| Show HOW now TYPHOID F even EVER IS CON BY DR DE T J MACLAGAN typhoid fever is one douthe most common of the serious all ali ailments aliments ments of civilized life no household is safe against it there is no family which it may not invade in great britain alone not much short of people suffer from it every year of these nearly 20 die most of them in the prime of ll 11 life ilfe it is even more prevalent on the continent the question of the contagiousness of such a disease js is one of vital importance and yet it is one on which the most antagonistic 0 opinions are held among the many ailments which may be transmitted from the sick to the healthy the ones with which weare we are most familiar in this country are those which are grouped together under the name of the eruptive fevers I 1 to this group typhoid f fever feser ever belongs belongs it includes also smallpox small pox cyp typhus fever scarlet fever and measles mea mba sies each consists of an attack of lever of more or less definite duration and of a local inflammation or eruption during the course of each its poison is largely reproduced in the system and each may te be transmitted from the sick to the healthy there are several ways in which a disease may be transmitted 1 its poison may be introduced directly by inoculation as is daily done don e in the case of vaccination i it may pass directly into the surrounding atmosphere from the persons of the sick and be inhaled by those in their neighborhood as constantly happens in smallpox small pox typhus I 1 fever ever inea measles sies and scarlet fever it may be conveyed indirectly and to a distance in articles of clothing bed linen etc and passing from them maybe may be inhaled by those who wear or hand handle handie lethem them as often happens inthe in the same diseases or it may be conveyed in food or water and enter the system through the digestive organs as frequently quenell happens with the poison of typhoid fever ever when we wish to say that a disease is transmitted from person to person without defining the mode of transmission we say that it is 18 communicable the term is a general one which includes every mode of transmission when we wish to say that a disease may be transmitted by inoculation we say that it is when we wish to say that the poison may be conveyed in articles of clothing in linen in food iu in water etc we say that these articles have been infected f by the poison and that the disease is infectious when we wish to say thata a disease is produced by personal contact with one suffering f from rom it and that the danger of catching it increases with the closeness and intimacy of such contact conta et we call it contagious A contagious disease therefore is one in which the danger of contracting it increases as we approach and diminishes as we recede irom from from a person suffering from it it is contagion may be defined as direct infection and infection as indirect contagion in both a poison passes f from rom vue vie tue sick to the healthy it is the difference in the mode of conveyance of the poison that makes the difference between the ti vo the distinction is one of the ut utmost practical importance and must he bo orne in mind in discussing the qu t n of the contagiousness of lany alny any diss diar an ailment aliment in may 37 be in without being contagious when with reference to a case of typhoid fever in his own house bouse a man asks the question Is it contagious he be does docs not wish to know whether or not some one in the next street may take the disease but whether or not there is a likelihood of its spreading aan the members of his own household and whether or not there is danger of going near the sufferer the only accurate and proper meaning of theford the word is that attached to it in the definition which I 1 have given that therefore is the sense in which it is used in this paper what is the nature of the poisons which pass from the sick to the healthy their most distinctive peculiarity is that they are largely reproduced in the system during the course of the maladies to which they give rise chemin the minutest possible portion of smallpox small smail pox in matter atte tor for or instance maybe may be introduced in into to tr the e system of a person who has not had that disease and who has not been vaccinated vaccina ted ali wll with the certainty of giving rise to a malady during whose course there will be formed many thousand times as much of the poison as sufficed to set the disease contagion then consists physically of minute solid particles the process of contagion is the passage of these from the oodles dodies of ze the sick into the surrounding atmosphere and in the inhalation of one or more of them by those in the immediate neighborhood if contagion were a gaseous or vapory emanation lt it would bu be equally diff diffused used through the s sickroom sick 1 k room and all who entered it aou would 1 d tom if u ae suffer alike and inevitably but such Js is not the case f for fon or many people are exposed for we weeks C k 9 and months without suffering in g of two persons situated in c exactly I 1 y ahe the s same ame circumstances and exposed P iad lad 1 in exactly the same degree to a given contagion one may suffer and the other escape the explanation of this is that the little particles of contagion are arc irregularly scattered about in the atmosphere so that inhalation of one or more of them is purely a matter of chance such chance bearing behring a direct relation to the number of pai pal particles which exist in a given cubic space suppose that a hundred kundred germs are floating about in a room contain containing inar two thousand cubic feet of air there therb is one germ for every twenty cubic feet naturally the germs will be most numerous in tile the im mediate immediate neighborhood of their source the person of the sufferer but excepting t this Is one tone place they may be pretty equally equal y distributed through the room or the they r may be very unequally distributed 1 A draught across the bed may carry them now to one side now to the other the mass of them may be near the ceiling or near the floor ina lna in a given twenty cubic feet there may be a dozen germs or there may be none at all one who enters the room may inhale a germ before he has been in it ten minutes or he may remain there for an hour without outdoing outgoing doing so 0 o double the number of germs and you double the danger diminish the size of the room by one half and you yon do the same keep the windows shut and you keep the germs in open en them and they pass pasq rut put out with the ora oga c changing aging air hence the importance of free ventilation and hence one reason why fevers should be bb treated if ff possible 0 isible in large airy rooms not oury only is free ventilation good for the sufferer but it diminishes the risk to the attendants we see in this to the reason for banishing bed curtains carpets and all unnecessary furniture from the sick room in cases of contagious fever the germs are apt to adhere to such articles and so make them the means of conveying the disease to others all AH organisms consume in their growth nitrogen and water those with which we are now dealing are no exception to the rule growing in the system they must get these elements eFe ments there but nitrogen and water are the chief materials rc required alred for the nutrition and repair repair oi of the various bance and so it does this dastur and tissues of the body the kropa propagation in it of millions mill ihns of organisms hii hip having wanas identical in the tiie ma main maln with those of its own tissues must cause serious disturbance declares itself by that aggregate of phenomia phen omna oruna to which we vve apply the term fever an organism which thus grows in and at the expense of another is a parasite ono one of 01 the peculiarities of parasites is that they flourish not in any part of their host but only in some particular organ or tissue which is called the or nest of the parasite the organisms with which we are now dealing tae poisons of the eruptive fevers show similar peculiarities each has its own its own localized habitat in which it is propagated and out of which it cess cerps to be reproduced the or small smail pox ox has its in the deep layer of tie tre the skin hence its characteristic eruption that of scarlet fever in the superficial layer of the skin and in the throat hence the rash and the sore throat of that disease that of measles in the skin akin and in the mucous membrane of the air passages hence its characteristic symptoms symptom hat wat that of typhoid fever in the glands of the intestine hence that disease consists of f fever ever even and of ulceration ulc cration of the bowel the contagiousness of a given eruptive fever must be directly as the number of germs which in a given time pass from the body of a sufferer into the surrounding atmosphere this in its turn must depend on the seat of the propagation of the poison and on the relation which this bears to that atmosphere phere phene lver in n sn smallpox small smail a pox scarlet fever typhus fever a and d measles the seat of tius tins ils p propagation 1 is the skin and mucous membrane CM ra 1 ie 0 of t the h air passages it is therefore in direct free and constant communication with the external air the poisons of these diseases are arc accordingly cor cur freeli freely freely given off into the atmosphere mo sphere of t the e room in which the sunn sufferer berer is and they themselves are highly contagious S in typhoid fever the poison Is propagated in the bowel and an is thrown off with the discharges from it it thus passes from the s system stem in a manner and ina lna in a combi combination naMon which insure its speedy removal from the neighborhood of the sufferer the typhoid germs erms are there but they arg ard are mingled mingle f with discharges which may be removed and as matter of course are removed before the germs can pass off from them into the surrounding atmosphere tile the seat of the propagation gation gatlon of the typhoid poison has no direct relation with this atmosphere germs can not pass directly from the one to the other the disease therefore does docs not display the property of contagiousness contagiousness the danger in typhoid fever is not contact with wit the person peron of the sufferer but contact with his stools it if these are properly managed and disposed of the disease can scarcely spread but if they arc are allowed to pass into drains which are imperfectly trapped inadequately ventilated or insufficiently flushed or if they are carelessly thrown on the ground or allowed to percolate through the soil into drink ing in water then one case of typhoid fg fever ever may give rise to many others the occurrence of a case of typhoid fever ina lna in a house is a test of the efficiency of its sanitary arrangements it these are perfect and the stools properly pro p erly managed manage all will po go well if they tiey are defective defect ve I 1 one case may give we rise to many others but the communication muni cation of the disease is not dl direct b by contact it is indirect by infection 0 of T drinking water or of an atmosphere which may be remote from the person who is the source of the poison A case of typhoid fever is introduced into a locality the stools are thrown out on the ground or into a cesspool whence they percolate through the soil soh into a well the person who wro drinks water from that well runs a greater risk than one who sleeps in the same room as the sufferer and is in constant attendance on him the practical outcome of all this is 1 that the mother may nurse her son the wife her husband hus baud the sister her brother without the risk involved in the case of typhus or scarlet fever and 2 that there is little or no dan danger daner er to tiie the other inmates of the house if its sanitary arrangements are perfect and the stools properly managed on this view of the nature and mode of action of contagion it is easy to see sec not only how the process of contagion and its varying phenomena may be explained ila iia elainee pia pla ined but how hov by care much may be e done both to prevent the poison from passing into the atmosphere and to diminish its chance of acting after it has got there we have only to consider what Is the chief channel by which the contagion gets exit from the system to know by what means we are most likely to prevent its pass passing IV into the surrounding atmosphere in typhoid f fever ever the poison passes off in the stools and what we have to do is to see that these are promptly and properly disinfected infected dis and disposed of in smallpox small pox scarlet fever typhus fever and measles it is eliminated by the skin and we can not altogether prevent its getting into the atmosphere but by fire frequent quent sponging with some disinfecting infecting dis fluid or even with plain water many germs erms may be arrested in their outward outward course the apostolic mode of anointing with oil is also an efficacious way of fixing and arresting the germs it is especially useful during convalescence les cence from scarlet fever in fixing the particle peeling skin which are a source of much dai daf danger iker iger they are dangerous because they contain the germs which have been produced in them what we see happen in the larger particles of skin happens also in many of the much smaller particles of contagion by the adoption of these various measures b by y ri rigorously ra busly isolating the sufferer an and by raving having the room well ventilated much very much may be done to check the spread of contagious fevers the matter of which organisms are composed is one of the most peril perli perishable things in nature contagion is an exception 7 to the rule by exposure to the air much of it is destroyed hence such exposure is one of the best of all disinfectants disinfect ants sanitary science has done much to show us how some of the diseases with which we are now dealin dealing in might ht be extinguished and how all nil 71 of them might have their prevalence greatly diminished minish mini shed cd it rests with those who have such ailments in their houses to carry into effect the measures calculated to destroy and act get rid of the poison before it has had time or opportunity to be a source of danger to those around rut the adoption of proper measures presupposes a knowledge of the nature of the poison with which we have to deal and of the manner in which it passes off from the system in not one is this knowledge more necessary than in typhoid fever in not one are the me ceasur measures asur s which such knowledge dictates more easily applied or more likely to be effective iut tut but to regard typhoid f fever ever eyer as contagious in the same sense that smallpox small pox and typhus f feve ever rare are so is to divert divent at from the true source of danger to lead to the adoption ot measures which are uncalled for to the neglect of those which are urgently required is to cause unnecessary concern to the sufferer and his friends and to deprive him and them of the mutual comfort and solace which a little dally daily anter Q the peculiarities ofir afir the illness may be b such UCA as atoman to malte maite i right to exclude the friends but isola not requisite for the same reason that it Is so in typhus one more point the rhe receiver K well as the giver of the poison hi lan something to do with the deterling de termini terming i tion of its action not every into whose system a germ passes necessarily essa rily suffers from its action man who has had smallpox small pox forli fork stance is no longer susceptible to tt action of its rolson poison and why N because the poison cannot get into hi system for we can make sure of t th by inoculating him with it but tx be cause during the first attack the ni di |
