The Prevention of Typhoid Fever
By Alfred B. Olsen
Typhoid fever is a dirt disease, a typical example of the preventable diseases that ought to be done away with entirely. Strict cleanliness, public and personal, is the essential weapon in the warfare against typhoid fever. Notification, quarantine, isolation, and disinfection are the most important means of insuring the necessary cleanliness. The bacillus typhosus is the offending microbe, and its invasion of the alimentary canal produces the disease; that is, provided the soil is favorable, and the victim of the invasion is not able promptly to destroy the germs before they gain a foothold and begin colonization. One of the most common means of infection is through our drinking water, and most epidemics of typhoid fever are believed to be water-borne. For example, there was an epidemic in Maidstone, England, in 1897, when 1,847 cases of typhoid fever occurred in the course of a few months. This epidemic was traced to the pollution of the water-supply by a colony of hop-pickers who suffered from typhoid fever. More recently the town of Lincoln, England, was attacked, and there were about nine hundred cases, the cause of which was believed to be due to the pollution of the Witham. To insure safe drinking water, it is necessary to distil or boil it before using. This applies not only to drinking water, but to all water used in the kitchen in the preparation of vegetables and other food and the cleaning of the dishes. There is no evidence that cattle suffer from typhoid fever, and consequently if milk becomes the carrier of typhoid fever, it is due to a local case of the fever among the dairy hands, or to contact with typhoid-contaminated water. For fifty years or more milk has been recognized as a disseminator of typhoid fever. The milk may become infected with the germs through washing the cans or other milk-vessels, or through diluting the milk with contaminated water. Flies, too, may infect the milk. Furthermore, direct contact with the course of infection is possible through carelessness in failing to wash the hands properly, or through other means. To prevent the transmission of typhoid by milk, see that it is Pasteurized before being used. The oyster has long been supposed to be an agent in the transmission of typhoid, and the case against it has been proved. In the mayoral banquets at Southampton and Winchester in 1902, there was in each case an epidemic of typhoid fever among the participants, and the infection was traced to the oysters. Some of the cases ended fatally. Consider for a moment the habitat of the oyster. It is a natural scavenger of the sea. It thrives on sewage, and not infrequently oyster-beds are planted in the vicinity of the sewage outflow for the purpose of providing the oysters with nourishment. Of course, as long as the sewage is free from the bacillus typhosus, the oysters will be comparatively harmless. Nevertheless they can not be considered wholesome. The safest way to treat oysters is to let them alone; then there will be no chance of their transmitting the fever. What is true of oysters is also believed to be true of mussels, cockles, and other shell-fish, all of which are none too particular in their feeding. If they become contaminated with sewage containing excreta of typhoid patients, there is real danger in eating them. It must be obvious to any one that if the stream in which watercress is growing becomes contaminated with typhoid excreta, there is danger of transmitting the microbes. Great care is necessary to maintain the purity of watercress beds; for it is quite impossible to free the cress from the germs of disease by washing. The time has come when we should recognize in the fly an implacable foe to health and life. The old-fashioned idea that the fly is an interesting insect, and quite harmless, is altogether wrong. The fly is a veritable pest, and every possible means should be taken to destroy the insect, and to keep it out of the home and away from food. The problem is a difficult one, but much can be done by burning as much rubbish and waste matter as possible, and by keeping the garbage receptacle a good distance from the house, and having it emptied regularly two or three times a week. As soon as the garbage-can is emptied, it should be scalded with boiling water and thoroughly rinsed. It should be kept covered always. Flies have been known to transmit the germs of typhoid as well as of dysentery and other microbic diseases. There is a common belief among the laity that sewer-gas is a direct cause of typhoid fever. This may be true, but if9so, the cases are rare. Still, small particles of the sewage may get into the air of the sewer, and so spread disease; and every precaution ought to be taken to prevent its gaining access to the house. The breathing of the sewer-gas at any time interferes with the appetite, lowers the vitality, brings on headache, and becomes an important predisposing cause of typhoid fever and other diseases. Perfect sanitation and good drainage are essential in the prevention of typhoid. A not uncommon mode of infection arises through direct contact with the sick-room and the patient. For this reason efficient quarantine and isolation are required in order to prevent the disease from spreading among other members of the family or the neighbors. The visiting of typhoid patients should be prohibited. Typhoid fever is associated with overcrowding, poor ventilation, and filth, hence it is not only more prevalent, but also more fatal, in the large towns and cities than in the country. But it is by no means confined to the poorer classes; for it is met with in all stations of life. It has recently been found that patients who have suffered from typhoid fever may continue to carry the germs for weeks, months, and even years afterward, and thus remain a source of infection. Such persons are known as “typhoid carriers.” Although typhoid carriers are fortunately not very common, yet the very fact that it is possible for a convalescent patient to carry the germs in the system for months and years, is of the greatest significance. It is a wise precaution in the case of convalescing typhoid patients to have the excreta examined, to ascertain that they are free from the germ, and to keep the patients under medical observation until this is the case. One of the most efficient means of combating typhoid fever is the proper treatment of the excreta. The stools should always be received in a vessel containing a strong disinfectant agent, and then they should be burned if possible. If they can not be burned, they should be well mixed with a strong disinfectant, and later buried where they can not possibly drain into any well or watercourse. Soiled linen should be promptly soaked in five-per-cent carbolic acid before washing. The nurse attending the patient should invariably wash the hands in an efficient disinfectant, and change the clothing before leaving the room. All possible precautions should be taken to destroy the germs at their source, and thus prevent the further spread of the disease. Such a course entails the most scrupulous and scientific cleanliness possible, but this is essential to success.