216 Transactions of the Society. 



be carried out. Of masks I prefer the one invented by Mrs. M. 

 Simpson, called the " Simpsonette." Chemical preparations to 

 keep off mosquitoes are advantageous — the best is citronella oil ; 

 on the Piave Front (Italy) every man of the Brigade of Marines, of 

 which I was in medical charge, was supplied with it and the result 

 was satisfactory. A more pleasant preparation to use, though less 

 effective, is menthol powder. As regards prophylaxis based on 

 quinine administration, the usual dose of 5 gr. daily is utterly 

 inadequate in the Balkans. The daily dose should be increased 

 to at least 8 or 10 gr., and even these doses are at times insufficient 

 to prevent infection. 



II. — Typiiup. 



The microscopical agent of typhus has not yet been found with 

 certainty, though a spirochiete has been isolated. 



The terrible epidemic of this disease in Serbia during the years 

 1914-1915 will not easily be forgotten. It probably wiped out 

 one-sixth of the entire population, and made havoc especially 

 among doctors and nurses. One-third of the Serbian doctors died 

 of typhus, and a number of victims occurred also among the 

 medical men and nui-ses of various nationalities, but chiefly 

 British, who had answered the Serbian call for help. 



Among these courageous helpers I may perhaps be permitted to 

 mention the name of Lady Ealph Paget. I think no one who was 

 there at that time will ever forget the impression of Lady Paget, 

 a tall, slim figure in the dress of the Eed Cross, in the wards of the 

 make-shift subterranean hospital, which was all she had at that 

 time — wards airless, stifling, scarcely lighted, reeking with typhus, 

 and crowded with the dead and dying — ministering to the sick and 

 the wounded, without a thought or a care for her own safety. 



A little later Lady Paget's untiring energies succeeded in obtain- 

 ing the splendid, well-equipped hospital unit which bore her name, 

 and which, with the other fine hospitals opened by the various 

 allied missions, etc., were the means of saving hundreds of lives 

 and ending the outbreak. I can testify to the great amount of good 

 these institutions did, having been attached to both the American 

 Eed Cross Hospital and the Lady Paget Hospital. 



According to my Serbian experience, typhus begins generally 

 abruptly, with pains all over the body, a feeling of prostration, and 

 rigors ; but cases in which the onset is slow, somewhat typhoid- 

 like, are far from rare. On an average the duration of fever in my 

 cases was from fourteen to eighteen days. In 80 p.c. of them the 

 fever did not come down by crisis, as usually stated, but by lysis, 

 lasting in general three to five days, and occasionally much longer. 

 Eelapses may occur, but are rare. I would call attention to the 

 frequent co-existence of typhus and relapsing fever. This is 



