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or Enteric Fever Typhoid Fever

water, polluted, drinking, especially, disease, infection and germs

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TYPHOID FEVER, or ENTERIC FEVER, a specific continued fever of long du ration and communicable, due to the Bacillus typhosus or Eberth's bacillus. It is usually attended with diarrhcea,sometimes with an eruption and is characterized by inflammation and ulceration of Pcyer's patches (q.v.) in the small intestine, by enlargement of the spleen and mesenteric glands and catarrhal inflamma tion of the intestinal mucous membrane. It is one of the exanthemata (q.v.). This fever was called typhoid and at one time abdominal typhus, from its supposed resemblance to typhus fever (q.v.). It has also been known as low and as slow fever and as autumnal or fall fever. It is considered to 'be a preventable disease, yet it prevails frequently as an endemic and epidemic, especially in large cities, destroying many lives. It occurs most often in the fall and early winter and mostly between the ages of 18 and 45, when men especially are less prudent and run more to excesses than at other periods of life. Improper dwellings and bad sanitary environments, excess in eating and drinking, want of sleep and too much mental work — by these the vitality is un dermined, predisposes persons even in the prime of life to the onset of typhoid, especially if it be prevailing in their community. It is believed that the blood of such persons has undergone some chemical change which has diminished its bactericidal quality and so lowered its inherent power of resistance to disease. It is not very uncommon to find cases of "walking typhoid," Le., persons not sick but having a temperature of 102° to especially toward evening.

Typhoid fever is frequently, if not always, a seliticamic disease and its range of infectivity is greater than is usually supposed. The bacillus has been found in the blood, urine, faces and sputum. Milk, vegetables, flies, oysters, etc., are bearers of the germs, while the bacilli may be conveyed by air to the respiratory mucous membrane and their initial colonization take place there rather than in the gastrointestinal tract. Typhoid fever like cholera is consid ered as ((ingestion infection" and both are disseminated from the excreta, vomit and per haps sputum. But drinking water polluted by the bacilli through infected sewage, etc., is the most frequent cause of typhoid infection. Germs from a single case of typhoid may find their way into springs and other sources of water supply and cause widespread dissemina tion of the disease. The epidemics in Lausanne,

Switzerland (1872), Chicago and Philadelphia (1890-1900) and Ithaca, N. Y. (1903), are ex amples of typhoid outbreaks caused by polluted water. "In Vienna, when for a period the water supply from guarded springs was turned into the city, typhoid which had persisted in epidemic form for years almost entirely disappeared and when as the drier season advanced this purer supply was insufficient and the water of the Danube was again turned on the scourge broke out with renewed violence but in those parts of the city supplied by river-water. This experience was repeated in Paris and it is practically true of every city supplied with drinking water from exposed streams and lakes." Freezing does not sterilize water so that contaminated ice used in drinking fluids or coming in direct contact with food is a source of infection. The boiling of water is a safeguard while filtration is not trustworthy in the elimination of infective or ganisms. Next to infected drinking water in fected milk is the most common cause of typhoid through the polluted hands of milkers or from the washing of receptacles for milk in cold water polluted by typhoid discharges. Such vessels should be thoroughly scalded. The ingestion of uncooked articles of food and especially of salad vegetables — lettuce, celery, etc.— raised in ground fertilized by infected sewage, is a source of infection, as is the in gestion of oysters and clams grown in water similarly contaminated. Dust carrying typhoid germs, if inhaled, may convey the disease into the system. That flies which have found access to the excrement of typhoid fever patients may carry the infecting organism to food and so produce typhoid was proved in the Spanish American and the Boer wars. The danger of typhoid in is always imminent; soldiers will drink polluted water, not caring to wait till it is boiled; the ground becomes saturated with discharges ; flies and dust abound, and many of the men will not keep clean. "Typhoid fever in our camps," says Sternberg, °has been to a large extent due to the neglect of well-known sanitary measures." This has been the experi ence in nearly all wars.

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