17, i Gomez et al. : Diphtheria in the Philippines 39 
10 years of age; three, or 4.8 per cent, were more than 15 
years of age, one being an adult 35 years old. 
There seems to be a greater prevalence in males than in fe- 
males. There were thirty-six males and twenty-six females in 
the San Lazaro cases, nineteen males and eight females in the 
autopsy cases. 
CLINICAL RESUME 
This is based on the clinical records of cases diagnosed clinic- 
ally as diphtheria in San Lazaro Hospital during 1919 and 
January and February of 1920. Altogether sixty-two cases 
have been studied, in thirty-one of which the diagnosis was 
confirmed bacteriologically. 
The patients are usually admitted to the hospital with the 
following symptoms noted by the relatives : Slight fever, cough, 
sore throat, difficulty in swallowing, stertorous and difficult 
breathing, and more or less cyanosis. 
The local findings are similar to those in other countries; 
there is a hyperemia of the pharynx extending beyond the 
pillars of the fauces and a characteristic grayish white pseudo- 
membrane which leaves a bleeding surface when detached. The 
pseudomembrane most often involves both tonsils, frequently ex- 
tending to the uvula and to a slight extent to the pharynx, soft 
palate, and larynx. Three cases were diagnosed as diphtheria 
but showed no typical membrane, one case showing only some 
white mucus patches on the tonsils; on bacteriological examina- 
tion, however, this case was found positive for the Klebs- 
Loeffler bacillus. 
The fever is rather low in the majority of cases, as shown 
by the following data taken on admission from sixty-one patients. 
In one case the temperature was not taken as the patient was 
practically in a dying condition when admitted. 
Table 3 . — Temperature on admission. 
Temperature. 
Patients. 
Per cent. 
9 
14.7 
15 
24.2 
38° but less than 39° C __ _ __ __ _ _ _ _ _ 
30 
49.1 
6 
9.8 
1 
1.6 
The pulse rate is accelerated, ranging as a rule from 100 to 
120 per minute, depending on the age of the patient, the tem- 
perature, toxic symptoms, and heart complications. There was 
no study on abnormal characters of the pulse. Of the sixty- 
