Chapter 13 - Diseases of the General System and Miscellaneous Diseases
Introduction to Diseases of the General System and Miscellaneous Diseases
Blood Aneamia
Typhoid Fever
Prevention of Typhoid
Bilious Remittent Fever
Congestive Fever
Fever and Ague
Yellow Fever
Purple Disease
Bubonic Plague

13.6 Fever


IT is now well understood that every specific disease, every communicable disease is due to the introduction into the body of a specific cause of that disease which is called a germ. For example, one variety, a microscopical form of animal life the so called plasmodium of Laveran, the discoverer, is the cause of malaria. An example of another variety is one of vegetable life in its lower form and the germ of the disease the bacillus of tuberculosis. During the life processes of these germs a poison is formed called a toxin which has a marked influence in the course which the disease runs and in many instances it is the toxin manufactured rather than the primary onset of the disease which makes the trouble greater or less. The membrane of diphtheria in many instances is not great enough to cause the severe results obtained in this disease and persons die from an attack with relatively little membrane present in the throat. This is the result of the toxin, or poison generated by the germ, and during its circulation through the body causes the fatal result by several paths, one being the paralysis of the nerves so that swallowing is impossible or the heart is not controlled by the nerves that usually act upon it with a control similar to a safety valve. The toxin of tuberculosis is tuberculin. Pneumonia is due to the pneumococcus.

Typhoid fever is due to the bacillus of Eberth, the discoverer. The disease of plague is due to the bacillus of Yersin discovered in 1894. Even now, many diseases, some of the oldest have escaped giving up the secret of their communicability to investigators. It seems strange too, for many of them have been accepted as contagious from earliest times. Take leprosy as an example of a disease known since the world began and yet while we are sure it is due to a specific germ, yet the identical one has never been insolated.

It is necessary to understand methods of prevention of disease as well as the causes and the treatment of them. Only the ignorant, or worse still, those unwilling to believe facts can refuse to accept the record compiled each year of the great decrease in the mortality rate of disease. This it is our duty to prevent transmission of, and that it is due to this prevention in many cases, may well be verified by further reports. For example, the death rate of typhoid is not much diminished in general practice from that of ten or twenty years ago but the per cent. of cases reported annually is much diminished. Of course by newer treatment and quicker methods of diagnosis the comfort of the patient is increased and complications averted, and in that way the patient is carried through the illness with less loss of strength, but it is much better not to have been sick, and since we now understand about the transmission of disease through drinking water, milk, and from foul matter, disease is prevented or stopped after our investigation determines its source. Malaria was formerly very prevalent in Michigan but in ten years the percentage of cases is less than one fourth. This benefit was due to better draining of swamps, marshes, and stagnant pools, employment of mosquito nettings, and improvement of drinking water service.

Yellow fever is transmitted by the mosquito in a manner identical with malaria.
There has been a great amount of labor expended by our government as well as the medical profession determining how far the cause of malaria is due to infection of mosquitoes. By injecting the organism of malaria in the saliva of the mosquito after a bite of a person by a mosquito, it has been possible to cause that patient to have a true attack of chills and fever, also germs have been found in the deposit of eggs by a mosquito upon the surface of pools of stagnant water, as shallow wells, ponds without an outlet, etc. The germs are liberated and drinkers of such water acquire the disease.
An example of an entirely different nature in regard to action, but similar in result, is a disease best known of all from the standpoint of its fearful results, and that is tuberculosis or consumption, sometimes spoken of as phthisis.
Now this disease is spread mostly through atmospheric dust which is also true of most of the communicable diseases as diphtheria, pneumonia, influenza, scarlet fever, measles, whooping cough and smallpox, and not only are they contracted through the nose and throat, but are most often spread from the nose and throat. It must be explained that the germs of many diseases which are prevalent in the air are often distributed upon mucous membranes of persons not ill with the disease. The more numerous the germs the greater the danger that they will land upon some abrasion of the membrane, or the vitality of the person will be lowered to a degree of so-called susceptibility, which is the term used for the condition when a person is especially liable to contract that disease.
Expectoration is, of course, the great carrier of germs, but coughing, sneezing and sometimes in speaking, little drops of saliva or a fine, moist spray are thrown out which contain germs.
Plague is the disease where the infection by this manner causes the glands of the body to be swollen sometimes to a very large size, and until the antidote was discovered there was no cure known after a person had once become afflicted by this disease.
Another method of transference is by rats, either by biting or from fleas which have infested the rats, also flies, conveying by means of their feet germs from sputa, excreta, sores, etc. Probably typhoid has been transferred in this way many times. Tuberculosis of the bowels results from swallowing of saliva or sputum of a patient whose lungs are already infected or from milk or water. Should the milk or water have been boiled, this danger would have been done away with.
Having considered at some length how bacteria obtain an entrance into the body our common sense shows us the way to a prevention of the disease in many of the cases. Stings of mosquito and bites of animals can be guarded against in many instances and when contagious disease is about us we may with more safety keep people from that ; but we have got to breathe and our object must be to make the air as pure as possible either by cleansing the air or by ventilation, changing the contaminated air for pure air, which is the far better way.
And the method of cure as well as prevention is instanced by our efforts in paying attention to the person of the patient as well as the disease. As good soil is necessary for the growth of germs, so we make the soil as poor as possible by building up the patient and assist the tissues to fight the disease as well as to destroy the organisms themselves. So tonics, and general tissue builders, with a few symptomatic remedies to control cough, produce sleep, etc., enable us to obtain the trinity of pure air, good food, necessary rest.

Now a few words on the counteraction of the poisons or toxins by antitoxin either by nature or by man. The help we hoped to obtain when it was thought an antitoxin of consumption had been discovered has not been realized, for it has proved to be more or less of a poison and its results have proved of little value except as a method of diagnosing the disease.
The antitoxin of diphtheria, of tetanus which is lockjaw, that of bubonic plague, and that of septicemia or blood poisoning have all been proved of great service.
The word antitoxin explains itself, meaning against poisons. When the germs obtain a foothold in the system they occur both as the local manifestation, such as the membrane in diphtheria, and the destruction of the lung in tuberculosis and the general manifestation such as the poison I have described. Nature herself attempts to counteract this poison by an antitoxin of her own, but in many cases the amount of antitoxin manufactured is in too great a quantity and the time limited too short for nature to do satisfactory work before the patient would be dead.
So we reinforce nature with antitoxin manufactured by man. With antitoxin of diphtheria as an example I will explain briefly how it is accomplished. The primary object is to inject toxin in quantity sufficient to cause nature to manufacture her own yet by gauging the quantity and increasing the amount gradually until at last a dose can be injected which would have caused death if given in the first place. If no reaction of temperature and no sickness occurs after these large doses, then the animal is said to be immune and the serum of the blood drawn from such an animal is the antitoxin we use.
Malaria being caused by a form of animal life does not require an antitoxin as quinine has been found to be a sufficient drug to cause the destruction of the cause.

Of course smallpox is caused by a specific germ and yet no specific treatment is at present known. Vaccination as you know is a preventive and not a cure. Immunization has been known since 1798 when the first published reports from Jenner to whom we owe the discovery, appeared.
He had noticed that the dairy maids were practically free from smallpox. Then sores were noticed on their fingers which resembled the sores on the cows. It has not even yet been settled that cow pox is or is not similar to smallpox but with its virulence modified. As a matter of fact smallpox has been given to a cow, but the further fact remains that cow pox does prevent in the human system the disease of smallpox. Formerly vaccination took place through human beings after originally being taken from the cow, but it was discovered that the protective power diminished by repeated transmissions through the human system so that virus obtained from the cow is now used almost exclusively. Formerly the death rate of persons exposed was 50 per cent. of those who took the disease, and about that rate remains today but it will be shown how much less the danger is when vaccination is enforced.
Notwithstanding the fact that it has been accepted by some since 1798 that an immunity has been offered from the disease, yet even today many of the, if I may use the terms, ugliest opponents are intelligent medical men.
Germany made the first laws and in fact she stands alone in enforcing vaccination. In 1871 a smallpox epidemic broke out, and out of a population of 50,000,000 she had 143,000 deaths. In 1874 she made her famous laws of compulsory vaccination and last year with a much increased population she had 100 deaths and these occurred on the towns of the frontier. Another instance was the Franco German war when Germany with her army vaccinated, lost only 278 by death from smallpox, while France without any vaccination laws lost 23,000 men. In those whom the attack was from one to five years old one might contract the disease with chances against it, and if contracted, only in a light form. If unvaccinated and you get the disease, you stand just an even chance of recovery or death.

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