THE AMERICAN COMMISSION ON TYPHOID FEVER IN MILITARY CAMPS DURING THE SPANISH WAR OF 1898.

1419 five years

as

apprentice

to the late Mr. Thomas Lucas of

Barwell, Cambs. He then attended a course of lectures on botany by the late Professor Henslow, and also one of

ROYAL COLLEGE OF SURGEONS OF

ENGLAND. chemistry at Cambridge, afterwards becoming a student at the Middlesex Hospital. He became a resident of Saffron Walden in 1854 and retired in 1895 after having been in Aw ordinary meeting of the Council was held on Nov. 13th, active practice for 41 years. He has always taken an active the President, Sir HENRY G. HowsE, being in the chair. part in everything that tended to promote the welfare and The PRESIDENT reported that in the absence of any meetHe entered the town interests of his tellow townsmen. council in 1863 and retired after holding office for three ing of the Museum Committee he had authorised the purchase of the skeleton of an Arawak Indian from Surinam. years, but entered the council again four years ago. Totnes.-Mr. G. J. Gibson, M.D., M.Ch. R.U.I., qualified The Council decided to remove from the roll of Members a in 1866 and entered the medical department of the army in Member of the College for repeatedly issuing certain handOctober of the same year. He served in the Ashanti cam- bills or circulars of an objectionable character, in spite of a paign of 1873-74, for which he obtained the medal, and former undertaking given by him that he would not again in the Afghan campaign in 1878-79 with the Kuram Field issue such handbills. Force. He was mentioned in despatches and obtained the The PRESIDENT reported the appointment of Ernest Francis medal and clasp for Peiwar Kotal. For services in the Bashford, M.D. Edin., as director of the Cancer Research cholera epidemic in Peshawar in 1875 he received the thanks Laboratory. of the Governor-General of India in Council. He retired A letter was read from Sir William H. Bennett, K.C.V.O., from the service in 1891 with the rank of surgeon-lieutenant- resigning his membership of the Court of Examiners and colonel. In 1899 he was elected mayor of Totnes and was requesting that his resignation may take effect at the end of elected for the second time this year. the ensuing final examination for the Fellowship. The resignation was accepted and the President stated that the vacancy thus occasioned would be filled up at the ordinary meeting of the Council in December. The PRESIDENT stated that the Bradshaw Lecture would be delivered by Mr. Howard Marsh on Wednesday, Dec. 10th, at 5 P.M., and that the subject of the lecture would be " Infective Arthritis."" FROM A letter was read from Messrs. S. F. Miller, Vardon, and NOV. 20, 1824. Miller reporting that the late Mr. James William Groves, formerly Professor of Botany at King’s College, had bequeathed to the College for the benefit of the museum three-fourths of his residuary estate, subject to the life inST. THOMAS’S HOSPITAL. terests therein of his wife and his sister. It is understood that the amount will be approximately £30,000. Curious case of Anchylosis, of great part of the vertebral Leave was granted in reply to the request from Mr. W. column, Probably produced by an ossification of the McAdam Eccles that he might publish his Jacksonian Essay intervertebral substance. on Imperfect Descent of the Testicle. Mr. Reginald Harrison, who is about to represent the E. B., a young woman, aged 19, was admitted into Dorcas’s ward about three weeks ago under the care of College at the forthcoming medical congress at Cairo, was asked to report on the medical school in that city. Mr. TRAVERS. She says that, about three years since, she was attacked with aching pains in her back, from which time she has been gradually getting worse ; and that in the early part of her life she had been accustomed to lift heavy weights. She THE AMERICAN COMMISSION ON TYPHOID first came into the Hospital about twelve months since, as FEVER IN MILITARY CAMPS DURING a patient of Mr. Travers, and remained here six months, THE SPANISH WAR OF 1898. during which time moxas were applied on each side the spine and alterative medicines taken without any benefit. She went afterwards to Margate, and remained there four months THE subject of the prevalence of typhoid fever in armies without any advantage. has of late very naturally attracted an unusual amount of There is no external appearance of disease, no swelling, no attention. In addition to the undertaken by deformity, nor has there ever been any tenderness on the an American commission it hasinvestigation been made the subject of spine when pressed. The patient is incapable of flexing the spine below the last cervical or first dorsal vertebra ; below careful inquiry by Major R. H. Firth, R.A.M.C., and Major this point it appears completely anchylosed. There is no W. H. Horrocks, R.A.M.C., who have dealt in a scientific motion allowed excepting that of the pelvis on the thigh spirit more especially with the influence of soil, fabrics, and bones ; so that, if you desire her to stoop forwards, the flies in the dissemination of its infection ; and a distrunk immediately falls with great suddenness below a right angle with the thighs ; from this position she cannot cussion has also ecently taken place at the Medical raise herself, but when assisted by raising the arms, Society of London - in connexion with a paper read by the extensor muscles of the spine, and even of the Dr. H. Leigh Canney. The prevention of this fever in head, act spasmodically, so as to jerk the head back. armies by safeguarding the water avenues against pollution This may arise from mechanical irritation, as from an by the method which Dr. Leigh Canney has proposed for ossific deposit projecting into the muscular structure ; or, practically accomplishing this formed the subject of his what is more probable, it may be owing to these muscles paper. While there exists, on the one hand, a practical being put very powerfully and suddenly upon the stretch, unanimity in regard to the occurrence of water-borne when the spine is thrown so forcibly forward. Muscular epidemics it is nevertheless contended, on the other hand, contractions are not performed regularly immediately after that there are various other channels besides water by which considerable extension has taken place. This may be noticed the infection might be spread and that these also must be in the attempts made to reduce dislocations. taken into account. As may be readily imagined the different Since she has been in the hospital this time the warm, speakers who took part in the debate at the Medical cold, and vapour baths have been used, and also frictions. Society of London were not altogether of one mind in regard Blisters have been twice applied to the whole length of the to the relative importance to be assigned to these causes spine, but have not afforded any relief. The girl’s appetite in the origin and spread of the enteric fever of armies. is unimpaired ; she sleeps well, and her general health is In these circumstances we have thought that it would be of interest to our readers if we referred to what the good. American commission has to say on the origin and spread of No operations have been performed here this week; and this fever in the military camps during the late war with the only accident received that is at all out of the common Spain. An abstract of the report was issued by the way, is a dislocation of the sternal end of the clavicle 1 THE LANCET, Nov. 1st, 1902, p. 1195. forwards.

Looking Back.

THE LANCET, SATURDAY,

-

1420 Printing Office in 1900, but it has practicable up to the present time to publish

the provision of means for the sterilisation of water, and various other points, are cited and passed in review. The This is of a very elaborate and voluminous part played by flies as carriers of infection and by the nature, consisting as it does of 2600 type-written pages,, transport of infective material by soldiers on their persons or accompanied by numerous maps, plans, and charts. It is in their clothing, bedding, and tentage, and its dissemination meanwhile deposited in the library of the office of the through the air in the form of dust as well as the persistence of the disease in companies and corps when once introduced Surgeon-General of the United States army for reference. The declaration of war against Spain found the United are likewise all considered and Passed in review. Nor is it States Government in a state of medical unpreparedness. overlooked that susceptible material in the way of drafts Surgeon General G. M. Sternberg in his brief introduction to and reinforcements composed of young and newly arrived the abstract of the report in question tells us that the assem- soldiers is being supplied to the force in the field. It is bling of 250,000 volunteer troops in military camps in the stated emphatically by the commission that infected water spring of 1898 taxed all the bureaus of the War Department was not an important factor in the spread of typhoid fever in to the utmost, the medical corps of the regular army being the national encampments of 1898 and at pages 182 and 183 hardly sufficient for the small army of 25,000 men. To this some of the reasons on which this opinion is based are given. corps of trained medical officers a large addition had perforce Taking the case of Jacksonville and Knoxville, for example, to be made and this enlarged medical department had soon it is alleged to be beyond question that the water there to confront an enormous task, as may be judged by the fact was not infected. The supply at Jacksonville " came from that more than 20,000 cases of typhoid fever occurred among artesian wells more than 1000 feet deep and was distrithe troops encamped within the limits of the United States. buted by means of pipes. In August and September of 1898 A board of medical officers was convened by special orders there were in round numbers at Jacksonville 30,000 civilians issued from the Adjutant-General’s office in August, 1898, or inhabitants of the city and the same number of soldiers and an abstract of its report has been published in order encamped near by. Both civilians and soldiers drank water that the conclusions arrived at by the board may be avail- from the same source. There were only a few sporadic cases able for the use of the profession at the earliest practicable in the city at a time when each of the three division hosdate. The first 12 chapters of this abstract describe and deal pitals was receiving a score or more of patients with this with the facts connected with the medical history of thisdisease each day. The same condition existed at Knoxville. fever in the different divisions and camps and in the several Here the soldiers obtained their water-supply from the pipes army corps, and the remaining three chapters treat of that furnished West Knoxville. We satisfied ourselves from coincident malaria and typhoid fever and of the etiologyan inspection of the health officer’s books that there were no of the latter disease, with a summary of general statementscases of typhoid fever among the citizens at that time and and conclusions. still there were hundreds of cases among the soldiers." The abstract, consisting of 239 pages, forms a very Allusion is made in the abstract to the results and medical condensed pricis of the report itself but is nevertheless full histories of other campaigns in other countries, and the of interesting and important material. This does not readilybacteriological information about the enteric bacillus and lend itself to further analysis and we must content ourselves ttyphoid fever is up to date, but we have exhausted our space. with dealing with some of its more salient features only.We have, however, said enough, we trust, to show that the While the commissioners express their confident conviction ireport of the American commission is an able, comprehensive, that water infection was one of the means by which typhoidand important official document. fever was spread through a division at Chickamauga, for example, they are, as will be seen, very far from adopting this as an exclusive channel. While not implying that this fever ever originated de novo, they nevertheless hold that typhoid fever is so widely distributed that in any large assembly of men collected from different parts there will always be some present who are already infected with it. LOCAL GOVERNMENT BOARD. They regard it, in other words, as an axiom that typhoid fever will appear and spread whenever and wherever a large number of men are congregated and allow their own excreREPORTS OF MEDICAL OFFICERS OF HEALTH. tions to accumulate about them. the war of it was found that 1898 West During Spanish typhoid Riding County District.-The strides made by the fever showed itself in every regiment constituting six army sscience of bacteriology have rendered it necessary in the corps. More than 90 per cent. of the volunteer regiments interests of the public health that medical practitioners t the country should be afforded facilities for developed this fever within eight weeks of going into camp ; throughout it was also developed in certain of the regular regiments oobtaining a bacteriological examination, not only in cases within three to five weeks after going into camp ; and it presenting some diagnostic difficulty, but also in order to p became epidemic in both small and larger encampments, eenable the physician to determine when infection is at an end whether located in the Northern or in the Southern States. aand when the patient may safely mix with the public. Seeing The origin, progressive development, and persistent preva- that this is a matter of public health concern it is right that t:t facilities in question should be provided by a public lence of the disease in companies and corps seem to have the The commissioners’ investiga- health been carefully worked out. b authority, and the county council would seem to be tions confirm the doctrine of the specific, and do not support the t authority which can most usefully perform this function. the pythogenic, origin of this fever. Typhoid fever is dis-We are glad to see that the West Riding County Council has seminated by the transference of the excretions of an t taken this view and that it has recently provided a laboratory and appointed a competent bacteriologist. Dr. J. R. Kaye, infected individual to the alimentary canal of others and an a the county medical officer of health, tells us in his current infected man may scatter the infection before the disease is t] recognised in him. It is easy to see why typhoid fever is aannual report that each medical officer of health in the c more likely to become epidemic in camp than in civil life county has been provided with outfits for obtaining samples f( bacteriological examination, and that any medical pracfor on account of the greater difficulty of disposing of the ti in the county can now obtain such outfits free of all excretions, alvine and urinary, in the former case espe- titioner ciallv, where, as in the war of 1898, camp pollution is ccharge from the local medical officer of health. Specimens stated to have been the greatest sanitary sin committed by when taken are at once forwarded to the county laboratory and the results are transmitted as expeditiously as possible the troops. Owing to the observations of Professor A. E. a t( the local medical officer of health and to the practitioner Wright and Major D. Semple, R.A.M.C., and to those of to who furnished the sample. The facilities thus afforded Dr. P. Horton-Smith and others we know how frequently and R a persistently typhoid bacilli are present, sometimes in enormous are being much appreciated by the medical profession in tl West Riding and from April 22nd to Dec. 31st, 1901, quantities, in the urine of enteric fever patients and how the the disease may consequently be spread through the urine of no n less than 177 Widal’s tests were applied, 228 specimens of were examined for the tubercle bacillus, and 383 swabs patients affected with typhoid bacilluria. sl sputa Instances of ignorance of camp hygiene and neglect of from fI suspected cases of diphtheria were sent to the laboratory. N useful work has been done with regard to the exasanitary precautions in the way of too long occupation and Much mination of the urine of patients who had suffered from insafficiently frequent change of sites, improper or inade- rr quate methods of sewage disposal and disinfection and of enteric fever, and in one case the facts suggested that a guarding against contamination of the water-supply or of ti trooper returned from South Africa had suffered while there

Washington

Government

not been found the full report.

Public Health and Poor Law.