﻿370 



The Philippine Journal of Science 



1914 



it does occur it is considered to be of grave importance in prog- 

 nosis as well as in elucidating the diagnosis. In most of our 

 cases we have come to rely more upon the relation between tem- 

 perature and pulse in making a diagnosis than upon the tem- 

 perature itself. 



The onset of the fever usually is so irregular that the sugges- 

 tion of the possibility of typhoid does not occur until the disease 

 is well advanced. The most frequent symptoms during this 

 period in the series of cases under discussion were headache, 96 ; 

 general pain all over the body, 25 ; chilly sensation, 29 ; malaise, 

 24; abdominal pain, 22; pain in the right iliac region, 3; epis- 

 taxis, 1. Headache is the most constant of all symptoms, often 

 intense and frequently lasting well into the second week of the 

 disease. Very frequently the patients state that the onset was 

 sudden, preceded by a chill, and followed by fever. It some- 

 times subsided to recur again after a few days' intermission. 

 In certain instances there is a sudden chill, followed by high 

 continuous fever from the onset. The period of rising tem- 

 perature could not be ascertained with accuracy in most cases, 

 because most patients were admitted to the hospital during the 

 second week of the disease or later. 



Fastigium. — The stage of continued fever is not so prolonged 

 nor the fever as high as is usually described for this stage. Out 

 of 115 cases in which the temperature was studied carefully, 

 only 8 showed a temperature over 40, and in only one case did 

 the temperature reach 41. In Osier's 1,118 cases, 67.48 per cent 

 showed a temperature above 40, while in my series 43.4 showed 

 a maximum temperature of 40 degrees. Osier quotes 25 per 

 cent remaining below 40, whereas 44.34 per cent in the present 

 series remained below this point. Another important deviation 

 during this stage is the marked remission of temperature in the 

 Manila cases, a condition which was noted in 24.34 per cent. 

 This discussion is illustrated by Table III. 



Table III. — Temperature during the fastigium. 



Number of cases. 



Temperature. 



Percent- 

 age. 



8 



40° C 



6.95 

 36.52 

 44.34 



9.56 



42 - 



40° Cor below 



38° to 39-50° 



54 



11 









Stage of decline. — The fever in my series lasted on an average 

 of thirty days. It began to show marked remissions and declines 



