316 



CHAMBERLAIN. 



We have tried the agglutination reaction with Bacillus paratyphosus on a 

 considerable number of patients, and aside from the above have obtained positive 

 reactions only twice, one of these sera also reacting with Bacillus typhosus. A 

 more detailed report of the above ease and a discussion of the subject of group 

 agglutinations is contained in our quarterly report for December 31, 1910. 



OBSEKVATIONS ON THE BLOOD OF TYPHOID FEVER PATIENTS. 



The blood of all of the patients considered was examined ' for malarial 

 organisms with negative results except as noted below under complications. 

 No other blood work was done on the cases except leucocyte counts, most of which 

 were made at the laboratory of the Division Hospital on patients who were 

 being treated in that institution. Thirty-six white blood counts were made 

 on the blood of 19 patients and 31 differential counts on 15 of the same 

 individuals. The average results divided as to race, appear below: 



Table XIV. — Average white blood counts on typhoid fever patients. 



Average. 



Leuco- 

 cytes per 

 c. mm. 



Polymor- 

 pho- 

 nuclears. 



Small 

 lympho- 

 cytes. 



Large 

 lympho- 

 cytes. 



Trani- 

 tionals. 



Eosino- 

 philes. 



Mast 

 cells. 



Americans 



6,540 

 10, 234 



66.2 

 66.9 



25.7 

 26.3 



6.3 

 5.3 



1 

 0.3 



0.6 



0.5 



0.1 

 0.7 



Filipinos. 



Both races 



7,669 



66.5 



2.5.9 



6 



0. 8 0. fi 



0.3 









These counts were made in the first week or ten days of the disease 

 and do not show a tendency to the usual leucopenia, the average being 

 normal for the white men and rather above normal for the natives. 

 The lowest count for a native was 6,300 and the highest 15,400. For the 

 Americans ten counts were below 6,000, fourteen between 6,000 and 

 10,000, and one was 11,500. 



Rogers in a study of typhoid in India found the small lymphocytes to ba 

 increased above the normal maximum of 30 per cent in over one-half his 

 patients. In our series this was not the ease, in fact we should consider the 

 average of 25.9 per cent as low, since it has been our experience that in the 

 Philippines the count of the small lymphycytes is uniformly high in healthy men, 

 usually ranging above 30 per cent. This is true for natives, and for Americans 

 with one or more years of tropical service. 



The low eosinoph'ile count in this native series is very unusual and probably is 

 due to the fact that most of the patients were Scouts who had been relieved of 

 their intestinal parasites prior to acquiring typhoid fever. 



PART III. CLINICAL ASPECTS OF TYPHOID FEVER IN THE PHILIPPINES. 



After excluding vaccinated patients, persons with clear histories of 

 previous typhoid and one case of paratyphoid there remain the clinical 

 histories of 157 patients sick during the last two and one half years 

 and- for whom the laboratory findings indicated the existence of typhoid 

 infection. For clinical analysis we have divided these cases into four 

 groups as follows : 



Group I ; 7 cases terminating fatally ; 4.5 per cent. 



