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

  • William Osler
Date:
1930
Catalogue details

Licence: Public Domain Mark

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

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    lected by Ernest Hart and by Kober. The germs may be conveyed in ice, salads of various sorts, spaghetti, etc. The danger of eating celery and other uncooked vegetables, which have grown in soil on which infected material has been used as a fertilizer, must not be forgotten. Much attention has been paid to the oyster as a source of infection, but it plays a very small relative part. In several epidemics, such as that in Middle- town, reported by Conn, that in Naples, by La vis, and the outbreak at Win¬ chester, the chain of circumstantial evidence seems complete. Foote showed that oysters taken from the feeding-grounds in rivers contain a larger number of microorganisms of all sorts than those from the sea. Chantemesse found typhoid bacilli in oysters which had lain in infected sea-water, even after they had been transferred to and kept in fresh water for a time. Mussels have been found contaminated with typhoid bacilli, and it is stated that dried fish have carried the infection. (e) Flies.—The importance of flies in the transmission of the disease was brought out very strongly in the Spanish-American War in 1898. The Report of the commission states that “flies were undoubtedly the most active agents in the spread of typhoid fever. Flies alternately visited and fed on the in¬ fected faecal matter and the food in the mess-tent. . . . Typhoid fever was much less frequent among members of the messes who had their mess-tents screened than it was among those who took no such precautions/7 Firth and Horrocks demonstrated the readiness with which flies, after feeding on typhoid stools or fresh cultures of typhoid bacilli, could infect sterile media. One of the most interesting studies was made in the Chicago epidemic of 1902 by Alice Hamilton. Flies caught in two undrained privies, on the fences of two yards, on the walls of two houses, and in the room of a typhoid fever patient, were used to inoculate eighteen tubes, and from five of these tubes typhoid bacilli were isolated. (/) Contamination of the Soil.—This is important if water supplies are infected as a result. Filth, bad sewers, or cesspools can not in themselves cause typhoid fever, but they furnish the conditions suitable for the preservation of the bacillus, and possibly for its propagation. Dust may be an important factor, though the bacilli usually die quickly when desiccated. Types of Infection.—We may recognize the following groups: (a) Ordinary typhoid fever with marked enteric lesions. An immense majority of all cases are of this character; and while the spleen and mesenteric glands are involved the lymphatic apparatus of the intestinal walls bears the brunt of the attack. (b) Cases in which the intestinal lesions are very slight, and may be found only after a very careful search. In reviewing the cases of “typhoid fever without intestinal lesions,77 Opie and Bassett call attention to the fact that in many negative cases slight lesions really did exist, while in others death occurred so late that the lesions might have healed. In some cases the disease is a general septicaemia with severe intoxication, high fever and delirium. In others the main lesions may be in organs—liver, gall¬ bladder, pleura, meninges, or even the endocardium, (c) Cases in which the typhoid bacillus enters the body without causing any lesion of the intestine. In a number of the earlier cases reported as such the demonstration of the typhoid bacillus was inconclusive. In others the intestine showed tuberculous ulcers, through which the organisms may have entered. But after excluding
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