Show I What Medicine Knows Today TYPHOID FEVER EVER Typhoid fever kills about Americans annually Like pulmonary tuberculosis it reaps Its harvest In the golden years ears of its vie vic victims Urns tims are between and anO forty years ears old The time Is coming when an epi epidemic epidemic epidemic demic of typhoid fever foyer will be looked upon as a disgrace to a civilized com community community Typhoid Is always prevent preventable preventable preventable able Its occurrence Is almost Invariably invariably ably abl a proof of gross official careless carelessness ness and neglect In Germany where such things are managed with unsentimental thorough thoroughness ness the disease dlease Is almost extinct In Berlin where whore it once raged violently the death rate per annum has been reduced to little more than three per of population and these are cases Introduced from the coun country count country try t In Munich once a veritable pest pesthole pesthole pesthole hole typhoid has disappeared almost entirely In the whole of Germany rural as well as urban the mortality has sunk to seven seen per But In Inthe inthe Inthe the United States between 1900 1300 and 1904 the rate In registration tion cities was and In the terri territory territory territory tory outside the registration area it was probably nearer fifty 1 Typhoid fever is la caused by bad I drainage and Impure drinking water The germ appears In the water supply Pretty soon a multitude of per persons persons persons sons Is Infected Then these patients In turn Infect a multitude of or others The only way to stamp out the mal malady malady malady ady Is to make male the water supply pure and amI to see that those who are ill are properly nursed and guarded and so sodo sodo sodo do not transmit the Infection to others All of this may be difficult of attain attainment attainment attainment ment but the experience of or Germany Switzerland and Norway has demon demonstrated demonstrated demonstrated that given ghen Intelligent official supervision it is far from being so in point of fact The germ of typhoid Is a minute or organism organism organism called the bacillus It was discovered In 1880 by a German named Eberth In the small Intestinal blood vessels of a man who had suc succumbed succumbed to the disease Soon after afterward afterward afterward ward Koch the great German biologist biolo biologist biologist gist found It In the other organs of or typhoid victims In 1884 1881 It was cul cultivated cultivated cultivated artificially for the first time Since then pathologists have learned a great deal about It It It is very small but It has a dozen long or feelers and It Is ca capable capable pable pablo of darting about in blood or water like a water beetle When the bacillus enters the human body and It Invariably gets In by the digestive tract it makes its way to the Intestines and here takes up Its home in the intestinal walls Two or three thre weeks later the Invaded person loses loges appetite and begins to pave have ave head headaches headaches headaches aches and pains In the back A few days das later the patient is in bed and helpless and the chances of never leaving it again are about fifteen in ina ina Ina a hundred Typhoid fever feer is a dis disease disease ease eafe This means menns that It runs a definite definite definite nite course coure and that medicine can do dolittle dolittle dolittle little to shorten or modify that course During the first week the patients temperature rises gradually until it stands at or lO degrees Then for another week It remains high During the third week If all ll goes well It begins belins to decline de line and during the fourth week the patient regains strength and appetite and is on the mend This is the course of oC the malady un under der df r favorable conditions Under un unfavorable unfavorable unfavorable favorable conditions the typhoid germ burrowing into the walls of the intes intestinal Intestinal intestinal tract breaks through into the abdominal cavity cavit General peritonitis follows or the high fever long con continued continued continued saps the th strength and causes collapse In either event the patient dies Years Tears ago there wore a hundred so 50 called cures for typhoid Modern medi medicine medicine cine has rejected all of them one by byone byne one ene ne as worse than useless Today Todar the malady is more by nursing than by drugs The patients strength is I kept up by bJ judicial feeding the fever is reduced by ice baths and a desperate fight right Is made from the be beginning beginning ginning tInning to prevent the fatal Intestinal perforation All of or this treatment is best obtainable obtain obtainable obtainable able In a good hospital therefore it Is becoming more and more common to send typhoid patients to hospitals In Inthe Inthe Inthe the home no matter how great the effort It Is almost alm st Impossible to make conditions entirely favorable The medicine or appliance needed in an emergency f is not at hand the doctor perhaps has just left and the nurse is 1 I helpless s In a hospital everything necessary Is to be had at once and expert attendance is unceasing unceasing ing in Typhoid fever it U should be remembered remembered remembered Is a malady of sudden surprises and alarms The patient play may seem to tobe tobe i be progressing admirably when liter literally literally ally without an Instants warning a crisis will come and unless the needed aid Is immediately at hand a fatal re result result result sult may follow Eternal vigilance in indeed indeed indeed deed is the price of life An hours neglect ne led may easily mean death Even mor morn important than the cure of the individual patient in Its bearing bear bearing bearing ing upon the welfare of the community community community ity Is the prevention of further Infection infection infection tion Persons ill III with typhoid are as dangerous to those around them as sufferers from smallpox or yellow fever feer The bacilli of the malady swarm in the patients blood and they swarm too In the secretions of the body Therefore a great effort must be made to prevent the latter from coming Into contact with healthy persons The vessel from which the typhoid patient cats eats and drinks must be ster sterilized sterilized sterilized afterward The bedclothes must be washed In antiseptics The dis discharges discharges discharges charges must be burned The very water used to bathe him must be treated with strong germicides before it is poured way away The bacillus Is extraordinarily extraordinarily extraordinarily tenacious of life Ilfe It wilt will live for three months In water and an for four months in milk Extreme Extremes cold seems to have no effect upon it for It has been found alive after days ays of freezing On fruits and an vegetables usually carried to them by washing in contaminated water It will live for tor thirty days das and In oysters even eveD long longer er It has been found after eighty days dayson on clothing and rags and after three months on linen of patients p Flies are known to carry it There are Investigators who say that it Is sometimes transmitted in dust dustIn dustIn In view of all this the prime hn Im Importance of intelligent precautionary measures Is apparent All sickroom debris must be destroyed All who have occasion to touch the patient must cleanse their hands thoroughly with antiseptics antiseptic Carbolic acid and cor corrosive corrosive corrosive sublimate are the agents v em employed m most commonly In ill this war upon the germs However great all other precautions are all Mho wh have no noI I 4 t f This and the other articles to f ff f appear appeal In this series have been f prepared by specialists and med medIcal f leal Ical men of wide reputation atlon f Each contributor stands high f ff f in his field Professional ethics prohibit them from attaching f ff f their names but every state statement f merit ment me t is made m ide with the highest 4 t authority f f f business in the sick room must stay out If the water supply of every large city were guarded properly typhoid fever feer would be confined to imported cases ases cases As It Is It happens frequently that the disease appears in the coun surrounding the watershed and the debris of sickrooms finds its way Into the storage lakes There the germs flourish and multiply Soon they are arc In every everyone one of the main The result of course is an outbreak of typhoid and the usual roll rollof rollof of deaths th f The way to avoid such an accident Is to see to It that the streams which flow into the water supply are not contaminated When this seems a task of hopeless magnitude it is best to filter the entire water supply Filtration Filtration Filtration tion however Is a sorry substitute Undoubtedly It rids the water of a good many germs but to say that It kills all of them Is grossly Incorrect The damage In typhoid fever Is not done by the bacillus itself It is done by a toxin or poison found in its tissues tissues tissues sues The body fights the disease first by turning the blood serum upon the germs and secondly by manufacturing an nn antitoxin to counteract the toxin Whenever a toxin oi of o any infectious appears in inthe inthe inthe the human blood the th latter begins begin au automatically automatically automatically to make antitoxin to neutralize It IL If the blood manages to manufacture enough to do the work I the patient recovers if the toxin gain gam upon It it the patient dies I This fact Is the principle at the bot bottom bottom I Itom tom of a typhoid vaccine made by Sir Almroth Wright the great English I pathologist Dr Dr Dc Wright cultivates cultivates tes ty typhoid typhoid typhoid bacilli in bouillon u until til they at attain attaIn attain tain toa to a healthy growth Then he subjects them to a high temperature for tor a day or more This heat kills the germs themselves but It does not change the toxin within them I The dead germs each with Its bur burden burden burden den of toxin are injected Into the pa patient patient patient tient who is to be Immunized First Firsta a billion germs erms are Injected A week or two later a second injection Is made this time of two billion germs The result Is that the blood of the patient Invaded by b all this toxin begins to manufacture antitoxin in enormous quantities Pretty soon enough has been made to neutralize all of the toxin but instead of or stopping the blood keeps on The extra supply pf of anti antitoxin antitoxin antitoxin toxin thus formed remains In the blood for a good while and If it the patient Is exposed afterwards to ty typhoid typhoid typhoid Infection and live germs wander into his system the toxin in them Is overcome at once and they die Thus the patient is protected against typhoid fever fe r rOther Other investigators and Rowland Inject bacilli into horses and let the blood of the latter manufacture the an antitoxin antitoxin antitoxin Then this blood is drawn and injected into human patients where It pounces upon typhoid toxin Just as vig vigorously vigorously as If it were at home These two methods of fighting ty typhoid typhoid typhoid have little favor in the United Uni ed States mainly perhaps because of the great fear of serums rums s and anti antitoxins antitoxins antitoxins toxins which prevails in this country But in SoOth Africa and Japan they have been employed with great suc success success success cess During the Boer war ar Dr Wright Inoculated d thousands of British sol soldiers soldiers soldiers diers with ith his typhoid vaccine It did not nol stamp out the disease entirely but I the reports of the army surgeons show I that those who were inoculated were considerably less susceptible than those who were tvete w e not and that even een If they contracted the disease after all their chances of recovery were ere increased materially ma materially During the war Russia Russi the Japanese made extensive experiments with typhoid vaccines As a result there was little If it any typhoid In the Japanese army arm Inasmuch as this mal malady malady malady ady in past wars commonly common killed more men than thal the bullets of the enemy the value of the experiment is obvious Within a few years no doubt such vaccines will be employed extensively In the United States The study of the reactions which take place between blood and germ has hasbrough brought brough t forth an Ingenious and amI effect effective effective effective ive method of determining the pres presence presence presence ence or absence of typhoid fever In Inpatients Inpatients inpatients patients whose outward symptoms are puzzling This method is based on the fact that when typhoid germs Invade the human blood the latter begins to produce not only antitoxins to neu neutralize neutralize neutralize the toxins In the germs and arod leu leucocytes leucocytes leucocytes to gobble them but also a number of or mysterious substances called agglutinins whose function it is to tomake tomake tomake make th the germs genns grow sticky and gather In clumps and so ro lose their capacity for multiplying These agglutinins appear in a pa patients p blood very verJ soon after the ty typhoid t germs first invade imade his body Therefore when they are arc found it is pretty safe te to conclude that he is in infected infected and that in a short while the themore themore themore more conspicuous manifestations of the milady will appear The agglutinin test called the reaction after its discoverer Is made by drawing a small quantity of blood from Crom the patient diluting it mixing it with a culture of or virulent typhoid germs and observing the mixture un under under under der a microscope If the dIe patient has typhoid the agglutinins in his blood will cause the typhoid germs to gather in clumps If the patient is i not In Infected infected there will be no typhoid agglutinins agglutinins agglutinins in his blood and in consequence the germs will continue to swim about freely frech This test unluckily Is not Invariably invariably invariably ably accurate for reasons too recon recondite recondite recondite dite to be discussed here but it fails falls so seldom that it Is pretty generally employed It Is commonly known to laymen as the blood test for ty typhoid l It used to be accepted as an axiom that typhoid was a malady of large communities and that It was far more prevalent In cities than In the Ure coun country country count try But recent Investigations have proved the falsity of this In most large cities citie of today some effort no matter how small Is being made to protect the water supply but In the country the romantic farm f rm well with Its sparkling limpid water Is frequent frequently ly full tuti of or germs This is because sur surface surface surface face draining is universal outside of the cities In consequence the debris of one sickroom frequently infects a whole neighborhood Typhoid still kills Americans a year but It is js unlikely that It will continue its deadly work much longer It Is Indeed one of the maladies certain c certain r tain to fall eventually before modern medicine Hydrophobia diphtheria and smallpox have been conquered and tu tuberculosis tuberculosis tuberculosis Is yielding Next on the list listIs listis listis Is typhoid Vaccines will prevent It and serums at no distant day will probably take the place of the hard worked In fifty years It Is likely the civilized white hite man who dies of typhoid will be a rarity Copyright 1907 1107 by J W Muller Mullen |