and in

cases

where

relapses

much

occur,

longer

than this. The disease is

by

one or

other of the

following

be contracted

to

modes

the medium of the

Through

1.

generally supposed

:?

drinking

water,

(soil). By contaminated milk? (a) Water added, (polluted). (b) Dirty vessels, &c.

2.

(c) Diseases of cow, garget, &c. Foul air from sewers, drains, cesspools, &c. Attendance on the sick.

3. 4.

The condition which appears to be most influen-

of enteric fever is the precircumstances leading under sence filth, to the pollution either of the atmosphere, of the

tial in the

development

of human

soil, or of the drinking water, occurring monly in conjunction. Professional of the de

tiovo

opinion origin

most

com-

is still divided

on

the

and infection

by

attendance

subject

the sick.

on

Dissemination by meatis of drinking ivater.?Of all the different modes of diffusion in Europe, that by of the water used for

means

with human filth is

drinking being polluted perhaps by far the most important

one, from the fact that it is

infective

ON ENTERIC FEVER. By Surgeon W. E.

Saunders,

a.m.d.

( Continued, from page 97.) V. Modes of Spread.?Having decided that

a

is necessary to cause enteric fever, review the different modes in which the disease is transmitted and disseminated. The virulent part of the specific poison, by which

specific poison must now

we

the disease is communicated, is admitted by most persons to be contained in the diarrhoeal discharges. Dr. Watson says, "if this fever is

it is

not

only

erroneous

but

really contagious, dangerous to hold the

contrary opinion." To what extent it is dangerous can be gathered from the following. The reports of the Registrar-General show about 260,000 cases

occurring yearly

in

England alone,

which doubtless

falls very far short of actual numbers, and each case manufactures a large quantity of poison, daily for 15

days

in mild

to

26

days

in

severe

cases.

(Louis);

the mode in which the

which

gives rise to the disease can certainly widely diffused. The mechanism of the production of the disease through the medium of the water supply is less widely and clearly apprehended than it should be, although the detailed accounts of the various outbreaks of late years prove it to be the most readily and effectually controlled mode of propagation. This is equally true as regards India and other hot be

matter

and

most

countries. Greater

gards

'uniformity

of

practice

is indicated

the internal economy of

matter

of

protecting

the

as

in

re-

regiments water-supply chance" pollution; in

the

wells and "

against what may be termed the washing and culinary arrangements,

and also the It is obvious that, however much Government may be desirous of aiding in this mat-

milk supply.

immense deal must

ter,

an

ing

and medical

operation exists not be perfect.

officers;

between

depend

upon command-

for unless

them,

thorough

co-

the arrangements will

The filtration of water and other measures will be worse than useless, and a considerable expense to the Government will have been incurred to no

?

iso

THE INDIAN MEDICAL GAZETTE. t*p

purpose, unless every detail is

The greatest

out.

fever is most

when

seasons

scientifically carried during the

should be taken

care

The bazaars

prevalent.

in the

villages vicinity should then be placed "out of bounds," for the men, after a stroll in the evening, regale themselves by drinking ginger-pop and other beverages prepared from the unfiltered and and

generally

contaminated

pools (tanks), which

or

still

of

water

-after

bazaar

some

wells

polluted, being' in no way protected, and receiving drainage of the filthy ground in the vicinity of native villages. r.. The chemical analysis of water probably can tell us with absolute certainty when water is safe; but we must resort,to the use of the microscope to find out when U is actively noxious, for that alone will inform us. Diluted excreta, if fresh and from a healthy individual, would be unlikely to injure anybody; but as the excreta frequently contain the germs of enteric more

the surface

the sewage contaminated

fever,

well, which is

harm-

less one week may become deadly the next, although analysis reveals no difference?{Lancet.) The microscopical examination is one of the greatest importance, and should be always resorted to, for it is most likely to yield the secret of the transmission of disease.

The presence of the actual enteric fever in

certain well

a

the

supposed

was

A

typhoid fungus.

been said

the

on

organic poison causing

to

have been discovered and

continent,

species

of bacillus has

to be the cause of an

termed

was

recently

enteric attack.

,Neither chemistry nor the microscope has as yet, however, afforded any definite ground of determining what is deleterious and what is harmless, although much has been done in this direction. Chemists

simply regard

quantities

the

in which

organic

matters

present, combined with the circumstances under which they occur, as the measure of the impurity to which they are exposed, and as indicating the degree are

of liability qf any water to become contaminated with the special poisons of enteric fever and other diseases. The

great

depth

of

influence

spring

a

on

its

or

well of

purity,

course

and

exerts

although

a

the

presence of fissures communicating with the surface (a common thing in India) will render the deepest well impure,

as

a

rule the

depth

against contamination?(Professor The numerous investigations well

by

as

a

large number of

of

100

Sanders of

ft.

secures

Frankland, analyses made in Germany

Wibel and others, show

conclusively

as

the almost

of well

\'KM

drawn from

water

shallow surface wells, varying in depth from 12 to 3d ft., and it follows that they are worse when close to the

dwellings

of natives in India and elsewhere.

A very sudden and localized outbreak

fever is almost certain

be

to

owing

to the

of enteric

introduction

the medium of the

poison through

of the

drinking

water.

So

many

cases are now on

has been traced to the

record where the

of contaminated

use

cause

drinking

water, (and in some the evidence was so complete as almost to amount to the precision of a chemical experiment) that this mode of diffusion must be admitted

to

be the

commonest one.J

The various out-

breaks that have occurred of late years, viz., Nunney, Lewes, Croydon, Over Darwen, Cambridge, Caterham,

others, have shewn

the result of

investigation sanitary authorities by new modes of contamination of the drinking many water, hitherto unsuspected, and which explained in a most satisfactory manner the origin of several out-

and

some

of

our

most

as

eminent

breaks which would have

been

regarded

as

very

mysterious. Some of the ablest

failed

to

detect the

men

true

in London for many years cause of unhealthiness of

Millbank Prison, and assigned causes for it, as is now done in India, which later experience has found to be unconnected with it. The probability is that

is frequently made elsewhere, and that the prevalence of enteric fever and other diseases is ascribed indefinitely to a

similar

error

locality, malaria, heat and cold, climate, variations of temperature, moral depression, and other intangible influences, which act as aiding and predisposing but actual causes, and would" be entirely removed by At the stations the general disuse of impure water. I have served in, I have noticed that the water almost not

invariably year,

became

although

impure

at

the reports of

always record it. At Millbank, in spite

certain

seasons

previous

of the

years did

not

>

of the low

site, the proximity

ground, open sewers, moral depression consequent on imprisonment, we find that the prevalent diseases,?diarrhoea, dysentery, enteric fever, &c., were put a stop to by the substitution of of

low and ill-drained

artesian well of the

)

"-lb:.

constant contamination

rain become

heavy

[May, 1883.

1.0

5.

" water; and the health has since always been good, notwith-

water for Thames

prisoners

free from every form occupied the healthiest site

standing the surroundings, and of disease

as

if the

in the kingdom."

prison

as

SAUNDERS ON ENTERIC FEVER.

1883.]

May,

I feel satisfied that the

introduction

the

water in our -

It is

has

deep

supply of drinking foreign stations.

purer

no case

occurred at Pentonville

imprisoned drinking water

The

month.

of enteric fever the

Jail amongst

who have been

prisoners, a

a

remarkable fact that

a

ever

than

of

Indian and other

there for

more

from

comes

a

owing probably

present,

at

water

so

precise cases

a

exact

basis

might

as

be

wished.

however very little careful

without

careful collection

a

which

often been the

only ground

been

As well observed

come

to.

on

has been

a

of

the

of

the water,

using

fallacious of all evidence

most

impression,

insidious, but

not

the less certain

with the indifference and In

be

of the

innocuous,

perience some

apathy

evils,

borne

are

of custom."

it is

has been

has shewn

really restricted,

the

necessity

of

or

that

the

same

The

was

cases

left Durban.

found

confined the

viz.,

cause,

following

that

there

although

corps, and due

to one

use

to

of impure water.

table shows the admissions for En-

teric fever and Dysentery at Durban during 1879 from among the men who had never been out of Durban after

landing

there.

>? 3

Number of Cases. water

water.

2 O

?> O

o

O

*5

Q

M 3

On Enteric Fever.

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