Sidebilder
PDF
ePub

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:

Received one dose, 21.1 per cent..
Received two doses, 51.6 per cent..
Received three doses, 27.3 per cent..

Cases. Deaths.

63 1 7.1
48.1 2.2
47.9 13

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 principally by the children. The school children especially play a very important role. They all see one another daily and they play together the whole day long, and when one is sick the rest all come to see him and are infected. The infections came principally, however, through the careless way in which the excreta were disposed of. As a result of these observations Koch came to the conclusion that the antityphoid campaign must be conducted by a trained corps of sanitary officers, that all patients and suspects must be isolated and the necessary disinfection carried out. For this purpose he established a temporary barrack hospital where the severest cases were treated, while those who remained in their houses were watched over by the nurses and the disinfector. The general principles carried out were early diagnosis, isolation of the patient, prompt disinfection of the excreta and linen, final disinfection of the premises and the search for bacillus carriers. None of cases were discharged from observation until they had been proved free from typhoid bacilli in three successive bacteriological examinations. After three months there were absolutely no more typhoid bacilli to be found, the patients were all well and no more fresh cases developed.

Professor Koch says some one may raise the point that the disease might have disappeared without any special effort. This objection, he says, does not apply in this case, for in the High Forest there are many other villages where similar or even exactly the same conditions were found and there the disease still rages.

Dr. Russell tells us that although this general campaign has now been conducted for five years in different parts of Southwestern Germany the disease has not been stamped out in any one locality, as was at first hoped, and that this failure is most likely due to the chronic bacillus carriers. It has been shown that from 3 to 5 per cent of all cases become chronic bacillus excretors, and that about 85 per cent of the bacillus carriers are women. The management of such cases involves extraordinary difficulties, because medicinal treatment has so far been without appreciable results, unless indeed it can be shown that inoculations or medicinal treatment can correct this condition. The Germans for the present rely upon absolute disinfection of the hands of the bacillus excretor after each visit to the toilet, the keeping his linen separate from all other linen, and having it separately boiled. He must also use a toilet or privy or chamber pot which is reserved exclusively for him. He is not permitted to handle or work with food stuffs. If the subject is poor he is furnished with cresol soap, basin and towels free and a privy is constructed for him if necessary. All treatment and diagnosis is free to the poor.

On the whole the prospects for an ultimate successful antityphoid campaign in a country like Germany, where sanitary ordinances can be strictly enforced and where the Government is willing to make liberal appropriations, are quite encouraging.

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:

Received one dose, 21.1 per cent....
Received two doses, 51 6 per cent..
Received three doses, 27.3 per cent..

Cases. Deaths.

63 1 7.1
48.1 2.2
47.9 13

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 principally by the children. The school children especially play a very important rôle. They all see one another daily and they play together the whole day long, and when one is sick the rest all come to see him and are infected. The infections came principally, however, through the careless way in which the excreta were disposed of. As a result of these observations Koch came to the conclusion that the antityphoid campaign must be conducted by a trained corps of sanitary officers, that all patients and suspects must be isolated and the necessary disinfection carried out. For this purpose he established a temporary barrack hospital where the severest cases were treated, while those who remained in their houses were watched over by the nurses and the disinfector. The general principles carried out were early diagnosis, isolation of the patient, prompt disinfection of the excreta and linen, final disinfection of the premises and the search for bacillus carriers. None of the cases were discharged from observation until they had been proved free from typhoid bacilli in three successive bacteriological examinations. After three months there were absolutely no more typhoid bacilli to be found, the patients were all well and no more fresh cases developed.

Professor Koch says some one may raise the point that the disease might have disappeared without any special effort. This objection, he says, does not apply in this case, for in the High Forest there are many other villages where similar or even exactly the same conditions were found and there the disease still rages.

Dr. Russell tells us that although this general campaign has now been conducted for five years in different parts of Southwestern Germany the disease has not been stamped out in any one locality, as was at first hoped, and that this failure is most likely due to the chronic bacillus carriers. It has been shown that from 3 to 5 per cent of all cases become chronic bacillus excretors, and that about 85 per cent of the bacillus carriers are women. The management of such cases involves extraordinary difficulties, because medicinal treatment has so far been without appreciable results, unless indeed it can be shown that inoculations or medicinal treatment can correct this condition. The Germans for the present rely upon absolute disinfection of the hands of the bacillus excretor after each visit to the toilet, the keeping his linen separate from all other linen, and having it separately boiled. He must also use a toilet or privy or chamber pot which is reserved exclusively for him. He is not permitted to handle or work with food stuffs. If the subject is poor he is furnished with cresol soap, basin and towels free and a privy is constructed for him if necessary. All treatment and diagnosis is free to the poor.

On the whole the prospects for an ultimate successful antityphoid campaign in a country like Germany, where sanitary ordinances can be strictly enforced and where the Government is willing to make liberal appropriations, are quite encouraging.

« ForrigeFortsett »