TYPHOID FEVER IN THE PHILIPPINES. 32? 



barracks before the new garrison entered them. This was carried out under the 

 supervision of Major Clayton who believed the epidemic was spread by contact 

 and not by water. 



This Board made two investigations of the epidemic, one in the fall of 1909 

 and the other in the spring of 1910.(5) (6) From all the evidence at hand 

 several months after the disease had entirely disappeared we concluded: 



(1) That the Nitwan river was badly contaminated with human excrement 

 and that very probably some of the cases originated from drinking this impure 

 water at a time when it contained Bacillus typhosus. There was no positive 

 evidence to show how the first cases originated. 



(2) That the spread of the epidemic was due mainly to contact infection, 

 including in this the probability of cooks or attendants infecting food while 

 handling it in the kitchens and dining rooms. We based this opinion mainly 

 on the following facts: (a) The vast majority of the cases for the whole period 

 of six months were peculiarly grouped in certain barracks, one group of adjacent 

 organizations having few or no cases while another group of contiguous buildings 

 had many cases. ( 6 ) The cases in Parang, where unboiled Nitwan water was prob- 

 ably in very general use for drinking, were all among individuals coming in close 

 personal contact with the troops, (c) No cases occurred among the oflBcers and 

 non-commissioned officers living in separate quarters, (d) Typhoid disappeared 

 from among the troops at Ludlow Barracks following a change in the garrison 

 and rigid disinfection of the buildings. The period of freedom has now been 

 over a year.* (e) There was complete failure to suppress the epidemic by means 

 of stringent measures based on the water borne theory. 



The dates of admission of the cases to hospital largely supports the contact 

 theory, but too much reliance should not be placed on this point since the 

 clinical records indicate that many men had been sick between one and two 

 weeks before going on sick report. 



Efforts were made to locate typhoid bacillus carriers but without success. 



A more extended discussion of some features of this epidemic can be found 

 in the references (4), (5), (6), and (7). A "spot map" of the post and the dates 

 of admission are on file in the offices of the Surgeon General of the Army and the 

 chief surgeon, Philippines Division under the heading shown in reference. (6) 

 The clinical aspects of the Parang epidemic are of considerable interest as 

 possibly showing a rather unusually large percentage of extremely mild cases. 

 The diagnosis in all cases was made as a result of a positive Widal reaction 

 (1 to 50 in one hour), nearly all of these serum tests having been performed by 

 members of the Board. None of the patients considered had ever received anti- 

 typhoid vaccination. In several instances the blood, stool or urine cultures 

 were positive for Bacillus typhosus. On many soldiers suffering from slight 

 indispositions the Widal reaction was tried with negative results. 



Including the July case and the 4 cases detected after the 23d Infantry left 

 Parang we have clinical records of 81 patients in whom there was a positive 

 Widal reaction. Of these three died, a mortality of 3.7 per cent. One showed 

 at autopsy "congestion and slight ulceration" of Peyer's patches. He apparently 

 died of overwhelming toxaemia about the 17th day of the disease. The second 

 patient died of toxsemia on the 22d day and at autopsy showed the character- 

 istic intestinal lesions of typhoid. The Bacillus typhosus was isolated from the 



'Eight months after the epidemic ceased one case of typhoid was admitted 

 to the hospital. The patient was a native. Three months later an American 

 civilian was admitted with typhoid fever and two months after this another 

 native, the latter coming from a neighboring barrio. 



