1214  ©■/>«  RURAL  NEW-YORKER 
Typhoid  Fever 
The  Scourge  of  Summer — What  it  is;  How  Handled 
Germ  Infection. — Typhoid  fever.  or. 
as  it  is  called  in  the  old  world,  enteric 
fever,  is  now  known  to  be  solely  due  to 
the  presence  and  growth  iu  the  body  of  a 
particular  germ,  called  by  scientists  the 
typhoid  bacillus.  The  disease  has  long 
been  definitely  coupled  by  mankind  with 
smells,  bad  sewerage,  and  especially  with 
impure  drinking  water;  though  it  was  not 
till  1880  that  its  true  character  as  an  in¬ 
fection  due  to  a  particular  germ  was  rec¬ 
ognized.  This  germ  is  not  found  at 
large  in  natural  conditions  unassociated 
with  human  beings.  If  present  in  water 
it  has  come  there  from  some  person,  for 
though  the  germ  may  live  and  multiply 
for  a  long  time  outside  the  human  body, 
under  conditions  favorable  to  it,  yet  it 
does  not  occur  spontaneously  in  .stagnant 
pools  or  wells  contaminated  by  dead  ani¬ 
mals,  etc.,  as  is  often  believed.  The  rea¬ 
son  badly  befouled  water  is  dangerous  for 
typhoid  is  not  because  of  its  foulness,  but 
because  in  the  filth  there  may  be  bowel 
contents  from  a  person  who  is  suffering 
from  or  has  once  passed  through  an  at¬ 
tack  of  typhoid  and  is  still  carrying  the 
germs  iu  Ids  interior.  A  slimy  pool 
might  he  full  of  carrion,  yet  not  cause 
typhoid  if  drunk,  while  a  well  might  ap¬ 
pear  crystal  pure,  yet  be  filled  with 
myriads  of  deadly  typhoid  germs. 
Responsibility  of  Milk. — In  the 
neighborhood  of  New  York  a  certain 
amount  of  typhoid  is  always  present 
throughout  the  year,  though  the  number 
of  cases  is  very  small  except  iu  Summer 
and  Autumn,  when  a  distinct  increase 
takes  place.  Then  from  time  to  time 
there  occur  small  epidemics  of  the  dis¬ 
ease,  traceable  in  nearly  all  cases  to 
milk  contamination,  the  appearance  of 
cases  following  closely  the  milk-route  of 
s<>me  one  particular  milkman  or  dairy. 
Less  commonly  arise  more  widespread 
epidemics  iu  which  a  large  proportion  of 
a  whole  community,  or  a  certain  district 
iu  a  city  or  town,  suffers  from  the  dis¬ 
ease,  and  in  such  cases  the  dangerous  fac¬ 
tor  is  almost  always  found  to  be  the 
water-supply. 
Typhoid  Carriers. — Until  a  few  years 
ago,  when,  the  preventive  typhoid  vaccin¬ 
ation  came  into  use,  typhoid  was  almost 
certain  to  make  its  appearance  in  a 
camp,  prison -compound  or  other  place 
where  large  masses  of  men  were  living 
crowded  together  under  imperfect  sani¬ 
tary  conditions.  Why  should  this  be  so  t 
Why  should  typhoid  crop  out  here  and 
there  in  the  midst  of  a  well  community V 
Why  should  it  claim  victims  by  tbe  hun¬ 
dred  in  a  camp  where  the  individual  men 
had  been  healthy  before  assembling? 
Where  is  the  source  of  infection?  The 
answer  is  not  at  all  difficult  in  the  light 
of  our  present  knowledge  ;  the  blame  lies 
with  the  so-called  typhoid  ‘'carrier."  By 
a  typhoid  “carrier’'  is  meant  one  who, 
having  once  had  the  disease  and  recov¬ 
ered  as  far  as  Ins  health  is  concerned, 
still  carries  iu  his  bowels  typhoid  germs 
able  to  give  a  fresh  attack  to  other  peo¬ 
ple.  It  is  this  person  who.  passed  by  th- 
medical  examiner  as  “healthy,"  enters 
among  his  comrades  in  a  camp,  spreading 
disease  germs  about  as  lie  goes.  There 
are  probably  many  such  “carriers"  in 
every  large  gathering,  their  danger  to 
their  fellows  depending  on  their  occupa¬ 
tion.  If  they  are  very  clean  in  their  per¬ 
sonal  habits  and  have  no  connection  with 
food  distribution  they  may  harm  no  one, 
but  if  they  handle  the  food-supply  in  any 
way  with  their  germ-laden  fingers  they 
become  a  widespread  danger  to  all.  To  a 
far  less  extent  the  disease  may  be  intro¬ 
duced  into  a  well  community  by  those  ac¬ 
tually  suffering  from  an  attack  of  the 
fever  themselves,  either  because  their  at¬ 
tack  is  so  light  that  it  is  not  recognized 
by  the  doctor,  or  else  in  the  early  stages 
of  what  later  develops  into  a  typical 
ease. 
Spreading  The  Disease. — The  actual 
details  of  the  spread  of  the  disease  may 
be  readily  imagined.  Of  the  '.scattering  of 
germs  by  touch  from  the  dirty  fingers  of  a 
‘  carrier,"  which  are  constantly  re-charged 
with  death  from  the  germs  within  and 
harmless  to  himself,  we  have  already 
spoken.  The  bowel  contents  are  the 
usual  medium  of  distribution  for  typhoid, 
though  the  urine  is  sometimes  fairly 
loaded  with  the  germs.  They  may  also 
often  be  found  in  the  mouth  and  are  reg¬ 
ularly  present  in  tbe  blood.  The  escape 
of  privy  contents  then  onto  the  surface  of 
the  soil,  whence  tbej  may  be  washed  into 
the  nearest  stream,  is  a  very  common 
cause  of  danger.  The  same  is  true  of  all 
discharges  thrown  out  of  doors  in  Win¬ 
ter.  for  though  freezing  prevents  them 
from  growing  it  does  not  usually  kill 
them,  and  with  the  Spring  thaw  they  will 
be  sent  abroad  in  the  water  courses.  It 
might  seem  almost  that  with  regard  to 
these  last  ways  of  spreading  and  consid¬ 
ering  the  extraordinarily  rapid  growth  of 
germs,  all  the  larger  bodies  of  water 
would  be  infected  with  typhoid.  So  they 
would  be,  only  fortunately  the  germs  do 
not  multiply  well  in  running  water  unless 
it  is  very  dirty  and  warm.  Moreover  in 
the  salt  water  they  die  out  very  quickly. 
Otherwise  all  our  coasts  would  be  fairly 
bathed  in  germs  of  disease  from  the  great 
cities  ou  the  rivers  and  seaboard. 
Character  of  The  I usease  —  Per¬ 
haps  the  most  characteristic  thing  about 
typhoid  fever  is  the  duration  of  its 
course.  It  is  a  long  disease  often  fol¬ 
lowed  by  one.  not  rarely  by  two,  relapses. 
The  typical  attack  of  fever  lasts  four 
weeks,  following  an  ‘  incubation  period" 
of  12  to  14  days,  i.  c\,  a  period  during 
which  the  germs  are  growing  iu  the  body 
but  have  as  yet  produced  no  symptoms  of 
illness  in  the  future  sufferer.  During  the 
first  week  there  is  a  steady  stop-like  rise 
of  temperature  from  normal  at  the  onset 
to  102  or  104  degrees  ou  the  seventh  day. 
with  daily  drops  of  one  or  two  degrees, 
which,  however,  never  bring  tbe  fever 
down  to  normal  after  it  has  once  begun. 
The  second  week  is  typically  one  of  con¬ 
tinued  high  fever  which  never  approaches 
the  normal.  During  the  third  week  th' 
fever  begins  to  break,  so  that  while  the 
high  mark  continues  as  on  the  second 
week  at  102.  103.  or  104  degrees,  there 
are  daily  drops  which  first  approach, 
then  reach  normal.  In  the  fourth  week 
the  high  mark  of  the  fever  also  slowly 
drops  to  normal.  This  of  course  is  only 
the  typical  example,  for  there  may  be 
short  courses  of  three  weeks  or  the  dis¬ 
ease  may  drag  on  six.  seven,  eight  or  nine 
weeks,  even  without  relapses.  A  relapse 
comes  on  usually  within  two  days  to  a 
week,  and  may  last  a  week  only  or  may 
repeat  the  whole  illness. 
The  Death  Rate. — Bleeding  from  the 
bowels  appears  in  about  20  per  cent,  of  all 
cases  and  may  be  a  great  danger,  but 
many  of  the  sickest  patients  never  show 
it,  and  many  deaths  occur  without  any 
bleeding.  The  death  rate  in  hospitals  for 
this  disease  varies  from  nine  to  12  per 
cent.,  but  cases  treated  iu  the  home  show 
a  much  higher  loss  of  life,  chiefly  due  to 
the  difficulty  iu  getting  the  patients  prop¬ 
erly  bathed,  and  fed  when  not  iu  an  in¬ 
stitution,  Specific  medicine  for  typhoid 
has  not  as  yet  been  effective.  Different 
vaccines  have  been  tried  by  different  doc¬ 
tors  with  results  that  have  differed  so 
widely  that  no  sure  proof  of  their  value 
can  bo  said  to  have  been  shown.  And 
yet  the  treatment  of  typhoid  is  a  very  im¬ 
portant  factor  in  the  patient’s  chance  of 
good  recovery. 
Treatment. — Successful  treatment  de¬ 
mands  complete  rest  in  bed  throughout 
the  entire  period  of  fever;  frequent  cool 
or  cold  bathing  wherein  the  whole  body  is 
put  into  a  tub  and  rubbed  there  by  accus¬ 
tomed  hands,  and  lastly  continued  and 
sufficent  feediug  throughout  the  course  of 
the  disease.  If  this  last  is  successfully 
done  it  does  away  with  the  long,  long  con¬ 
valescence  so  often  seen  in  the  past  fol¬ 
lowing  severe  attacks  of  typhoid.  It  has, 
moreover,  often  been  proved  that  fever 
patients  have  no  particular  difficulty  in 
digesting  suitable  foods  if  they  can  be 
persuaded  to  swallow  them.  Nowadays 
the  doctor  dealing  with  a  diet  thinks  of 
the  patient  much  as  he  would  a  steam 
engine.  How  much  has  the  engine  to  do? 
How  much  fuel  does  it  require  to  do  that 
work?  To  lessen  the  work  done  by  the 
patient  he  is  kept  flat  in  bed  and  bathed 
to  lower  his  temperature,  since.  like 
other  engines,  the  hotter  he  gets  the  more 
fuel  he  burns.  The  bathing  is  also  of 
very  great  importance  in  soothing  his 
nervous  system  and  keeping  down  de¬ 
lirium. 
Diet. — With  regard  to  the  fuel  nec¬ 
essary.  it  is  known  how  many  heat-units, 
“calories"  as  the  scientist  calls  them,  are 
needed  for  each  pound  of  body-weight  at 
rest  and  during  moderate  or  heavy  work. 
The  amount  of  fuel-value  of  each  sort  of 
food  per  ounce  is  also  known,  so  that  the 
task  of  feeding  the  patient  is  reduced  to 
simple  mathematics.  The  amount  of  food 
needed  by  the  patient  iu  his  condition  is 
first  calculated,  then  it  is  fed  to  him  as 
nearly  as  possible.  In  doing  this  the  doc¬ 
tor  takes  advantage  largely  of  the  high 
September  1C,  1910. 
heat-value  of  sugar — especially  of  milk- 
sugar  which,  though  not  nearly  so  sweet 
as  the  common  sort,  has  an  equal  heat- 
value.  Even  a  patient  most  unwilling  to 
take  milk,  eggs,  soups  or  recognized  nour¬ 
ishment,  seldom  objects  to  a  cool  glass  of 
lemonade  into  which  has  been  carefully 
dissolved  a  whole  ounce  of  milk-sugar, 
thus  raising  its  heat-value  to  about 
double  that  of  rich  milk. 
Symptoms. — Just  a  word  as  to  the  rec¬ 
ognition  of  typhoid,  before  we  go  on  to 
the  most  important  subject  of  its  preven¬ 
tion.  Any  long-continued  fever,  especial¬ 
ly  if  accompanied  by  headache,  should 
suggest  the  possibility  of  typhoid,  even 
though  the  sufferer  does  not  feel  ill 
enough  to  take  his  bed.  Then  beside  the 
symptoms,  the  doctor  lias  two  most  val¬ 
uable  blood-tests  at  his  command.  Blood 
enough  can  lie  obtained  with  a  hollow 
needle  through  the  skin  and  the  tests  are 
as  positive  as  anything  in  the  science  of 
medicine.  They  can  be  performed  at  any 
laboratory  if  the  doctor  lias  not  the  train¬ 
ing  necessary  to  perform  them  himself. 
Prevention. — With  regard  to  the  pre¬ 
vention  of  typhoid  great  advances  have 
been  made  by  tbe  use  of  anti-typhoid  vac¬ 
cine.  That  is  by  injecting  into  the  per¬ 
son  who  wishes  to  escape  the  disease  a 
measured  quantity  of  typhoid  germs 
which  have  first  been  killed  by  beat.  This 
is  done  iu  increasing  doses  for  three 
times  at  intervals  of  one  week  or  10  days. 
The  immunity  thus  obtained  is  not  abso¬ 
lute.  though  it  is  very  marked,  and  lasts 
about  three  years.  Moreover,  if  a  person 
does  take  the  disease  after  being  vaccin¬ 
ated  he  has  usually  a  much  lighter  attack. 
In  anti-typhoid  vaccination  then  we  have 
the  best  means  to  combat  the  spread  of 
the  disease  by  increasing  people’s  power 
to  resist  it.  The  oilier  measures  have 
been  already  indirectly  suggested.  They 
consist  of  careful  disinfection,  by  soaking 
in  five  per  cent,  carbolic  and  later  boiling 
all  clothes  from  about  a  typhoid  patient, 
by  the  addition  of  “chloride  of  lime"  in 
large  quantities  to  the  wash  water,  pas¬ 
sages  and  urine  of  such  a  patient,  and  by 
the  careful  cleaning  of  the  hands  of  all 
those  about  him  to  prevent  them  carrying 
germs.  All  liis  eating  utensils  should  be 
boiled  separately,  and  he  should  be 
screened  from  flies,  so  that  germs  from 
about  him  may  not  be  carried  by  these 
pests  to  the  food  and  faces  of  others.  Be¬ 
yond  this  toilets  and  privies  must  be  in 
proper  places,  and  so  kept  as  to  prevent 
the  escape  of  their  contents.  A  pure 
water  supply  must  also  be  assured  aud  if 
any  suspicion  of  the  water  exists  it 
should  be  boiled,  for  filtering  in  any  form 
is  rarely  effective  in  removing  typhoid 
germs  Lastly,  the  men  employed  in  all 
distributing  dairies  should  be  regularly 
examined  to  prevent  a  “carrier”  from  en¬ 
tering  their  number. 
LAWRENCE  F.  RAINSFORD.  M.  D. 
Daniel  Webster  Clam  Chowder 
Can  you  give  us  the  recipe  for  Daniel 
Webster’s  dam  chowder — tbe  kind  he  used 
to  make  at  his  home  in  Marshfield.  Mass.? 
E.  C» 
The  foundation  of  New  England  chow¬ 
ders  is  the  same.  Proportions  to  suit  taste. 
Salt,  pork,  potatoes,  onions,  milk,  crack¬ 
ers,  salt  and  pepper.  Probably  the  kind 
Daniel  Webster  was  familiar  with  was 
similar  to  this  recipe,  which  came  from 
Plymouth  and  is  used  in  Green  Harbor 
and  Marshfield.  The  clams  are  the  soft, 
long  clams,  and  not  round  hard  ones.  The 
round,  hard  ones,  or  quahungs.  are  not 
used  to  make  the  regular  clam  chowder 
that  Daniel  Wehster  ate.  They  are  best 
when  taken  from  the  shell  raw,  but  it  is 
easier  to  steam  tbe  clams  and  then  take 
them  from  the  shells.  The  recipe  sent 
calls  for  raw.  fresh,  soft,  long  clams. 
Clam  Chowder. — One  quart  clams,  one 
quart,  sliced  potato,  1  slice  of  fat  pork, 
1  oniou,  1  quart  milk,  common  crackers, 
blitter  size  of  egg.  Cut  off  snouts  of 
clams.  Chop  rims  and  empty  bags  of 
dark  stuff.  For  fish  chowder  use  cod  or 
haddock.  Cut  pork  into  smalt  cubes  and 
fry  out  with  onion  cut  up.  Remove  pork 
and  put  iu  clams,  potatoes,  salt  and  pep¬ 
per  and  cover  with  boiling  water.  Cook 
one  hour.  Then  add  one  cup  of  clam 
water  if  clean  and  nice,  also  the  milk  aud 
butter  the  size  of  egg.  Split  crackers,  dip 
in  cold  water,  add  and  bring  to  a  foil. 
Stand  on  back  of  stove,  8  r-  >. 
The  Manufacture  of  Aunt  Mary’s  Apple  Pie — No  Germs  ! 
