was born at Melbourne Aug. 8 1857 and educated at its Central
school, proceeding on to its university. He was called to the
Victorian bar and in 1889 was elected to the Victorian legis-
lature as member for St. Kilda. Two years later he became
Minister of Health and later held office as Minister of Customs,
Solicitor-General and Minister of Defence. From 1894-9 he
was Premier and Treasurer of his colony and again from 1900-2.
From 1901-5 he was Treasurer of the Commonwealth of Aus-
tralia. He was also president of the Federal Council of Australasia,
'which came to an end in 1899. He represented his colony at
2ueen Victoria's Diamond Jubilee (1897) and was then created
G.C.M.G. and sworn of the Privy Council. He retired from
politics in 1906 and died at Melbourne Aug. 14 1916.

TURNER, SIR WILLIAM (1832-1916), British anatomist,
was born at Lancaster Jan. 7 1832. He was educated at various
srivate schools, and afterwards studied medicine at St. Barthol-
>mew's hospital, and graduated M.B. at London University.
1 In 1854 he became senior demonstrator in anatomy at Edinburgh
University, in 1867 professor of anatomy, and in 1903 was
:lected principal and vice-chancellor of the university. He was
rom 1898 to 1904 president of the General Medical Council,
md in 1900 was president of the British Association. He was
:nighted in 1886 and made a K.C.B. in 1901. Turner was best
mown as a brain surgeon, and published various valuable
>apers on the subject. He died at Edinburgh Feb. 15 1916.

TWINING, LOUISA (1820-1912), English philanthropic worker,
vas born in London Nov. 16 1820. In early life she was an
irtist, and published Symbols and Emblems of Mediaeval Chris-
ion Art (1852) and Types and Figures of the Bible (1854). In
:853, however, she became interested in movements for social
eform, and began the work in connexion with the Poor Law to
vhich she devoted the rest of her life. In March 1861 she
lelped to establish a home for workhouse girls sent out to service,
md in 1864 a Workhouse Visiting Society. In 1867 an act was
>assed separating infirmaries from workhouses, and after 12
nore years of work Miss Twining in 1879 established the Work-
louse Infirmary Nursing Association. She was a Poor Law
^tardian for Kensington during 1884-90, and for Tonbridge
Jnion during 1893-6. She promoted the opening of Lincoln's
nn Fields to the public, helped to start the Metropolitan and
National Association for nursing the poor in their homes, did
nuch to secure the appointment of police matrons, and was
iresident of the Women's Local Government Society. She
mblished Recollections of Life and Work (1893), Workhouse



825



and Pauperism (1898), and many papers on Poor Law subjects.
She died in London Sept. 25 1912.

TYLOR, SIR EDWARD BURNETT (1832-1917), English
anthropologist (see 27.498), died at Wellington, Som., Jan. 2
1917. He was knighted in 1912.

TYPHUS FEVER (see 27.508). This acute specific fever is
spread by the agency of the body-louse, and is characterized
by a sudden onset, a maculo-petechial eruption, severe toxaemia,
lasting some 12 to 15 days, and ending by a rapid lysis. The
disease has many synonyms: Typhus exanthema ticus, synochus
putrida, spotted fever, gaol fever, famine fever, prison fever,
Brill's disease. This last term is often applied to denote a
very mild type of the disease occurring in the United States.

Hippocrates' mentions the word " typhus," but he applied it to
any stuporous and delirious condition and does not appear to have
been acquainted with the fever in question. The malady was appar-
ently confused with plague until the i6th century, when Fracas-
torius differentiated it from the latter disease and called it petechie.
During the i8th and igth centuries typhus fever was well known in
Europe, but included typhoid and relapsing fever, from the former
of which it was distinguished by a long series of researches beginning
with those of Strother, Gilchrist and Huxham in the early i8th cen-
tury and ending with the classical work of Still in 1837. From relaps-
ing fever typhus was definitely differentiated by Henderson of
Edinburgh in 1843.

Climatology and Epidemiology. Typhus is mostly a disease
of temperate and cold climates; in tropical countries it occurs
only in the hills or during the cool season. In 1921 typhus was
endemic in many parts of E. and S.E. Europe, Poland, Galicia,
many provinces of Russia and certain districts of the Balkans.
It was endemic also in some parts of Asia, Persia, Afghanistan,
and an endemic area exists in India on the W. of the Indus,
stretching from Baluchistan in the S. to Yusafzai, Hazara,
and Kashmir in the N., and then passing eastwards along the
ranges of the Himalayas, where it is especially prevalent at
Kulu, and also passing southwards into the district of Rawal
Pindi. It also occurs in Indo-China, in N. China and in Japan
in the province of Hiogo. It does not occur in Australasia or
Oceania. In America it is endemic in Mexico, in certain dis-
tricts of Peru and northern Chile.

Before the World War it was eradicated from most European
countries where hygienic measures for the destruction of vermin
were in existence. During the war, extremely severe epidemics
raged in the Balkans, Poland and Russia. Epidemics are
caused by anything which favours the propagation and dis-
semination of lice. The principal factors which do so are:
(i) massing together of people of all classes; (2) retaining these
masses under conditions which render personal cleanliness and
clean clothing difficult or impossible, typically in times of
war or famine; (3) a suitable atmospheric temperature, not too
high i.e. a temperate zone temperature.

Aetiology. The disease is spread by means of the body-louse,
Pediculus carports de Geer (1778). The virus is apparently present
in the blood of a patient from the fifth to the twelfth day, but in
greatest abundance from the fifth to the seventh day. The louse
requires approximately eight days interval before it becomes infec-
tive, and probably remains infective for the rest of its life, but it is
not certain whether it passes the virus on to the next generation or
not. When an infected louse bites a non-immune human being, a
period of six days to ten days elapses before symptoms appear.
The virus was reported by Nicolle to be filterable, but more recent
investigation has shown this to be doubtful. The guinea-pig and
the monkey are susceptible. As regards the nature of the virus,
innumerable bacteria and protozoa have been described. In 1921
most authorities favoured de Rocha Lima's theory, viz. that the
causative agent is an organism which he has called Rickettsia pro-
wazeki. Rocha Lima has given this name to some peculiar, minute,
gramme-negative, oval bodies often showing polar staining when
stained by Giemsa's method, and found in the epithelial cells of the
alimentary canal of lice which have fed on the blood of typhus
patients. Attempts at cultivation have so far failed. Brumpt and
others do not give any etiological importance to these bodies, as,
according to them, they are found also in lice which have not fed
on typhus patients. Rocha Lima contends, however, that there are
:wo forms of the parasite, one non-pathogenic, Rickettsia pediculi,
found only in the lumen of the alimentary canal of lice; and the
other, pathogenic, Rickettsia prowazeki, which multiplies in the cells
of the insect's alimentary canal.



826



TYPHUS FEVER



Plotz has described an anaerobic, gramme-positive, bacillus which
he now identifies with Rickettsia prowazeki. (For similar disease-
carrying by body-lice, see TRENCH FEVER.)

Morbid Anatomy. There are no specific anatomical lesions.
A certain amount of oedema of the lungs and hypostatic pneumonia
is often present. The spleen is enlarged, usually of a dark red colour
and juicy red pulp. The liver and kidney show cloudy swelling, and
punctate haemorrhage may be present. In the intestine there are
no changes in Peyer's patches, and the mesenteric glands are not
enlarged. The heart muscle may show cloudy swelling and fatty
degeneration. The cerebral spinal fluid may present a slight
lymphocytosis.

Symptomatology. Incubation varies from 4 to 21 days, but is
usually about to to 12 days. The onset is usually sudden, being
characterized by severe headache, pains in various parts of the
body, often rigours; marked rise of the temperature, quick pulse,
flushed face and suffused eyes, and quickened respirations. The
patient complains of extreme weakness. The duration of the fever
on an average is 14 to 15 days. During the first 2 or 3 days the tem-
perature continues to rise at night, with remission in the morning,
to a maximum of 104 to 105 on the second to fourth day. During
this time the tongue becomes dry, swollen, and coated with a thick
brown deposit on the dorsum, while the tip and sides of the organ
are red. The patient quickly becomes apathetic, drowsy, with dull
expression. As the disease progresses, the rapidity of the pulse
increases and may reach i<jo a minute, and is usually small and of
low tension. The respirations are generally quickened and there
are usually signs of laryngitis and bronchitis and occasionally
bronchial pneumonia. Delirium is known, especially at night.

Definite preliminary rashes are rare. What one generally sees
the first two or three days of the disease is a very marked flushing
of the face, neck and upper portion of the chest, with a subcuticular
mottling of the skin of the lower part of the chest and abdomen
(cutis marmorata). It should be noted at once that this symptom
is far from being specific, a similar flushing being very often notice-
able in many cases of Pappataci fever. The true typhus rash appears
generally on the fourth or fifth day in the form of small roseolar
spots, indistinguishable from typhoid roseola but often more abun-
dant. According to some of the old authorities, it appears first on
the arms and legs, but, in the writer's experience of Serbian and
Polish epidemics, the rash generally starts on the abdomen and then
spreads to the chest, arms and legs. The spots are at first roseolar
and disappear completely on pressure, then some of the spots slowly
fade away, while others become of darker hue and do not disappear
completely on pressure, becoming petechiae, though it is rare for
them to develop the dark blue appearance of petechiae in such
eruptions as those of purpura. The rash, in a few cases, may remain

furely roseolar-like, without any of the spots becoming petechial.
n exceptional cases, the rash may be absent altogether: typhus
exanthematicus sine exanthema. The medical man with little expe-
rience of typhus should be on his guard not to mistake for true
typhus rash a petechial rash, the so-called Balkanic rash, due to
bites of innumerable fleas, composed of numerous perfectly circular
dark red petechiae, which is extremely common in the Balkans and
in Galicia in peasants and soldiers. Anyone who has not been to
those countries can hardly believe how profuse this rash can be.
The whole body, with the exception perhaps of the face, is com-
pletely covered with it, while the shirt of the sufferer may be abso-
lutely black from the number of living fleas upon it. With a little
Cractice one soon learns to distinguish the two rashes. Each flea-
ite shows at first a central haemorrhagic spot surrounded by a
hyperemic circular zone, which disappears on pressure. This
peripheral hyperemic zone fades away spontaneously within a day
or two, while the central haemorrhagic spot remains as a petechial
area, which is, as a rule, perfectly circular, not raised, and of a dark
red, sometimes copper-like, colour which does not disappear on
pressure. In the blood there is often a marked leucocytosis,
and a differential count shows a large increase of polymorphonu-
clears. An interesting feature is the complete absence of eosinophiles
in practically every case.

Termination. On or about the fifteenth day, the temperature
generally falls by crisis, or, much more frequently, by rapid lysis
which may extend through three to five days.

Convalescence may be slow, and fairly frequently there is danger
during this stage, as the general condition may not improve after
the cessation of the fever, and death may occur some two to three
weeks after defervescence. In certain cases, while the temperature
has become normal, the pulse does not improve, and the patient
becomes weaker and weaker until he dies.

Complications and Sequelae. The most usual complications are:
parotitis, ending often in suppuration, gangrene of feet and poly-
arthritis; neuritis, hemiplegia, severe mental depression amounting
almost to melancholia (seen during convalescence) may be men-
tioned, also bubonic swellings; otitis media, abscesses and boils
occur, while jaundice, endocarditis, and meningitis are rare, but
myocarditis is fairly common.

It is interesting to note that different epidemics of typhus have
been reported as being characterized by special features in regard
to complications and sequelae; thus, the Serbian epidemic in 1914-5



showed a great tendency to gangrene of the feet, while those of
Ireland have generally been associated with bronchial and pneu-
monic complications. On the other hand, in the recent epidemics in
Poland and Galicia, complications have been comparatively rare.

Diagnosis. The principal data on which to base the diagnosis
are as follows:

(a) Incipient Typhus. (l) The sudden onset, often with head-
ache, rigours, and vomiting. (2) The congested eyes and face and
the subcuticular mottling of the skin over the chest. (3) The
mental confusion and stupor, associated with the log-like attitude
of the whole body. (4) The increased percentage of polymorphonu-
clear in the differential count.

_(&) Fully Developed Typhus. (i) The typical rash. (2) The
history of the sudden onset, etc. (3) Leucocytosis and increased
polymorphonuclear percentage. (4) The Weil-Felix reaction, viz.,'
the blood of typhus patients agglutinates a proteus-like germ, iso-j
lated from the urine of some cases of typhus by Weil and Felix and
called by them Proteus Xig.

Prognosis. The case mortality may be from 10 to 50% and,
greatly varies in different epidemics. It is low in the young and very
high in the old. The malady is slightly more fatal in males than in
females, while alcoholism and kidney disease are bad prognostics. 1

Treatment. This is merely palliative. Patients suffering from
typhus should be placed, whenever possible, in airy, well-ventilated
wards, and in the summer months tents may be used with advantage. ',
Cleanliness and good nursing are essential. During the febrile attack
the diet should consist of broths and milk and soft solids, \vhilei
plenty of water is allowed to be drunk. The temperature should be
controlled by cool sponging and the nervous symptoms by ice to the
head, hyoscin, bromides or morphine, while the heart is supported
by hypodermic injections of strychnine and digitalin. Special atten-
tion should be paid to the mouth and throat. The legs and feet
should be kept warm and pressure on the feet, even from the bed-
clothes, should be avoided, lest it contribute to the production of
gangrene. Prostration is extreme in most typhus cases, and a most
striking fact is the occurrence of many deaths after the period of
defervescence, even when severe complications have not developed.
To combat this extreme exhaustion, the administration of alcohol
in moderate doses is sometimes useful.

Attempts at specific medication have been made by various
authors, and Nicolle has prepared a serum, by injecting horses with
emulsions of spleen and adrenals of guinea-pigs artificially inocu-
lated, said to have good results, the dosage being 20 c.c. daily.

Prophylaxis. This consists in taking every possible measure for
the destruction of lice. There is no doubt that heat, whenever it
can be employed, is the most satisfactory means for the destruction
of lice and their eggs in clothes, blankets, bedsheets, etc. When dry
heat is used, a temperature of 68 C. for 15 minutes is the safe;
standard for routine practice. When steam is used, articles should
be submitted to a temperature of 100 C. for 30 minutes to allowi
the steam to thoroughly penetrate all parts of the clothing. For
disinfestation of rooms, barracks, etc., sulphur fumigation is prob-i
ably the most satisfactory routine method. The rooms, whenever
possible, should be sealed and rendered approximately airtight,
and then the sulphur fumigation is carried out, using 5 to 8 Ib. of'
sulphur per 1,000 cub. ft., the rooms remaining sealed up for a period:
of not less than 12 hours.

With regard to the usual chemical insecticides, their utility is
somewhat limited; among the liquid ones, petrol is, in practice, prob-
ably the best ; guaiacol is a powerful licecide but is expensive. Among 1
solid insecticide substances, naphthalene is the most useful and con-|
venient. It is interesting to note that according to Jackson's and 1
the writer's experiments in Serbia insecticide chemicals do not act;
equally well on lice, bugs and fleas; for instance, pyrethrum (many
patent insecticide powders are merely pyrethrum) acts powerfully
on bugs while its action on lice is very slight; on the other hand,,
iodoform, which will kill lice in 10-15 minutes, has no action on bugsj
and very little on fleas. When an insecticide for general use is
required therefore, several chemical substances should be combined,;
and the following powder has been found fairly efficacious, viz.,
naphthalene, previously soaked in guaiacol or creosote 3'j pyre-
thrum 3ij zinc oxide ad. 8- The wearing of undergarments made
liceproof by soaking in crude carbolic acid and soft soap, as recom^
mended by Bacot and others, has been found useful.

In badly infected districts a large number of bathing and disin-
fecting stations should be established and a general disinfection of
people should be carried out. The following procedure, as adopted
by the American Typhus Commission with most satisfactory results
in the Serbian epidemic of 1914-5, is recommended. The infested
person goes into a room, takes off the clothes, which are steamed or
boiled, passes into another room where he is bathed, then into a
third room where he is sprayed with petrol, and finally into a fourth
room in which he receives clean or sterilized clothes. The steriliza-
tion of the clothes may be conducted by boiling, but better still byi
making them into lightly packed bundles and placing them in a!
truck or room into which steam is blown.

AUTHORITIES. Arkwright, Bacot and Duncan, Trans. Soc. Trap.
Med. (1919) ; Borrel, Cantacuzene, Jonesco and Nasha, C.R. Soc.
Biol. (1919); Gumming, Buchanan, Castellani and Visbecq, Report






TYRRELL TYRWHITT



827



of Inter- Allied Med. Comm. to League of Red Cross Societies (1919);
Gerard, Arch. Inst. Pasteur de Tunis (vol. xi, No. 3, 1920); Jorge,
Med. Contemporanea (No. 9, 1918); C. Nicolle, Bull. Path. Exot.
Paris (with C. Comte and E. Conseil, 1912); Comptes Rendus de
L 'Academic des Sciences (cxlix, 486, 1909 and 1910); C. Comte and
E. Conseil, Annales de L'Institut Pasteur (xxv, 13, 1911); Nuttall,
Parasitology (Feb., 1919); Rocha-Lima, Arch. f. Schiffs- u. Tropen-
Hyg-, (xx. 1 7< I9!6): Rocha-Lima and Prowazek, Berl. klin. Wchn-
schr. (liii, 567, 1916); Strong, Shattuck, Sellards, Zinsser, Hopkins,
Typhus Fever with particular reference to the Serbian epidemic (1921) ;
Wolbach, Todd and Palfrey, Jnl. Trap. Med. (xxlv, 13, 1921); Weil
and Felix, W. kl. W. (1920); Compton, Jnl. Royal Army Med. Corps
(1920). (A. Ci.)

TYRRELL, ROBERT YELVERTON (1844-1914), Irish classical
scholar, was born at Ballingarry, co. Tipperary, Jan. 21 1844.
He was educated at Trinity College, Dublin, where he sub-
sequently became a fellow in 1868 and professor of Latin in 1871.
From 1880 to 1898 he was Regius professor of Greek at Dublin,
and from 1900 to 1904 professor of ancient history. He was a



Commissioner of Education for Ireland and one of the original
fellows of the British Academy. Amongst his published works
were an edition of Cicero's Letters (7 vols., the later vols. with
Dr. Purser, 1879-1900); Latin Poetry (1893); Sophocles (1897);
Terence (1902), and Essays on Greek Literature (1909). He
died in Dublin Sept. 19 1914.

TYRWHITT, SIR REGINALD YORKE, IST BART. (1870- ),
British Admiral, was born at Oxford May 10 1870, the young-
est son of the Rev. Richard St. John Tyrwhitt. He entered
the navy in 1883, was promoted lieutenant (1892), commander
(1903), captain (1908), commodore (1914) and rear-admiral
(1919). He was in charge of a landing party at Nicaragua in
1894. During the World War he commanded destroyer flotillas
in actions in Heligoland Bight (Aug. and Dec. 1914) and off
the Dogger Bank (1915). He was created K.C.B. in 1917,
and in 1919 received a baronetcy, a grant of 10,000 and the
thanks of Parliament.



828



UGANDA



UGANDA (see 27.557*). The area of the protectorate,
after taking into account an exchange of certain dis-
tricts with the Anglo-Egyptian Sudan in 1914, is some
110,300 sq. m., including 16,000 sq. m. of water (chiefly
those parts of lakes Victoria and Albert Nyanzas within its limits).
The pop., given as 2,843,325 at the 1911 census, was in 1919
officially estimated at 3,318,190 of whom 847 were Europeans
and 3,516 Asiatics (mostly Indians). The most numerous races
are the Baganda and Banyoro.

Industries, Trade and Communications. The economic resources
of the protectorate greatly increased in the decade 1910-20. This
period was marked by the rapid development of cotton-growing an
industry entirely in the hands of the natives and by the acquisition
of numerous plantations by Europeans, who engaged chiefly in the
production of coffee and Para rubber. These, with ox-hides, goat-
skins and ivory formed the chief exports. Sesame seed, red chillies
(which grow wild) and ground nuts were fluctuating crops. _Cocoa,
tea, tobacco and other plantations were started and a beginning was
made in the export of timber. Ghee (clarified butter), in consider-
able quantities, was sold in Kenya Colony (British E. Africa).

At first the cotton produced was mainly ginned in the E. Africa
Protectorate, but by 1919 ginneries established at Kampala,
Entebbe, Jinja and other centres by European companies ginned and
baled all the cotton exported. The value of the cotton exported
(most of it taken by Indian merchants for the Bombay market),
165,000 in 1910-1, had increased to 965,000 in 1918-9. The last-
named figure was, however, due to the inflation of prices and repre-
sented an export of 4,909 tons; in 1914-5 when 6,866 tons were
exported the value was only 351,000. In 1919 a tax of 4 cents per
pound on all cotton exported was imposed, the proceeds to be de-
voted wholly to the development of the industry. In 1920 the tax
was reduced to 3 cents per pound, and was to so continue for three
years. Progress made in the rubber plantations was shown in the
increase of exports from 9 tons in 1914 to 113 tons in 1919. Coffee
exports increased from 13 tons in 1910 to 2,716 tons (valued at
106,000) in 1919.

External trade is almost wholly through Kenya Colony by rail
to Mombasa. The value of the imports, chiefly textiles and hard-
ware, rose from 347,000 in 1910-1 to 744,000 in 1916-7, exclu-
sive of Government stores, specie and goods in transit. (The transit
trade is almost entirely with the north-eastern part of Belgian
Congo and consists largely in bullion from the Kilo gold mines.)
In the same period the value of exports of domestic produce rose
from 306,000 to 637,000. The Customs Depts. of the two pro-
tectorates were amalgamated in 1917, and since that date no separate
statistics have been kept, except in regard to domestic produce.
The value of such produce in 1918-9 was 1,247,000.

The development of trade and the work of administration was
aided by a well-planned system of metalled roads suitable for motor
traffic. A railway 61 m. long from Jinja (by the Ripon Falls) to
Namasagali, the first navigable point on the Nile, was begun in 1910
and opened on Jan. I 1912. It was built entirely by Busoga natives
and is called the Busoga Railway. It connects with a line of steamers
which serves Lake Kioga and the Bukedi district, where a rich soil
and well defined dry season provide excellent conditions for cotton
growing. Besides the Busoga Railway there is a 7-m. railway
(opened 1915) connecting Kampala, the capital of Buganda, with
Port Bell on Victoria Nyanza. It was designed as the first stage in