MEDICINE i 77 



practised is most marked, and the case in favour of the procedure much strengthened by 

 our experiences during 1911." 



(b) President Taft, at a medical banquet given to him in Philadelphia, on May 4, 

 1911, spoke as follows: 



"We have a division of 18,000 men in Texas and California. They have been there for 

 two months, living under canvas, and in a country soaked with rain and deep with profanity- 

 provoking mud. But so effective have been the regulative and preventive methods adopted 

 to reduce sickness, that the percentage of sick men is less than it was in the posts from which 

 these men were mobilised. I need not recall the dreadful record of sickness from typhoid 

 fever in the camps at Chickamauga and other camps established during the Spanish-American 

 war. The percentage of typhoid cases was so high that it is hard to believe. Of 120,000 

 men there were 20,000 cases, with a mortality of 7 per cent. Of the volunteer regiments 

 mobilised during the Spanish-American War, 90 per cent became infected with typhoid 

 fever within eight weeks from the date of mobilisation. To-day, two months after mob- 

 ilisation, with the modern health regulations, and by the use of vaccination against typhoid, 

 not one case of typhoid fever has appeared in the entire force, except that of one teamster 

 who was not vaccinated." 



A few weeks later, in the autumn of 191 1 , an Army Order was issued, that the protective 

 treatment against typhoid fever was to be made compulsory in the United States Army 

 on all officers and men under 45 years of age; excluding, of course, those who had al- 

 ready suffered from the fever. The total number of men to receive the treatment was 

 76,000. 



In 1912, it was stated that a similar measure was to be adopted in the United States 

 Navy (See Brit. Med. Journ., Feb. 3, 1912). See also, on this point, Dr. Ford's paper on 

 " The present status of the anti-typhoid campaign in Germany " (Johns Hopkins Hosp. 

 Bulletin, Sept. 1912), and Dr. Vincent's results with anti-typhoid inoculation in 

 Morocco (Brit. Med. Journ. , Jan. 6, 1912). 



Much attention has lately been given to the important subject of carriers of typhoid 

 and paratyphoid fever. See, inter alia, Dr. Bainbridge's paper, with discussion, on 

 " The Etiology and Epidemiology of Paratyphoid Fever and ' Food-poisoning ' ; 

 (Proc. Roy. Soc. Med., Feb. 1911) and Dr. Hamer's paper, with discussion, on " Typhoid 

 Carriers .and Contact-Infection " (ibid., April 1911). The whole subject has been 

 reviewed in an authoritative volume by Dr. Ledingham and Dr. Arkwright, of the Lister 

 Institute, The Carrier Problem in Infectious Diseases (Arnold, London, 1912). 



This question of carriers came into public notice, in 1910, over an outbreak of illness 

 in Wrexham, which affected 107 persons, with 5 deaths. The cases presented signs of 

 paratyphoid infection; and the epidemic was associated with the eating of pork pies from 

 a certain bakery. The bakehouse was sanitary; the meat was wholesome; the pies had 

 tasted all right, and no chemical poison was found in them. But paratyphoid bacilli 

 were found in them, and in blood from the heart of one of the fatal cases; 1 and, in several 

 cases, after recovery, a blood-test gave evidence that they had suffered from paratyphoid 

 infection. One of the staff at the bakery, apparently in perfect health, was found to be 

 a carrier of paratyphoid bacilli identical in type with those found in the pies and in the 

 blood from the fatal case. The opinion of the experts was, that this outbreak of 

 " food-poisoning " was a genuine epidemic of paratyphoid fever, due to infection with 

 " paratyphoid B bacilli;" and that the probability was " practically conclusive " that 

 the carrier was the source of the infection. 



The existence of typhoid carriers is a sure fact; but opinions differ as to the measure 

 of danger of infection from them. Dr. Theodore Thomson, in his address on " The 

 Enteric-fever Carriers " (Proc. Roy. Soc. Med., Nov. 1910), estimates that 3 per cent of 

 typhoid cases continue, after recovery, to be " chronic carriers;" and he thinks the 

 estimate would be higher if more general use were made of bacteriological examination 

 of the excreta after recovery from the disease. On a few occasions, evidence has been 

 brought forward as to typhoid carriers which may, without offence, be called sensational. 

 " The most noteworthy example," says Dr. Theodore Thomson, " is that of the Folke. 



1 It is to he noted, as a sign of the virulence of the infection, that this fatal case seems to 

 have infected three persons attending on her, one of whom died. 



