in the hospital from September 5 to October 

 14, 1910, his temperature never went above 37°. 4C. and was generally normal. 

 Pulse averaged 90 at times reaching 110. Repeated examinations of the stools 

 for ova and amoebte were negative. 



The first stool culture was made on October 13, the day before he sailed for 

 the United States and about 110 days after his original attack of diarrhoea. It 

 was positive for Bacillus typhosus. Meantime the patient had sailed for the 

 United States, but by telegraphic request we obtained a specimen of his blood 

 while the transport was at Mariveles and this gave a positive Widal reaction. 



Under date of November 19, 1910, the commanding officer of the General 

 Hospital at Presidio of San Francisco notified us that the soldier was still 

 excreting typhoid bacilli. 



As far as we can learn this is the only carrier which has been found in the 

 Philippines. 



PAEATYPHOID FEVER AND GROUP AGGLUTINATION. 



Strong in 1902 reported the recovery at autopsy of a paracolon organism from 

 a soldier who had died with the usual symptoms of typhoid. (21) Ruediger, at 

 the Bureau of Science, recently isolated a para-typhoid strain from the blood 

 of a dog which died of rabies and showed also a purulent pneumonia. Our 

 experience with the paratyphoid organism is confined to one case. The patient, 

 who also had tuberculosis, ran a febrile course of eighteen days' duration, the 

 curve suggesting mild typhoid fever. There were the usual premonitory symp- 

 toms of typhoid fever, and the progress of the disease was characterized by 

 constipation, tympanites, pain in head and neck, splenic tumor, and normal 

 leucocyte count. From the blood was obtained a pure culture of Bacillus 

 paratyphosus "A." The blood serum at first agglutinated both Bacillus typhosus 

 and Bacillus paratyphosus. At a later date it failed to react with the former 

 organism.' 



- Since this writing we have isolated Bacillus paratyphosus "A" from the 

 blood of a Japanese with a continued fever at Camp Stotsenburg. 



