A text-book of medicine : for students and practitioners / by Adolf Strümpell.
- Date:
- 1893
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell. 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.
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![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 iinding 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 hundi'ed and thu'ty 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 tj'phoid in a house on a hill sloping toward a water-supply of the town. The dejec- tions 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 soui'ce of water-supply was drawn upon to an unusual de- gree just at that time, but it has been shown that those who derived theii* water from other sources were spared hy the disease. The original case came from Phil- adelphia.] 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 (bacilli or spores) is pi'obably swallowed, either directly with water or polluted food, or after being inhaled or in some other way introduced into the mouth. If not desti'oyed in the stomach, it passes on in viable condition into the alkaline contents of the intestine, and here finds the conditions essential to its fui-ther development. It penetrates at first into the follicles and Peyer's patches, and thence goes on into the mesenteric glands, the blood-current, the spleen, and other organs. As in the case of most other infectious diseases, tlie occurrence of infection is dependent not only on outward conditions, but also on an individual predisposi- tion. Details of the circumstances attending this latter are as yet not at all accu- rately understood. Even in the worst typhoid centers, where the possibility of infection must be universal, many escape the disease. Age has an indubitable influence upon the liability to the disease. Typhoid is especially a disease of youthful, vigorous individuals, of fifteen to thirty years. Above that age it is noticeably less frequent, although cases do occur at sixty and even seventy years. Formerly it was often said that young children were never attacked; but this was because the disease was not recognized, for in reality it is only children under one year old who seem to be seldom infected. At a later age, cases are by no means rare. Sex can not be shown with, certainty to have an especial predispo.sing influence upon the frequency of typhoid fever. Mental excitement and gross errors in diet seem to predispose to the disease. On the other hand, a certain immunity has been alleged to be given by many cir- cumstances, especially pregnancy, the puerperal state, and other diseases already existing (tuberculosis, heart disease). Most of these statements are shown, how- ever, by more extended experience, to be veiy doubtful. It does seem to be certain](https://iiif.wellcomecollection.org/image/b21981553_0032.jp2/full/800%2C/0/default.jpg)
