Editorial Department.

EUGENE H. PORTER, A.M., M.D.

GEORGE W. ROBERTS, PH. B., M.D.

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EDITORS.

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YELLOW FEVER.

ARLY in June, yellow fever was discovered at McHenry, Mississippi, one of the towns where the disease was prevalent last year. The United States Marine Hospital authorities immediately took charge. The result was that out of a population of 323 persons-only ten of whom were so-called "immunes"-but twenty-six contracted the disease. The effective quarantine, isolation, and other sanitary measures adopted were responsible for this small number of cases. Of the twenty-six patients none died. This would seem to indicate that the disease is not necessarily the fearful scourge it has been depicted. Up to the present writing, yellow fever has not appeared elsewhere within the epidemic zone of 1897, but may be expected to at any time.

In the more widespread epidemic of that year, the death-rate was less than ten per cent., a smaller mortality than is generally found in typhoid fever, scarlet fever, diphtheria, pneumonia, dysentery, and a number of other diseases, the appearance of which in a community does not cause universal panic.

Yellow fever has been the text of many articles in the medical and newspaper literature of the past few months. Some information, more misinformation, and not a little hysterical fear have been the ingredients.

As to Sanarelli's serum treatment, the NORTH AMERICAN took

its stand some months ago. Let us see what the author himself claims for it. He has treated twenty-two cases with six deaths, a mortality of twenty-six per cent. At McHenry there were twentysix cases with no deaths. In the epidemic of 1897, with hundreds of cases, the death rate was less than ten per cent. Sanarelli inoculated a number of prisoners in a jail where the fever had broken out. All the inoculated ones escaped. So did 297 of the 323 inhabitants of McHenry. Under the circumstances there seems as yet to be no reason for wild enthusiasm over the serum treatment of yellow fever. There may be later. Judging by the rise and fall of preceding serum treatments the outlook is not hopeful.

Yellow fever has broken out among the troops, but thus far it has been of a mild type. Several hundreds of the men have been attacked, but the statement is made that the mortality has been less than that of typhoid fever at Camp Alger and Chickamauga.

The disease, though mild, has been more extensive than anticipated. This has been due to the exigencies of the campaign which did not permit of the troops being moved away from the source of infection.

Yellow fever seems to be developed by a tropical climate and lack of sanitation. The only natural climatic condition that kills the germ is frost. Mere altitude will not do it. Sanarelli's recent paper furnished several instructive points on the natural history of yellow fever, and this was one of them. Some of his experiments with his serum were conducted in a town at an altitude of three thousand feet. The disease was carried there from coast towns. With the warm climate (it was in Brazil), and the unsanitary surroundings, the disease spread despite the altitude.

Another point that has been brought out, has been already noted by the NORTH AMERICAN. That is, that the same person may have more than one attack of yellow fever. The physician in charge of a party of so-called "immune" nurses that passed through New York, en route to Santiago some weeks ago, stated that one member of his party had had yellow fever six times, and that several of them had had the disease a second and a third time. Immunity may exist for a certain time after one attack, but the immunity

is not permanent. Persons of experience where yellow fever is prevalent know this to be so. A regular army officer who had had yellow fever years ago, died of it on August 9 at Santiago.

The only preventive seems to be quarantine.

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TYPHOID FEVER IN THE ARMY.

YPHOID fever has for some time been recognized as a pre

ventable disease. Why it has been allowed to make such havoc among the troops, might at first thought seem strange. It it not worthy of belief that the surgeons of the regular and volunteer armies are ignorant of the etiology of typhoid. The fault for the epidemic conditions must lie largely with the victims.

First cases must have come from outside the camps, for each camp was known to be healthy at the beginning. From first cases it is easy to see how succeeding ones could develop. In large camps without systems of sewerage, the slightest deviation from the most stringent antiseptic disinfection of the stools of typhoid patients, has given the disease an impetus. Then the carelessness, or ignorance, or both, of the other men in drinking contaminated water or other sanitary error has kept the infection traveling.

Most elaborate and stringent rules were issued from the Surgeon-General's Office regarding food. In some cases the rules could not be carried out, in others their need was not appreciated and they were not. For this the Medical Department is hardly to blame.

Nevertheless, there seems to be ample room for improvement in the conduct of the various military hospitals. It is unfortunate that Uncle Sam has not employed more physicians of large experience from civil life. Plenty of them are willing to serve, but are not wanted, apparently, by the Medical Department of the army. And yet, there are probably more surgeons outside the army who are capable of superintending a large hospital than there ever were or ever will be in it. Until the war came the average army surgeon

of five or more years service had probably drawn more pay and seen less professional work than nine out of every ten civil practitioners of one-third the number of years in private practice. There is, therefore, no reason why the Surgeon-General or his assistants should have incompetent contract surgeons. Enough of the best and most experienced of civil physicians have offered their services to take care of half a million men. If experienced men have not been accepted, the fault lies with the Medical Department of the

army.

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TROPICAL DISEASES.

ROPICAL diseases have not been specially emphasized in the curricula of the medical schools of the United States heretofore. In fact, medical geography has been almost totally ignored. The Hispano-American war has brought into prominence its importance. With thousands of our soldiers going to tropical climates, the necessity of a better knowledge of the diseases indigenous to those places, has naturally forced itself alike on the laity and on the profession.

We

Some of our Southern institutions have paid some attention to tropical diseases, because located nearer to tropical climates. speak now more particularly of the medical schools at New Orleans and at Galveston.

England, with her numerous colonies in hot countries, has given much attention to tropical diseases. Now a hospital for the special treatment of tropical diseases is about to be opened in

London.

and

We have seen one composite work, entitled Diseases Hygiene of Warm Climates, edited by Davidson of Mauritius, and more recently a work on Tropical Diseases by Manson, of London. We mention these books by name, because of their great value at this time. So far as we are aware they are the only books on their special line published in English. We understand that

each United States Army Surgeon has been equipped with the latter.

In the presidential address this year, presented to the American Medical Association, Surgeon-General Sternberg placed medical geography in the list of fundamental studies necessary for the educated physician. The NORTH AMERICAN had a leader on the subject in July, and various papers are appearing in the current medical literature.

Dr. T. S. Dabney of New Orleans, in the New York Medical Journal, of June 18, had a brief paper entitled Diseases of Tropical Climates. Among them he includes Insolation, Tropical Anemia, Variola, Typhus Icteroides, Yelllow Fever, Beri-Beri, Malarial Fever, and Dysentery.

It may be of some interest to summarize is description and treatment of these diseases. He knows nothing of course of homœopathic methods. But it is in these very fields that homœopathy has won some notable triumphs.

Insolation is not limited to tropical climates. It is not of infrequent occurrence in our Northern cities during the summer months. Climate does not enter into the question of treatment.

Tropical Anemia, Dr. Dabney says, is due to an intestinal parasite, the Ankylostoma duodenale. The best remedy is prevention. Any treatment looking to a permanent cure must eliminate the parasite. The secondary anemia following their removal, requires the same treatment as ordinary anemia. Dabney recommends Bozzollo's remedy to rid the economy of the parasites. Thymol in doses of two to three grammes at two-hour intervals. A brisk purge should always be given first, and large saline enemata afterward, in order to wash away the ova and larvæ in the rectum.

Variola, smallpox, needs no special mention. The introduction. of vaccination will probably dispose of that. In 1897, there were 2,500 deaths from variola among the Spanish troops in Cuba. This was entirely due to neglect and indifference.

Yellow fever, Dr. Dabney also believes, to owe its existence to sanitary sins. There were 6,030 Spanish soldiers killed by it in 1897.