Disease outbreak

“ All infectious diseases, and many others, tend to run a definite course of so many days, or so many weeks, within certain limits, and at least ninety per cent of them tend to terminate in recovery. It is a most serious and fatal disease which has a death-rate of more than twenty per cent. Typhoid, pneumonia, diphtheria, and yellow fever all fall below this, smallpox barely reaches it, and only the bubonic plague, cholera, and lockjaw rise habitually above it. ”

“ The Progress of an Epidemic That it is at least as difficult to stay a moral infection as a physical one; that such a disease will spread with the malignity and rapidity of the Plague; that the contagion, when it has once made head, will spare no pursuit or condition, but will lay hold on people in the soundest health, and become developed in the most unlikely constitutions: is a fact as firmly established by experience as that we human creatures breathe an atmosphere. ”

“ No change in the habit takes place previous to the action of the contagion, but the body is from the first equally susceptible of it as of the itch, or any other infectious disease. Whilst the plague ceases in the civilized parts of Europe spontaneously, or by human precautions, its revival is prevented, from the care that is bestowed in purifying or destroying every infected substance. ”

“ Except in the case of the relatively rare pneumonic form, plague, though " catching," is not nearly so contagious as are scarlet fever, measles, or small-pox. Medical men, and even nurses, in clean airy hospitals rarely contract the disease, provided they have no open wounds and do not remain too long in close proximity to their patients. In cities the cleanly districts are generally spared. ”

“ As a consequence, the death-rate was 26·47 in 1880, 31·08 in 1881, and 29·64 in 1882.
In overcrowded places the danger is great when contagious disease makes its appearance. The spread of such diseases as typhus, measles, and whooping-cough is very much favoured by overcrowding. ”

“ The word infection is applied to the vehicle by which a malady is transmitted from one person to another by the air, and with or without actual contact. The type of infectious disease is small-pox, and this is also, as is well-known, a highly contagious complaint. Scarlet-fever, measles, whooping-cough, mumps, etc., are likewise both contagious and infectious, and make up the class of disorders popularly known as diseases which are "catching." ”

“ When any large proportion are down at once, the doctors call it an epidemic, and it is attributed to a “wave”—an epizootic or influenza wave, for example, according as the victims are horses or men (the poor animals depend upon the elevated race for their habits, and never have disease except these are unphysiological) ,—when, in fact, the so-called epidemic, whether it be10 scarlet or yellow fever, diphtheria, or what not, is the result chiefly of the uniformly bad living habits of our people and their consequent predisposition to sickness. ”

“ First, that they are contagious and absolutely dependent upon a living germ, whose spread can be prevented; and secondly, and practically even more important, that more than half the deaths from them are due, not to the disease itself, but to complications occurring during the period of recovery, caused, for the most part, by gross carelessness on the part of the mother or nurse. ”

“ Contagious matter is lodged in goods of a loose and soft texture, which being packed up, and carried into other countries, let out, when opened, the imprisoned seeds of contagion, and produce the disease whenever the air is disposed to give them force, "otherwise they may be dispersed without any considerable ill effects." ”

“ Clinical and epidemiologic investigations have yielded confirmatory evidence, and we are thus left with a conception of the virus of a given disease being distributed fairly widely throughout the world as an apparently harmless parasite on the human host, but taking on during epidemic periods a new and sinister role, only to relapse again into comparative quiescence as the epidemic subsides. ”

“ They have either copied or contradicted each other, in all their publications. Plagues and malignant fevers are still leagued with war and famine, in their ravages upon human life.
To prevent the formation and mortality of this fever, it will be necessary, when it makes its appearance in a city or country, to publish an account of those symptoms which I have called the precursors of the disease, and to exhort the people, as soon as they feel those symptoms, to have immediate [324] recourse to the remedies of purging or bleeding. ”

“ Examples are furnished in the small-pox, the plague, the measles, and, if we may include diseases not febrile, the leprosy, the itch, and the venereal disease. The latter, on the other hand, are not always in existence, they are called forth from nonentity by the causes of general diseases or epidemic constitutions, and they disappear again after the extinction of the epidemic diseases by which they were bred; they likewise vary in their development and their course in each particular epidemic. ”

“ Loathsome contagious diseases include those whose presence excites abhorrence in others, and which are essentially chronic, such as favus, ringworm of the scalp, parasitic fungus diseases, Madura foot, leprosy and venereal disease. Dangerous contagious diseases are such as trachoma, filariasis, hookworm infection, amœbic dysentery, and endemic hematuria. ”

“ That the termination of epidemics is peculiar, since they cease suddenly at the exact period when the greatest number of persons is affected by them, and when the greatest mortality prevails. This fact is inexplicable under the supposition that epidemics owe their spread from person to person. To suppose that a disease which is propagated by contagion can rapidly decline and even suddenly cease, just when most persons are affected and the mortality is greatest—that is, when the contagious matter is proved to be in its most active and malignant state—is utterly absurd. ”

“ Facts such as these help us to understand the production and propagation of disease through the medium of an infected atmosphere, whether on a large scale, as in the case of an epidemic which rapidly extends over a nation or a continent, or on a small scale, in the sick chamber, the dissecting room, the church, and the church-yard. ”

“ Often the first indication of an attack with a biological agent will be the development of symptoms in exposed personnel. Diagnosis and treatment are complicated by the fact that many of the agent-induced diseases described in the guide begin with symptoms associated with common illnesses, such as influenza. In such cases, biological agent attacks may generally be distinguished from naturally occurring epidemics by the sudden onset of disease, the large number of personnel presenting with similar symptoms, and the concentration of those personnel in geographically contaminated areas. ”

“ There are no epidemical nor contagious diseases that attack every person who breathes the same air, or that is in contact with the infection, else whole regions would be depopulated. The habit must be graduated, or adapted, for the reception of a disease. ”

“ The air about poor patients is more infectious than about the rich. These things being established, I am of opinion that, in the greatest contagion, we may securely see a patient at the distance of two ells, if the chamber windows be not all shut.——Fra. Luigi: The infection is greater or less in proportion to the virulence of the contagion; but I have made no observation as to the distance. The disease is communicated by contact of all infected things, and by close inspiration of the breath of the sick.
4. What are the seasons in which the plague chiefly appears ”

“ In all epidemics which increase to such a degree as to become contagious, it is of importance to distinguish which of these causes are the more powerful, the predisposing or epidemic causes, which originate the proneness to the disease, or the proximate causes, among which, in the generality of cases, contagion is the most prominent. ”

“ Natural Outbreaks of Disease Naturally occurring outbreaks of category A agents have become rare because of improved living standards, hygiene, and health services in developed nations. For example, human bubonic plague,which was transmitted by rats and fleas to humans in past centuries resulting in large losses of life, has virtually been wiped out. However, agents used in an aerosol attack may act differently than naturally occurring outbreaks and could produce a form of the disease with a shorter time of onset of illness, making timely diagnosis, treatment, and containment more difficult. ”

“ The contagious disease, spreading from the head to the members—from the Pope to lesser prelates—has spread far and wide, so that scarcely any one is to be found who does right, and who is free from infection. ”

“ Our common epidemic influenza or grip, occurring practically isolated or in very small outbreaks, belongs to the same type of disease as the pandemic variety, but is due to a mitigated form of the causative organism, one of decreased virulence and of shorter viability. ”

“ In a common source epidemic, as where members of a population contract a non-contagious disease from a poisoned well, the disease spreads only by exposure to the common source. If one eliminates the source, or closes the contaminated well, the epidemic is stopped. ”

“ Even the eyes of the patient were considered as sources of contagion [24] , which had the power of acting at a distance, whether on account of their unwonted lustre or the distortion which they always suffer in plague, or whether in conformity with an ancient notion, according to which the sight was considered as the bearer of a demoniacal enchantment. Flight from infected cities seldom availed the fearful, for the germ of the disease adhered to them, and they fell sick, remote from assistance, in the solitude of their country houses. ”

“ It was so common in America during the Civil War and for half a century prior thereto, that there were frequent epidemics of it in hospitals and it was generally recognized that the disease was so contagious that when it once gained a foothold in a hospital, nearly every patient suffering from an open wound was likely to be affected by it. ”

“ A curious method for arresting the spread of infectious disease is to surround the patient with a circle of some disinfectant, and during a cholera scare I saw it applied to a man on the Galata bridge who had an apoplectic stroke. ”

“ To sleep in the infected atmosphere in sickly quarters was thought more dangerous; but any business man considered himself safe, if he only breathed the poisonous air in the daytime. The resident physicians, in their recent treatment, feel the disease quite in their hands, when no other foe than the fever is to be combated. ”

“ In contagious diseases, infection proceeds chiefly from personal contact with a diseased person or objects that have been touched by him. In malarial diseases there is no danger from personal contact; the disease resulting clearly from a poisoned atmosphere. ”

“ What are the causes of Epidemic, Endemic, and Infectious Diseases? The occurrence of Epidemic Cholera last year in this country, awakened a spirit of enquiry. Where there is unrest, whatever may be the cause, there also is disquiet and discontent. ”

“ Along these lines, no doubt, it has very frequently been found, because a malarious, a terrestrial, a contagious, or indeed any other disease, would for many reasons, best prevail on the lowest levels of the country, or the deepest lines on its surface, like the vallies of rivers, provided the food on which it fed—population—there abounded. ”

“ If we suppose the plague, or any other epidemic disease, to arise from some general cause, let that cause be contagion or any thing else, it ought to operate upon all who come within its sphere of action, as Dr. Mosely observes of infection. If experience shows that it does not, the argument will hold equally against a constitution of the atmosphere, putrid effluvia, heat, cold, or any thing else ”

“ Such simultaneous eruptions of disease, in different distant places, appear incompatible with the hypothesis of contagion—irreconcileable with the belief that it arises from, and is communicated by one body to another, either directly or indirectly, either by recent emanations from a diseased body acting speedily on proximate healthy bodies, or by the same emanations, in a concrete form—called formites—acting on distant healthy bodies, after uncertain lapses of time. ”

“ The infectious diseases appearing in the form of great epidemics have been important factors in determining historical events, for they have led to the defeat of armies, the fall of cities and of nations. ”

“ A few brief observations on the control and prevention of infections diseases, such as small-pox, measles, scarlet fever, typhus fever, typhoid fever, cholera, &c.
The above-mentioned diseases are capable of being transmitted from those who are infected to those who are not. It is at once cheering and obligatory to know that the spread of these infectious diseases depends upon certain specific conditions, and that these conditions are primarily within the control of man. ”

“ Every epidemic that sweeps through our communities is a testimony to the crying need of education in regard to such simple facts as the source of infectious material, the methods of its distribution, and the means of rendering it harmless.
PREVENTION IN INOCULATION. It has long been recognised that in most cases recovery from one attack of a contagious disease renders an individual more or less immune against a second attack. It is unusual for an individual to have the same contagious disease twice. ”

“ Fresh air, moderate exercise, good food, and some mild nerve depressant is all that can be done. The disease is very contagious and is usually transmitted directly from the sick person to the well person. It may, however, be carried in clothing, particularly in handkerchiefs and towels. Like measles, if it gains a foothold in an uncivilized community, it attains the size of an epidemic or plague with very fatal results. It seems to have a great power over girls and children, particularly those whose vitality is below the normal. ”