Writing in answer to an inquiry as to the propriety of using typhoid vaccine in civilian institutions, in November 1909, Major Russell said :
I do not think that it is the only thing to be considered in the prevention of typhoid fever by any means; attention must be paid to all the usual sources of infection in addition to the use of vaccine. This is for the reason that the protection gained by vaccination is not absolute but only relative, and that if the infected material is present in sufficient quantities some people might develop typhoid in spite of previous vaccination. 33[1]
Greater knowledge of medical officers and greater authority for the Medical Corps resulted in stricter sanitary controls. Broader knowledge of sanitation and disease prevention among officers and men of the line made such controls more readily enforcible. The combination of a lesser number of cases and lesser chances of infection from such cases as there were, created a diminishing spiral of morbidity. There was to be no repetition of 1898. By 1910, the chances of typhoid infection in the Army had been reduced to the point that the soldier was no more likely to suffer from the disease than the civilian. And then, into this already diminishing incidence of the disease, there was introduced the added safeguard of preventive vaccination, voluntary at first and then, for the military forces, compulsory. In the 5-year period 1911-1916, the chances of typhoid in the Army were further reduced to the point that the soldier was only one-fifth as liable to the disease as the civilian. 34[2]
The English physician, William Budd, writing in 1874, stoutly maintained that typhoid was a "perfectly preventable plague" if pollution from alvine dis- charges of infected individuals could be checked. The Reed-Vaughan-Shakespeare study assembled overwhelming evidence to sustain the Budd theory, and outlined methods of prevention. The application of these methods, together with improved sanitary conditions generally, and the added protection of prophylactic vaccination of both civilian and military personnel, has brought measurably near Budd's prediction of perfect prevention.
For this triumph over typhoid, many causes are responsible, but no small part of the responsibility rests upon three successive curators of the Medical Museum — Reed, who organized and carried forward the great study of the disease and its prevention; Carroll, who initiated experiments with the prophylactic vaccine; and Russell, who carried the experiments to successful conclusion and mass application.
