Preventable Diseases

by Woods Hutchinson

Obviously, if infectious disease be, as we say, "self-limited," that is to say, if the body will defeat the invaders with its own weapons, on an average in nine cases out of ten, our wisest course, as physicians, is to back up the body in its fight. This we now do in every possible way, by careful feeding, by rest, by bathing, by an abundance of pure water and fresh air, with the gratifying result that we have already reduced the death-rate in most fevers, even such as we have no antitoxin against, or may not even have discovered the causal germ of, to one-half and even three-fourths of their former fatality. The recognition of the fact that disease has a natural history, a birth, a term of natural life and a death, has already turned a hopeless fight in the dark into a victorious campaign in broad daylight. Huxley's pessimistic saying that typhoid was like a fight in the dark between the disease and the patient, and the doctor like a man with a club striking into the mélée, sometimes hitting the disease and sometimes the patient, is no longer true since the birth of bacteriology.

Nowhere can the natural history of disease be more clearly seen or more advantageously studied than in the case of typhoid fever.

The cause of typhoid is simplicity itself, merely drinking the excreta of some one else, "eating dirt," in the popular phrase; simple, but of a deadly effectiveness, and disgracefully common. The demon may be exorcised by an incantation of one sentence: Keep human excreta out of the drinking water. This sounds simple, but it is n't. Eternal vigilance is the price of health as well as of liberty.

We can, however, make our pedigree of typhoid a little more precise. It is not merely dirt of human origin which is injurious, but dirt of a particular type, namely, discharges from a previous case of the disease. Just as in the fight against malaria we have not the enormous problem of the extermination of all varieties of mosquito, but only of one particular genus, and only the infected specimens of that, so in typhoid, the contamination of water or food which we have to guard against is that from previous cases. From one point of view, this leaves the problem as wide as ever, for, obviously, the only way to insure against poisoning of water by typhoid discharges is to shut out absolutely all sewage contamination. On the other hand, it is of immense advantage in this regard,—it enables us to fight the enemy at both ends of the line, to turn his flank as well as crush his centre.

While we are protecting our water-supplies against sewage, we can, in the meantime, render that sewage comparatively harmless by thoroughly disinfecting and sterilizing all discharges from every known case of the disease. A similar method is used in the fight against yellow fever and malaria. Not only are the breeding places of the two mosquito criminals broken up, but each known case of the disease is carefully screened, so as to prevent the insects from becoming infected, and thus able to transmit the disease to other human victims.

It cannot be too emphatically insisted upon that every case of typhoid, like every case of yellow fever and of malaria, comes from a previous case. It is neither healthy nor exhilarating to drink a clear solution of sewage, no matter how dilute; but, as a matter of fact, it is astonishing how long communities may drink sewage-laden water with comparative impunity, so long as the sewage contains no typhoid discharges. One case of typhoid fever imported into a watershed will set a city in a blaze.

The malevolent Deus in the sewage machina is, of course, a germ—the Bacillus typhosus of Eberth. The astonishing recentness of much of our most important knowledge is nowhere better illustrated than in the case of typhoid. Although there had been vague descriptions of a fatal fever, slow and lingering in its character and accompanied by prolonged stupor and delirium, which was associated with camps and dirty cities and famines, from as far back as the age of Cæsar, the first description clear enough to be recognizable was that of Willis, of an epidemic during the English civil war in 1643, both Royalist and Roundhead armies being seriously crippled by it. Since that time a smouldering, slowly spreading fever has been pretty constantly associated with armies in camps, besieged cities, filthy jails, and famines, to which accordingly have been given the names, familiar in historical literature, of "famine fever," "jail fever," and "military fever."

So slowly, however, did accurate knowledge come, that it was actually not until 1837 that it was clearly and definitely recognized that this famine fever was, like Mrs. Malaprop's Cerberus, "two gentlemen at once," one form of it being typhus or "spotted fever," which has now become almost extinct in civilized communities; the other, the milder, but more persistent form, which, like the poor, we have always with us, called, from its resemblance to the former, "typhoid" (typhus-like).

Typhus was a far more virulent, rapid, and fatal fever than its twin survivor, though as to the relations between the two diseases, if any, we are quite in the dark, as the former practically disappeared before the days of bacteriology. The fact of its disappearance is both significant and interesting, in that it was unquestionably due to the ranker and viler forms of both municipal and individual filthiness and unsanitariness, which even our moderate progress in civilization has now abolished. There can be no question that, with a step higher in the scale of cleanliness, and further quickening of the biologic conscience, typhoid will also disappear.

Typhus, the bubonic plague, the sweating sickness, were alike plagues and products of times when table-scraps were thrown on the dining-room floor and covered daily with fresh rushes for a week at a stretch, and fertilizer accumulated in a living-room as now in a modern stable. Clothing was put on for the season, shirts were unknown, and strong perfumes took the place of a bath. Michelet's famous characterization of the Middle Ages in one phrase as Un mille ans sans bain (a thousand years without a bath) was painfully accurate.