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 santÉ 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 aËrial 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.