The importance of the value of anti typhoid inoculations in producing im munity against enteric fever can hardly be overestimated. The results of the inoculations of members of the staff and establishment of the Scottish Na tional Red Cross Hospital serving in South Africa are of interest sufficient to warrant their publication.
The first section of the hospital, con sisting of 61 persons,—officers, nursing sisters, and establishment,—left South ampton on April 21. 1900, by steamer Tanjore for South Africa. During the voyage out all except 4 of the GI per sonnel of the hospital were inoculated twice at an interval of about ten days. The injections were all made in the flank, and were all followed in from two to eight or ten hours by marked symp toms, both local and constitutional, lasting from two to four or five days.
In many cases the symptoms were just as severe after the second as after the first inoculation. This would seem to show that it takes more than ten days before any immunity is established. Two of the nurses were not inoculated because they had both suffered from enteric fever, and 2 of the orderlies were only inoculated once.
Immediately after reaching the Cape, the hospital was sent up to Kroonstadt, in the Orange River Colony, and re mained there as a stationary hospital till the middle of October. During this period there were always many cases of enteric under treatment in the hospital. Further, some of the medical officers and student orderlies had charge of the Kroonstadt Hotel temporary hospital, which was crowded up with enteric cases, and the nursing sisters for three weeks did duty in the military hospitals at Bloomfontein in May and June, when enteric fever was at its worst. There was not a single case of enteric among the personnel of this first section of the hospital.
The second section of the hospital, medical officers, nurses, and establish ment,--32 in all,—left Southampton in May, 1900. On board ship nearly all were inoculated, but many of them only once. The material for inoculation had been on board for some time, and was not so fresh as in the first instance. Of this second section, 1 nurse had en teric at Kroonstadt. She was the only one out of a total of 36 nurses who suffered from enteric, and she was the only nurse who was not inoculated, excepting the two who were protected by a previous attack of enteric. A third
section of the hospital, consisting of 4 medical officers and 16 went out in July; they were all inoculated, and none of them had enteric.
Of the second section, 5 orderlies had enteric fever at Kroonstadt, of whom 2 died. Of these 5, there were 2 inocu lated (once) and 3 non-inoculated. Of the 2 who died, 1 had been once inocu lated.
Of the first section who had been in oculated four months previously, Dr. Dodgson tested the blood of 23. Of these, 21 gave good reaction with dilu tions ranging from 1 in 40 to 1 in 500; 2 gave only slight reaction; these were the two orderlies who had only been once inoculated.
Of the second section of the hospital, who had been inoculated only three months previously, the blood of 22 was tested. Of these, 11 gave no reaction, 9 gave very slight reaction, and only 2 gave good reaction.
It would appear from the above that the members of the first section were much more fully protected against en teric than those of the second section.
The results above given are very strong evidence in favor of the pro tective power of the antityphoid inocu lation, when the inoculations are very carefully performed, and they point to the necessity for two inoculations at a suitable interval. Henry Gayley (Brit. Sled. Jour., Jan. 12, 1901).
Review of Wright's observations of typhoid among inoculated and uninocu lated in the British Indian Army. Pe riod of observation, about nine months; total number of men under observation, 11,295; number inoculated, 2S35; num ber not inoculated. 3460; number of cases of typhoid among inoculated, 27. or 0.95 per cent.: number of cases of typhoid among uninoyulated, 213, or 2.5 per cent.; number of deaths from ty phoid among inoculated, 5, or 0.2 per cent.; number of deaths from typhoid among uninoculated, 23. or 0.34 per cent. McLauthlin (Med. News, Mar. 2. 1901).
Results of antityphoid inoculations iii Egypt and Cyprus during the year 1900. Of a total number of 2669 unin oculated and 720 inoculated soldiers. 63 of the former and 1 of the latter con tracted the disease. The proportion, therefore, was 2.50 to 0.14 of incidence. The reduction was nineteenfold. A. E. Wright (Brit. Med. Jour., May 4, 1901).