﻿IX, B, 4 Gutierrez: Typhoid Fever in the Philippines 371 



at about the end of the third week. The temperature usually 

 reached normal in about seven days, but in some cases the stage 

 of decline was more prolonged and the temperature did not 

 entirely subside until the eighth to the thirteenth day. How- 

 ever, in no instances was the stage of decline as prolonged as 

 the maximum given by Rogers. 



Recrudescence and relapse. — Manson in describing his expe- 

 rience with typhoid in China says, "Not only is the tropical form 

 grave from the outset, but extremely liable to relapse." In the 

 Manila series there were 6 cases of recrudescence, or 4.3 per 

 cent, and 11 cases actually relapsed, or 8.02 per cent. In only 

 one of these cases did the temperature relapse more than once. 

 This patient is just recovering from the third attack at the time 

 of writing. 



Irregular temperature. — Of the 115 cases in which the tem- 

 perature was studied, in 11 cases, or 9.56 per cent, the temper- 

 ature was exceedingly irregular. The fever presented many 

 different phases, not one feature being constant. The temper- 

 ature may be 39° or 40° for two or three days, and then quickly 

 drop to 38° or 37°.5; or it may even drop to normal for two or 

 three days, only to rise again to its former height. In one 

 case the temperature was as low as 38° for a number of days 

 and then became normal; this period in turn was followed by 

 an intermittent type of 39° or more in the afternoons and 

 normal in the morning. In this case, after thirteen days, the 

 serum reaction was positive and culture of the urine showed 

 typhoid bacilli at four different intervals after convalescence, 

 finally becoming negative on the eighteenth day. 



Rigors. — Actual chills as described by Rogers were present in 

 only 2.91 per cent of my cases. In two of these cases the rigors 

 were caused by an intercurrent malaria, but the actual cause 

 in the others could not be ascertained. 



Abortive cases. — There were 19 cases, or 13.86 per cent, in 

 which the duration of the fever varied from five to fifteen days, 

 or an average of eleven days from the onset, until the temperature 

 became normal. During this period the temperature varied from 

 38° to 39° C, rarely reaching the latter figure. The onset may 

 be a typical steplike rise as is seen in classical cases of the disease. 

 It may then become continuous for from two to five days, and 

 then marked remissions appear and the temperature reach normal 

 in a few days. These cases are interesting clinically as well as 

 epidemiologically, because of obscurity of the diagnosis which 

 rarely would be made outside of a hospital. Undoubtedly many 

 such cases go through the course of the disease without being 



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