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SALVAGE

THE LANCETLONDON: : SATURDAY, APRIL 26, 1941

BALVA(3E.-TYPHOID PROPHYLAXIS

THE number of men boarded out of the British

Army in the first year of the war must be not farshort of 100,000. Most of them are young men,under 30 years of age, and they probably suffer forthe most part from such conditions as gastric andduodenal ulcer, mental and nervous disorders,rheumatism and rheumatic heart disease, disordersof the chest (including pulmonary tuberculosis), visualdefect and foot disabilities. The army has a measureof responsibility for their medical care for 28 daysafter they are boarded out. Some of the men areawarded pensions, and their subsequent care is in thehands of the Ministry of Pensions, others do not getpensions and on return to civilian life are dependentfor their treatment on ordinary civil resources. Mostmen boarded out of the Army require medical atten-tion from their family doctor after discharge, andmany require hospital treatment, which as things arethey find more difficult to obtain after they leave theArmy. Their treatment should be pressed home tosecure the fullest possible degree of stable recovery,partly to prevent chronic invalidity and partly tomake the most of them as producers. Reabsorptionof these men into civil life does not always proceedsmoothly ; probably only about two-thirds of themare in employment six months after discharge, andof these only a minority are working at their old jobs,some of them intermittently. Most of those who find

employment drift, generally at the dictate of physicalnecessity, into some form of light work which entailsdiminished earnings, or into some dead-end occupationwhich fails to harness their efforts to the best national

advantage.Some remain unemployed because they are unable

to work on account of their physical condition ; somehave tried to do their old job and have broken down ;some have tried light work and found they wereunequal to it ; some inevitably seem to be condemnedto prolonged incapacity. In other cases continuingdisability is associated with a development of theillness (e.g. bleeding or perforation of duodenal ulcerafter starting work), or-a common source of trouble- inability to carry on at work on account of specialfood difficulties, common in war-time. In many casesthe problem is one of securing work suited to theman’s aptitudes and physical limitations, which maybe general or local-as with a miner who has sufferedfrom acute rheumatism, or a labourer from traumaticarthritis of the spine unable to get a job affording thenecessary support to his back. Occasionally, failureto obtain work is due to some incidental-even stupid-cause, as in the foreman who was repeatedlyrefused employment because he had been " classed asunfit.by a medical board."

It will not be possible to restore all these men tofull working capacity, but there can be no doubt thatif rehabilitation and reabsorption into civil life arestriven for systematically, much can be done toreduce their incapacity, and here is a magnificentopportunity for the promised influx of new blood

from America. With his flair for doing the rightthing at the just moment Mr. ROOSEVELT has imple-mented the Red Cross appeal for 1000 male medicalgraduates from the U.S.A., under the age of 40 forservice with the R.A.M.C., under 45 for service withthe E.M.S. While retaining their status as Americancitizens they will become, in Mr. ERNEST BROWN’Sphrase, an integral part of our own services. In thisconnexion the Minister of Health has also spoken ofthe overruling need that workers, whether in industryor in civil defence, should be restored as soon aspossible to active life by skilled supervision andtreatment. This is not a task for tired and listlessmen ; the work of rehabilitation requires all thedrive and initiative of an offensive campaign if it isto give results. It is not sufficient to tackle a fewisolated groups, like the psychoneurotics : the prob-lem must be approached as a whole, and at once.Its solution may well be the special concern of theseNew World crusaders.

TYPHOID PROPHYLAXISTHE time is near when the chemist will extract from

cultures, or perhaps synthesise, clearly defined chemicalsubstances which will confer sound protection againstthe enteric group of fevers. But these substances arenot yet available ; and meanwhile the engrossingsaga of antigenic analysis grows. The official medicalhistorian of the Great War was of opinion that, just asthe typhoid vaccine then employed was superior to thatused in the South African War, in like measure wouldthe vaccine of the future surpass in protective valuethat of 1918. Between 1925 and 1930 there arose a

general recognition of the importance of the somatic0 agglutinin as a measure of the immunity attainedand the relative unimportance of the flagellar Hagglutinin. Next, owing to the work of GRINNELLIin the United States in 1932 and PERRY, FINDLAYand BENSTED2 of the R.A.M.C. from 1933 onwards,realisation came that the degree of protection con-ferred by a vaccine was closely related to the mouse-killing power or

" virulence " of the culture used toprepare it. These workers thought that the exalta-tion of virulence and therefore of the protectivecapacity of a culture passaged through animals mightdepend on the presence of an antigen elaboratedduring passage. FELIX and his colleagues elucidatedthis conception in 1934 by their estimations of theantigen and agglutinin related to virulence, whichthey called Vi. Of late years cultures rich in Vi havebeen selected for the production of T.A.B. vaccine forthe British Army. A new series of papers by FELIX aand his collaborators may herald a new development.The agreed aim of all vaccine makers has been to

retain as much as possible of the 0 and Vi antigensin the finished vaccine. BENSTED4 in his Harbenlectures referred to the observation by FELIX andPiTT in 1934 that phenol, the preservative used in theArmy vaccine, reduced the agglutinogenic value ofthe Vi antigen. BENSTED found the immunisingpower of this vaccine, as judged by mouse-protectiontests, unimpaired, and he said that other preservativescould be devised which left the agglutinogenic powerunaltered. FELix goes further ; his work leads him

1. Grinnell, F. B. J. exp. Med. 1932, 56, 907.2. Perry, H. M., Findlay, H. T. and Bensted, H. J. Jour. R. Army

med. Cps, 1933, 60, 241.3. Felix, A. Brit. med. J. March 15, 1941, p. 391.4. Bensted, H. J. J. R. Inst. publ. Hlth, 1941, 4, 7.