Entered October 21, 1901, as second-class matter, Post Office at Brattleboro, Vt., CONTENTS. Review of Some Recent Literature with Special Reference to Anti- Sewage Disposal, by Prof. J. W. Votey, Engineer of State Board of 3 11 .... Infectious Diseases, by David D. Brough, M. D., Inspector, Boston 23 The Ventilation of Public Buildings, by Prof. J. W. Votey, Sanitary 40 Tuberculosis, by J. H. Huber, M. D. 54 Specimens Examined at Laboratory of Hygiene, First Quarter, Jan- 62 News Items 82 BRATTLEBORO, VT. BULLETIN OF THE VERMONT STATE BOARD OF HEALTH. Vol. X. No. 4. Issued Quarterly at Brattleboro, Vermont. The Bulletin is published quarterly by the State Board of Health under the authority of Section 5 of Act No. 90, Legislature of 1900. It will be sent to all Boards of Health. A copy will be sent to any person in the state upon request addressed to the Secretary, Henry D. Holton, Brattleboro. REVIEW OF SOME RECENT LITERATURE WITH SPECIAL REFERENCE TO ANTITYPHOID VACCINATION, THE HYGIENE OF MEDICAL CASES, TRANSMISSION OF DISEASE BY INSECTS, ANTISMALLPOX VACCINATION. BY GEORGE M. KOBER, M. D., LL. D., PROFESSOR OF HYGIENE, GEORGETOWN UNIVERSITY, WASHINGTON, D. C. During the last year or two much has been written on the subject of. vaccination against typhoid fever, cholera and pest. Dr. Sterling Ruffin in an admirable review of Internal Medicine (Washington Medical Annals, '09, VIII. p. 77) described, in a most thorough manner, the character of infection of typhoid fever, its contagiousness, the chronic bacillus excretors and the prevention of typhoid fever by vaccination. Major F. F. Russell of the Medical Corps U. .S. A. in “The Military Surgeon" for June, 1909, discussed the prevention of typhoid fever by vaccination and by early diagnosis and isolation. His article, although written with special reference to the prevention of typhoid in the military service, is nevertheless of the utmost importance to public health. He points out, very properly, that in cities the diseases tend to diminish from year to year as sanitary conditions improve, but in the rural districts it remains just about the same, and that whenever troops take the field for active operation there is the greatest probability that the disease will become epidemic. He attributes this difference largely to the lack of suitable facilities for the collection and disposal of excreta and refuse. The army, he says, has tried many substitutes for water carriage of sewage and is now using an incinerator, which, while cumbersome and expensive, has proved very satisfactory. In Dr. Russell's opinion the question of the cost of incineration is perhaps unimportant when we consider the terrible pecuniary losses entailed by the prevalence of typhoid fever, dysentery, diarrhoeal and other camp diseases. He quotes figures to show that the 31,000 cases of typhoid fever with 5877 deaths during the Boer War involved an expenditure of 4,000,000 pounds sterling. In the Spanish American War we had 20,730 cases with 1580 deaths among 120,000 men. In the Franco-Prussian War there were 73,396 cases with 8789 deaths among the German troops alone, and in the Civil War the Northern army had over 80,000 cases. In view of the great economic importance of the subject no effort should be spared to prevent the ravages of this disease and Dr. Russell believes one of the simplest and most promising of these is antityphoid vaccination, which has already been subjected to extensive practical tests in both the English and the German colonial armies. The following is a condensation of Dr. Russell's elaborate and valuable paper: Inoculation with killed typhoid cultures was made by A. E. Wright of England in 1896 in about twenty cases and in January, 1897, he urged this procedure on young soldiers who were going to typhoid infected districts and on nurses in attendance on typhoid patients. The vaccine consists of a broth culture of the bacillus typhosus, which has been killed by heat and contains usually from three to eight million dead bacilli per dose. Enough antiseptic is added to preserve it and prevent the growth of any contaminating germs. The vaccine is quite harmless and is patterned after the well-known cholera prophylactic of Professor Haffkine's, which has been successfully used for many years. The antityphoid inoculation, as practiced now, consists in the subcutaneous injection at the insertion of the deltoid of 0.5 cc. of the vaccine for the first dose; 1 cc. for the second dose to be given ten days later, and a third dose of 1 cc. after another interval of not less than ten days. The arm should be cleaned as for any other operation. No person should be vaccinated who is not perfectly healthy and free from fever at the time. The entire reaction, which consists of some headache, malaise and a local red and tender area about the size of the palm of the hand and some tenderness in the axillary glands, rarely extends beyond forty-eight hours. In isolated instances very susceptible subjects develop a more general reaction, headache, backache, nausea, vomiting, perhaps herpes labialis and rarely albuminuria and some loss of body weight. No untoward results of any kind have ever been noted. According to Russell the prophylactic vaccination was introduced into the British army in India in 1898, where 4000 men were inoculated. When typhoid became epidemic in South Africa during the Boer War, Wright introduced the practice there. Wright's experience was as follows: There were 19,069 soldiers inoculated, and among this number there occurred 226 cases of typhoid (11.84 cases per 1000 of strength, or 1 in 844) and 39 deaths, which gives a mortality of 17 per cent. Among 150,231 untreated soldiers, there were 3739 cases of fever (24.88 cases per 1000, or 1 in 40) and the death rate in this class was 25 per cent. So that in Wright's opinion the incidence of the disease was diminished about one half by the antityphoid vaccination and the mortality was lessened even more than this. The value of these figures was questioned and Russell states that the practice was suspended in the British army about 1902. Colonel Leishman and Major Harrison of the British army, and Pfeiffer, Kolle, Hetsch and Kutscher in Germany took up the subject again and developed the present or second stage of the subject. The results in the British army to June 1, 1908, were published by Colonel Leishman in the Journal of the Royal Army Medical Corps, 1909, XII., p. 166, and are as follows: "In a total strength of 12,083 soldiers 5473 were inoculated and among these 21 cases with 2 deaths developed. Among the 6610 unprotected soldiers 187 cases with 26 deaths occurred; which indicates that for one case of typhoid among the inoculated, there are ten among the uninoculated and that for one death among the inoculated there are ten among the uninoculated." (Russell.) Although the German Government took cognizance of Wright's inoculations in 1900, it was not until 1904, when a rapid extension of typhoid fever among the expeditionary forces in German Southwest Africa suggested the necessity of the preventive inoculations which were begun in November, 1904. About 8000 of the 16,496 colonial troops availed themselves of this prophylactic procedure, without an untoward accident of any kind. In the body of 16,496 men there occurred between 1904 and 1907, the date of Dr. Musemold's report, 1277 cases of typhoid fever. Among each 1000 uninoculated men there occurred 98.4 cases of typhoid and 12.6 deaths; among every 1000 of the inoculated there were 50.9 cases of typhoid and only 3.3 deaths. These figures show that the man who refused inoculation was twice as liable to have typhoid as the man who accepted and four times as apt to die of it. It was also shown that two or more inoculations gave much better results in affording protection than a single one, and the death rate also shows very strikingly the increase in the amount of protection obtained by re-inoculation. Among the vaccinated the cases were distributed as follows: Professor Koch's Antityphoid Campaign. In the investigations conducted about eight years ago under the direction of Prof. Robert Koch with a view of stamping out typhoid fever in the rural districts of Germany, it was found that there were a great many cases which are never recognized and reported as such, and that these unrecognized cases constitute a serious menace in the spread of the disease, so for example in a group of villages where a total of eight cases. had been reported by the local physicians, his corps of investigators demonstrated that there were really seventy-two. This, however, was not the fault of the physicians, but was because in the country these cases do not come into the hands of the physician at all, and were mostly children; as a matter of fact fifty-two of seventy-two cases occurred in children and of these only three had been reported. The investigation also developed the fact as expressed by Koch that all the cases were due to contact, that is the infection was always carried directly from one to another; the cases in any single house always formed a chain. One person is taken sick and two or three weeks later a second, and some weeks later still another and so on. The sickness was introduced prin |