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Preventable Causes of Typhoid Fever.

the surface waters are low, is affirmed to be a fact in respect to the epidemics of that locality, but is not proposed as a working theory for general application.

The manner in which the decomposition of ordure, and the influence of human excretions generally affect Man has been sufficiently set forth. It should be considered further how climatic influences act on these processes, to promote or retard them, to favor or to prevent the development of the Typhoid germ.

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The mean annual isothermal, isochimenal and isotheral lines have little influence over the genesis of Typhoid. In Norway and Sweden, in the most northern of the provinces in Finland, in European Russia up to the latitude of the permanent snow-line, Typhoid levies its tolls on the human race. In the most southern parts of Portugal and Spain it is equally at home, nor does it spare the most beautiful islands of the Mediterranean. On this side of the ocean, cases occur from Labrador to the Central American States, and as far south as Montevideo. Severe epidemics have occurred in the coldest parts of Siberia and Finland. These facts indicate the powerful viability of the germ, as has been set forth, and also prove that the mere decomposition of animal excretions cannot produce it de novo - a conclusion arrived at by independent examination of other data.

Besides the influence of age in modifying certain anatomical structures referred to in another place, age has also some effect in lessening or increasing the susceptibility to the action of the Typhoid germ. The greatest number of cases occur between the ages of twenty and thirty years. This decennium has twice the number of victims compared with those nearest in age, according to the estimate of the best medical statisticians. Or to state the same fact in another form-from the ages of fifteen to thirty there are eighty per cent of the whole number of cases. The relative proportions decline from the period of fifteen to thirty in both directions. Hence it may be said that the suscepti

Preventable Causes of Typhoid Fever.

bility to Typhoid is the greater the nearer the age to the most vigorous period of life.

The same principle holds in regard to sex: men are more liable than women, but the difference is not very great. Other diseases lessen the proneness to attacks: pregnant women are almost, but not entirely exempt, and chronic diseases that keep the bodily strength at a low point exercise some protective influence, and lessen the susceptibility. These modifying influences must not be confounded with morbid states that increase the gravity of Typhoid when it does occur in the subjects of such conditions. Thus, Chickahominy Fever, a Typhoid occurring in soldiers whose tissues were depraved by evil personal and camp hygiene, had the more a destructive character because their constitutional forces had been undermined by the composite toxic influences in question.

As the occurrence of Typhoid procures immunity to a less or greater extent from future seizures, it is classed among the specific infections, with the eruptive fevers as Measles, Scarlet Fever and others, having the property to so impress the system that no subsequent exposure will cause a recurrence; but it does not have the same degree of power to exempt as those named. It is not common to find a second case in the same individual; but by no means unprecedented. The reason for exemption in a partial degree is probably the changes which were made in the glands of the intestine when the first infective microbes began their growth about and in them.

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If the data above set forth are based on a true estimate of the conditions which have to do with the development of Typhoid, and there can be no doubt as to the accuracy of the statements, the means and methods by which the occurrence of the fever may be restrained or prevented follow as a necessary consequence. A correct summary of the con

Preventable Causes of Typhoid Fever.

clusions reached will make more clear the nature of the methods which should be utilized for this purpose.

Typhoid is a separate and distinct morbid entity - a specific (in general sense) disease, self-limited, and always conforming in its essential characteristics to the original model.

Its cause is a disease-germ—a microbe or micro-organism which reaches Man by air, or food, or drink.

When in the intestine, coming to the lower end of the ilium, or small bowel, it finds in the glands situated there its proper pabulum - or food suitable to its growth.

The disturbances of the human system (the symptom-complexus) which we call Typhoid Fever, is caused by the injury done at the point where the growth and reproduction of the parasite are going on; namely, in the groups of glands imbedded in the mucous membrane there, called "Peyer's patches," and also in the solitary glands and other organs: or by the production of some poison which, entering the system causes all the symptoms of the fever. The latterthe peculiar poison produced by these microbes - may be the more probable because by a similar process as Dr. Vaughan has proved, Tyrotoxicon is produced, and this poison acts on the human system in a way identical with Cholera Infantum. Whether the direct effect of the changes induced in important excretory glands, or of a poison generated by them, it is certain that the presence of these parasites is necessary to the result.

The multiplying germs are found in the stools of Typhoid Fever, and not only organisms complete in their development, but spores having a greater power of resistence to destructive agents, and having the potentiality of indefinite millions of parasites. It is probable that some preparation is necessary to put the germs in a state for action, and these changes occur most readily under circumstances most unfavorable to health.

Preventable Causes of Typhoid Fever.

The proportion of infected persons in any community depends, first, on the number of germs present in food, air or water; secondly, on the susceptibility of those who receive the germs. Susceptibility may be an original fault of the organism: it may consist in an abnormal state of the small intestine, especially the lower ilium, whence it becomes an adaptable home-a nidus for the parasite; or it may consist in the preliminary influence of filth, the emanations from ordure, inhalation of sewer gas, etc. That organic matter from human bodies can have an influence is probable, because the parasites are found to have close relations with such materials, especially when decomposing.

Certain climatic and terrestrial causes also, influence to some extent the activity of the Typhoid germ, but do not prevent its development under any circumstances of heat, cold, or character of soil. It is true, nevertheless, that the Typhoid parasite has its preferences, but these are only partial in operation, and do not act in such force as to prevent its lodgment and multiplication wherever civilization creates the conditions shown herein to be influential.

LEPROSY, WITH SPECIAL REFERENCE TO ITS

EXISTENCE IN WISCONSIN.

BY K. HOEGH, M. D.

The vast immigration to this country from every part of the globe brings us in many instances in contact with conditions which are essentially foreign to the original white population. The different nationalities in their different stages of development confront us often with problems, that long ago have been solved by the English speaking race, and with defects, it has long ago outgrown. The German and Bohemian come often with political and social notions, which are an immediate outgrowth of the military organization of their governments, and socialism and anarchism are to be met and defeated by a civilization, which, but for foreign immigration would have been an entire stranger to them. On this continent and at this day we have to meet the descendants of the ancient Huns and our laboring classes have to compete with those whose standard of living recalls the squalor and filth of Attila's host; we are brought face to face with the negro's gross, childish and cruel superstitions and with the Chinese laborer's oriental degradation. In a similar way diseases which long ago have ceased to exist among the more advanced nations are brought to our land, and we are called upon to fight them here, while nations behind us in development and civilization can look back upon them as dangers of the past.

Such a disease is Leprosy which once existed in terrible endemic form all over Europe, but which now only lingers on the very outskirts of European civilization. During the middle ages Leprosy was so common in Europe, that there existed thousands of houses or hospitals for this disease only, and even the richest and fairest countries suffered from this terrible scourge. Today there is probably not a Leper in

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