TYPHOID FEVER.
PRoPuvLAxis.--This is of vital importance to the public health in a disease of such widespread distribution, frequent incidence and serious mortality. The Bacillus tvphosus is easily carried by water, milk, food contaminated by flies, shellfish as cockles, whelks and mussels collected from the polluted foreshore in the vicinity of maritime cities. and by the use of uncooked vegetables or salads soiled by the excreta of typhoid patients, and probably it is conveyed by the bites of insects.
The water supply obviously should be guarded against the possibility of contamination by rigid protection of the catchment area, conduit pipes, filters and house cisterns. In times of epidemic, house-filters should not be depended upon, hut all water used for drinking and cleansing purposes should be boiled. In many of the milk-borne epidemics the spread of the affection has been traced, not to disease in the milk-supplying animal. but to the use of polluted well-water employed in rinsing out the milk-pails. Acid Sodium Sulphate in tablet form is of great value for disinfecting doubtful water when boiling cannot be resorted to 15 grs. will sterilise 20 oz. water in 15 minutes.
The necessity of sterilising all milk admitted to the house, whether for the use of the healthy or for the typhoid victim, in areas where the disease is prevalent is also obvious.
Though the potentiality of sewer gas as a carrier of infection has been denied, nevertheless it is imperative that the house drains should he tested and put in perfect order. The writer has witnessed a formidable hospital epidemic caused by turning a jet of waste steam into a sewer, which caused all the house traps to be forced by the abnormal pressure. In this case an otherwise isolated building became converted into a hot-bed of typhoid fever which for ycars defied every effort made for its disinfection, one nurse after another becoming affected by the disease in spite of every precaution which perfect, cleanliness and a sterile milk and water supply provided.
The rigid isolation of the typhoid patient is necessary, and the treatment of such in the wards of a general hospital should not be permitted.
As the bacillus is excreted in the feces and urine of typhoid patients, these discharges should be rigidly sterilised by the use of strong anti septics before being emptied into the closet or buried in the soil. In the
latter medium the bacillus may retain its virulence unimpaired for at least a year. The best disinfectant and the cheapest is Chlorinated Lime, which should be previously placed in the bed-pan, night stool and urinal. Absolute cleanliness will effectually prevent the spread of the disease in all isolated cases.
It. has been a recognised fact that the bacilli may continue to be dis charged in the urine of patients long convalescent of the disease, since T. published his case in 1899, but the somewhat alarming discovery of the " typhoid-carrier " has upset all former calculations regarding the spread of the affection by personal contact. Many of these individuals present no history of ever haying suffered from typhoid fever, or they may have been victims to it several years before coming under notice; nevertheless, the bacilli are to be found in great numbers in their bile, bowel discharges, or in the urinary secretion.
The discovery of this source of the disease has introduced a new prob lem into the prophylaxis of typhoid fever. It may be regarded as proven that the bacilli in typhoid carriers are mainly produced in the gall-bladder. As they continue to be passed out in the aces and urine in enormous numbers during intermitting periods, and possibly for the whole length of a carrier's long life, the existence of these individuals is a standing menace to public health. Fortunately compulsory notification aids the health officer to trace each epidemic to its source, hut the new problem is—what is to be clone with the typhoid carrier as soon as he has been discovered ? (Theodore Thomson calculates that 3 per cent. of the patients who pass through an attack of typhoid fever become carriers; this would give ro8.000 carriers for England, and for London alone about 14,000.) The problem has been solved in lunatim practice by performing the operation of removal of the gall-bladder, but this is a measure to which few carriers would submit. Vaccine treatment, though successfully car ried out in a case by _Houston and Irwin, has failed in the hands of others, and it has been demonstrated that the opsonie index of the typhoid carrier is generally much above the normal.