This Bulletin Will Be Sent To All In The State Who Ask For It Reasons Why You Should Let Patent Medicines Alone 134 136 Baby Killers.... 137 No. 4 COMMITTEE ON BULLETIN S. L. Jepson, Editor, G. D. Lind, Wm. W. Golden. Published Quarterly at the Office of the Board, Wheeling, W. Va. Entered as second class matter Feb. 19, 1914, at the postoffice, Wheeling. S. L. JEPSON, Editor, G. D. LIND, W. W. GOLDEN HYGIENIC LABORATORY JOHN N. SIMPSON, M.D., Director AARON ARKIN, Ph.D., M.D., Chief Bacteriologist and Pathologist This Bulletin will be sent to physicians, including County and Municipal Health Officers in the State. These officers should read the Bulletin carefully and preserve for future reference. Thus we may avoid repeating rules and general instructions given. Typhoid Fever Control By S. L. Jepson, Secretary State Board of Health. Typhoid fever is one disease that is almost constantly with us. It prevails more extensively in the late summer and autumn, but cases exist in populous communities the year 'round. Onefifth of a million cases are said to occur in the United States yearly, causing about twenty-five thousand deaths. While the statistics of this state are not accurately kept, and we therefore have no correct knowledge as to the number of cases of this disease occurring annually, yet from the imperfect returns of deaths it has been estimated that nearly seven thousand cases occur within the borders of this state annually-the number some years being less and others greater than this. In recent years the type of the disease seems to have changed somewhat, so that on the whole the disease is less malignant than formerly, and the mortality consequently lower; but it would be safe to say that five hundred patients die in the state each year from this disease. To say nothing of the unmeasured sadness and grief from this sickness and mortality, the expense in money outlay for physicians, nurses, medicines, special food and care is enormous; and little less is the money lost by compulsory absence from business and employment of the sick and their helpers. The sickness, the suffering, the money loss, the sorrow occasioned by this disease together make the control of typhoid fever, a disease generally classified as preventable, the greatest sanitary problem of the time. We know its causes, we have the means of destroying these causes. It seems worth while, therefore, to try to instruct the people as to the nature, origin, mode of propagation and sanitary management of this disease, to the end that they may, as far as possible, avoid its causes and co-operate with the attending physician and the sanitary authorities in preventing its spread once it makes its appearance in a community. Every intelligent layman now knows that typhoid fever is a germ disease. The germ is so minute that it can be seen only with a microscope, but this germ is capable of rapid multiplication if conditions are found favorable for its propagation. The disease does not spread by contagion as does scarlet fever, measles and other infectious diseases. One may remain indefinitely in the presence of a typhoid patient without fear of harmful results if he refrain from touching the patient or anything in the room that may be infected, or, in less technical language, poisoned. More than half a century ago Dr. Budd, a distinguished English physician, became convinced that this disease was communicated from the sick to the well through the excreta from the former's body, and now all physicians recognize the correctness of this view. It has often been demonstrated that both the urine and bowel discharges of typhoid patients are loaded with the germs, or bacteria, of the disease. The disease is conveyed by these germs or bacteria finding access to the stomach of the well person and in time entering the blood circulation. In plain language, one must swallow typhoid germs in order to contract typhoid fever. It is not a pleasant thought, and yet the statement is true, that "we have typhoid fever because our food and drink have become contaminated with the excretions, such as the stools, urine or the sputum of persons who have previously been infected with these disease-producing bacteria" (Richardson). It is true, however, that not all who swallow these germs contract the disease. Some persons have greater powers of resistance than others, and the systems of such persons seem able to combat successfully the invasion of these poisonous germs, which may pass through the bowels without doing any perceptable harm. They may even develop considerably in the bowels, and, in exceptional cases, may enter the blood stream without exciting the general symptoms of the disease which usually follows their presence. Such persons may constitute what are called healthy typhoid carriers, and they constitute a menace, since they are capable of conveying the disease to others without having it themselves. There are many ways in which the bacilli of typhoid fever may enter the body. Drinking water may become infected by typhoid excreta being carelessly thrown on the ground or into streams and later washed into the well, spring or other source of water supply. These germs do not live long in water. It is supposed that they perish in about a week; but water in running streams along which large populations reside is apt to become repeatedly infected from the many typhoid cases so generally present in large communities from which the drainage empties into those streams. It is a well established fact also that springs and wells in the country are often infected through contents of privy vaults, manure heaps, pig styes, etc., percolating through porous soil or fissures in the rocky ground; or from surface wash gaining entrance to wells through cracks in the well casing or the covering of the wells. One-third of all typhoid fever is tracable to infected water. S. C. Prescott of the Massachusetts Institute of Technology, examined 202 water supplies on dairy farms within 25 to 40 miles of Boston, "in a long-settled, intelli gent and well inspected region, probably rather superior hygienically to the rural districts of most of the country." And yet of these one-seventh were found to be so badly polluted that the water was rendered unfit for drinking or domestic purposes, or for the washing of milk utensils. This impurity the investigator found to be due to the location of wells in proximity to privies, sink drains or other sources of contamination (American Journal Public Health, September, 1913). Outbreaks of the disease have been traced to the ingestion of oysters fattened in infected beds, but this cannot be regarded as a common cause. Fruits and vegetables eaten raw may cause the disease if handled by persons with infected hands or washed in infected water. Ice also may become a source of danger. Not infrequently milk becomes infected. This may occur in the process of washing with infected water the cans and other utensils used in the handling of milk, or by diluting the milk with such water, which dishonesty we hope is not now frequently practiced. The germs live much longer in milk than in water, since milk constitutes what is known to physicians as a good culture medium, or, in other words, a good soil for the cultivation of bacteria which multiply rapidly and enormously in warm milk. Many outbreaks of typhoid fever have been traced to dairies. A method of milk infection somewhat recently discovered is from the handling of milk by persons known as "typhoid carriers." As already stated the typhoid germs are sometimes carried for weeks or months, in rare cases for years, in the intestines, gallbladder and other organs of persons who have previously gone through an attack of the disease. The carrier's hands are liable to become soiled with some of his own excreta which harbor these germs, and, unless extremely cleanly in his personal habits, in the process of milking or later in handling the milk it may become poisoned, and, as just pointed out, the germs rapidly increasing in numbers, the infection of those using the milk becomes a quite easy and natural process. Epidemics from this. cause are sometimes quite easily traced. It is found that of those attacked many are the young who use milk freely, and in the community where the disease prevails it is found that those who use milk from one dairy are victims of the disease, while the families procuring milk from other sources escape. Milk products also, as ice cream, butter, etc., may convey the disease. A few words more as to the typhoid carrier. Dr. Bolduan of the Health Department of the City of New York says that as a result of his investigation he finds about three per cent of persons convalescent from typhoid fever become germ carriers. Others claim that the percentage reaches 4 to 6. Regularly repeated examinations of the stools of such persons have shown that the excretion of typhoid bacilli is not constant. A stool showing very few of these germs may be followed by one showing great num |