In the last two years the New York Department of Health has been able to trace definitely several typhoid-fever outbreaks. In nearly every instance it was found that the disease could be traced to a “carrier.” A carrier is a person who has recovered from an attack of typhoid, but who remains infected. One outbreak of four hundred cases was traced to the infection of a milk-supply by a typhoid carrier who had had the disease forty-seven years before. In another outbreak of fifty cases the contamination was traced to a man who had the disease seven years before.
Within the last few months the case of “Typhoid Mary” has received much attention. This woman has recently brought suit against the Department of Health for damaging her career as a cook. For more than six months she was kept in a sort of exile by the department. Before that time she had been a cook in many households, and wherever she went typhoid fever followed her. Although she had suffered with the disease many years before she was apprehended, the germs were said to be still very lively in her system. The authorities asserted that her blood tests revealed that she was likely to communicate typhoid to any one at any time; and therefore Mary did no more cooking.
There is no telling how many carriers are loose in New York at present, and the only known way of averting the danger is by the use of the serum which the army has found efficacious. It is estimated that about three per cent. of those recovering from typhoid become bacillus-carriers. As yet typhoid vaccination is not compulsory among the public at large, as in the army; but a strong movement is felt in the city to make it so. When typhoid-fever becomes as thoroughly controlled as smallpox, or even as diphtheria, the death-rate will drop another point or two. It will be the last of the filth diseases to go. It is asserted by competent authorities that eighty-five per cent. of the cases are preventable.
OPINIONS OF AN EXPERT
DR. LEDERLE, Health Commissioner of New York City, says that while typhoid vaccination is likely to prove of untold benefit, other specific improvements should be made. There should be a more perfect control of the milk-supply. At present there is no central testing-station. He recommends also an improved method of sewage disposal, either by treatment or by carrying it farther out to sea, thus preventing pollution of the harbor. There should be a drainage of surrounding land to do away with mosquitos; improved methods of street-cleaning that would result in the prevention of flying dust-clouds; and the open garbage receptacles and dumps should be abolished in favor of cremation of all refuse. The campaign against the fly must be carried on more vigorously every year, and immediate steps are to be taken for the protection of all foods from fly contamination. This will be an extension of the control of food, together with the proper filtration of the public water-supply. Dr. Lederle says further that increased hospital facilities for contagious diseases are needed. There will be further popular education in sanitary matters, special stress being laid on the need of fresh air in homes, schools, factories, offices, theaters, and churches; and a comprehensive publication will be made, chiefly for the aid of the poorer classes, of the comparative nutritive and cost values of foods; and further changes in the customs of the time, due to these plans and to other activities, will result in a simpler manner of living. This should render overeating less frequent and reduce the consumption of alcohol and medicines.
Finally, in addition to these efforts, which are under the direction of public officers, the health commissioner declares that if the death-rate is to be further reduced, there must be in the immediate future two changes: first, a definite advance in bacteriological knowledge; and, second, a change in the attitude toward the health of our adult population.
“Save the babies!” was the cry of the last decade. “Save the middle-aged!” will be the cry of this. The real race suicide is not in the insufficiency of births, but in the inadequate knowledge of the diseases of maturity, and in the inadequate care and prevention of these diseases. Deaths from arterio-sclerosis, apoplexy, kidney affections, stomach disorders, and cancer are continuously on the increase, and have been for ten years past. Of the 75,000 persons that died in New York in 1911, 17,000 died of “middle-age complaints.”
The intense life of New Yorkers, their intemperance in eating, drinking, and working, contributes chiefly to the increase in the middle-age death-rate. However, Bright’s disease, diabetes, and cancer are not more a mystery than diphtheria was before antitoxin was discovered. Bacteriology has its fields of further effort well laid out in those directions.
It is the contention of those that give their lives to the study of the subject that “public health is a purchasable commodity.” The struggle, then, is between the death-rate and the dollar rate. Contribute more money to the cause of public health, and the death-rate will go down. Forty thousand babies were saved in 1910 at an average cost of eighteen dollars. It would have cost more to bury them, as the cheapest sort of funeral costs twenty-five dollars.
The appropriation for the care of the public health in New York is not niggardly; it is larger than in most cities. Still, it is not enough. Where the health officers ask for a dollar and a half, they get a dollar. The excuse is that the rest of the desired money is needed to improve parks and streets, for the police and fire departments, for the city government, the water-fronts, etc. Besides, the people of this city are absolutely obliged to spend about $100,000,000 a year on automobiles, candy, theaters, alcoholic drinks, tobacco, diamonds, and such other urgent needs of life. What is left over, after those necessities are provided for, goes toward the preservation of health!