330 CHAMBERLAIN. 



The clinical histories of these cases are very meager, but the charts show some 

 points of interest. Two of the cases are classed as typical typhoid, the febrile 

 course being at least twenty days in one and nineteen in the other. There was 

 a well-marked fastigium. One ease had a relapse of twelve days' duration and 

 the other a post-typhoid psychosis. Two others might have been diagnosed clinic- 

 ally as very mild typhoid, the febrile period after entry to hospital being betvceen 

 ten and twelve days and the temperature curve not typical. The nine remaining 

 cases showed fever for a week or ten days and may well have been either entirely 

 atypical or the last portion of a typical typhoid chart. 



The stools during convalescence were negative in these thirteen cases and 

 cultures from small quantities of blood taken from several in the earlier part 

 of the disease were negative. The specific diagnosis of typhoid rests solely on 

 positive agglutination reactions with Bacillus typhosus. We might question the 

 certainty of this method of diagnosis in the atypical cases were it not for the 

 following points: (a) Two of the cases gave first a negative reaction followed a 

 few days later by a positive one. (b) Many Scouts at the post during the same 

 period who were suiTering from mild fevers reacted negatively. ( e ) We have done 

 Widals on several hundred healthy natives and only rarely have obtained a 

 positive reaction. 



The writer as representative of the Board at the present time, wishes 

 to acknowledge his obligations to the many medical officers at the 

 Division Hospital and throughout the Philippine Islands who have 

 furnished the materials for the laboratory studies and the clinical records 

 for the analysis, and also to the former members of the Board who did 

 a large part of the lalwratory examinations on which this report is based. 



PAIiT Y. CONCLUSIONS. 



1. Typhoid is a widely scattered and common disease in the Philip- 

 pines ; its incidence in Manila is above the average rate for the United 

 States and is exceeded by only a few of the worst American cities; 

 the average admission rate among American soldiers in the Philippines 

 exceeds that for the troops serving in the United States ; medical officers 

 from many regions report its frequent occurrence among the Filipinos. 



2. The statistics from the Filipino (native) Scouts show a much 

 lower typhoid rate than for white troops, possibly due to failure to 

 diagnose the atypical cases. 



3. Widal reactions performed on the blood of 591 healthy Filipinos 

 suggest a comparatively recent attack of typhoid in about 6 per cent 

 of adults, but do not indicate that the disease is prevalent in childhood. 



4. Many epidemics have occurred among soldiers in the Philippines 

 and three outbreaks among natives have been studied. Epidemics of 

 great severity among the Filipinos are either rare or ininoticed. 



5. The occurrence of the disease in the Philippine Islands is quite 

 -evenly distributed throughout the- year. The incidence is least in the 



second quarters. 



6. The appearance of the Widal reaction in typhoid fever in the 

 Philippines is not as a rale delayed. 



