of the cases which occurred in France indicate that almost all the patients had escaped receiving the typhoid prophylactic. During the Spanish War of 1898 the admission rate for typhoid was 141 per 1,000 and the death rate 14 per 1,000. If this experience had been repeated in this war, for each 1,000,000 men there would be 140,000 cases of typhoid and 14,000 deaths. It can not be claimed that all of our protection from such a calamity is due to vaccination. as sanitation had much effect, but enough cases are occurring in spite of all precautions to show that there is constant danger of infection and constant need of protection by vaccination. Recent experiments conducted at the Army Medical School have resulted in the perfecting of an oil vaccine modeled after the French vaccine, by which a complete immunization can be given in one dose. This is a distinct practical advance as an administrative measure. as it saves time and labor. A full report of the work of the Army Medical School is presented elsewhere. Examination of all food carriers has been made for carriers of the typhoid group of organisms, and carriers found have been excluded from food handling. Where possible these carriers have been sent to the Walter Reed General Hospital for study and treatment. One cook whose urine was practically a pure culture of typhoid bacilli was found to have a pyonephrosis on one side. His kidney was removed and he made a complete recovery as a carrier. Two gall-bladder typhoid carriers have been operated on for cure by removal of the gall bladder and are still under observation. 2. VACCINATION AGAINST TYPHOID AND THE PARATYPHOID FEVERS. Since the mobilization on the Mexican border, paratyphoid vaccines have been used in addition to the typhoid vaccine for all troops on duty in the Southern Department. When troops began to go to Europe they, too, were given the para-vaccines. After the 1st of August, 1917, the two vaccines were combined and were given as a triple typhoid vaccine on one course of three doses, since experimental work during June and July had shown that the reaction, both local and general, was no more severe than that occurring after the typhoid alone. 3. REPORTS FROM DEPARTMENTS. Southern Department. With the prompt routine administration of typhoid and paratyphoid prophylaxis the number of cases of these infections among the military personnel is almost negligible. But four of each are reported from the regular service and three of typhoid in the National Army. There have been cases among the civilian employees who have not had the proper vaccination, but the present rate among those who have had the vaccination shows an almost perfect immunity. With such a record, when the large number of new recruits handled is considered, it would seem that with proper enforcement of suitable vaccination regulations outside the Army as well inside. these diseases might almost within a comparatively short time be rendered things of the past. In regard to one case of death due to typhoid among the militia during the year, when no cases of typhoid are reported in the admissions for that disease, note that this was a case admitted in 1916, which died January 15, 1917, and is consequently included in this report. Central Department. There were 5 cases of typhoid fever, 2 of these being at Fort Leavenworth, Kans., and 1 at each of the following posts: Fort Benjamin Harrison, Ind.; Fort Crook, Nebr.; and Fort iley, Kans. The records show that the two soldiers at Fort Leavenworth, Kans., had completed typhoid inoculations; that the case at Fort Benjamin Harrison had been last immunized about the year 1912; that the case at Fort Crook had not been immunized; that the case at Fort Riley had received first dose only toward immunization prior to attack. In addition to the above, Fort Leavenworth reports three cases of typhoid fever among civilians with no records of inoculation, their respective ages being 6, 16, and 20 years. No typical cases of typhoid or paratyphoid reported. During the year, 16,075 cases have been immunized with excellent results and practically no serious reactions. Number at present not immunized, 217. These are new recruits and inoculations are now being given. Western Department.-There have been eight cases of typhoid fever and one of paratyphoid in the command during the past year. In each case the medical officer was called upon for special report, required by instructions from the Surgeon General's Office. These reports indicated that either immunization had not been completed or that the soldier had acquired the infection prior to enlistment. Delay in immunization was apparently due to the rapidity with which it was necessary to move recruits from depots to regiments. Eastern Department.-During August. five cases of typhoid fever were reported in the Fifth New Jersey Infantry stationed at Pompton Lakes, N. J. The surgeon of the regiment stated that there was considerable pollution of the ground by men defecating and urinating outside the latrines. On account of broken pipes connected with the toilet in a pumping station, discharges from the toilet entered a near-by well. This was proven by an aniline test. The records in regard to inoculation against typhoid were not properly kept, and it was found that there were large numbers in nearly all the companies who had not had the typhoid vaccination completed. This carelessness, no doubt, accounts for the epidemic of typhoid in this organization. One case of typhoid occurred in the Forty-seventh New York Infantry while at Lynchburg, Va., in September. The soldier had received one inoculation against typhoid in July, 1917. One case of typhoid occurred at Grove Hill, Va.. in a detachment of the Second Virginia Infantry on guard duty at that place. Typhoid existed outside of the camp in the section from which the milk supplied to the detachment came, but the source of the infection could not be definitely determined. On August 27, in Companies C and L, First Virginia Infantry, at Lynchburg, Va., 75 out of 212 men were sick. Twenty-five of these had a temperature no higher than 99 degrees and little or no toxemia. The remaining 50 had temperatures of 100 degrees or more. Ten of the 25 mildly sick developed more severe symptoms and had to be confined to bed in the following 48 hours. The surgeon reported that the symptoms in these cases suggested typhoid, “if typhoid, was modified by vaccination." One case, sick three weeks in hospital, was reported to have a true clinical typhoid, but one of the State bacteriologists stated with regard to blood cultures in this case that he had obtained an organism "probable typhoid bacillus" but he could not satisfactorily identify it and on a second culture being obtained he was unable to find the organism. He secured 15 blood cultures from soldiers of this organization in hospitals but could find no evidence of typhoid. He remarked, however, that the media and the containers were unsatisfactory, the cultures being contaminated. The soldier who had clinical symptoms of typhoid had received only one vaccination against typhoid. Two cases of typhoid were reported in the First Maryland Infantry during August, and one case in the Maryland Coast Artillery about the same time. The surgeon, Fort Jay, N. Y., reported one case of typhoid fever admitted to the hospital September 4, 1917, and stated that the source of infection is unknown, probably contracted in a civilian community. One case appeared at the camp of the Twelfth Field Artillery while stationed near Fort Myer, Va., and was sent to the post hospital, Fort Myer, Va., for treatment on October 7, 1917. The patient had recently been transferred from mobilization camp at Syracuse, N. Y., and his typhoid inoculation was completed at the encampment of the Twelfth Field Artillery on September 11, 1917. At Fort Myer, Va., one case of typhoid in a candidate at the officers' training camp was admitted to the hospital August 23, 1917, the same day that he arrived, showing that the disease was contracted elsewhere. Fort Oglethorpe. Ga.-During the summer and early autumn 43 cases of typhoid fever occurred. Of these 22 cases were part of an epidemic among German war prisoners as a result of eating contaminated cheese. Most of the Germans were vaccinated. This matter is covered by a special report forwarded to the Surgeon General. 4. HAWAII. Since the epidemic of typhoid fever recorded in the report of 1916, there have been a few scattered cases at Schofield Barracks. Two of these are recorded in the report for 1917. For two years previous to October, 1915, when the small epidemic mentioned in the 1916 report occurred, there were no cases of typhoid fever. The 13 cases occurring in 1915 and 1916 developed in the following order: Six in October, 3 in November, 1 in December, 1915; 2 in January, and 1 in February, 1916. Of the 13 cases, 6 were Japanese, 5 were soldiers, 1 was an officer's son, and 1 was a white civilian employee. There was only one death, and that in an uninoculated Japanese. The noteworthy feature of the small epidemic in October, 1915, was the fact that all cases used the Koolau water supply. One of the cases, developing in the latter part of the epidemic, was taken sick at a camp of the constructing quartermaster, located on this water supply. The fact that this case occurred on the water supply and at a later date than the other cases rather tends to support the theory that the five other cases in this epidemic may have been due to one common source of infection, and that on the watershed. The opportunity for a carrier to infect this water supply by walking in the water, was present in 1915; but at this time there was no water going to the post except through a system of tunnels into which no water from the general drainage area occupied by human beings found its way. Toward the end of September, 1917, an epidemic of typhoid fever occurred in Schofield Barracks. The first cases were positively diagnosed on the 8th of October in two quartermaster employees. The first case reported to medical officers with symptoms and later diagnosed as typhoid fever was taken ill on the 23d of September. From then until January 17, 1917, 55 soldiers and 56 civilians contracted this disease. The last 11 cases, occcurring in civilians, were in unprotected persons, and from the nature and time of their occurrence were in all probability contact infections. During the period immediately preceding this epidemic, that is from the middle of August until the middle of September, there had been little heavy rainfall on the watershed and there was a large amount of construction on the water system with no reserve supply of water. Therefore, it had been found necessary, in order to keep up the flow of water, to use the accessory pumping station mentioned in the 1916 report more or less constantly, although the sanitary authorities did not realize that this was being done. It developed that, in the early part of August, a Japanese arrived at one of the camps of the laborers on the watershed, afflicted with a disease the symptoms of which indicated a typhoid-like condition, although the man himself was not located. While he was sick, a Japanese laborer, Mizusawa, in another camp designated "No. 2," visited him and Mizusawa was taken sick with typhoid fever during the last week in August. He continued to work for several days afrer the beginning of his illness and lived at Camp No. 2. He stopped work on the 1st of September, but continued at the camp until September 7 and arrived at Honolulu on the 10th, where he presented himself for admission to a hospital. His symptoms on admission were those of hemorrhage into the intestine and his blood showed a positive Widal reaction. In October his blood still agglutinated the typhoid bacillus in high dilution. This man used an unsanitary privy at Camp No. 2, located on the drainage area of the stream which supplied the pool at the so-called "east pumping station," supplying water to the Castner section of Schofield Barracks. On the 13th and 14th of September, during this comparatively dry period, rather heavy rains occurred on the watershed, suli ient to cause the supply at Castner to become exceedingly muddy, as noticed at the faucets in the post. Ten days after the occurrence of this heavy rain the first cases of typhoid developed, and within a comparatively short period 100 cases had occurred. All of the cases at some time during the incubation period drank water from the Koolau supply. The vaccinated population of the Castner section, supplied by water from the Koolau Range at the time of the epidemic, was 4,087; the unvaccinated population, 812. The following table shows the incidence and mortality in these two groups: This table indicates very clearly the protection afforded by the prophylactic and shows that whereas it is the most important factor in the elimination of typhoid fever from the Army, it can not be considered an absolute and never-failing protection and that all of the safeguards of general sanitation and personal hygiene must be preserved unimpaired. It is the first time in the history of prophylactic vaccination against typhoid in the United States Army that it has been possible to see the protection afforded by the prophylactic against water-borne infection. It is noteworthy that, all proper protective measures being used, the epidemic promptly ceased in the protected population, whereas 11 secondary cases occurred among those not vaccinated. The investigation of this epidemic was made by a board appointed by the department commander. In addition to this board, the commanding officer of Schofield Barracks detailed a board. Both boards arrived at essentially the same conclusions in regard to the origin of the epidemic. In the report of the board first mentioned, the inadequacy of the present water supply, with its attendant conditions, namely, employees residing on the watershed and the necessity of using the pumping station whose source of supply came from a region polluted by human excreta, was considered as the essential contributory cause, and both boards also recommended the chemical treatment of all water from this watershed during the construction period and the treatment of all water during any time in which it became necessary to use the pumping station. TABLE NO. 125.--Pleurisy purulent as a complication with the following diseases, enlisted men in United States, 1917. TABLE NO. 126.—Mastoiditis as a complication with the following diseases, enlisted men in United States, 1917. 1 Cases not included in Table No. 55, of otitis media as a complication. |