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.
32/874 page 4
![tion being insufficient. The yearly endemic prevalence of typhoid in certain cities (Hamburg, Munich, St. Petersburg, etc.) is explained by the condition of the water in the conduits; it has already been frequently shown that typhoid can be almost completely checked by improvement in that direction. Not infrequently the transmission of the typhoid bacilli from water occurs indi¬ rectly—as, for example, by means of ice, artificial mineral waters, washed vegetables and other food stuffs, and, above all, by watered milk, which is an especially good culture medium for typhoid bacilli. Direct contagion of typhoid through the air does not exist. Although its importance is not to be overestimated, there is a certain amount of danger of transmission of the disease from a fyphoid patient to his environment. Nurses, physicians, and, in hospitals, other patients in the same ward, not infrequently become infected by soiling of the hands with stools or urine, kitchen utensils, linens, etc. The more unfavorable the surroundings (over¬ crowded neighborhoods, filth) the more readily can such types of contact- infection occur. The isolation of the typhoid patient is therefore desirable under any circumstances. Physicians may also become infected by post-mor¬ tem examination of typhoid cases. [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,. Pa., a town of eight thousand inhabitants. In the spring of 1885 a dis¬ ease, 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 J anuary, 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.] In almost all cases the intestine seems to be the actual point 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 is swallowed, either directly with'water or polluted food, or after being in some other way introduced into the mouth. | Raw oysters- grown in impure waters may convey the infection.—V.] If not destroyed in the stomach, it passes on in a viable state into the alkaline contents of the intestine, and here finds the conditions essential to its further development. It penetrates at first into the lymphatic follicles and Peyer’s patches, and](https://iiif.wellcomecollection.org/image/b3136276x_0001_0032.jp2/full/800%2C/0/default.jpg)
