BBVIEW — TROPICAL MEDICINE, ETC. 61 



lengthy list of thorough preventive or protective measures. Most of these are the same as Enteric 



those laid down for any dangerous, infectious disease. We specially note that all remains Fever— 



of food supplied to patients, and not consumed, should be destroyed, that everything which continued 



enters an enteric ward, books, journals, even empty soda-water bottles, should be regarded 



as infective and treated accordingly, that all utensils and apparatus for use in enteric cases 



should be kept separate and apart and specially marked, and that nursing attendants should 



be specially detailed, fed and housed apart, and, while not absolutely isolated, should wash 



and change their clothing before associating with the rest of the staff. 



Eules are given for the procedure to be followed on admission of a case to hospital 

 (disinfection of kit, bedding, etc.), when convalescence is established (use of urotropine, 

 examination of the stools, etc.), also in slight cases apt to be unrecognised (provision of 

 quarantine or segregation camps, etc.). The piaper then goes on to deal with enteric under 

 active service conditions, and, while space forbids further quotations, it may safely be said that 

 it is well worth the perusal of all in medical charge of troops and those responsible for the 

 health of men in camps, as for example the camps of the Survey Department in the Sudan. 



Another useful paper on the same lines is that of Caldwell. ^ He recommends shallow 

 and narrow latrine trenches 1 foot in depth and 1 foot in breadth, and the direction that 

 men should straddle across these to prevent fouling of their edges. Straton, whom he 

 quotes, advocates the use of a 2 per cent, solution of crude carbolic acid in latrine buckets 

 to keep away the flies. 



Statham,-* dealing with etiology, mentions that there are a number of allied but distinct 

 species of bacteria, which may produce disease indistinguishable from typhoid fever, and 

 tliat most of the varieties of bacteria composing the typhoid colon group, are found in 

 apparently healthy animals, while many diseases amongst domestic and other animals are 

 caused by bacteria which may produce typhoid in man. He also refers to the fact that 

 typhoid has been induced in human beings by eating the improperly cooked flesh of such 

 diseased animals. 



As regards anti-typhoid inoculation, Leishman^ describes the preparation of the new 

 modified vaccine. The bacilli are only subjected to 53° C, the minimum temperature which 

 ensures their death within one hour. The results with this vaccine have been most encouraging. 

 In one regiment out of a strength of 509, 147 were inoculated. Sixty-two cases of enteric 

 with eleven deaths occurred, all amongst the uninoculated with the exception of two, both 

 being men who had refused the second inoculation ; both of these men recovered. 



This author^ also records the utterances of Chantemesse as regards the remarkable 

 results obtained by the use of his curative serum. Chantemesse stated that he had never 

 lost a patient in whom the treatment was commenced during the first seven days of the 

 disease. Especially noticeable is the fact that the spleen appreciably enlarges after the 

 serum injections — Chantemesse attributes to this an important part in the origination of 

 the beneficial changes which are found in the blood itself (leucocytosis, increase of 

 mononuclears, rapid reappearance of eosinophiles). 



With reference to treatment, perhaps the most suggestive of recent papers is that by 

 Young-' on the dietetic management of cases. After prolonged trial he has entirely 

 disregarded the " antiseptic " method of treatment in all its forms, being convinced that 

 when diarrhoja (or tympanites) occurs the only true remedy is a careful revision of the dietary. 

 In a properly dieted case these troublesome symptoms should not arise, for the diet should 

 fulfil the following requirements : — 



1. It must be such that no solid residue, and certainly none of the least irritating character, enters that part 

 of the tcstiual tract where the local lesions are situ.ated. 



2. It must be such that fermentation of such a kind as to generate flatus does not take place. 



3. Inasmuch as the whole of the digestive functions are below par, it must be one which is readily digested 

 and assimilated. 



4. It must be such that the various tissues are provided with proper material for the renewal of that waste 

 of substance and vitality common to all prolonged fevers, and especially such pyrexial conditions as are 

 accompanied by the circulation of toxins. 



' Caldwell, R. (August 31st, 1907), " On Enteric Fever during Active Service." British MedicalJournal, p. 513. 



= Statham, J. C. B. (January, 1908), "The Complex Nature of Typhoid Etiology, etc." Transvaal Medical 

 Joitrnal. 



' Leishman, W .B. (March, 1908), " The International Congress of Hygiene, Berlin." Journal of the Royal 

 Army Medical Corps, Vol. X., No. 3, p. 247. 



" Leishman, W. B. (March 23rd, 1907), "Anti-typhoid Inocul.ation in the Army." Lancet, p. 806. 



^ Young, M. (September, 1906), "The Dietetic Treatment of Enteric Fever." Public Health, p. G8G. 



• Article not consulted in the original. 



