THE SECRET OF A TERRIBLE DISEASE
This generation, which is so thankless to the great discoverers of the
causes of disease, so forgetful of the epoch-making labours of the
English sanitary reformers of last century, has not seen nor even
heard of the awful thing once known as "gaol-fever." A hundred years
ago it was as dangerous to the life of an unhappy prisoner to await
his trial in Newgate as to stand between the opposing forces on a
battlefield. Gaol-fever attacked not only the prisoners, but the judge
and the jury and the strangers in the court. The aromatic herbs with
which the hall of justice was strewn were supposed to arrest the
spread of the terrible infection, and it is still customary to provide
with a bouquet of such plants the judge who presides at a "gaol
delivery." The inexorable ministers of justice, who, seated high above
the common herd, and clad in their ancient robes of office, were about
to deal shameful death to the guilty wretches brought from the prison
cells, were often themselves struck down by the Angel of Death moving
invisibly through the court. The "black assizes" were not isolated,
but repeated occurrences in our great cities. Typhus fever was the
name given by the learned to this awful pestilence. There was a
mystery and horror surrounding it which paralysed those who came into
contact with it, and produced something like consternation. Men fled
in terror from the infected buildings, business was arrested, the
universities deserted, palaces left empty, and the dying abandoned to
their misery when it appeared. There was a feeling that some deadly
unseen power was present, irresistible and malignant.
It is only to-day--in fact, within the last two years--that we have
learnt what that unseen power was. The Angel of Death which moved
through the Old Bailey Sessions House in bygone days was, indeed, a
living thing. It passed silently and unseen from the prisoner to the
warder, from him to the usher, thence to the bar--the jury and the
exalted judge. It had no wings, yet it moved slowly and surely
carrying black death with it. This terrible and mysterious assassin
has at last been unveiled. The shroud of concealment has been torn
away and there the dire monster stands--naked, remorseless and
hideous. It is of small size, though it makes us all shrink with
horror and disgust. It has six claw-like legs and no wings. It is, in
fact, neither more nor less than the clothes louse, the _Pediculus
vestimenti_. The filthy, crowded condition in which the prisoners were
kept, and (let us well remember and reflect thereon) the personal want
of cleanliness of judge, jury, barristers and ushers, rendered the
existence of the little parasite and its effective transference from
man to man possible. Those pompous emblems of authority, the horsehair
wigs--those musty robes of unctuous dignity--were full of dirt, and
harboured the wandering bearer of typhus infection. Gaol-fever was due
to dirt; its infecting germs were distributed by loathsome insects.
It is an interesting and really instructive thing to pass in review
the gradual process by which the cleanliness of the population of
Western Europe has advanced, and to observe that, consciously or
unconsciously, the end pursued has been, step by step, the removal
from man's body outside (and inside), from his clothing, from the
water he drinks, from the food he eats, from the air he breathes, and
from the surfaces with which he necessarily comes into contact,
of injurious parasites and hurtful living things which lurk
in dirt and rubbish. At first the larger and more obvious hurtful
creatures--snakes, rats, mice, scorpions, blow-flies--were eliminated
by some elementary attempts at removal of rubbish and kitchen
middens. Then ticks (which African savages still do not trouble to
remove from their bodies) and later fleas and bugs became unpopular;
lice were long regarded as inevitable, and even beneficial, and by
some populations and by part of the most civilised at the present day,
are still, not merely tolerated, but favoured. In a country school in
France a child who was found to be afflicted in this way was the
daughter of the local medical practitioner. She remarked, "Oh! Ce
n'est rien; papa dit que c'est la sante des enfants"! Parasitic worms
of various kinds, though they often cause disease and death, are
accepted and tolerated even by the most refined and luxurious, who
risk infection rather than submit to the precaution of abstention from
raw vegetables and fruits, or to the expenditure of trouble in
cleansing those nests of infective germs. It is only within the last
thirty or forty years that such cleanliness of body and of clothing
and of house-fittings as will banish parasitic insects has become at
all general. The common house-fly is still tolerated, although it is a
notorious carrier of dirt and disease, and is bred by dirt and dirt
only, its eggs being hatched in old stable manure. The diminution of
late years of house-flies in London houses is simply and solely due to
legislation compelling the removal of horse manure from the "mews" so
frequent at the back of London streets. Egyptian natives still allow
flies to gather on their eyelids without protest.
Of the bacteria and similar microscopic germs of disease--to which all
our infective fevers are due--we have only become aware quite
recently, within the half-century. Before they were known, cleanliness
and the destruction of putrescible matter in man's surroundings had,
it is true, been urged by sanitary reformers. Disinfectants and
antiseptics were deliberately made use of for this purpose in the
mid-Victorian period, when carbolic acid and chlorinated lime were
established in the place of those feebler destroyers of the germs of
putrefaction and disease--namely, the extracts of aromatic herbs or
the essential oils themselves. These, as perfumes and unguents, really
served, not merely to gratify the olfactory sense, but to destroy by
their chemical action the germs of disease. Men tolerated gnats and
their bites (mosquitoes as we prefer to call them in order to delude
ourselves into the belief that they are not British) until it was
discovered that they, and they only, carry the parasitic germs of two
deadly diseases--malaria, or ague, and yellow fever. Now we shall
destroy the pools in which they breed, just as we are destroying the
manure heaps in which the house-fly breeds. When we look over the list
it is really astonishing how much remains to be done, even in England,
in establishing increased cleanliness and freeing ourselves from the
murderous tyranny of parasites. It is a simple but horrible fact that
the poorest class in our big cities still swarms with vermin. And not
only are the poor in great cities thus afflicted. The recent
compulsory medical inspection of school children has shown that in
some of the smiling rural districts of England 80 per cent. of the
children have lice in their heads. Everyone should help to gain
further cleanliness and freedom from this form of oppression.
In the middle of the nineteenth century, England alone, and with
absolute conviction and determination, demonstrated to the civilised
world the beneficial results in diminishing the death-rate of large
towns, to be obtained by cleanliness, the destruction or removal from
man's body and surroundings of organic "dirt," viz. his excreta, the
exudations and exuviations of his body, the waste and fragments of his
food. The names of Rawlinson, Chadwick and Simon remain as those of
the prime movers in that legislation which has given us improved water
supply, sewerage, removal of dust heaps, clearance of cesspits,
cleansing of houses, and prevention of over-crowding. Yet there are
writers who, in ignorance and infected with the modern madness which
makes half-educated Englishmen presume to teach where they have yet to
learn, and to pose as prophets by belittling and running down,
without regard to truth, their own country and its finest efforts in
the cause of civilisation, actually declare that Germany has led the
way in this matter. This is the very reverse of the truth. Foreign
countries are, in this matter, following long in the wake of England.
There are no cities in the world so healthy as British cities.
Practical measures of cleansing, faithful activity in destroying dirt
and preventing over-crowding, enforced by legislation, have reduced
the death-rate of our great centres of population in fifty years by
more than one third--that is to say, from something like 29 per 1,000
to something like 18 per 1,000. No other country can show such a
result.
Gaol-fever, spotted or putrid fever, or typhus fever has practically
ceased to be a regularly occurring disease in the West of Europe. The
last cases in London were, I well remember, in a poor district near
the Marylebone Road about thirty years ago. A very few cases have
appeared since, in the over-crowded and poorest districts of our
largest cities. Beleaguering armies and beleaguered cities suffered
from it as late as in the Crimean War, but we may now fairly say that
it has disappeared from our midst. It, however, still abounds in
Russia and her eastern provinces, and in Algeria, Tunis, and Morocco.
It is a disease of cold and temperate climates rather than of the
tropics.
In the last century typhus was distinguished definitely and clearly
from "typhoid" or "enteric" fever, and from "relapsing" or "famine"
fever, with which it had previously been confounded. The bacterial
germs causing enteric and relapsing fevers are now known, and have
been isolated and cultivated, and the mode in which they are conveyed
into the body of a previously healthy patient is ascertained. But
until the past year we knew neither the parasitic germ which causes
typhus fever nor the mode by which it passes from one individual to
another. A vague idea that it was spread through the air prevailed.
Typhus is remarkable for the frequency with which the nurses and
doctors attending a case become infected. About 20 per cent. of those
attacked by it die, but in persons above forty-five years of age the
mortality is much greater--about half succumb.
Dr. Nicole and his colleagues of the Institut Pasteur in Tunis have
recently had the opportunity of studying typhus there. They found that
the ordinary local monkey could not be made to take the disease. But a
drop of blood of a typhus patient injected into a chimpanzee (which is
far nearer akin to man) produced the disease after an incubation
period of three weeks. This fact was definitely established. From what
is now known as to relapsing fever, malaria, yellow fever, plague, and
sleeping-sickness, it seemed probable that some migratory insect must
be the carrier of the typhus infection from man to man. The typhus
patients brought into the hospital at Tunis were carefully washed
before admission, and no infection of other patients or nurses took
place in the wards, although the cases were not isolated, and bugs
were abundant. The only cases of infection which occurred were in
persons who had the duty of collecting and disinfecting the clothing
of the patients when admitted. This seems to exclude the bug as a
carrier. The flea is excluded by the fact that in the phosphate mines
of Tunis the flea is abundant, and bites both natives and Europeans.
Yet when typhus fever broke out among the miners--although all were
equally bitten by the fleas--no European was infected. The indication,
therefore, was that if any insect is the carrier, it is neither the
flea nor the bug, but probably the clothes-louse. Although the smaller
monkeys cannot be directly infected with typhus fever from man, it was
found that (as with some other infections) the bonnet monkey was
susceptible to the infection after it had passed through the
chimpanzee. Experiments were, therefore, made with clothes lice taken
from a healthy man, and kept for eight hours without food. They were
placed on a bonnet monkey which was in full typhus eruption. A day
afterwards they were removed to healthy bonnet monkeys with the
result that the healthy bonnet monkeys developed typhus fever. There
is thus no doubt whatever that typhus fever can be carried in this way
from bonnet monkey to bonnet monkey. The whole history of typhus fever
fits in with the carriage of the infection in the same way from man to
man, and not with the notion of an aerial dispersion of the infection.
The fact that typhus only exists in very dirty and crowded
populations, and that it has disappeared where even a moderate amount
of cleanliness as to person and clothing has become general, coincides
with the possibility of the body louse as carrier. This little
parasite is known to be a wanderer, and is gifted with a very acute
sense of smell. An individual placed in the centre of a glass table
invariably walked, guided by the scent, towards the observer, at
whatever position he placed himself. Sulphurous acid is a violent
repellant of these creatures. Not only will it kill them if they are
exposed to its fumes, but traces of it drive them away. Hence doctors
and nurses who have to handle typhus patients or their clothes have
only to wear a small muslin bag of sulphur under their garments, or to
rub themselves with a little sulphur ointment in order to be perfectly
guarded against infection; the louse will not approach them, nor
remain upon them should it accidentally effect a lodgment.
It is not always obvious at once in what way a knowledge of the mode
of carriage of a deadly disease can be of service to humanity. But in
this case it is strikingly and triumphantly clear. In the vast
poverty-stricken population of Russia typhus is still common. Public
medical officials attend these cases, and the Russian Government keeps
a record of the annual deaths of its medical staff, and of the causes
of their deaths. In the first six months of last year 530 Russian
medical officers died, and twenty-four of these deaths were caused by
typhus fever acquired by these devoted public servants in attendance
upon cases of that fever. Henceforth they will make use of sulphur or
sulphurous ointment to keep the little infection-carriers at a
distance, and not one medical man or nurse will catch the disease,
still less be killed by it.
A remarkable fact in this history is that the actual parasitic germ
which causes typhus, whether a bacterium (Schizophyte) or a protozoon,
has not been detected, although the louse has been shown to be its
"carrier." The same is true of yellow-fever: we have not seen with the
microscope the microbe which produces it. But we know with certainty
that the gnat, _Stegomya fasciata_, and no other, is the carrier of
the unseen germ, and that we can obliterate that fever by obliterating
the gnat. So, too, although we know how the infection of rabies acts,
and how it is carried, yet no one has yet isolated and recognised the
terrible infective particle itself. There is a very high probability
that in these cases, and also in cancer (where as yet no specific
infective germ or parasitic microbe has been detected), such an
infective microbe is nevertheless present, and has hitherto escaped
observation with the microscope on account of its excessive minuteness
and transparency.