Rural Hygiene

by Henry N. Ogden

CHAPTER XVII

TYPHOID FEVER

The two diseases already described, tuberculosis and pneumonia, are by far the most serious of all the infectious diseases, being responsible in New York State alone, in 1908, as already stated, for 5727 deaths. No other infectious disease even approximates the virulence and deadliness of these two, and while some of the constitutional disorders, such as Bright's disease, diarrhœa, and irregularity of the circulation, each result in from 2000 to 3000 deaths, the cause and prevention of these are so little understood as to baffle the hygienist. There are a number of contagious diseases which, while comparatively unimportant in the number of deaths, yet are of concern because the cause of the disease is so well known that the means of prevention is quite within our power. Of these, typhoid fever, in New York State in 1908, among the rural population alone resulted in 437 deaths, a rate of 18.7 per 100,000 population. The facts substantiate the assumption that for every person dying with typhoid fever there are ten cases of it, so it is a fair statement that in the rural part of New York State, in 1908, there were not far from 5000 persons afflicted with this disease.

Perhaps one of the reasons why so determined a fight against this particular disease, involving only 5000 cases of illness during the year, has been made, is on account of the length of the illness in each case and on account of the fact that the disease usually attacks those in the very prime of life, from 15 to 40 years. It is also to be economically considered by reason of the loss of time involved in an illness of nearly two months and the loss of money implied in the nursing, doctors, and medicine. The movement against the disease is most encouraging because the line of attack is well known, and there is, humanly speaking, no reason at all why the disease should not be stamped out.

Cause of the disease.

Typhoid fever is a modern disease, and only for the last fifty years has it been recognized in medicine. It is caused by bacteria, and its manifestations are the results of bacterial growth in the body, chiefly in the smaller intestine. Here the toxin produces a violent poison which results in an attack of fever, lasting about six weeks. Owing to the bacterial growth, serious failings, commonly known as perforations, may develop after a severe attack, in the membranes and linings of the intestine, and the resulting inflammation is not infrequently the immediate cause of death. It is a thoroughly established fact that the disease is caused by a special type of bacteria and that if the bacteria could be killed outside the body, no transmission of the disease could occur. It is also true that if the disease germs could be destroyed within the body the patient would recover immediately, provided the toxins had not been already distributed through the system.

There are, therefore, two possible methods of doing away with typhoid fever, one by eliminating all possibility of transmission outside of the body of the patient and the other by killing the germs while in the body of the patient. The latter plan is not feasible, since no antiseptic has been found which will kill the germs without killing the patient. It has been discovered that a drug called utropin will act on the germs when located in certain parts of the body, as in the kidneys; but this drug, although very effective in destroying germs in those organs, has no effect elsewhere. In general, we must eliminate the disease by preventing its transmission from the sick to the well.

The bacillus of typhoid.

Unfortunately, the typhoid fever germ is comparatively hardy and is not so easily killed by unfavorable environment as is the germ of pneumonia, for instance. It lives in water and in the soil, although probably it does not increase in numbers in either place. Nor will it live in the soil or in water indefinitely, and a great deal of study has been expended in trying to determine just how long typhoid fever germs will live under different conditions. It has been found, for example, that drying kills the typhoid bacillus in a few hours, although a few may survive for days. Experiments have also shown that it cannot leave a moist surface. It cannot, for instance, jump out of cesspools and drains and take to flight through the air, conveying the disease.