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curs occasionally in cases of para- may also contain the typhoid baciltyphoid, especially if the blood has lus. Many epidemics have been not been diluted sufficiently and in definitely traced to a polluted water the cases of persons who have re- supply. The pollution is usually ceived preventive typhoid inocula- near by and there is a direct transtion or who have recently had ty- fer of fresh infection. Samples of phoid.

all water which is used for drinkIn interpreting results, therefore, ing purposes and regarding which it is important for the physician to there is any suspicion should be know whether the patient has had sent to the laboratory to determine typhoid previously or has been vac- the presence of pollution, and the cinated against typhoid. After all water should be considered unsafe attack of typhoid, agglutinins per- for use if samples are found to be sist in the blood for about two contaminated. No other single years, so that an examination made

measure in reducing typhoid fever within this period is of little value in cities has met with such success as a diagnostic measure. The as substituting a safe water for a same statement holds true in cases polluted supply of vaccinated persons. Agglutinins Many outbreaks of typhoid fever are not as a rule detected in the have been due to milk infected blood until the fifth day and often either directly with typhoid excreta not until the tenth. Consequently, or by polluted water used in rinsing the result of an examination made cans or other utensils. In many inbefore the fifth or seventh day has stances the presence of typhoid invery little significance.

fection in milk has been traced to This phenomenon may be ob- "typhoid carriers" employed in the served either under the microscope handling of the product. or in a test tube with the naked eye. Milk is a favorable medium for The former is the method used in the growth of typhoid organisms, most laboratories.

which multiply rapidly in it. It is Another way in which the lab- with great difficulty that typhoid is oratory has proved its value in isolated from milk and the milk combating typhoid is in ascertain- responsible for an epidemic is seling the source of infection. It has dom available for analysis. Howbeen well established that the ty- ever, the source of infection in phoid bacillus is transmitted di- milk epidemics may be determined rectly through water, milk and indirectly through laboratory methother foods, such uncooked ods. vegetables and oysters, through Some epidemics have been traced flies and through the so-called car- to the eating of raw oysters. It riers. It is almost impossible to was discovered that these oysters detect the typhoid organism itself had been planted in polluted in water. However, if there is ty- streams, a method which some oysphoid present the water is also al

ter men practice to fatten their most certainly contaminated with product Oysters suspected of excreta. As all excreta contain coming from such streams should members of the colon group the

be examined for the presence of detection of this organism in water the colon bacillus, which indicates indicates pollution and there is such contamination. strong probability that such water The fact that persons who have

as

suffered from an infectious disease carriers generally give a positive may continue to harbor the organ- Widal test it greatly facilitates isms of the disease after ap- matters to examine the excreta of parent recovery from it has long those giving the positive reaction been recognized. Investigations first, in order to detect the carriers. have shown that about four per- Even after long and heroic treatcent of the recovered cases of ty- ment many individuals still conphoid remain "carriers” for vary- tinue to have the organisms and ing lengths of time, some even for offer a most perplexing problem years. So-called healthy carriers to health authorities. give off virulent organisms in their One of the important means in feces and urine in enormous num- preventing the spread of typhoid bers. These carriers are a source fever is the use of vaccines. In of the greatest danger. Many 1896 Pfeiffer and Kolle tried the cases of typhoid have been traced effect of giving human beings small to cooks in restaurants and private injections of typhoid bacilli. It families. Some cooks have become was discovered that a few doses notorious on account of the trail had the effect of producing aggluof typhoid they have left behind tinins in the blood of these individthem. Fortunately the presence of uals, which indicated that they were typhoid in excreta can be demon- probably protected against typhoid strated by laboratory methods. fever. At the same time Wright The excreta of all typhoid conva- began injecting British soldiers lescents engaged in the handling of

who volunteered for the purpose. food stuffs should be submitted for Today all the soldiers of the bacteriological examination and world are given protective inocuproved to be free from typhoid in- lations of typhoid vaccine. The fection before such persons are

present world has demonallowed to resume their former strated without question the value occupations. As many carriers of typhoid vaccination. During give off typhoid organisms only the Franco-Prussian war sixty perintermittently, two or more exami- cent of all deaths were due to tynations should be required. Speci- phoid. Today in both the German mens should be examined within and Allied armies typhoid is exa few hours after they are taken, tremely rare. During our or where this is impossible speci- Spanish-American War there were mens of stools should be sent to seven times as many deaths from the laboratory in twenty percent typhoid as from bullets. One-fifth glycerine and saline.

of the enlisted men contracted the The method of detecting the disease. In 1912 vaccination was organism in excreta consists in made compulsory in the l'nited plating the material on special dif- States Army, with the result that ferential media, and isolating sus- there developed only twenty-seven picious colonies. These are subse- cases that year. In the following quently confirmed by cultural and year this number was reduced to agglutinin tests. Where a number four. Today, although we have of people are under suspicion of over two million men under arms, being carriers, specimens of the the weekly reports from the surblood are usually taken and sub- geon general's office show no cases unitted for the Widal reaction. As of typhoid. This disappearance of

war

Own

typhoid from the army cannot be tested by animal inoculations and attributed only to improvements in cultural methods for the presence sanitation, as outside the army of other living organisms, especamps the men are subject to the cially tetanus. same conditions as in civil life,

Typhoid fever is still a disease where typhoid still prevails ex- of the greatest significance, ranktensively.

ing fourth among the diseases causSeveral methods of making and

ing death and disability. There are administering typhoid vaccine are

encouraging prospects, however, in use. At the present time the use that this foe of human life can be of a single strain is generally em- entirely abolished, and certainly the ployed, three injections being

being laboratory will play no mean part given. In the United States Army

in accomplishing this end. this method has produced superior

R. V. S. results. Some workers use several strains in combination in order to insure protection against the possibility of several types existing.

Whooping Cough Strikes Others also consider it advisable to

Heavily combine the typhoid with the para- The dangers of whooping cough typhoid strains in order to protect to

young children were again against paratyphoid fever, which is

brought to notice in two news items very similar to typhoid. Whatever which appeared within a few days method is used, the inoculation pro- of each other last month. One duces in the individual usually only told of the death of three children a discomfort which lasts but a few from the disease within two days days. Some persons are entirely in Tiffin, the second told how the unaffected. Serious or permanent disease had taken two children results probably never follow the from each of two Columbus houseinoculation.

holds in two successive days and The laboratories of the Ohio

the third told of still another death State Department of Health manu- in Tiffin. facture typhoid vaccine and distribute it to physicians free of charge upon request. This vaccine is made according to the methods

Lima Regulates Barber-shops of the l'nited States Hygenic Lab- Sanitary methods in barberoratory. Only one strain is em- shops are required under regulaployed, care being taken to secure tions recently passed by the Lima one that produces strong agglu

board of health. The regulations tinins. This property is regarded were drawn up by the barbers as most essential. The vaccine themselves, acting through their consists of an emulsion of the ty- union. Regular inspections are to phoid bacillus killed by heat. The be made of all shops. A permit emulsion is so diluted that the from the board of health inust be doses consist of about five hundred obtained by anyone desiring to opmillion and one billion organisms erate a barber-shop. All instrurespectively. Each dose is placed ments must be sterilized after each in an ampoule and preserved with time used and no powder-puffs or tricresol. The finished product is sponges may be used.

Typhoid Fever As a Contagious Disease

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HEN one studies the re- the case should, therefore, disinfect

ports of typhoid fever her hands by washing with soap

which come to the State and water, soaking them in disinDepartment of Health

is fectant and then rinsing in clean struck by the number of cases water every time she performs any which occur in families in which service for the patient, and always there have previously been cases of before leaving the sickroom to go the disease. The usual history of to any other part of the house. these cases is that of a first case, The dishes from the sickroom contracted perhaps away from should always be placed in a sepahome, which is followed after a

rate pan and boiled before being couple of weeks by another case, handled. They should be entirely evidently contracted from the first

separate from those used by others case, and frequently even by other

of the household. cases, until sometimes the whole

The bed and body linen of the family is stricken one after an

patient should likewise be put into other.

a wash boiler, covered with water These secondary cases are prac- and boiled before being handled by tically always" unnecessary and anyone outside the sickroom. easily preventable. Typhoid fever

In view of the fact that these is not contagious like measles or

precautions require great care and scarlet fever, in that one may con- vigilance for success, it is well for tract it by simple bodily contact those who are called on to nurse with a previous case.

It is con

a case of typhoid, or who live in a tracted only when some of the house where there is a case, to progerms from the body of the patient tect themselves still further by subare actually introduced into the

mitting to typhoid vaccination. mouth of a well person. This sort The process is not dangerous and of infection may be prevented by causes only slight disturbance in care on the part of those who have

most cases, and it affords very the nursing of the case.

great protection against the disease. To prevent the spread of typhoid The carrying out of the precaufrom a case the first care should tions outlined above, by those who be to disinfect the discharges from are immediately in contact with the bowels and bladder of the case. cases of typhoid fever would save These discharges are the principal several hundreds of cases in Ohio source of the infection and consti

every year. tute the greatest danger. Even if the discharges are carefully disinfected, however, there is danger that the hands of the attendant Good health at home is as immay have become soiled. The portant a factor in the war as good nurse, or other person attending health in the field.

1

Four of Five Largest Ohio Cities Have Typhoid

Death Rates Under 10 Per 100,000 for 1917

Of the five Ohio cities with more than 100,000 inhabitants, according to the 1910 census, four had typhoid death rates of less than 10 per 100,000 population in 1917. This information is gained from the sixth annual report of the Journal of the American Medical Association on "Typhoid in the Large Cities of the United States.". The four cities

'1 with low rates are: Cincinnati, with a rate of 4.1; Cleveland, 7.1; Columbus, 7.6, and Toledo, 9.7. Dayton's rate was 13.7.

The following table, comprising statistics taken from the Journals tables for the country at large, shows the changes in the typhoid rates in recent years in the five Ohio cities :

DEATHS FROM TYPHOID PER 100,000 POPULATION. City.

Average Average 1917. 1916.

1911-15. 1906-10. Cincinnati

4.1 3.4 7.8 30.1 Cleveland

7.1

5.3 10.0 15.7 Columbus

7.6

13.4 15.8 40.0 Toledo

9.7 22.9 31.4 37.5 Dayton

13.7 14.7

14.8

22.5 Especially noteworthy was ently indicating that the lack of Toledo's great improvement con- sewer connections has a good deal cerning which the Journal says: to do with the occurrence of "Toledo, for the first time, shows typhoid in that town. a substantial reduction in the ty- The cities given "first rank” phoid rate. It is no longer in the those with rates under 5.0, among fourth rank (cities with a typhoid which Cincinnati is the only Ohio rate of over 20), whereas in 1916 city included, are (with their it was the only Northern city in rates): that unenviable position." The 1916

Chicago

1.7 rate in Toledo was 22.9. The city's Oakland, Calif.

1.9 average rate for the period 1911-15

St. Paul

2.4

2.5 was 31.4, and for 1906-10 was 37.5.

Tacoma, Wash.
Boston

2.9 The Journal's comment on Day

Rochester, N. Y.

3.1 ton is as folows: "Dayton seems Jersey City

3.2 to have a relatively high rate for Newark, N. J.

3.5

3.7 a Northern city, and does not show

Camden, N. J
New York

4.0 as marked improvement in the Cincinnati

4.1 past two years as do some other

Cambridge, Mass.

4.4 cities in this group (of cities from Worcester, Mass.

San Francisco

4.9 100,000 to 125,000 population). A careful study of typhoid in Day- Cincinnati therefore stands ton in 1917 was made by the health eleventh among the sixty cities commissioner, the study appar- covered by the survey.

In its 'Journal of the American Medical Association, LXX, 11 (March 16, 1918).

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