A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.

  • Strümpell, Adolf von, 1853-1925.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.

    24/1008 (page 2)
    tial to their further development and to the display of their pathogenetic properties. It must be confessed that the ability to answer these questions accurately is a goal from which we are quite distant. It is almost universally believed that, as a rule, typhoid bacilli do not have any permanent, independent existence outside the human body. Often, however, the conditions essential to an abundant development of the bacilli arise in certain places, and thus make it possible for a greater or less number of persons to absorb the pathogenetic poison, and, as a result, to be attacked by typhoid fever. In this way arise the numerous greater or smaller epidemics of typhoid fever in contrast to the sporadic cases, which are likewise possible, and are not infrequent. If an epidemic of typhoid appears in a place till then entirely free from the disease, we must always refer it to an importation of the disease-germs, and seek their source in some previous case of typhoid. We must, therefore, take for granted that the poison of typhoid can in some way escape from the body of the patient into the outer world. If we believe this, we shall be sure to think, first of all, of the intestinal discharges as the source of infection. In all probability, these con- tain the typhoid bacilli or their spores ; but this fact has not yet been fully dem- onstrated, because of the presence of numerous other micro-organisms in the con- tents of the intestine. As to the exact manner of infection, views are still widely different. Up to the present time there are chiefly two contrasted theories, called, respectively, the ground-soil and the drinking-water* theories. According to the former, which is maintained principally by Pettenkofer and his pupils, the ground-soil is to be regarded as the chief place of development for the schizomycetic fungus of typhoid fever. Whether this will flourish depends chiefly on the condition of the soil (varying at different times and in different places), and this alone should ex- plain all the peculiarities observable in the spread of the disease—e. g., that single nouses, streets, or wards of a city should suffer. According to Pettenkofer, a soil that air and water easily penetrate—e. g., one made up of alluvial or detrital depos- its—is most favorable for the spread of the disease, while a firm, rocky bottom makes its further development impossible ; and, where this tendency of the ground-soil is wanting, the disease can neither be introduced nor, if brought in, spread any further ; for, according to Pettenkofer, the typhoid poison is seldom if ever transferred directly from one person to another. The poison in the stools must first be changed by the soil before it becomes infectious. The ground-air, which is continually rising, carries the poison not only into the open atmosphere, but into the air of dwelling-rooms, and, being then inhaled, produces infection. We can thus understand why Pettenkofer regards typhoid fever as not directly contagious. The chief support of the ground-soil theory, beyond the results of comparing the character of the soil with the extent of the epidemics, consists in the proof which Buhl and Pettenkofer have given (taking Munich as an example) that a relation exists between the variations of the standing water in the soil and the frequency of typhoid cases. It appears that, when the water stands high (near the surface), fewer cases occur, and when it falls below the mean height cases are more numerous. This relation, which is said to hold true also for Berlin and some other places, is not yet, we may add, explained with certainty. To be contrasted, or rather compared, with the soil-gas theory is the view held by many physicians, despite the vigorous protest of Pettenkofer, that drinking- water plays an important role in the origin of many epidemics of typhoid. In fact, in the case of numerous epidemics, whose extent bears an unmistakable rela- * Compare with what follows the statements concerning the aetiology of cholera, where the same dis- puted points are considered.