318 CHAMBERLAIN, 



the death rate would be lower if every case of mild enteric fever occurring 

 among the Scouts received the appropriate diagnosis. Eogers found a 

 death rate of 26 per cent among 50 native Indian cases. Among the 26 

 Filipino cases for which we received clinical histories onl}^ one died, a 

 mortality of 3.8 per cent. The average mortality for ten years among 

 the American soldiers in the Philippines is very much higher than at 

 home, 16.83 per cent compared with 7.05. This can be attributed mainly 

 to the large amount of typhoid with a high mortality in the first four 

 years of the decade, a time when the facilities for nursing, feeding and 

 sheltering the patients were less favorable than in the United States. 

 During the last six years, when the conditions in the Philippine hospitals 

 have approximated those of similar institutions in the United States, 

 the mortality has been no higher than at home (255 cases, 18 deaths, 

 mortality 7.1 per cent). Therefore, it seems safe to conclude that the 

 type of typhoid infection now heing encountered in the Philippines is, 

 under present conditions, no more fatal to the American than that met 

 with in the United States. 



6H0UP II. CASES WITH ILL-DEFINED FEVER OF LESS THAN TEN DAYS DUEATION. 



Nineteen out of the 157 clinical records (12.1 per cent) show a slight 

 febrile movement lasting less than ten days with few symptoms and 

 nothing characteristic on which to base a diagnosis. The true nature 

 of these cases could be determined only by laboratory methods. In addi- 

 tion to finding a clear-cut positive Widal reaction in all of the nineteen 

 we were able to obtain by cultural methods the Bacillus typhosus from 

 the stools of three and the urine of one other of this group. 



GEOtrP III. CASES WITH IRREGULAB FEVER OF LESS THAN TEN DAYS, DURATION, 

 PROBABLY REPRESENTING THE LAST PART OF LATENT OR AMBULANT TYPHOID 

 TYPES. 



Forty-two cases out of the 157 (26.6 per cent) presented an irregular 

 temperature chart which resembled the last week or ten days of the 

 classical typhoid curve. These patients were, in our opinion, suffering 

 from a mild ambulant form of typhoid fever and came under observation 

 only late in the disease. Such cases were particularly numerous in the 

 Ludlow Barracks epidemic, constituting 33 per cent of the admissions, 

 and many of them probably never would have come on sick report had it 

 not been for the fact that the temperatures of all soldiers were being 

 taken daily and every one with fever was placed in hospital for ob- 

 servation. 



In addition to obtaining positive serum reactions in all of this group 

 we isolated Bacillus typhosus from the stools of 5 patients and from the 

 urine of another. 



