TYPHOID FEVER IN THE PHILIPPINES. 323 



received a correct diagnosis. This clinical t3'pe of infection with Bacillus 

 typhosus may account for a considerable part of the so-called undeter- 

 mined fevers met with in the Tropics, the prevalence of which in our army 

 is shown in Tables III and IV. The sanitary importance of detecting 

 such atypical typhoid cases is obvious. 



Throughout our analysis we have been on the look-out for cases cor- 

 responding with the description of Brill's disease but have seen none 

 suggesting that condition or the recently described Manchurian 

 typhoid. (24) 



DIAGNOSIS, PROGNOSIS, AND TREATMENT. 



In the well-marked cases of tj-phoid in the Philippines the diagnosis 

 can be made by the usual symptoms and physical signs recognized in 

 temperate climates. In the large group of short atypical fevers diagnosis 

 is impossible without resort to laboratory procedures. The prognosis 

 with favorable facilities for treatment is good, the moriality for the last 

 few years, as shown above, being about 7 per cent and no higher than 

 wa? seen in the United States. The study of our series suggested no- 

 thing new in the direction of treatment. Hydrotheraphy was almost 

 universally practiced and drags were rarely used and only to relieve 

 definite symptoms. The diet in general was liquid and consisted largely 

 of tinned milk. 



PART IV. A STUDY OF RECENT TYPHOID EPIDEMICS IN THE PHILIPPINES. 



Many epidemics of typhoid fever have been recorded among troops 

 in the Philippines before this Board began the study of the subject. The 

 outbreaks chronicled below are ones in the investigation of which the 

 Board took a share. The epidemic at San Fernando is of special interest 

 in view of its occurrence in the native population of a town where there 

 was no contact with an American garrison, the adjacent military post 

 of Camp Wallace being occupied by native Scouts. 



SAN FERNANDO (UNION) EPIDEMIC. 



In July 1910 we learned that an epidemic fever was prevailing in San Fernando 

 and a member of the Board (Captain Bloombergh) was sent to investigate. 

 San Fernando has a population of 16,000 and is located on the coast about 240 

 kilometers north of Manila. The municipal records show that cholera visited the 

 town in 1908 and is credited with 170 deaths. There are also recorded 34 deaths 

 from intermittent fever, 26 from dysentery and diarrhoea and 9 from menigitis 

 for the same year. In 1909 there are recorded 45 deaths from dysentery and 

 diarrhoea, 12 from intermittent fever and one from meningitis. It is easy to see 

 how typhoid may have been masked by these diagnoses during 1908 and 1909. 



Statistics as to the amount of illness prevailing in 1910 were difficult to obtain. 

 A native doctor said there were many cases and a mortality of 50 per cent. 

 An intelligent priest reported much sickness but few deaths. An American 

 teacher stated that out of an average enrollment of 392 children there have been 

 28 cases of fever with 1 death. 



104912 5 



