The principles and practice of medicine : designed for the use of practitioners and students of medicine / by Sir William Osler.

  • William Osler
Date:
1918,
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine : designed for the use of practitioners and students of medicine / by Sir William Osler. Source: Wellcome Collection.

    33/1258 page 5
    meningeal and pleural exudates and from foci of suppuration in various parts of the body, the bacilli have also been isolated. A most important and remarkable fact is that at times they may be present in the stools of persons who show no symptoms of typhoid fever, but who have lived in very close asso¬ ciation with typhoid-fever patients. This is especially true of children. (c) The Bacilli outside the Body.—In sterile water the bacilli retain their vitality for weeks, but under ordinary conditions, in competition with saprophytes, disappear within a few days. The question of the longevity of the typhoid bacillus in water is of great importance, and has been much discussed in connection with the supposed pollution of the water of the Mis¬ sissippi by the Chicago drainage canal. The experiments of E. 0. Jordan would indicate that the vitality was retained as a rule not longer than three days after infection. Whether an increase can occur in water is not finally settled. Their detection in the water is difficult, and although they undoubt¬ edly have been found, many such discoveries previously reported are not cer¬ tain on account of the inaccurate differentiation of the typhoid bacillus and varieties of intestinal bacilli closely resembling it. Both Prudden and Ernst have found it in water filters. There are cities deriving their ice supply from polluted streams with low death rates from typhoid fever. Sedgwick and Winslow conclude from their careful study that very few typhoid germs survive in ice. The Ogdens- burg epidemic in 1902-T3 was apparently due to infection from ice. Typhoid bacilli were grown from frozen material in it (Hutchins and Wheeler). In milk the bacilli undergo rapid development without changing its appearance. They may persist for three months in sour milk, and may live for several days in butter made from infected cream. Robertson has shown that under entirely natural conditions typhoid bacilli may live in the upper layers of the soil for eleven months. Von Drigalski says if stools which contain typhoid bacilli are kept at room temperature the B. typhosus disappears in a few days. The direct infection by dust of exposed food-stuffs, such as milk, is very probable. The bacilli retain their vitality for many weeks; in garden earth twenty-one days, in filter-sand eighty-two days, in dust of the street thirty days, on linen sixty to seventy days, on wood thirty-two days; on thread kept under suitable conditions for a year. Modes of Conveyance.— (a) Contagion.—Direct aerial transmission does not seem probable. Each case should be regarded as a possible source of infection, and in houses, hospitals, schools, and barracks a widespread epi¬ demic may arise from it. Fingers, food, and flies are the chief means of local propagation. It is impossible for a nurse to avoid finger contamination, and without scrupulous care the germs may be widely distributed in a ward or throughout a house. Cotton or rubber gloves are used in some institu¬ tions. Even with special precautions and an unusually large proportion of nurses to patients, it was not possible to avoid “house” infection at the Johns Hopkins Hospital. T. B. Futcher has analyzed the 31 cases contracted in the hospital among our 'first 1,500 cases; physicians, 5* among a total of * Only three of these were in attendance on typhoid cases. Two of the five died.— Oppenheimer and Ochsner.
    digitised image 1
    digitised image 2
    digitised image 3