30 The Philippine Journal of Science i9i9 
The above necropsy records show that no known treatment 
would have prevented the fatal outcome. Undoubtedly, these 
patients died of what are commonly known as “accidents of 
typhoid.” 
Gay and Chickering,(il) in 1915, had 9 per cent mortality 
in fifty-three cases, treated with their vaccine; Gay, (9) in 1917, 
had 6.6 per cent mortality in ninety-eight cases. In my series 
the mortality is 10 per cent, after excluding the three hopeless 
cases. Ichikawa, (15) however, in 1914, had 12 per cent mor- 
tality in eighty-two cases; but his controls showed 30 per cent 
mortality, while my controls showed 23.8 mortality. McWil- 
liams (34) has this to say about the rate of mortality; 
The percentage mortality in itself offers but little evidence as to the 
danger or efficacy of the treatment, as it will necessarily vary according 
to whether only mild cases, only severe cases, or all types of cases are 
subjected to the injections. The highest death rate, 23 per cent., was 
observed by Paulicek. His patients were soldiers who had suffered from 
severe exposure in cold weather, and they died in most instances from 
a complicating pneumonia. The high mortality of 23 per cent, represents, 
he says, a reduction by 20 per cent, from what was obtained without the 
injection of vaccine. It has already been mentioned that the death rate 
in Ichikawa’s control cases was more than twice as high as in the treated 
cases. 
Of far greater importance than the percentage mortality is the question 
as to how many, if any, of the deaths could be attributed directly to the 
action of the vaccine. Five cases (treated by Boral, by Csernel and 
Marton, by Lowy, Luksch and Wilhelm, and by Paulicek) showed intestinal 
hemorrhage following the injection and terminated fatally. One case (of 
Sladik and Kotlowski) resulted fatally from hemorrhage into the thyroid 
gland. One of Eggerth’s patients developed a hemorrhage from the lungs 
and died three hours after the injection. One of Biedl’s had hemorrhage 
from the nostrils before the intravenous injection of vaccine was given; 
after the treatment the hemorrhage recurred and could not be stopped. 
CONTROLS 
The fact is well known to all who have had experience with 
the disease that, strictly speaking, no two cases of typhoid 
fever are of equal severity. But this does not mean that we 
should disregard entirely the value of controls; for, although 
the results are not necessarily equal, yet, taking them as a 
whole, the factors concerned are minimized and the results thus 
obtained are approximate, if not exact. 
By the term control, as used in this paper, I mean the classi- 
fication of typhoid patients into groups of cases showing a more 
or less equal degree of infection, as a basis of comparison with 
other groups of patients, similarly affected by the same disease 
but undergoing different kinds of therapy. That is to say, the 
