BEVIEW — TROPICAL MEDICINE, ETC. 231 



Houston, ^ who has been conducting research work in London, summarises his Water- 

 conclusions regarding the effects of storage on water as follows : — continued 



(«) It is most desirable that the question of storage should be looked at from a general standpoint, so as to 

 render the length of time during which water is stored more uniform throughout the different districts ; hence 

 the poUcy of intercommunication, already being applied to the filtered water, should be extended to the stored 

 water as far as this is practicable. 



(6) The advantages accruing fi-om even a few days' storage may be so material that, exceptional cases 

 apart, the use of raw unstored water for filtration purposes should strongly be deprecated. 



(c) Although, as a counsel of perfection, the water should possibly be stored for one or two months, storage for 

 four weeks may perhaps, in the present state of our knowledge, be regarded as affording a sufficient margin of 

 safety. 



(d) It is possible to determine, with reasonable accuracy, whether the water being used for filtration 

 purposes has been stored antecedently for such a length of time as to give relative (if not absolute) assurance 

 that any harmful properties it may originally have possessed have been destroyed in the process of storage. 



(c) It is not impossible that the additional " safety " conferred by adequate storage may come to be regarded 

 as a reasonable pretext for filtration through mechanical filters, at specially rapid rates, thereby effecting 

 considerable economies in the cost of filtration, as ordinarily practised ; but any departure from old-established 

 filtration custom should not be entertained in the absence of convincing experimental proof of the reliability of 

 the new process. 



(/) The question of storage is one both of quality and quantity, and, strictly speaking, the number of days 

 it is desirable to store water to improve its quality should be added to the minimum number of days of storage, 

 which it is necessary to provide in guarding against the possibility of a shortage of water ; nevertheless, 

 during a considerable part of each year, there is an abundance of water of relatively good quality in the 

 Thames and the Lea, and the existing storage reservoirs are sufficiently large in the aggregate, to improve 

 enormously the water derived from these rivers. 



(g) . . . {h) The advantages accruing from adequate storage of water are of a general character and are 

 not limited to the elimination of danger from typhoid fever. 



Weil's Disease. This comparatively rare but interesting disease known under the 

 various synonyms of febrile jaundice, infectious jaundice, epidemic jaundice, Griesinger's 

 disease, bilious typhoid, is an acute infectious disease characterised by fever, jaundice, 

 enlargement of the spleen and liver, nephritis, and various nervous symptoms. Although 

 occurring in epidemic form, especially in the summer months, it is not a contagious disease. 

 Its geographical distribution is of interest. In Smyrna it has been more or less endemic 

 since the year 1837, and its recognised presence in Alexandria dates from the year 1870. 



Griesinger in Cairo, in 1851 and 1852, called attention to its peculiar features, and 

 differentiated it from yellow fever and bilious remittent fever. At the Kasr-El-Ainy 

 hospital, 132 cases were treated by him, and, as a result of various post mortem examinations 

 on cases which died from this fever, he chose the synonym of Bilious Typhoid, owing to the 

 fact that so many organs were affected. 



In 1886, during four months, 185 cases were reported from Nauplia in Greece, and 

 Professor Weil, of Heidelberg, published in 1886 four cases of acute infectious jaundice 

 with swelling of the spleen and nephritis, and since then several cases have been recorded 

 from Germany. 



Small epidemics have occurred in England, the United States and China, and more or 

 less doubtful cases have occurred in several towns in Egypt, Greece, Malta, Dalniatia, Syria 

 and the Ionian Islands. Larrey's " yellow fever " in Cairo, in 1800, was probably a form of 

 this disease ; and in the British Medical Journal of 1898, Colonel Crombie noted, amongst 

 the unclassed fevers of hot climates, an outbreak occurring in the Central Provinces of 

 India which was reported by a native doctor as " yellow fever." 



Anderson-* reported an epidemic in Buxar Central Gaol in India, where sixteen cases 

 occurred, and undoubtedly it may occur in other parts of India and otlier tropical 

 countries, though described under other headings. 



This disease generally attacks men between the ages of twenty and thirty, having a 

 tendency to affect natives and Greeks, though cases have occurred amongst other 

 Europeans. The disease is not contagious, but one attack seems to confer immunity. 

 It is not confined entirely to the poorest classes, for many cases, in an epidemic at 

 Alexandria, occurred amongst professional men, and its seasonal incidence seems to 

 reach the maximum between the months of April and October. 



■ Houston, A. C. Special Report reviewed in Lancet, July 25th, 1908. 



'^ Anderson, S. (September 17th, 1904), " Epidemic Catarrhal Jaundice." British Medical Journal. 



• Article not consulted in the original. 



