322 CHAMBERLAIN. 



apparently were received in the last week of a classical typhoid attack 

 while the remaining 12 passed through a period of continued fever rang- 

 ing from ten to thirty-nine days in length and averaging 29.6. 



These last 12 cases, which on clinical gTounds alone appeared to be typhoid, 

 are included in our Group IV. considered above, but will be briefly touched on at 

 this point in order to determine if the disease in natives differs from that seen 

 in the white man. All but two of these natives ran a febrile course of over 

 19 days. The onset was gradual in all instances. Chills were noted for two 

 patients. The temperature chart showed a well defined fastigium in seven eases 

 and the fever ranged at the height of the disease between 40° and 41.°1C. 

 Nose bleed occurred in three, rose spots in two, marked abdominal pain in four 

 and tympanites in 7. Diarrhoea was noted in 4, constipation in 5 and there 

 was no record as to bowel movements in 3. As complications, haemorrhage oc- 

 curred in two cases, post-typhoid psychosis in one and bronchial spirochetosis in 

 two 



From a study of these cases it can be said that they did not differ from 

 typical tjrphoid fever of moderate and severe type as seen among white 

 men in the United States or in the Philippines. 



The atypical cases which constituted so large a proportion of the 

 Filipino admissions in the Camp Gregg epidemic and occasionally else- 

 where are of special interest because of their probable role in spreading 

 and keeping up infection. We have not had enough of them under 

 observation to make any analysis of their symptomatology profitable. 

 Eogers found such types in 17.8 per cent of his patients in India, this 

 percentage being much lower than was seen in our series. How com- 

 monly these atypical cases occur in the general native population is one 

 of the imsolved problems of tropical medicine. 



Summing up the clinical aspects, we found that more than one-third 

 of the admissions were atypical and that the well marked cases of typhoid 

 in the Philippines, whether the patients were white or native^ differed 

 in no essential respect from the same disease as seen in the United States 

 and Europe. The experience corresponds in general with the findings of 

 Eogers in India. The atypical cases were about equally common in the 

 two races. 



RELATION OF BACILLUS TYPHOSUS TO THE SO-CALLED UNDETERMINED FEVERS. 



It seems to us that the most important point brought out by the 

 clinical study of the cases is the frequency of occurrence in the Philip- 

 pines of the short irregular and atypical forms of typhoid fever. Groups 

 II. and III. constituted 38.7 per cent of the entire 157 cases of typhoid 

 infection. These two classes of mild infections formed 45.6 per cent of 

 the total admissions at Ludlow Barracks and 69.2 per cent of the ad- 

 missions among the Scouts at Camp Gregg. Without laboratory exami- 

 nations or the presence of a wide-spread epidemic, such as prevailed at 

 Ludlow Barracks, few, if any, of these mild enteric fevers would have 



