APPENDIX E. cxli 



that emanations from sewage and from some forms of putre- 

 fying matter are capable of exciting the disease in those who 

 are favourably predisposed, although, in other cases, it seems 

 to be more directly communicated by means of drinking 

 water contaminated by sewage containing the dejections 

 from a typhoid patient ^. 



Relapsing fever and typhus present many points of resem- 

 blance : both are essentially epidemic diseases ; both are 

 undoubtedly contagious. They generally occur during 

 seasons ' of great scarcity, and they prevail most widely 

 amongst the poorest class of the population. Overcrowding 

 and defective ventilation, especially when associated with bad 

 and insufficient food, ' not only favour the propagation of 

 typhus, by concentrating the emanations from the sick, but 



2 Referring to the views of Dr. W. Budd and others as to the disease 

 being propagated only by sewage which is contaminated by typhoid 

 stools, Dr. Murchison says : — ' Admitting fully that this view offers the 

 best explanation of those cases where the fever is propagated by the 

 sick, many, if not most, of the facts adduced in its support are explicable 

 on the theory of spontaneous generation, while in the others the mode 

 of transmission is less clearly established than might be desired. On the 

 one hand, facts are adduced to show that the disease is contagious ; and, 

 on the other, cases are mentioned to demonstrate the intimate connection 

 between its origin and bad drainage. The evidence, however, is still 

 insufficient to prove that the stools of the sick have constituted the 

 medium of communication. This conclusion, it seems to me, has been 

 jumped at from the unwillingness to admit that a communicable disease 

 can ever have a spontaneous origin. But, in the second place, there are 

 many facts which show that enteric fever often arises from bad drainage, 

 independently of any transmission from the sick. As long as the current 

 flows freely through a drain, there is little danger of the emanations from 

 it giving rise to enteric fever. The danger arises when the drain becomes 

 choked up, when the sewage stagnates and ferments.' The dejections 

 from a typhoid patient being remarkably prone to undergo decomposition, 

 Dr. Murchison adds : ' It is possible that the stools of enteric fever are 

 more prone than ordinary sewage to undergo the peculiar fermentation by 

 which the poison is produced, and that even in certain cases the fermenta- 

 tion may have commenced before their discharge from the bowels. In this 

 way, enteric fever may occasionally be propagated by the stools, but 

 even then it seems more probable that the poison is always the result of 

 decomposition, than that it is derivable from a specific eruption like that 

 of small-pox.' (^' On the Causes of Continued Fevers,' in ' Lond. Med. 

 Rev.,' 1S63). 



