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Some Considerations connected with the Relative Immunity of the Japanese Armies from Typhoid Fever.
1365 discusses the possible relations of these thalamic changes to the epilepsy but he does not venture to express an opinion as to whether they are directly connected with the attacks or are only part of a general pathological condition of the brain. He suggests that there was probably optic atrophy in some of these cases and therefore he lays stress on the importance of an examination of the fundus in patients suffering from epilepsy. Such marked changes describes have not been recorded by as Dr. ONUF
and casualties caused by the weapons of the belligerents. With the Japanese the case has, however, been different ;. they have succeeded in minimising the losses from disease
and in
obtaining
results in this respect which have not by other nations in war. All
been hitherto attained
who have dealt with the have borne
testimony
medical
history of this war organisation of the
to the admirable
and to the thoroughness with which every detail connected with their sanitary and medical arrangements has
Japanese
been thought out beforehand, as well as to the skill disobservers in this country. Sir WILLIAM GOWERS1 has made some valuable com- played in practically adapting these to the end’ in view. The ments on this subject which support Dr. ONUF in the striking statistical results which have been published have reserve which he rightly maintains in the conclusions called attention to the success that has attended their efforts. which are to be drawn from the results of his exa- These results as regards the greatly decreased scale of sickminations. Sir WILLIAM GOWERS points out that the ness and mortality which they set forth are in striking "instability" of the cerebral motor functions, instead of contrast with the experience of Europe and the United being solely due to alterations in the chemical constitution of States of America in modern war. Are these results to be the grey matter, may be the result of obvious disease. It is not ascribed solely to the efficiency of the Japanese sanitary indeed due to disease that can be seen in the damaged part, and medical systems or have there been any other factors but beyond the visible disease, whatever its nature, is a zone or contributory causes at work in the case of the Japanese of altered nerve tissue in which the slightness of the change armies in Manchuria which have also to be taken into permits activity in altered form. In such cases the morbid account ?’! In order to illustrate the point which we are more discharges constituting epilepsy may take place. Arising locally, they spread through the brain according to their especially seeking to elucidate let us take the most It is energy and then leave a tendency to repetition which important disease of modern war, typhoid fever. involves parts unaffected by the primary disease. The same the scourge of European armies operating in the field, writer proceeds to state that, although it is not customary (as especially, perhaps, in the case of operations conducted in " we mentioned above) to include under the term ’’ epilepsy hot climates, and the United States in their recent war active progressive brain disease, such as a tumour, even had the same experience. It has been said that typhoid though it cause epileptiform convulsions, yet there is a large fever has no geography : it is ubiquitous. The typhoid class of cases of considerable interest in connexion with bacillus, about which and its life-history our knowledge organic disease. In these instances there is an old spot of has of late years become so much more extended and disease which induces the nervous discharges which may be precise, is far more widely distributed in nature than slight or local at first but may spread when more intense is generally imagined. It is no longer to be mainand ultimately leave a general dispcsition hardly tained that this fever is an exclusively water-borne disease, be distinguishable from idiopathic epilepsy. Some of Dr. although sudden and rapidly spreading epidemic outONUF’S cases may perhaps be placed under this heading. breaks of it are, no doubt, more readily explicable in His observations are well worthy of note but whether the that than in any other way. But the investigations made records have added materially to the present pathology of after the Spanish-American war into the causes of epilepsy is open to doubt nor does he advance any claim of that fever in the vast camps occupied by the United this nature. That so many and varied morbid conditions States troops, together with those of a German scientific were found in the cases which he examined accentuates the commission of later date and the results of experimental is definite conthat in at observations in this country, have tended to enlarge our views difficulty experienced arriving any clusion as to the precise pathology and morbid anatomy of about the existence of vehicles and sources of infection other than water, of a direct and indirect nature. In the epilepsy. case of the Japanese armies it is very important to note that, in addition to the great attention paid to sanitation, typhoid Some Considerations connected fever is treated as a contagious disease and the sufferers with the Relative of from it are carefully isolated. It is difficult to understand how in this way the dissemination of the bacillus can be the Armies from prevented altogether, considering the length of time during Fever. which it may be detected in the urine, but possibly some AMONGST the many points that have served to rivet public of the immunity enjoyed by the Japanese has been due attention on the stupendous war in the Far East none has to these laudable precautions. Race, however, has probably done so more,, perhaps, than the signal success which has a part in this immunity. Without dwelling attended the efforts of the Japanese in dealing with the played the influence of raceit has, nevertheless, so-called preventable diseases of armies in the field. It is unduly upon to be recognised as a matter of ordinary observation and notorious that in every great war of history disease has experience that Asiatics, native races and those indigenous proved,amost treacherous and dangerous foe and has given to the soil, possess a relativeimmunity, real or acquired, from rise to far greater losses than have arisen from the wounds the diseases common to their own climate, as compared with 1 Professor Allbutt’s European and other immigrant races foreign to it. It may System of Medicine, vol. ii., p. 761.
which may
Immunity
Japanese
Typhoid
1366 be that such immunity in the case of typhoid fever, for example, is attributable to the fact that the natives have in infancy or early life paid their tribute to that disease
generally, is attributable in any way to their environing conditions, and especially to their Fyr,tem of dietary. These questions cannot be answereddefinitely without exhaustive
it may be that from the nature of their environing conditions they become possessed of an acquired tolerance
and statistical examination of the available
or
evidence,
but
to surmise that the diet of the than their admirable tactics of precaution, less Japanese, them the has saved from scourge of typhoid fever. we
But may it not also be suggested rendering that the relative immunity of Asiatics in general, and of the Japanese soldier in particular, from typhoid fever is not so much attributable to any racial as to physiological them immune.
may be
permitted
no
Annotations.
differences from the
European owing to the nature of his food and his habits and customs ? Tbe typhoid bacillus may find a most unfavourable II Ne quid nimis. soil for its growth and development in the graminiTHE INFLUENCE OF TRADITION ON MEDICAL vorous, rice-eating Japanese soldier, as compared with that PRACTICE. to be found in the body of the flesh-feeding European, for AT a meeting of the Manchester Medico-Ethical Associaexample, whose diet so largely consists of meat and alcohol ’, tion held on April 18th Dr. S. Holgate Owen opened a disaa some form or other. The bacterial intestinal flora may be cussion on the Influence of Tradition on Medical Practice. very different in the two cases. An effort has been made in He pointed out that it was extremely difficult to judge India of late to solve the problem as to the prevalence or correctly of tendencies in any social or scientific organisation not of typhoid fever among its native populations by means when viewed within a short space of time but that, as af the serum agglutination and sedimentation reaction test, regards the organised practice of medicine, the trend of with the result that typhoid fever is believed to be more method had, during the past 30 years, undergone a change which was almost revolutionary. The wider the range of common among the natives of India, and especially among survey the more it was found that fixed principles, estabnative children, than has been supposed. Still, there cannot lished rules, and uniform systems, or what used to be called be any doubt that the prevalence and the mortality from this "orthodoxy," were becoming uncertain as guide3 and less infoirn of fever among the natives, as tested by ordinary Indian fluential upon the minds and the action of medical men. In experience and corroborated by the records of the native the midst of this apparent instability, and, as if to taunt us with our want of light and guidance, there came to us from army and jail population, are quite insignificant as compared of the world, but especially from America, drugs with what obtains in the European army serving in that many parts of all descriptions suitable for all complaints and said to be eountyy ; to which it may be added that the cases of typhoid absolutely certain in their curative effects. This absence of fsvey which do occur in the native army are mainly among systemisation might be observed in all countries. France, the Gurkha troops who are meat-eaters and spirit-drinkers. Germany, and America seemed to be devoid of any Moreover, from what is known of the well-nigh universal authoritative teaching in the medical art ; there was no habits of the native population in regard to fascal contamina- medical school or society anywhere which at the present tion of the soil the amount of typhoid fever among them time could agree to promulgate any system or mode of treatment which could be influential beyond its immediate should be proportionately large if their excreta were sowing surroundings or for any length of time. Scholasticism, the soil with its bacillus. There are no sewers in the indeed, had received its death-blow, but only within a century plains of India and, speaking generally, next to none ago. Although medicine had now asserted for itself a in the East or in subtropical climates, consequently the position among the sciences, it must be remembered that inhabitants are compelled to have recourse to the soil for traditional influence had held universal sway for nearly the disposal of their excreta. In the case of the native 2000 years-namely, from the time of Hippocrates to the of the seventeenth century, the period of William jails in India this has long been done without having been beginning and Thomas Sydenham, when scientific discovery Harvey found to cause outbreaks of typhoid fever in the jail began to lay the ghosts of superstition and dogma. The population. The adoption of a dry-earth system, on the spirit of dogma, however, survived to the beginning of the other hand, may be, and probably is, a dangerous method nineteenth century. At the present juncture social and fo]’ the disposal of fasces in the case of communities so scientific developments were taking place which were influliable to typhoid fever as European soldiers have always encing the practice and, Dr. Owen believed, the status of the medical man. The rapid advance which public sanishown themselves to be when living under the conditions domestic sanitation, and personal hygiene were tation, of field service-presumably because of the risk of intromaking, on scientific lines, was forcing its way at the urgent duction of the bacillus to susceptible hosts. Assuming, as demand of a social development unprecedented in rapidity we must do in our present state of knowledge, that the and intellectual breadth at any previous period of our typhoid bacillus is veritably and indeed the cause of that history. The problem which now faced us every day was disease, the problem may be summarised in the following less frequently, What are we to give to cure a disease, and more commonly, How are we to correct the error of life questions : To what is the relative immunity of Eastern through which it has arisen and to prevent its occurrence ?7 peoples from typhoid fever due, and has such an immunity played any part in the case of the Japanese armies operating HOSPITALS AND THE WELL-TO-DO. in Manchuria? If this latter question be answered in the IN a recent case heard by Mr. Justice Darling and a affirmative, it may be suggested as a subject for further common jury Mr. Bale, a tailor, sued the London County inquiry whether this relative immunity from, or insus- Council for damages for personal injuries and for damage ceptibility to, typhoid fever on their part, as compared to a trap received through a collision with a tram-car with our experience in the case of European armies in the Camberwell-road. Mr. Bale was awarded ae:314 "
I
and casualties caused by the weapons of the belligerents. With the Japanese the case has, however, been different ;. they have succeeded in minimising the losses from disease
and in
obtaining
results in this respect which have not by other nations in war. All
been hitherto attained
who have dealt with the have borne
testimony
medical
history of this war organisation of the
to the admirable
and to the thoroughness with which every detail connected with their sanitary and medical arrangements has
Japanese
been thought out beforehand, as well as to the skill disobservers in this country. Sir WILLIAM GOWERS1 has made some valuable com- played in practically adapting these to the end’ in view. The ments on this subject which support Dr. ONUF in the striking statistical results which have been published have reserve which he rightly maintains in the conclusions called attention to the success that has attended their efforts. which are to be drawn from the results of his exa- These results as regards the greatly decreased scale of sickminations. Sir WILLIAM GOWERS points out that the ness and mortality which they set forth are in striking "instability" of the cerebral motor functions, instead of contrast with the experience of Europe and the United being solely due to alterations in the chemical constitution of States of America in modern war. Are these results to be the grey matter, may be the result of obvious disease. It is not ascribed solely to the efficiency of the Japanese sanitary indeed due to disease that can be seen in the damaged part, and medical systems or have there been any other factors but beyond the visible disease, whatever its nature, is a zone or contributory causes at work in the case of the Japanese of altered nerve tissue in which the slightness of the change armies in Manchuria which have also to be taken into permits activity in altered form. In such cases the morbid account ?’! In order to illustrate the point which we are more discharges constituting epilepsy may take place. Arising locally, they spread through the brain according to their especially seeking to elucidate let us take the most It is energy and then leave a tendency to repetition which important disease of modern war, typhoid fever. involves parts unaffected by the primary disease. The same the scourge of European armies operating in the field, writer proceeds to state that, although it is not customary (as especially, perhaps, in the case of operations conducted in " we mentioned above) to include under the term ’’ epilepsy hot climates, and the United States in their recent war active progressive brain disease, such as a tumour, even had the same experience. It has been said that typhoid though it cause epileptiform convulsions, yet there is a large fever has no geography : it is ubiquitous. The typhoid class of cases of considerable interest in connexion with bacillus, about which and its life-history our knowledge organic disease. In these instances there is an old spot of has of late years become so much more extended and disease which induces the nervous discharges which may be precise, is far more widely distributed in nature than slight or local at first but may spread when more intense is generally imagined. It is no longer to be mainand ultimately leave a general dispcsition hardly tained that this fever is an exclusively water-borne disease, be distinguishable from idiopathic epilepsy. Some of Dr. although sudden and rapidly spreading epidemic outONUF’S cases may perhaps be placed under this heading. breaks of it are, no doubt, more readily explicable in His observations are well worthy of note but whether the that than in any other way. But the investigations made records have added materially to the present pathology of after the Spanish-American war into the causes of epilepsy is open to doubt nor does he advance any claim of that fever in the vast camps occupied by the United this nature. That so many and varied morbid conditions States troops, together with those of a German scientific were found in the cases which he examined accentuates the commission of later date and the results of experimental is definite conthat in at observations in this country, have tended to enlarge our views difficulty experienced arriving any clusion as to the precise pathology and morbid anatomy of about the existence of vehicles and sources of infection other than water, of a direct and indirect nature. In the epilepsy. case of the Japanese armies it is very important to note that, in addition to the great attention paid to sanitation, typhoid Some Considerations connected fever is treated as a contagious disease and the sufferers with the Relative of from it are carefully isolated. It is difficult to understand how in this way the dissemination of the bacillus can be the Armies from prevented altogether, considering the length of time during Fever. which it may be detected in the urine, but possibly some AMONGST the many points that have served to rivet public of the immunity enjoyed by the Japanese has been due attention on the stupendous war in the Far East none has to these laudable precautions. Race, however, has probably done so more,, perhaps, than the signal success which has a part in this immunity. Without dwelling attended the efforts of the Japanese in dealing with the played the influence of raceit has, nevertheless, so-called preventable diseases of armies in the field. It is unduly upon to be recognised as a matter of ordinary observation and notorious that in every great war of history disease has experience that Asiatics, native races and those indigenous proved,amost treacherous and dangerous foe and has given to the soil, possess a relativeimmunity, real or acquired, from rise to far greater losses than have arisen from the wounds the diseases common to their own climate, as compared with 1 Professor Allbutt’s European and other immigrant races foreign to it. It may System of Medicine, vol. ii., p. 761.
which may
Immunity
Japanese
Typhoid
1366 be that such immunity in the case of typhoid fever, for example, is attributable to the fact that the natives have in infancy or early life paid their tribute to that disease
generally, is attributable in any way to their environing conditions, and especially to their Fyr,tem of dietary. These questions cannot be answereddefinitely without exhaustive
it may be that from the nature of their environing conditions they become possessed of an acquired tolerance
and statistical examination of the available
or
evidence,
but
to surmise that the diet of the than their admirable tactics of precaution, less Japanese, them the has saved from scourge of typhoid fever. we
But may it not also be suggested rendering that the relative immunity of Asiatics in general, and of the Japanese soldier in particular, from typhoid fever is not so much attributable to any racial as to physiological them immune.
may be
permitted
no
Annotations.
differences from the
European owing to the nature of his food and his habits and customs ? Tbe typhoid bacillus may find a most unfavourable II Ne quid nimis. soil for its growth and development in the graminiTHE INFLUENCE OF TRADITION ON MEDICAL vorous, rice-eating Japanese soldier, as compared with that PRACTICE. to be found in the body of the flesh-feeding European, for AT a meeting of the Manchester Medico-Ethical Associaexample, whose diet so largely consists of meat and alcohol ’, tion held on April 18th Dr. S. Holgate Owen opened a disaa some form or other. The bacterial intestinal flora may be cussion on the Influence of Tradition on Medical Practice. very different in the two cases. An effort has been made in He pointed out that it was extremely difficult to judge India of late to solve the problem as to the prevalence or correctly of tendencies in any social or scientific organisation not of typhoid fever among its native populations by means when viewed within a short space of time but that, as af the serum agglutination and sedimentation reaction test, regards the organised practice of medicine, the trend of with the result that typhoid fever is believed to be more method had, during the past 30 years, undergone a change which was almost revolutionary. The wider the range of common among the natives of India, and especially among survey the more it was found that fixed principles, estabnative children, than has been supposed. Still, there cannot lished rules, and uniform systems, or what used to be called be any doubt that the prevalence and the mortality from this "orthodoxy," were becoming uncertain as guide3 and less infoirn of fever among the natives, as tested by ordinary Indian fluential upon the minds and the action of medical men. In experience and corroborated by the records of the native the midst of this apparent instability, and, as if to taunt us with our want of light and guidance, there came to us from army and jail population, are quite insignificant as compared of the world, but especially from America, drugs with what obtains in the European army serving in that many parts of all descriptions suitable for all complaints and said to be eountyy ; to which it may be added that the cases of typhoid absolutely certain in their curative effects. This absence of fsvey which do occur in the native army are mainly among systemisation might be observed in all countries. France, the Gurkha troops who are meat-eaters and spirit-drinkers. Germany, and America seemed to be devoid of any Moreover, from what is known of the well-nigh universal authoritative teaching in the medical art ; there was no habits of the native population in regard to fascal contamina- medical school or society anywhere which at the present tion of the soil the amount of typhoid fever among them time could agree to promulgate any system or mode of treatment which could be influential beyond its immediate should be proportionately large if their excreta were sowing surroundings or for any length of time. Scholasticism, the soil with its bacillus. There are no sewers in the indeed, had received its death-blow, but only within a century plains of India and, speaking generally, next to none ago. Although medicine had now asserted for itself a in the East or in subtropical climates, consequently the position among the sciences, it must be remembered that inhabitants are compelled to have recourse to the soil for traditional influence had held universal sway for nearly the disposal of their excreta. In the case of the native 2000 years-namely, from the time of Hippocrates to the of the seventeenth century, the period of William jails in India this has long been done without having been beginning and Thomas Sydenham, when scientific discovery Harvey found to cause outbreaks of typhoid fever in the jail began to lay the ghosts of superstition and dogma. The population. The adoption of a dry-earth system, on the spirit of dogma, however, survived to the beginning of the other hand, may be, and probably is, a dangerous method nineteenth century. At the present juncture social and fo]’ the disposal of fasces in the case of communities so scientific developments were taking place which were influliable to typhoid fever as European soldiers have always encing the practice and, Dr. Owen believed, the status of the medical man. The rapid advance which public sanishown themselves to be when living under the conditions domestic sanitation, and personal hygiene were tation, of field service-presumably because of the risk of intromaking, on scientific lines, was forcing its way at the urgent duction of the bacillus to susceptible hosts. Assuming, as demand of a social development unprecedented in rapidity we must do in our present state of knowledge, that the and intellectual breadth at any previous period of our typhoid bacillus is veritably and indeed the cause of that history. The problem which now faced us every day was disease, the problem may be summarised in the following less frequently, What are we to give to cure a disease, and more commonly, How are we to correct the error of life questions : To what is the relative immunity of Eastern through which it has arisen and to prevent its occurrence ?7 peoples from typhoid fever due, and has such an immunity played any part in the case of the Japanese armies operating HOSPITALS AND THE WELL-TO-DO. in Manchuria? If this latter question be answered in the IN a recent case heard by Mr. Justice Darling and a affirmative, it may be suggested as a subject for further common jury Mr. Bale, a tailor, sued the London County inquiry whether this relative immunity from, or insus- Council for damages for personal injuries and for damage ceptibility to, typhoid fever on their part, as compared to a trap received through a collision with a tram-car with our experience in the case of European armies in the Camberwell-road. Mr. Bale was awarded ae:314 "
I