Part 23 (1/2)

_Milk infection by typhoid._

Milk is responsible for perhaps 5 per cent of the cases of infection.

Although the infection is always foreign to the milk itself,--that is, enters the milk only after the milk is drawn from the cow,--milk frequently becomes infected because infected water has been added to it or because the cans have been washed in infected water, or because some persons in contact with a typhoid patient have had their hands infected and then handled the milk or the milk utensils. There are a number of epidemics which have been clearly traced to milk polluted in one of these ways. In Somerville, Ma.s.sachusetts, for example, in 1892, 32 cases occurred, 30 of which were on the route of a single milkman. It was found that the milkman had two sons, one of whom had typhoid fever just before the outbreak. This son washed the milk cans and mixed the milk in a milk house in the city, and the inference was that in some way this man infected the milk, probably in one of the mixing cans.

In Stamford, Connecticut, in 1895, an epidemic occurred which caused 386 cases and 22 deaths. Ninety-five per cent of all the cases occurred among those who took milk from one dealer, and it was probable that in this case the infection came from using a badly polluted water to wash the cans. In Montclair, in 1902, a small epidemic involving 28 cases occurred, where the health officers decided, after having found out that the cases were all among those customers taking milk in pint bottles, that the infection came from a house on the route, where typhoid fever had occurred. It appeared that this family infected the bottles left at their house, and since the milkman failed to sterilize the bottles before re-filling them, the infection was pa.s.sed on to others also taking milk in pint bottles.

_Infection by flies._

Flies also transmit typhoid fever chiefly because they are essentially such unclean insects. They are born in filth and they delight in living in filth, and if privies and cesspools and manure piles and garbage piles could be shut out from flies, the fly pestilence would be at an end. The feet of the flies are suction tubes, and when a fly lights on any object, it causes more or less of that material to stick to his feet, and then when he flies elsewhere, he may leave the particles on the object on which he alights. This has been proved by allowing a fly, caught in the house of a typhoid fever patient, to walk over a gelatine plate, leaving on the plate not merely his tracks, but the germs which his feet had carried. When the plate was exposed in an incubator, it was found that, within two or three days, millions of bacteria had grown from the number deposited by the one fly.

It is believed that the number of cases of typhoid which occurred in our Spanish-American War, at the military camps, and which were so disastrous, were due largely to flies. Among the 107,973 soldiers quartered in military camps at that time, there were 20,738 cases of typhoid fever, and the number of those which were fatal const.i.tuted 86 per cent of all the deaths from disease during this campaign. It was shown by the commission appointed to investigate the matter that the spread of the disease was not due to water or to food, but in most cases to the direct transmission of the germs through the agency of flies. In the j.a.panese and Russian war, where in the j.a.panese army of over a million men only 299 deaths from typhoid occurred, strict measures were taken to do away with all the breeding places of flies, and Major Seaman, who writes most interestingly on the success of the j.a.panese in avoiding typhoid, describes the ways in which the j.a.panese soldiers made flycatchers of themselves and waged war against flies quite as actively as against the Russians.

_Other sources of typhoid fever._

There are other sources of the disease; for instance, there have been a number of small epidemics undoubtedly caused by infected oysters. One of the unpleasant habits of the oystermen is to bring in oysters from the ocean and leave them for a few days in shallow water where they may plump up or fatten, and they have found by experience that this fattening occurs more rapidly in dirty water. If the oysters are fattened in sewage-polluted water, the typhoid germs get inside the sh.e.l.l in the oyster liquor and are thus transmitted to those persons who eat the oysters raw.

Some kinds of food may transmit the disease: lettuce and celery, for instance, if washed in contaminated water or handled by persons with unclean hands or perhaps fertilized with manure containing typhoid germs. Finally, it is possible to acquire the disease by direct contact--not that the germs of typhoid are in the air in the room where a typhoid fever patient is lying, but rather that the nurse in some way soils her hands and then infects herself by putting her fingers in her mouth, or handles dishes or food afterwards used by other people, and so infects those others. It is not uncommon, for example, to see food partly consumed by a sick person given to children, or it may be that a child in the sick room is fed dainties prepared for the use of the patient. The result of such division of food is very apt to be a division of the sickness to the injury of the child.

_Treatment of typhoid fever._

So far as present knowledge extends, the disease is one best treated by being let alone, with some moderate modification. When germs have been swallowed and when the vitality of the individual is such that the disease is contracted (happily, as has already been said, only about 10 per cent of those into whom the germ effects an entrance are inoculated), the first stage in the disease is a multiplication of the germs. This const.i.tutes what is known as the incubation period, and lasts about ten days. During this time, the individual feels uneasy, has more or less headache and backache, and loses mental energy. The typhoid bacillus during this time spreads into almost every organ and tissue of the body, and towards the end of the period, when the resisting forces of the body have been proved unable to counteract the attack and the fever is well developed, the condition of the patient is deplorable. The bacteria are everywhere throughout the system, although they are especially active in the small intestines. This inflammation may produce ulceration and the blood vessels may be attacked, so that hemorrhages or even peritonitis may occur. A slight rash appears on the body, and a peculiar appearance of the tongue is to be found in severe cases. In from two to four weeks, the battle has been decided, and if the resisting forces prevail, the fever stops, and the patient begins to get well. This means probably, not that the bacilli are all dead, but that the patient has developed in his blood a sufficient antidote to the poison, so that the effects of the latter are no longer noticeable. The period of recovery, if the patient does recover, is most tedious, since the condition of the alimentary ca.n.a.l is such that great care must be exercised lest serious disorders there occur, and, although the patient is excessively hungry and really in great need of nouris.h.i.+ng food, no greater folly can be committed than in allowing his desire for food to lead to indiscretion.

Injudicious exposure or fatigue will also cause a relapse, and while recovery is usually a simple matter, it is only so when under the eye of a judicious and careful nurse. The only treatment required is plenty of water for drinking, to make up for the enormous loss by perspiration from the skin, which helps to wash out the poisons from the body. Then baths, where such methods of treatment can be used, as in hospitals, are also used both to lower the skin temperature and to add water to the surface. Sponge baths in water or alcohol are valuable and in some cases tub baths with the temperature as low as 40 degrees are used. Then a proper diet to keep up the strength of the patient, liquids always, and usually milk, forms the only other treatment possible. No drug is of any avail, and uninterrupted watchful care is the only way of combating the disease.

In concluding this chapter, it may be mentioned that certain army officers interested in medical work have discovered what they believe to be an ant.i.toxin for typhoid fever, and they have inoculated hundreds of soldiers as a preventative. The results are not yet conclusive, but there seems to be great promise. It is hoped that the time may come soon when people will be so educated that there will be no opportunity of the germs escaping from the sick room, and that food and drink will be so cared for that there will be no possibility of infection. The writer feels that it is in these last two methods of prevention rather than in the use of ant.i.toxin that the hope of the future lies.

CHAPTER XVIII

_CHILDREN'S DISEASES_

There are four diseases, scarlet fever, measles, whooping cough, and chicken pox, which are recognized as belonging preeminently to the period of childhood and which are supposed to be the result of bacterial contagion, although, curiously, the specific bacteria concerned in any one of these four diseases has not been detected. They may be rationally grouped together for two reasons. First, because of their attacking, in the majority of cases, children under the age of fifteen years, and second, because the first stages of these diseases are very similar, so that the recognition of them is not easy except for the practiced physician. It must not be thought, however, that because these are diseases of childhood and because a majority of children have them at one time or another, without great suffering and without serious after effects, they are on that account to be despised. Scarlet fever, for instance, is to-day probably the most dreaded of children's diseases, not because so many children die of it,--although the death-rate is large, about 20 per cent of the cases finally succ.u.mbing,--but because of the large number of complications and consequences which are directly due to this disease. Measles, also, though not to the same extent, is frequently followed by serious after results. In the United States, about 13,000 children die every year of measles and about half as many die of scarlet fever. It is a significant fact that the death-rate is much higher among younger children, so that if, by carefully keeping children from the possibility of infection, the disease can be postponed until they are well along in years, the danger of fatal termination is much reduced.

The following table, for instance, shows the number of deaths from measles and scarlet fever at different ages, and it is very evident from this table that if the former disease is contracted by a child under five years old, the danger of death is four times as great as if it were postponed until the child were ten years old:--

TABLE XIX. TABLE SHOWING DEATHS AND PERCENTAGES FROM MEASLES AND SCARLET FEVER FOR DIFFERENT AGES IN UNITED STATES REGISTRATION AREA FOR 1907

====================================+===================================== MEASLES

SCARLET FEVER ------------+----------+------------+-------------+----------+------------

Per cent of

Per cent of Age Period

Number of

Total

Age Period

Number of

Total

Deaths

Deaths

Deaths

Deaths ------------+----------+------------+-------------+----------+------------ All ages

4302

100

All ages

4309

100 Under 1 yr.

1058

24

Under 1 yr.

175

4 1-2 yr.

1315

31

1-2 yr.

474

11 2-3 yr.

626

14

2-3 yr.

639

15 3-4 yr.

343

8

3-4 yr.

640

15 4-5 yr.

189

4

4-5 yr.

511

12 5-9 yr.

350