﻿IX, B, 4 Gutierrez: Typhoid Fever in the Philippines 375 



appearance during convalescence from the typhoid. In one of 

 the four cases malarial symptoms predominated. In two cases 

 the stage of fastigium was somewhat irregular, the temperature 

 varying greatly. Repeated doses of quinine, both intravenously 

 and by mouth, made the temperature more regular, but other- 

 wise failed to modify the course of the disease. The double 

 infection was verified by blood examination in each case. 



Other complications. — Periostitis was found in 5 cases, throm- 

 bosis of the left femoral in 1, and typhoid spine in 1. Post- 

 typhoid psychosis or mania was encountered three times, but 

 all of the patients affected recovered. Peripheral neuritis was 

 encountered in a number of cases, but the total number could 

 not be ascertained as they were not recorded in every case. 



Mortality. — Osier gives 7.5 per cent as the mortality rate 

 in his Baltimore series. However, he states that the death 

 rate varies from 5 to 12 in private practice and from 7.03 to 

 12 per cent in hospital practice. Curschmann places it at 12.7 

 per cent, and Rogers at 16.3, for white troops in the tropics 

 and at 26 per cent for the Indians. When we come to the 

 Philippines we find Chamberlain placing it at 17.65 per cent for 

 the Filipinos, while 16.8 per cent was the figure set for Americans. 

 In this series there were 20 deaths, or about 20.43 per cent. 

 Upon closer examination it was found that about half of these 

 cases were admitted in a dying condition, or, if not actually 

 dying, they were in a hopeless condition. There were as follows : 

 three cases with general peritonitis ; 4 patients lived only two or 

 three days after admission; 3 were admitted from the twenty- 

 third to the sixtieth day of the disease; and another 3 cases 

 came in after the fifteenth day of the disease. Excluding 10 

 cases which certainly were hopeless from the time they came 

 in, we have a mortality of 13.13 per cent. This is certainly 

 a high percentage of mortality, but it compares favorably with 

 those cases of Rogers, Chamberlain, and Curschmann. Outside 

 of the delayed hospitalization, a serious handicap is the generally 

 poorly nourished condition among most of the Filipinos. The 

 class of patients dealt with in this article are mostly from the 

 poorer class, many of whom cannot afford the services of an 

 outside physician, so that alimentation and intestinal disorders 

 are wholly neglected. 



Laboratory method of diagnosis. — There does not appear to 

 be any unusual disturbance of the blood picture. From a 

 diagnostic standpoint the leucocyte count is interesting, and it 

 is especially so in the tropics because of the increased difficulties 

 of diagnosis. 



