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