The principles and practice of medicine : designed for the use of practitioners and students of medicine / originally written by Sir William Osler.

  • Osler, William, Sir, 1849-1919.
Date:
1928
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine : designed for the use of practitioners and students of medicine / originally written by Sir William Osler. Source: Wellcome Collection.

    36/1272 (page 2)
    Alfred Stille and Austin Flint made the subject very familiar in American medicine. In 1842 Elisha Bartlett’s work appeared, in which, for the first time in a systematic treatise, typhoid and typhus fever were separately con¬ sidered with admirable clearness. In Great Britain the recognition of the difference between the two diseases was slow, and due largely to A. P. Stewart, and to the studies of Jenner between 1849 and 1850. Etiology.—General Prevalence.—Typhoid fever prevails especially in temperate climates, in which it constitutes the most common continued fever. Widely distributed throughout all parts of the world, it presents everywhere the same essential characteristics, and is an index of the sanitary intelligence of a community. Imperfect sewerage and contaminated water-supply are two special conditions favoring the distribution of the bacilli, while from an infected person the disease may be spread by fingers, food and flies. In England and Wales in 1923 the disease was fatal to 450 persons, a mortality of 12 per million of living persons. It destroys more lives in pro¬ portion to population in towns than in the country. The rate was lower in 1923 than in any year since 1869. In the United States there has been a marked decrease, due largely to chlorination of the water supplies. The death rate per 100,000 population in the registration areas has fallen from 35.9 in 1900 to 7.8 in 1920. In 1922 the death-rate in the sixty-nine largest cities was 3.3 per 100,000. It is more prevalent in country districts than in cities, and, as Fulton showed, the propagation is largely from the country to the town. Typhoid fever has been one of the great scourges of armies, and killed more than powder and shot. In the Spanish-American War the report of the Commission (Reed, Vaughan, and Shakespeare) showed that in the national encampments among 107,973 men there were 20,738 cases of typhoid fever with 1,580 deaths. In 90 per cent, of the volunteer regiments the disease broke out within eight weeks after going into camp. In the opinion of the Commission the most important factors were camp pollution, flies as carriers of contagion, and contamination through the air in the form of dust. In the South African War the British army, 557,653 officers and men, had 57,684 cases of typhoid fever, with 8,225 deaths (Simpson), while only 7,582 men died of wounds received in battle. The disease was essentially one of the standing camps; troops constantly on the move were rarely much affected. While contaminated water was no doubt an important factor, as it always is in camp pollution, yet certain of the conditions in Africa were peculiar. Faecal and urinary contamination must have been very common, as in the cooking, performed in the open air, sand “entered largely into every article of food.” As there was a plague of flies, they were a factor in the infection of both food and drink. In the great European war typhoid fever did not prevail to any extent in the Western armies and the efficacy of inoculation was thoroughly demonstrated. The large proportion of paratyphoid cases was remarkable. Season.—Almost without exception the disease is everywhere more preva¬ lent in the autumn, hence the old popular name autumnal fever. The study by Sedgwick and Winslow shows everywhere a striking parallelism between the monthly variations in temperature and the prevalence of the disease. In a few cities the curves were irregular, showing, in addition to the usual sun?-