Leave the room quickly, for the fumes are highly poisonous when breathed, and close the door tightly. Let the room remain closed twenty-four hours or more. Then air thoroughly for several days. BENJAMIN LEE, M. D,

EXECUTIVE OFFICE, Philadelphia.

Secretary.

XIV. PRECAUTIONS AGAINST TYPHOID FEVER.

Typhoid fever (called also enteric fever, gastric fever, drain fever, low fever, pythogenic fever and, by the Germans, abdominal typhus) is a common and protracted disease, terminating fatally in about one case in eight or ten. We have no statistics for the whole State of Pennsylvania to show how many persons die of this disease each year, but the secretary of the Michigan State Board of Health estimates, from the complete returns which he receives from all parts of that State, that about one thousand persons die each year in Michigan of typhoid fever, and that from eight to ten thousand are yearly sick from the same disease. This would equal three thousand deaths, and from thirty to forty thousand sick of this fever each year in Pennsylvania, for it is at least as prevalent here as in Michigan.

A disease which causes so much suffering and the loss of so many lives, should be understood in its nature by all intelligent persons, since sanitarians agree that it is a disease entirely preventable under good hygienic conditions.

How the Disease is Spread or Communicated.

Typhoid fever is believed to be caused by a special poison (contagium). This poison, whether specific or not, may be conveyed to other persons by drinking water contaminated by discharges from the bowels of a person affected with the disease, or by leachings from the bodies of those who have died of it. Physicians now believe that contaminated water is the most frequent cause of this disease. The contamination must be with the focal discharges of a person suffering with this disease, or from a graveyard in which persons dead of this disease have been buried. The disease has also been traced to contaminated milk, which has had infected water added to it, or has been kept in vessels which have been washed with impure water, or in a room adjoining one in which there has been a case of typhoid fever. In some few cases, it seems that the disease has been produced by breathing the emanation from putrid privies and from sewers. It prevails most in times of drought, in the fall of the year, especially after a period of high temperature, and when the water in wells and springs

is low and the contaminations much concentrated. It is a disease constantly present in the fall of the year, in country districts which have been subject to the above conditions. Experience proves that, with ordinary care, those in attendance upon the sick do not contract the disease directly from the patient. The poison in the focal matter getting upon the nurse's hands may, in this way, be conveyed into the system, but not through the air breathed. Filth and bad sanitary conditions of dwellings probably increase the danger of spreading this fever which has been classed as a "filth disease."

Time Required to Develop Typhoid Fever.

The interval of time between receiving the poison of typhoid fever and becoming sick therefrom varies considerably, and may be from eleven to twenty one days, or even longer. The patient may feel exhausted, and have pains through the body, and especially headaches, for some time before he is willing to admit himself sick. Often the incipient symptoms are confounded with those of "malaria."

Persons Liable to the Disease.

The greatest number of deaths from this disease is of persons in the prime of life, and this should prompt to greater efforts to prevent the disease. But persons of all ages have it, and even though it may be of only a mild form, yet the mild form may be the means of communicating the most malignant type of the disease to others. Typhoid fever may not be, strictly speaking, contagious, but it is certainly communicable through infected foods and drinks.

Preventive Precautions.

This fever being communicated through contaminated water, the principal precaution is to protect the water-supply. The most scrupulous care should be taken to keep the present sources of drinking water pure, and to procure future supplies only from clean sources. The general water supply of cities and villages is a matter of the greatest concern, and should be procured from places where there can be no probability of immediate or remote contamination. The wellknown outbreak of typhoid fever at Plymouth, in this State, where over a thousand cases and many deaths occurred, is apparently an illustration of how great a calamity may follow the fouling of a general water supply by the discharges of one person sick with typhoid fever. When there is no general water supply, much may be done to protect the wells by the abolition of cess-pits, and privy-vaults, by the use of dry earth in privies and by the frequent removal therefrom of all their contents.

Great care should be taken to prevent the contamination of the water supply by discharges from the bowels of a person sick with typhoid fever, as by drainage into wells, springs, or other water-supply, from a privy-vault, sewer, drain, or cemetery. Privies often drain.

into wells, unsuspected by those who use the water. Should typhoid discharges pass into such a privy an outbreak of typhoid fever among those using the water from a neighboring well would be likely to occur. If such a well were the source of the general water-supply of a city, typhoid fever might soon be epidemic there. Extraordinary care should be taken to prevent typhoid fever discharges from entering any general water supply from a well or from a small stream. The use of water from a source likely to be infected with excreta from a typhoid fever patient should be promptly stopped; and great care should also be given to the milk supply.

There is good reason to suspect the water of a well whenever a vault is situated within two hundred feet of it, particularly if the soil be porous. In numerous instances fluids from excreta have leached. into wells from much greater distances; and it has been proved that a well thirty rods from a cemetery received water which had filtered through the soil of the cemetery. Dangerously contaminated water may be, and often is, found to be clear and colorless, and to have no bad taste.

Since this disease is so prevalent in country places, it would be well to establish the following

Rules for all Farm and Village Homes.

1. That the privy pit be absolutely abolished, and that the earth closet take its place. The earth closet costs less at first, the excreta can all be returned to the earth without the least offense, and at great profit to the farmer and gardener, and besides, the earth closet is free from most, if not all, of the dangers resulting from the use of the privy pit, principally the contamination of the water supply, and the production of offensive and poisonous vapors.

2. That in the fall of the year, when the waters are low, only boiled water be used as a beverage. Boiling destroys the germs of this disease. Whenever a case of typhoid fever appears, the polluted well water must be abandoned at once, and boiled water resorted to. When visiting in a district where typhoid fever prevails, one should drink only tea or coffee which has been well boiled. People who rent houses, should be careful to ask if typhoid fever (or any other contagious disease) has been in the house within a year, and to require a written statement of the owner or agent.

Anything which deteriorates general good health, tends to render the system liable to disease, and in this way filth may be considered a promoter of typhoid fever. Perfect cleanliness should be enjoined in the house and all its surroundings.

In a town, sewer gases must not be permitted to enter a house from defective pipes, and in the country foul gases in privies must not be tolerated. Cases of typhoid fever should be at once reported to the

local board of health, and, if a number occur in the same neighborhood, to the State Board of Health.

Precautions in the Care of the Sick.

1. The sick chamber should be as large, airy and as pleasant as possible, and in a part of the house where quiet can be obtained for the patient. The room should have means for free ventilation without the production of draughts; an open fireplace with a lamp burning in it is the best means of ventilation. Unnecessary articles of furniture should be removed from the room, but it is not needed to remove the carpet.

2. No special precautions need be taken to isolate the patient from the rest of the family, but the house should be marked so that strangers. may not drink the water on the premises.

3. Whenever the hands of the nurse become soiled with the excretions, they should be washed, first in a water containing chloride of lime, and then with pure water and soap. The hands of those about a typhoid fever patient should always be washed before eating.

4. All glasses, cups or other vessels used by the patient should be cleansed in boiling water before being used by others, and all food or drink, touched and not consumed by the patient, should be burned or buried. Perfect cleanliness must be enjoined.

5. The discharges from the bowels and from the kidneys should be received on their very issue from the body into vessels charged with disinfectants, and in cities where sewers exist, thrown at once into the water closet, but in country places these excreta, after disinfection, should be buried in the soil, at least one hundred feet from any well' and in no case should they be thrown into a running stream, nor into a privy-vault. Rags, paper, etc., which have become infected with excreta, should be burned in a strong fire. It will be well in all cases of typhoid fever to place a piece of India rubber cloth, or a rubber blanket, under the patient, to protect the bed from the discharges.

6. All articles of the patient's clothing which are soiled, and all the sheets, towels, napkins, etc., used in the rooms, should be boiled thoroughly and as soon as possible to destroy all germs which may be in them.

7. It is hardly necessary to add that in this disease, even in its mildest form, the patient should be under the care of a reliable physician.

The Convalescent Patient.

In this disease, the recovering person is not dangerous to his friends. He may have cheerful society. The fever usually has its seat in the bowels, and often causes ulcerations of their walls, and on this account, for some time, the patient must be very careful of what he eats, as solid substances sometimes cause perforations of the intestinal walls,

and nearly instant death. The patient must be willing to get well slowly.

Burials.

After death the body should be wrapped in a sheet saturated with a solution of corrosive sublimate and buried as soon as possible. At the funeral, in country places, the contaminated water should be rendered inaccessible to the visitor by the removal of the pumphandle or by means of a conspicuous notice.

Disinfection after Recovery or Death.

This work should be done thoroughly, and generally it will be best. done by an intelligent person who has had experience in the work. Recent investigations by a committee of the American Public Health Association show that some substances, on which much reliance has been placed, are of very little value as disinfectants. Only those which the committee recommend are here mentioned.

Standard Disinfecting Solutions Recommended by the State Board of

Health.

1. Standard Solution No. 1.-Dissolve chloride of lime or bleaching powder of the best quality (containing at least twenty-five per cent. of available chlorine) in soft water in the proportion of four ounces to the gallon.

2. Standard Solution No. 2.-Dissolve corrosive sublimate and permanganate of potash in soft water in the proportion of two drachms of each salt to the gallon.

(NOTE.-1. This solution is highly poisonous. 2. It requires a contact of one hour to be efficient. 3. It destroys lead pipe. 4. It is without odor.)

3. Standard Solution No. 3.-To one part of Labarraque's solution (liquor soda chlorate-U. S. P.,) of hypochlorate of soda add five parts of soft water.

(NOTE.-Competent authority has pronounced this superior to all other disinfec

tants.)

Standard Solution No. 4.-Dissolve corrosive sublimate in water in the proportion of four ounces to the gallon, and add one drachm of permanganate of potash to give color to the solution as a precaution against poisoning. One fluid ounce of this solution to the gallon of water is sufficiently strong. Articles should be left in it for two hours. (NOTE.-Corrosive sublimate solutions should be kept in wooden or crockery ves

sels.)

To Disinfect Discharges from the Patient.

Use standard solutions, Nos. 1, 2 or 3, keeping a pint of the solution used constantly in the vessel ready for any emergency. Let the excreta be passed directly into the solution, and then let a pint more of it be added; the whole should stand for some time before being thrown into the sewer or being buried. These discharges, containing