TYPHOID FEVER. 625 



nalations from the skin and lungs (which, in exanthematic typhus, are 

 certainly vehicles for the contagion, while in cholera they just as cer- 

 tainly are not so). Infection of the nurses and physician is rarely seen 

 in abdominal typhus, and, when it occurs, it is always questionable 

 whether it be due to the emanations from the patient, or from his de- 

 jections. At all events, using the bed-pans, night-stools, and privies, 

 where the dejections of the patients have been emptied, appears more 

 dangerous than being brought in contact with the patient himself. 



The miasmatic origin of abdominal typhus is rendered probable by 

 cases occurring in places removed from travel, where no cases of this 

 disease have occurred for years, and where there is not the slightest sus- 

 picion of a contagious origin. If it be not considered an axiom that mi- 

 asmatic diseases are never contagious, no wild hypotheses are necessary 

 for the explanation of such cases. The most simple and probable ex- 

 planation of them is, that the low organisms, which we suppose con- 

 stitute the germs of abdominal typhus, may originate and increase not 

 only in the bodies of patients and their dejections, but outside of them 

 also. We at least partially know the circumstances that favor the 

 origin and development of this poison, since we know that abdominal 

 typhus occurs sporadically, and in so-called house-epidemics, especially 

 in places where quantities of animal matter are decomposing. The 

 absorption of the germs appears to take place chiefly through the 

 lungs ; but there are some instances where several persons, drinking 

 water from a well that communicated with the privy, were attacked 

 with abdominal typhus. I consider it doubtful whether the germs of 

 this disease can also be swallowed with decomposing meat. The cele- 

 brated Andelfinger epidemic is often quoted as such an instance, but 

 Liebermeister, in opposition to Griesinger, has shown that this was 

 not abdominal typhus ; while the latter, in opposition to the former, 

 nas shown that it was not a trichina epidemic. 



In large, overcrowded cities, it can rarely be determined whether 

 the cases of abdominal typhus be of miasmatic or contagious origin. 

 At all events, the requirements for the development and increase either 

 of spontaneous germs, or those from the dejections of typhus patients, 

 are excessively favorable in such places, as the soil of large cities 

 always contains quantities of decomposed and putrid animal sub- 

 stances. Pettenkofer reckoned that the excrement of Munich amounted 

 to one hundred and fifty loads daily, and that on an average scarcely 

 ten were removed, so that over seven-eighths of the excrement of the 

 city remained and were absorbed by the soil. We shall hereafter show 

 that the number of cases of intermittent fever in malarious regions 

 varies with the rise and fall of the water in the marshes, because this 

 induces the decay of vegetable matter, on which the production of the 





