TYPHOID FEVER IN THE PHILIPPINES. 



319 



GROUP IV. CASES WITH WELL MARKED CONTINUED FEVER LASTING MORE THAN TEN 



DAYS AND CLINICALLY TYPHOID. 



In this group there are 89 cases (56.6 per cent of the entire 157) which 

 ran a febrile course of ten days or more and "w^hich in nearly every instance 

 would be considered typhoid fever from clinical observations alone. The 

 diagnosis was confirmed in each of these cases by the laboratory findings 

 which for the great majority were positive Widal reactions and for the 

 remainder cultures otBacilltis typhostis obtained from the blood or excreta. 

 There were 4 positive urine cultures, 5 positive stool cultures and 15 

 positive blood cultures from this group. 



Based on clinical appearances we divided these cases as follows ; typical, severe, 

 18 (20.2 per cent) ; typical, moderate, 46 (51.7 per cent) ; typical, mild, 10 

 (11.2 per cent); atypical, mild, (lacking a fastigium) 12 (13.5 per cent); 

 atypical, severe, 3 (3.4 per cent). The clinical histories for many of these cases 

 are deficient as regards the presence or absence of the less important symptoms and 

 signs, therefore in the analysis which follows the percentage of occurrence for 

 some of the minor features will be an underestimate. With all the clinical records 

 there were well kept temperature charts which rendered easy a correct estimate 

 of the febrile type of the disease. 



Onset of the disease. — The onset was sudden in i cases and gradual 

 in the remaining 85. The premonitory symptoms included headache, 

 backache, pains in bones and joints, lassitude, anorexia, diarrhoea, abdom- 

 inal pain, nausea, vomiting, chills, fever, stiff neck, vertigo, and myalgia. 

 They did not differ from those commonly encountered in the United 

 States. Chills or chilliness were recorded in 10 cases. 



Febrile course. — The onset of the disease could be fixed with reason- 

 able accuracy in all of these 89 cases. The lengths of the febrile reaction, 

 collected in groups each covering a 5 -day period, are shown below. 



Table XVI. — Duration of febrile course for 89 characteristic typhoid cases. 



Days. 



Num- 

 ber. 



Percent. 



Days. 



Num- 

 ber. 



Percent. 



Between 10 and 15 



8 

 24 

 21 

 13 



8.98 

 26.97 

 23.60 

 14.61 



Between 31 and 35 



9 

 10 



4 



10. a 



11.24 



4.49 



Between 16 and 20 



Between 36 and 40 



Between 21 and 25 



Over 40 



Between 26 and 30 



Average, 26.1. 





The cessation of fever in all cases has been arbitrarily taken as the 

 date after which the evening temperature did not rise above 37°. 2 C. 

 We believe that the above figures represent the minimum of febrile 

 course and that possibly the real average was slightly longer as a result 

 of the patients having been taken sick somewhat earlier than appeared 

 upon the records. The average for our series was 25.1 days. For com- 

 parison may be mentioned the 780 cases studied by the Spanish-American 



