17,1 Banister: Military and Civilian Surgeons 13 
not brilliant. The system worked up for the United States 
Army by Colonel Russell of our Medical Department has pro- 
duced brilliant results, and has made typhoid fever almost a 
negligible item in our morbidity lists. This consists in the in- 
jection of 500 million killed bodies of the typhoid bacillus, hypo- 
dermically, and of two additional doses, at seven-day intervals, 
of one billion each. During the World War, in the entire army 
of the United States in 1917-1918, 1,083 cases of typhoid fever 
occurred with 158 deaths. If the rate had been the same as for 
1898-1899, during the Spanish-American War, when no typhoid 
prophylaxis was used as at present, the number of cases would 
have been 291,637 with 30,916 deaths. This method of typhoid 
prophylaxis could be used by the civilian practitioner to prevent 
typhoid fever among the civilian population with better pros- 
pects of success than in the army, because most cities have 
sewer systems with water carriage, and many other sanitary 
advantages. The military surgeon has been using typhoid 
prophylaxis since 1909 on volunteers, and since 1911 it has been 
compulsory in the army. 
The United States has suffered very severely from yellow 
fever epidemics, originating principally in Havana, Cuba (and 
with enormous economic loss), where it has been known to have 
existed since 1648. Nearly all the epidemics in the southern 
United States have been traced to Havana. The French were 
unable to build the Panama Canal because of the ravages of 
malarial and yellow fever, principally the latter, among the 
laborers. In 1900, during the American occupation of Cuba, a 
board of military surgeons of the United States Army, headed 
by Maj. Walter Reed, demonstrated the method of transmission 
of yellow fever by the Stegomyia calopus mosquito. With this 
knowledge General Gorgas, a surgeon of the United States 
Army, attacked the disease in its favorite lair, first in Havana, 
and eliminated it after it had prevailed there for over 300 years; 
then with equal success in Panama; and recent reports show 
that it has been abolished in Guayaquil, Ecuador, its last strong- 
hold, and is now nonexistent on this mundane sphere. The 
cardinal idea in conquering this disease was to attack it in its 
lair, and not waste time and money on its outposts. 
It was the military surgeons of Japan who first demonstrated 
that beriberi was a disease due to defects of nutrition. By 
adding more vitamines to the diet, which consisted principally 
of fish and rice, it was eliminated from the Japanese Navy. As 
late as 1883, 23 per cent of the Japanese Navy had beriberi. 
