TYPHUS FEVER, TRENCH FEVER, ETC. 939 







Army during its first invasion of Serbia, and there may well have 

 been endemic cases in Serbia before the invasion. After the Aus- 

 trian repulse of the late summer of 1914, typhus broke out among 

 Austrian prisoners and Serbian soldiers. Owing to the fighting in 

 the north the Serbian civilian population was forced southward 

 and conditions of personal hygiene, housing, etc., were made par- 

 ticularly difficult. There was insufficient shelter, and the cold 

 autumn weather, the lack of clothing, etc., brought about conditions 

 of crowding and a tendency to remain close in quarters and wear 

 whatever clothes the people had, without changing for long periods 

 at a time. Filth and lousiness naturally resulted, and ideal condi- 

 tions for typhus dissemination were created. In addition to this, short- 

 age of food and the hardships attendant upon the general conditions 

 reduced resistance. It is natural that under the circumstances very 

 little was done at the beginning of the outbreak to circumscribe 

 the disease, and it is doubtful whether this would have been possible. 

 By January of 1915 the epidemic had begun to spread throughout 

 the country from that period on, and reached its height in March 

 and April. According to Strong, at the height of the epidemic 

 cases were appearing at the rate of 9,000 a day. It is estimated 

 that the mortality at the height of the epidemic ranged between 

 30 and 60 per cent, and that 150,000 deaths occurred within six 

 months. 



Animal Transmission. One of the most important steps of course 

 in etiological study of an infectious disease is the production of the 

 disease in animals. In the case of typhus this was first accomplished 

 by Nicolle. 



In 1909 Nicolle 8 successfully inoculated an anthropoid ape, and 

 Anderson and Goldberger 9 in the same year succeeded in inoculating 

 lower monkeys, rhesus and capuchin. Similar successful monkey 

 inoculations were made by Ricketts and Wilder, 10 by Gavino and 

 Girard. 11 In these animals inoculation with blood from active cases 



8 Nicolle, Compt. rend. Acad. d. Sc., 1909, p. 157; Ann. de 1'inst. Past., 1910, 

 1911, 1912. 



9 Anderson and Goldberger, Jour. A. M. A., 1912, p. 49; Jour. Med. Res., 1910, 

 p. 469; N. Y. Med. Jour., 1912, p. 976. 



w Rich-efts and Wilder, Jour. A. M. A., Feb., 1910, p. 463; ibid., April 16, 

 1910, p. 1304; ibid., April 23, 1910, p. 1373; ibid., July 23, 1910, p. 309; 

 Wilder, Jour, of Inf. .Dis., vol. 9, 1911. 



11 Gavino and Girard, cited from Anderson and Goldberger. 



