NOMA IN THE PHILIPPINE ISLANDS WITH REPORT OF A CASE 

 ENDING IN RECOVERY 



By C. M. Reyes 



(From the Clinics of the College of Medicine and Surgery, University of 

 the Philippines, and the Philippine General Hospital, Manila, P. I.) 



One plate 



The problems of epidemic diseases and intestinal parasitic 

 infections have received a great deal of attention from writers on 

 tropical conditions, but literature on the more common clinical 

 diseases is not so voluminous, and very little mention of the 

 incidence of noma in hot countries is to be found. Yet it is a 

 fact that noma does exist and makes its ravages among children 

 in tropical climates; it is spoken of as being fairly common in 

 Korea and Formosa, and it is occasionally met with in China. In 

 India it is said to be especially frequent in adults. 



It is a noteworthy fact that in the Philippines, at least, measles, 

 which is the one eruptive fever most commonly followed by noma, 

 rarely ever assumes the gravity it does in the more temperate 

 zones, like the United States, for example. Whether this may 

 account for the apparent rarity of the malady in this and other 

 tropical countries, as judged by the scanty literature on the 

 subject, is open to question. 



The several cases of noma seen at the Philippine General 

 Hospital were unfortunately seen too late in the course of the 

 disease to justify surgical intervention. All such patients have 

 succumbed to the effects of a most virulent saprsemia. In the 

 following case the disease developed while the patient was being 

 treated for empysema in the hospital, and is reported on account 

 of the extreme rarity of recoveries from this fatal affection. 



REPORT OF CASE 



Patient. — A. 0., 2^ years of age, male, born of Filipino parents. 



History. — Patient was admitted to the hospital May 17, 1912, 

 complaining of fever and cough of one month's duration. After 

 examination, a diagnosis of empysema on the left side was made 

 and drainage instituted. The temperature gradually subsided, 

 and the patient did well up to August, when he began to develop 



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