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Prevention of Typhoid Fever in Small

Towns and Villages

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HE prevention of typhoid large number of private supplies.

fever in small communities Even here, however, the problem

is so easy that it seems is not very difficult, for almost surprising that the disease should

any well may be made safe by still be permitted to prevail in proper construction and by prepractically all of the towns and venting the gross pollution of the villages in the state of Ohio. If soil about it. a town or village wishes to rid When a town has provided a itself of typhoid fever, the pro- proper supply of water for every cedure to be followed is very inhabitant, it has taken one of the simple. The one thing necessary two great steps in typhoid preis to prevent the dissemination of vention. The second necessary step human filth in the community. The is that of providing for the proper prevalence of typhoid fever in a disposal of human waste within the community is measured by the community so that none of it may amount of human filth which is per- be scattered about by flies or other mited to be scattered about and to mechanical means and thus reach pollute food and drink. To pre- food and drink. Next to polluted vent typhoid fever we have only to water, and frequently even prevent this soiling of food and ceeding that in importance, the most drink with human filth. The important factor in the spread of measures necessary to do this are typhoid fever in a small community simple, practical, and in line with is the insanitary outdoor privy. ordinary decency and cleanliness. As has been stated so often, the

The first step to be taken by a only source of typhoid infection is community in preventing typhoid,

in human filth. These collections is to furnish a pure water supply

of human filth constitute, thereto every inhabitant. Where there fore, the greatest danger to the is a public water supply, and the

health of the community. number of public water supplies in The privy found on the premises small communities is constantly in- in the average small Ohio comcreasing, it may with but few ex- munity consists of a more or less ceptions be depended upon to be

well-built structure surmounting pure. The state law forbids the some sort of pit or vault. If this installation of a public water supply vault is not water-tight, there is except with the approval of the always danger that the filth will State Department of Health, and seep through the ground, sometimes this approval will not be given even for considerable distances and except for a supply, the purity of may reach and pollute some well. which is amply safeguarded. Even if the toilet is provided with · Where there is no public supply a water-tight vault, however, the the problem is more difficult, since contents are usually not screened it involves the safeguarding of a against flies.

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Every one knows that flies feed this kind, certain people will inon and breed in filth of all kinds. variably permit privies to overThey therefore constantly carry

flow and the contents to be spread about on their feet and in their about and scattered by flies and bodies practically all of the dif- other means of transmission. To ferent germs which are found in keep the system sanitary, therefore, filth. Where a village has a num- we must have a regular scavenger ber of privies, the contents of system. This should provide for which are exposed to flies, the flies cleaning at frequent intervals, in that village will be constantly depending on the size of the resoiled with human filth and some of ceptacle used, but certainly not less these flies will carry on their feet than twice a month in summer and the germs of typhoid fever. These once a month in winter. germs reach the mouths of well After safeguarding water suppersons, usually by soiling bread plies and filth disposal, a small or other food, or by being drowned community has done all that it can in milk, or sometimes actually by do to provide against wholesale and direct deposit on the lips.

continuous typhoid infection. The The insanitary privy, therefore, danger next in importance is that constitutes a very great source of of infection by milk and typhoid infection, particularly in a casionally by food served at some climate where the summers are as public entertainment. Milk infeclong and as warm as they are in tion is particularly difficult to preOhio. If a community is to pre- vent in small towns, because there vent typhoid therefore, it must re- are usually numerous small milk quire that every toilet be provided dealers, none of them sufficiently with a water-tight vault so that large to provide proper equipthe ground water may not be pol- ment for handling milk in a safe luted, and must be so constructed manner. The only protection in that Mies may not reach the con- such a case is to be sure that one's tents.

milk comes from a person who is The sanitation of the privies of of cleanly habits and who cona community is not nearly so ducts his dairy in a cleanly manner. difficult or expensive a matter as

This is not always easy to do, but it sounds. For an average cost

if the inhabitants of a town will of a few dollars, almost any toilet

buy milk only from those dealers can be provided with a water-tight who keep themselves and their receptacle and so protected that dairies clean, the danger will be flies cannot reach its contents. If much minimized, and all milk a system of privies is to be ex- dealers will soon recognize the pected to remain in satisfactory necessity for cleanliness in handling condition, after once being made their product. sanitary, it is absolutely necessary Even should it not be possible that some regular provision be to obtain milk about whose quality made for cleaning the privies and one is absolutely sure, the home for removing the contents a suf- pasteurization of milk is not difficient distance from the town and ficult or troublesome. This conthere disposing of them in a sists of heating the milk sufficiently sanitary manner. Where there is high to kill any living germs which no regular scavenger service of may be contained in it. It can be

accomplished in any home without impairing in any way the taste or the nutritive value of the milk.

The danger of contracting typhoid from food which has been soiled in its preparation by a "typhoid carrier" cannot be absolutely avoided. Against this danger, which is after all not very great, typhoid vaccine is the only preventive.

For a small community, therefore, to rid itself of typhoid fever it is necessary, first of all, that the council or other governing body pass an ordinance for the sanitation of all toilets and provide for a regular scavenger system.

The passage and enforcement of this ordinance is the most important step in the prevention of typhoid fever. After this is done every

citizen must protect his own water supply against accidental contamination, by seeing that the well is properly curbed and provided with a water-tight top and a suitable pump. These things, as can readily be seen, are not expensive or difficult and can be done by any community in Ohio. The adoption of these small precautions would result in preventing at least a half and probably three-fourths of the amount of typhoid fever now prevailing in the small communities in the state, and will have no small effect on the general prevalence of the disease in the state at large.

Persons interested in the details of the questions discussed above should write the State Department of Health for further information.

A. W. F.

Typhoid

Prevention on Farms

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HE prevention of typhoid ground and pollute the well, or

fever farms depends may be scattered about, get on the

upon the same simple prin- feet of man or of domestic animals, ciples as does the prevention of and in some way reach the food typhoid fever in cities, towns or of those living on the farm. The villages. The one and only thing receptacle must not only be waternecessary is to prevent human filth tight; it must be so arranged and from being scattered around so constructed that Aies cannot get that it may reach the mouths of to the filth contained in it. This human beings, either directly or is a matter of common-sense conthrough pollution of food and struction, and there are countless drink.

ways in which it may be accomThe first essential is the provision plished. The necessary things are of a sanitary privy, and the use of the protection of the filth so that it at all times by all members of none of it may by any means be the family. A sanitary privy is a scattered about the place or may privy which has some sort of a seep into the soil, and the arrangereceptacle, whether tub, bucket or ment of the privy so that it may vault, which is water-tight. If the easily and conveniently be cleaned. receptacle of the privy is not water- If the farmer will get these two tight the filth may seep into the facts clearly in mind, he can ar

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range his privy in any way most except that which has been filtered convenient to him.

by passing through many feet of It must be understood, of course,

soil and which comes from the that there is no particular use in

water-bearing stratum underbuilding a sanitary privy unless ground, and to keep all filth of any every member of the family uses it character from getting into the regularly. Filth deposited on the well. It is after all only a matter ground behind the barn or in the

of common sense. fence corner is just as dangerous The protection of a spring is also as that deposited in an insanitary simple. The spring should be privy. If there is objection on the walled about with a water-tight part of the male members of the coping to keep surface water from family to using the house privy a the slope above it from washing in. separate privy should be

The spring should be covered, and structed for their use, located some- wherever possible be provided with where about the barn. If a stool a pipe or spout, so that the bucket is deposited in the fields or any- may be set under the spout and where on the farm other than in not have to be dipped into the a sanitary privy it should be im- spring. The bucket is not always mediately covered with earth. clean on the outside.

Next in importance to the privy When the water supply and the is the well or spring. Here again privy are properly cared for on the the thing to be done is simple in farm, the farmer has done about the extreme. All that is necessary all that can be done to protect the is so to protect the well or spring family against typhoid originating that no surface water can get into

on the place. The rest is a matter it, and that no filth or trash can of ordinary cleanliness; washing be washed or carried into it. the hands before eating or before

A well should be located as far handling food, washing the hands as possible from the privy. It before milking, and above all washshould be provided with a good ing the hands well immediately afcurb of brick or cement, going ter attending to the needs of several feet into the ground and nature. rising several feet above it. The The principles outlined in this well platform should be be abso- brief article may seem so elemenlutely water-tight.

tary as to be unworthy of notice. should sit on a shoulder raised a One need only recall, however, that couple of inches above the plat- they are violated on practically all form, so that the joint between the Ohio farms today, and that as a pump and the platform may not result typhoid fever prevails as exadmit water.

The well should, tensively in the rural districts as in wherever possible, have a water- the crowded cities. If the farmers tight casing extending down to the of Ohio would attend to these simwater-bearing strata. For this pur- ple matters it would save thousands pose terra cotta sewer pipe, with of cases of typhoid every year. the joints laid in cement, is almost Any farmer desiring more or deideal. The purposes of the well tailed information on this subject construction are to prevent any

should write the State Department water from getting into the well, of Health at Columbus.

The pump

The Laboratory and Typhoid Fever

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YPHOID fever was one of bator the inoculated bouillon is exthe first of human infectious amined for the presence of a motile

diseases to yield the secret bacillus, which if found is further of its parasitic cause and control tested for typhoid by cultural and to laboratory investigation. The agglutination methods. Typhoid value of the laboratory in control- bacilli appear in the blood early in ling typhoid fever has been con- the disease. After the first week clusively demonstrated. It is use- the percentage of positive findings ful in the following ways:

decreases rapidly. 1. In assisting the practitioner in

A more widely used and almost making a diagnosis.

as reliable method of laboratory 2. In ascertaining the source of diagnosis is the Gruber-Widal reinfection.

action. This makes use of the fact 3. In determining when the con

that in the blood of patients suffervalescent is no longer a source of ing from typhoid, certain antidanger to others.

bodies are produced which are 4. In making and distributing

called agglutinins. These aggluvaccines.

tinins possess the power of renderThe clinical symptoms of ty- ing the organisms motionless and phoid fever are not always sharply of grouping them into clusters,' or defined. Physicians experience clumps as they are called. The great difficulty in diagnosing the technic consists in mixing the blood disease, especially in the earlier serum of the patient with a known stages, and often confuse it with

culture of typhoid in a dilution of malaria, tuberculosis and some at least one to forty. A dilution other diseases. In treating typhoid below one to forty may give false an early diagnosis is very im- readings, as the blood of healthy portant and can be assured only individuals often gives agglutinathrough laboratory methods.

tion in low dilutions. After an Probably the best method of hour the action, if it is to take diagnosis in the early stage of the place, is completed. Dried blood disease is by blood culture. The may be used, only a drop on a slide taking of the blood is neither dif- being necessary, but it is preferable ficult nor annoying to the patient. to submit several drops in a small This method consists of withdraw- tube so that an accurate dilution ing two or three cubic centimeters of the serum may be used. In case of the patient's blood from the the specimens are to be mailed median basilic vein by means of a most laboratories recommend the syringe and injecting it immediately use of dried blood. This reaction into twenty-five cubic centimeters is specific; that is, with certain exof plain bouillon. Great

ceptions, agglutination occurs only should be taken to prevent con- if the patient is suffering from tytamination. Weedle and Syringe phoid, and not if from some other should be carefully sterilized. Af- disease. The exceptions to this ter twenty-four hours in the incu- statement are that the reaction oc

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