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Prevention of Typhoid Fever in Small Towns and Villages

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HE prevention of typhoid fever in small communities is so easy that it seems surprising that the disease should still be permitted to prevail in practically all of the towns and villages in the state of Ohio. If a town or village wishes to rid itself of typhoid fever, the procedure to be followed is very simple. The one thing necessary is to prevent the dissemination of human filth in the community. The prevalence of typhoid fever in a community is measured by the amount of human filth which is

permited to be scattered about and to pollute food and drink. To prevent typhoid fever we have only to prevent this soiling of food and drink with human filth. The measures necessary to do this are simple, practical, and in line with ordinary decency and cleanliness.

The first step to be taken by a community in preventing typhoid, is to furnish a pure water supply to every inhabitant. Where there is a public water supply, and the number of public water supplies in small communities is constantly increasing, it may with but few exceptions be depended upon to be pure. The state law forbids the installation of a public water supply except with the approval of the State Department of Health, and this approval will not be given except for a supply, the purity of which is amply safeguarded.

Where there is no public supply the problem is more difficult, since it involves the safeguarding of a

large number of private supplies. Even here, however, the problem is not very difficult, for almost any well may be made safe by proper construction and by preventing the gross pollution of the soil about it.

When a town has provided a proper supply of water for every inhabitant, it has taken one of the two great steps in typhoid prevention. The second necessary step is that of providing for the proper disposal of human waste within the community so that none of it may be scattered about by flies or other mechanical means and thus reach food and drink. Next to polluted water, and frequently even exceeding that in importance, the most important factor in the spread of typhoid fever in a small community is the insanitary outdoor privy. As has been stated so often, the only source of typhoid infection is in human filth. These collections. of human filth constitute, therefore, the greatest danger to the health of the community.

The privy found on the premises in the average small Ohio community consists of a more or less well-built structure surmounting some sort of pit or vault. If this vault is not water-tight, there is always danger that the filth will seep through the ground, sometimes even for considerable distances and may reach and pollute some well. Even if the toilet is provided with a water-tight vault, however, the contents are usually not screened against flies.

Every one knows that flies feed on and breed in filth of all kinds. They therefore constantly carry about on their feet and in their bodies practically all of the different germs which are found in filth. Where a village has a number of privies, the contents of which are exposed to flies, the flies in that village will be constantly soiled with human filth and some of these flies will carry on their feet the germs of typhoid fever. These germs reach the mouths of well persons, usually by soiling bread or other food, or by being drowned in milk, or sometimes actually by direct deposit on the lips.

The insanitary privy, therefore, constitutes a very great source of typhoid infection, particularly in a climate where the summers are as long and as warm as they are in Ohio. If a community is to prevent typhoid therefore, it must require that every toilet be provided with a water-tight vault so that the ground water may not be polluted, and must be so constructed that flies may not reach the con

tents.

The sanitation of the privies of a community is not nearly so difficult or expensive a matter as it sounds. For an average cost of a few dollars, almost any toilet can be provided with a water-tight receptacle and so protected that flies cannot reach its contents. If a system of privies is to be expected to remain in satisfactory condition, after once being made sanitary, it is absolutely necessary that some regular provision be made for cleaning the privies and for removing the contents a sufficient distance from the town and there disposing of them in a sanitary manner. Where there is no regular scavenger service of

this kind, certain people will invariably permit privies to overflow and the contents to be spread about and scattered by flies and other means of transmission. To keep the system sanitary, therefore, we must have a regular scavenger system. This should provide for cleaning at frequent intervals, depending on the size of the receptacle used, but certainly not less than twice a month in summer and once a month in winter.

After safeguarding water supplies and filth disposal, a small community has done all that it can do to provide against wholesale and continuous typhoid infection. The danger next in importance is that of infection by milk and occasionally by food served at some public entertainment. Milk infection is particularly difficult to prevent in small towns, because there are usually numerous small milk dealers, none of them sufficiently large to provide proper equipment for handling milk in a safe manner. The only protection in such a case is to be sure that one's milk comes from a person who is of cleanly habits and who conducts his dairy in a cleanly manner. This is not always easy to do, but if the inhabitants of a town will buy milk only from those dealers who keep themselves and their dairies clean, the danger will be much minimized, and all milk dealers will soon recognize the necessity for cleanliness in handling their product.

Even should it not be possible to obtain milk about whose quality one is absolutely sure, the home pasteurization of milk is not difficult or troublesome. This consists of heating the milk sufficiently high to kill any living germs which may be contained in it. It can be

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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.

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Typhoid Prevention on Farms

HE prevention of typhoid fever on farms depends upon the same simple principles as does the prevention of typhoid fever in cities, towns or villages. The one and only thing necessary is to prevent human filth from being scattered around so that it may reach the mouths of human beings, either directly or through pollution of food and drink.

The first essential is the provision of a sanitary privy, and the use of it at all times by all members of the family. A sanitary privy is a privy which has some sort of a receptacle, whether tub, bucket or vault, which is water-tight. If the receptacle of the privy is not watertight the filth may seep into the

ground and pollute the well, or may be scattered about, get on the feet of man or of domestic animals, and in some way reach the food of those living on the farm. The receptacle must not only be watertight; it must be so arranged and constructed that flies cannot get to the filth contained in it. This is a matter of common-sense construction, and there are countless ways in which it may be accomplished. The necessary things are the protection of the filth so that none of it may by any means be scattered about the place or may seep into the soil, and the arrangement of the privy so that it may easily and conveniently be cleaned. If the farmer will get these two facts clearly in mind, he can ar

range his privy in any way most convenient to him.

It must be understood, of course, that there is no particular use in building a sanitary privy unless every member of the family uses it regularly. Filth deposited on the ground behind the barn or in the fence corner is just as dangerous as that deposited in an insanitary privy. If there is objection on the part of the male members of the family to using the house privy a separate privy should be constructed for their use, located somewhere about the barn. If a stool is deposited in the fields or anywhere on the farm other than in a sanitary privy it should be immediately covered with earth.

Next in importance to the privy is the well or spring. Here again the thing to be done is simple in the extreme. All that is necessary is so to protect the well or spring that no surface water can get into it, and that no filth or trash can be washed or carried into it.

A well should be located as far as possible from the privy. It should be provided with a good curb of brick or cement, going several feet into the ground and rising several feet above it. The well platform should be be absolutely water-tight. The pump should sit on a shoulder raised a couple of inches above the platform, so that the joint between the pump and the platform may not admit water. The well should, wherever possible, have a watertight casing extending down to the water-bearing strata. For this purpose terra cotta sewer pipe, with the joints laid in cement, is almost ideal. The purposes of the well construction are to prevent any water from getting into the well,

except that which has been filtered by passing through many feet of soil and which comes from the water-bearing stratum. underground, and to keep all filth of any character from getting into the well. It is after all only a matter of common sense.

The protection of a spring is also simple. The spring should be walled about with a water-tight coping to keep surface water from the slope above it from washing in. The spring should be covered, and wherever possible be provided with a pipe or spout, so that the bucket may be set under the spout and not have to be dipped into the spring. The bucket is not always clean on the outside.

When the water supply and the privy are properly cared for on the farm, the farmer has done about all that can be done to protect the family against typhoid originating on the place. The rest is a matter of ordinary cleanliness; washing the hands before eating or before handling food, washing the hands before milking, and above all washing the hands well immediately after attending to the needs of

nature.

The principles outlined in this brief article may seem so elementary as to be unworthy of notice. One need only recall, however, that they are violated on practically all Ohio farms today, and that as a result typhoid fever prevails as extensively in the rural districts as in the crowded cities. If the farmers of Ohio would attend to these simple matters it would save thousands of cases of typhoid every year.

Any farmer desiring more or detailed information on this subject should write the State Department. of Health at Columbus.

The Laboratory and Typhoid Fever

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YPHOID fever was one of the first of human infectious diseases to yield the secret of its parasitic cause and control to laboratory investigation. The value of the laboratory in controlling typhoid fever has been conclusively demonstrated. It is useful in the following ways:

1. In assisting the practitioner in making a diagnosis.

2. In ascertaining the source of infection.

3. In determining when the convalescent is no longer a source of danger to others.

4. In making and distributing vaccines.

The clinical symptoms of typhoid fever are not always sharply defined. Physicians experience great difficulty in diagnosing the disease, especially in the earlier stages, and often confuse it with malaria, tuberculosis and some other diseases. In treating typhoid an early diagnosis is very important and can be assured only through laboratory methods.

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bator the inoculated bouillon is examined for the presence of a motile bacillus, which if found is further tested for typhoid by cultural and agglutination methods. Typhoid bacilli appear in the blood early in the disease. After the first week the percentage of positive findings. decreases rapidly.

The

A more widely used and almost as reliable method of laboratory diagnosis is the Gruber-Widal reaction. This makes use of the fact that in the blood of patients suffering from typhoid, certain antibodies are produced which are called agglutinins. These agglutinins possess the power of rendering the organisms motionless and of grouping them into clusters, or clumps as they are called. technic consists in mixing the blood serum of the patient with a known culture of typhoid in a dilution of at least one to forty. A dilution below one to forty may give false readings, as the blood of healthy individuals often gives agglutination in low dilutions. After an hour the action, if it is to take place, is completed. Dried blood may be used, only a drop on a slide being necessary, but it is preferable to submit several drops in a small tube so that an accurate dilution of the serum may be used. In case the specimens are to be mailed most laboratories recommend the use of dried blood. This reaction is specific; that is, with, certain exceptions, agglutination occurs only if the patient is suffering from typhoid, and not if from some other disease. The exceptions to this statement are that the reaction oc

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