Sept. 1, 1902. J THE TROPICAL AGRICULTURIST, 
1G5 
AIRBORNE TYPHOID. 
BY LIEUT.-COLONEL E.H. QUILL, R.A.M.C., 
[LATE] SENIOR MEDICAL OFFICER, CEYLON. 
At the late meeting of om- Association, Dr 
Leigli Canney read a very interesting paper on 
the Etiology of Typhoid Fever, in which, while 
strenuously supporting the proposition that epi- 
demics of typhoid fever are always waterborne, he 
vigorously denounced those who ventured to believe 
that such epidemics could sometimes be traced 
to an airborne origin. I should like to say, at 
the outset of the remarks I have to offer on Dr 
Ganney's proposition, that I, in common, as I 
believe, with the officers of the R A M 0, as a 
body, hold that epidemics of typhoid fever are 
chiefly waterborne, and it is to the water supply 
we first turn our a'ttention, when investigating the 
origin of typhoid cases, occurring sporadically or 
epidemically. But I am entirely at issue with Dr 
Canney when he lays down the hard-and-fast 
proposition that typhoid epidemics are invariably 
waterborne— never airborne. The subject is one of 
far-reaching importance, well deserving of full 
discussion. I will therefore, as briefly as possible, 
adduce evidence to prove that the wateroorne 
theory will not always account for the occurrence 
of a typhoid epidemic. My facts will be drawn 
from our experience in connexion with the targe 
camp in this Island where Boer prisoners of war 
are confined. In August, 1900, a large camp was 
formed at 
DIYATALAWA, 
in the hills of (Ceylon, for the Boer prisoners of 
war. The first batch of prisoners arrived on 
August 9th, and succeeding batches quickly fol- 
lowed, until by the end of December 96 officers 
and some 5,000 men were under confinement. Oa 
September 2lst, 1900, one of the prisoners who 
liad arrived on September 5th reported sick. He 
was found to be suffering from typhoid fever of 
probably ten or more days' duration. This was the 
commencement of an epidemic of typhoid among 
the prisoners, which soon assumed formidable 
proportions. ]3y the end of December 600 cases 
had been diagnosed as typhoid fever, and during 
the same period some 200 cases of simple continued 
fever occurred, many of which, it is highly prob- 
able, were mild cases of typhoid. We fully 
satisfied ourselves that this epidemic of typhoid 
among the prisoners had been imported from South 
Africa, but in that connexion I refrain from 
further remarks, as it has nothing to do with the 
proposition I have set myself to prove. It is here 
necessary for my argument that I should briefly 
describe the relationship wliich exists between the 
prisoners' cainp and that of the surrounding camp, 
wiiere is located the military guard. The prisoners' 
camp, situated on an undulating slope, is sur- 
rounded with a strong fence of barbed wire ; out- 
side that fence are inner and military guard lines. 
Tiie " inner guard " consists of a number of sentry 
boxes at intervals of 100 yards, and placed only 
some 20 yards from the barbed-wire fence. The 
" outer guard " consists of guard huts occupied 
by strong guards, placed on rising ground soma 
200 yards further back. The latrines, urinals, 
washhouses, and hospitals for the prisoners are all 
situated close to the barbed^wire fence which 
surrounds the prisoners' camp as a whole. The 
guard tor the prisoners was formed by the 2nd 
Battalion, King's Royal Rifies, who were a fine 
healthy body of men. No suspicious fever of any 
kind, prior to the outbreak among the prisoners, 
existed among them. The battalion remained in 
a thoroughly satisfactory healthy condition until 
October 18th, 1900 — that is, for over two months 
after its arrival at Diyatalawa, and for a month 
after the first case of typhoid occurred among the 
prisoners 
On October 18th a man reported sick ; he was 
found to be sulfeiing from fever, which quickly 
proved to be typhoid. From that date admis- 
sions for typhoid among the battalion occurred at 
short intervals, until by the end of December 
there had been altogether 24 admissions and 5 
deaths. Now in attempting 
TO ACCOUNT FOR THIS GUTBr.'ilAK OF TYPHOID 
FEVER AMONG THE MILITARY GUARD 
at Diyatalawa Camp I commenue by advancing 
the following evidence against the outbreak having 
been in any sense waterborne : — 
1. The water supply was obtained from a moun- 
tain stream some three miles distant, and was 
brought into camp by underground iron pipes. 
The intake in the hills was so isolated that its 
pollution was, indeed, very remote. On the arrival 
in camp of the main iron pipes, smaller ones pass- 
ed directly into four large Pasteur tank filters 
disposed about the camp in suitable positions, 
while in each barrack hut portable Pasteur or 
Berkefeld filters were placed and kepc under care- 
ful supervision ; thus all water used in the camp 
before its distribution invariably passed through 
a thoroughly reliable filtering medium. The water 
prior to filtration was subjected to a weekly che- 
mical analysis, and the report always gave the 
water a high character ; a similar verdict followed 
frequent bacteriologicol examinations, There has 
been no alteration in the water supply or filtering 
arrangements since the camp was opened, and no 
case of typhoid fever has occurred among the troops 
since December, 1900 — that is, since the practical 
cessation of the epidemic among theprisoners of war. 
2. No fresh milk was allowed within the camp 
precincts. When milk was required condensed 
milk (Milkmaid Brand) was irsed. 
3. AH aerated waters used in camp came from the 
Ceylon Brewery at NuwaraEliya, and were identi- 
cal with those used at that sanatoriuhi. There 
has been no enteric fever at Nuwara Eliya. 
4. No uncooked food or uncooked vegetables 
were used in camp, 
5. No native hawkers of any kind were allowed 
to enter the camp. 
6. Within the camp there were five or six native 
shops ; these were uniler strict military supervi- 
sion. No native drinks of any kind were sold in 
them. The aerated waters sold in them were invari- 
ably procured from the Ceylon Brewery at Nuwara 
Eliya. 
7. All men leaving the camp for purposes of duty 
or pleasure were obliged to take with them a water 
bottle filled with filtered water, 
8. It is to be remembered that for obvious mili- 
tary reasons the camp was situated in an isolated 
position in the hills, far removed from habitations 
of any kind. 
As the foregoing considerations, in my judg- 
ment, completely put out of c ourc a waterborne 
cause as being responsible for the typhoid outljreak 
in the military camp, I was driven to the conclu- 
sion that the infection was airborne, being derived 
fronj the adjoining prisoncrs-of-war camp, where 
at t[\e time an epidemic of typhoid fever was 
raging. In support of that opinion I submit the 
following observations : 
