A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck.
- Adolph Strümpell
- Date:
- 1901
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![there is an epidemic—water contaminated with typhoid bacilli certainly plays a frequent and most important part. All persons who indulge directly or indirectly (rinsing cooking utensils, etc.) in water from an infected spring or infected aque- duct are in danger of becoming ill. For example, it has been remarked in Eng- land, and lately in Cologne, that the fever in certain epidemics was limited to individuals who had their 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. 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. [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 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 source of water-supply was drawn upon to an unusual de- gree 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 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 probably SAvallowed, either directly with water or polluted food, or after being inhaled or 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 viable condition 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 thence goes on into the mesenteric glands, the blood-current, the spleen, and other organs. As in the case of most other infectious diseases, the occurrence of infection in typhoid is dependent not only on outward conditions, but also on an individual predisposition. Details of the circumstances attending this latter are as yet not at all accurately understood. Even in the worst typhoid centers, where the pos- sibility of infection must be universal, many escape the disease. Age has an indubitable influence upon the liability to the disease. Tj^hoid is especially a disease of youthful, vigorous individuals, of fifteen to thirty j^ears. 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](https://iiif.wellcomecollection.org/image/b21206296_0032.jp2/full/800%2C/0/default.jpg)
