﻿IX, B, 4 Gutierrez: Typhoid Fever in the Philippines 369 



Rogers calls attention to the frequency of typhoid in children 

 in India. In his Calcutta series 41.67 per cent of his cases 

 occurred in patients under 15 years of age. Manson also calls 

 attention to the frequency of typhoid among oriental children, 

 but Nichols, writing from the Philippines, states that only 9.6 

 per cent of the total cases occurred in patients under 15 years 

 of age. In examining the table, it is seen that the percentage 

 of infection, according to ages, in my series corresponds fairly 

 well with statistics from other countries. 



CLINICAL DESCRIPTION 



The following discussion of the clinical picture of typhoid as 

 seen in this country is based on the study of 125 cases treated 

 during a period of a little less than two years. Diagnoses of 

 about 90 per cent of these cases were verified by blood culture 

 or serum reaction. Of the remaining cases the diagnosis was 

 based upon the course of the disease, the fever, low leucocyte 

 count, enlarged spleen, etc., and in some of these the diagnosis 

 was verified by autopsy. It is fully realized that the number 

 of cases studied is too small to justify conclusions regarding the 

 incidence of rare complications, but the evidence seems to be 

 useful in analyzing the most important features of the disease 

 as it is seen in the Philippine Islands. 



The disease, in a general way, presents essentially the same 

 symptoms in the tropics that it does in the temperate climates; 

 yet there are a few exceptions which stand out prominently 

 before the clinician. The mortality seems to be higher while the 

 fever is lower, and the duration of the fever at first sight would 

 seem much shorter than that encountered in other countries. 

 The temperature curve is less frequently characteristic than 

 it is in the temperate climates. 



The course and type of temperature. — The typical typhoid 

 temperature of the temperate climates is divided into three 

 stages : the steplike rise at the outset, the evening temperature 

 always higher than that of the evening before, which lasts for 

 a period of from three to five days, after which the stage of 

 continued fever or fastigium is recognized. During this period 

 the temperature ranges from 39°.5 to 40°. 5 C. with but very 

 slight remissions. This stage lasts from a few days to three 

 or four weeks, and ushers in the third stage, or the stage of 

 decline, during which the remissions become more and more 

 marked until the normal is reached. This typical temperature 

 in typhoid is very seldom encountered in the Philippine Islands. 

 Indeed, such a classical temperature curve is so rare that when 



