Volume 1
A text-book of medicine for students and practitioners / by Adolf v. Strümpell.
- Adolph Strümpell
- Date:
- 1911
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf v. Strümpell. Source: Wellcome Collection.
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![the greatest factor in this connection, but the urine also often contains a great number of virulent typhoid bacilli. Of especial importance is the fact that, in a typhoid epidemic, there are numerous ambulant individuals who carry and discharge typhoid bacilli—individuals who do not seem to be seriously ill and complain of only indefinite symptoms, or are apparently entirely well. It is obvious that such “ bacillus carriers ” are often greater factors in the spread of the disease than the really sick patients who are in bed and isolated. It is also of epidemiological significance that individuals who have recovered from typhoid fever may for months [and even years] discharge virulent ty¬ phoid bacilli in their dejecta. As to the exact manner of transmission of the disease (i. e., the way in which the typhoid bacillus enters the body of a well person from the external world) there were, till recently, widely differing views. There were chiefly two contrasting theories, called, respectively, the 66 ground-soil ” and the “ drinking-water ” 1 theories. According to the former, which was maintained principally by Pettenkofer and his pupils, the ground soil was regarded as the chief place of development for the schizomycetic fungus of typhoid fever. The poison in the stools must first be changed by the soil before it becomes infectious. The “ ground air,” which is continually rising, carries the poison. The chief support of the ground-soil theory, beyond the results of comparing the character of the soil with the extent of the epidemics, consisted in the proof which Buhl and Pettenkofer have given (taking Munich as an example, and later Berlin and other places) that a relation exists between the varia¬ tions of the standing water in the soil and the frequency of typhoid cases. It appears that, when the water stands high (near the surface), fewer cases occur, and when it falls below the mean height cases are more numerous. Pettenkofer explained this relation by the fact that the level of the ground water is certainly an index of the moisture and other conditions of the soil upon which the development of the typhoid bacilli depends. This “ ground-soil ” theory is no longer tenable. The observations of Pet¬ tenkofer only indicate that the upper strata of the soil are but partial factors in the spread of the typhoid bacilli. Above all, it is highly improbable that the typhoid poison enters the organism by inhalation. All experiences show that the typhoid bacilli commonly gain entrance by being swallowed; it is unquestionable that the most common source of infection is water used for drinking and domestic purposes. This may become infected with typhoid bacilli in the most varied ways. In numerous typhoid epidemics of recent years, a definite relationship between the spread of the disease and the source of the water has been demonstrated. In addition, the typhoid bacilli have often been found in the suspected water. The infection depends, in many cases, on well water that becomes tainted from near-by privies or from other sources. It may also come from running water. Thus, for example, we so strikingly often have outbreaks of typhoidal disease among the employees in the Oder River service at Breslau. Of especial importance, however, are those epidemics of typhoid which arise from infected water flowing through pipe- mains into towns—the sources of the water having been polluted and the filtra- 1 Compare with what follows the statements concerning the aetiology of cholera, in which ■disease the same disputed points were in the past considered. 2](https://iiif.wellcomecollection.org/image/b3136276x_0001_0031.jp2/full/800%2C/0/default.jpg)
