684 PATHOGENIC MICROORGANISMS 



days in the Civil War and the Spanish American War, the admission 

 rates for typhoid fever were enormous. During the first year of the 

 Civil War the annual admssion rate was 70.69, with a death rate of 19.61, 

 and it is likely that, in addition to this, a large number of unrecognized 

 cases occurred. During the Spanish American War and the Philippine 

 Insurrection in the years 1898 to 1899, the annual admission was 91.22, 

 and the death rate 9.67. During the last World War the method of 

 vaccination used consisted in three inoculations at seven-day intervals, 

 of the salt solution suspension triple vaccine, containing typhoid 

 "Rawlings," paratyphoid A and B, the first dose containing one-half 

 million bacilli, and the second and third containing a billion each. The 

 typhoid rate was so low in the camps in the United States that a young 

 man in the camp had 45 times less opportunity of getting typhoid fever 

 than did the same age group in civilian life during the same period. 

 Although approximately three million men passed through the camps 

 during the course of 1918, the actual admission rate for the United 

 States was 0.17. In Europe, in spite of the most terrific sanitary condi- 

 tions in some of the battlefields during the summer, and with perhaps 

 two million troops in France, there were only 488 cases with 88 deaths, 

 and this, in spite of the fact, as we, ourselves, observed, that the oppor- 

 tunities for transmission were enormous in battle areas in which sani- 

 tation was practically impossible, and water supplies were bad and 

 could not be corrected. 



The question still remains as to how long typhoid vaccination can be 

 regarded as efficient. There is no absolute information upon which 

 opinions can be based. Vaccination is not a complete protection at any 

 time, and a recently vaccinated individual may still occasionally con- 

 tract the disease if he is injected with a large dose of virulent organisms. 

 The protection, however, is very powerful and will prevent contraction 

 of the disease from the ordinary chance infection. We should state on 

 general information that repetition every two years ought to be suf- 

 ficient for civilian purposes. For the armies in the field, we ourselves 

 would favor a first vaccination with three doses as stated above, and 

 single or double doses repeated every six months. 



Specific Treatment of Typhoid Fever. 7 Anti-sera against typhoid 

 fever have been produced by a large number of workers, notably Chante- 

 messe 121 and Besredka 122 both of whom used the serum of horses 

 immunized with typhoid bacilli or "endo-toxin," so-called. Garbat 



121 Chantemesse, Prog, med., 7, 1989, 245. 



122 Besredka, Ann. Inst. Past., 16, 1902, 918. 



