﻿372 The Philippine Journal of Science 1914 



diagnosed as typhoid fever, especially as there are many fevers 

 in the tropics of obscure etiology. These irregular types fre- 

 quently are diagnosed as malaria or "fiebre continua." 



In view of the above findings, there are a few diagnostic points 

 that the clinician should constantly bear in mind when dealing 

 with fever patients. In irregular types of typhoid the usual 

 headache is generally present, sometimes intense but most fre- 

 quently a dull ache is complained of at the top of the head. The 

 relation of the fever to the pulse is maintained. A continued 

 temperature of 39° C. with a pulse of 90 or 80 per minute is 

 rather suspicious when noted in connection with the other above- 

 mentioned symptoms. The spleen was enlarged at least to per- 

 cussion in nearly all of these cases, and the typhoid tongue was 

 present in all except the mildest cases. The serum reaction 

 usually and blood culture almost invariably will, of course, con- 

 firm the diagnosis. Therefore, in the tropics when we see a case 

 of continuous or even intermittent fever with slow pulse, head- 

 ache, and an enlarged spleen, we should be suspicious of its being 

 typhoid, even though the fever is not high and the duration not 

 as long as we expect to see in typhoid. The diagnosis in many 

 of these cases is difficult or impossible except by laboratory 

 methods. Twelve of the cases in this series probably would not 

 have been diagnosed outside of a hospital, where blood culture 

 is routine in all doubtful fevers. 



Recently we have had a small epidemic of 12 cases of typhoid 

 among the students in one of the Government dormitories in 

 Manila. In all of these patients the disease was of short duration 

 with an atypical fever, and other features of the disease were 

 so irregular that the disease would not have been recognized 

 except by blood cultures. 



The recognition of these atypical cases of typhoid is of partic- 

 ular interest to public-health officials. An epidemic similar to 

 the one mentioned above occurring in a country town, or other 

 remote district, is liable to cause a great deal of trouble before 

 the nature of the illness is recognized. This is particularly true 

 in this country because the sanitary conditions are of the most 

 primitive character. Frequently, there is no sewer system and 

 the excreta is disposed of as the family sees fit. The usual 

 method is to allow pigs and other scavengers to take care of it. 

 Flies usually are abundant throughout the year, and the infective 

 material is freely accessible to them. Clothes and utensils are 

 never boiled, and the people around the patient probably eat with 

 their fingers without so much as washing their hands with soap 

 and water. 



