Preventable Diseases

by Woods Hutchinson

Doubtless certain habits of our own to-day will be regarded with equal disgust by our descendants. Typhus, by the way, may possibly be remembered by the dramatic "Black Assize" of Oxford, in 1577, in which not merely the wretched prisoners in the jail, but the jurors, the lawyers, the judges, and every official of the court were attacked, and many of them died.

It was only in 1856 that the method of transmission of the disease was clearly recognized, and in 1880 that the bacillus was discovered and identified by the bacteriologist Eberth, whose name it bears, so that it is only within the last thirty years that real weapons have been put into our hands with which to begin a fight of extermination against the disease.

What is the habitat of our organism, and is it increasing its spread? Its habitat is the entire civilized world, and it goes wherever civilization goes. In this sense its spread is increasing, but, in every other, we have good ground for believing that it is on the wane. Positive assurance, either one way or the other, is, of course, impossible, simply for the reason that the disease was not recognized until such a short time ago that no statistics of any real value for comparison are available; and, secondly, because even to-day, on account of its insidious character and the astonishing variety of its forms, and degrees of mildness and virulence, a considerable percentage of cases are yet unrecognized and unreported.

It might be mentioned in passing that this statement applies to the alleged increase of nearly all diseases which are popularly believed to be modern inventions, like appendicitis, insanity, and cancer. We have no statistics more than thirty years old which are of real value for purposes of comparison.

However, when it comes to the number of deaths from the disease, there is a striking and gratifying diminution for twenty years past, which is increasing in ratio instead of diminishing. That we are really getting control of typhoid is shown by the, at first sight, singular and decidedly unexpected fact that it is no longer a disease of cities, but of the country. The death-rate per thousand living in the cities of the United States is lower than in the rural districts. For instance, the mortality in the State of Maryland, outside of Baltimore, is two and one-half times as great as that in the city itself. Our period of greatest outbreak in the large cities is now the month of September, when city dwellers have just returned from their vacations in the pure and healthful country, bringing the bacilli in their systems.

The moral is obvious. Great cities are developing some sort of a sanitary conscience. Farmers and country districts have as yet little or none. Bad as our city water often is, and defective as our systems of sewage, they cannot for a moment compare in deadliness with that most unheavenly pair of twins, the shallow well and the vault privy. A more ingenious combination for the dissemination of typhoid than this precious couple could hardly have been devised. The innocent householder sallies forth, and at an appropriate distance from his cot he digs two holes, one about thirty feet deep, the other about four. Into the shallower one he throws his excreta, while upon the surface of the ground he flings abroad his household waste from the back stoop. The gentle rain from heaven washes these various products down into the soil and percolates gradually into the deeper hole. When the interesting solution has accumulated to a sufficient depth, it is drawn up by the old oaken bucket or modern pump, and drunk. Is it any wonder that in this progressive and highly civilized country three hundred and fifty thousand cases of typhoid occur every year, with a death penalty of ten per cent? Counting half of these as workers, and the period of illness as two months, which would be very moderate estimates, gives a loss of productive working time equivalent to thirty thousand years. Talk of "cheap as dirt"! It is the most expensive thing there is.

Typhoid still abundantly earns its old name of "military fever," and its sinister victories in war are even more renowned than its daily triumphs in peace. Strange as it may seem, the deadliest enemies of the soldier are not bullets but bacilli, and sewage is mightier than the sword. For instance, in the Franco-Prussian War, typhoid alone caused sixty per cent of all the deaths. In the Boer War it caused nearly six thousand deaths as compared with seven thousand five hundred from wounds in battle, while other diseases caused five thousand more. In the majority of modern campaigns, from two-thirds to five-sixths of all deaths are due to disease and not to battle. It may be that we sanitarians will achieve the ends of the peace congresses by an unexpected route, and make war a healthful and comparatively harmless form of national gymnastics. Its battle-mortality rate, for the number engaged, is not so very far above football now!

Given the bacillus, how does it get into the human system? Here the evidence is so abundant and overwhelming that we may content ourselves with bald statements of fact. The three great routes of this pestilence are water, milk, and flies. Of the three, the first is far the most common and important. While only a rough statement is possible, probably eighty-five per cent of all cases from water, five per cent from milk, five per cent through flies, and five per cent through other channels, would fairly represent the percentage.

That it is conveyed through water is as certain as that the sun rises and sets. The only embarrassment in proving it lies in selecting from the swarm of instances. There is the classic case of the Swiss villages on opposite sides of the same mountain chain, the second of which drew its water-supply from a spring that came through the mountain from a brooklet running by the first village. Typhoid fever broke out in the first village, and twenty days later it appeared in the second village, twenty miles away on the other side of the mountain. Colored particles thrown into the brook on one side promptly appeared in the spring upon the other. Then there was the gruesome modern instance of Plymouth, Pennsylvania, in 1885. A single case of imported typhoid occurring on the watershed of a reservoir was followed, thirty days later, by an epidemic of eleven hundred cases in a population of eight thousand.

An equally vivid instance came under my own observation. A school and a penitentiary drew their water-supply from the same power-flume, carrying a superb volume of purest water from a mountain stream. Early in the autumn a single case of typhoid appeared in a small town near the head of the flume. The discharges were thrown into the swiftly running water. Two weeks later an epidemic of typhoid broke out in the school, and three weeks later in the penitentiary. An unexpected freak, however, was the appearance of fifteen or twenty cases in another state institution farther down on the same stream, which did not draw its water-supply from the flume, but from deep wells of tested purity. This was a puzzle, until it was found that, owing to a fall in the wells, the water from the flume had been used for sprinkling and washing purposes in the institution, being allowed to run through the water-pipes only at night, while the well-water was used in the daytime. This was enough to contaminate the pipes, and a small epidemic began, which promptly stopped as soon as the cause was suspected and the flume-water no longer used.