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turned their attention to the Balkans, they were and fatigue along the roadside. A report upon joined by the Bulgarian forces, and the Triple the Armenian atrocities, compiled by Arnold J. Alliance became a Quadruple Alliance." The Toynbee, may be consulted for further details treaty whereby Turkey had ceded a small strip regarding the savage cruelty with which the Arof territory to Bulgaria, in order to secure Bul menians were treated. garia's support (see BULGARIA), was referred to TURKS AND CAICOS ISLANDS. Two in the speech from the throne and submitted to groups of islands, over 30 in number, constithe Parliament for ratification. Alluding to the tuting a dependency of the British colony of recent arrival of a new German ambassador to Jamaica, though geographically a part of the the Porte, Count Wolff-Metternich, the speech Bahamas. Area, 169 square miles. . Only eight continued: "Our political affiliations with our of the islands are inhabited; their population in allies (Germany, Austria-Hungary, and Bul- 1911 was 5615, of whom 1681 in Grand Turk. garia) are founded for all time upon the mutual Salt raking is the only important industry. Imconfidence which is constantly increasing. ... ports and exports in 1913, £30,231 and £27,808, Together we will pursue the plan of coöperating respectively; in 1914, £28,191 and £28,348. Rev. against the enemy on all fronts.” As the result enue and expenditure in 1913, £10,867 and of the war, Turkey would win the opportunity £8505; in 1914, £9051 and £9391. for the "complete development of her resources." TURNER, SIR JOSEPH. English surgeon, died

RELATIONS WITH GREECE. In February, Cap. May 13, 1915. He was born in Melbourne, Austain Kriezis, a Greek naval attaché at Constan- tralia, in 1851, and saw service as medical offitinople, was insulted by an agent of the Turkish cial of health in Cape Colony and the Transvaal. secret police. Refusing to be satisfied with sim. During his service in South Africa he became ple apologies for the insult, the Greek govern- interested in leprosy, and the research work ment demanded the dismissal of the offender. which he carried on to discover a cure for it won The Porte agreed to the Greek demands, but de- him his knighthood. He successfully checked an layed the promised satisfaction, until in disgust epidemic of typhoid fever which raged throughthe Greek minister, M. Panas, took his de- out military hospitals and concentration camps parture from Constantinople, February 14th. during the Boer War, and while at Pretoria in The incident for a time threatened to bring about 1901 fought an epidemic successfully. His a complete rupture of diplomatic relations be- studies of leprosy were carried on at a camp in tween Greece and Turkey, but the Porte finally which were nearly 100 Dutch and native lepers. consented to give full satisfaction to Greece, and Upon reaching the age limit he was retired the affair was settled peaceably.

from active service, but would not leave Pretoria, RAILWAY EXTENSION. One of the most sig. and continued the study and examination of nificant features of the year was the progress of lepers. Several years after his retirement, he railway construction indicated by reports from discovered that he had the disease. From then Turkey. The subject of Turkish railways is until a few months prior to his death he lived treated in detail in the section of this article among the lepers in the Pretoria camp. When under the caption Communications (supra). In his death became only a matter of a few months this place it is necessary only to remark the he was taken back to England. additional importance which attached to Turkish TUSKEGEE NORMAL AND INDUSrailway construction in Asia, since the path TRIAL INSTITUTE. An institution for the from Berlin to Constantinople had been opened industrial and higher education of negroes, up, and German engineers and machinery could founded at Tuskegee Institute, Alabama, by be imported for the development of the agricul. Booker T, Washington, in 1881. The total entural and mineral resources of Turkey in Asia. rollment in all departments in the autumn of Germany in turn would purchase supplies of 1915 was 1502. The faculty numbered 194. metal, oil, cotton, and foodstuffs from Asia Booker T. Washington, founder and principal of Minor, Syria, and Mesopotamia. The develop the institute for 34 years, died on November ment of the railway system by which armies 15th, after a brief illness due to a sudden breakand munitions could be transported for opera- down caused by overwork. Maj. R. R. Moton tions against Egypt or in the direction of India, was chosen his successor in December. J. R. E. would furthermore have a most important stra- Lee, for several years director of the academic tegic value.

department, resigned during the year. Ezra C. ARMENIAN ATROCITIES. While the attention Roberts, for several years head of the department of the Powers was occupied by the war in Eu- of history and economics, and assistant to the rope, the Turkish government authorized, or at director, was made director. The gifts received least permitted, a most atrocious persecution of during the year amounted to $28,102. The prothe Armenian Christian population inhabiting ductive funds at the end of the year amounted the region about Adana and the northeastern to $1,970,214. The total receipts from all sources portion of Asia Minor. The ancient enmity be were $379,704. The library contained approxitween Armenians and the Kurds had for many mately 10,000 volumes. years manifested itself in periodic massacres. TWILIGHT SLEEP. Less clamor concernThe Armenian atrocities of 1915, however, were ing twilight sleep, or the scopolamin-morphin more cruel and more extensive than any in the treatment of the parturient woman while in unhappy history of the Armenian people. Not child bed, arose in 1915 than in 1914; yet there only were single villages wiped out, the men was a hysterical and often genuine demand killed, and the women and children carried off, voiced by many people for the compulsory adopas in the past,—this time a systematic cam- tion of this expedient during delivery, in spite paign was carried on. The Armenian villagers of the fact that those who clamored most loudly who had not been butchered outright were taken were least educated in the technique or physifrom their homes by thousands, and driven like ology of the process, which civilization has renherds of cattle, to find new homes in other parts dered far from simple. It should not be necesof the Ottoman Empire, or to die of exposure sary to remind people that it is manifestly improper for any one to demand that for a certain 7.1; Philadelphia, 9.4; Cleveland, 8.3; Boston, class of patients any routine method should be 9.1; St. Louis, 11.1; Detroit, 13.0; Pittsburgh, followed, without regard to the wisdom and 13.8; Baltimore, 22.4. The excellent showing judgment of the physician as exercised for the made in the city of New York is believed to be individual case. The twilight method is not due to the careful studies made of the situation new in this country. It was employed experi. in that city. The chief factor, in the opinion mentally about 10 years ago, and abandoned by of sanitarians, is the effective control of the American accoucheurs. A very instructive se- milk supply practiced in New York City. It is ries of deliveries under scopolamin-morphin noted that the average death rate of 1913 and treatment was begun in the Michael Reese Ma- 1914 was less than that of the years from 1906 ternity on Jan. 1, 1915, and carried on with the to 1910. Chicago has a lower mortality for greatest care, in the service of Dr. L. E. Franken- much the same reason. Philadelphia also shows thal. The preparations were perfect, and the an astonishing improvement; it has become one results may be accepted as the best possible un of the safest instead of the most dangerous der the method. Nurses, graduates with exten- cities in the United States as regards typhoid. sive obstetric experience, were constantly in at. Here purification of the water supply was the tendance, as well as the junior or senior intern chief factor. Detroit's comparatively high rate on obstetrics, and the day or night head nurse is believed to be connected with the public water in charge of the Maternity. All results were supply. Some attempts have been made to tabulated and the observations were constantly ameliorate this by the hypochlorite method, as checked by three physicians. The scopolamin a result of which the mortality is lower than used was from the best chemists and was most that of previous years. Cleveland, Pittsburgh, accurately dosed. Subdued light, smoked and St. Louis have also reduced their mortality glasses, and a suppression of noise were enforced. from 18 and 16.8, respectively, to 13.8 and 11.1, The results were: No success in 26 cases; little respectively, per 100,000. Baltimore shows a in 7; partial in 8; fair in 5; good in 8; and slight decrease, but it still has far the highest completely successful in 6 cases. Memory tests mortality in this group. Boston is the only were carefully carried out; 26 remaining clear city which shows an increase in 1914 over 1913, throughout, 39 being cloudy. Thirty-two women this being due partly to a milk-borne epidemic. complained of unquenchable thirst, incessantly Among the smaller cities many show an increase begging for water with parched mouths. Head- over an already high typhoid death rate. Birache and vertigo were present in 27 and 31 cases, mingham, Ala., had a rate of 40.2 per 10,000 respectively. Yet these same women would have population; Nashville, Tenn., 47.3. The total gone through a normal confinement of from 8 average from 1910 to 1914 shows that the morto 11 hours' total duration, and been comfort. tality has been practically cut into halves. able and happy thereafter; whereas they were The problem of the typhoid carrier has been rendered wretched for hours or days after de- attacked by several clinicians. Geronne suclivery by the "twilight” method. Pain was felt ceeded in eliminating the typhoid bacilli from by many, regardless of the number of doses of the intestines of chronic carriers. He used scopolamin. It was diminished in 39, absent thymol as a disinfectant, giving animal charin 1, average in 19, and increased in 1. Pain coal with it in order to prolong its action. He is similarly borne at Freiburg, as evidenced by administered 1 gram of charcoal and I gram of the cases reported from that city in which ether, thymol three times a day, the charcoal half an ethyl-chloride, etc., were used at the end. Rest hour before meals, the thymol in capsules half lessness was present in 18, and delirium in 9, an hour after meals. This was kept up for and in 7 of the latter cases restraint was neces- from 8 to 14 days. Kalberlah had equally good sary. The risk of self-infection was great in results with tincture of iodine and charcoal. these latter cases. “The exhaustion of labor," He gave from 7 to 15 drops of the iodine diluted absent at Michael Reese Maternity except in the in water from 3 to 5 times a day. occasional pathologic primipara, was distress. The use of vaccines in the treatment of typhoid ingly constant in the "twilight” cases. Diffi- fever and to some extent their value in prophy. culty with the placenta, and often dangerous laxis, is still in the experimental stage, although narcotizing of the children have also to be recko many reports have been published on the subject oned with in the "twilight" cases. The whole in the last few years. Watters, after analyzing sale adoption of the Freiburg method would be 1120 cases of typhoid fever treated with vacabsolutely unjustifiable with the cruelty, danger, cines, is of the opinion that the death rate is and distress practically unencountered by the lower, that the febrile stage is 10 days shorter, modern American methods. Libby, of San Fran and that relapses are less frequent; the patients cisco, makes a similarly unfavorable report. A were less depressed, and averaged a lower temvery interesting part of his careful report shows perature than the ordinary typhoid case. Ichithat a large proportion of the women became kawa has used sensitized bacteria by intravenous excited and even violent and unmanageable, a injection. His method is as follows: living bacondition which is found to have been reported cilli are treated with serum from convalescent by Gauss, Preller, Hocheisen, Steffen, and Mayer, typhoid fever patients, then washed, and finally all of Germany, in from 1.4 to 26 per cent of suspended in salt solution containing 0.3 per their cases. See ANÆSTHESIA.

cent phenol. The vaccine was not only effectual TYPHOID FEVER. The Journal of the in typhoid, but also in paratyphoid fever. IchiAmerican Medical Association published its kawa explains his remarkable results by saying third annual statistical study of the mortality that in typhoid only a small amount of anti: in typhoid fever in the cities of the United bodies is produced, so that the bacteria are not States having 100,000 or more population. The all killed. By injecting a large number of sensi communities in the group having over 500,000 tized bacteria the manufacture of antibodies is population are New York, showing a death rate enormously stimulated and all the bacteria are of 6.2 per 100,000 inhabitants; Chicago, with killed. He thinks that in ordinary subcutaneous

injections the bacteria are retarded in their the organism causative of this disease, described progress and consequently the amounts of as a small, pleomorphic, obligatory anærobic anti-bodies are too small to overcome the infec- gram-positive bacillus, not motile, not encapsution.

lated and not acid-fast, varying in length from Pfeiffer and Kolle, in Germany, and Wright 0.9 to 1.93 microns, usually straight, sometimes and Netley, England, published the results of slightly curved, and rarely appearing in coccoid experiments in preventing typhoid fever by vac- forms. Plotz's work has been confirmed by cination with Bacillus typhosus killed by heat. Wilder, Ricketts, and others. The germ is carThe New York Department of Health has pub- ried by the body louse (pediculis vestimenti), lished its experiments in regard to immunization and therefore the habits of this insect are being with typhoid vaccine. Many different varieties studied attentively. Gasoline or benzine, as well have been prepared since 1896. The culture used as passing a hot iron over the clothing, kills the by the Department of Health is prepared as fol- vermin, for they cling to the inner side of it, lows: "A laboratory culture of typhoid bacilli and not to the body, when the patient is stripped. which has lost much of its virulence through The disease has desolated large parts of Serbia, long artificial cultivation is used. Large sur and between 50,000 and 60,000 people have died faces of agar in Blake bottles are inoculated of it in that small country. An American sanifrom fresh agar cultures. After 24 hours' tary commission, organized under the auspices growth at 37 C. the bacteria are washed from of the American Red Cross and the Rockefeller the surface of the agar with normal salt solu Foundation of New York, with a fund of $50,000, tion. The suspension is then standardized by consisted of Drs. Richard P. Strong, Andrew W. counting the bacilli by the Wright method. This Sellers, George C. Shattuck, and Francis B. Grinis done by mixing an equal part of blood and nell of Boston; Thomas W. Jackson of Spartanthe bacterial suspension. Smears are made from burg, S. C.; and Hans Zinssner of New York; this mixture and strained. The number of ba- with Charles W. Eby of Washington as secrecilli and red cells are then counted under the tary. Sixty of 400 native Serbian physicians microscope in about 25 fields. When the pro- had died of the disease, and nurses and phyportion between the two has been determined, sicians of the American and British units of the the number of red cells per c.c. being known, the Red Cross had also met death from this source. number of bacilli per c.c. can then be estimated; Acting on the clinical observations so carefully suspension is then heated one hour at 56 C. to made by Nathan E. Brill, of New York, in inkill the bacilli. After heating, the sterility of vestigating "Brill's Disease," determined to be the suspension is tested by inoculating generous typhus by the brilliant experimental work of amounts into media and incubating these under Ricketts, and aided by the work of Anderson ærobic and anærobic conditions. If no growth and Goldberger, the commission was able to occurs, 0.25 per cent of carbolic acid is added to terminate the epidemic of the disease in Serbia, the suspension, which is diluted with 0.25 per and save countless valuable lives of the unfortucent carbolic acid in normal saline solution, so nate people of that country as well as of the that I c.c. contains the appropriate dose. It is divisions of invading and allied forces who enthen bottled for distribution.” While a few tered its territory, and thus doubtless to precases developed severe reaction, others were only vent the imminent spread of a pestilence over all partially immunized and still others resisted im- Europe. The names of Dr. James F. Donnelly, munization entirely. The evidence is overwhelm- who died at Gevaglia of typhus, and Drs. Ethan ing that immunization by vaccine is as effective F. Butler and Ernest P. Magruder, both of against typhoid fever as is a previous attack of Washington, D. C., should be mentioned for their the disease, and this immunity lasts from at heroism; while scores of assistant physicians least two to a great many years, in all but a and nurses unnamed risked their lives in the very few individuals. Those who subsequently work. The erection of a sufficient laboratory, develop the disease have it in a lighter and less and the organization of a pathological and bacfatal form. Warning is given that in order to teriological bureau at the Quarantine station avoid severe reactions several precautions must of the port of New York by the State Health be observed. Only healthy individuals should Officer of the Port, Dr. J. J. O'Connell, puts the be vaccinated; individuals below par for any rea- immigration officials in good condition for reson should not receive vaccination; children are pelling this disease, if danger should approach not to be exposed to the sun after vaccination; at the close of the war. See also VITAL STAand alcohol and hard work should be avoided in TISTICS. the case of adults.

TYROL (TIROL). See AUSTRIA-HUNGARY. The full text of this valuable article is to be UGANDA PROTECTORATE. A British found in the Journal of the American Medical protectorate in east Africa. Pending a comAssociation, Jan. 2, 1915.

plete survey, the area cannot be stated with acTYPHUS FEVER. The work on epidemics curacy; up to the fifth parallel of north latitude, by Hippocrates, the father of medicine, describes it is estimated at 121,437 square miles, includmost accurately cases of fever occurring as epi. ing 16,377 square miles of water. The protecdemics, which were in all probability cases of torate is divided into five provinces—Rudolph, typhus. An Athenian pestilence well described Eastern, Northern, Western, and Buganda. The by Thucydides was probably typhus. In the population, as estimated March 31, 1914, was siege of Granada in 1489 as many as 17,000 of 2,909,122; March 31, 1915, 2,927,494, consisting Ferdinand's soldiers perished of “tabardillo," of 2,923,031 natives, 3560 Asiatics, and 903 Eudoubtless typhus. It is the old "jail fever,” ropeans. These figures for native inhabitants "ship fever," or "spotted fever.” It devastated must be taken with some reserve, as there are Ireland; it was prevalent among the poor of insufficient data for an accurate calculation. England; and it has followed war for centuries. The climate is not healthful. Sleeping sickness In 1914, Harry Plotz, of Mt. Sinai Hospital has ravaged the country, and malaria, spirillum staff, New York, made the brilliant discovery of fever, and dengue fever are prevalent.

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proper for any one to demand that for a certain 7.1; Philadelphia, 9.4; Cleveland, 8.3; Boston, class of patients any routine method should be 9.1; St. Louis, 11.1; Detroit, 13.0; Pittsburgh, followed, without regard to the wisdom and 13.8; Baltimore, 22.4. The excellent showing judgment of the physician as exercised for the made in the city of New York is believed to be individual case. The twilight method is not due to the careful studies made of the situation new in this country. It was employed experi- in that city. The chief factor, in the opinion mentally about 10 years ago, and abandoned by of sanitarians, is the effective control of the American accoucheurs. A very instructive se milk supply practiced in New York City. It is ries of deliveries under scopolamin-morphin noted that the average death rate of 1913 and treatment was begun in the Michael Reese Ma. 1914 was less than that of the years from 1906 ternity on Jan. 1, 1915, and carried on with the to 1910. Chicago has a lower mortality for greatest care, in the service of Dr. L. E. Franken- much the same reason. Philadelphia also shows thal. The preparations were perfect, and the an astonishing improvement; it has become one results may be accepted as the best possible un of the safest instead of the most dangerous der the method. Nurses, graduates with exten- cities in the United States as regards typhoid. sive obstetric experience, were constantly in at Here purification of the water supply was the tendance, as well as the junior or senior intern chief factor. Detroit's comparatively high rate on obstetrics, and the day or night head nurse is believed to be connected with the public water in charge of the Maternity. All results were supply. Some attempts have been made to tabulated and the observations were constantly ameliorate this by the hypochlorite method, as checked by three physicians. The scopolamin & result of which the mortality is lower than used was from the best chemists and was most that of previous years. Cleveland, Pittsburgh, accurately dosed. Subdued light, smoked and St. Louis have also reduced their mortality glasses, and a suppression of noise were enforced. from 18 and 16.8, respectively, to 13.8 and 11.i, The results were: No success in 26 cases; little respectively, per 100,000. Baltimore shows a in 7; partial in 8; fair in 5; good in 8; and slight decrease, but it still has far the highest completely successful in 6 cases. Memory tests mortality in this group. Boston is the only were carefully carried out; 26 remaining clear city which shows an increase in 1914 over 1913, throughout, 39 being cloudy. Thirty-two women this being due partly to a milk-borne epidemic. complained of unquenchable thirst, incessantly Among the smaller cities many show an increase begging for water with parched mouths. Head over an already high typhoid death rate. Birache and vertigo were present in 27 and 31 cases, mingham, Ala., had a rate of 40.2 per 10,000 respectively. Yet these same women would have population ; Nashville, Tenn., 47.3. The total gone through a normal confinement of from 8 average from 1910 to 1914 shows that the morto 11 hours' total duration, and been comfort. tality has been practically cut into halves. able and happy thereafter; whereas they were The problem of the typhoid carrier has been rendered wretched for hours or days after de- attacked by several clinicians. Geronne suclivery by the "twilight” method. Pain was felt ceeded in eliminating the typhoid bacilli from by many, regardless of the number of doses of the intestines of chronic carriers. He used scopolamin. It was diminished in 39, absent thymol as a disinfectant, giving animal charin 1, average in 19, and increased in l. Pain coal with it in order to prolong its action. He is similarly borne at Freiburg, as evidenced by administered 1 gram of charcoal and 1 gram of the cases reported from that city in which ether, thymol three times a day, the charcoal half an ethyl-chloride, etc., were used at the end. Rest hour before meals, the thymol in capsules half lessness was present in 18, and delirium in 9, an hour after meals. This was kept up for and in 7 of the latter cases restraint was neces. from 8 to 14 days. Kalberlah had equally good sary. The risk of self-infection was great in results with tincture of iodine and charcoal. these latter cases. "The exhaustion of labor," He gave from 7 to 15 drops of the iodine diluted absent at Michael Reese Maternity except in the in water from 3 to 5 times a day. occasional pathologic primipara, was distress- The use of vaccines in the treatment of typhoid ingly constant in the "twilight” cases. Diffi- fever and to some extent their value in prophy. culty with the placenta, and often dangerous laxis, is still in the experimental stage, although narcotizing of the children have also to be reck- many reports have been published on the subject oned with in the "twilight” cases. The whole in the last few years. Watters, after analyzing sale adoption of the Freiburg method would be 1120 cases of typhoid fever treated with vacabsolutely unjustifiable with the cruelty, danger, cines, is of the opinion that the death rate is and distress practically unencountered by the lower, that the febrile stage is 10 days shorter, modern American methods. Libby, of San Fran and that relapses are less frequent; the patients cisco, makes a similarly unfavorable report. A were less depressed, and averaged a lower temvery interesting part of his careful report shows perature than the ordinary typhoid case. Ichithat a large proportion of the women became kawa has used sensitized bacteria by intravenous excited and even violent and unmanageable, a injection. His method is as follows: living bacondition which is found to have been reported cilli are treated with serum from convalescent by Gauss, Preller, Hocheisen, Steffen, and Maver, typhoid fever patients, then washed, and finally all of Germany, in from 1.4 to 26 per cent of suspended in salt solution containing 0.3 per their cases. See ANÆSTHESIA.

cent phenol. The vaccine was not only effectual TYPHOID FEVER. The Journal of the in typhoid, but also in paratyphoid fever. IchiAmerican Medical Association published its kawa explains his remarkable results by saying third annual statistical study of the mortality that in typhoid only a small amount of antiin typhoid fever in the cities of the United bodies is produced, so that the bacteria are not States having 100,000 or more population. The all killed. By injecting a large number of sensicommunities in the group having over 500,000 tized bacteria the manufacture of antibodies is population are New York, showing a death rate enormously stimulated and all the bacteria are of 6.2 per 100,000 inhabitants; Chicago, with killed. He thinks that in ordinary subcutaneous

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