1 Typhoid Fever-Its Preventable Causes. TYPHOID FEVER. ITS PREVENTABLE CAUSES. The following paper on Typhoid Fever and its preventable causes, by Prof. Robert Bartholow, M. D., LL.D., Professor of Materia Medica, Therapeutics and Hygiene in Jefferson Medical College, Philadelphia, and one of the most learned and revered men in his profession, gives so exhaustively, clearly, concisely and authoritatively withal, the best means of preventing Typhoid Fever, it is deemed worthy of a place in this report, and of earnest perusal by every citizen of the State: GERMS [MICRO-ORGANISMS; MICROBES:] ARE THEY CAUSATIVE OF SPECIFIC DISEASES? FORMER THEORIES OF TYPHOID GENESIS. Only within a comparatively short period has it been held that Typhoid Fever is produced by some special poison. It was not until the agency of the minutest living bodies in Nature was known (microscopic organisms, "Animalcules" in common language), that the character of the Typhoid poison began to be understood. It was held until recently that the Typhoid-producing agent was developed in the course of "crowd-poisoning," which is a necessary result of the aggregation of human beings in masses. Human ordure in cess-pools, under conditions not known, was supposed to be an important poison, or a source of poison-generating material. Sewer gas also, was considered to have the same morbific or pathogenic power. That the noxious matters generated by the conditions of crowd-poisoning were active in the genesis of Typhoid was considered proven by the fact that as density of populations increased, so the number of fever cases increased. It was observed in this country that in the sparse settlements within the Malaria zone, malarial fevers first occurred; but when the density of the Typhoid Fever-Its Preventable Causes. population became sufficient, Typhoid supplanted malarial fevers to a considerable extent. In the progress of scientific knowledge it has been found that another explanation must be given, and the theory of a Typhoid poison only becomes tenable by the discovery of morbific germs—micro-organisms or microbes (bacteria or bacilli). The modern scientific definition of Typhoid and similar maladies, is that they are specific diseases arising from a special cause, are continually reproduced according to the original type or pattern, and are self limited in duration. Modification of symptoms, or of the external form, or of the whole morbid complexus may be imposed by the surrounding conditions-by race, climate, social state and other circumstances to a limited extent; but the typical form persists, the essential changes of structure are always to be found, and in these, conformity in essentials to the original is preserved. What is true of the disease in its symptoms and in its morbid changes, is also true of its germ, in that the life-history of special organisms is correspondent in all important details, and they continually reproduce themselves in conformity to the laws of their being. It should be distinctly recognized that each special germ produces its own kind, and not another kind. The old phrase "like produces like" continues eternally true. Also in the vegetable kingdom forms are constantly reproduced through all time although they may be modified somewhat by their environments. A grain of wheat, sown in suitable soil, produces wheat only. The same law governs the germs of disease; they produce their own kinds of disease, and these diseases, age after age, manifest themselves by the same external symptoms and internal changes of structure. In the natural history of Typhoid Fever we have a typical illustration of the same law. The first accurate description of this fever is equally descriptive of the fever of our day, and no modification is necessary, because a new discovery-the Typhoid germ-has now to be reckoned with. It is understood, therefore, that Typhoid Fever is a special or specific form of fever and that its real source, its germ, or seed, or special organism, always produces its own kind. The product Typhoid Fever--Its Preventable Causes. developed by the growth of its germ may take on some peculiarities of form, but remains typical always in respect to essential features. The soil in which the germ is planted may not be adapted to it may be cold, barren and otherwise hostile; the germ may be stunted or blighted in its course of development; but if it grow at all, it will be found to present always, in some recognizable shape, the true characteristics. The Typhoid germ has been the subject of many investigations. The first announcement of the discovery of this special micro-organism that attracted attention was that of Klebs. (') Since then many others have been "discovered," but no satisfactory proof of such "discovery" has yet been offered. Until its toxic power has been demonstrated by the method to be hereafter described, a final conclusion is not possible. Before any given germ supposed to be causative of any special disease, can be admitted to universal recognition as such, various essential powers must be shown to exist. If the tests to which it is not submitted are not satisfied, or are not complied with, the supposed germ is not genuine, how near soever it may appear to be so to the eyes of the prejudiced observer. To test the nature of any pathogenic or disease-producing microbe, it must be cultivated, i. e., grown in or upon some suitable soil, as on a fresh section of a raw potato, on a surface of gelatine, or on some other material suitable for the purpose. Careful microscopic observation can then ascertain the form and character of the growing organism and can then be properly figured. The infective or non-infective character of the organism can be demonstrated only by crucial experiments on animals-by inserting it into the tissues of animals. Although a decision is not finally reached regarding the micro-organism causative of Typhoid, the fact of its existence is no longer denied by bacteriologists and pathologists in general. (1) Archiv fur experimentelle Pathologi und Toxicologie, Vol. 1. Typhoid Fever-Its Preventable Causes. IS THE MODE IN WHICH THE RESULTS CAUSED BY MICRO-ORGANISMS ARE STUDIED CORRECT? The results produced by the infection of animals will be found to correspond to those found in man by the same parasitic form of pathogenic microbe; the germ whose character is to be ascertained is cultivated on a prepared surface, as mentioned above. Some viable and active specimens of significant form are put under the most favorable conditions as to soil, temperature and moisture, and allowed to proceed to full development, carefully guarded against all interferences. When full growth is attained, the "culture," as it is called, is studied by its action when introduced into the tissues of a warm-blooded animal. Placed under the skin, in the substance of the cornea or other parts, or thrown into the blood currents, it must develop as did the original from which it was obtained. In the new organism in which it has been placed, it must grow into the same forms and cause the same changes of structure as those its spontaneous development in other animal structures had brought about. The objection is urged that the results of studies in animals cannot be applied to explain phenomena occurring in man. It has long been known that the effects of medicinal agents on warm-blooded animals are entirely applicable to man, and the actions of many of the most important of them now in use have been explained in this way with entire fidelity. Proofs have greatly multiplied, and the fact must now be admitted that for the most part, the actions of pathogenic micro-organisms on the functions and tissues of warmblooded animals, also correspond fully to those occurring in man. It is true that some yet resist the demonstration, or do not exactly conform, and morbid conditions are not produced in a shape that can be referred to the manner in which the original germ affects the human system. Thus the "comma bacillus," the parasitic organism which Koch finds to be the cause of Cholera, has not thus far acted in an entirely satisfactory manner, but the evidence of the disease-producing powers of germs [microbes] rests now on a vast body of unquestionable facts. As doubts should not be felt in any Typhoid Fever-Its Preventable Causes. quarter, that preventive measures may thereby be made truly efficient, some of the examples that cover all disputed points may well be mentioned. Probably the most conclusive example of disease produced by infective microbes is Tuberculosis, or tubercular consumption. It has long been supposed that Tubercle had infective quality that when inserted into the tissues of animals it produced its own kind, or developed into the disease Tuberculosis. Several years ago a French pathologist, VILLEMAIN, showed by experimental evidence that the substance called tubercle, had infective property-for when inserted into the skin of the rabbit, it will spread through this animal, and when it is examined after death, the matters developed from it have the same composition and structural form as its progenitors, the true tubercle. It was presently said, however, that rabbits have a scrofulous constitution, and any irritation of their tissues results in a general infection, or a general Tuberculosis. The real nature of this matter was therefore involved in doubt, until Dr. Robert Koch, of Berlin, made the invaluable discovery of the Bacillus Tuberculosis. Now, the Bacillus Tuberculosis is as well established as any scientific fact can be, and it is nowhere denied that Tuberculosis consists in the reception, growth and development-pollulation-of the bacillus. To free the human race of this greatest of all scourges, it is necessary to destroy this parasite, and thus stop finally its destructive mission. In prevention rather than cure, therefore, lies safety and immunity from the worst evil that besets humanity. In relapsing fever, a spiral bacillus has been found in vast numbers in the blood during the existence of fever. [Spirochete plicatilis.] A peculiar parasite gives to vaccine virus its power to infect the system and thus prevent subsequent action of the same organism. Malarial infection consists in the presence and development of a microbe whose special seat is the red blood globule, as has lately been demonstrated by Laveran. The poison of Scarlet Fever is also a parasite, which we now know is often conveyed in milk. Recent investigations render it highly probable that Yellow Fever is due to a peculiar form of germ which is found within certain climatic areas, and is supposed to be spread by a mosquito that |