LIBRARY TABLE
1905
The Lancet
The following are the most important statements and conclusions derived from the report. During the war every regiment constituting the first, second, third, fourth, fifth, and seventh army corps developed typhoid fever. More than 90 per cent. of the volunteer regiments developed typhoid fever within eight weeks after going into camp. Typhoid fever developed also in certain of the regular regiments within from three to five weeks after going into camp. Typhoid fever became epidemic both in the
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... mall encampments of not more than one regiment and in the larger ones, consisting of one or more corps, and in camps located in the northern as well as in the southern states. Typhoid fever is so widely distributed in America that one or more cases are likely to appear in any regiment within eight weeks after assembly. The miasmatic and pythogenic theories of the origin of typhoid fever are not supported by these investigations, which confirm the doctrine of the specific origin of typhoid fever. With typhoid fever as widely disseminated as it is in America the chances are that if a regiment of 1300 men should be assembled in any section and kept in a camp, the sanitary conditions of which were perfect, one or more cases of typhoid fever would develop. Typhoid fever is disseminated by the transference of the excretions of an infected individual to the alimentary canals of others. It is more likely to become epidemic in camps than in civil life because of the greater difficulty of disposing of the excretions from the human body. A man infected with typhoid fever may scatter the infection in every latrine in a regiment before the disease is recognised in himself. Camp pollution was the greatest sin committed by the troops in 1898. In some instances the space allotted to the regiments was inadequate. Many commands were allowed to remain on one site too long. Requests for change in location made by the medical officers were not always granted. Greater authority should be given to medical officers in questions relating to the hygiene of camps. It may be stated in a general way that the number of cases of typhoid fever in the different camps varied with the methods of disposing of the excretions. The tub system of disposal of fagcal matter is to be condemned. The regulation pit system is not a satisfactory method of disposing of fascal matter in permanent camps. In permanent camps where water carriage cannot be secured all fsecal matter should be disinfected and then carted away from the camp. Infected water was not an important factor in the spread of typhoid fever in the national encampments in 1898. To guard against the contamination of the water-supply troops in the field should be provided with means for the sterilisation of water. Flies undoubtedly served as carriers of the infection. It is more than likely that men transported infected material on their persons or in their clothing and thus disseminated the disease. ' Typhoid fever as it developed in the regimental organisations was characterised by a series of company epidemics, each one having more or less perfectly its own individual characteristics. It is probable that the infection was disseminated to some extent through the air in the form of dust. When a command badly infected with typhoid changes its location it carries the specific agent of the disease in the bodies of the men, in their clothing, bedding, and tentage. After a command becomes badly infected change of location, together with thorough disinfection of all clothing, bedding, and. tentage, is necessary. Except in the case of the most urgent military necessity one command should not be located upon the site recently vacated by another. The fact that a command expects to change its location does not justify neglect of proper policing of the ground occupied. It is desirable that the soldier's bed should be raised from the ground. In some of the encampments the tents were too crowded. Medical officers should insist upon soldiers removing their outer clothing at night when the exigencies of the situation permit. In addition to the recognised cases of typhoid fever there were many short or abortive attacks of this disease which were generally diagnosed as some form of malarial fever. About one-fifth of the soldiers in the national encampments in the United States in 1898 developed typhoid fever. Army surgeons correctly diagnosed about half the cases of typhoid fever. The percentage of death among cases of typhoid fever was 7' 61. When a command is thoroughly saturated with typhoid fever it is probable that from one-fourth to one-third of the men will be found susceptible to this disease. In military practice typhoid fever is often apparently an intermittent disease. The belief that errors in diet with consequent gastric and intestinal catarrh induce typhoid fever is not supported by the investigations. More than 90 per cent. of the men who developed typhoid fever had no preceding intestinal disorder. The deaths from typhoid fever wcje 86'24 per cent. of the total deaths. The morbidity from typhoid fever per 1000 of mean strength was a little less than onefifth. The mortality from typhoid fever per 1000 of mean strength was 14'63. The average period of incubation in typhoid fever is probably about ten and a half days. The maps and charts in the second volume show graphically what has been stated in words in Vol. I. The object of displaying by charts the diseases prevalent in the different regiments is to show to the eye the distribution of diarrhoea, typhoid fever, so-called malarial fever lasting ten days and upwards, and so-called malarial fever lasting less than nine days, but especially of typhoid fever, not only in point of time, but also with reference to company outbreaks. A glance at the charts emphasises the fact that typhoid fever generally appeared as separate company outbreaks. This appears to the authors to be most convincing proof that the agent of infection, as a rule at least, was not present in either the food or the drink supplied to the regiment. Typhoid fever must have been spread largely by personal contact and by the contamination of tents, blankets, clothing, and the persons of individuals. This is also emphasised in the smaller maps introduced into the text of Vol. I., in which the tent distribution of the disease was demonstrated. The relation between typhoid fever, diarrhceal diseases, and the so-called malarias, both short and long, is graphically illustrated in many of the charts. The report is a most interesting one. LIBRARY TABLE. Notes on the Sorbonne. -We have received a small pamphlet, written by Mr. J. A. Randolph and published by Mr. Dennis Lane, of the Strand, London, W.C., entitled " The Sorbonne and its Secret Chapels." It gives an interesting account of the vicissitudes through which this famous establishment has passed during its lifetime of over 700 years, for it was founded in 1201. The founder was a pious villager from the diocese of Rheims, by name Robert de Sorbon, and he it was who, with the aid of St. Louis and the then Archbishop of Paris, founded a theological college for 16 poor students. By the fourteenth century this number had been increased to 36 and during the middle ages the doctors of the Sorbonne were acknowledged masters of theology. In the seventeenth century Richelieu offered to rebuild the college buildings and to provide a church if they would make him Provisor.
doi:10.1016/s0140-6736(01)21383-x
fatcat:clx2pf3jq5azzpywa3cnko53h4