10 
some of the reported cases in these blocks had been diagnosed on 
what appeared to be scant clinical evidence and without any attempt 
at confirmation by laboratory tests. 
A better acquaintance with the situation inclines us to believe that 
practically every case of clinical typhoid fever occurring in the Dis- 
trict of Columbia is reported to the health officer. On account of 
the frequent association of the medical profession and the lay people 
with the disease, many cases of continued fever of obscure nature, 
but not typhoid, are, however, diagnosed as typhoid. In other words, 
few cases of clinical typhoid fever are ever overlooked, but the official 
records contain more typhoid fever than actually exists in a clinical 
sense. How much more could only be determined by persistent 
and prolonged laboratory confirmation of the clinical diagnoses. 
This we expect to do at a future investigation. We are inclined to 
believe, from our observations of the situation and from experimental 
data, that perhaps from 10 to 20 per cent of the cases reported as 
typhoid fever are really some other disease. This may in part 
account for Washington’s relatively high typhoid rate when com- 
pared with that of other American cities. 
In a community where typhoid fever has been markedly prevalent 
for a number of years, as it has been in Washington, it is but natural 
that physicians should form somewhat of a habit of reporting doubt- 
ful cases as typhoid fever. 
The correct diagnosis of cases is, of course, of first importance both 
in the obtainment of correct data for epidemiological studies and in 
the adoption of proper measures to prevent the spread of the disease. 
In most American cities physicians report to the health office, for 
official confirmation of diagnosis, suspected cases of certain com- 
municable infectious diseases, such as tuberculosis, diphtheria, small- 
pox, etc. The communicability of the infection of typhoid fever 
from the sick to the well is now thoroughly recognized, and, consid- 
ering the widespread prevalence of typhoid fever in America, we 
believe that it is of prime importance from a public-health stand- 
point for official diagnosis of cases of this disease to be required. 
To the competent and careful physician, the assistance of official 
expert opinion and of laboratory facilities would be welcome, while 
to the incompetent or careless physician such assistance would be 
important. 
Specimens for examination at the laboratory can be obtained with 
so little inconvenience to the patient, that there seems to be no excuse 
for physicians to fail to have laboratory tests made to aid in the 
diagnosis of all suspected cases. 
Specimens of the stools and urine, of course, may be obtained with- 
out any inconvenience to the patient, and bacteriological examination 
of these excreta by comparatively recent methods will demonstrate 
the typhoid bacillus in a large percentage of cases. 
