A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.
- Date:
- 1887
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
35/1022 (page 3)
![tion to the water-supply, we seem perfectly justified in supposing that the typhoid germs are brought into the body by means of water used in (banking or otherwise. Even then we are by no means wholly to disregard the character of the soil, for the disease-producing poison—not to speak of direct pollution—is probably often communicated to the well-water from the soil. The possibility of this will he especially great if the wells are near drains or cess-pools containing typhoid dis- charges. We believe the idea is continually gaining ground that no single “theory” can fully explain all the facts, and that the possibility of infection occurring in several different ways must be considered. Beside the possible inhalation of the poison, or the ingestion of polluted water, it may be that sometimes the disease is conveyed by food. For example, it has been remarked in England, and lately in Cologne, that the fever in certain epidemics was limited to individuals who had then- milk from one common source. In such cases, however, the probable cause is not a disease in the cows, but a pollution of the milk or the milk-cans by water. It is as yet doubtful if animals can have typhoid fever ; at any rate, all attempts at artificial inoculation have had a negative result. This fact makes it uncertain whether the illnesses which have been observed to follow the ingestion of the flesh of diseased calves (e. g., the epidemic of Kloten) are actually to be considered typhoid fever, although the pathological changes are said by Huguenin to be very similar to those found in typhoid. Finally, it seems very probable that persons who come into direct contact with typhoid discharges are thereby exposed to the danger of infection. Many deny this (vide supra), but it would explain why- nurses and laundresses, who have to handle clothing soiled by the discharges of patients, are comparatively often attacked by typhoid fever. Through the agency of dirty linen, utensils, etc., the poison may be spread even further. [It is not probable that sewer-gas in itself is an exciting cause of typhoid fever. Especially in large cities typhoid dejections are constantly finding their way into the sewers, which afford all the conditions favorable to the further growth and development of the poison. If, then, the drainage of any house is defective, the seeds of the disease can readily gain access to the interior of the house and infect susceptible individuals. One of the most instructive epidemics on record is that in Plymouth, Pennsyl- vania, a town of eight thousand inhabitants. In the spring of 1885 a disease, at first supposed to be of a strange character, broke out in the place, and, before it ceased, affected twelve hundred persons, causing one hundred and thirty deaths. It was soon found that the malady was typhoid fever, which arose from one case, briefly in this wise: In January, February, and March there was a case of typhoid in a house on a hill sloping toward a water-supply of the town. The dejections were thrown out on the snow, under which the ground was deeply frozen. On March 25th a sudden and great thaw occurred, the water did not sink into the ground, but ran immediately into the natural surface channels, and on April 10th the epidemic began. There were reasons, which it is not necessary here to detail, why the above source of water-supply was drawn upon to an unusual degree just at that time, but it has been shown that those who derived their water from other sources were spared by the disease. The original case came from Philadelphia, which was at that time unprovided with a board of health ; but the lessons of this epidemic, most carefully studied by competent physicians, have secured such a board, and will strengthen the position of every board of health in the country.] In almost all cases the intestine seems to be the actual gate of entrance for the typhoid poison into the human system. This is shown by the fact that in all cases which come to autopsy in early stages of the disease, the typhoid bacilli are mainly confined to the lymphatic tissues of the intestine. The typhoid poison](https://iiif.wellcomecollection.org/image/b21981565_0035.jp2/full/800%2C/0/default.jpg)
